I am a dentist. I am against water fluoridation. As a dentist for me to say this openly is quite controversial and for many this may be challenging for them to accept or understand why a dentist would say something so outrageous and opposed to the norm of my profession.
When somebody’s beliefs are challenged they can react and become defensive and start to attack the messenger rather than look at and consider the message.
Recently I have copped some flack and received very heated comments and one might even say abuse on social media platforms over my stance on fluoridation.
So I wanted to set the record straight and explain that yes I am anti-fluoridation on many levels when it comes to adding fluoride to our drinking water supply.
Why I Say No To Fluoride
Community water fluoridation can be considered to constitute medical treatment because sodium silicofluoride is added to the drinking water to increase the concentration of fluoride ions for the therapeutic purpose of preventing dental decay in the population.
The target level of 0.75ppm of fluoride has been chosen to promote mineralisation of tooth enamel while minimising toxic side-effects such as dental fluorosis.
Adding fluoride to water differs from adding iodine to salt or folic acid to bread because fluoride is not a nutrient, no physiological reaction in the human body requires fluoride, and fluoride is not required for any aspect of human growth, development or reproduction.
To ethically justify treating whole populations without their consent, stringent conditions must be met with the treatment being clearly effective, the benefits conferred being greater than the harms caused, the treatment being necessary, the treatment infringing on individuals as little as possible and the treatment being publicly justifiable.
A recent review (Public Health Ethics) found there was insufficient ethical justification of artificial water fluoridation in Australia.
Peer-reviewed papers describing adverse health effects from fluoride show that:
- Water fluoridation caused dental fluorosis, stage I skeletal fluorosis with arthritis, decreased thyroid function particularly in individuals with inadequate dietary iodine intake, and adverse effects on the brain.
- Fluoride caused neurotoxicity with lowered IQ, including in children in a low iodine area with 0.88ppm of fluoride in their drinking water.
- Fluoridated water created a higher risk of the bone cancer osteosarcoma for young boys before the age of 20.
The efficacy of water fluoridation is modest. In other words the ability of fluoride to reduce or prevent dental decay is limited. In a 2009 New Zealand Oral Health Survey which noted that in 2008, for all of New Zealand, the 5-year-olds in fluoridated areas had a percentage caries-free rate of 58.7% compared to the rate of 55.0% for those in non-fluoridated areas. However, the 2011 figures show little difference, with the rate for fluoridated areas being 59.91% and that for non-fluoridated areas being 59.18%.
Medical treatments require informed consent, the adjustment of the dose to the needs of the individual and their response to treatment, and stopping the treatment if side-effects occur.
Although the level of fluoride in water can be controlled, the dose consumed by an individual cannot be, as it varies with the amount of water consumed.
As fluoride acts topically on teeth rather than systemically, applying fluoridated toothpaste is a more rational way of delivering fluoride to the teeth and avoids the ethical difficulties of water fluoridation.
The sensible public health decision is to discontinue water fluoridation and allow people to choose for themselves should they wish to ingest fluoride or not.