The Department of Health is back from the drawing board, determined to force all big towns and cities to dose their drinking water with fluoride.

And while government dentists believe the move is necessary to protect children’s teeth, the international scientific community remains sharply divided about the potential for long-term harm to elderly people, the sick, and very young children who drink fluoridated water.

New draft laws were circulated recently to water boards and municipalities. But the latest version appears to contain few changes to previous regulations which were rejected by several large water supply boards and other groups opposed to the compulsory medication of national drinking water supplies.

The recommended guideline for optimum fluoride levels has been fixed at 0,7mg of fluoride per litre of water, the same level originally gazetted in September 2000.

The original plan for compulsory fluoridation was due to take effect in September 2003, but was quietly shelved following widespread concern about the cost implications for water suppliers along with several concerns about health, including the potential for bone disease, cancer, infertility and mottled teeth.

The Water Research Commission also published a comprehensive review of the government fluoridation plans in 2004 which raised several red flag risks – including the possibility that HIV/Aids patients and people with kidney disease and heart problems could be especially vulnerable to the toxic effects of fluoride.

Bettina Genthe, of the Council for Scientific and Industrial Research, also cautioned parliament’s portfolio committee on water affairs that fluoride appeared to be toxic to immune system cells, even at very low water concentration levels.

She warned against the fluoridation plan on the basis that there were still too many gaps in the scientific data.

Former Rand Water chairman Piroshaw Camay said that the country could be setting itself up for more “national disasters” and urged the Health Department to “abandon this fruitless exercise”.

Camay, who is also director of Core, a Johannesburg-based policy research and advocacy group, noted that water supplies in Mangaung, near Bloemfontein, had to be cut off a month ago because they had not been chlorinated properly.

“Proper chlorination is almost as routine as tying your shoelaces, but if some people are still failing in this area, what new problems can we expect from fluoridation?”

In 1993, the American town of Middleton, Maryland, discontinued fluoridation permanently after an over-dosing problem forced city officials to drain their entire water works system and to supply customers with bottled water.

Camay said cost estimates by Rand Water five years ago showed that the price of water would go up by at least 1c/kl from compulsory fluoridation.

Although the new draft regulations suggest that the National Treasury will contribute towards the initial fluoride equipment costs, along with operating costs for five years, Camay said municipal ratepayers would ultimately be saddled with extra costs.

He said the primary beneficiaries of fluoridation would be children between the ages of 7 and 12, which was seen as a critical period in dental development. “However, I believe there are better ways of protecting children’s teeth than by dosing all South African tap water.”

The alternatives included providing fluoride tablets, fluoridated toothpaste and toothbrushes to specific target groups, but the Health Department had yet to prove that it had ever investigated these options seriously.

The new draft regulations do make allowances for smaller towns to be exempted from fluoridation because of prohibitive costs, and there are also provisions for exemptions if the natural water fluoride levels comply with government guidelines.

However, the draft law states members of the National Fluoridation Committee “shall not be liable in respect of anything done in good faith under these regulations”.

The question of legal liability in the event of toxic overdoses or cumulative health damage has been a source of concern for several interest groups.

In some parts of the world, including Rajasthan in India, young children and adults have developed crippling bone diseases and deformities from drinking water with naturally high levels of fluoride.

Although fluoridation is common in the United States, Canada, and parts of Latin America and Asia, only about 1 percent of water in Western Europe is dosed with extra fluoride.

The majority of Western Europe has either banned, discontinued or never practised fluoridation. Some countries also allow cities and towns to opt out of fluoridation after a popular vote, but there is no such allowance in the proposed South African legislation.