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Should Fluoride 2223

Should Fluoride 2223

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Should Fluoride be added to drinking water in the UK?

1.1 Introduction Fluoride has been added to drinking water in parts of the UK since the 1960 s, and today approximately 5 million people in the west Midlands, Yorkshire and Tyneside receive water with added fluoride. The UK s first fluoridation scheme took place in Birmingham and Solihull in a bid to increase dental health in areas of deprivation. Recent scientific studies have sought to establish a fluoride / cancer connection. So, whilst the current Health Secretary puts pressure on health chiefs in areas of very high levels of tooth decay to proceed with fluoridation, there is a growing opposition who claim, the entire population will be medicated because a small minority fail to brush their teeth. 1 Some doctors argue that while fluoridation would cut the levels of tooth decay in children, the long-term medical consequences are unknown.

Figure 1.Chris Neurath,


Figure 1 demonstrates relative rates of tooth decay in fluoridated and unfluoridated nations. Although all four nations with fluoridated drinking water are in the lower part of the graph with the least tooth decay, there is not a great disparity between the fluoridated and unfluoridated nations. Whilst the lowest incidence of DFMT (decayed, missing or filled teeth index) is in Australia , which is just under 70% fluoridated, the next five countries with the lowest level of DFMT are unfluoridated.

1.2 Biological Methods and Processes Data collected for Figure 1 comes from oral health surveys undertaken by WHO (World Health Organisation).2 To achieve standardised and valid results the Oral Health Survey devised a basic method as follows: Examination with a plane mirror and explorer was used to keep a consistent methodology. The recording of the data was standardised in the following way: the assessment of each individual s teeth was recorded consistently with the use of universal codes and with the use of condition charts (see figure 2). The WHO adviseexaminers to take a systematic approach proceeding from one tooth to the adjacent. When any part of the tooth is visible or can be touched with the explorer it should be considered present. If a permanent and a primary tooth occupy the same tooth space, the status of the permanent tooth only should be recorded. Dentition Status A numerical coding system is used for recording the status of permanent teeth and an alphabetical coding system for primary teeth. An entry must be made in every box on the chart. Codes for the dental caries status of primary and permanent teeth are as follows:

1 2

The Times, 3 February, 2008 World Health Organisation 2004 Chris Neurath, FAN http://www.whocollabo.mah.se/


individual response. any other reason F 6 Fissure sealant G 7 7 Bridge abutment. with decay D 3 3 Filled.eirco fluoride sources such as brick tea or pollution m.net from high fluoride coal. The severity of dental fluorosis depends on the amount of fluoride exposure. 1. Although water fluoridation can cause fluorosis. fluorosis appears as tiny white streaks or specks that are often unnoticeable. as well as cracking and pitting of the teeth.pwista. or by exposure to other Fluorosishttp://homepage. The critical period of exposure is between 1 and 4 years old. 8 8 Unerupted tooth (crown) / unexposed root. replenishing the calcium and phosphorous that keep your teeth hard. This process is caused remineralisation.Basic methods". most of this is mild and not usually of aesthetic concern. After you eat. and nutritional and other factors. special crown or veneer implant. helping to strengthen your teeth and prevent dissolution during the next demineralization phase. An Excess of Fluoride Can Cause Dental Fluorosis Figure 3 Diagram of effects of fluoride on enamel Dental fluorosis is a health condition caused by a child receiving too much fluoride http://www. the age of the child. Fluoride works during the demineralisation and remineralisation processes that naturally occur in your mouth. When fluoride is present during remineralisation.3 Validity of Methods 2 . In its severe form it is characterized by black and brown stains.com during tooth development. children over age 8 are not at risk. At other times when your saliva is less acidic it does just the opposite.Code Condition/status Primary Permanent teeth teeth Crown Crown Root A O O Sound B 1 1 Decayed C 2 2 Filled. In its mild form. Fluoride helps to harden the enamel on adult teeth that have already emerged. T T Trauma (fracture) 9 9 Not recorded Figure 2. Severe cases can be caused by exposure to water that is naturally fluoridated to levels well above the Figure 4 Dental recommended levels. which is the most common. helping to harden the enamel on baby and adult teeth before they emerge. How Fluoride Helps Fluoride concentrates in the growing bones and developing teeth of children. no decay E 4 Missing as result of caries 5 Missing . the minerals deposited are harder than they would otherwise be. Geneva 1987. your saliva contains acids that cause demineralisation a dissolving of the calcium and phosphorous under the tooth's surface.Extracts of the Third edition of "Oral Health Surveys .

The extent of this underestimation varies with disease prevalence and the number of restorations in the population. This study also compared the level of tooth caries in Australia s 12 year olds with those countries who have comparable national data available. The problem with this method for such a huge study is the expense of machinery and training along with the ris of exposing participants and dentists to small levels of radiation. the low tech collection of data probably results in underestimation of caries The WHO admits this Radiography is not recommended because of the impracticability of using the equipment in all situations It should be reali ed. The12-year-old DMFT SiC was 7. J.0 or more (and especially if there are districts where it is greater than 2. and where the local water treatment works serve populations of at least 200. J. the graph generali es countries by using the mean average. 2. Spencer. the Significant Caries Index. A.od. WHO Techn cal Report Series No 846. University of York. several individuals have a high number of caries. that without radiographic information the need for restorative care will be underestimated. 6The researchers discovered that among 12 year olds. GD Slade. it showed there was huge variation in DMFT values for individuals. the validit of the methods can be questioned on two counts Firstly. York: York Health Economics Consortium.html The Significant Caries Index is calculated as follows: y y y Individuals are sorted according to their DMFT values One third of the population with the highest caries scores is selected The mean DMFT for this subgroup is calculated.An Economics Perspective. Aboriginal and Torres Strait Islander children from the Northern Peninsula area of Queensland had more than four times the caries experience of Australian children for both 6 -year-olds and 12-year-olds. 3 Radiology produces a 3D image of the tooth structure so that any damage to the tooth below the gum-line can be identified. 5 A national study was conducted in 2002 in all Australian states and territories except New South Wales.This is clearly demonstrated in the case of the Aboriginal population in Australia. This means that a proportion of twelve year olds still have a high or even very high DMFT value even though a proportion is totally cariesfree. 2008-9 it was estimated that the actual 3 4 http://www. 6 7   . Sanderson D.8 in 2002. 4 was introduced in order to bring attention to the individuals with the highest caries values in each population under investigation. University of Adelaide. Firstly. The Child Dental Health Survey. missing or filled teeth per child (DMFT) is 2. the economic benefits of fluoridating water are that for a very little financial resource. Ibid. Secondly. They placed Australia 7th and concluded that children from areas with drinking water with negligible fluoride had poorer dental health than children from areas with either naturally or artificially fluoridated water. as noted in Figure 1. however.1 Implications of the Biology There are economic and ethical dimensions to this argument. it was discovered that they had around five and a half times the national average of DMFT.000 peoplethe benefits of water uoridation are likely to be signi cantly greater than the costs. Geneva: World Health Organisation. where it might be the case that different parts of the country may have chosen differently about the fluoridation of drinking water. Australia. World Health Organisation Expert Committee on Oral Health Status and Fluoride Use. In 1998 the University of York Health Economics Consortium undertook a further detailed examination of the costs and benefits of water fluoridation and concluded: In areas where the average number of decayed. the National Health Service ( NHS) can instigate preventative measures against tooth decay.whocollab.. G. when detailed analysis of the caries situation in many countries was carried out it showed that there is a skewed distribution of caries prevalence.mah. but when a new index. D. Clearly.se/expl/orhsurvey. This factor was also shown to be more influential than the socio -economic status of the children. Dental caries was a significant problem for these remote communities. (1998): Water Fluoridation .9 per cent of 12-year-old children had DMFT that equaled 0.Fi u 1 gi s an extensi e overview of the DMF status of fluori ated countries against the unfluoridated countries Although this gives the broadest possible data on the matter. the mean DMFT value does not always accurately reflect this skewed distribution leading to the incorrect conclusion that the caries situation is controlled while in reality.08. Australia has one of the lowest levels of DMFT at 0. (1994): Fluorides and Dental Health. and only 28. M.6). 7 In Southampton and West Hampshire.. (2002) Water Fluoridation and Children s Dental Health. The WHO noted the limitations of this study. over 40% had some history of decay in their permanent teeth and in those 10% with the most pronounced level of tooth decay. 5 Armfield.

28 Feb 2009. The right to fluoride free water is not a basic civil right we should ask not are we entitled to impose fluoridation on unwilling people. The Times. Those who question the wisdom of adding fluoride to the water suggest that It is not enough that you were unable to show it did cause cancer. University of Manchester. which must be carried out under general anesthetic. it is an ethical and economic debate. NHS Report. It is estimated that each tooth saved would cost just £0. 3 Feb 2008 10 ibid 11 World Health Organisation Expert Committee on Oral Health Status and Fluoride Use. In certain areas. (1998) The Ethics of Fluoridation.newmediaexplore r. 12 Abacus International.org/chris/Yiamouyiannis. As the kidney accumulates more fluoride than other soft tissues. (o = nonfluoridated before 1969. (2008). Those in favour point to the increased health and wellbeing of huge numbers of children.jpg 9 ¤ ¡ 8 Jon Reeve. Thereby cutting down on the dental work children will need in the future at a huge cost to the public purse. there is a concern that an excess of fluoride causes damage to the kidney and in turn the bone and other organs. (1997). a small risk can affect a large number of people.2million for the upkeep of the scheme. 15 Those that believe fluoridation is at best ineffective and at worst dangerous to health quest ion the moral justification of Fluoridation. Fluoride: Risks and Benefits. W O Tech ical Report Series No 846. also estimated that over the next 20 years it will cost £1. This makes it particularly expensive. Fluoridation of Manchester s water supply could redu ce demand for tooth extraction under a general anesthetic by between 35% and 67%. but are the unwilling people entitled to impose the risks. Southampton: The Real Cost of Fluoride . Professor John Harris from the Centre for Social ethics and Policy argues that. For him. Colqhuoun (2006) cited in Chris Neurath. The late Dr Colqhuoun asked How many teeth would you have to save to justify one child dying from osteosarcoma? 18 The Fluoride-Cancer connection has been investigated since the1950s. The onus would be on you to show that is does not cause cancer . University of Calgary. (1994): Fluorides and Dental Health. 14 The Times.fluoridation of the water supply would cost £471. Daily E ho. Some scientists also consider there is a link between fluoride and kidney disease. Costs and Benefits. the Health Secretary argues that the government has a duty to prevent tooth decay in areas of high deprivation9. Many believe that the adverse effects have been suppressed.32 12.8Alan Johnson. 2008 15 David R. The Fluoride Action Network states that even the kidney foundation admits that kidney patients should be notified of the potential risk from fluorides and Figure 5 http://www. 11 Fluoridation is cost-effective as it reaches the entire target population and the population does not have to change their behaviourto receive the benefits. The Primary Care Trust. Canada 16 ibid 17 ibid 18 Dr. He sees fluoridation [as] an effective and relatively easy way to address health inequalities giving children from poorer backgrounds a dental health boost that can last a lifetime. damage. community water fluoridation is safe and cost -effective and should be introduced and maintained wherever it is socially acceptable and feasible. Fluoride Action Network £ ¢ 4 . and the costs of failure to fluoridate on the community at large. (this does not include the £140.000 for public consultation). PCT. Hill. bringing the number of cases to between 500 and 1000 a year rather than the present 1500. 17 He adds that this means the addition of fluoride becomes completely unethical . In 1977 Yiamouyiannis and Burk carried out an ecological cancer mortality study of major cities and discovered overall cancer death rates continued climbing in fluoridated cities after fluori dation but started leveling off in never-fluoridated cities. o = fluoridated 1952 and thereafter). 3 February.13 The ethics of fluoridation are fiercely contested. especially as the most common treatment for tooth decay in children is extraction. 14 On the other hand the National Pure Water Association argues that The entire population will be forced to take medication because a minority fail to brush their teeth and these children are already being identified and treated in more effective ways .16 David R Hill argues that while the risk seems statistically negligible because the entire population is at risk. NHS South Central 13 Professor John Harris. Geneva: World Health Organisation. 10 The WHO endorses this view. tooth decay cost the NHS a significant amount. The Fluoride Cancer Connection.000.

5 mg for children aged 2-3 years and 0.3 Alternative Methods Method 1: The addition of fluoride to milk. Fluorine that is located in soils may accumulate in plants . McNee S. Results: Reductions of 72% were observed in the DMFT indices in the 3-6-year-old groups when comparing with children in the control group who did not receive fluoridated milk. vol. (1984). The advantages of fluoridated milk are that the child can have a measured dose of fluoride and the milk can be targeted at an age of high caries risk. fluorine will become strongly attached to soil particles.uk The Borrow Foundation seeks to promote the study and research into the fluoridation of milk and to publish and disseminate the results of such work.borrowfoundation. Children in a test group consumed 200ml of milk containing 1. Fluorine primarily accumulates in bones. The efficacy of fluoridated milk was tested by Steven et al in 198421.. Chile. showed that milk fluoridation programmescan be recommended as a preventative measure for caries. When the leave primary education they would stop ingesting fluoridated milk and therefore the suggested long-term risk of fluoride such as liver disease. A Community Trial of Fluoridated Powdered Milk in Chile . it can only change form. bone degradation and gastrointestinal problems. or absorbed through the leaves retards growth and reduces crop yields. The results were that in those children that had received fluoridated milk showed a reduction in the incidence of tooth decay by 31. allowing parental choice over the exposure of fluoride to their child.fluoridated drinking water. Method: Fluoridated milk was given to 1000 pre-school children in Codegua. In the environment fluorine cannot be destroyed. Five-Year Double Blind Fluoridated Milk Study in Scotland. This institution. Boyle I.223-229. 29 (6): 435-442 5 . Fluorine occurs naturally and fluoridation will only increase concentration fluorine around urban environments. Health Effects. 22 Marino R. When fluorine from the air enters the water cycle it will settle in the sediment. W. Since the 1950s fluoridated milk has been investigated and favorable results obtained from early studies lead to the establishing of the Borrow Dental Milk Foundation 20. http:/fluoridealert. They also believe there is a link between fluoride and liver damage. whereas those in the control group received 200ml of non-fluoridated milk. Too much fluoride whether taken from the soil by roots.. 0.2%. The daily fluoride dose from fluoridated powdered milk was 0. animals that are exposed to high concentrations of fluorine suffer from dental decay and bone degradation. children in the study group 19 20 Fluoride Action Network... bioaccumulation. Community Dentistry and Oral Epidemiology (2001).19 2. Guerrero S. T.. which has collaborated with the WHO on clinical trials and clinical studies with community preventative programmes. which is from 3 -12 years of age. Future generations could be exposed to fluoride when they are most vulnerable to dental caries for the years needed.75 for children aged 3-6 years. With plants that are sensitive to fluorine exposure even low concentrations can cause leaf damage and a declining growth.2 Benefits and Risks to Organisms and the Environment Scientists have proven that fluoridation of the water has widespread environmental implications. may accumulate large amounts of fluorine in their bodies.22 The objective was to investigate the efficacy fluoridated powdered milk and milk derivati ves on the dental caries prevention programme. using the standard National Complementary Feeding Program (PNAC). 2. brain damage. Boyle P. Consequently.. Those most affected are corn and apricots. A community trial of fluoridated powdered milk was tested in Chile in 1994-1999. When it settles in soils. The amount of uptake by plants depends upon the type of plant of the type of soil and the amount and type of fluorine found in the soil.org. The parent would give consent to whether the child receives fluoridated milk or non-fluoridated milk. Villa A. 12: pp.5mg of fluoride on school days.. This method allows health professionals to target vulnerable children and avoids medication of the entire population. Animals that eat fluorine-containing plants.org/ 21 Stephen K. kidney disease and cancers would all be vastly reduced if the risk were real. Campbell D. Cross-sectional samples of children aged 3-6 years were taken from Codegua (study community) from 1994 to 1999 and from La Punta (control community) from 1997 and 1999. In 1999. http://www. Community Dentistry and Oral Epidemiology.25 mg for infants aged 0-2 years.

Manchester and Ontario.e.scotland. This combination of qualitative and quantitative review techniques showed that dental health interventions have: a small positive. Method 2: Increased dental health education in young children. (1996) Is Dental Health Education Effective? A Systematic Review of Current Evidence. Costs and Benefits. In short the positive effects of our dentistry practice and dietary habits outweigh the effects of fluoridation on the DMFT values. especially among the most disadvantaged children and tooth brushing schemes are being targeted in deprived communities. Those conducting the trial concluded that under Chilean rural conditions. fluoridation of powdered milk distributed through the PNAC is an effective caries prevention alternative for areas where water fluoridation might not be feasible. Canada and Manchester. Fluoride has been added to the milk in 42 Primary Schools in Sheffield in response to the high levels of tooth decay (1. there are certain disadvantages with the use of milk to administer fluoride. J. Kay and D. The programme also offers dentists educational resources. not least because of the public consultation needed to impose an unpopular fluoridation scheme. It includedthe distribution of 38.0% to 48. Annual Review. On a practical level some children may not like milk. 23 Jeni Harvey Sheffield: Fluoride is added to children's milk in 42 primary schools Yorkshire Post October 14. the addition of fluoride to the drinking water in the UK. The National Smile Month in 2007 was supported by politicians. 25 Research undertaken in both Toronto.gov. That fluoride causes negative health risks to certain individuals is fiercely contested by scientists on both sides of the debate and the question remains. 231-235. In other words people know more about dental health.23 However. Bibliography Abacus International. pp. 24 25 British Dental Health Foundation. The financial case is hard to establish with any certainty. Towards Better Oral Health in Children. be lactose intolerant or may not drink milk for ethical beliefs i. NHS South Central.2010) 26 E. nurseries and playgroups disseminate oral health messages. (2007). no discernable effect on caries increment and a consistent positive effect on knowledge levels. Scottish Executive www. but temporary effect on plaque accumulation.uk (accessed 22. 6 . Tesco and several national newspapers. is an improvement in the dental health of the nation enough to justify the risk to a small percentage of that population? Using the data from the Chris Neurath WHO graph (figure 1). A larger issue than these administrative factors and the health factors are the political factors and the outcry of groups like FAN who oppose water fluoridation and would see the fluoridation of milk as mass medication. asked the question. The aim was to encourage everyone to brush his or her teeth thoroughly twice a day.2. vegan children.4%.000 guides to dentists. 24. NHS Report. Vol. (2008). the evidence points towards the invalidity of the addition of fluoride as the disparity between the DMFT values between fluoridated and unfluoridated nations has become negligible at present. Conclusion To conclude.showed 41% lower DMFTs than children in the control group.47) and to tackle the huge problem in the city s deprived areas (4. schools and pharmacies. This suggests there are too many other positive factors that deem fluoridation unnecessary regarding health and therefore would be a waste of economic resources. Locker. The promotion of dental health does not always reach the target audience. but it does not change their behavioursigni cantly. The proportion of caries-free children in the study group increased after 4 years of program implementation from 22. The British Dental Health Foundation24 and other charitable groups promote good dental health. 2008. Community Dentistry and Oral Epidemiology. In Scotland health visitors were encouraged to talk about good oral health in babies and young children. Is dental health education effective? Their conclusion from systematically reviewing current evi dence in both countries suggested that any improvement in dental health is at best temporary. England26. would prevent a significant number of dental caries.21 DMFT).72 which is higher than the national average of 1.

Spencer.vol. A.org. E. The Child Dental Health Survey. World health Organisation. Marino R. Neurath. University of York. The WHO. UK and Ontario. (2007).borrowfoundation. Eval ati This research was conducted by members of two Universities in Manchester. 29 (6): 435-442.ece World Health Organisation (2004) Chris Neurath.timesonline. Canada. D. Fluoride: Risks and Benefits. (1996) Is Dental Health Education Effective? A Systematic Review of Current Evidence. York: York Health Economics Consortium. J. British Dental Health Foundation. (1998): Water Fluoridation . 231-235.. Stephen K. (1998)...whocollabo. 2008. Boyle P. Sheffield: Fluoride is added to children's milk in 42 primary schools Yorkshire Post October 14. Geneva: World Health Organisation. J. Fluoride Action Network. WHO Technical Report Series No 846. it presents a relatively reliable source of data. Harris. The Ethics of Fluoridation Journal of Medical Ethics.. Community Dentistry and Oral Epidemiology. M. they also used qualitative data such as collecting data on knowledge and attitudes towards dental health. The research took the form of an in depth study into the various educational programmes in both countries and was peer reviewed. Campbell D. Villa A. J. Guerrero S. local anomalies would become insignificant and therefore give a more reliable outcome.se/ World Health Organisation Expert Committee on Oral Health Status and Fluoride Use. 3 February.Community Dentistry and Oral Epidemiology (2001). ¨  §¦  ¥ © Reeve. In addition there have been many contributions from many centres therefore findings are corroborated. University of Adelaide. Sanderson. McNee S. FAN http://www. Australia. (1994): Fluorides and Dental Health. 28 Feb 2009.. University of Calgary. Southampton: The Real Cost of Fluoride . is a speciali ed agency of the United Nations. W. and Locker. Hill. (1984). Five-Year Double Blind Fluoridated Milk Study in Scotland.. 24.. University of Manchester. (1997).An Economics Perspective.org.mah. D. 12: pp. Annual Review. 2008.. Web ites: The Borrow Foundation http://www. it is the Eval ati coordinating authority on international public health. http:/fluoridealert.. The Fluoride Cancer-Connection. Vol. The report makes clear that it has limitations so while the data is very broad and even flawed in places because of this. For example they measured the plaque on children s teeth and number of caries after health education. J. J. The Sunday Times. Harvey. http://www. It was both qualitative and quantitive data that was collected making the study more valid as it was both accurate and in depth. G.. T. J. D. GD Slade. R.223-229. D.. pp.uk  7 ..Armfield. Canada Kay. Minister orders fluoride to be added to water. Boyle I. Daily Echo. The work in this report is based on empirical evidence and the research has been extensively peer reviewed and the methodology in the public domain.uk/tol/news/uk/health/article3295310. A Community Trial of Fluoridated Powdered Milk in Chile .co.CommunityDentistry and Oral Epidemiology.. By looking at so many studies. C. (2002) Water Fluoridation and Children s Dental Health. but unlike the WHO study.

jpg  List of Fi res: 8 .org/chris/Yiamouyiannis.mah.gov. 2004 Chris Neurath.newmediaexplorer. but only sights research that substantiates its views on fluoride being toxic.com Figure 4. Articles are peer-reviewed.2010) Figure 1. FAN http://www. Figure 3.   Towards Better Oral Health in Children.net12 Figure 5 http://www.uk (accessed 22.Eval ati : The Fluoride-Cancer Connection. Figure 3 Diagram of effects of fluoride on enamel http://www.scotland.whocollabo. Extracts of the Third edition of "Oral Health Surveys . but only articles in agreement with this stance are published by FAN and therefore it must be concluded that this evidence is biased.eircom. World Health Organisation. So the article gives a detailed history of the research into fluoridated water.2. Scottish Executive www. Fluoride Action Network are an international coalition who say they are seeking to broaden public awareness of the toxicity of fluoride.pwista. Geneva 1987.se/ Figure 2.Basic methods". Dental Fluorosishttp://homepage.

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