Public health
Splashing back A
Documentary producer Marcus Stewart gives his response to Gerry Byrne’s recent article on water fluoridation
fter reading a pro-fluorida- tion article by Gerry Byrne in the May/June issue of Ireland’s Dental magazine, which completely missed
the fundamental points of why this issue is so contentious, I felt it was time for an open debate on the subject while sticking to the science. Painting all the anti fluoridation activists
as “on the fringes of the alternative lifestyle movement where homeopathic remedies are favoured over trips to the doctors” as Mr Byrne did, is not accurate. Of course, this movement does attracts people with a spectrum of viewpoints. But anti water fluoridation groups globally include many credible health scientists, epidemiologists, dentists and toxicologists, including Dr Arvid Carlsson, medical physiologist and Nobel Laureate. It’s worth noting from the outset that,
whereas there was almost unanimity in the dental and public health community when water fluoridation was introduced as to its effectiveness, there are now clear differences of opinion among specialists on the subject in the science community. But, there is some common ground
and it’s worth reflecting on these points of agreement. When fluoride was first introduced it was thought generally to act systemically, i.e. it had to be ingested. We now know it acts topically, i.e. in the mouth and on the surface of the tooth. We also know that there are increased sources of other fluoride now, compared to fifty years ago. All sides admit – and the evidence points to – a huge increase in the incidence of fluorosis, a cosmetic condition which indicates an excess of fluoride. Both sides take the view that fluoride in toothpaste
has reduced the rate of dental caries. They also agree that children who use fluoride toothpaste require supervision and proper instruction. In Europe, only Ireland (73 per cent),
Spain (ıı per cent), and the UK (ıı per cent) fluoridate any of their water. Most developed countries, including Japan and the other 97 per cent of the western European population, do not consume fluoridated water. Some countries have areas with high natural fluoride levels in the water. These include India, China and parts of Africa. In these countries measures are being taken to remove the fluoride because of the health problems that fluoride is known to cause. When countries like Norway, Sweden, Denmark, Holland, Belgium and Switzer- land, who have the best public health and environmental standards in the world, choose a direction on an issue like this, we in Ireland would be arrogant or stupid not to take note. Two important points need to be made clear here:
Fluoridation’s role in the historical de- cline of tooth decay is in serious doubt The largest survey ever conducted in the US (over 39,000 children from 84 communities) by the National Institute of Dental Research showed little difference in tooth decay among children in fluori- dated and non-fluoridated communities (Hileman ı989). According to NIDR researchers, the
study found an average difference of only 0.6 DMFS (Decayed, Missing, and Filled Surfaces) in the permanent teeth of chil- dren aged five to ı7 residing their entire lives in either fluoridated or unfluoridated
areas (Brunelle & Carlos, ı990). This difference is less than one tooth surface, and less than ı per cent of the ı00-plus tooth surfaces available in a child’s mouth. Large surveys from three Australian
states have found even less of a benefit, with decay reductions ranging from 0 to 0.3 of one permanent tooth surface (Spencer ı996; Armfield & Spencer 2004). A multi-million dollar, US National Institutes of Health (NIH)-funded study found no significant relationship between tooth decay and fluoride intake among children (Warren 2009). This is the first time tooth decay has been investigated as a function of individual exposure (as opposed to mere residence in a fluoridated community).
Tooth decay does not go up in popula- tions when fluoridation is stopped Where fluoridation has been discontinued in communities from Canada, the former East Germany, Cuba and Finland, dental decay has not increased, but has generally continued to decrease (Maupomé 200ı; Kunzel & Fischer, ı997, 2000; Kunzel 2000; Seppa 2000). Proponents of water fluoridation often point to comparative examples like Dublin
20 Ireland’s Dental magazine
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