The Fluoride Debate

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TABLE OF CONTENTS

INTRODUCTION

HISTORY/
ENVIRONMENT

CENSORSHIP

THE FLUORIDE
DEBATE

BENEFITS
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

ALTERNATIVES
Question 9
Question 10
Question 11
Question 12


SAFETY
Question 13
Question 14

OVERDOSE
Question 15
Question 16
Question 17

DISEASES
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33

PUBLIC
POLICY

Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

COST
EFFECTIVENESS
Question 41
Question 42
Question 43

CONCLUSION

PUBLIC POLICY

Question 39.
Is community water fluoridation accepted by other countries?

ADA's Fluoridation Facts Short Answer
Yes. Water fluoridation is practiced in approximately 60 countries benefiting over 360,000,000 (three hundred sixty million) people.1

ADA's Fluoridation Facts Long Answer
The value of water fluoridation is recognized internationally. Countries and geographic regions with extensive fluoridation include the U.S., Australia, Brazil, Canada, Hong Kong, Malaysia, United Kingdom, Singapore, Chile, New Zealand, Israel, Columbia, Costa Rica and Ireland.79 The most recent countywide decision for fluoridated drinking water occurred in South Africa.225 Following the recommendations of the World Health Organization (WHO), the initial phase of the project is expected to reach 40% of the country's population. By the year 2000, the goal is to reach 60% of the population which is widely spread in rural areas. Some of the most thorough investigations of fluoridation have been conducted in Britain and Australia. These investigations have resulted in a significant amount of published documentation which supports the safety and effectiveness of water fluoridation.92, 94, 226 Considering the extent to which fluoridation has already been implemented throughout the world, the lack of documentation of adverse health effects is remarkable testimony to its safety.54, 92-96

The World Health Organization (WHO) and the Pan American Health Organization have endorsed the practice of water fluoridation since 1964. In 1994, an expert committee of WHO published a report which reaffirmed its support of fluoridation as being safe and effective in the prevention of tooth decay, and stated that "provided a community has a piped water supply, water fluoridation is the most effective method of reaching the whole population, so that all social classes benefit without the need for active participation on the part of individuals."82 In many parts of the world, fluoridation is not feasible or a high priority, usually due to the lack of a central water supply, the existence of more life threatening health needs and the lack of sufficient funds for start-up and maintenance costs.

Political actions contrary to the recommendations of health authorities should not be interpreted as a negative response to water fluoridation. For example, although fluoridation is not carried out in Sweden and the Netherlands, both countries support WHO's recommendations regarding fluoridation as a preventive health measure, in addition to the use of fluoride toothpastes, mouthrinses and dietary fluoride supplements.82, 227

Repeat of Question 39.
Is community water fluoridation accepted by other countries?

Opposition's Response

Twenty-five countries in Europe, with bodies of health professionals, scientists and public health agencies of their own, reject fluoridation, some with outright bans. (See 39-1: "Most Major Developed Countries do not Fluoridate Their Water Supplies," from Chemical and Engineering News, Vol. 66, Aug. 1, 1988, pp. 26-42). 98% of Europe is now fluoridation free. The two holdouts are represented by England, 10% fluoridated, and Ireland, 73% fluoridated. The second largest political party of the most fluoridated population in the world, Ireland's Fine Gael, reported the week of January 15, 2001, that they have established as a major platform the eradication of all artificial fluoridation in the country due to "serious health concerns," even directing that the amount of natural fluoride in the water be reevaluated.

"Most of the world has rejected fluoridation. Only America where it originated, and countries under strong American influence persist in the practice. Denmark banned fluoridation when its National Agency for Environmental Protection, after consulting the widest possible range of scientific sources, pointed out that the long-term effects of low fluoride intakes on certain groups in the population (for example, persons with reduced kidney function), were insufficiently known. Sweden also rejected fluoridation on the recommendation of a special Fluoride Commission, which included among its reasons that: 'The combined and long-term environmental effects of fluoride are insufficiently known.' Holland banned fluoridation after a group of medical practitioners presented evidence that it caused reversible neuromuscular and gastrointestinal harm to some individuals in the population." (See 39-2: Perspectives in Biology and Medicine, 41,1 - Autumn 1997, by John Colquhoun, M. D., past Principal Dental Officer of New Zealand's largest city, Aukland).

Statements on fluoridation by governmental officials from several countries:

To access the full, photocopied letters from which these statements came (except for France's & Luxembourg's), visit www.fluoridation.com/c-country.htm.

France
"Fluoride chemcials are not included in the list [of 'chemicals for drinking water treatment']. This is due to ethical as well as medical considerations." (Louis Sanchez, Directeur de la Protection de l'Environment, August 25, 2000.)

Luxembourgh
"Fluoride has never been added to the public water supplies in Luxembourg. In our views, the drinking water isn't the suitable way for medicinal treatment and that people needing an addition of fluoride can decide by there own to use the most appropriate way, like the intake of fluoride tablets, to cover their diary [sic] needs." (Jean-Marie RIES, Head, Water Department, Administration De L'Environment, May 3, 2000.)

Japan
"Japanese government and local water suppliers have considered there is no need to supply fluoridated water to all users because 1) impacts of fluoridated water on human health depends on each human being so that inappropriate application may cause health problems of vulnerable people, and 2) there is (sic) other ways for the purpose of dental health care, such as direct F-coating on teeth and using fluoridated dental paste and these ways should be applied at one's free will." (T. Nagayama, Environment Agency, Government of Japan, Mar. 8, '00.)

Belgium
"This water treatment has never been of use in Belgium and will never be (we hope so) into the future." (Chr. Legros, Directeur, Belgaqua Brussels, Feb.28, '00.)

Denmark
"We are pleased to inform you that according to the Danish Ministry of Environment and Energy, toxic fluorides have never been added to the public water supplies." (K. Werner, Danish Embassy, Washington, DC, Dec. 22, '99.)

Norway
"In Norway we had a rather intense discussion on this subject some 20 years ago, and the conclusion was that drinking water should not be fluoridated." (T. Krogh and T. Hofshagen, National Institute of Public Health, Oslo, Mar.1,'00.)

Sweden
"Drinking water fluoridation is not allowed in Sweden ... New scientific documentation or changes in dental health situation that could alter the conclusions of the Commission have not been shown." (G. Guzikowski, Chief Government Inspector, National Food Administration, Feb.28,'00.)

Germany
"In the former Democratic Republic (DDR) in several districts the drinking water was fluoridated but after the unification of both German states in 1990 fluoridation was stopped. In the Federal Republic of Germany there was in about 1952 a drinking water fluoridation experiment. But it was stopped after one or two years." (Dr. K. Ewing, Geschaftszeichen, Bonn, Feb.11, '00.)

Finland
"We do not favor or recommend fluoridation of drinking water. There are better ways of providing the fluoride our teeth need." (P. Poteri, Acting Managing Director, Helsinki Water, Feb. 7, '00.)

Austria
"Toxic fluorides have never been added to the public water supplies in Austria." (M. Eisenhut, Head of Water Department, OsterreichischeYereinigung fur das Gas-und Wasserfach, Feb. 17, '00.)

The full text of these statements can be accessed at: www.fluoridealert.org.

Despite the fact that these countries have decided against fluoridation, they have experienced the same significant declines in dental cavities as the United States has (which is around 70% fluoridated). See the World Health Organization chart below.

Table 1 : Declines in tooth decay in different countries. Based upon Decayed, Missing & Filled teeth (DMFTs) for 12-year-olds (WHO data).

Country
DMFTs
Year
DMFTs
Year
% Difference
Austria
1.0-3.5
1973
1.7
1997
+70, -51
Belgium
3.1
1972
2.7
1991
-13
Denmark
6.4
1978
1.2
1995
-81
Finland
7.5
1975
1.2
1994
-84
France
3.5
1975
1.9
1998
-46
Germany
6.0
1973
1.7
1997
-72
Greece
3.8
1959
1.6
1993
-58
Iceland
8.7
1980
1.5
1996
-83
Italy
4.0-6.9
1978-79
2.1
1996
-48, -70
Japan
5.9
1975
2.4
1999
-59
Netherlands
6.5-8.2
1974
0.9
1992-93
-86, -89
Norway
8.4
1973
2.1
1993
-75
Sweden
6.3
1977
1.0
1997
-84
Switzerland
2.3-9.9
1963-75
2.0
1987-89
-13, -80
United States
4.0
1965-67
1.4
1991
-65

Table 2: Current DMFT Status

Country
DMFTs
Year
Status
Australia
0.9
1996
fluoridated
Austria
1.7
1997
unfluoridated
Denmark
1.2
1995
unfluoridated
Finland
1.2
1995
unfluoridated
France
1.9
1998
unfluoridated
Germany
1.7
1997
unfluoridated
Greece
1.6
1993
unfluoridated
Iceland
1.5
1996
unfluoridated
Ireland
1.4
1993
fluoridated
Netherlands
0.9
1992-93
unfluoridated
New Zealand
1.5
1993
fluoridated
Sweden
1.0
1997
unfluoridated
Switzerland
2.0
1987-89
1% unfluoridated
United Kingdom
1.1
1996-97
10% fluoridated
United States
1.4
1991
fluoridated

Data from: World Health Organization (WHO) Oral Health Country/Area Profile Programme Department of Noncommunicable Diseases Surveillance/Oral Health WHO Collaborating Centre, Malmš University, Sweden www.whocollab.od.mah.se/euro.html

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