Abstract
Ignoring evidence on causes of disease such as smoking can harm public health. This report explores how public health experts started to ignore evidence that pediatric vitamin D deficiencies are associated with dental caries. Historical analyses show that an organization of clinical specialists, the American Dental Association (ADA), initiated this view. The ADA was a world-leading organization and its governing bodies worked through political channels to make fluoride a global standard of care for a disease which at the time was viewed as an indicator of vitamin D deficiencies. The ADA scientific council was enlisted in this endeavor and authorized the statement saying that “claims for vitamin D as a factor in tooth decay are not acceptable”. This statement was ghost-written, the opposite of what the ADA scientific council had endorsed for 15 years, and the opposite of what the National Academy of Sciences concluded. Internal ADA documents are informative on the origin of this scientific conundrum; the ADA scientific council had ignored their scientific rules and was assisting ADA governing bodies in conflicts with the medical profession on advertising policies. The evidence presented here suggests that professional organizations of clinical specialists have the power to create standards of care which ignore key evidence and consequently can harm public health.
Highlights
Systematic reviews of controlled clinical trials suggest that dental cavities can be prevented with vitamin D supplementation, not with oral hygiene [1,2]
This report shows that a professional organization of clinical specialists—the American Dental Association (ADA)—was first to reject the evidence that vitamin D deficiencies are a potential cause for dental caries
Dental caries informs on the human vitamin D requirement: An article in the Journal of the American Medical Association (JAMA) prepared under the auspices of two AMA Councils and cited in the 1944 edition of Accepted Dental Remedies reported that “the prevention and arrest of dental caries” was the only criterion to have “a considerable degree of usefulness” for defining a vitamin D deficiency in childhood [31]
Summary
Systematic reviews of controlled clinical trials suggest that dental cavities can be prevented with vitamin D supplementation, not with oral hygiene [1,2]. The World Health Organization (WHO) reported in 1984 that self-performed oral hygiene was ineffective to prevent dental caries [4]. These organizations reversed their public health messages in 1989 and 2020, respectively. The National Academy of Sciences reversed their recommendation in 1989 and described the dental caries prevention claim for vitamin D as unresolved [5]. The reversal on the role of a vitamin D deficiency in dental disease etiology was opposite of clinical trial evidence and may still cause harm. This report shows that a professional organization of clinical specialists—the American Dental Association (ADA)—was first to reject the evidence that vitamin D deficiencies are a potential cause for dental caries. (4) how the medical management of dental diseases became a historical artefact
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