Flouride: Helpful or Harmful
Advisor: Nancy Fisher
Internship Location: Mitra Hooshangi, DDS
Onsite Mentor: Dr. Hooshangi
The infusion of fluoride into our water supply has recently become a highly politicized and hotly debated topic. A recent controversial systematic review & meta-analysis published by the NIH (Taylor Et al.) found a statistically significant correlation between higher fluoride exposure and lower children’s IQ scores. While this paper has come under heavy scrutiny and some flaws have been pointed out, it does serve as an interesting starting point for future research on this increasingly relevant topic.
While fluoride has been used for decades and is proven to prevent decay and strengthen tooth enamel, there are a variety of health conditions that may be caused by fluoride exposure, including but not limited to dental fluorosis, skeletal fluorosis, thyroid dysfunction, reduced neurological function, kidney damage, osteosarcoma, gastrointestinal issues, and reproductive impairment.
My systematic literature review will analyze the trade-offs between positive and negative health effects fluoride can cause when used for the general population’s drinking water. I will also aim at researching the developmental effects of fluoride exposure in children. Finally, while an exceedingly high exposure to fluoride is obviously and undisputedly detrimental to ones health, I will examine whether current fluoride levels are capable of causing significant harm at all.
Project Blog
Week 1: Fluoride in Drinking Water: Friend or Foe?
Hello! My name is Daniel, and I'm writing a literature review on the merits of water fluoridation. While the fluoridation of public drinking water in the United States has been a common and scientifically advised practice for almost eighty years, the idea has come under recent scrutiny. My paper aims to interpret and analyze the available data on this topic to present the benefits and drawbacks of fluoridation, while also educating the audience on the physiology of fluoride’s effects on the body. While the proper use of fluoride significantly benefits dental health, how does fluoride negatively affect other parts of the adult body? How does fluoride affect the development of children? Should current fluoride levels be increased or decreased? Combined with other sources of fluoride, such as toothpaste, mouthwash, or others, does drinking water increase fluoride over the safe threshold amount? Through answering these questions to my best ability, given the current literature on these topics, I plan on answering the overarching question of whether the benefits of public water fluoridation outweigh the drawbacks.
Week 2: Socioeconomic Condition and Fluoride
I've been interning at a local dental practice as part of my senior project. Engaging with patients from many different walks of life has been eye-opening. I see patients with varied habits: some clearly floss every day, while others brush only once. Many have naturally thin tooth enamel, essentially a genetic disadvantage in the fight against cavities and tooth decay. On top of everything, I'm only exposed to a group of people who actually go to the dentist. When I set out on my research project, I wanted to produce a "yes or no" answer to the question of whether we should fluoridate our water supplies. What I now realize more and more, is that fluoridation has a different effects for different people.
Take, for example, Western and Central Europe, regions that have some of the highest living standards in the world. Countries, such as France, Switzerland, Germany, Denmark, Sweden, and Finland, all do not fluoridate their public water supplies. Yet, all of the countries I just listed, have a comparable or better average dental health than the majority-fluoridated United States, according to the OECD. This information points me toward a theory that the effect of fluoridated public water sort of "levels off" as a population's living standard increases. It could make sense, that for someone who neglects dental care, for example someone who doesn't regularly brush (and thereby doesn't recieve much external fluoride from toothpaste), the additional tap water fluoride could play a much larger marginal effect than for someone who regularly brushes and uses listerine.
In the case of the United States, the country's population is far less homogeneous (in terms of socioeconomic condition) than an average Western European counterpart. This could essentially mean that certain regions of the United States would benefit much more from fluoridation than others. In rich, developed regions, where the average resident already ingests fluoride from other sources, extra fluoride from tap water could not only be an "overkill" amount, but it could actually do more harm than good.
Week 4: A New Roadblock
I recently broke my right middle finger while playing flag football, something quite ironic considering my last name. While I'm glad that this didn't happen during the first two trimesters, it still presents a new challenge. My capabilities at my dental internship are now severely limited, now that my dominant hand is immobile. I have since gotten a new, much smaller, and sturdier splint that isolates just the tip of that finger.
Initially, I was almost completely limited to shadowing, but now with the smaller splint, I am able to fit a large-size glove on my right hand, as movement returns to my joint. I can once again assist cleaning procedures by suctioning saliva from patients, and doing similar tasks, but I am no longer advised to handle tools when washing and sterilizing them, out of concerns of a new injury.
Internship aside, typing has become much more annoying. I still haven't fully adjusted to using my pointer and ring finger in substitution, and writing large sums of text for my literature review can get tiring for some muscles. Overall, a small unexpected challenge has come up during my project, but it should be no real issue.
Week 5: Artificial Intelligence
I am lucky enough to be doing my senior project at a time when internet technology is rapidly advancing. And while the development of artificial intelligence may have opened a Pandora's box of sorts, I will still take advantage of its services (when appropriate). To clarify, I never use ChatGPT to write my paragraphs, or anything like that, but I have been utilizing the services of Elicit AI for my project. I first discovered this hidden gem while writing a paper on atrial fibrillation, when I attempted to draw a connection between excessive exercise and the onset of the condition. I would spend hours scowering PubMed (the NIH's database of peer-reviewed medical papers) in often futile attempts to find what I was looking for. Elicit AI helped me break through the deadlock by searching through millions of papers based on my chat prompt. Elicit has saved me so much time, and I highly recommend anyone use this for medical literature reviews. Often, it will find questionable or obscure sources, but it is your job as the researcher to properly sift through papers anyway. If you are struggling to find papers on a super niche topic, it can be super helpful to outsource a part of the search process to AI.
Week 6: Organizing the search
I love going down rabbit holes. At home, I often spend an egregious amount of time in a state of distraction and wonder, as I read through a long chain of increasingly-specific Wikipedia articles. I am just as distracted when I research medical papers. It all begins when I read an intriguing sentence or two in a paper. My newly piqued interest drives me down to the "references" section, where another paper elaborates on this new topic. Of course, this new paper also has various interesting papers linked in its references. After half an hour's worth of reading, I have over ten separate tabs open of related papers. By now, I have read more than enough to start writing, but it hasn't all stuck in my memory. I feel accomplished and more educated on the topic, but can't regurgitate the vast majority of information I have just taken in.
Luckily, I have found a solution to this problem. Zotero is an app and browser extension that allows you to organize documents and papers with extreme ease. Whenever I read an interesting paper, all I have to do is click on the browser extension, and it automatically saves all the metadata of the document and downloads a .pdf of it (if it's not behind a paywall). You can sort things super easily, and it even cites papers automatically for you and rearranges them chronologically. For a super unorganized and easily distracted person like myself, it's been an amazing tool keeping me on track.
Week 7: Combatting procrastination
As you can probably tell, I am a serial procrastinator. I've struggled with deadlines and work speed for as long as I can remember. I struggle especially with long projects that have a distant deadline. I have seen many kids my age struggle with the same problems I face while working, so I'd like to mention two things that have helped me progress on my senior project.
Firstly, I stopped listening to music while working on this project. More specifically, I cut out listening to music with lyrics. I know for others like me with ADHD, listening to ambient music without lyrics can actually help. For me this is also the case. Simple background music without lyrics or crazy instrumentals has helped put me into flow states much faster.
Secondly, I have worked on recognizing when I lie to myself. As a procrastinator, I often find myself saying "I'll do that later" many times a day. The truth is, I will either forget to do it altogether or put out work that I am not proud of because I rushed to finish it. Catching myself when I try to push back work has helped me refocus and keep researching/writing for the project.
In conclusion, I still am far from winning my battle with procrastination, but I have made some progress by cutting out unnecessary distractions when I work, and being mindful of procrastinatory thoughts.
Week 9: Closing in on the home stretch
As I near the end of my senior project, I want to look back on the third trimester. Over these weeks, while I have been researching at home, I've spent much of my weekdays at the dental practice where I intern. There, I've learned much about not just the physical procedures, but also about the significance of bedside manners and small-talk in the industry. Patient satisfaction is heavily intertwined with a good social experience at a dental practice. Many patients reluctantly come for treatment and are in a tense mood on arrival. However, I've seen countless times how the dentist I shadow has effortlessly broken the ice with people. Dentistry is, after all, a service where the client is quite literally face-to-face with you. While the main focus is, of course, healthy teeth, leaving the office with a positive mood definitely is the second priority. Humans are wired in such a way that the final memory of something plays an abnormally large part of one's perception of the event. For example, if I went to the dentist and was distressed by the mouth injections and drilling, but ended up having great-looking teeth and a wonderful conversation with the dentist, my brain would disproportionally weigh that appointment as positive, despite the distress I earlier had. If you think about this phenomenon from a business perspective, it becomes clear why the last impression is just as important as the first in dentistry.
Week 10: A Question of Philosophy
As I discussed in a previous blog, water fluoridation means different things to different people. For someone with a high standard of living, someone who has plenty of access to alternate fluoride sources and dental care, fluoridated drinking water may only play a negligible or even detrimental health effect. However, for children, who don't exercise the same level of discipline for dental hygeine, fluoridated water may be one of the only consistent sources of fluoride to aid their dental health. For those with a lower standard of living, fluoridated drinking water once again increases in importance.
While I set out to create a literature review purely based off of peer-reviewed research, my project does have an inherent philosophical angle. Those with a more individualistic temperament may argue that on a single-person basis, you cannot consent to having these chemicals not being put in your drinking water by the government. A more collectivist approach could argue that, assuming the net effect of fluoridation is positive for public health, water fluoridation should be put in place as it benefits the majority of people, whether they consented or not. While I will give my personal opinion on the 22nd, I will still present the facts, many of which may point each individual listener in a different direction.