1. Managing Challenges to Water Fluoridation
Strategies and Resources
Judith Feinstein, MSPH, Director
Maine CDC Oral Health Program
Augusta, Maine
Chair, ASTDD Fluorides Committee

2. Objectives Describe effective strategies to use when CWF is challenged
Discuss the role of a State Oral Health Program/State Health Department in a challenge
Discuss the roles of partners and outside collaborators
Identify ASTDD and web-based resources

3. Strategies Shift from “stealth” to proactive stance
Issue specific as a tactic
Variety of voices – not only the usual suspects
Develop support apart from/along with responding to challenges

4. Community Water Fluoridation: Advantages and Benefits
Judith Feinstein, Director
Maine CDC Oral Health Program
Augusta, Maine
These next few slides summarize a presentation that was prepared for a specific audience and then used to create a template. This is only one of several templates that is available to you – you’ll hear more from Marcy shortly about other resources.
A version of this presentation (with 26 slides) is available in the Members Only section of the ASTDD website as a template and resource for you:
Purpose of presentation – explain why your organization supports CWF and why it is safe, effective and still important – even with multiple exposures and pending lower optimum level.
The reason for developing this presentation was twofold – to have something for a technical training session at a state water utilities association meeting, and to create a template type approach to proactively present information about water fluoridation.
As needed – start with an overview of your program/organization to give a context for your work around the promotion of CWF as one component of efforts around dental disease prevention.
OVERVIEW: SAMPLE/TEMPLATE PPT (next 5 slides)
Acknowledgements to the New York State Department of Health, Bureau of Dental Health for parts of this presentation.

5. Presentation to Water System Operators: Why CWF matters and why water systems are important
Objectives
Review history and extent of CWF in the state
Demonstrate impact of CWF on health status *
Demonstrate economic benefits *
Acknowledge role of PWS operators *
Topics
Public policy and research (reviews)
Why fluoridate? *
Impact of tooth decay and dental disease (lifespan) *
Action of fluoride *
FAQs *: Health concerns; why fluoridation is still needed; fluorosis; changes in CDC & EPA recommendations

6. Background Public Policy on Fluoridation Reviews – Benefits & Safety
Why Fluoridation?
Fluoridated communities have 20%-40% less tooth decay (25%)
Single most effective intervention
Saves money: every dollar spent on water fluoridation avoids on average $38 - $42 in dental care
Benefits all consumers across socio-economic status
Benefits children and adults
Benefits last a lifetime

7. Fluoride Action Systemic vs. topical and benefits to adults
FAQs for water districts:
Health concerns
Why do we still need it
Fluorosis, infant formula
Changes pending from CDC and EPA

8. Why Fluoridation is Still Needed
Water fluoridation is a population (community) level intervention
Broad reach (equal opportunity)
Safety, effectiveness, low cost
Delivers a sustainable level of benefit in an inexpensive way (cost-effective)
Changes in individual behaviors are difficult to accomplish

9. Conclusions Oral health status is improving
We still have significant challenges
Community water fluoridation is important
Although it’s not an additive that makes water safer (as do other treatments), there is an important public health benefit
Water systems and operators play an important role

10. Role of the State Oral Health Program
Know your limits
Work up through your organization
Speak with one voice
Provide/facilitate information and resources, data, and training
Convene collaborating parties

11. Examples from states
Maine: focus on issues raised by opponents framed by supportive arguments and information
Iowa: countered public complaints with evidence of cost savings, public awareness campaign, and equipment grants program
Alaska: in Bethel campaign, used previous experience to organize approach, with strong emphasis on data showing less decay

12. Partners and Collaborators
New York experience…
Iowa: partnered with Pew, Delta Dental of Iowa, and Iowa Public Health Association for public awareness campaign; with Delta Dental of Iowa Foundation for equipment
Others

13. ASTDD Resources
ASTDD Statement in response to DHHS and EPA fluoridation announcements: Community water fluoridation remains the cornerstone of dental caries prevention in the United States and has been demonstrated to be safe, cost-effective and beneficial…
Resources:
Policies On Fluoride
Best Practice Reports
ASTDD Fluoridation Fact Sheet
Organizations - General Fluoride Information
Information by Topic Area
Community Water Fluoridation
ADA Links
CDC Links

14. ASTDD Resources, continued
Research
Topical Fluorides, Gels, Foams
Fluoride Supplements
School Fluoride Programs
Fluoride Toothpaste
Members Only Section:
Fluoridation Messaging Webinar, February 2012, “Rethinking How We Talk About Fluoridation”
PowerPoint template
Fluorides Committee

15. Judith A. Feinstein judith.a.feinstein@maine.gov
Thank you
Judith A. Feinstein