Water Fluoridation in Ireland
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Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries
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- There has been more research into water fluoridation than virtually any other public health issue. It has been studied for over 60 years and it’s safety has been regularly endorsed by the leading medical and scientific authorities, such as the World Health Organisation (W.H.O.). There is no reliable scientific evidence to link fluoridation to any harmful medical effects. Every major scientific body that has examined the issue has given water fluoridation the thumbs-up on health grounds. Sir Richard Doll, the scientist who established the incontrovertible link between smoking and lung cancer, is on record as saying “in so far as I can say anything is safe, I say fluoridation is safe”. In contrast, the “evidence” being quoted by antifluoridation groups originates from material published on internet web sites. Many of these are anonymous, many are sites of antifluoride groups in the USA, and NONE of them are sites belonging to reputable scientific groups.
- One man’s drink is another man’s poison. Hydro fluo silicic acid is a by-product of the fertiliser industry, derived from the same mineral source as phosphate. This is not the same as labelling it toxic waste. And the statement that fluoride is more poisonous than lead is meaningless – many nutrients, medications, and even foodstuffs are toxins if the correct dose is exceeded, including vitamins A and D, paracetomol and table salt. Acute fluoride toxicity occurring from the ingestion of optimally fluoridated water is impossible. The amount of fluoride necessary to cause death for a human adult (155 pound man) has been estimated to be 5-10 grams of sodium fluoride, ingested at one time. At 1ppm, equivalent to 1mg/litre, this would require the consumption of 5000-10000 litre of water at one sitting.
- The Irish Government has set an upper fluoride target of 1 part per million in Irish water supplies; in 1988 the EU set a limit of 1.5 parts per million for all EU water fluoridation schemes. The US Environmental Protection Agency (EPA) has set acceptable limits in the United States which are four times higher than those in Ireland. Some readings from Irish sites occasionally stray fractionally above 1 part per million, but mostly the County Councils tend to err on the low side. It should be noted that the EU, while critical of aspects of some Irish water supplies, are perfectly satisfied with the operation of Irish fluoridation schemes.
- 360 million people in over 60 countries benefit from fluoride in the public water supply. Ireland is not the only democracy in the world with public water fluoridation. Approximately 70% of the United States and Australia are fluoridated in this way. The most recent democracy to move to water fluoridation is South Africa. Countries with better dental profiles might not use water fluoridation but they certainly use fluoride. Virtually all of the EU is fluoridated in one way or another. According to the EU Commission, 95% of all toothpaste sales in the EU are of fluoridated toothpastes. Salt fluoridation is far more common in Europe than water fluoridation. But fluoride is fluoride, is it not? If Holland, Sweden, France and other countries have shied away from water fluoridation on health grounds it seems difficult to explain why they are happy to use school fluoride rinsing programmes in Holland, fluoridated milk in Sweden, and fluoridated salt in Germany, France, Belgium and Switzerland. Why are fluoridated toothpastes and rinses not banned in these countries? The reason of course is simple. These countries decided against fluoridation for political or practical reasons, not because of any alleged health effects.
- Political actions contrary to the recommendations of health authorities should not be interpreted as a negative response to fluoridation. While fluoridation is not carried out in Sweden and the Netherlands, both countries support WHO’s recommendations regarding fluoridation as a preventive health measure, in addition to the use of fluoride toothpastes, mouthrinses and dietary fluoride supplements. As an alternative to water fluoridation, many European countries have opted for salt fluoridation, in addition to the use of fluoride toothpaste for topical benefits, as a means of bringing the protective benefits of fluoride to the public. Fluoridated salt is available in Switzerland, France, Germany and Spain, and in a further 30 countries world wide. In the Swiss canton of Vaud, bulk commercial salt, and almost all domestic salt, is fluoridated at 250 mg/kg. 75% of the domestic salt sold in Switzerland in 1987-91 was fluoridated. (Basel has water fluoridation.)
- Fluorosis at the level of mottling is extremely rare in Ireland and is associated with sudden large intakes of fluoride (such as from taking fluoride supplements or from swallowing toothpaste as a young child) rather than from water fluoridation. 94% of all dental fluorosis is the very mild to mild form, is not readily apparent to the affected individual or casual observer and often requires a trained specialist to detect.In a 1998 survey in Sligo, there was a higher level of moderate fluorosis among 15-year olds in the non-fluoridated region than in the fluoridated area. There was no severe fluorosis in either region.
- Ireland has the lowest rate of dental decay in 5 year olds in the EU. We have currently one of the lowest rates of decay in 12 and 15 year-olds, though not the lowest. According to all of the non-fluoride criteria quoted by the W.H.O. as relevant determinants of dental decay levels (sugar consumption per capita, National Income per capita and dental manpower availability), Ireland should have one of the worst dental decay profiles in Europe. We have the highest confectionery consumption per capita, the second greatest regional dental manpower inequality and, up to recently, one of the lowest income scores in the EU. Yet we perform extremely well in terms of low decay scores. Why? Because of water fluoridation.
- Sometimes it can be difficult for members of the public to judge the quality of “scientific” information available to them. A very strong hint as to the value of such information can be gained by examining its source. If the source is a widely respected body with strong scientific credentials, such as the World Health Organisation, it carries great weight. If the source is an Internet website, it is best treated with extreme suspicion until its provenance can be determined. Information from lobby groups is naturally biasedtowards their point of view, and often concentrates on maverick studies and academics whose point of view runs counter to that of the scientific community.
- Water fluoridation is ultimately a political decision. In Ireland, had the decision to fluoridate local water supplies been left to local authorities, all the members of such an authority would have had to evaluate the mass of scientific literature on the subject before coming to a decision. They were saved this onerous duty because of a legal challenge to the introduction of fluoridation in Ireland. Not only was the constitutionality of the Act tested in the courts, but the scientific basis for fluoridation was argued by both scientists and lawyers, before its introduction.
- Fluoridation has brought great benefits to the Irish people. If there is a fault on the part of the dental profession it has been in taking fluoridation for granted rather than in publicising its merits. It is safe; it is effective. It is not in anyone’s interests to do away with this excellent public health measure as it is the single most effective way of promoting better dental health in this country.
See our oral health promotion section