According to a report prepared by Public Health England (PHE) children in local authorities with water fluoridation schemes have less tooth decay than those in local authorities without such schemes (1). It also claims that as many as 45% fewer children aged one to four in fluoridated areas are admitted to hospital for tooth decay – primarily to have decayed teeth extracted under a general anaesthetic – than in non-fluoridated areas. The report concludes that there is no evidence of harm to health in fluoridated areas. PHE has found no differences between fluoridated and non-fluoridated areas in their rates of hip fracture, osteosarcoma (a form of bone cancer), cancers overall, Down’s syndrome births or all-cause mortality (all recorded causes of death).
So everything in the garden is rosy then! We can carry on with the policy of fluoridation and fluoride can be introduced into the water supply in areas which currently are not doing so.
It is important to appreciate that the figures which are being bandied about in the media are relative rather than absolute. Digging into the report it emerges that the actual rate of decayed teeth was 30% in fluoridated areas and 33% in non-fluoridated areas. These differences are very small and could well be due to other factors which have not been taken into consideration or may simply be due to chance. In any case these figures certainly do not demonstrate “cause and effect”. The values for hospital admissions are per 100,000 per year which means they are relatively small and therefore the differences may not be real. In any event they do not constitute proof that the low values are the result of the presence of fluoride in the drinking water.
Of much greater significance is the complacent assumption that fluoridation is undoubtedly beneficial and that there can be no possible adverse effects. It is very clear that much highly relevant but inconvenient information has been totally ignored.
The fundamental weakness in the approach adopted by the report is that dental caries is a very good indicator of other health problems in any given individual. There is widespread agreement that dietary sugar is one of the major causes of dental caries. But excess sugar is obviously the prime cause of diabetes (which has doubled in the last 15 years), obesity, kidney disease, heart disease and cancer. So that rather than fiddling about with fluoridation the public health authorities should focus their attention on reducing sugar consumption because of the beneficial effects that will have on general health. So even if fluoridation is effective, it is really only scratching the surface.
In addition, here are some facts that should certainly be of interest to those who are currently consuming fluoridated water and those who may be required to do so in the future.
The PHE report refers to a review of fluoridation conducted by the National Research Council of the US National Academy of Science (NAS) which was published in 2006 and implies that it provides support for the PHE conclusions. However Dr John Doull, who chaired the review, says that the safety of fluoridation remains “unsettled” and that:
“we have much less information than we should, considering how long it has been going on”.
Here are some of the issues which were identified in the NRC report (2):
- Fluorides have the ability to interfere with the functions of the brain and the body by direct and indirect means. Fluorides increase the production of free radicals in the brain through several different biological pathways. These changes have a bearing on the possibility that fluorides act to increase the risk of developing Alzheimer’s disease. The possibility has been raised by studies conducted in China that fluoride can lower intellectual abilities
- Evidence of several types indicates that fluoride affects normal endocrine function or response; the effects of the fluoride-induced changes vary in degree and kind in different individuals. Fluoride is therefore an endocrine disruptor in the broad sense of altering normal endocrine function or response
- Several lines of information indicate an effect of fluoride exposure on thyroid function
- Exposure to fluoride appears to bring about increases in blood glucose or impaired glucose tolerance in some individuals and to increase the severity of some types of diabetes. As diabetic individuals usually have higher than normal water intake, this means they will have higher than normal fluoride intake for a given concentration of fluoride in drinking water
- There is no question that fluoride can affect the cells involved in providing immune responses
- A few human studies suggested that high concentrations of fluoride exposure might be associated with alterations in reproductive hormones, effects on fertility, and developmental outcomes, but design limitations make those studies insufficient for risk evaluation
- The possible association of cytogenetic effects with fluoride exposure suggests that Down’s syndrome is a biologically plausible outcome of exposure
- Human kidneys concentrate fluoride as much as 50-fold from plasma to urine. Portions of the renal system may therefore be at higher risk of fluoride toxicity than most soft tissue
- Fluoride appears to have the potential to initiate or promote cancers, particularly of the bone
In the light of these conclusions the PHE statement that there is no evidence of harm is complacent in the extreme. The NRC review has clearly identified a range of possible harms that may be associated with fluoridation of the public water supplies. It is simply not good enough for the PHE to discount these possible risks in this way. It is blindingly obvious that there are huge gaps in our knowledge of the role of fluoride in the body. Hence a much more precautionary approach is needed, especially as the benefits are so marginal.
It would certainly be helpful if the UK government could explain why 97% of the population in Western Europe have water which has not been subject to the fluoridation process (3). It does not happen in Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, Netherlands, Northern Ireland, Norway, Portugal, Scotland, Sweden or Switzerland. Despite the lack of fluoridation the rates of teeth decay have fallen at least as fast, if not faster, than in those few countries where it is allowed. If the PHE report was to have any credibility it should have included these results from other European countries!