Fifty Years of Fluoridation: Part I
Few topics have polarised opinion more sharply than fluoridation of the water supply. In 1993 the then Health Secretary, Virginia Bottomley, told the annual conference of the National Association of Health Authorities and Trusts that it was time to go into battle to reduce tooth decay and cut NHS costs by extending the fluoridation of tap-water. (Brindle, D, 1993)
The privatised water companies have not all concurred. Yorkshire Water PLC, fearful of the risks of storing toxic and corrosive fluorides on the Companys premises and of possible litigation should harm result, tried to obtain an indemnity from the Government. When this was not forthcoming the Company announced (on April 11th 1995) its decision not to fluoridate. Welsh Water, North West Water and Southern Water have taken the same stance. (Vaughan,L, The Guardian, Letter , 22 September 1995).
According to the Concise Medical Dictionary (Oxford University Press) Drinking water with a fluoride ion content of one part per million is effective in reducing caries throughout life when given during the years of tooth development. (Martin et al,1990)
Not everyone agrees. The National Pure Water Association maintains that studies of over 39.000 children in the U.S.A.(National Institute of Dental Research data 1986 -87), over 60,000 children in New Zealand (1980 -1990, Colquhoun, J, former Chief Public Health Dental Officer, Auckland) and over 191.000 children in the U.K. (British Association for the Study of Community Dentistry 1994) demonstrate that there is no benefit from fluoridation.(N.P.W.A. Leaflet Official School Dental Data 1995)
The Environmental Health Reference Book states At levels of fluoride in drinking water greater than 5mg per litre the consumer may suffer from fluorosis which is hardening of the bones and mottling of the teeth. However, children who drink water containing 1 mg per litre of fluoride do not suffer from tooth decay and at this level of fluoride (do) not suffer from fluorosis. After the teeth have formed there is no further advantage in drinking water containing fluoride (nor in using fluoridated toothpaste compared to non-fluoridated toothpaste). The E.C. Directive on drinking water states a maximum concentration of 1.5 mg/litre (1.5 p.p.m.) of fluoride if the temperature is 8 to 12?C. At 25 to 20?C the maximum drops to 0.7 mg/litre.(Jackson et al, 1989)
G.V.Black and F.S.McKay drew the attention of the dental profession to mottled teeth in 1916. They were surprised that mottling was associated with lower levels of tooth decay and suspected that something in the water was responsible. By 1931 scientists had concluded that fluoride was the cause of both the mottling and the strengthening of the enamel. Epidemiological investigations were carried out in the U.S. by H.Trendley Dean and colleagues. Deans conclusion that the amount of tooth decay was inversely proportional to the prevalence of mottled enamel led to the adoption of a fluoride concentration of 1 mg/litre ( 1 p.p.m.) as optimal for the prevention of dental caries in temperate climates. (Waldbott, 1978 P 63 et seq.)
In 1940, after surveying teeth in St. David, Arizona where the natural fluoride in water ranges from 1.6 to 4.0 p.p.m., Doctors M.C. and H.V. Smith wrote:- Although mottled teeth are somewhat resistant to the onset of decay, they are structurally weak; when decay does set in the result is often disastrous. Few people over 21 had been found without caries, there was a high incidence of extracted teeth in all age-groups and 50% false teeth at ages 24 to 26. Drs. Smith commented on the difficulty of repairing the carious teeth in this district. (Waldbott, 1965, p 12)
In 1945, fluoridation experiments were started in Newburgh, Grand Rapids and seven other American cities. In Britain it was observed that caries in the permanent teeth of twelve-year-olds in North Shields (with 0.25 p.p.m. of fluoride in the water supply) was double the level in South Shields (with 1.4 p.p.m. fluoride.) (Picton,L.J., 1946)
Dr. Robert Weaver looked for further health benefits which he expected to accompany the improved dentition of South Shields. To his surprise he discovered that South Shields had a lower life-expectancy and a higher infant mortality than North Shields.
By 1948 he had concluded that fluoride merely delayed the onset of dental caries by one to two years and conferred no long-term benefit on teeth. (Weaver, R., 1948)
In America, however, the bandwagon of enthusiasm for fluoridation was already rolling and attracting zealous converts. A note of caution came from H.M.Sinclair, Director of the Laboratory of Human Nutrition at Oxford University. Pointing out the extreme toxicity of fluorine, he commented:- Slightly too much fluorine produces the condition of fluorosis, in which the teeth become stained brown and break, the bones of the spine become eroded and fuse together producing a stiff bent back-bone and changes occur in the kidneys. Slightly too little fluorine causes dental caries . . . a case may be made for adding the element to water supplies or to a foodstuff. This has in fact been done in certain communities in the U.S. . . . It should not lightly be undertaken since our knowledge of the effects is not sufficient and further research is required. (McCarrison, R. & Sinclair, H.M., 1953, P113)
Fluorosis as described by Sinclair is endemic in Kenya, Turkey, parts of India, Texas and Colorado where fluoride levels in water exceed 1.4 p.p.m. and may reach 7 p.p.m. It has been suggested that cases of osteomalacia (osteoporosis), ankylosing spondylitis, calcified ligaments and calcified excrescences on bones may be fluorosis but, in the absence of proof are not diagnosed as such. (Exner, F.B. & Waldbott,G.L. Pp 64 65) Cases of fluorosis in cattle have occurred as a result of industrial air pollution. (Gotszche, A-L, 1975)
Much early opposition to fluoridation was on legal/ethical grounds. People who had recently witnessed the Nuremberg trials found enforced medication and experiments on humans offensive. Compulsory mass medication was said to invade the principles of English law, of the 1st and 14th amendments of the U.S. Constitution and of the U.N. Declaration of Human Rights. Once the principle of no medical treatment (of sane adults) without consent was breached a precedent would be established whereby the state could administer any prophylactic agent via the water supply. (Exner, F.B. & Waldbott G.L., 1957. Blount, P.C. 1964)
Exner pointed out that, for technical reasons, water engineers were unable to guarantee an even concentration of fluoride and that under the fluoridation programme an entire urban population would be treated with a medication designed to benefit only a few (children). Dosage could not be adapted to the tolerances of individuals who may be young or old, well or sick, allergic or malnourished. (Exner & Waldbott,1957.)
As fluoride acted cumulatively, it would be many years before the experiments could be properly evaluated. (Ibid.) Rorty made another remarkable charge that the interested health professionals had been censored, intimidated and regimented by public health officials who had deliberately falsified, distorted and suppressed scientific evidence tending to impugn the safety of a public health measure. (Exner & Waldbott, 1957)
The U.S. Public Health Service had (in 1950) given an unqualified endorsement to water fluoridation promising two thirds fewer cavities and extractions, straighter, stronger, better looking teeth and benefits that last a lifetime. By 1960, H.Trendley Dean had personally obtained endorsements of fluoridation from twelve dental and medical schools and associations. (Waldbott, 1965, P136)
K.K.Paluev took a careful look at the statistics. He found no measurable reduction in decay as a result of fluoridation, only a delay of up to 2.3 years in the timing of the decay. He pointed out that use of the criteria of decayed, missing, filled (DMF) teeth made even a tiny carious patch count as equivalent to a badly decayed or missing tooth. He also criticised the expressing of reductions in percentages which were then averaged as in the following example:
AVERAGE DMF PER CHILD
6 7 8 9 10
0.5 2.0 3.5 5.0 6.5
0.0 0.5 2.0 3.5 5.0
0.5 1.5 1.5 1.5 1.5
100 75 43 30 2
In the above table, the rate of increase in DMF per year and the accumulated number of DMF teeth in the two groups is identical but Group B lags one year behind Group A. Group B would be described as having a 54% reduction in tooth decay, this being the average of the figures in the final row. (Exner & Waldbott, 1957. Appendix 3 by
Philip R. Sutton of the Department of Oral Medicine and Surgery at the University of Melbourne said that DMFs should be counted not per mouth but per hundred erupted teeth. Otherwise comparisons between rates in fluoridated and control cities and between different years would not be valid. (Gotzsche, 1975).
Dr. George Waldbott was alerted to fluoridation in 1953 by his wife. As an allergist, he was aware of the wide differences in constitution and nutritional status which led to variable toleration of individuals to environmental components. He embarked on a serious study of the possible effects of fluoride on his allergic patients. Some of the literature pointed to factors other than fluoride (eg calcium) having a greater beneficial effect on teeth. Roholm, a Danish biochemist and physician had studied fluorine toxicity in both man and animals near a cryolite (Na3AlF6) quarry and had published Fluorine Intoxication in 1937. Roholms book detailed the respective solubilities of different fluorine compounds. Calcium fluoride is the one most often found as a natural contaminant of water. It is much less soluble and hence less toxic than fluorosilicic acid and sodium fluoride (byproducts of the phosphate fertiliser, aluminium smelting and ceramics industries) which are used in fluoridation. (Waldbott,1965. P 79)
In 1973, Medical journalist Anne-Lise Gotzsche was criticised by the British Fluoridation Society for writing a feature on fluoride for The Sunday Times.(Gotzsche, A-L., 1973) She went on to write a book, The Fluoride Question, published in 1975, which was an attempt to shed scientific light on 25 years of controversy. (Gotzsche, A-L, 1975)
In the introduction she says: Such attacks demonstrate the extent to which fluoridation is a political and not a purely scientific or dental controversy. A great many interests are at stake and some have very little to do with dentistry. In so far as environmental health concerns industry and the waste products produced by industry as well as the legislation which is necessary to cope with such pollution, the dental profession could be said to be trespassing into territory which belongs to other experts..
(Gotzsche,A-L., P 7)
Gotzsche quotes a number of researchers and toxicologists who have recorded concern about the long-term ingestion of fluoride, a protoplasmic poison with effects on enzyme systems. Critics of the methodology of fluoridation studies find their letters are rejected by the leading medical and dental journals. Results of the British investigations are by no means clear-cut. Fluoridation is often accompanied by a general campaign in dental health, nutrition and oral hygiene which practically invalidates before-and-after studies.
Gotzsche found no evidence of government monitoring neither of fluoride levels in individuals nor of detailed systematic studies of the health of fluoridated populations compared with control groups. Such studies are probably impossible because fluoride levels in foods, beverages and pharmaceuticals often contribute more to total fluoride intake than does tap-water. (Gotzsche ,A-L, 1975)
By the 1970s the controversy over fluoridation was world-wide and showed no signs of abating. Dr. Hans Moolenburgh led the fight against fluoridation in Holland. It culminated in the total rejection of fluoridation by the Dutch parliament in August 1976. By the early 1980s fluoridation had been rejected in Austria, Belgium, Denmark, Egypt, France, Germany, Greece, Holland, Luxembourg, Norway, Spain and Sweden. The Swiss health department advised cessation of the small experimental programme in that country because of its ineffectiveness. Germany had discontinued fluoridation in 1991 for health and legal reasons. India and Italy, with high levels of natural fluoride in water actually defluorinate the drinking-water in some districts. (Valentine, T&C, P 121)
After 23 years of experiments in Holland (involving 9 million citizens) had ended, Moolenburgh wrote:- Neither I nor the other anti-fluoridationists looked the least bit like James Bond, Robin Hood or Ivanhoe or any such great heroes. We more closely resembled Stan Laurel, Oliver Hardy, Charlie Chaplin or Mickey Mouse. In the wings, however there had been a Great Stage Manager who let us stumble, stutter, choke and blunder and who was behind all these small people playing a mighty game against gigantic bureaucratic forces; and he also made us win. (Moolenburgh, H, 1987)