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Saturday, June 8, 2013

Fluoridation - yes or no?

Interesting article in The Dominion Post today about where anti-fludiodation campaigners will be targeting their next efforts after they managed to persuade Hamilton City Council to drop fluoride and it is apparently Wellington.

I'm a strong believer in science and collective action to deal with public health issues like tooth decay. Most of us could do a better job of looking after our health (including me) so I don't have much of an issue with efforts by authorities to help us deal with our health.

One of the things that worries me about anti-fluoride action campaigners is their emphasis on individual choice. The issue here is that collective action is necessary otherwise we call pay - either through illness (i.e. if people are not fully vaccinated) or through higher taxes.

The issue for me is whether the science is robust, does the evidence support fluoridation or not? The Council has been lobbied extensively but at the moment it is clear that it is a minority of people. This does not of course make them wrong but there is no groundswell to take fluoride out.

The Council does rely on The Ministry of Health to provide strong evidence and I would expect research to be closely monitored to see if we need to change our practice. But until the evidence is clear that there is no need to fluoridate, I will continue to support fluoridation.

8 comments:

  1. Dear Iona Pannett,

    It's not simply a question of choice, although in a true democracy, yes, all viewpoints must be duly considered.

    Water fluoridation is an old idea. It started around about the 1950s and gained traction in the 1970s. Ideas change as new research comes to light. Remember, there was a time when we all believed the earth was flat!

    From my perspective, the need to eliminate fluoride from public water supplies is based on three things: 1. Unlike topical fluoride, systemic fluoride (fluoridated water, oral tablets) has been proven to be ineffective in lowering dental decay rates. In fact, Iona, there are many credible evidence-based studies around. Please take the time to look at WHO (World Health Organisation) data on DMFT (decay trends) in 12 year olds from eight countries (including NZ), 1970 to 2010. In 2010, Belgium (a non-fluoridated country) has the lowest decay rate, and New Zealand (fluoridated) has one of the highest decay rates; 2. Recent studies suggest links between water fluoridation and in particular bone and thyroid diseases. This is new research, but it certainly merits further investigation; and 3. Medicating the public water supply goes against basic medical ethics: the fundamental principle of pharmacology is the right medicine, in the right dose, and at the right time for individuals requiring meds.

    How many more reasons do we need to remove fluoride from our drinking water?

    Regards,

    Stan Litras BDS (Otago) BSc (VUW)
    Wellington City Dentist

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    1. In case people believe that this is actually a good argument:
      https://www.facebook.com/photo.php?fbid=588668964517454&set=a.470308316353520.123122.189094991141522&type=1&comment_id=2008765&offset=0&total_comments=6

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    2. I've tried to provide Stan with the evidence that his statements are unfounded (see link above), however he obviously is a big fan of FANNZ and as such, the evidence is unimportant to him.

      For other interested parties, I will post a rebuttal.

      “Unlike topical fluoride, systemic fluoride (fluoridated water, oral tablets) has been proven to be ineffective in lowering dental decay rates.”

      There are a few problems with this statement. The first being that water fluoridation IS a topical treatment. This is very well understood in the research, and it is frankly astounding that dentist would be unaware of it. Drinking fluoridated water results in an increase in concentration of fluoride present in saliva and the biofilm on the tooth, which maintains fluoride exposure after the water has been consumed. (Ten Cate, 1999, Featherstone, 2000, Ten Cate, 2004, Buzalaf, et al., 2011).

      “In fact, Iona, there are many credible evidence-based studies around. Please take the time to look at WHO (World Health Organisation) data on DMFT (decay trends) in 12 year olds from eight countries (including NZ), 1970 to 2010. In 2010, Belgium (a non-fluoridated country) has the lowest decay rate, and New Zealand (fluoridated) has one of the highest decay rates”

      Any reputable scientist knows the limitations of comparing dissimilar populations with each other. This is also true for dental research as dental cultures are known to play a very significant role in determining dental health of communities (Källestål, et al., 2007). For this reason caution needs to be applied when comparing the very dissimilar Belgium and NZ communities. While it is possible for a community to achieve greater dental health through alternative methods such as dental hygiene and dietary education and investment into school dental clinics, water fluoridation remains a great tool in the arsenal of those wishing to provide community dental health. Given the low price (around 50c per person per year) it is also extremely cost effective compared to alternatives. Stan however seems to ignore more appropriate research into the effectiveness of water fluoridation. Take the Armsfield (2010) study of over 100 thousand Australian children that found a ~30% reduction in dental carries in fluoridated communities. For research at home he could have read Lee & Dennison (2004) Mackay & Thomson (2005), Kanagaratnam, et al., (2009) or Gowda, et al., (2010). Then there are international meta-analysis (Griffin, et al., 2007, Parnell, et al., 2009, Rugg‐Gunn & Do, 2012) and they all say the same thing. Water fluoridation is very effective. Instead Stan chooses to cherry pick two incomparable nations, the only explanation of such behaviour, is to be deceitful.

      “Recent studies suggest links between water fluoridation and in particular bone and thyroid diseases.”

      Uncited evidence is as good as no evidence. Considering Stan’s lack of intellectual integrity previously in his statements, this claim should be taken with a large grain of salt. There is no known negative effect on bone health from fluoride at concentrations achieve by water fluoridation (McDonagh, 2000). However, there is a significant reduction in fracture risk for communities with water fluoridation, compared to those without water fluoridation (Li, et al. 2001, Vestergaard, et al. 2008). This means that water fluoridation in fact strengthens bones. As for the claims about thyroid function, these are difficult to respond to in the absence of cited literature. I suggest that Stan is has been so misled that he is confusing water fluoridation with naturally occurring high source of fluoride, or fluoride overdoes via other mechanisms. While high fluoride concentration are known to have health effects, the required concentrations are much too high to any relevance to discussion of water fluoridation. This is an unfortunate consequence of an individual whose ‘research’ does not extend beyond water fluoridation propaganda.

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    3. “Medicating the public water supply goes against basic medical ethics: the fundamental principle of pharmacology is the right medicine, in the right dose, and at the right time for individuals requiring meds.”

      I will leave this to a man much more eloquent than myself:

      "We should ask not are we entitled to impose fluoridation on unwilling people but are the unwilling people entitled to impose the risks, damage and costs of failure to fluoridate on the community at large. When we compare the freedoms at stake, the most crucial is surely the one which involves liberation from pain and disease. " - John Harris (1989)


      References:

      Armfield, J. M. (2010). Community effectiveness of public water fluoridation in reducing children's dental disease. Public Health Reports, 125(5), 655.

      Gowda, S., Thomson, W., Page, L. F., & Croucher, N. (2010). Caries Experience Before And After Fluoridation In New Zealand. The Preliminary Program for IADR General Session.

      John Harris (1989) The Ethics of Fluoridation. British Fluoridation Society. http://www.bfsweb.org/facts/ethics/ethicsharris.htm

      Källestål, C., Wang, N. J., Petersen, P. E., & Arnadottir, I. B. (1999). Caries‐preventive methods used for children and adolescents in Denmark, Iceland, Norway and Sweden. Community dentistry and oral epidemiology, 27(2), 144-151.

      Kanagaratnam, S., Schluter, P., Durward, C., Mahood, R., & Mackay, T. (2009). Enamel defects and dental caries in 9‐year‐old children living in fluoridated and nonfluoridated areas of Auckland, New Zealand. Community dentistry and oral epidemiology, 37(3), 250-259.

      Lee M., Dennison P.J. (2004). Water fluoridation and dental caries in five- and 12-year-old children from Canterbury and Wellington. New Zealand Dental Journal 100(1): 10–5.

      Li, Y., Liang, C., Slemenda, C. W., Ji, R., Sun, S., Cao, J., Emsley, C. L., Ma, F., Wu, Y., Ying, P., Zhang, Y., Gao, S., Zhang, W., Katz, B. P., Niu, S., Cao, S., & Johnston, C. C. (2001) Effect of longterm exposure to fluoride in drinking water on risks of bone fractures, Journal of Bone and Mineral Research, vol. 16, no. 5, pp. 932-939.

      MacKay T.D., Thomson WM. (2005). Enamel defects and dental caries among Southland children. New Zealand Dental Journal 101(2): 35–43.

      McDonagh, M., Whiting, P., Bradley, M., Cooper, J., Sutton, A., Chestnutt, I., Misso, K., Wilson, P., Treasure, E., & Kleijnen, J. (2000), A Systematic Review of Water Fluoridation. British Medical Journal, 321(7265), 855-859.

      Vestergaard, P., Jorgensen, N. R., Schwarz, P., & Mosekilde, L. (2008). Effects of treatment with fluoride on bone mineral density and fracture risk-a meta-analysis. Osteoporosis international, 19(3), 257-268.

      Buzalaf, M. A. R., Pessan, J. P., Honório, H. M., & Cate, J. T. (2011). Mechanisms of action of fluoride for caries control. Fluoride and the oral environment, 97-114.

      Featherstone, J. D. (2000). The science and practice of caries prevention. Journal-American Dental Association, 131(7), 887-900

      Ten Cate, J. M. (1999). Current concepts on the theories of the mechanism of action of fluoride. Acta Odontologica, 57(6), 325-329

      Ten Cate, J. M. (2004). Fluorides in caries prevention and control: empiricism or science. Caries research, 38(3), 254-257

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    4. Stan must admit that he holds a position at odd with the MOH, with the WHO, with the CDC, the hundreds of reputable health organisation (http://www.ada.org/4051.aspx), with the York report (2000), the NHMRC report (2007) and the NFIS reports (2013), and with all the other research I have cited in this discussion.

      As Carl Sagan said "Extraordinary claims require extraordinary evidence".

      Where is his evidence?

      References:

      McDonagh, M., Whiting, P., Bradley, M., Cooper, J., Sutton, A., Chestnutt, I., Misso, K., Wilson, P., Treasure, E., & Kleijnen, J. (2000), A Systematic Review of Water Fluoridation. NHS Centre for Reviews and Dissemination, University of York, York

      National Health and Medical Research Council (2007). A Systematic Review of the Efficacy and Safety of Fluoridation. Australian Government, Canberra.

      NFIS (2013). Review of Scientific Papers, Relating to Community Water Fluoridation. Regional Public Health. Wellington.

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  2. Andrew you can post individual experiments and old science reports till the cows come home The large scale, long term stats and the world's top scientists are against you.You know as well as me how science and stats can and are bought. Therefore the large scale population studies supercede all you put up and they say fluoride in water does not work and it toxic. Coupled with that is the bad science used by the pro faction - causal correlation and the precautionary principle are out the window, The bottom line is this. There is dissension about this so leave it ou till safety and efficacy are shown to be in your favour. Truth is and you know it that this will never happen - but the opposite Hown dare you put your ego and pocket above people's health!

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    1. "and old science reports"
      2013 is old? And just because it is old doesn't mean it is no longer true.

      "The large scale, long term stats and the world's top scientists are against you."
      I really suggest you read the papers he posted. There are systematic reviews in there that use a LOT of studies.

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  3. sorry for spelling glitches couldn't see till posted

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