To most people, fluoride is a wholly beneficial chemical with no downside whatsoever. Its remarkably favourable public image is based on our trust of the dental profession which has been telling us since the 1950s that fluoride is good for our teeth and advising us to brush them with fluoride toothpaste and swallow fluoride tablets. Fluoride is the dental magic bullet for deprived urban children whose teeth are rotten at an absurdly early age. Fluoridate their drinking water and hey presto, Blackhill kids get Bearsden teeth, even if they don?t possess a toothbrush and live on sugary fizzy drinks. But a growing body of international scientific and environmental opinion sees fluoride as nothing more than a poisonous pollutant, profitably and misleadingly rebadged as the scourge of dental caries. Discomfitingly for the fluoride lobby, evidence to support these claims is building up as studies link it with adverse health effects including tooth discolouration, lowered IQ, increased perinatal mortality and birth defects, bone cancer, osteoporosis and hip fractures.
Even leading dental authorities are having second thoughts. Aubrey Sheiham, professor of community dental health at University College London, says: “I have gone cool on water fluoridation. Fluoride does have a definite negative effect on teeth. Also the dental profession’s concentration on fluoride has let sugar off the hook.” Could it be that fluoride is one of the greatest chemical blunders of the last century?
Fluoride entered the public health frame in the 1930s when an American doctor noted that the teeth of children in areas with a high natural calcium fluoride level in water were stained and discoloured, a condition named fluorosis. It was no surprise that fluoride damaged teeth. In 1936, the American Dental Journal condemned fluoride as “a general protoplasmic poison the most important symptoms of chronic poisoning known at present are mottling of the teeth and interference with bone formation”. Until then, it had been commonly used as a rat poison. Fluoride is still classified as an “extremely toxic” substance, rated between 4 and 5 on a toxicity scale of 1-6, more poisonous than lead and almost as poisonous as arsenic. Not the sort of thing you want to ingest. Fluoride is not a nutrient, you do not need it in your diet. But doctors and dentists were persuaded that the children with fluorosis had fewer dental caries, and therefore, that fluoride prevented decay. Mottled teeth were just a small cosmetic price to pay for this dental breakthrough. And to this day fluoridation is still pursued with missionary fervour. “We’re talking massive improvements to tooth health and less avoidable pain and misery all by implementing a safe and effective public health measure,” says Sheila Jones, spokeswoman for the British Fluoridation Society, a government-funded body which promotes fluoridation.
This government has targeted four areas of poor tooth health it wants to see fluoridated – Northwest England, Northern Ireland, the West of Scotland and Inner London. Over the past three decades, Northern Ireland and the North of England have rejected fluoridation four times. In a landmark court battle in 1983, Lord Jauncey ruled that Strathclyde was exceeding its legal authority when it tried to fluoridate its water. London mayor, Ken Livingstone, has said that he will oppose it too. Others have tempered their traditional unbridled advocacy of fluoride with more measured warnings which reflect its toxic status. “In the past 10 years we have been aware that children do have an increased risk of adverse effects and are recommending that when brushing teeth, only a pea-sized drop of fluoride toothpaste should be used and that parents supervise brushing to make sure that children spit it out,” says Dr John Beal of the British Dental Association. What otherwise might they be swallowing? Fluoride is a by-product of phosphate fertiliser or aluminium production and a dangerous pollutant.
“Companies cannot by law dump this material in the environment but they are allowed to sell it to public water utilities where it is diluted down in the water supply,” says Dr Paul Connett, an international expert on environmental toxins. He states that whenever fluoride is tested in laboratories, usually on rats, a pharmaceutical grade of sodium fluoride is used with distilled or double-deionised water and this is entirely different from the substance put into the public water supply which is hexafluorosilicic acid, a toxic soup of silicofluorides and a number of other contaminants from the phosphate process which commonly include arsenic, cadmium and radionuclides. According to the BDA, such claims are “complete, unmitigated drivel”.
“Fluoride from phosphate manufacture is just a convenient type of recycling which meets strict government safety standards, monitored by the Drinking Water Inspectorate,” says Beal.
But can there ever be a “safe” level for any poison? The “optimal” level for fluoride in water was set at one part per million back in 1945, with no allowance made for the cumulative effect of other sources of fluoride such as fluoridated dental products, soft drinks and processed foods. Nor have the possible synergistic cocktail effects of fluoride with other chemicals we ingest been taken into account.
While the BDA insists that “fluoridation could reduce decay in cities like Glasgow by a half”, other European countries remain unconvinced. Only the UK, Ireland and Spain fluoridate their drinking water in some areas. It is the same story internationally. The Japanese government’s position, for example, is that wholesale water fluoridation can cause health problems and that individuals are at liberty to use a fluoride toothpaste if they wish. These days, non-fluoridated Western Europe and Japan have the same, or in some cases fewer, dental cavities than the US. Meanwhile in the 62%-fluoridated US, fluorosis, which ought to be rare, is running at between 20% to 80%. More than 50 US towns and cities have stopped fluoridation since 1990.
Sheiham says: “When I worked in the US, the first thing I noticed was what nice white teeth Americans had. But tooth whitening is an initial sign of low-score fluorosis. The staining comes later with the higher scores. Ironically, it is the middle-class children that are most badly affected by excess fluoride because they also use fluoride toothpaste.”
Increasingly more scientists seem to agree that if there is any benefit to fluoride at all, it comes from topical application (toothpaste), not indiscriminate and ill-targeted mass fluoridation which could cause problems for vulnerable groups such as the elderly, diabetics, people with vitamin and mineral deficiencies and cardiovascular or kidney problems. And what about the perfectly healthy population? Why ingest a known toxin on a lifetime basis just because some children suffer from too much tooth decay? Why not add aspirin to water in order to prevent heart disease and strokes in the elderly, or spray steroids into the air because some people get asthma?
British opponents of fluoridation point out that only about 3% of the global population is artificially fluoridated and that the strong American drive to promote the practice has been spectacularly unsuccessful. “The trick is to make people think that they are somehow behind the times and should feel guilty for depriving their children of this miracle-working pollution,” says Jane Jones, campaign director of the National Pure Water Association.
The fluoride debate is certainly calling into question the integrity of the dental research community. Can we trust dentists? And even if we are talking about those well-intentioned dentists who have simply subscribed to a professional orthodoxy, do they see the wider health picture?
“The public have been sold a Janet and John story about fluoride,” says Jones. She makes the ultra-cynical observation that dentists have a financial interest in promoting fluoride because they can make more money covering up the staining of fluorosis than carrying out extractions or fillings.
Recently the credibility of the British Dental Association took a knock when it gave its official accreditation to a soft drink – Ribena Tooth Kind – which claimed it was “safe for teeth”. (The BDA makes tens of thousands of pounds each year from product accreditation.) The Advertising Standards Authority found that these claims were misleading. Now the BDA defends its accreditation on the grounds that that it was only saying that Ribena Tooth Kind was less harmful than other sweet drinks and not suggesting that there was no danger of decay.
This debacle illustrates the somewhat ambivalent relationship that exists between the advocates of fluoride and the sugar industry.
Sugar and the corrosive acids in fizzy drinks are the number one cause of tooth decay and their effect is most damaging amongst deprived urban children with poor diets who do not take care of their teeth. Yet sugar overconsumption in such communities is often met with shoulder-shrugging and patronising tolerance while Nanny State interventionism is advocated in the form of water fluoridation.
“Fluoride has been found to be effective over 40 years in improving dental health by 60%. It is a much more realistic way of tackling tooth decay than approaching the manufacturers of sugary drinks,” says Margie Taylor, consultant in Dental Public Health in Lanarkshire.
Now the University of York has been funded by the government to come up with a “once and for all” review of the science around fluoride. It is due to report in two weeks and expected to conclude that fluoride is safe and effective.
“They set narrow criteria for the review which excluded all biochemistry and animal studies, mathematical models and the cocktail effect. What’s more they have been looking at areas with naturally high calcium fluoride, not the artificial product that is put into water,” explains Jones.
But the public’s current disillusionment with tame government scientists in the wake of BSE is high. Consumers were assured by august committees that the risk to humans was “remote”. It seems unlikely that the York review will silence the long, persistent and mounting opposition to fluoridation.