Legislature(2005 - 2006)CAPITOL 124
02/02/2006 08:00 AM House COMMUNITY & REGIONAL AFFAIRS
| Audio | Topic |
|---|---|
| Start | |
| Department of Commerce, Community, & Economic Development | |
| HCR5 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| *+ | HCR 5 | TELECONFERENCED | |
HCR 5-FLUORIDATION 8:45:29 AM CO-CHAIR THOMAS announced that the final order of business would be HOUSE CONCURRENT RESOLUTION NO. 5, Relating to support of community water fluoridation. 8:45:38 AM REPRESENTATIVE PAUL SEATON, Alaska State Legislature, sponsor of HCR 5, related that HCR 5 would support community water fluoridation, which is important to the health of Alaskans. He informed the committee that Alaska cities with a population in excess of 30,000 have fluoridated water. Fluoride, he highlighted, has been identified as an effective tool in addressing dental disease. Therefore, HCR 5 merely illustrates that the legislature recognizes the importance of community fluoridation and that all new village safe water projects should design water systems such that fluoridation can be utilized, if the community chooses to do so. The committee packet, he noted, includes letters of support, including the letters from the Alaska Native Tribal Health Consortium and various dentists. 8:49:08 AM REPRESENTATIVE CISSNA recalled learning that life span is linked to the presence of teeth. She also recalled that the clinics in the Aleutians related to her that the largest reason for Medivacs were related to dental problems. Therefore, she inquired as to whether there are any studies specifying the costs related to not taking care of teeth. REPRESENTATIVE SEATON indicated that the committee packet includes a number of studies, including one that specifies that for every dollar spent on fluoridation, approximately $37 in medical costs would be saved. 8:50:57 AM REPRESENTATIVE SEATON, in response to Co-Chair Olson, said that he has received little opposition and what opposition that was received has been included in the committee packet. 8:52:07 AM TROY RITTER, Senior Environmental Health Consultant, Alaska Native Tribal Health Consortium (ANTHC), informed the committee that his expertise is really in relation to the cost of implementing the fluoride. He related that to implement fluoride it costs approximately $1 per person per year, and therefore most communities can be fluoridated for a year for what filing one cavity would cost. He characterized the aforementioned as a fairly good return, although he acknowledged that there are very few public health interventions that save more money than they cost. 8:53:09 AM REPRESENTATIVE NEUMAN asked if the fluoridation system is a simple injection system. He related his understanding that it requires minimal infrastructure. MR. RITTER replied yes. He noted that the delivery system for fluoride is similar to that used for chlorine. He noted that from an operation and maintenance standpoint, fluoride is easier to deliver than chlorine because fluoride is chemically stable. In further response to Representative Neuman, Mr. Ritter explained that the type of fluoride injected [in Alaska] is a powder form. He related the basic principle of toxicology that the dose makes the poison. Therefore, operators use a respirator that is similar to a dust mask. There haven't been any problems experienced with the operators, he said. 8:55:32 AM REPRESENTATIVE CISSNA returned to her concern with regard to the costs of dental problems, and requested information regarding the total cost of not taking care of dental needs. MR. RITTER, from the best studies available and from his Alaska- specific observations, related his belief that fluoridated communities probably reduce dental disease by about 40 percent. 8:57:13 AM MR. RITTER, turning to his prepared testimony, informed the committee that he has worked within Alaska's tribal health system for the last seven years. He also informed the committee that ANTHC is the largest health organization managed by a tribe in the nation. The ANTHC works with its partners to deliver comprehensive health services. Mr. Ritter specified that he is responsible for ensuring that his division's activities provide maximum health benefits. Therefore, ANTHC strongly supports HCR 5. He highlighted that HCR 5 doesn't require fluoridation and helps to align state, tribal, and federal efforts with regard to this issue. Mr. Ritter opined that fluoridation has sometimes been the subject of misunderstanding and misinformation. However, in the mainstream health and public health communities there is no controversy surrounding fluoridation, he further opined. Therefore, passage of HCR 5 would allow the state to say that it relies on credible, science-based information when making health decisions. Mr. Ritter acknowledged that not everyone agrees on fluoridation, but he expressed hope that those communities that choose to fluoride should receive [the state's] best efforts to keep [the residents] healthy and safe. In conclusion, Mr. Ritter characterized HCR 5 as a win-win situation in which public health professionals are provided a tool to provide safer and healthier communities without negatively impacting another area. 9:00:45 AM ARTHUR HANSEN, retired dentist, noted that he has worked in the villages. He related his support of HCR 5, and indicated that fluoridation is the least expensive way in which to reduce decay and dental problems. 9:01:57 AM WILLIAM MARLEY, retired dentist; Representative, Fluoride Committee, Alaska Dental Society, informed the committee that the American Dental Association (ADA) publishes a booklet with fluoride facts, in which it cites over 358 references to scientific studies supporting the safety and efficacy of fluoridating community water supplies. He related that fluoride is endorsed by the Alaska Dental Society, the ADA, the Center for Disease Control, the American Medical Association, the U.S. Surgeon General, the National Institute of Cranial and Facial Research, and over 100 other national and international associations dealing with water and health. Dr. Marley stated that fluoride has been found to be both safe and effective. With regard to cost effectiveness, he related that for every $1 invested [the state would] receive $18 in return. DR. MARLEY highlighted that fluoride has over 60 years of experience in the U.S. and millions of years of natural existence. In 1992 Alaska had 120 communities fluoridating their water, but that has decreased to 37 communities at this point. He then pointed out that Article 7, Section 4, of the Alaska State Constitution specifies that the legislature shall provide for the promotion and protection of the public health. Therefore, HCR 5 would be consistent with the constitution while providing leadership and reducing the rate of decay and the number of dentists that are needed. 9:08:07 AM REPRESENTATIVE NEUMAN inquired as to why there has been such a decrease in the communities that provide fluoridation. DR. MARLEY said he couldn't answer. 9:08:49 AM JIM TOWLE, Executive Director, Alaska Dental Society, stated that the Alaska Dental Society supports HCR 5. He pointed out that tooth decay is a chronic disease and the most common chronic disease in children. He echoed Dr. Marley's comments regarding the history of fluoride, which is naturally occurring. Mr. Towle emphasized that community water fluoridation is a public health measure that benefits individuals of all ages and socio-economic groups. From the information he has, he related that the average cost to fluoridate a community is around $.50 per person with the annual average per person cost being less than one-third of the cost of an average dental restoration or filling of a cavity. Mr. Towle informed the committee that there are over 225 current peer-reviewed studies that recognize the benefit of community water fluoridation. In 2004 Alaska spent $19.3 million for Medicaid and Denali Kid Care dental care, he mentioned. 9:11:24 AM MR. TOWLE, in response to Representative Cissna, agreed to supply the committee with the overall dental costs of the state. 9:12:41 AM SHELLEY HUGHES, Policy Analyst, Alaska Primary Care Association, related the association's support for HCR 5. She related that the Alaska Primary Care Association, which represents 24 health organizations throughout the state, recognizes that fluoridation does benefit the health of residents. She concluded by emphasizing that HCR 5 would be a positive step for the betterment of the health of Alaskans. 9:13:59 AM TOM BORNSTEIN, Director, Dental Services, Southeast Alaska Regional Health Consortium (SEARHC), related his support of HCR 5 for all the reasons stated earlier. 9:14:27 AM CO-CHAIR THOMAS inquired as to why the decrease in the villages fluoridating their water. MR. BORNSTEIN explained that in 1992 there was an overfeed incident in a fluoride system in Hooper Bay. This tragic event resulted in a review that determined one of the issues was the inadequate monitoring of the village water system. The aforementioned caused the Department of Environmental Conservation (DEC) to promulgate new regulations concerning the use of fluoride. Therefore, some of the communities that were just barely able to comply with the current water fluoridation rules were unable to meet the new standards, which were more stringent. Thus, many of the fluoridation systems were taken off-line. 9:16:17 AM CO-CHAIR THOMAS inquired as to what happens to those who drink water that has too much fluoride. MR. BORNSTEIN confirmed that over fluoridation results in sickness. However, he pointed out that it takes many times, about 50 times the recommended dose over a brief period of time before there is an acute effect. A chronic overfeed would result in mottled teeth. He related his understanding that in the Hooper Bay incident an individual who was sick became dehydrated and was told to drink lots of water. That individual ended up with 100 times the dose of fluoride and the individual ultimately died. He characterized the incident as extremely rare. 9:17:55 AM REPRESENTATIVE CISSNA expressed the need to include in the funding for these systems a training component. MR. BORNSTEIN related that the implementation of these systems require a level of training and monitoring as specified in the regulations. 9:19:57 AM REPRESENTATIVE SALMON inquired as to what causes the spots on the teeth of younger kids in Fort Yukon where the water became fluoridated in the 1970s. MR. BORNSTEIN answered that over exposure to fluoride, that is beyond the proper dose, can result in white spots/decalcification on the teeth. White spots/decalcification can also occur prior to decay. Therefore, he said that one would need to review the specific case to make a determination. 9:22:20 AM BRAD WHISTLER, Dental Officer, Department of Health and Social Services (DHSS), related that DHSS is supportive of community water fluoridation, which has a long-standing history in the U.S. With regard to the white spots, he reiterated that it's not always attributed to over fluoridation. In fact, in terms of fluoride, he attributed the white spots mainly to swallowing toothpaste, particularly with young children. Furthermore, amoxicillin may also discolor teeth. The studies that have reviewed long-term controls infrequently report that water fluoridation results [in white spots]. MR. WHISTLER then turned to the costs related to fluoridation. He informed the committee that Alaska would probably experience savings between $37 and $140. With regard to total dental costs in Alaska, he said he didn't know of a source from which to obtain that figure. He agreed that there is a training and capacity issue in rural areas. He also agreed that at very high doses, fluoride isn't good for individuals and thus it needs to be done in a safe manner and monitored. This resolution recognizes that if fluoride is delivered properly, substantial savings can be reaped in terms of dental costs, he said. 9:27:45 AM REPRESENTATIVE NEUMAN recalled that when he ran a water system monthly samples were sent to an engineer and the content of the water was reported to DEC. Therefore, he assumed that the same would be true for water systems using fluoride and thus over fluoridation would only last for a month. MR. WHISTLER informed the committee that water testing is reported monthly but most of the systems are [tested] daily. Therefore, he didn't believe over fluoridation would even last a month. He opined that immediate action would occur if the fluoride level reached four parts per million or more. 9:29:21 AM REPRESENTATIVE CISSNA related her interest in the costs of dental emergencies, particularly in relation to Medivac situations. MR. WHISTLER suggested that such information was available from the Eastern Aleutian tribes who, upon reviewing their Medivac services, found that adult dental emergencies were the most frequent reasons for Medivacs into Anchorage. REPRESENTATIVE CISSNA recalled that perhaps she heard it from a tribe in Dutch Harbor. 9:30:39 AM CO-CHAIR OLSON moved to report HCR 5 out of committee with individual recommendations and the accompanying fiscal notes. There being no objection, it was so ordered.
| Document Name | Date/Time | Subjects |
|---|