Water Fluoridation

In common with every other recognised national dental association across the world, the Irish Dental Association strongly supports the policy of fluoridation in Ireland as an essential element of oral health policy. The benefits of fluoridation as regards the oral health of the population, and most particularly those in deprived circumstances, are extremely well documented.

A useful summary of the history of water fluoridation in Ireland is contained in the attached address to the Seanad last Wednesday, October 1st 2014 by the Minister of State at the Department of Health, Ms Kathleen Lynch (her speech also addresses perceived risks as well as the established benefits of water fluoridation). The Seanad motion which enjoyed the support of the anti-fluoridation campaign was not carried and in fact the sponsors of the motion sought that it would not be put to a vote given the paltry support evident during the Seanad debate.

Recently, dental leaders, representing over one million dentists in 134 countries, reaffirmed their strong support for fluoridation as essential in promoting oral health.  The assembly of the annual meeting of the FDI, world dental federation, reaffirmed its strong support for fluoridation at its latest meeting which concluded in New Delhi, India in the last few weeks. The full FDI statement is attached.

The FDI statement recognises that more than 370 million people in over 27 countries receive the benefits of water fluoridation.

In recognition of the importance of promoting oral health through water fluoridation, the FDI World Dental Federation states that:

  • Over seventy years of research and recent systematic reviews have shown that water fluoridation is an effective public health measure for the prevention of dental decay in children and adults.
  • Water fluoridation is particularly appropriate for populations demonstrating moderate to high risk of dental decay.
  • Water fluoridation confers positive health savings and contributes to reducing disparities in the rates of dental decay in communities.
  • At the fluoride concentrations recommended for the prevention of dental decay, scientific research and reviews show that human general health is not adversely affected.

The policy of fluoridation is supported by all dental schools in Ireland, all the representative and training bodies for dentists, nurses and hygienists and indeed all of the officially recognised representative, training and education bodies for dentistry in Ireland.

A new statement in the name of the deans of Ireland’s three dental schools and the Irish Dental Association was published recently in the Irish Times.

Apart from all its obvious oral health benefits, the US health authorities have published an estimate that every $1 spent on fluoridation saves $38 dollars in costs. http://www.cdc.gov/fluoridation/factsheets/cost.htm.

The two latest major reviews commissioned by the public health authorities can be viewed here for the UKand New Zealand, both of which conclusively endorse fluoridation as a safe and effective policy, essential to better oral health, and which also dismiss many of the alarmist claims made by opponents of fluoridation who suggest links with medical conditions or diseases without any credible basis.

In fact, there have been fifteen major peer-reviews of fluoridation undertaken across the world by recognised academic authorities in the past twenty years. None of these major reviews has concluded that community water fluoridation poses a known risk to general health or has suggested halting water fluoridation. These, and other reviews which dealt solely with oral health, show a significant benefit to dental health and through this to general health. In fact, there is evidence to show that the biggest beneficiaries from fluoridation in terms of their oral health are those categorised as socio-economically deprived.

To address some claims being made by opponents of fluoridation, we refer you to the most recent (March 2014) report from Public Health England (PHE), the organisation whose mission is to “protect and improve the nation’s health and to address inequalities.”

Regarding the dental health benefits of fluoridation, the PHE report finds that:

  • 28% fewer five year olds have tooth decay in fluoridated areas than in non-fluoridated areas (when deprivation and ethnicity are factored in)
  • 21% fewer twelve year olds have tooth decay in fluoridated areas than in non-fluoridated areas (when deprivation and ethnicity are factored in)
  • In fluoridated areas, there are 48% fewer hospital admissions of children aged one to four for dental caries (mostly for extraction of decayed teeth under a general anaesthetic).

The PHE Report also found no evidence of a difference in the rate of hip fractures, in the rate of Down’s Syndrome or all types of cancer between fluoridated and non-fluoridated areas while the rates of kidney stones and bladder cancer were lower in fluoridated areas than in non-fluoridated areas.

Regrettably, an amount of scaremongering has been engaged in by opponents of fluoridation claiming an association between fluoridation and adverse medical outcomes, none of which have been supported by credible, peer-reviewed research. It is alarming that so many outlandish claims are still being propagated by anti-fluoridation campaigners in spite of the fact that all of these scares have been debunked by the independent Expert Body in its assessment of the report prepared by Mr Declan Waugh (see copy attached) and also in many other expert reviews, most recently in New Zealand where, in August 2014, the Royal Society of New Zealand review again addressed the most common scares cited by anti-fluoridation campaigners.

In recent times, public representatives have been circulated by anti-fluoridation campaigners with scare-mongering claims which have been dismissed repeatedly by independent expert panels. You should be aware that the Supreme Court here in Ireland, and most recently again in recent times the High Court in New Zealand, have consistently found that fluoride is not a medicine and fluoridation is not ‘mass medication’ as is alleged in a deliberately emotive piece of propaganda by some campaigners. You should also be very wary of false claims regarding claims that fluoride amounts to poison and claims of adverse health outcomes based on fluoridation levels which are multiples of the levels obtaining here in Ireland.

Furthermore water fluoridation breaches no legally binding human rights or EU directives. This is addressed in the Expert Body’s review of the Waugh Report, which details commentary from the EU in reply to petitions to anti-fluoride campaigners . The EB report states:

“It is helpful that the EU Commission has addressed such concerns in its replies to the petitions made by Irish and British anti-fluoridation campaigners (EU Petitions 0210/2007 and 0211/2007). The EU Commission clearly does not have any difficulty in law with the practice of water fluoridation. The Commission stated in 2007: “Taking into account that there is no evidence of an infringement of EU law in this case, the Commission can take no legal action”.

Also, claims you may receive from the group “Fluoride Free Towns” are just a rehash of anti-fluoridation arguments that have no credible legal or scientific basis whatsoever. Furthermore, to be awarded the accolade of being a “Fluoride Free Town”, all you need is six businesses that agree to install reverse osmosis water filters. These towns are, of course, still fluoridated.

The same campaigners have misrepresented the NRC report and in regard to the claims made in relation to the York Review, I must advise you that the York Review was itself reviewed three years later by the Medical Research Council (UK) who felt that it did give fluoridation a clean pass on health and effectiveness. The persons on the NRC report who spoke out had been appointed to that panel as well known anti-fluoridation campaigners.

You are also advised to beware anti-fluoridationists’ claims and inferences related to comments made by the Chairman of the National Research Council’s (NRC) comprehensive fluoride review, Dr John Doull. In fact, Dr Doull has confirmed in writing that “I do not believe there is any valid scientific reason for fearing adverse health conditions from the consumption of water fluoridated at the optimal level.”

Alarmist Claims

Dr Strangelove : “General Jack D. Ripper: Fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face.”

As mentioned, I attach for your information two major reviews commissioned by the public health authorities in the UK and New Zealand both of which conclusively endorse fluoridation as a safe and effective policy, essential to better oral health, and which also dismiss many of the alarmist claims made by opponents of fluoridation who suggest links with medical conditions or diseases without any credible basis.

Finally, I believe you need to consider an important warning in an academic study wherein the author, an Australian health academic, Mr Jason Armfield, warns as  follows:

“Water fluoridation is an important public health initiative that has been found to be safe and effective. Nonetheless, the implementation of water fluoridation is still regularly interrupted by a relatively small group of individuals who use misinformation and rhetoric to induce doubts in the minds of the public and government officials. It is important that public health officials are aware of these tactics so that they can better counter their negative effect.

Water fluoridation opponents employ multiple techniques to try and undermine the scientifically established effectiveness of water fluoridation. The materials they use are often based on Internet resources or published books that present a highly misleading picture of water fluoridation. These materials are used to sway public and political opinion to the detriment of public health. Despite an extensive body of literature, both studies and results within studies are often selectively reported, giving a biased portrayal of water fluoridation effectiveness. Positive findings are downplayed or trivialised and the population implications of these findings misinterpreted.

Ecological comparisons are sometimes used to support spurious conclusions. Opponents of water fluoridation frequently repeat that water fluoridation is associated with adverse health effects and studies are selectively picked from the extensive literature to convey only claimed adverse findings related to water fluoridation. Techniques such as “the big lie” and innuendo are used to associate water fluoridation with health and environmental disasters, without factual support. Half-truths are presented, fallacious statements reiterated, and attempts are made to bamboozle the public with a large list of claims and quotes often with little scientific basis. Ultimately, attempts are made to discredit and slander scientists and various health organisations that support water fluoridation.”

Fluoridation has been described as one of the greatest public health success stories of the century and we would ask that you would continue to supports its operation in Dublin and in Ireland and to continue to engage in evidence-based decision making in regard to this and all other health related matters.

We would ask: do you feel, as a public representative, that you can deny children a proven safe and effective means for reducing chronic dental disease levels and reducing the number of children attending hospitals for reasons of dental infection?

We would be happy to assist with any further queries arising.


www.swords-dental.ie Tel 8401001