Debate
“Since the early trials, more than 60 years ago, the incidence of caries has declined similarly in fluoridated and non-fluoridated communities”
possible confounding factor here, since it happens that areas of high natural fluoride levels in the east of Denmark also tend to receive higher levels of UV-B irradiation9, but further investigation is needed. Reports from Finland, the former East Germany and Cuba10-12 show that when fluoridation ceased, caries rates in children remained static or declined. This may have been partly due to the use of topical fluoride applications, but the impor- tant point is that fluoridation was clearly shown to be either ineffec- tive or easily replaceable. Although it is widely believed
that fluoridation is particularly beneficial to poorer communities, the York13 and European Commis- sion SCHER14 reports considered that the evidence supporting such a selective benefit was fairly weak. It has been described with some reason as a ‘sticking plaster’ measure to avoid dealing with inequalities in a more fundamental way. Awofeso15 has recently argued cogently that fluoridation cannot be justified ethi- cally on the grounds of its public
value. Cheng et al2 also provide a useful discussion of this issue.
What are the risks? Numerous government agencies in the main fluoridating countries – USA, Australia, New Zealand, Irish Republic – have continued to assert the safety of fluoridation since its original endorsement by the US Public Health Service in 1950. Such assurances rest more on faith than reality since very few studies have, in fact, been done to investigate the range of plausible dangers identified in animal or biochemical studies or the prolific anecdotal evidence that some people are hypersensitive to fluoride. So, health authorities can continue to state that there is ‘no evidence’ of harm. The oft-repeated belief that ‘if there was any danger we’d have noticed it by now’ is not well founded. There are many sources of fluo-
ride exposure, so even if the fluoride imbibed with water alone is not enough on its own to cause harm, its presence may tip the scales. Mans- field16 has calculated that many
ABOUT THE AUTHOR
H S Micklem is an emeritus professor in the School of Biolog- ical Sciences, University of Edinburgh. He holds MA and DPhil degrees from the Univer- sity of Oxford. He is co-author of The Case against Fluoride (Chelsea Green Publishers)
xvi+372pp 2010.
people in the UK are exceeding the total intake of fluoride that is officially recognised as safe, and the proportion is higher in fluori- dated areas.
Dental fluorosis This is the one risk that everyone agrees about – usually (not always) very mild or mild, but readily visible particularly on the maxillary inci- sors, and not always appreciated by the owner. More important than any cosmetic effect are the underlying mechanisms, including disruption of normal mineralisation by the incorporation of fluoride into apatite crystals producing fluorapatite and interference with the function of ameloblasts17 with resulting irregu- larities in the mineral structure. The teeth provide a visible window to the largely hidden effects that these processes may have on the skeleton over a lifetime.
Skeletal fluorosis Throughout life, about 50 per cent of
Continued » Scottish Dental magazine 41
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