It’s a controversial question which rears its head every few years – should Wales fluoridate the water supply to improve notoriously poor dental health? Health Wales brought together two views from either side of the argument
OUR principal objection to water fluoridation is that it is indiscriminate mass-medication by the state.
Fluoridated water is presented by health authorities as having the properties to prevent tooth decay, especially in children.
It thus fulfils the European Union’s definition of a medicinal product for human use – “any substance or combination of substances presented as having properties for treating or preventing disease in human beings”.
Article five of the Council of Europe’s Convention on Human Rights and Biomedicine enshrines the individual’s right to withhold consent to any medical intervention.
It is significant that UK and Ireland (the Republic), which have fluoridated water supplies, have failed to sign this important agreement.
Fluoride, internalised during tooth development, can cause teeth to become permanently mottled and stained, a condition known as “dental fluorosis”.
One part per million (ppm) of fluoride in drinking water – the so-called optimal level at which dental fluorosis was expected to be very mild – has been reduced independently by several fluoridating countries, including Hong Kong, Canada and Ireland, because at 1ppm, the prevalence and severity of dental fluorosis became unacceptable.
There has never been a high quality scientific study showing that water containing 1ppm fluoride has any worthwhile lasting benefit to teeth.
Comparisons of DMF rates between different areas are misleading because they take no account of the many factors that influence tooth decay, such as sugar consumption and expenditure on preventive treatments.
Much clearer evidence exists for the effectiveness of topical fluoride applications (toothpastes, gels and varnishes), which do not involve coercion.
Since the introduction of fluoride toothpastes in the 1970s, most Western countries have shown marked improvement in tooth decay rates regardless of fluoridation status.
Forcing water consumers to ingest fluoride in their drinking water without their individual, informed consent doesn’t make sense because fluoride has never been shown to have any essential physiological role in humans.
After about 50 years of dentists’ belief that fluoride had to be ingested to benefit teeth, the US Center for Disease Control wrote, in 1999: “Fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.” So swallowing fluoride isn’t necessary.
It is impossible to control the daily amount anyone receives. That depends on how much fluoridated water is drunk but also on how much fluoride is obtained from other sources – foods, including drinks, pharmaceuticals and air pollution.
Fluoride is a poison. It interferes with vital cell functions and cannot be justifiably represented as a beneficial supplement.
The World Health Organisation’s guideline value (the recommended maximum on safety grounds) in drinking water is 1.5mg per litre, which is 1.5ppm. This maximum is reflected in the EU’s current drinking water directive. Thus, there is a very narrow margin between the 1ppm advocated for fluoridation schemes and the 1.5ppm maximum to avoid cumulative harm.
In India, high natural levels of fluoride in ground water have crippled millions of relatively young people. India has adopted an absolute maximum for fluoride in drinking water of 1ppm but recommends “the less, the better”.
Many people in the UK are already over-exposed to fluoride, with 25% getting more than is safe. This figure rises to 67% in fluoridated areas.
The US National Research Council’s Review Fluoride in Drinking Water (2006) identifies “susceptible subpopulations” in respect of fluoride. Infants and small children are highly susceptible to fluoride’s toxicity.
With water fluoridation, fluoride goes to everybody who drinks the water, from the very young to the very old and to people in all states of health. Even the toothless get their daily dose.
Baby formula mixed with fluoridated water could supply a baby with up to 200 times as much fluoride as mother’s milk – a number of studies indicate naturally-occurring fluoride, at levels not much higher than 1ppm, lowers IQ in children.
Typically, kidneys remove only a third to half of a person’s fluoride intake. Retained fluoride accumulates throughout life and is stored mainly in the bones. This may lead, years later, to pain or fracture and the cause may go unrecognised.
Absurdly, fluoride is added to all the piped water leaving the treatment works but less than 1% of that water is consumed by children. The rest is lost in leaks; is used by industry or domestically for bathing, laundry, washing the car, irrigating the garden and flushing the toilet.
The Water Act 2003 removed a water company’s former discretion to fluoridate or not. A three-month public consultation must be held prior to any new scheme. Despite many Parliamentary assurances that fluoridation would not be imposed without a majority of the affected population in favour, the wording of the regulation on consultations allowed the South Central Strategic Health Authority to ignore the wishes of the population of Southampton and South West Hampshire who were consulted in 2008.
Almost three-quarters (72%) of the written responses to that consultation rejected fluoridation but South Central Strategic Health Authority voted unanimously to fluoridate and still plans to do so although SHAs in England will be abolished in April 2013.
Proposing new schemes and terminating existing schemes in England will subsequently become the responsibility of local authorities. All affected councils in Southampton and south west Hampshire are opposed to the planned scheme and it is hoped they will jointly propose its termination at the earliest opportunity.
In Wales, the responsibility for proposing new schemes – and terminating existing schemes if there ever are any – becomes the responsibility of the Welsh Government. The National Pure Water Association (NPWA) understands it has no current plans to do so.
Since 1999, oral health in Welsh children has been addressed by the Designed to Smile programme. The programme’s protocols vary with age group, and include educational initiatives, tooth brushing with fluoride toothpaste and professionally applied topical fluoride treatments. The results are being evaluated.
Meanwhile, the Assembly’s children and young people committee has investigated the issue and in its report said the Welsh Government should keep the evidence for fluoridating water supplies in Wales “under review”.
We would urge Welsh residents both to write to their AMs, asking them to reject all calls to fluoridate Welsh water supplies, and to lobby the UK government for the repeal of the fluoridation sections of the Water Industry Act 1991 as amended.
The NPWA has campaigned against water fluoridation, nationally and internationally, for more than 50 years. NPWA has called for a halt to all UK fluoridation schemes and for all legislation regarding water fluoridation to be withdrawn from the statute books.