To the surprise of many, it was not until six years after the repeal of the fluoride law that the Socialstyrelse (National Social Welfare Board) and the responsible Minister for Social Services lngegerd Troedsson started any significant activity to enable the Riksdag (Parliament) to introduce once more a law permitting the fluoridation of drinking water. The reason given for the actions is given as new results which are said to show the question in a new light. I have gone through the current literature in the field and have so far come to the same conclusion that the situation has changed since the question was last debated in 1970. The new situation means, however, that the argument against water fluoridation is today stronger than in 1970 (as regards the position in 1970, see Carlsson 1970 a and b).
In this article the new situation is discussed with reference to the prophylactic effect of fluoride against caries and its other effects on the teeth, the skeleton and the general state of health. In order to understand the new situation it is necessary first to discuss the increasing fluoride load in our environment.
The total intake of fluoride
In Fredholm’s report (1978), which is quoted by the Socialstyrelse, it is stated without any indication of sources the “the percentage of fluoride in drinking water is, for practical purposes, a sufficiently good measure of the intake, if special exposures do not occur”. On the other hand, Friberg end Camner, of the National Institute for Public Health, in a report submitted at the request of the National Social Welfare Board (1.6.1971), state that the material available for an assessment of the total fluoride intake in Sweden is very incomplete, especially as regards introduction through food and industries. A rough estimate was made in relation to food: an average of 0.5 mg, with extreme variations from 0.25 – 5 mg per 2000 kcal. Unfortunately the available Swedish information is old; for the most part it dates back to the 1950s. No current Swedish data on the individual variations in water consumption seems to exist. Information from the U.S.A. and Canada show that a considerable increase in total fluoride intake has occurred during the last decades. According to Marier (1977), who made a comprehensive literature search, it may now amount to 2 mg or more per day in places without fluoridation and 5 mg or more per day in localities with fluoridation
He points out that the fluoridation or drinking water also brings about an increased intake of fluoride through food – even in localities without fluoridation- and that the present fluoride intake in localities without fluoridation is as great as the initially calculated intake in fluoridated areas He fears, moreover, that the escalation in fluoride intake is still not concluded. It is difficult to decide whether these figures are applicable to Sweden. On the one hand, the widespread fluoridation in the U.S.A. and Canada may bring about higher values (even in food) in this area, but on the other hand, according to Friberg and Camner, we eat more fish and shellfish, which are rich in fluoride.
Infant foods mixed with water pose a special problem. With a water fluoride content of 1 mg/l they provide an approximately 50-fold increase in fluoride intake compared with human or cow’s milk. In areas with a high fluoride percentage the incidence of dental fluorosis is greater in infants fed with mixtures than in breast-fed babies (Foreman 1977)…
The question of fluoride and allergy
At the great fluoride conference in Stockholm in June 1970 the allergy expert Helge Colldahl expressed apprehension on the grounds of reports of “adverse reactions” after the administration of small doses of fluoride. For this reason she claimed that she had doubts about fluoridation of water. (The minutes of this conference were marked as secret by the National Social Welfare Board.)…
I am quite convinced that water fluoridation, in a not-too-distant future, will be consigned to medical history. It is directly contrary to the efforts which are prompted by the increasing chemical pollution of our environment and the increasing understanding of the dangers of this. Our health authorities will in the future be involved to an even greater extent with the problems which this pollution brings in its train, problems of a very high degree of complexity as regards difficulties in quantitative surveying, interactions with other substances, etc. Our community will require even greater resources to be put to use to hold chemical exposure down to an acceptable level. The fact that in this situation a poison should deliberately be distributed throughout our environment in enormous quantities represents an ill-considered action, especially as this is a poison which, through industrialization, will probably find its way in increasing quantities into our environment (Marier 1977). Water fluoridation also goes against leading principles of modern pharmacotherapy, which is progressing from a stereotyped medication of the type of 1 tablet 3 times a day to a much more individualized therapy as regards both dosage end selection of drugs. The addition or drugs to the drinking water means exactly the opposite of an individualized therapy. Not only in that the dose cannot be adapted to individual requirements. It is, in addition, based on a completely irrelevant factor, namely consumption of drinking water, which varies greatly between individuals and is, moreover, very poorly surveyed.