The issue of fluoridation, adding fluoride to our public drinking water supplies, is a highly emotive one in Ireland. While some argue that it has led to better dental health, others view it as ‘mass medication’ with a substance that could actually be detrimental to health. In an effort to answer some of the many questions and criticisms levelled at fluoridation, Health Minister Micheal Martin established a Forum on Fluoridation in May 2000. The overall objective of the forum was to review the fluoridation of public piped water supplies in this country and then to make recommendations to the Department of Health. This represented the first major review of water fluoridation since its introduction in Ireland in 1964.

Rejection of Forum Report

Following a number of delays, the report of the forum was recently published. However, as it backs fluoridation, any hope that this issue would be resolved appears to have been lost, with a number of groups condemning the report and indeed the forum as ‘too little, too late’.

“The decision to establish a forum back in 2000 was little more than a token gesture”, Dr Don McAuley, spokesperson for Irish Dentists Opposing Fluoridation (IDOF) told irishhealth.com. He supports this viewpoint by the fact that of the 1,050 members of the public who submitted their views to the forum, just over 8% supported fluoridation, while an overwhelming 89% said they disapproved of it. Opponents of fluoridation view this as indicating a very low level of support for fluoridation, a practise which was stopped by most other European countries back in the 1970s.

Reduced levels recommended

The most significant recommendation contained in the report is that the fluoridation of piped water supplies should continue ‘as a public health measure’. However it also recommends that levels of fluoride be reduced, ‘in the light of both international and Irish research which shows that there is an increasing occurrence of dental fluorosis’.

However this appears to contradict the Health Minister Martin’s comments at the launch of the report, in which he said scientific evidence had led to the primary conclusion of the forum, ‘that there are no adverse health effects of water fluoridation at the maximum permitted level’.

“If there are no adverse effects, why are they reducing it at all?”, asked Dr McAuley. “Around 40% of teenagers attending my dental practise are now showing signs of dental fluorosis. This is unacceptable”. Fluorosis results in structural damage to the enamel (hard outer covering) of the tooth. It results in white lines and spots appearing on the tooth and requires substantial dental work, such as crowns or veneers.

According to IDOF, the argument that fluoridation reduces dental decay is an unfounded one, as Ireland has had no greater reduction in the level of dental caries among the population than other European countries, where fluoridation is not allowed. “One only has to look at to the rest of Europe, which the Government claims we are such an integral part of, to see that dosing the population via drinking water with a so-called tooth preservative is not best practise”, according to the group VOICE (Voice of Irish Concern for the Environment”.

While the forum report notes that the ‘prevalence and severity’ of fluorosis is increasing throughout the country, it also argues that fluoridation is beneficial to dental health. “Health board surveys conducted since 1984 have all consistently shown that children who have been lifetime residents of fluoridated communities have considerably lower decay levels than those resident in non-fluoridated communities”, the report adds.

Toothpaste

Another issue covered by the report is that of fluoride in toothpaste. It recommends the continued use of fluoride toothpaste in fluoridated and non-fluoridated areas ‘because of the additive benefit from the combination of fluoridated water and fluoride toothpaste’.

However parents are advised not to use toothpaste when brushing their children’s teeth, until the age of two. Prior to this, a toothbrush and tap water is sufficient. Where a child under two years of age is considered to be at high risk of dental decay, ‘professional advice on the use of fluoride toothpaste should be sought’.

Between the ages of two and seven, children should only use a pea-sized amount of toothpaste. However the IDOF does not agree with this recommendation, believing that no child under the age of seven should be using a fluoride toothpaste.

The concern over fluoridation is not just confined to dental health. Earlier this year, the Belgian health ministry announced it was considering banning tablets and chewing gum containing fluoride. The proposal came about following the release of a study, commissioned by the Belgian ministry, which found that excessive use of fluoride products increased the risk of osteoporosis and damage to the nervous system. Public water supplies in Belgium are not fluoridated.

“We should all be concerned by this new research, as we have so much fluoride in our water, our fluoride levels will be higher than the Belgians”, Dr McAuley said.

High Court case looms

In Ireland, Dr Andrew Rynne, a well-known Kildare GP is taking a case to the High Court, in an effort to halt fluoridation. The case is expected to come before the court in early 2003, he told irishhealth.com. Dr Rynne is suing the State, the Health Minister and the Attorney General and wants to halt fluoridation. A case taken by a Dublin woman in the early 60s claiming that fluoridation was mass medication and unconstitutional was not upheld by the Supreme Court.

Disabled campaigner, Kathy Sinnott, of the Hope Project, has also expressed her concern at the possible effects of fluoridation on more vulnerable people, such as those with illnesses or disabilities. “Setting aside fluoridation’s risks for healthy children and adults, it must be recognised that some people do not fall into the ‘healthy’ category and for them, fluoridation carries added serious risk. For these people, many chemicals and even more natural and wholesome substances are dangerous”, Ms Sinnott claimed.

So what does the future hold for our public drinking water supplies? And what are the choices open to those who do not wish to drink fluoridated water?

“I think that fluoridation will be turned off slowly over a long period of time. Stopping it now would lead to a huge litigation problem”, said Dr McAuley. According to the forum however, there is still an element of choice for those who do not wish to drink fluoridated water, however even this, it admits has its problems.

“Even though fluoride is in piped water, there is still an element of choice. People can choose not to drink tap water. Admittedly the choice is not an easy one and if the State were concerned about real choice, then consideration would be given to supplying an alternative source of water”, the forum report says.

Given the issues at the centre of this long running controversy, it is clear that the opponents of fluoridation will not be brushed aside easily.

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