Public health
vs Glasgow, where average dental cavi- ties are almost twice as high in Glasgow. leaving one to conclude that it was a lack of fluoride in the water of Glaswegians that was to blame. However, this is Monty Python logic.
If we were to compare Dublin with Edinburgh or London where they don’t fluoridate water either, it’s clear that dental health is the same as Dublin, as are dozens of more cities who do not fluoridate water. Here in Ireland it is true that communities who don’t use fluoride, such as rural group water schemes, have slightly worse levels of dental decay than non fluoridated urban areas. This tends to be the ultimate nail in the coffin for the pro fluoridation lobby. However, this again is madness to
compare urban populations with rural areas and assume the same level of dental hygiene habits and diets comparing groups of different socioeconomic backgrounds. Comparing Dublin to Copenhagen with the same methodology would lead one to conclude that fluoridated water is bad for DMFT’s. Nobody here is arguing that. This debate about how big a role
water fluoridation has on dental health is an important one, but many countries have concluded that the reasons for not fluoridating water far outweigh any small potential benefits. These are some of the reasons to not fluoridate public water:
1) Fluoridation is unethical Informed consent is standard practice for all medication. Fluoride is the only chemical added to water for the purpose of medical treatment. Also, fluoride is not an essential nutrient. No disease, not even tooth decay, is caused by a “fluo- ride deficiency”(NRC ı993; Institute of Medicine ı997, NRC 2006). Not a single biological process has been shown to require fluoride.
2) The dose cannot be controlled Once fluoride is put in the water it is impos- sible to control the dose, because people
drink hugely different amounts of water. For example, manual labourers, athletes, diabetics, and people with kidney disease drink substantially more water than others. People now receive fluoride from many other sources besides water.
3) The highest doses of fluoride are going to bottle-fed babies Because of their sole reliance on liquids for their food intake, infants consuming formula made with fluoridated water have the highest exposure to fluoride, by body- weight, in the population. The level of fluoride in mothers’ milk is
very low (0.004 ppm, NRC, 2006) even in fluoridated communities. This means that a bottle-fed baby consuming fluoridated water (0.6 – ı.2 ppm) can get up to 300 times more fluoride than a breast-fed baby (an age where susceptibility to environ- mental toxins is particularly high and the blood brain barrier is not fully developed). No sufficient safety trials have been
carried out to prove that fluoridated water at any level does not have adverse effects on children. In fact, most of the major studies have warned that babies should not be drinking fluoridated water.
4) Fluoride accumulates in the body Healthy adult kidneys excrete 50 to 60 per cent of the fluoride ingested each day (Marier & Rose ı97ı). The remainder accumulates in the body, largely in calcifying tissues such as the bones and pineal gland (Luke ı997, 200ı). Infants and children excrete less fluoride from their kidneys and take up to 80% of ingested fluoride into their bones (Ekstrand ı994). The fluoride concentration in bone
steadily increases over a lifetime (NRC 2006). The health effect on bone and relationship to osteoporosis etc is conten- tious, but more research is certainly needed.
5) No health agency in fluoridated countries is monitoring fluoride exposure or side effects No regular measurements are being made of the levels of fluoride in urine, blood, bones, hair, or nails of either the general population or sensitive subparts of the population (e.g. individuals with kidney disease or bottle-fed children).
6) There has never been a single randomised controlled trial to demonstrate fluoridation’s effectiveness or safety (Cheng 2007) Randomised, placebo-controlled trials are the standard method for determining the safety and effectiveness of any purportedly beneficial medical treatment. The British Government’s York Review (2000) could not give a single fluoridation trial a Grade A classification – despite 50 years of research (McDonagh 2000).
7) Dental fluorosis may be an indicator of wider systemic damage There have been many suggestions as to the possible biochemical mechanism underlying the development of dental fluorosis (Matsuo ı998; Den Besten ı999;
Continued »
Ireland’s Dental magazine 21
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