PFAS: An Oral Health Perspective

From pizza boxes to shampoo, and even some dental floss, PFAS (per-and polyfluoroalkyl substances) are everywhere. These “forever chemicals” are so widespread that it is virtually impossible to avoid exposure. While they have been commercially used since the 1940s, the scientific community is just beginning to learn about the adverse health effects that PFAS exposure can cause.

PFAS are a group of manmade chemicals widely used in a variety of industries. The story of PFAS calls to mind the history of asbestos. While we are aware of the danger that asbestos poses today, decades of prior use exposed many to adverse health effects, and its ubiquity has made removing the substance from everyday life a difficult and still incomplete, task.

In 2016, North Carolina became the center of attention after a joint study published by scientists from North Carolina State University, the University of North Carolina at Charlotte, the EPA, and other local agencies shed light on PFAS pollution in the Cape Fear River.

The Chemours Company, a spin-off of DuPont, had been releasing PFAS pollutants into the Cape Fear River for decades.

More recently, Pittsboro and other communities along the Haw River in North Carolina have been added to the high exposure list.

The most-studied PFAS chemicals, PFOA and PFOS, have been linked to low infant birth weight, immune system deficiencies, multiple forms of cancer, thyroid hormone disruption, and they can negatively impact the liver and kidneys.

To underscore just how serious and widespread PFAS contamination is, an agreement reached by the Southern Environmental Law Center and the Chemours Company in 2018 includes the “largest fine ever levied by the North Carolina Department of Environmental Quality,” $12 million on top of funding for studies regarding the health impacts of PFAS chemicals.

From an environmental health perspective, PFAS are a nightmare. They were given the name “forever chemicals” because of their durability. They are so persistent that the EPA simply states that the chemicals don’t break down in the human body or in the natural environment.

From a public health perspective, PFAS pollution also underscores the importance of integrated care, especially when managing a health crisis.

It isn’t obvious at first glance that oral health providers have any significant role to play in responding to PFAS contamination. There are no known direct oral health impacts, after all.

However, one of the recommendations for anyone living in an area impacted by PFAS pollution is to install a water filter, specifically a reverse osmosis two-stage filter. Reverse osmosis filters remove around 99 percent of PFAS chemicals, a great preventive step for anyone in an impacted area. Unfortunately, those filters also remove fluoride from drinking water.

Preventing the negative health impacts of PFAS pollution is priority number one. But down the line, it would be tragic for tooth decay and gum disease to emerge as an adverse side-effect.

From simply adding discussion of water filtration devices to dental health questionnaires, to potentially boosting supplemental fluoridation programs in areas heavily impacted by PFAS contamination, dental providers have an important role to play.

NCOHC had the pleasure of working with Dr. Kelly Bailey as she completed her public health practicum for the UNC Gillings School of Global Public Health during the summer of 2021. Dr. Bailey created this toolkit to help the dental community better understand PFAS contamination and the role that oral health providers can play in helping impacted communities remain healthy, from head to toe.

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