What is the connection between dry mouth and diabetes?

 

Dry mouth, or xerostomia, occurs when a person’s salivary glands do not produce enough saliva to keep the mouth moist. Xerostomia can be a symptom of diabetes and, also a side effect of the medication that treats diabetes.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), dry mouth is a common symptom of diabetes.

In this article, we look at the symptoms of dry mouth and its link with diabetes. We also explain how a person can treat dry mouth.

What are the symptoms of dry mouth?

Dry mouth occurs when there is not enough saliva in the mouth.

According to the NIDDK, people with dry mouth may experience:

• a frequent dry feeling in the mouth
• mouth pain
• a rough, dry tongue
• difficulty eating, talking, chewing, or swallowing.
• sores or infections in the mouth

In addition, the American Dental Association (ADA) note that dry mouth may involve:

• a sore throat
• nasal dryness
• hoarseness

What is the connection between dry mouth and diabetes?

The NIDDK list dry mouth among the most common problems that people living with diabetes experience.

Its high prevalence in this population may be due to:

• Dehydration: People with diabetes are prone to dehydration.
• Increased blood sugar levels: In those with diabetes, a person’s blood glucose levels can become too high. The term for this is hyperglycemia, and it can cause a person to experience dry mouth.
• Kidney conditions: Over time, high blood glucose can lead to kidney disease, which can cause dry mouth.
• Diabetes medication: Some medications that a person can take to help control diabetes can cause dry mouth as a side effect.

Also, according to Johns Hopkins Medicine, approximately two-thirds of those with diabetes have high blood pressure or use medications to help control hypertension. Dry mouth can occur as a side effect of these medications.

 

 

Is dry mouth a symptom of diabetes?

According to a 2014 review, dry mouth can be a warning sign of diabetes. However, although it is common in those with diabetes, it is not the only symptom.

A person may potentially experience several symptoms due to diabetes, including:

• blurry vision
• fatigue
• increased thirst
• more frequent urination
• increased hunger
• unexplained weight loss
• tingling or numbness in the extremities, such as the hands or feet
• sores that do not heal

Although both type 1 and type 2 diabetes have similar symptoms, the NIDDK state that they do not develop in the same way.

They note that while people who develop type 1 diabetes usually experience a fast onset of symptoms, people living with type 2 diabetes tend to see a gradual onset of symptoms, which they may not notice until another complication develops, such as blurred vision.

 

Treatment 

People who experience dry mouth because of medication can ask a doctor about the possibility of switching medications. Managing any underlying conditions — for example, keeping blood sugar levels within a safe range to control diabetes — may also help.

Healthcare professionals can also prescribe medications to stimulate saliva production. These include pilocarpine (Isopto Carpine), which has a typical dosage of 5 milligrams (mg) three times a day, and cevimeline (Evoxac), which has a typical dosage of 30 mg three times a day.

A person will need to take these medications for 3 months to ensure that they are working.

A person can also try saliva substitutes that come in the form of gels, sprays, and lozenges. However, the authors of a 2020 article note that these do not work reliably and that when they do, they only provide temporary relief.

Home remedies

The National Institute of Dental and Craniofacial Research recommend that a person take the following steps to minimize the symptoms of dry mouth:

• avoiding spicy or salty foods because they can aggravate the issue.
• sipping water slowly throughout the day
• chewing sugar-free gum or sucking on sugar-free candy to help stimulate saliva production.
• sipping water or other sugar-free drinks during meals to aid swallowing.
• refraining from alcohol or tobacco use.
• using a humidifier when sleeping.
• avoiding caffeinated beverages.

 

How often should I get my teeth cleaned?

If you went to your dentist for a check-up and dental clean in the last year, give yourself a pat on the back. Not everyone loves the dentist, but research shows people who visit at least once a year for preventative care are healthier and happier with their mouths.

Why do I need to get my teeth cleaned?

While we all do what we can on our own, professional teeth cleaning removes plaque, the soft yellowish build-up, and calculus (hardened plaque) we can't get to. This soft build-up is made up of billions of different types of bacteria that live and reproduce in our mouth by feeding on the food we eat.

Most bacteria live in our bodies without causing too much trouble. But certain bacteria in dental plaque, when they grow in numbers, can lead to cavities (holes in the teeth) or gum disease.

A dental cleaning will reduce your chance of getting cavities or gum disease by significantly reducing the amount of plaque and calculus in your mouth.

So how often?

We are all different when it comes to how often we should get our teeth professionally clean. The frequency of our dental cleanings should be suggested by our dentist, who is the one that knows our mouth condition and our risk factors. Some people are at higher risk of getting dental cavities or gum disease this group should get their teeth cleaned more often.

We know certain health and lifestyle factors can affect a person's risk of developing cavities and gum disease. Here are some yes/no questions you can ask yourself to understand whether you're at a higher risk:

1.   Is your drinking water or toothpaste fluoride-free?

2.   Do you snack a lot, including on sweets?

3.   Do you avoid flossing?

4.   Do you have dry mouth?

5.   Do you brush your teeth less than twice a day?

6.   Do you visit your dentist for toothaches rather than check-ups?

7.   Do you need new fillings every time you visit the dentist?

8.   Do you have to wear an appliance in your mouth such as a removable partial denture or braces?

9.   Do you suffer from a chronic long-term health condition such as diabetes?

If you answered "yes" to more than 3 of these questions, you're likely to need to see your dentist or hygienist at least every six months, if not more often.

As well as removing the bug-loaded plaque and calculus, people prone to cavities benefit from the fluoride treatment after scaling.

Evidence shows professional fluoride treatment every six months can lead to a 30% reduced risk of developing cavities, needing fillings or having teeth removed.

Dental health is related to our overall health

Some people with chronic health issues such as heart conditions or diabetes will need to see the dentist more frequently. This is because they are more prone to inflammation and gum disease.

People taking blood thinners and other medications, such as pills and infusions for osteoporosis, may need to visit the dentist more regularly too. These medications can complicate the process of an extraction or other dental work, so regular checks and cleanings are best to help detect problems before they become serious.

People with bleeding gums should also see their dental practitioners more often. This is especially important if you have been diagnosed with advanced gum disease, known as periodontal disease.

Some people prefer to go more often to reduce the chance of a nasty toothache.

There are many benefits to regular checks and cleanings. Visiting the hygienist and dentist regularly helps reduce the chance of needing more complex and expensive dental treatment later on.

So, eat healthy, brush better (preferably with an electric toothbrush), floss more often and visit your dentist/hygienist at least twice a year.

The unexpected dangers of gum disease

Gum disease is common and unpleasant, but, according to a growing body of evidence, it could also play a role in a surprising range of seemingly unrelated health problems.

Plaque — a sticky substance that contains bacteria — builds up on teeth. If it is not brushed away, the bacteria can irritate the gums.

The gums may then become swollen, sore, or infected; this is referred to as gingivitis.

In general, gum disease can be treated or prevented by maintaining a good oral health regime.

However, if it is left to develop, it can result in periodontitis, which weakens the supporting structures of the teeth.

Gum disease, which is also called periodontal disease, is widespread. According to the Centers for Disease Control and Prevention (CDC), almost half of adults in the United States have some degree of gum disease.

The mechanisms behind periodontal disease are relatively well-understood, and newer research shows that this health problem may play a role in the development of a number of other conditions, including Alzheimer's disease, cancer, and respiratory disease.

Gums and the brain

Although spatially the gums are near the brain, one wouldn't normally associate dental complaints with neurological conditions.

However, some studies have found a link between periodontal disease and tooth loss and cognitive function. One study looking at cognitive performance followed 597 men for up to 32 years. The authors conclude:

"Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline."

Researchers have also linked periodontal disease with an increased buildup of beta-amyloid in the brain — the neurological hallmark of Alzheimer's.

Other experiments have produced evidence that one type of bacteria commonly found in cases of periodontitis — Porphyromonas gingivalis — can be found in the brains of individuals with Alzheimer's.

Following on from that discovery, in a more recent study, researchers showed that P. gingivalisinfection boosts the production of beta-amyloid in the brain.

In this study, the researchers paid particular attention to an enzyme produced by P. gingivaliscalled gingipain. They found that this protease was toxic to tau, another protein that plays a pivotal role in Alzheimer's.

The heart of the matter

Although not everyone with heart disease has gum disease, and not everyone with gum disease has heart disease, there does appear to be a correlation.

Of course, individuals who smoke or drink large quantities of alcohol are more likely to have both oral and cardiovascular issues, but there appears to be more to the relationship than shared risk factors alone.

Whether gum disease is an independent risk factor for heart disease is still being discussed, but there are some theories as to how the two might be related.

Some think that the link could involve inflammation.

Primarily, inflammation is a response to irritants or pathogens; it is a protective mechanism. However, if it continues for an extended period, it can damage tissues and organs.

It is possible that inflammation in the gums sets off a cascade that, ultimately, sparks inflammation in the cardiovascular system.

Alternatively, the link between heart and gum diseases may be due to bacteria.

Bacteria in the gums can enter the blood supply and be propelled to distant destinations, including the heart, where they can cause inflammation and damage.

As evidence that this is possible, researchers have shown that P. gingivalis is the most commonly found bacterial species in the coronary artery.

Cancer risk increase

Once again, gum disease and cancer do not, on the surface, appear to have much in common.

A study published in 2008 investigated tooth loss and cancer in 48,375 men. The authors concluded that there was, indeed, a link between gum disease and cancer. They write:

"Periodontal disease was associated with a small, but significant, increase in overall cancer risk."

Another, more recent, study involving more than 68,000 adults found a strong association between gum disease and overall cancer risk; the link was also significant between gum disease and pancreatic cancer.

Why might this be the case? A paper published in Nature goes some way toward an explanation.

The researchers found that an enzyme produced by a type of bacteria commonly associated with gum disease — Treponema denticola — commonly appears in certain tumors of the gastrointestinal system.

The enzyme, known as T. denticola chymotrypsin-like proteinase, helps the bacteria invade tissue in gum disease. The researchers found that it also activated other enzymes that promote cancer cells as they advance into healthy tissue.

Gums and lungs

Of course, the mouth is a shared gateway to the gums and the lungs, making a link between gum and lung diseases less surprising than some of the others that we have encountered.

A study published in February 2019 investigated the records of 1,380 men. The authors found a significant relationship between chronic periodontitis and a reduction in respiratory function.

This link remained significant, even after controlling for confounding variables, such as smoking.

Once again, inflammation may be the link between the two conditions. If the tubes in the lungs that carry air are inflamed, they become narrower and air flow is restricted.

Aside from the probable role of inflammation, bacteria present in the mouth might also be breathed into the lungs. Once in the lungs, the bacteria could trigger infections that directly lead to inflammation.

A recent meta-analysis investigated potential links between gum disease and lung cancer. The authors concluded that "patients with periodontal disease are at increased risk of developing lung cancer."

In their paper, they outline some potential ways in which gum disease might increase lung cancer risk. For instance, breathing in bacteria, such as P. gingivalis, from the mouth could cause infections.

Similarly, enzymes produced during the course of gum disease might pass into the lungs. Once there, they could help pathogens take root and colonize the lung tissue.

These changes spark inflammation; over the long term, inflammation causes changes in cells that raise the likelihood of cancer developing.

The take-home message

One could read this article as a worrying collection of conditions made all the more likely to occur, courtesy of gum disease.

If we adopt the opposite approach, though, the take-home message could be much more positive: Good dental hygiene may reduce our risk of developing a range of serious health problems.

As the authors of the lung cancer analysis, mentioned above, write, "periodontal disease is a preventable and treatable disease." Managing it at an early stage might reduce the risks of a multitude of ills.

10 Ways to Relieve Stress

Life is like a roller coaster, says Dr. Paul J. Rosch, president of the American Institute of Stress in New York.

And the people on board each have their own way of dealing with the bone-rattling ride. “In the front of the car are the wide-eyed thrill-seekers who can’t wait for the next breathtaking plummet,” Rosch notes. “In back are the white-knuckled timorous types who won’t open their eyes until the ride is over. And in between are those who seesaw between courage and fear.”

“We all respond to stress differently,” Rosch says. “One person’s stress is another person’s challenge. It’s all in how you perceive it.” Those who handle stress well are said to have a strong sense of control and commitment, and who enjoy challenges that would overwhelm others. They thrive on stress.”

But for those of us less “hearty” types who feel the need to reduce stress, there are some simple remedies. Most experts agree that walking is a universal stress reliever. Whether you take an impromptu stroll to blow off steam or a regular walk of 30 to 45 minutes four times a week, walking is a mood-lifter. It can be the foundation for a variety of ways to reduce stress. Here are 10 ways to get you started.

1. LOCK IN YOUR WALK. Make a walk part of your daily schedule – just as taking a shower or eating dinner. Locking it into your routine will help ease your exercise painlessly into your day. It may also eliminate the guilt and worry associated with trying to find time to exercise on an intermittent basis.
2. BE KIND TO YOUR STOMACH. Acid stomach and ulcers are painful conditions sometimes associated with stress. In the past, spicy foods topped the list of things to avoid, but more recent evidence shows that caffeine, alcohol, smoking, and painkillers, such as aspirin and ibuprofen, are more likely to aggravate the condition.
3. TIME YOUR MEALS. Keeping your energy level high throughout the day requires a ready supply of blood sugar. Skipping breakfast or lunch will cause your blood sugar to drop. It’s better to eat four small, low-fat meals during the day. Eating small, well-balanced meals periodically during the day and avoiding large doses of caffeine and processed sweets can help you maintain even blood sugar levels and control your weight.
4. MASSAGE YOUR HANDS. A 5-minute hand routine can prevent or release tension. Try a few of these:

1.      Place a tennis ball in your palm. Grip and release 12 times.

2.      Put a rubber band around the tips of your fingers and thumb. Open and close 20 times.

3.      Make loose fists with both your hands, then move your fists in a circle to increase your range of motion.

4.      Pat or gently slap your hands all over to increase circulation.

5.      Open one hand and grasp it with the other. Press the thumb firmly on the base of the hand for several seconds. Continue pressing, slowly moving toward the space between the first two fingers. Repeat for each pair of fingers.

6.      Turn your hand over and massage the top of the hand, starting at the base and working toward your fingertips.

7.      Grip the fleshy portion between your thumb and index finger. Press and release it at least five times.

8.      Grip the knuckle of the thumb between the thumb and index finger of the other hand. Move the thumb in a circle.

5. NIX NECK PAIN. One of the first places you feel tension gathering is in the neck. Poor posture is the most common cause of neck pain. Try to keep your back straight but relaxed and your head centered directly over your spine while sitting, standing, or walking. Gently stretching the neck muscles can also relieve tension. Tilt your head to the left, keeping shoulders down. Place your left hand on the right top side of your head. Gently pull your head toward your left shoulder for 20 seconds. Reverse position and stretch to the right.
6. ENERGIZE WITH EXERCISE. Don’t rely on supplements like monthly injections of vitamin B12 to restore your energy. B12 is no more capable of providing a burst of energy than it is able to relieve muscle soreness, headaches, or anxiety. A proven energy booster is regular exercise. Pick any rhythmic, aerobic activity such as walking, rowing, biking, or swimming. Do it at least four times a week and feel your energy pick up.
7. GET MORE SLEEP. About one out of five adults routinely suffers from insomnia. It can be triggered by stress and anxiety, but it may persist even after the source of stress is removed. Lack of sleep itself can cause stress. Improve your sleeping habits by sticking to a regular schedule. Go to bed and get up the same time every day, even on weekends. Do not try to make up for lost sleep by napping or sleeping late- this will disrupt your schedule, and don’t drink beverages containing caffeine within four hours before bedtime.
8. CREATE FREE TIME. Analyze your daily schedule and look for ways to simplify it. Could you do errands on your lunch hour rather than after work? Can you combine a trip to the grocery store with picking up your child at soccer practice? The goal is to have some time for yourself left over at the end of the day. Count on some unscheduled time each day for tending to your own need to relax.
9. REACH OUT TO OTHERS. Regular physical contact with others can lower anxiety levels. Expressing physical affection toward friends and family members is a healthy, stress-relieving habit. Or, try giving and receiving a massage from your mate. Even the physical contact of handling a pet improves some people’s moods.

HELP SOMEONE ELSE. Doing volunteer work that benefits others can reduce your own tension and anxiety. Such volunteering is particularly effective when you can see the results. Sign on for an activity that gives you direct contact with other people, such as elderly or children. Volunteer to teach adults to read. Serve meals to shut-ins. For best results, volunteer for a project that offers you freedom of choice rather than work where you have no control over your own activities or those of the people you’re helping.

Science says fluoride in water is good for kids. So why are these towns banning it?

In the past five years, 74 cities have voted to remove fluoride from their drinking water, despite thousands of studies showing it prevents cavities.

It has been hailed by the Centers for Disease Control and Prevention as one of the top public health achievements of the 20th century. Numerous studies have proven its safety and efficacy. But fluoride — the naturally occurring compound that prevents cavities and tooth decay — is still sparking heated debates, seven decades after it was first added to America’s water supply.
“Anti-fluoridationists” — a small but vocal minority — are disputing long-established science to say that fluoride added to tap water lowers IQ and causes everything from acne to anemia to Alzheimer’s.
These anti-fluoride believers are active online but also at the polls: In the past five years, 74 cities have voted to remove fluoride from their drinking water, according to the American Dental Association. This year, there have been 13 votes around the country on fluoridation, and at least three more cities have fluoride referendums on the ballot in November: proposed bans in Brooksville, Florida, and Houston, Missouri, and a vote on bringing fluoridated water back in Springfield, Ohio.
The frets over fluoride are reminiscent of the unfounded fear that vaccines cause autism: disproved by science, yet steadfast nonetheless. The persistence of fluoride conspiracy theories — which emerged in the 1950s with claims that fluoridation was a communist plot to dumb down Americans — is alarming public health officials, including the American Dental Association and the American Academy of Pediatrics, who say fluoride is a safe, inexpensive way to boost children’s oral health.
Dr. Johnny Johnson, a retired pediatric dentist who is president of the nonprofit American Fluoridation Society, calls the anti-fluoride efforts “cult-like.”
“You cannot tailor public health to the whims of a small group of people,” he said. “If you are doing that, you are harming a large group of people.”
The anti-fluoridationists, though, say that it’s the fluoride supporters who are harming the public’s health. Some argue that the government uses fluoride as a form of mind control; others believe it's designed to boost the sugar lobby by enabling people to eat more sweets without getting cavities; and still others believe that health officials are afraid to reverse course on fluoride after promoting it for decades.
They spread the word on Facebook groups, like that of the New York State Coalition Opposed to Fluoridation, which blames fluoride for problems including thyroid damage and was slammed in 2012 for falsely claiming that the federal government “recommends avoiding fluoridated water when making infant formula.” (The CDC says it’s fine to use fluoridated tap water for formula, though the agency notes it may cause mild spotting on babies’ teeth, so parents can use low-fluoride bottled water some of the time instead.) Reddit users claim fluoride kills gut bacteria. And on Twitter, fluoride is regularly called a cancer-causing neurotoxin.
The anti-fluoride movement has also made headway offline. In June, the Texas Republican Party opposed water fluoridation in its 2018 platform. In New Jersey, where more than 80 percent of residents do not have fluoridated water, the town of East Brunswick stopped fluoridating three years ago after Mayor David Stahl called it "mass medication of the public," a familiar refrain on anti-fluoridation forums. In Brooksville, Florida, a city of 8,000 about an hour north of Tampa, Mayor Betty Erhard has said for years that fluoride is a toxin and a waste of taxpayer money. Next month, at her urging, Brooksville will vote on removing it.

“I believe that people should consent to what’s in their water,” Erhard said. Some townspeople agree.

“Fluoride is a dangerous cancer-causing agent. I don't even like taking a shower in it,” one wrote on Erhard’s Facebook page.

CONTROVERSY FROM THE VERY START

The first place in America to receive fluoridated water was Grand Rapids, Michigan, in 1945, when residents there became guinea pigs for the theory that boosting existing natural fluoride levels in water would decrease tooth decay, particularly in children. The experiment, by the United States Public Health Service, was done without residents’ consent — still a point of contention among anti-fluoridationists.

The experiment was so successful that 11 years into what was supposed to be a 15-year study, researchers announced the rate of cavities among Grand Rapids’ 30,000 schoolchildren had dropped by 60 percent. But not everyone was pleased.

"I was called a murderer and a communist," Dr. Winston Prothro, director of public health in Grand Rapids during the early days of fluoridation, told The Washington Post in 1988. "I must have had letters from every city in America, and plenty from other countries, too. It fell on me to defend the physical and moral health of our entire city."

Since then, the conspiracy theories have evolved from fears of a communist plot to other worries about purported dangers of fluoride — an abundant element that occurs naturally in water, even when it’s not added by the government.
“Now, you have this weird backlash where people think that anything that is a chemical is bad, even though everything is a chemical,” said University of Miami associate professor Joseph Uscinski, co-author of the book “American Conspiracy Theories.” “There are groups of people who think that if something isn’t natural, it is somehow impure or bad, and it grosses them out.”
To experts, objecting to fluoride is nonsensical. The compound, consumed in water or applied topically through toothpaste or mouthwash, prevents cavities by replacing weakened structures in the teeth, said Dr. Kerry Maguire, associate clinical investigator of Forsyth, an independent research institute specializing in oral health.
It’s true that too much fluoride can be dangerous — one complication is skeletal fluorosis, which causes stiffening and pain of the joints and bones or abdominal pain, nausea and vomiting — but those effects only occur with prolonged exposure to a far higher level of fluoride than is found in public water systems in the U.S., experts say. In this country, the only common side effect of fluoridation is fluorosis of the teeth — minor staining that is often only visible to a dentist.

THE ANTI-FLUORIDE MOVEMENT

Today, nearly 75 percent of the U.S. receives fluoridated water from community water systems.

That’s a number that Paul Connett, a chemistry professor emeritus at St. Lawrence University in Canton, New York, hopes to get down to zero.

“There’s umpteen ways that fluoride can cause damage,” said Connett, executive director of the nonprofit Fluoride Action Network, which aims to end fluoridation worldwide.

Connett was initially skeptical of concerns about fluoride when his wife asked him two decades ago about its health effects.

“The prevailing attitude is that people who are opposed to fluoride are crazy, so I didn’t want to be stigmatized in that way,” Connett said.

But the more he looked into it, the more convinced Connett became that fluoride was indeed toxic.
He now cites what he bills as a “dynamite” 2017 study that concluded that higher prenatal fluoride exposure was associated with lower cognitive outcomes in children in Mexico.
The findings, he says, are consistent with more than 50 other studies that concluded that fluoride lowers IQ.
But many dental experts dismiss such studies as bogus, particularly because many of them were done in other countries, where natural fluoride levels are far higher than in the U.S. and there may be other factors, like polluted water.
“It’s as though you have something you want to prove, so you look at other countries that have naturally high levels of fluoride at multiples of what we have in the United States, and they see changes and then they backwards extrapolate it to water fluoridation,” said Johnson of the American Fluoridation Society. “You can’t do that in science.”
Some anti-fluoridationists oppose all fluoride, including in toothpaste. (Sales of fluoride-free toothpastes are relatively small but projected to grow; an article in the dental journal Gerodontology in August found that such toothpastes have “no impact” on preventing cavities.) Fluoride opponents seize on the warning label on toothpaste cautioning that a poison control center should be called if a child accidentally ingests too much, saying that proves fluoride is a toxin.
The American Dental Association, which has supported water fluoridation since 1950, disputes that, pointing out that the amount of fluoride in an entire tube of toothpaste wouldn’t be fatal, but other additives would likely cause a child to vomit.
As for fluoride in water, “there have been literally thousands of studies published in peer-reviewed journals that demonstrate the safety of community water fluoridation,” said Dr. Brittany Seymour, the American Dental Association’s consumer spokeswoman, calling it “the single most important public health measure to prevent cavities.”

The Fluoride Action Network disagrees. The group sued the Environmental Protection Agency in federal court in San Francisco last April to stop water fluoridation.

“Which is more important: protecting your children’s brain, or protecting your children’s teeth?” Connett said.

He expects the case to be heard next August. The EPA said it does not comment on pending litigation.

MORE THAN A TOOTHACHE

Kentucky is the only state to require fluoridation in every community water system that serves 1,500 or more people, and as a result, 99.99 percent of residents receive fluoridated water. Anti-fluoridationists have tried to reverse the law, but it’s not going anywhere, said Dr. Julie Watts McKee, the state dental director of the Kentucky Oral Health Program, a public initiative that carries out community programs to reduce oral disease. The cost to fluoridate water for a person’s entire lifetime is cheaper than the price of a single filling, McKee said.

“The science — the true science — proves its effectiveness over and over again,” she said. “It helps people of all ages. It helps the kids better because they have growing teeth and are at a cavity-prone age, but it helps us all.”

Elsewhere in the country, the percentage of residents receiving water varies, with Hawaii at the low end at 11.7 percent.

Fluoride by the numbers

The percentage of people in each state who receive fluoridated water

Hover your mouse over states to see the percentage

It’s not always a health fear that keeps states from raising fluoridation levels; sometimes the decision is budgetary. Either way, the low levels are troubling to fluoridation proponents, who argue that it gives everyone a shot at fighting cavities — regardless of access to dental care.

The effects of cavities, particularly untreated ones, can be far-reaching.

“It’s very, very difficult to concentrate when you have a toothache, and if we are trying to help children succeed in school … this is an important component that is often overlooked,” Maguire said. “It is a winnable war.”

In Brooksville, Florida, where the vote on removing fluoride is just a couple weeks away, Mayor Erhard has high hopes that her townspeople will vote it out. The city has spent about $19,000 on fluoridation over the past five years, and she would like to see that money go someplace else — such as repairing the city’s roads.

Erhard said she doesn’t worry about how kids will fare with nonfluoridated water, so long as parents do their part to encourage good oral health.

“If you’re feeding them a lot of sugar, naturally, you’re going to get a lot of cavities,” she said. “I can tell you firsthand from my experience that I’ve always brushed and I love going to the dentist, and my teeth are healthy.”