In an open letter to the dental profession, Dr. Johnny Johnson, the president of the American Fluoridation Society, questioned the profession’s development of silver diamine fluoride (SDF) products instead of advocating community water fluoridation and “pro bono work in indigent areas.”
On April 3, Dr. Johnson submitted the letter stating, “I just question building an expanded dental health-care model based on the use of silver diamine fluoride. We should put our emphasis on fluoridating the rest of the U.S. community water systems while requiring all of our licensed dentists, dental hygienists, and dental therapists to do pro bono work in indigent areas to be able to renew their licenses.”
The American Fluoridation Society was started in 2014 to promote the benefits of community water fluoridation. Dr. Johnson is a retired pediatric dentist based in Florida.
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Dr. Johnson said his motivation for writing the letter was based on a photo published in a dental journal. He said the photo “made me feel like a piece of donkey doo doo.”
While he made it clear that he was not criticizing the care given to the teenager depicted in the photo, he wrote, “How about the quality of life (QOL) of the recipients of this care? Do we think that this will have little to no effect on folks receiving it? Would you like this black-toothed smile as a teenager or an adult? The answer is obvious. We discuss the QOL of the unnoticeable to barely noticeable white marks on our teeth from fluoride in water from community water fluoridation. We all know that studies have shown that these white spots are highly desirable versus the brownish to dark stained cavities. How can we not consider this QOL issue when recommending silver diamine fluoride as a method to control cavities in the underserved?”
Dr. Johnson did not identify the article’s authors or publication in his letter. But PennWell editors traced the photo back to “Clinical Use of Silver Diamine Fluoride in Dental Treatment,” published by Compendium of Continuing Education in Dentistry in its February 2016 issue.
The authors stated in the article’s conclusion, “Studies and clinical cases have found that SDF has a broad application in dentistry … It has shown to be an effective agent in preventing new caries and arresting existing caries. … The black staining of an arrested carious lesion can be an esthetic concern of SDF treatment; thus, the patients must be informed about this treatment outcome.”
In his letter, Dr. Johnson also blamed “organized dentistry” and “public health folks” for evading issues associated with community water fluoridation.
“I hear, ‘That’ll take a law change; dentists won’t want to do it,’ and so on. While organized dentistry doesn’t want to see dental therapists, and many in public dental health don’t want to see this neglected population, those in public health are pushing hard for dental therapists because ‘Dentists don’t want to see Medicaid patients in their offices; dentists won’t do it, so we’ll shove dental therapists down their throats and legislate it,’ and so on. All of this rhetoric and stalling of implementation does not do a single thing to bring pain relief from suffering to those most in need.”
