Dear All,

One of the emails waiting for me on my return from my trip to Australia and Japan was a press release issued jointly by the Dental Association of South Africa and the the South African Medical Association, calling on the public to support water fluoridation.

It would appear that “professionals” in South Africa are just as ill-informed and just as willfully gullible as their counterparts in the US, Australia, New Zealand, Ireland and the UK, who, ever since the US Public Health Service endorsed water fluoridation in 1950, have bent over backwards to support the hand that feeds them.

Meanwhile, their South African counterparts, tell us that:

1) Water fluoridation is “cost effective”.

This is only true if you use very cheap industrial grade hexafluorosilicic acid instead of pharmaceutical grade sodium fluoride, and even then usual cost analyses ignore the delay in tooth eruption; the costs of treating dental fluorosis; the costs of promotion and the costs to those taxpayers who are forced to take avoidance measures.

2) “Extensive scientific documentation over the past half-century has established and consistently reaffirmed that fluoridation of public water supplies is a safe and cost-effective community-based method of preventing tooth decay.”

They cite no specific studies which discuss the escalating increase in dental fluorosis in fluoridated communities (Heller et al, 1997; Spencer et al, 1996); the numerous studies which indicate that fluoride damages bones and makes them more brittle, especially with lifetime exposure (Li et al, 2001); Luke’s study (1997, 2001) which found that fluoride accumulates in the pineal gland and lowers the levels of the important biological regulator melatonin in animal studies; Varner’s work (1998) which found that fluoride increases the uptake of aluminum into the brain when fed to rats at 1 ppm in their water; Masters and Coplan’s work ( 1999, 2000) which indicates a greater uptake of lead into children’s blood in coummunities using hexafluorosilicic acid (or its sodium salt) as fluoridating agents and the several Chinese studies which have found that fluoride exposure lowers the IQ of children.

It is interesting that Professor Chitke, one of the signees of this press release has actually studied the levels of fluorosis in South Africa and has found them to be extremely high. An abstract from a recent paper (see below) of his indicates that 19% of the children in the LOW F community (0.4 to 0.6 ppm) had moderate or severe dental fluorosis, while this figure is 31% in the “optimal” F community (.99 to 1.1 ppm). It is interesting that he titles his paper “perceptions” of fluorosis. Most honest commentators would argue that moderate and severe forms of dental fluorosis go way beyond a mere “perceptual” problem. For example, last year Alarcon-Herrera et al, reported that in Mexico they have found a clear correlation between the incidence of bone fractures in children and the severity of dental fluorosis.

3) “Fluoridation is an equitable measure. It will particularly benefit those at greater risk of tooth decay, such as the lower socio-economic groups and children.”

Here they have ignored the arguments that it will be precisely the poor families who will not be able to avoid fluoridated water by using reverse osmosis equipment or by buying bottled water and precisely the poor who are more likely to be malnourished and thus more vulnerable to fluoride’s toxic effects. Thus this is not an equitable program but one which adds inequity onto inequity for the poor. Moreover, the most common causes of tooth decay among poor children (baby bottle tooth decay and pit and fissure decay) are not alleviated by exposure to fluoride. This is probably why the recent York Review (McDonagh, 2000) according to the chairman of the advisory board, Professor Trevor Sheldon, concluded that “There was little evidence to show that water fluoridation has reduced social inequalities in dental health.”

4) ” Fluoridation is endorsed by virtually every major national and international organization concerned with health and safety, including the National Department of Health and the World Health Organization.”

It is amazing that they make a statement like this without pointing out, that most industrialized countries have rejected fluoridation as a public health policy, including the vast majority of European countries and without pointing out that WHO’s own figures indicate that children’s teeth in these non-fluoridated countries are just as good, if not better, than those of their fluoridated counterparts. Nor do they point out that WHO warns that those authorities who are intending to fluoridate, should first ascertain the current fluoride dose children are getting from all sources. This is something the SA authorities have not done, which is shocking because there are literally hundreds of communities in SA which have high enough natural levels of fluoride to cause endemic fluorosis.

5) “It has been identified as one of the 10 greatest public health achievements of the 20th century.”

They clearly haven’t checked out the report in which this infamous statement was made. Had they done so they would have found that the Center for Disease Control and Prevention ( CDC) report in question ( MMWR, October 22, 1999) has been severely criticized for being six years out of date in the literature they cite to support the lack of any serious health effect and also for misrepresenting the cause of falling tooth decay in the US.

6) “Community water fluoridation is the process of adjusting the amount of fluoride that is present naturally in the community’s water, to the best level for protection against tooth decay.”

All propagandists for this foolish measure make a big point of stressing the “natural” occurence of the fluoride ion without acknowledging that many toxic substances (like arsenic) appear “naturally” in some water. This doesn’t make it safe to drink.

The “natural” level they should be most focussed on, is the natural level which appears in mothers’ breast milk. This level ( 0.007 – 0.012 ppm) is about 100 times lower than the level added to the water in artificial fluoridation schemes ( Institute of medicine, 1997). This means that women who bottle feed their babies and use tap water to do it, will be giving their babies 100 times more fluoride than the baby would get “naturally”. This was one of the major reasons that Dr. Arvid Carlsson led the fight against fluoridation in Sweden. He was concerned about exposing the young brain, both in the fetus and in the new born baby, with elevated levels of a pharmacologically active substance. He won the Nobel Prize for medicine in 2000.

Wake up you doctors, the citizens you serve, deserve better than this. Follow your creed, “First Do No Harm” instead of peddling second hand propaganda from the US.

The good news is that the representatives of the two organizations (Professor Usuf Chikte, Dr Neil Campbell, Professor John Terblanche and Dr Kgosi Letlape) have identified themselves on this press release. Hopefully our SA friends will organize a meeting in which these individuals can defend their position in an open public debate. If invited I would be more than happy to participate in such a debate.

Below I have printed the full statement from the SADA and SAMA. Hopefully, our readers can be getting their thoughts together while I try to gather email addresses for any correspondence they wish to send.

Paul Connett.

PS All the studies cited above are listed alphabetically at http://www.fluoridealert.org/reference.htm

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JOINT STATEMENT BY THE DENTAL ASSOCIATION OF SOUTH AFRICA AND THE SOUTH AFRICAN MEDICAL ASSOCIATION ON THE FLUORIDATION OF WATER

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7 August 2002

MEDIA RELEASE: Dentists and doctors support fluoridation of water to prevent tooth decay.

EMBARGO: None. For Immediate release.

South African doctors and dentists gave their full support for the implementation of water fluoridation in South Africa as a cost-effective public health measure to prevent tooth decay.

The South African Dental Association and the South African Medical Association (SAMA), after assessing the latest scientific information, are satisfied that there is no valid reason for denying the scientific benefits of water fluoridation to the people of South Africa.

Water fluoridation is the most cost-effective way of preventing tooth decay in South Africa. It is 18 times cheaper than fluoride toothpaste, 50 times cheaper than current preventive measures and 61 times cheaper than filling one tooth. The preventive benefits of water fluoridation will save many days lost at work and school.

The two Associations note that:

Tooth decay is a preventable disease. Yet, it is one of the most common diseases in South Africa, affecting substantial numbers of children and adults from all sectors of society, especially those socially and economically deprived.

The treatment of tooth decay is very expensive, millions of work and school days are lost because of it, and millions suffer unnecessarily because of it.

Extensive scientific documentation over the past half-century has established and consistently reaffirmed that fluoridation of public water supplies is a safe and cost-effective community-based method of preventing tooth decay.

Fluoridation is an equitable measure. It will particularly benefit those at greater risk of tooth decay, such as the lower socio-economic groups and children.

Fluoridation is endorsed by virtually every major national and international organization concerned with health and safety, including the National Department of Health and the World Health Organization. It has been identified as one of the 10 greatest public health achievements of the 20th century.

SADA  and  SAMA  call on the public to support water fluoridation and urged the  relevant  authorities to support and institute appropriate measures to implement  the  process  of changing the fluoride levels of community water supplies to optimum levels, as a matter of urgency. This process will vary, depending on local conditions.

Community water fluoridation is the process of adjusting the amount of fluoride that is present naturally in the community’s water, to the best level for protection against tooth decay.

Regulations on the fluoridation of water were gazetted in September 2000 (Regulation Gazette No. 6874) under the Health Act (Act No 63 of 1977).

Supporting documents available on request from magdan@samedical.org

1.    Water Fluoridation Facts -SA Dept of health
2.    National and International Organizations that Endorse or Support Water Fluoridation
3.    Systematic review of Water Fluoridation-summary

This statement is supported by:

Professor Usuf Chikte
President, the South African Dental Association

Dr Neil Campbell
Executive Director, the South African Dental Association

Professor John Terblanche
Chairperson, Health Policy Committee, the South African Medical Association

Dr Kgosi Letlape,
Chairperson, the South African Medical Association

Issued by the Corporate Communication Unit of the SA Medical Association on
behalf of the SA Dental Association and the SA Medical Association.
Queries: Magda Naude (012) 481-2042 / 082 452 5878
Tracy Sage (012) 481-2052/ 082 450 4332
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SADJ 2001 Nov;56(11):528-32

Perceptions of fluorosis in northern Cape communities.

Chikte UM, Louw AJ, Stander I.

Department of Community Dentistry, University of Stellenbosch, Private Bag XI, Tygerberg, 7505. umec@sun.ac.za

The objective of the study was to determine the perception of fluorosis in communities living in the Northern Cape Province of South Africa where there is a considerable range in fluoride levels of drinking water. The fluoride levels of the drinking water were categorised as suboptimal (0.40-0.60 ppmF), optimal (0.99-1.10 ppmF) or supra-optimal (1.70-2.70 ppmF). The teeth of 694 children aged 6, 12 and 15 years were examined. Dental fluorosis occurred among children of all ages in all areas studied. As anticipated there appears to be a direct relationship between fluoride levels in the drinking water and levels of dental fluorosis, and the severity of the condition increased with an increase in levels of fluoride in the water supplies. Children in low fluoride areas showed some form of mild fluorosis (37% very mild and 17% mild). However, 19% of this group experienced moderate or severe forms of fluorosis. In areas with optimal levels of fluoride 30% of children showed a questionable form of fluorosis and 21% mild fluorosis. Moderate or severe forms of fluorosis were recorded in 31% of children in the optimal fluoride area. The Community Fluorosis Index (CFI) scores for the sub-optimal and optimal areas were of medium public health significance and for the supra-optimal area of very high public health significance. Of concern is the high percentage of children (45%) in the supra-optimal area with severe forms of fluorosis. The awareness and concern for stains on teeth were mostly expressed by children with moderate or severe fluorosis. This study suggests that the proposed fluoride concentration (not more than 0.7 ppmF) prescribed in the Regulations on Fluoridating the Water Supplies for South Africa would minimise the risk of dental fluorosis.

PMID: 11885431 [PubMed – indexed for MEDLINE]