NDA Journal 20 Some may recall an inhalational anesthetic, penthrane. Kids liked penthrane because it smelled like Juicy Fruit gum. But anesthesiology residents were warned to be judicious when administering methoxyflurane, as penthrane is generically known, because its metabolites include fluoride, which was particularly troublesome in patients who possessed kidneys and livers. Dental anesthesiology residents couldn’t help wondering what would happen metabolically in our pediatric renal patients who might also metabolize fluoride from other sources in addition to that mandated by the government in the community water. Methoxyflurane use was largely discontinued in the mid-1970s, in large part because of fluoride issues. In spite of views expressed in popular media such as the 1964 movie Dr. Strangelove, fluoridated water is not likely a Communist plot to exert mind control. However, many creators of film, literature, television, music, etc. have suggested, theoretically tongue in cheek (humorous, not masticatory), a potential use for government prescribed psychogenic medication administration by means of community water supplies. Interestingly, we now have a very real, very scientific, suggestion that we should consider medicating water with another naturally occurring element, lithium. Studies, initially reporting about communities in Japan and Austria, found up to a 15% decrease in suicide in areas with naturally occurring lithium in the water.2 Further, lithium has been found helpful in Alzheimer disease. Anecdotal stories about towns with lithium laced “happy water” are abundant. Dental anesthesiology residents were also warned about psychiatric patients who had been prescribed lithium and were prone to complications of electrolyte imbalance and of the cardiovascular system secondary to concomitant anesthesia administration.3 The University of Arizona’s Arizona Water Resource newsletter reported on pharmaceuticals in the water supply, with particular emphasis on the ramification for the West, in July 2000.4 This article has been followed by many more commenting on the phenomena of things in our H2O in addition to hydrogen and oxygen molecules.5,6 Featured Article Reprint NDA Journal 6 The concern is all these additional additives in our water can have significant effects. As tempting as it might be to now pour lithium into the water supply to achieve what is generally seen as a public health benefit, we as health professionals need to keep an objective professional and ethical eye on things. As dentists, we can’t be concerned only about the teeth. To many of the lay public, fluoride is just another government mandated drug—safe and dentally effective though it appears to be. Dentists promoting fluoridation need to be sensitive to the concerns of our fellow citizens (patient autonomy). Many in Clark County were very agitated when fluoride was placed into the storage tanks in March 2000 after voters had been told that would only happen after a public vote. However, the Water District unilaterally decided the legislature actually meant the voters could vote the fluoride back out of the water.7 No one at the water district in Washoe County has turned on the fluoride yet. Nearly everyone understands the fact that fluoride helps prevent caries. It is the ancillary issues—real or imagined— associated with fluoridation that dentists are called on to explain logically. This risk benefit analysis not only includes the concerns about adverse effects of fluoridation, but also the political freedom and self-determination of others, which may even be more important. If artificial fluoride in the water is good, why isn’t lithium, or something else? Dental professionals must be prepared to discuss fluoridation in public fora with the same expertise and sensitivity they use in their offices in face-to-face communication. 0 References 1. Associated Press, Wichita Advocates to Fight Fluoride Nationally, 12 November 2012, http://kansaspublicradio.org/ news/5316-wichita-advocates-to-fight-fluoride-nationally, accessed 19 November 2012. 2. Kapusta ND, Moosaheb N, Etzersdorfer E, et al, “Lithium in drinking water and suicide mortality,” Brit J Psych, 198: 346-350, May 2011. 3. Leone, CW, “Anesthetic management of lithium-treated patients,” Anesth Prog, 31:138-140, May/June 1984 4. University of Arizona, Arizona Water Resource, Pharmaceuticals in our water supplies, July 2000. 5. www.msnbc.msn.com/id/23503485/ns/health-health_care/t/pharmaceuticals-lurking- us-drinking-water/, accessed 03 August 2012. 6.www.nytimes.com/2007/04/03/science/earth/03water.html, accessed 03 August 2012. 7.Weissenstein M, “Fluoride enters Las Vegas water supply,” Las Vegas Review Journal, 02 March 2000. » “…we as health professionals need to keep an objective professional and ethical eye on things.”
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