Q. WHAT IS FLUORIDATION?
It is the addition of a form of fluoride to the public water supply of an area, with the intention of protecting children’s teeth from decay, especially those who have a bad diet and don’t look after their teeth. About 5 million people in the UK currently receive artificially fluoridated water. Fluoridation was first introduced nearly 60 years ago in the USA.
Q. DOES LACK OF FLUORIDE CAUSE TOOTH DECAY?
No. Many people in areas of very low natural fluoride have excellent teeth. Diet and good dental care and hygiene are what prevent decay.
Q. WHAT IS ALL THE FUSS ABOUT?
There have always been questions about safety, and even about whether fluoride at 1 part per million does benefit teeth.
There is the ethical objection to people being treated against their will, since tap water goes to everyone and can’t be avoided.
And because of fluoride’s high toxicity there are environmental worries too.
Q. SURELY GOVERNMENTS WOULDN’T PUT SOMETHING IN THE WATER IF IT WASN’T SAFE OR DIDN’T WORK?
The government followed the United States in signing up to fluoridation many years ago, before proper scientific studies were done, under strong pressure from a dental profession convinced it had found a wonderful treatment for children’s teeth. It seemed an attractive and simple idea.
The trouble with public health policies that are promoted too soon and too strongly is that it becomes almost impossible for the authorities to retreat if later evidence undermines their claims. The temptation then is to save face by ignoring or suppressing whatever casts doubt on their policies, and only to let the public see favourable evidence. No doubts must be allowed.
Q. HOW DOES THIS APPLY TO FLUORIDATION?
It was only six years ago that the first and only thorough, systematic and transparently impartial scientific review of the evidence was conducted, to the highest international standards (the ‘York review’). This found that most of the assurances from earlier reports and public statements were wrong.
There was no good evidence to be found anywhere – all the studies were open to bias. Fluoridation appeared to work, though it was impossible to say with confidence what benefit (if any) it produced. Safety issues, and there were a number of these, had hardly been addressed. Around 1 in 2 people in fluoridated areas had mottled teeth, a quarter of these seriously so. From this it was clear that fluoridation had been promoted on a false basis.
Q. HOW DID THE AUTHORITIES RESPOND TO THE YORK REVIEW?
By saying they welcomed it, while doing their best to downplay or misquote it. They set up another body to second-guess York’s findings. The fluoridation lobby, remarkably, announced that York had confirmed fluoridation’s safety and effectiveness. The government continues to give the British Fluoridation Society £80,000 a year to further its work of promoting fluoridation. They now acknowledge that more research is needed since not enough is known about fluoridation, while at the same time encouraging its expansion.
Q. IF FLUORIDATION WERE HARMFUL, WOULDN’T WE HAVE NOTICED IT BY NOW?
No – not unless scientists had looked for the causes of illness among populations with the same care as they did with smoking fifty years ago (they guessed at first that lung cancer was caused by pollution on the roads). There are simply too many people, with too many medical conditions, following too many lifestyles, to see patterns just like that. Also, body levels of fluoride have been rising in un-fluoridated as well as fluoridated areas. Dentists and governments that have promoted the great benefits of a health policy have not been forward in doing studies which might undermine it.
It is easy to claim there is “no evidence of harm” if you haven’t looked for it. In fact some evidence has been gathered over the years. The quality was not good, and the results were mixed, but they were good enough for ‘York’ to recommend good-quality research into infant mortality, IQ, and congenital defects. Government have ignored these, but intend to investigate cancer rates in relation to fluoridation, and to monitor our total fluoride exposure more carefully. Anyone who says they know fluoridation to be absolutely safe is misleading the public.
Q. BUT 1 PART PER MILLION IS SURELY TOO SMALL A DOSE TO BE HARMFUL?
Not necessarily. Highly toxic substances reckon in parts per billion. If it can help, it can harm. Fluoride is known to have an unusually narrow margin of safety, with 4 ppm set as the USA’s “maximum contaminant level”, which a recent scientific report says is too high anyway.
1 ppm is not a “dose”: it is only a concentration. You get as much fluoride from water as you drink, and people in hot weather or with kidney ailments drink much more than others, and could be at greater risk. It is quite unlike the controlled dose that your doctor prescribes. Those who give you fluoride don’t know your medical history. And you take it for a lifetime.
Q. WHAT ABOUT THE ETHICS OF FLUORIDATION?
No person may be treated without their consent. This is a basic rule of medical ethics, restated in the Patients’ Charter, the Council of Europe Biomedicine Convention and the General Medical Council’s booklet on ethics. No one forces you to be vaccinated. No doctor can make you take a drug, even though it has been tailored to your needs and has been much better tested than fluoride. Governments are even wary about giving advice on healthy living for fear of being accused of nannying.
Fluoride is unique. No other treatment is given to you whether you like it or not. No one has explained why the bad teeth that some children have are so important that in this case everyone must be nannied, whether they have teeth or not.
Q. WE HAVE TO WEAR SEAT BELTS FOR OUR PROTECTION. ISN’T FLUORIDE SIMILAR?
No. Fluoridation is a specific medical intervention, for which individual consent is needed in our society. Besides, you are made to wear a seat belt for your own safety, whereas you are made to swallow fluoride to benefit somebody else – another extraordinary medical principle. Road accidents are also life-threatening: bad teeth are not.
Q. BUT IS FLUORIDE IN WATER A TREATMENT? ISN’T IT NATURAL?
It is not natural to take a different chemical form of fluoride and put it in the water at many times the usual level. Even with some vitamins – which fluoride is not – this could be dangerous for some people. Fluoridators say they are simple “topping up” to an “optimum” level. There is no good scientific support for this claim.
Anything given to modify “physiological function”, and with medical claims, is a medicine in European law. Fluoride in water was held to be a medicinal product under the Medicines Act 1968 in a famous Scottish law case in 1983. Governments have turned a blind eye to the legal requirements, probably because fluoridation would fail the safety and efficacy requirements of classification as a medicine.
Q. WHAT ABOUT THE ENVIRONMENT?
Governments are being urged to cut back on the unnecessary use of chemicals that get into the environment. Fluorides used in water have a number of drawbacks:
- they are highly toxic, and are classified as poisons under the Poisons Act 1972
- they are classified as hazardous to the aquatic environment under the EU Dangerous Substances Directive 1976
- over 99% of water from the mains misses its target of children’s teeth, and goes into baths, washing machines, gardens, industrial plants, and via leaks in the water mains direct into underground water.
Denmark and Sweden decided not to fluoride, partly because too little was known about its effects on the environment. Our own government has not begun to look at this issue.
Q. DO MANY COUNTRIES FLUORIDATE THEIR WATER?
No, very few. Fluoridation is practically unknown in Europe, most countries having given it up or decided not to fluoride in the first place. It is largely the English-speaking countries that have fluoridation schemes in some areas.
Q.IS IT TRUE THAT MOST PEOPLE IN THIS COUNTRY SUPPORT FLUORIDATION?
This is what the fluoridation lobby claim, but it has never been impartially tested and the government doesn’t want referendums on it. Opinion polls sponsored by the British Fluoridation Society have announced some 70% in favour, but sponsored polls are not reliable and the wording invited the answer “Yes”. Londoners are lukewarm, and the Scottish public (but not the health professions) very strongly against. In some 2000 local referendums in the first 35 years of fluoridation in the USA, 60% were against it.
Q. IF YOU ARE RIGHT ABOUT FLUORIDATION WHY DO DENTISTS AND OTHERS KEEP PROMOTING IT?
All professions and cultures have their blind spots and fixed ideas. The urge to do good can be very strong, especially towards the disadvantaged who have most tooth decay. Fluoridation is also attractive to the dental profession as a flagship that raises its profile in a positive way; it has never (as some believe) threatened dentists’ livelihoods.
But enthusiasm and do-goodery can get out of hand. Health professionals have been so sure about fluoridation for so long that they won’t hear anything against it, and can’t admit they were wrong. It has become a sacred cow.
Dentists make an emotional argument from the suffering of children, which is very genuine. But the real questions are whether fluoridation is ethical, whether it is safe, whether it actually works, whether it is cost-effective, and whether it is right to risk yet more environmental damage. The jury is still out on the last four.
Q. WHAT HAPPENS NOW?
Since the 2003 Water Act took away the water companies’ power to block new schemes, some areas have been gearing up to extend fluoridation. Decisions will be in the hands of Health Authorities, not elected councils, but since these are mostly long-term promoters of fluoridation they can’t be expected to give the public impartial information about their favoured policy.
Under new regulations they will have to consult you and take your views into account. They will have to weigh up your involvement with any new scheme, the way you put your case, and how strongly you feel. Only if there is strong support for fluoridation, says the government, will it go ahead.
Q. HOW CAN I FIND IMPARTIAL INFORMATION?
This has always been very difficult, since passionate opinions are held on both sides. Read what you can from either side, while being aware that government, dentists and Health Authorities, who have always been committed to fluoridation, have far greater resources for issuing information than do opponents.
The only true impartial source is on the scientific side, if you want to know about fluoridation’s effectiveness and safety: http://www.york.ac.uk/inst/crd/fluorid.htm gives you details of the ‘systematic scientific review’ conducted in 2000, which is as free from bias as you can get; http://www.york.ac.uk/inst/crd/fluoridnew.htm gives the reviewers’ later corrections of the public distortions of what they found. The reviewers are currently writing to the National Fluoride Information Centre, which claims academic independence and is headed by a dentist, about inaccuracies in the NFIC’s account of the evidence as well. So it is safest to stick to what the scientists from the ‘York review’ actually said, while making up your own mind on the ethics.