By

• JOHN CARNIE, Chief Health Officer, Department of Human Services

• MARK KENNEDY, GP Association of Geelong

• MICHAEL SMITH, Director of Dentistry, Barwon Health

DISCUSSION and debate about issues like water fluoridation is important but it is also important that information presented to the community is factual and supported by scientific and medical evidence. In a letter to the editor in the Geelong Advertiser on January 17, statements were made which are misleading in relation to water fluoridation in general and its specific effects on young children.

Water fluoridation is safe and effective as clearly stated by the World Health Organisation and Australia’s National Health and Medical Research Council along with other recognised and respected international and Australian health, research and educational organisations.

The letter also linked water fluoridation with diabetes, kidney disease and degenerative effects. It is important to note water fluoridation has been endorsed by a number of respected health organisations including Kidney Health Australia, the Australian Medical Association, the Public Health Association, Osteoporosis Australia, Arthritis Australia and the Cancer Council of Victoria. No convincing scientific evidence exists that fluoride, when supplied at the optimum level of one part per million, causes any harmful effects to people of any age, apart from dental fluorosis.

It is important to note, however, that when dental fluorosis does occur, it is almost always of very mild or mild forms. Furthermore, since the mid-1990s, the prevalence of dental fluorosis in Australia has markedly reduced, mainly attributable to the use of low-fluoride toothpastes in young children, and awareness raising of correct toothpaste use by children. Fluoride works by being incorporated into developing tooth structure and also by constantly bathing the teeth and repairing dental decay before a large cavity develops. Both of these mechanisms result from the ingestion of fluoride and redistribution into developing tooth structure and saliva, with the latter providing a long-lasting topical benefit.

Misleading statements were also made about the 2006 US National Research Council report. The report was commissioned by the US Environmental Protection Agency to examine the adequacy of the current US guidelines to protect public health from the effects of naturally-occurring fluoride levels greater than two parts per million, as in some parts of the US, naturally-occurring fluoride levels may be up to four parts per million. The study did not investigate risks associated with the adjustment of fluoride levels in drinking water at one part per million, the level recommended by the World Health Organisation and practised in Australia for more than 50 years, for dental health benefits.

Particularly disturbing was the inaccurate claim regarding the American Dental Association’s 2006 statement in relation to fluoridated water and infants. In November 2006, the American Dental Association issued interim advice recommending that if infant formula was the predominant food source for infants, it should be reconstituted with non-fluoridated water as some water supplies in the United States have naturally high levels of fluoride in the water from two to four times higher than recommended by the World Health Organisation and practised across Australia.

This is an important distinction to make. In 2006, the Australian Research Centre for Population Oral Health published The use of fluorides in Australia: guidelines , developed by 35 experts from universities, health departments and health organisations. Guideline 6 states: “Infant formula nowadays is safe for consumption by infants when reconstituted using fluoridated or non-fluoridated water.”

Water fluoridation helps protect teeth against decay in people of all ages, from very young children to the elderly. In relation to the letter’s reference to a document signed by 600 individuals prepared by the Fluoride Action Network, it is important to note that document presented no new evidence on water fluoridation, with the most recent reports/studies cited dating back to mid-2006.

It ignored recent developments internationally and in Australia showing evidence of the efficacy of fluoride and reaffirming support, including two studies by the Australian Institute of Health and Welfare (AIHW): Australia’s Dental Generations and Child Dental Health Study , and the 2007 National Health and Medical Research Council systematic review.

Melbourne has had fluoridated drinking water for more than 30 years and the AIHW’s recent survey on adult oral health showed members of the fluoride generation (those born after 1970) had about half the level of decay that their parents’ generation had developed at about the same age. The community of Geelong deserves the opportunity to have its own fluoride generation in years to come.

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