The CDC (Centre for Disease Control) lists water fluoridation as one of the ten great public health achievements of the 20th Century. Today, Dublin City Council will vote on whether to remove fluoride from our water supply, and when they do, it will not be because the CDC or the WHO have changed their mind about fluoridation, or because new and compelling information makes it the only choice. It will be because people who believe in angel healing, homeopathy, and chemtrails, have somehow gained the ability to influence public policy.
It never ceases to amaze me that, in matter of public health, the debate is more often informed by people who believe everything they read on the internet. Celebrities with a cause-du-jour and an audience are given more time and attention than scientists, doctors, or even just people who understand basic chemistry, and realise that not all scientific papers were created equal. It leads to invented medical scandals (such as the disproven MMR autism link), and poor decisions (such as the one the council may make tonight), and it’s really past time that it stopped.
The past few weeks have seen a number of claims made about fluoride, and I’ve been doing my best to counter them with evidence as they’ve appeared. Here are some of the most common issues presented to me every time I post a tweet using the word fluoride.
Is fluoride damaging our health?
In brief, all of the best evidence says no. Dental fluorosis is the most common side effect from fluoridated water, and it is almost always solely cosmetic. Lots of claims have been made about fluoride affecting brain development, affecting IQ, affecting bone growth – and all of these claims just don’t really apply to water fluoridation. Studies which claim to show adverse effects of fluoride are typically using concentrations of fluoride far higher than what is permitted in our water supply, and the concentration in our water supply is monitored. In high concentrations, fluoride absolutely can cause significant health problems, but these concentrations are hundreds of times more than what is currently in our water supply.
What about these countries that don’t fluoridate?
There are lots of reasons that a country may not fluoridate their water. In some cases, it is because they fluoridate alternatives, such as milk or salt (e.g. Germany, Switzerland). In other cases, it is because their water is naturally fluoridated (e.g. France, Argentina, Mexico, and many more). In still more cases, it is because the government has decided to approach dental health in a different way. No countries have yet decided to ban fluoridation because the angels told them it was a form of mind control, although Ireland seems to be teetering on the brink of gaining this dubious title.
This country doesn’t fluoridate, and their dental health is fine. What gives?
Systematic reviews (large studies which look at all of the data available) have concluded that water fluoridation results in a fewer children presenting with cavities, decreased decay, fewer missing teeth, and have concluded that it is responsible for significant cavity prevention across the population. But dental health is not a single point issue – many factors affect dental health, and water fluoridation is just one of them. Countries which have excellent dental health without fluoridation also typically have very robust dental health programs, providing free or inexpensive dental care for children, ensuring that they see dentists regularly, thus keeping the cavities down without fluoride.
More studies have also shown that dental health is highly linked to socio-economic status – in other words, families who cannot afford regular dental care, and do not have it provided for them by the state, tend to have more dental problems. Without fluoridation (and given no alternative), these families are disproportionately affected.
Water fluoridation is not a silver bullet for dental health problems, but without a dental health system which allows equal access to effective care (through school programs, subsidised or free care, etc.), it is one of the best solutions we have. Removing water fluoridation without implementing one or more solid alternatives is a recipe for disaster.
It should be my choice to fluoridate. I don’t approve of mass medication.
The mass medication issue is a tricky one, and like a lot of ethical issues, it is far from black and white. You could argue that a government has a responsibility to protect the health of its people, and that it should provide dental health care to do so (because poor dental health affects many areas of an individual’s life). And many people believe that it would be better if a government provided this through improved dental care system, and I’m inclined to agree. Where that cannot be provided, however, what is a government to do? Fluoride has been shown to help dental health, and if you agree that a government has a responsibility to do its best for the health, life, and wellbeing of its people, shouldn’t they use it?
Mass medication is an ethical dilemma– even if it is shown to benefit people, and cause little or no harm. It is a debate that needs much consideration, but it is a debate that deserves better than scaremongering tactics, false information, and outright lies.
(Edit: 1/10/14 – edited to add some some supporting info: in a 1965 court case, the Supreme Court decided that water fluoridation did not constitute mass medication. The term is inaccurate, and designed to scare people, and used here only because it is the term that will be used most often by those who oppose fluoridation. Water fluoridation is water treatment, not mass medication.)
The fluoride debate is an emotive issue, and because of this, it will probably continue to be controversial. The controversy, however, merely makes it even more important that our politicians do not bow to pressure from scare-tactic groups and appeals to emotion, but decide based on the best available evidence. And that evidence is pretty clear – just ask the WHO, the CDC, the ADA…
My name is Jennifer Keane. I studied at Maynooth University where I was awarded my BSc, and then at the Open University, where I received my MSc. I’m passionate about the truth, about science, and about education. I’m the Girl Not Against Fluoride. I won’t pose in my underwear, but I do have my very own superhero costume. It is my graduation robes, because I am qualified.