Debate
“It is delivered in an incompetent manner, since the so-called optimal concentration is a statistical compromise”
REFERENCES
1. Jones C 2010. Scottish Dental magazine. http://
www.scottishdentalmag.
co.uk/Articles/Glass half empty?
2. Cheng K K 2007. Adding fluoride to water supplies. BMJ 335,699-702
Continued »
tial nutrient, or even to selenium, which despite being highly toxic is still essential in trace quantities; fluoride is not required for any physiological process at all. It is not a nutrient, but a medicine, delivered without individual consent. Moreover, it is delivered in a most
incompetent manner, since the so-called optimal concentration is a statistical compromise and tells us little about the dosage to an individual consumer – an essential consideration for any prescribed medicine. Young children are particu- larly likely to receive an excessively high dosage (14,19). Fluoride’s medicinal status is confirmed
legally by Lord Jauncey’s opinion: “Section 130 [of the Medicines Act 1968] defines ‘medicinal product’ and I am satisfied that fluoride in whatever form it is ultimately purchased by the respondents falls within the definition.” 24 Shaw25 argues that fluoridation in
the UK subsists on the assumption that fluoride is not a medicine and that the assumption is a ‘legal fiction’.
Conclusion The precautionary principle calls for risks not to be taken unless more than balanced by countervailing benefits. If there is one situation where the principle should be invoked, it is surely the involuntary mass-medication of a population with largely uncontrolled dosages via the public water supply. The risks of water fluoridation are
substantial and varied, if still mostly unproven, and the benefits today are marginal. People should not be medicated without consent. Ineffectiveness, safety concerns and ethics all point in the same direction: we are better off without it.
3. Centers for Disease Control and Prevention 2001. Recommenda- tions for using fluoride to prevent and control dental caries in the United States. Morbidity and Mortality Weekly Reports 50, RR-14, 3
http://stacks.cdc.gov/ view/cdc/7086/
4. Lambrou D et al 1981. The effect of fluoride in saliva on remineraliza- tion of dental enamel in humans. Caries Res. 15(5):341-5.
5.Brunelle JA, CarlosJP 1990. Recent trends in dental caries in U.S. children and the effect of water fluoridation. Journal of Dental Research 69, Special Issue, 723-727
6. Komarek A 2005. A Bayesian analysis of multi- variate doubly-interval- censored dental data, Biostatistics 6(1). 145-155
7. Spencer AJ et al 1996. Community fluoridation in Australia. Community Dental Health 13, Suppl 2, 27-37.
8. Kirkeskov L et al 2010. The association between fluoride in drinking water and dental caries in Danish children. Linking data from health registers, envi- ronmental registers and administrative registers. Community Dent Oral Epidemiol 38, 206-2012.
9.
http://www.eurosun-
project.org/UV-Maps/ Maps.html
10. Seppä L et al 2000. Caries in the primary
dentition, after discontinu- ation of water fluoridation, among children receiving comprehensive dental care. Community Dent Oral Epidemiol. 28, 281-8.
11. Kunzel W et al 2000. Decline of caries preva- lence after the cessation of water fluoridation in the former East Germany. Community Dent Oral Epidemiol 28, 382–9.
12. Kunzel W, Fischer T 2000. Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Res 34, 20-25.
13. McDonagh M et al. 2000. A systematic review of public water fluoridation, NHS Centre for Reviews and Dissemi- nation. http://www.york.
ac.uk/inst/crd/CRD_ Reports/crdreport18.pdf
14. Scientific Committee on Health and Environ- mental Risks (SCHER)
2011.Critical Review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water. http://
ec.europa.eu/health/ scientific_committees/ environmental_risks/ docs/scher_o_139.pdf
15. Awofeso N 2012. Ethics of artificial water fluorida- tion in Australia. Public Health Ethics 5(2) 161-172.
16. Mansfield P 2010. Fluoride consumption: the effect of water fluorida- tion. Fluoride 43(4), 223-31
17. Bronckers ALJJ et al 2009. The impact of fluoride on ameloblasts and the mechanisms of enamel fluorosis. J Dent Res. 88(10), 877–893.
18.National Academy of Sciences 2006. Fluoride in
drinking water: a scientific review of EPA’s standards.
http://www.nap.edu/ catalog/
11571.html
19. Environmental Protec- tion Agency 2010. Fluoride: dose response analysis for non-cancer effects. Report 820-R-10-19.
http://water.epa.gov/ action/advisories/ drinking/fluoride_index. cfm
20. Bassin EB et al 2006, Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes Control 17, 421–428.
21. Hirzy WJ et al 2013. Comparison of hydrofluo- rosilicic acid and pharma- ceutical sodium fluoride as fluoridating agents – a cost-benefit analysis.. Environmental Science & Policy 29, 81-86.
22. Madhusudhan N et al 2009. Fluoride-induced neuronal oxidative stress and its amelioration by antioxidants in devel- oping rats. Fluoride 42(3) 179-187.
23. Choi AL, Sun G, Zhang Y, Grandjean P 2012. Devel- opmental fluoride toxicity: a systematic eview and meta-analysis. Environ- mental Health Perspec- tives 120(10) 1362-1368.
http://www.ncbi.nlm.nih. gov/pmc/?term=10.1289/ ehp.1104912
24. Scottish Court of Session Decisions. McColl vs Strathclyde Regional Council http://www.
bailii.org/scot/cases/ ScotCS/1983/1983_
SC_225.html
25. Shaw D. 2012 Weeping and wailing and gnashing of teeth: the legal fiction of water fluoridation. Medical Law International 12(1), 11-27.
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