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Fluoridation


Fluoridation Of Water

What Is Fluoride And Why Is It Good For My Teeth?

"Fluoride" is a compound of the element fluorine, which is found universally throughout nature in water, soil, air and in most foods. Fluoride exists abundantly in living tissue as an ion, and is absorbed easily into tooth enamel, especially in children's growing teeth. Once teeth are developed, fluoride makes the entire tooth structure more resistant to decay and promotes remineralization, which aids in repairing early decay before any damage is even visible.

Can Fluoride Affect My Health Negatively?

At low concentrations, Fluoride can be extremely beneficial, but it has a narrow margin of safety, and is detrimental to health at higher concentrations. This applies not only to human beings but also to animals and aquatic creatures. The beneficial concentration in water for humans is 0.7 to 1 milligram F- per liter or parts per million (mg/l or ppm) and 0.7 to 1.5 mg/l or ppm for animals.

Detrimental levels for humans start at 1.5 mg/l F- in drinking water When this amount is consumed over a long period of time (i.e. longer that a year), it will result in tooth staining. Damage to teeth and skeleton occurs at around 3 mg/l of F- according to the World Health Organisation. Death from acute fluoride poisoning may occur if the concentration of F- exceeds 100 mg/l. (Graphic from S J Bramhall (Dr. Chetan))

Dental fluorosis is the most common harmful effect of fluoride, and occurs during the early development of teeth. It is usually complete by the end of a child's fifth year and results in the discoloring of teeth. Once enamel has finished developing, dental fluorosis cannot occur and it has been concluded that fluorosis is no more than a cosmetic effect. In a mild case, fluorosis is hardly detectable and appears as slight white patches on the teeth. In a severe case, fluorosis causes mottling of the teeth, leaving permanent dark patches on teeth.




What Is Fluoridation?

Fluoridation is the process of adding fluoride to the water supply of a community, to reach optimum fluoride concentration of 0.7 mg/l, in order to preserve the teeth of the inhabitants. Tooth enamel ordinarily contains small amounts of fluorides and when the amount is augmented through the intake of fluoridated water, especially during the first eight years of childhood, tooth decay can be greatly reduced.

Is South African Water Fluoridated?

The Department of Health has legislated that water service providers are obliged to fluoridate water to a concentration level of up to 0,7 mg F-/l as of September 2003. As at 2006, according to the Client Care Service of the Rand Water, this has not yet been implemented and they do not fluoridate water, nor does any other water utility in South Africa. According to the Department of Health, the National Fluoridation Committee are currently (2006) adapting the old, and drafting some new regulations in terms of the new National Health Act. On completion of this process, the regulations will be published for commentary, after which they will be proposed to the Minister of Health, for promulgation.

What Is The Rand Water's Stance On Fluoridation?

Rand Water acknowledge the advantages of fluoride supplementation and do not wish to challenge the rationale for augmenting diets with fluoride. They will abide by regulations regarding fluoridation, however, they do express major concerns with the decision to fluoridate potable water. According to them the social and financial viability of fluoridating potable water supplies requires further consideration. It is therefore proposed by them that government reconsider the matter of fluoridating potable water supplies and that other options are investigated.

Rand water expressed the following concerns and recommendations on fluoridation:

  • Only 0,65% of Rand Water's supply to 10 million consumers is used for drinking purposes.
    Therefore fluoride added to 99,35% of potable water will be wasted insofar as the value of fluoride is concerned.
  • The mandatory fluoridation of water will cost water consumers in South Africa approximately R30 million per annum.
  • In spite of consumers paying R30 million per annum, fluoridated water will not reach all the target population since most people in rural areas do not receive piped water.
  • Alternative options as a means of augmenting diets of South Africans with fluoride require rigorous consideration. Examples of alternative options include supplementation of salt, maize meal, sugar and milk. If augmentation of dietary fluorides is done by methods other than water fluoridation it would enable consumers the freedom of choice and also limit the amount of fluorides returned to the environment as all the added fluorides will be used. Any consumer claims regarding possible health implications or impact on the environment, as a consequence of water fluoridation, will be referred to the Department of Health.
  • An inadequate level of public debate has occurred on the matter of fluoridation. It is recommended that the extent of debate be increased.

Is Water Fluoridation Safe?

Fluoride has proved to be a natural component with the remarkable ability to protect people of all ages against tooth decay. It has been incorporated into toothpastes, mouthwashes, supplemental fluoride tablets, and for more than 60 years to drinking water globally. However, together with positive results, Fluoride has had its share of criticism. It has been blamed for everything from cancer to kidney problems. However, according to the South African Dental Association there is no scientific proof for any of the abovementioned when fluoride is taken in at the correct small quantities to prevent tooth decay. In large uncontrolled amounts, it can be detrimental to health, but the public needs to differentiate between facts and propaganda since most of the statements made by those being opposed to the use of fluoride cannot be verified by controlled, scientific research.

One of the reasons that several thousand references on the study fluoride and the effect thereof on human health exist, is that over the years, people have made disturbing claims about fluoridation, none of which have been shown to be true. This has even been tested in courts of law: After one of the longest civil court cases in British history, the judge concluded that fluoridation was both beneficial and safe. The American courts, as well as the British courts, have ruled also that fluoridation does not impinge on any fundamental right.

The World Health Organization (WHO) made the following statement on Fluoridation:


"Water fluoridation in low fluoride-containing water supplies helps to maintain optimal dental tissue development & dental enamel resistance against caries attack during the entire life span. Fluoride in drinking water acts mainly through its retention in dental plaque & saliva. Frequent consumption of drinking water & products made with fluoridated water maintain intra-oral fluoride levels. People of all ages, including the elderly, benefit from community water fluoridation."

Professional And Scientific Support

More than 60 major international health organisations throughout the world support water fluoridation, including the:

  • World Health Organisation
  • International Dental Federation
  • Pan American Health Organisation, and
  • Every national dental association in the world

There is no doubt about the depth of professional and scientific support for fluoridation in South Africa. It is endorsed by the most authoritative dental and medical organisations including the:

  • The South African Dental Association
  • The South African Medical Association
  • Oral Hygienists' Association of South Africa
  • Dental Therapy Association of South Africa
  • Dental Assistants' Association of South Africa
  • Dental Traders Association of South Africa
  • International Association for Dental Research
  • World Health Organisation Collaborating Centre for Oral Health, University of the Western Cape
  • Medical Research Council
  • Community Health Association of Southern Africa
  • Nutrition Society of Southern Africa
  • Group for Environmental Monitoring
  • South African Society of Medical Oncology
  • Cancer Association of South Africa
  • National Council against Smoking
  • Centre for Health Policy, University of the Witwatersrand
  • South African Health and Social Services Organisation

The Ethics Of Water Fluoridation

Some opponents of fluoridation argue against it on the grounds that it is unethical. Do they have a point, or are they simply being emotionally up roused? John Harris, Professor of Applied Philosophy at the Centre for Social Ethics and Policy of the University of Manchester sees no dilemma about fluoridation. It is, he argues, perfectly ethical because:

  • It is a safe process which confers benefits on human beings (protection from tooth decay, one of the commonest diseases).
  • It does not in any way conflict with basic human rights (there is no such thing as the right to drink fluoride-free water, only a personal preference to do so; and there is, in fact, no such thing as fluoride-free water).
  • It is replicating a situation which occurs naturally (where fluoride already exists at the correct levels).
  • It does not have any harmful consequences (its safety has been demonstrated over sixty years of experience and by the wealth of endorsement from leading dental, medical and scientific organisations).

What About An Alternative For Water Fluoridation?

Fluoride toothpaste is used all over the world, but for people with a lower socio economic status, the relatively high cost means it is difficult to afford, and so it might not be used. A programme of subsidisation will be required to improve the availability of fluoride toothpastes to those communities most in need. Cost-saving measures such as the removal of VAT might even need to be considered. The effectiveness of fluoridated salt is about the same as that of water, but only when appropriate amounts are used. After appropriate studies are carried out on patterns of salt intake, fluoridation might be considered.

Fluoride can be applied topically to teeth by oral health professionals. Fluoride rinses, drops and tablets are also available. These forms of fluoride supplementation do however not guarantee a consistent intake and are much more expensive than water fluoridation. The greatest reductions in tooth decay have been shown where water fluoridation is available in addition to topical fluorides, toothpaste, and fluoride rinses. The question is also raised whether alternative methods of fluoride augmentation such as supplementing milk, sugar, or maize meal have been thoroughly investigated. These may also have a good chance of reaching the target population, especially if fluoridated foods are subsidised such that it is cheaper than non-fluoridated foods.

Sorting Out The Facts From Propaganda

  • Fluoridation does not cause kidney damage or allergic reactions
    According to the National Kidney Foundation of America, fluoridation does not harm the kidneys. The American Association for the Study of Allergy and the British Society of Allergy and Clinical Immunology both insist that there is no evidence of allergic reactions or intolerance to fluoride as used in water fluoridation
  • No association with cancer
    Nothing could be more calculated to frighten people than to suggest that something causes cancer. To show that fluoridation is a cause of cancer, it must be demonstrated, with accepted epidemiological methods, that it significantly increases the incidence of cancer in a community. So far, this could not be done. The studies that have been published that have made such claims have all been discredited for unscientific manipulation of the facts. Each time, the data was re-analyzed correctly, it was demonstrated to have been incorrectly and unscientifically manipulated to support a relationship that just does not exist.

    Throughout the world, the US National Cancer Institute, the Royal Statistical Society, Oxford University, the US Centers for Disease Control and Prevention, the National Heart, Lung and Blood Institute and the Royal College of Physicians have all refuted unanimously the claim that fluoride causes cancer. In South Africa the Cancer Association of South Africa and the South African Society for Medical Oncology support water fluoridation.

  • The ingestion of optimally fluoridated water over a lifetime does not adversely affect bone health
    Water fluoridation has no significant impact on bone mineral density. In 1991, a workshop, cosponsored by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institute of Dental Research, addressed the potential relationship of hip fracture and bone health in humans to fluoride exposure from drinking water. Researchers examined historic and contemporary research on fluoride exposure and bone health. At that time, they concluded there was no basis for altering current public health policy regarding current guidelines for levels of fluoride in drinking water. Recommendations were made regarding additional research in several areas. In 1993, two more scientific studies were published demonstrating that exposure to fluoridated water does not contribute to an increased risk for hip fractures. One study looked at the risk of hip fractures in residents of two similar communities in Canada. In this study, researchers compared a city with optimally fluoridated drinking water (1 ppm ) to a city whose residents drank water containing naturally occurring fluoride at a concentration of only 0.3 ppm. No significant difference was observed in the overall hip fracture hospitalization rates for residents of both cities. "These findings suggest that fluoridation of drinking water has no impact, neither beneficial nor deleterious, on the risk of hip fracture."

The second study examined the incidence of hip fracture rates before and after water fluoridation in Minnesota. Researchers compared the hip fracture rates of men and women aged 50 and older from 1950 to 1959 (before the city's water supply was fluoridated in 1960) with the ten-year period after fluoridation. Their findings showed that hip fracture rates had decreased, and that the decrease began before fluoridation was introduced, and then continued. These data demonstrate no increase in the risk of hip fracture associated with fluoridation of the public water supply in Rochester, Minnesota.

References:
http://www.randwater.co.za/CorporateResponsibility/WWE/Pages/WaterFlouridation.aspx (Nov. 2014)
SJ Bramhall. The Fight Against Fluoride: One We Can Win. OpEdNews.com
http://www.opednews.com/articles/2/The-Fight-Against-Fluoride-by-Dr-Stuart-Jeanne-B-110903-421.html (Nov. 2014)

Reviewed by JWe (2016)


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