1 EXECUTIVE SUMMARY
I am very
pleased to present my Report on Water Fluoridation to the Joint Oireachtas
Committee on Health and Children. I was appointed first to undertake this work
in 1999 during the last Dáil. Unfortunately, I was advised by the Committee
Chairman to interrupt my work when the then Minister for Health and Children,
Micheal Martin, set up the Fluoridation Forum to conduct a similar
investigation into the action of fluoride. Following the completion of the
Forum Report, the Health Committee recommenced its own investigation. Given
that sufficient time has now elapsed since the publication of the Forum Report
and that not a single recommendation out of 33 has been implemented, it is
timely to publish our deliberations on the subject.
Having
agreed to become the rapporteur, I quickly discovered that I faced a complex
and mammoth task. Not only did I have to analyse the testimony of those who
appeared before the Committee, I also had to wade through the often
contradictory scientific evidence and the endless archive material.
I have
tried to distil the essential elements of my research into this report. As well
as looking at why water fluoridation was introduced into this country, the
report seeks to answer two fundamental questions — (1) how effective is water
fluoridation in fighting tooth decay? (2) what are the side effects of water
fluoridation?
Those who
came before the committee had often diametrically opposed views on the subject.
There is no doubting the sincerity and dedication of both sides in this debate.
It is worth noting however, that whereas there was almost unanimity in the
dental community when water fluoridation was introduced as to its
effectiveness, there are now clear differences of opinion among dentists on the
subject. One only has to contrast the testimony of Dr. O'Mullane and Dr.
Clarkson with Dr. MacAuley and Dr. Limeback to understand how greatly views
diverge on water fluoridation. But there is some common ground. And it's worth
reflecting on these points of agreement at the very outset. When fluoride was
first introduced it was thought generally to act systemically i.e. it had to be
ingested. We now know it acts topically i.e. in the mouth and on the surface of
the tooth. We also know that there are increased sources of fluoride now
compared to fifty years ago. All sides admit - and the evidence points to - a
huge increase in the incidence of fluorosis, a condition which indicates an
excess of fluoride. Both sides also took the view that fluoride in toothpaste
did reduce the rate of dental caries. They also agree that children who use
fluoride toothpaste require supervision and proper instruction.
The
crucial question for the committee was whether the perceived benefits of water
fluoridation outweighed the negative side effects. The contribution of international
expert, Dr. Hardy Limeback was persuasive in this regard when he commented that
using the most authoritative international data, the risk of fluorosis far
outweighed the benefits of fluoride. Dr. Limeback was also very clear in his
recommendation that fluoridated water should not be used to bottle feed babies.
Indeed, his advice seemed to have been accepted by the Food Safety Authority
until it changed its mind in circumstances that have not been explained to the
satisfaction of the committee. The committee has also noted the latest advice
of the American Dental Association which states: "If using a product that
needs to be reconstituted, parents and caregivers should consider using water
that has no or low levels of fluoride". (ADA 9th November 2006).
Given
that it is extremely impractical for mothers who are bottle feeding to source
non-fluoridated water supplies and that fluorosis rates continue to rise, our
central recommendation — based on the precautionary principle - is that the
practice of water fluoridation should end immediately. All of the available
evidence suggests that not only will this lead to a marked reduction in
fluorosis but that there would not be a significant rise in dental caries.
The
evidence presented by Dr O'Mullane showed that Ireland had a very serious
dental health problem in the 1950s and early 60s. All of the available
historical records confirm this to be the case. They also show that Ireland had
a real shortage of dentists at the time. The committee fully appreciates why a
prophylactic measure such as water fluoridation seemed like a sensible approach
at the time. However, we have had to base our conclusions and recommendations
on all of the data now available to us. Quantifying the effectiveness of fluoridation
was our most difficult task. In our view, the most accurate measurement of this
is contained in the York Review, undoubtedly, the most comprehensive study ever
to be carried out on water fluoridation. Similarly, we have referred to York
Review in quantifying fluorosis rates.
A key
recommendation of the Fluoridation Forum was the reduction in the level of
fluoride in our water supplies. Significantly, this recommendation has not been
implemented, and even if the fluoride levels in the water were slightly
reduced, we could not recommend that this water be used to bottle feed babies.
The
Ireland of 2006 is a very different place with very different standards of
general and oral hygiene. We are a modern European state with dental caries
rates equal to and sometimes below other EU states which do not fluoridate
their water supplies. We do, however, continue to consume too much
confectionary, and our snacking habits are leading to continued dental caries
problems as well as higher rates of obesity. The Department for Health and
Children should tackle this problem by concentrating its efforts on education
in relation to better oral hygiene, banning junk food vending machines and
using fiscal means to change these poor eating habits.
If our
recommendations are implemented we are convinced that not only will we see a
reduction in fluorosis rates but that there will also be a drop in dental
caries rates.
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