To fluoridate or not to fluoridate

Fluorosis can affect anyone and reveals itself in the teeth as dental fluorosis (mottled teeth) and in the bones as skeleletal fluorosis. As this is where 90 per cent of fluoride concentrates during infancy, it is ideal to prevent this symptom developing in young children, our canaries, by finding a means to reduce their levels of fluoride intake. For this reason the ADA, which in 1962 described fluoride as harmless as mother’s milk, now advises parents to supervise intake until six years of age by the use of low fluoride toothpastes and to prevent swallowing it and to avoid toothpaste with infants under the age of 18 months.

After these warnings, the ADA advises parents to “encourage your child to drink fluoridated water as much as possible”. Advice to adults is also clearer. As the quantity of fluoridated adult toothpaste covering the head of the brush may contain the equivalent of a 1mg fluoride tablet or four glasses of 1ppm water, toothpaste tubes are now labeled with a warning to not swallow. For similar reasons mouth rinse which may contain 230ppm and the gel used at the dental surgery which may contain 10,000ppm is clearly labeled. Health professionals are obviously concerned.

Symptoms of fluorosis will vary depending on the degree of exposure to fluorides. Dean’s fluorosis index from 0 to 5 is easy for the lay person to follow.

Level 1 is “questionable” fluorosis where mottling is a few white specks to an occasional white spot on a tooth; level 2 “very mild” is where the tip is snow capped and less than 25 per cent of the tooth is affected; level 3 “mild” is where white striations cover up to 50 per cent of the tooth; level 4 “moderate” is where most teeth have brown to yellow stains on the surface and minute pitting; while level 5 is “severe” where teeth are smoky white, stained brown to black and pitted.

The WHO says the adverse affects of fluorosis ranges from mild dental fluorosis to crippling skeletal fluorosis as the level and period of exposure increases. The ADA says severe fluorosis is remedied with crowns or dentures.

QH says “The only known side effect of optimal water fluoridation is a slight increase in dental fluorosis levels” and says nothing about the affect of more than optimal levels. Mallinckrodt Chemicals (USA) states on its factsheet about handling the sodium fluoride and monofluoride it produces: these man-made chemicals are toxins which cause symptoms including fluorosis/mottled teeth and bone damage in people over exposed to these fluorides.

QH proclaims it is a myth to believe “Water fluoridation is banned in Europe”. True, it is not banned but the statement is a convenient omission of a simple truth: Europe does not endorse the fluoridated water agenda.

Europe gives many reasons for its position: personal choice and responsibility; angst about legislated fluoridation; concern that studies do not prove man-made fluorides are “safe”; and the influence of evidence in recent studies. For example Basel in Switzerland de-fluoridated its water in 2003 after 41 years. Norway again said “No” in 2000. The Pasteur Institute influenced the government so that no artificial fluorides are added to water in France. The same occurs in Sweden after advice from the Nobel Medical Institute.

Perhaps Europe simply believes the WHO when it says there is insufficient benefit to warrant mandatory fluoridation in a developed country which has ready access to clean water, good diet and appropriate oral hygiene practice. Perhaps other strategies to target the economically deprived are indeed our appropriate option.

Meanwhile of the countries that rushed to fluoridate after the successful US-led marketing of the product, Canada and Ireland Health now recommend reducing fluoridated water levels to 0.7ppm along with the measures advised by the ADA, in an attempt to control fluorosis levels to a publicly acceptable level. Hong Kong which never had fluorosis prior to fluoridated water is reducing its levels. Towns in the USA have also reduced optimal levels as studies by the Centre for Disease control (CDC) released study results showing (1999-2002) 40 per cent aged six to eleven have fluorosis, (1999-2004) 41 per cent aged 12 to 15 have fluorosis.

In 1990 a study of 12-year-olds in Perth, Western Australia reveals 40 per cent are affected with fluorosis. One concern of this study was “a need for studies to measure community acceptance of mild dental fluorosis” and to lower exposure and fluorosis levels through education about the danger posed by toothpastes. A study of 10-year-olds in 2000 reveals that this education has been a success as fluorosis levels reduced to 22 per cent.

Queensland with all the benefits of the wisdom of hindsight is to fluoridate South East Queensland at 0.8ppm, not the lower 0.5ppm level the Brisbane City Council taskforce report said that the WHO recommended for a sub- tropical city. For QH, as the governments marketing machine, it is not a case of to fluoridate or not to fluoridate; it is a case of retaining the hearts of the masses with clever propaganda like its “common fluoride myths” when the real issue at stake is just what level is a “safe” level for our children and our children’s children.