The fluoride controversy re-emerges

The debate over fluoridation of our water supplies has been raging for many years. The first pilot schemes in the UK were launched in 1955 and today around 10% of the population has a fluoridated water supply. However, as far as I can tell, there has been limited or no new fluoridation of supplies since the 1980s. New legislation in 2003 gave each Health Authority (HA) the power to ensure a supplier adds fluoride to the water supply but none of the authorities have made use of this. So why did I think it would be useful to discuss this now?

At the beginning of February the Health Secretary, Alan Johnson, stated that he wanted the authorities to start using these powers to enforce fluoridation of the water. The new drive is an attempt to halt tooth decay amongst the poorer sections of the population. Whether this will result in an increase of suppliers adding fluoride remains to be seen. In the meantime, I thought it would make an interesting topic for the blog.

So what is the evidence that fluoridated water supplies help prevent tooth decay?
Unfortunately the time to review all the evidence is not a luxury I have! So I’m just going to point out some of the sources I have found and let each of you do your own research as and when you need to.

A review of the evidence by McDonagh et al (2000) found that “the best available evidence” suggested that fluoridation of water supplies did reduce caries prevalence. But this beneficial effect could range anywhere from a substantial benefit to a slight disbenefit to children’s teeth and also came with an increased prevalence of fluorosis (mottling of teeth). The authors pointed out that they were unable to find any reliable good-quality evidence in the fluoridation literature world-wide. This study is widely recognised as the most recent, major review of the evidence in this country.

At this point, I’d like to suggest that an increase in fluorosis is not necessarily a minor discomfort. The social and psychological effects on children are significant.

I have also found two much more recent reviews (Cheng 2007, Pizzo 2007) that have attempted to re-evaluate water fluoridation’s purported benefits. According to Cheng (2007), if fluoridation was defined as a medical treatment there would be insufficient evidence to justify its continuation (very interesting!!). The authors state “although the prevalence of caries varies between countries, levels everywhere have fallen greatly in the past three decades, and national rates of caries are now universally low. This trend has occurred regardless of the concentration of fluoride in water or the use of fluoridated salt”.

Well that’s enough to make me question the benefits of mass fluoridation. As we all know, good nutrition can play a pivotal role in dental health – perhaps we should invite the Health Secretary to a BCNH lecture! ;-)

And the adverse effects?
Although the McDonagh study (2000) concluded that an association with water fluoride and adverse effects such as cancer, bone fracture and Down’s Syndrome was not found, in a later press release the authors stated “we felt that not enough was known because the quality of the evidence was poor”. Now, forgive me but if I was Health Secretary I’d be very reluctant to add something into our water supplies that hopefully was safe!

For those of you that are interested in reading more I have to recommend this website http://www.fluoridealert.org/. The website discusses a vast array of medical research on fluoride (check out the ‘Health Effects Database’) and the information is a good weapon to have if you’re ever asked to give an opinion on fluoridation. The list of conditions that fluoride has been shown to negatively impact is frightening.

So what can we do?

In order to introduce fluoridation in any area, the Health Authority is required to hold a public consultation. Check local newspapers regularly and contact your authority directly to find out if one is being held in your area. Arm yourself with some scary facts and speak up!

If you are already in a fluoridated area, unfortunately a jug filter (e.g. Brita) does not remove fluoride. Your best option if you are going to drink tap water is to install a reverse osmosis filter. Obviously the repercussions for your clients are going to be enormous. The very people that fluoridation is designed to help (the poorer sections of society) are unlikely to afford reverse osmosis filters

You can check whether your area has fluoridated water supplies here http://news.bbc.co.uk/1/hi/health/7228586.stm

It would be interesting to hear if anyone else has any ideas or feedback. Breda has asked me to write an entry for the blog once a month so please get in touch if there are any topics you feel would be of interest.

Bev Shergold
Level 1 & 2 Tutor


References:
Cheng KK Chalmers I Sheldon TA (2007) Adding fluoride to water supplies British Medical Journal Oct 6;335(7622);699-702

McDonagh MS Whiting PF Wilson PM Sutton AJ Chestnutt I Cooper J Misso K Bradley M Treasure E Kleijnen J (2000) Systematic review of water fluoridation British Medical Journal Oct 7;321(7265):855-9

Pizzo G Piscopo MR Pizzo I Giuliana G (2007) Community water fluoridation and caries prevention: a critical review Clinical Oral Investigations Sep;11(3):189-93