Diesendorf's article "Toxic Chemicals-The Case Against Fluoridation" makes some points that perhaps we should all be concerned about.
(1) It is true that a fundamental principle of medicine in a civilized society is the freedom for every individual to consent or withhold consent. Fluoride medication in our water supply takes that freedom away.
(2) The fact that a low-grade industrial waste mixture is used to medicate our water supply is concerning. At the very least you would think that a medical grade, purified substance should be used. This should be enough for medical personnel and citizens of conscience to protest long and hard to government authorities involved with fluoridation.
(3) The length of the piece was not enough for much detail on the harmful effects of toxic fluoride, at the level found in drinking water. Diesendorf should be asked to write another piece on the evidence of harm to water consumers. It is remarkable that most fluoridation critics and clean water campaigners have been nobbled by intimidation, or conned by the relentless propaganda booklets etc that fluoridation officials produce.

This topic should be explored more, in this media and all media
David McRae
Geelong, Victoria

Firstly I must thank Dr. Diesendorf for his comments. I went to Pub Med and typed “Fluoridation” and obtained 5308 references. The British Medical Journal reported 604 references. Compared to these numbers the Australian Medical Journal was very modest indeed. So let me say at the onset I have no intention of reviewing this vast literature, which means that I am forced to “cherry pick.” Ok I agree this is not satisfactory and is a long way short of a formal meta-analysis.

However, I am impressed that dental authorities worldwide are supportive of fluoridation. Colin Rix and Diana Donahue in their paper in this series, point out that over 150 public health and scientific organizations support fluoridation. Ok, this is still anecdotal.
The editor of the Aust Med J ranks fluoridation among the 10 great public health achievements of the 20th century (1).

In a systematic review of water fluoridation McDonagh (2) included 214 studies, but none they state were level A (high quality, bias unlikely).

“Water fluoridation was associated with an increased proportion of children without caries and a reduction in the number of teeth affected by caries.”

The main adverse dental effect reported was fluorosis. However, they admit that reporting was subject to observer bias, because assessment is subjective. Further assessment may have included non-fluoride caused enamel opacities. There was statistical heterogeneity between studies.

It is legitimate to ask, why where the dentists of half a century or so ago, so impressed with “bed times stories?” I suggest it is because the results of fluoridation were so dramatic. Remember this was of an era before the medical community appreciated the importance of random controlled double blind trials. I suspect it was similar to the benefits of penicillin in the treatment of infection. The results being so much better then what had gone on before.

The rate of Tooth decay in young children is also reflects by levels of social deprivation and presumable this also implies poor dental hygiene. Jones (3) noted the association of dental caries with social deprivation. From they’re in studies in the North of England included Hartlepool (naturally fluoridated water) concluded that fluoridation was effective in improving dental health in the social deprived areas.

“The more deprived an area, the greater the benefit from water fluoridation.”

With regard to fractures and osteoporosis I will, if you forgive me, “cherry pick” a paper by Phipps (4) who concluded that, “long term exposure to fluoridated drinking water does not increase the risk of fracture.” Phipps (4) further makes the point that those studies that have reported an increased fracture rate in communities with added fluoride in drinking water had not controlled for smoking, estrogen supplementation or body weight etc.

Would an epidemiological comparison between Western Australia where water is fluoridated and Brisbane be of value? Such a study would have to consider respective rates of dental caries as well as the rates of alleged adverse effects. Some variables that come to mind include: topical fluoride (mouth washes, tooth paste) v systemic (drinking water) fluoride; social factors, (affluent v deprived areas); the risk factors for osteoporosis and so on. Such a study to have sufficient statistical power would be both expensive and difficult to execute.

Another study would be to conduct dental surveys in selected areas before and after withdrawing fluoridation. However, to many, this would rank as an unethical experiment. Because the most likely end-point of the intervention is a deterioration in dental health.

1. Van Der Weyen M. Whither public health? (Ed) Aust med J 2003; 178:193
2. McDonagh MS et al. Systematic review of water fluoridation.
BMJ 2000; 321:855-9.
3. Jones CM et al. Water fluoridation, tooth decay in 5 year olds, and social deprivation measures by the Jarmen score: analysis of data from British dental surveys. BMJ 1997; 315: 514-7.
4. Phipps KR et al. Community water fluoridation, bone mineral density and fractures: prospective study of effects in older women. BMJ 2000;321:860-4

Comment on Anti-green, Feb 12: Cessation of Fluoridation:

Anti-green suggests (final paragraph) that studies should be conducted of communities that have discontinued fluoridation. Indeed, that is a good indicator of whether fluoridation is of any value. Such studies have been done. Anti-green must have forgotten these studies if he/she has been keeping up to date on fluoridation over the years.
Where fluoridation has been discontinued in communities from Canada, the former East Germany, Cuba and Finland, dental decay has not increased but has actually decreased ( Kunzel et al 2000; Kunzel & Fischer 2000; Maupome et al 2001; Seppa 2000).

(1) Kunzel W, Fischer T, Lorenz R, Bruhmann S. 2000, Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dentistry and Oral Epidemiology 28: 382-9

(2) Kunzel W, Fischer T. 2000, Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Research 34: 20-5

(3) Maupome G, Clark DC, Levy SM, Berkowitz J. 2001, Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: 37-47.

(4) Seppa L, Karkkainen S, Hausen H. 2000, Caries Trends 1992-1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: 462-468

David McRae, Geelong, Australia

My daughter, now aged 28, is in the one percent of people who is hypersensitive to flouride. Unfortunately she lives in a Queensland city that is adds flouride to its water supply. It is almost impossible to get water without flouride without great expense. During a recent stay in hospital they were not able to cater to her need for unflouridated water.
Flouride should not be added to our water supply as it takes away our freedom of choice.

Dr. Mark Diesendorf is spot on with his concerns about fluoridation. Research clearly shows that water fluoridation has an insignificant effect on dental caries, yet is creating other problems, which also require dental treatment. Recent studies in South Australia and Western Australia align with overseas studies and show that the disease Dental Fluorosis is on the increase. A recent survey in the US (39,000 children from 84 communities) by the National Institute of Dental Research showed little difference in tooth decay among children in fluoridated and non-fluoridated communities. This study found an average difference of 0.6 Decayed Missing and Filled Surfaces in permanent teeth of children aged 5-17 residing in either fluoridated or unfluoridated areas.
A difference of less than one tooth surface as there are 128 tooth surfaces in a child's mouth.
Other health and behavioural problems such as arthritic and ADD/ADHD which have been linked to fluoride exposure are also on the increase and people waiting for treatment are also overloading our health system. Instead of washing the majority of the funds down the drain providing fluoridation plants and maintaining them, the Government should bite the bullet and provide effective dental care, not the cheap and poisonous fix, which has failed the community.
I have the greatest sympathy for those who are allergic to fluoride, their situation is being ignored by our health officials.
I am also highly concerned by the lack of consultation and lack of transparency and accountability by our various health ministers in Australia. They have been ill-informed by their advisors who have so much to lose if proven to be wrong about the addition of fluoride to the water supply. Those proponents of asbestos, DDT, lead in petrol, tobacco had to finally admit they were wrong, and at what cost to the community? Fluoride will soon join them.
The NSW minister for health for example is burying his head in the sand and can't find the time to meet with his constituents who oppose fluoride to hear their side of the argument.
Shame on our government leaders!
ST

Anti-green writes:

With regard to fractures and osteoporosis I will, if you forgive me, “cherry pick” a paper by Phipps (4) who concluded that, “long term exposure to fluoridated drinking water does not increase the risk of fracture.” Phipps (4) further makes the point that those studies that have reported an increased fracture rate in communities with added fluoride in drinking water had not controlled for smoking, estrogen supplementation or body weight etc.

In actual fact in this study Phipps found an INCREASED risk of wrist fracture, which she downplayed.

Anti-green should also do some more cherry-picking! I suggest he reads the study by Li et al. (2001) who examined the hip fracture rates in the elderly in six Chinese villages, with about 1000 subjects in each village. All the hip frcture rates were compared with the rates in the village at 1 ppm fluoride. They found little difference in the hip fracture rates in the two villages less than 1 ppm, but in the two villages with fluoride levels between 1.5-3.6 ppm the hip fracture rates doubled (but not statistically significantly) and tripled for the village between 4.3 and 7.95 ppm, which was statistically significant. The overall trend is clear, hip fracture rates increase as fluoride levels increase. There is no margin of safety here when you consider the intention is to have people drink fluoridated water their whole lives, and we cannot control the dose they get because a) we cannot control how much water people drink and b) we can't control the other sources of fluoride to which they are exposed.

In short, fluoridation is a clumsy and reckless form of medication, which is totally unnecessary now that fluoridated toothpaste is universally available. If there are families too poor in Australia to afford fluoridated toothpaste then it would make far more sense for the health authorities to provide free toothbrushes and free toothpaste to them, than to force this accumulative poison on the rest of its citizens.

Dr. Paul Connett,
Professor of Chemistry,
St. Lawrence University,
Canton, NY 13617