The Oireachtas (Joint Irish Houses of Parliament) Draft report on Water Fluoridation in Ireland 11/1/2007 presented by Mr John Gormley T.D., former Minister for the Environment, Heritage and Local Government in Ireland.
1 EXECUTIVE SUMMARY
I am very pleased to present my Report on Water Fluoridation to the Joint Oireachtas Committee on Health and Children. I was appointed first to undertake this work in 1999 during the last Dáil. Unfortunately, I was advised by the Committee Chairman to interrupt my work when the then Minister for Health and Children, Micheal Martin, set up the Fluoridation Forum to conduct a similar investigation into the action of fluoride. Following the completion of the Forum Report, the Health Committee recommenced its own investigation. Given that sufficient time has now elapsed since the publication of the Forum Report and that not a single recommendation out of 33 has been implemented, it is timely to publish our deliberations on the subject.
Having agreed to become the rapporteur, I quickly discovered that I faced a complex and mammoth task. Not only did I have to analyse the testimony of those who appeared before the Committee, I also had to wade through the often contradictory scientific evidence and the endless archive material.
I have tried to distil the essential elements of my research into this report. As well as looking at why water fluoridation was introduced into this country, the report seeks to answer two fundamental questions — (1) how effective is water fluoridation in fighting tooth decay? (2) what are the side effects of water fluoridation?
Those who came before the committee had often diametrically opposed views on the subject. There is no doubting the sincerity and dedication of both sides in this debate. It is worth noting however, that whereas there was almost unanimity in the dental community when water fluoridation was introduced as to its effectiveness, there are now clear differences of opinion among dentists on the subject. One only has to contrast the testimony of Dr. O'Mullane and Dr. Clarkson with Dr. MacAuley and Dr. Limeback to understand how greatly views diverge on water fluoridation. But there is some common ground. And it's worth reflecting on these points of agreement at the very outset. When fluoride was first introduced it was thought generally to act systemically i.e. it had to be ingested. We now know it acts topically i.e. in the mouth and on the surface of the tooth. We also know that there are increased sources of fluoride now compared to fifty years ago. All sides admit - and the evidence points to - a huge increase in the incidence of fluorosis, a condition which indicates an excess of fluoride. Both sides also took the view that fluoride in toothpaste did reduce the rate of dental caries. They also agree that children who use fluoride toothpaste require supervision and proper instruction.
The crucial question for the committee was whether the perceived benefits of water fluoridation outweighed the negative side effects. The contribution of international expert, Dr. Hardy Limeback was persuasive in this regard when he commented that using the most authoritative international data, the risk of fluorosis far outweighed the benefits of fluoride. Dr. Limeback was also very clear in his recommendation that fluoridated water should not be used to bottle feed babies. Indeed, his advice seemed to have been accepted by the Food Safety Authority until it changed its mind in circumstances that have not been explained to the satisfaction of the committee. The committee has also noted the latest advice of the American Dental Association which states: "If using a product that needs to be reconstituted, parents and caregivers should consider using water that has no or low levels of fluoride". (ADA 9th November 2006).
Given that it is extremely impractical for mothers who are bottle feeding to source non-fluoridated water supplies and that fluorosis rates continue to rise, our central recommendation — based on the precautionary principle - is that the practice of water fluoridation should end immediately. All of the available evidence suggests that not only will this lead to a marked reduction in fluorosis but that there would not be a significant rise in dental caries.
The evidence presented by Dr O'Mullane showed that Ireland had a very serious dental health problem in the 1950s and early 60s. All of the available historical records confirm this to be the case. They also show that Ireland had a real shortage of dentists at the time. The committee fully appreciates why a prophylactic measure such as water fluoridation seemed like a sensible approach at the time. However, we have had to base our conclusions and recommendations on all of the data now available to us. Quantifying the effectiveness of fluoridation was our most difficult task. In our view, the most accurate measurement of this is contained in the York Review, undoubtedly, the most comprehensive study ever to be carried out on water fluoridation. Similarly, we have referred to York Review in quantifying fluorosis rates.
A key recommendation of the Fluoridation Forum was the reduction in the level of fluoride in our water supplies. Significantly, this recommendation has not been implemented, and even if the fluoride levels in the water were slightly reduced, we could not recommend that this water be used to bottle feed babies.
The Ireland of 2006 is a very different place with very different standards of general and oral hygiene. We are a modern European state with dental caries rates equal to and sometimes below other EU states which do not fluoridate their water supplies. We do, however, continue to consume too much confectionary, and our snacking habits are leading to continued dental caries problems as well as higher rates of obesity. The Department for Health and Children should tackle this problem by concentrating its efforts on education in relation to better oral hygiene, banning junk food vending machines and using fiscal means to change these poor eating habits.
If our recommendations are implemented we are convinced that not only will we see a reduction in fluorosis rates but that there will also be a drop in dental caries rates.
- Fluoridated water should not be used to bottle feed babies;
- Given the impracticality of sourcing non-fluoridated water for the bottle feeding of babies, the committee — on the basis of the precautionary principle — believes the practice of water fluoridation should cease immediately;
- The savings accruing from the policy change must be assessed in each HSE region. They should be ring-fenced before being re-allocated to educational programmes aimed at the socially deprived, in line with best practice in other European countries;
- Independent research into general health effects should be undertaken in order to assess the full impact of lifetime fluoride exposure in the population. Particular attention should be given to effects on infants and children of exposure to fluoride from all sources;
- The Minister for Health should not permit indiscriminate medication measures to treat the whole population via water or food because of the inability to control dosage and monitor individual reaction, evidenced by the forty year experience of water fluoridation;
- The Government should undertake a major educational programme to encourage healthy eating in order to tackle the twin problems of dental caries and obesity;
- More public dentists need to be employed and more regular check ups encouraged;
- Parents should be given advice about teeth brushing and the use of fluoridated toothpaste. Along with imaginative education programmes on regular tooth brushing, existing nutritional programmes already underway should continue to target sugary diets of children from 5 yr olds to 15 yr olds. Special emphasis should be laid on initiatives that target the socially disadvantaged where dental decay linked to poor diet is most prevalent; and
- Fluoride toothpastes should carry warnings similar to those in the United States about the dangers of swallowing fluoride toothpaste.