Across Hamilton, battle lines are being drawn.

On one side of town, in the suburb of Melville, medical transcriptionist Hazel Aughton knows she will be voting for the return of Hamilton’s water fluoridation. She wants to make sure children like her grandson have equal access to oral healthcare measures.

Mrs Aughton is concerned that stopping water fluoridation could disadvantage families in the area who may not get enough fluoride in other ways to keep their kids’ teeth healthy.

“I think it is vital that fluoride is readily available to everyone, everywhere.

“My little 14-month-old grandson has a very healthy, balanced diet with plenty of the right nutrients, but the fact is not all parents are able or willing to provide this for their children.”

On the other side of town, Hamilton resident and anti-fluoride advocate Pat McNair plans to do the opposite. She will be saying a big no to fluoridation on the voting form.

“I have no wish to prevent anyone else who wants to partake of fluoride, but I do not want to be forced to take it myself. [Until] long-term studies are done to show us that it is safe, we should stop adding it.”

Mrs Aughton and Ms McNair are part of a wider division across Hamilton – those who support fluoride being added to their drinking water, and those who do not.

Hamilton’s decision is being watched around the country as yet another example of the growing movement against fluoridation, which has seen many councils end the practice.

Pro-fluoride advocates fear the city’s decision may start off a domino effect of councils dropping fluoride.

Anti-fluoride movers believe the country would be safer without a chemical with questionable health benefits in the water.

SELF-DIAGNOSED SUFFERER

Fluoride sufferer Angus Hastie strongly believes water fluoridation is unsafe. He experienced health problems after moving to Auckland from the unfluoridated South Africa 12 years ago.

“I became quite fatigued, and also felt quite thirsty all the time. I began to not be able to focus and concentrate properly.”

Mr Hastie said he had not been tested by a doctor for fluoride-related problems, but attributed his illness to water fluoridation after reading on the subject himself.

“Most doctors don’t have any training on fluoridation issues.

“I had thought of going to see a doctor, but at the same time I discover the water was fluoridated, and I read up on that and started experimenting.

“I started drinking non-fluoridated water and all my health problems disappeared. If I drank fluoridated water all these problems would come back.

“I can have a [fluoridated] glass now and I can actually feel it – a sort of dull effect – coming on.”

Mr Hastie is a member of Fluoride Action Network New Zealand, an anti-fluoride group formed in 2003, who regularly petition against fluoridation at local councils and meetings.

‘IT’S MASS MEDICATION’

Spokeswoman Mary Byrne said the group’s main objection to water fluoridation was the absence of choice in its use.

“Fluoride is a mass medication. It’s one thing to have fluoride in your toothpaste – people can choose whether to use it or not. It’s a different story to have it in your water supply.”

The group does not deny fluoridation has oral health benefits, but believes it also poses serious health risks.

“Even naturally occurring fluoride is not healthy.

“The Ministry of Health is ignoring things like low-dose chronic poisoning and hypersensitivity to fluoride. It makes some people really sick, and it’s not good for any of us,” Ms Byrne said.

These kinds of arguments have helped fuel a growing tide of feeling against fluoridation.

Pro-fluoride advocates say the arguments are unscientific, and are furious they are gaining traction – but there is no doubt they are having some effect.

Of New Zealand’s 67 councils, 23 fluoridate their water. The country has been fluoridating since the 1950s, although not unanimously: Wellington, Auckland and Dunedin do; Timaru, Queenstown and Napier do not. Taumarunui, in the Ruapehu district recently stopped fluoridating, Clutha just started and Petone refused fluoridation from the start.

Why? Clutha District Council spokeswoman Jules Witt said it began fluoridation after advice from the district health board.

On the opposite side, Ruapehu District Council spokeswoman Pauline Welch said it stopped fluoridation because councillors were worried about potential health risks.

WHO IS RIGHT?

So who is right? How dangerous is it, and who does it?

Overseas, the United States, Australia, Singapore and others have fluoridated water. France, Sweden, Scotland and others do not. However, many of those without water fluoridation have high natural fluoride levels in their water, like France, or different methods of adding fluoride to the national diet, like Germany (which fluoridates its salt).

Fluoride is absorbed into tooth enamel, strengthening it and thus helping prevent cavities. New Zealand waters do not have enough naturally occurring fluoride to be effective as an oral-health measure, so we add more.

Both sodium silicofluoride (SSF), a powder, and hydrofluorosilic acid (HFA), a liquid, are used in our water treatment plants.

Both are fully soluble and deemed safe for consumption.

The question raised by anti-fluoride advocates is whether fluoride is actually safe, given that it is by nature a chemical.

Globally there have been reports of fluoride allergies and hypersensitivities. Fluorosis, a discolouration of developing teeth as a result of high exposure to fluoride, is a well-documented problem. Skeletal fluorosis, its rare but more- serious relative, is a buildup of fluoride in the bone – although only after extremely excessive consumption – that reduces flexibility and makes sufferers more prone to fractures.

WHAT THE EXPERTS SAY

Despite all this, the Ministry of Health describes water fluoridation as “a safe, effective and affordable way to prevent and reduce tooth decay across the whole population”.

The World Health Organisation is also a fluoridation advocate, and the National Fluoride Information Centre, which monitors fluoride research across the globe, maintains no health risks exist when fluoridation is at optimal levels (between 0.7-1 part per million).

Dental health expert Jonathon Broadbent believes water fluoridation should be a key part of New Zealand’s health systems.

“Community water fluoridation is unlike many other health interventions, in that it helps to reduce inequalities.

“The NZ Ministry of Health, the NZ Dental Association, and many other reputable health organisations advocate for community water fluoridation. I agree with them.”

Potential risks of fluoridation were often exaggerated, Dr Broadbent said.

“The New Zealand oral health survey of 2009 found no significant differences in dental fluorosis between regions that are fluoridated and those that are not fluoridated.”

For many public health advocates, especially from the medical community, the science is a done deal.

But some experts aren’t so sure.

Rutherford medal-winning molecular biologist and Otago University professor Warren Tate is not affiliated with any anti-fluoride groups, but does advocate caution in the use of fluoridation.

“Mass medication with any isolated chemical is potentially dangerous when we are not an homogenous population. It could be safe for 99 per cent of people but not for 1 per cent – but that is 40,000-50,000 people in New Zealand.

“I think the whole argument has been framed around teeth and yet the chemical affects other body systems.

“Most medical practitioners are not well informed because this is not usually highlighted in their training.

“Research has established that fluoride is a potent inhibitor of the initiation of protein synthesis at 30mM (millimolar), but will have some inhibitory effect down to at least 1mM.

“Fluoride acts by blocking the formation of the key complex of proteins involved in the initiation step of protein synthesis.

“Water fluoridation is at 0.03mM, and so is at a 30 fold lower concentration of known toxicity, which is not a huge difference. For most people this should be within safe limits, but the gap between toxic and safe is not too large. Without proper regulation of water fluoridation this could become an issue.

“If it means replacing a deficient natural mineral (selenium or iodine) or vitamin like folic acid to prevent neural tube defects, [then] I am not philosophically opposed – but fluoridation is not addressing a deficiency.

“I believe communities should be able to decide for themselves whether they wish to embrace this form of mass medication, not have it imposed on them,” he said.

WHERE TO NOW?

So, where does this leave us? Research is still being undertaken, the public are still raising questions, and the Government is keeping out of the argument.

It is because of such mixed messages from water fluoridation science that many city councillors would rather central government took responsibility of the matter. Hamilton’s councillors called fluoridation a central, not a local, issue when they voted it out.

Retiring councillor Daphne Bell, who voted to stop fluoridation, said her decision was based on public interest.

“For me it was a finely balanced decision: whether to stop fluoridation so as to allow freedom of choice . . . or to continue fluoridation to benefit the dental health of a vulnerable section of the community.

“I voted to stop fluoridation to allow people to decide for themselves.”

Cr Ewan Wilson, however, organised the coming public referendum.

“Fluoride added to the water supply at 0.7ppm is a very good oral health preventative measure, and I truly believe that those who feel that it’s not have just misinterpreted the science.”

The Waikato District Health Board has been advocating for the return of fluoride since the council’s decision in June.

Member and medical officer of health Felicity Dumble said that fluoridation was a completely safe option for the public.

“Put simply, fluoride has been added to Hamilton’s water at a safe level for the past 47 years and the only health outcome has been healthier teeth.

“If that fact is not enough for the people of Hamilton to make up their minds, then they need to turn to their health professionals – the people paid to protect the public’s health – for advice.

“You trust your GPs, dentists, specialists, community health team with the rest of your health care and advice – get their views on water fluoridation.

“The vast majority will tell you it is safe, effective and fair for all.

But, despite all this, the Government doesn’t want to know.

Minister of Health Tony Ryall was clear: “Fluoridation of public water supply is a decision for local communities to make.

“The Government’s role is to support local councils when they decide to use fluoride – not to make the decision for them, and we are not considering changing that.”

So what is next? Next month, Mrs Aughton will be voting for the return of fluoridation. Mrs McNair will be voting against it.

Unfortunately, the non-binding referendum will still mean that either the council, or the Government, will have to make a final decision.

Shannon Sweetman is a Massey University journalism student.