Chemists invented PFAS in the 1930s to make life easier: Nonstick pans, waterproof clothing, grease-resistant food packaging and stain-resistant carpet were all made possible by PFAS. But in recent years, the growing number of health risks found to be connected to these chemicals has become increasingly alarming.

PFAS – perfluoroalkyl and polyfluoroalkyl substances – are now either suspected or known to contribute to thyroid disease, elevated cholesterol, liver damage and cancer, among other health issues.

They can be found in the blood of most Americans and in many drinking water systems, which is why the Environmental Protection Agency in April 2024 finalized the first enforceable federal limits for six types of PFAS in drinking water systems. The limits – between 4 and 10 parts per trillion for PFOS, PFOA, PFHxS, PFNA and GenX – are less than a drop of water in a thousand Olympic-sized swimming pools, which speaks to the chemicals’ toxicity. The sixth type, PFBS, is regulated as a mixture using what’s known as a hazard index.

Meeting these new limits won’t be easy or cheap. And there’s another problem: While PFAS can be filtered out of water, these “forever chemicals” are hard to destroy.

My team at the University of Notre Dame works on solving problems involving contaminants in water systems, including PFAS. We explore new technologies to remove PFAS from drinking water and to handle the PFAS waste. Here’s a glimpse of the magnitude of the challenge and ways you can reduce PFAS in your own drinking water:

Removing PFAS will cost billions per year

Every five years, the EPA is required to choose 30 unregulated contaminants to monitor in public drinking water systems. Right now, 29 of those 30 contaminants are PFAS. The tests provide a sense of just how widespread PFAS are in water systems and where.

The EPA has taken over 22,500 samples from about 3,800 of the 154,000 public drinking water systems in the U.S. In 22% of those water systems, its testing found at least one of the six newly regulated PFAS, and about 16% of the systems exceeded the new standards. East Coast states had the largest percentage of systems with PFAS levels exceeding the new standards in EPA tests conducted so far.

Under the new EPA rules, public water systems have until 2027 to complete monitoring for PFAS and provide publicly available data. If they find PFAS at concentrations that exceed the new limits, then they must install a treatment system by 2029.

How much that will cost public water systems, and ultimately their customers, is still a big unknown, but it won’t be cheap.

The EPA estimated the cost to the nation’s public drinking water systems to comply with the news rules at about US$1.5 billion per year. But other estimates suggest the total costs of testing and cleaning up PFAS contamination will be much higher. The American Water Works Association put the cost at over $3.8 billion per year for PFOS and PFOA alone.

There are more than 5,000 chemicals that are considered PFAS, yet only a few have been studied for their toxicity, and even fewer tested for in drinking water. The United States Geological Survey estimates that nearly half of all tap water is contaminated with PFAS.

Some money for testing and cleanup will come from the federal government. Other funds will come from 3M and DuPont, the leading makers of PFAS. 3M agreed in a settlement to pay between $10.5 billion to $12.5 billion to help reimburse public water systems for some of their PFAS testing and treatment. But public water systems will still bear additional costs, and those costs will be passed on to residents.

Next problem: Disposing of ‘forever chemicals’

Another big question is how to dispose of the captured PFAS once they have been filtered out.

Landfills are being considered, but that just pushes the problem to the next generation. PFAS are known as “forever chemicals” for a reason – they are incredibly resilient and don’t break down naturally, so they are hard to destroy.

Studies have shown that PFAS can be broken down with energy-intensive technologies. But this comes with steep costs. Incinerators must reach over 1,800 degrees Fahrenheit (1,000 Celsius) to destroy PFAS, and the possibility of creating potentially harmful byproducts is not yet well understood. Other suggested techniques, such as supercritical water oxidation or plasma reactors, have the same drawbacks.

So who is responsible for managing that PFAS waste? Ultimately the responsibility will likely fall on public drinking water systems.

The EPA on April 19, 2024, designated PFOA and PFOS as eligible contaminants for Superfund status, which means companies that are responsible for contaminating sites with those chemicals can be required to pay for cleanup. However, the EPA said it did not intend to go after wastewater treatment plants or public landfills.

Steps to protect your home from PFAS

Your first instinct might be to use bottled water to try to avoid PFAS exposures, but a recent study found that even bottled water can contain these chemicals. And bottled water is regulated by a different federal agency, the Food and Drug Administration, which has no standards for PFAS.

Your best option is to rely on the same technologies that treatment facilities will be using:

• Activated carbon is similar to charcoal. Like a sponge, it will capture the PFAS, removing it from the water. This is the same technology in refrigerator filters and in some water pitcher filters, like Brita or PUR. Note that many refrigerator manufacture’s filters are not certified for PFAS, so don’t assume they will remove PFAS to safe levels.

• Ion exchange resin is the same technology found in many home water softeners. Like activated carbon, it captures PFAS from the water, and you can find this technology in many pitcher filter products. If you opt for a whole house treatment system, which a plumber can attach where the water enters the house, ion exchange resin is probably the best choice. But it is expensive.

• Reverse osmosis is a membrane technology that only allows water and select compounds to pass through the membrane, while PFAS are blocked. This is commonly installed at the kitchen sink and has been found to be very effective at removing most PFAS in water. It is not practical for whole house treatment, but it is likely to remove a lot of other contaminants as well.

If you have a private well instead of a public drinking water system, that doesn’t mean you’re safe from PFAS exposure. Wisconsin’s Department of Natural Resources estimates that 71% of shallow private wells in that state have some level of PFAS contamination. Using a certified laboratory to test well water for PFAS can run $300-$600 per sample, a cost barrier that will leave many private well owners in the dark.

For all the treatment options, make sure the device you choose is certified for PFAS by a reputable testing agency, and follow the recommended schedule for maintenance and filter replacement. Unfortunately, there is currently no safe way to dispose of the filters, so they go in the trash. No treatment option is perfect, and none is likely to remove all PFAS down to safe levels, but some treatment is better than none.

This article, originally published April 17, 2024, has been updated with EPA’s Superfund declaration.

Kyle Doudrick, Associate Professor of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame

This article is republished from The Conversation under a Creative Commons license. Read the original article.

C. Everett Koop, the avuncular doctor with a fluffy white beard who served as the U.S. surgeon general during the Reagan administration, was famous for his work as an innovative pediatric surgeon and the attention he paid to the HIV-AIDS crisis.

As dentistry scholars, we believe Koop also deserves credit for something else. To help make the medical profession pay more attention to the importance of healthy teeth and gums, he’d often say: “You are not healthy without good oral health.”

Yet, more than three decades after Koop’s surgeon general stint ended in 1989, millions of Americans don’t get even the most basic dental services, such as checkups, tooth cleanings and fillings.

Americans who rely on the traditional Medicare program for their health insurance get no help from that program with paying their dental bills aside from some narrow exceptions. This group includes some 24 million people over 65 – about half of all the people who rely on Medicare for their health insurance.

‘Medically necessary’ exceptions

When the Medicare program was established in 1965, almost all dental services were excluded due to the expense and vigorous opposition from associations that represent dentists out of fear that reimbursement rates would be markedly low compared to traditional insurance plans or out-of-pocket payment.

However, interest in including dental benefits in Medicare is on the rise at the Centers for Medicare and Medicaid Services, the federal agency responsible for the Medicare program, as well as many organizations that seek to provide dental benefits to all members of society.

The Biden administration initially considered the addition of comprehensive Medicare dental coverage as part of its proposed Build Back Better legislation, a broad US$1.8 trillion legislative package designed to fix problems ranging from child care costs to climate change, but failed to get enough support in Congress.

Dental coverage was eliminated from the version of the bill the House passed in 2021, in part due to cost concerns and resistance from organized dentistry due to the low reimbursement rates for medical care for patients with Medicare benefits.

In 2022, after the broader package was blocked in the Senate, the federal government added coverage for dental treatment that was designated as “medically necessary” for people with Medicare.

The list of circumstances that would lead patients to be eligible is short. Some examples include patients scheduled for organ transplants or who have cancer treatment requiring radiation of their jaws.

But we believe that dental care is necessary for everyone, especially for older people.

Chew, speak, breathe

While many working Americans get limited dental coverage through their employers, those benefits are usually limited to as little as $1,000 per year. And once they retire, Americans almost always lose even that basic coverage.

Given the importance of oral health for your overall health and quality of life, and increasing scientific understanding of the role of poor oral health in a wide array of chronic diseases, we believe that Medicare should include basic dental services.

A healthy mouth is essential for chewing, speaking and breathing. Being able to flash a good smile boosts self-esteem and helps maintain a sense of well-being.

Left untreated, dental diseases often result in infections that can cause severe pain. Poor oral health can lead to hospitalization and even death. Yet, routine oral care is frequently unavailable to many Americans.

Rich Americans with Medicare coverage are almost three times more likely to receive dental care compared to those with low incomes. And almost 3 in 4 low-income people over 65 don’t see a dentist in a typical year.

Connected to many serious conditions

Numerous epidemiological studies have associated atherosclerosis, a serious condition colloquially known as clogged arteries, cardiovascular disease and stroke, with periodontal disease – chronic inflammation of the bone and gum tissues that support the teeth.

Having diabetes makes you three times as likely to develop gum disease because diabetes compromises the body’s response to inflammation and infection. At the same time, treating diabetes patients for gum disease can help control their blood sugar levels. Researchers have found that when people with diabetes get preventive dental and periodontal care, their diabetes is better controlled and health care costs decline.

Poor oral health can also increase the risk of contracting pneumonia, especially for patients in hospitals and nursing homes. When patients see a dentist before entering the hospital, they’re less likely to get pneumonia during their stay.

There is also evidence that untreated dental problems may contribute to rheumatoid arthritis as well as Alzheimer’s disease and other cognitive impairments.

Chemo can damage your teeth

Many cancer treatments can damage teeth, especially for older adults.

As a result, Medicare has started to reimburse for dental bills tied to tooth decay or other oral conditions after they get chemotherapy or radiation treatment.

More than nice to have

The history of U.S. health care helps explain why Medicare generally won’t cover the cost of dental and gum treatment.

Doctors and dentists are educated separately, and doctors learn very little about dental conditions and treatments when they’re in medical school.

Most dental electronic health records aren’t linked to medical systems, hindering comprehensive care and delivery of dental care to those in need.

At the same time, medical insurance and dental insurance have evolved to serve very different functions. Medical insurance was designed specifically to cover large, unpredictable expenses, while dental insurance was intended to mainly fund predictable and lower-cost preventive care.

While protection from catastrophic medical costs has always been perceived as a necessity, coverage of dental services was conceived as a benefit that’s mostly nice to have.

But that’s an outdated idea disconnected from a large body of scientific evidence.

Medicare Advantage plans

Until Medicare expands coverage to include preventive dental services for everyone, alternative plans such as Medicare Advantage, through which the federal government contracts with private insurers to provide Medicare benefits, serve as a stopgap.

In 2016, only 21% of beneficiaries in traditional Medicare had purchased a stand-alone dental plan, whereas roughly two-thirds of Medicare Advantage enrollees had at least some dental benefits through their coverage. However, these plans vary greatly in the procedures that they cover.

The costs of this hole in Medicare coverage is high: 1 in 5 Americans with Medicare – including many with little disposable income – are spending at least $1,000 a year on dental care.

It seems that Dr. Koop was onto something – you can’t be healthy without good oral health. Adding basic dental benefits to Medicare would likely help many older Americans to live happier and healthier lives, and at the same time potentially reduce overall health care costs.

Frank Scannapieco, Professor and Chair of Oral Biology, University at Buffalo and Ira Lamster, Clinical Professor of Periodontics and Endodontics, Stony Brook University (The State University of New York)

This article is republished from The Conversation under a Creative Commons license. Read the original article.