The trooth about fluoride?

IT seemed like a good idea 35 years ago to put fluoride in the public water system and reduce the incidence of tooth decay in the country dramatically and there is no doubt that this has happened. Department of Health figures show that there has been a 70 per cent reduction in the number of tooth extractions in that period, but are there side effects to fluoridation that are not so beneficial?

An organisation called Fluoride Free Water Ireland would claim that there are. Quoting substantial international research, they link it with dental fluorosis, hip fractures, irritable bowel syndrome and cancer, for instance, but who exactly are we to believe?

Fluoridation began in this country in the 1960s as the result of a tooth decay epidemic. At a time when it was common for people in their 20s to have false teeth fitted, it was felt that something had to be done to arrest the effects of excessive sugar consumption and poor dental hygiene.

A major debate surrounded its introduction, with both High and Supreme Court challenges to its implementation. Deciding that the allegations linking it to serious illness were false, the legislation went ahead.

Presently, 73 per cent of drinking water in Ireland is fluoridated at the rate of one part fluoride to one million parts water, and the Department of Health's Chief Dental Officer, Dr Gerard Gavin, maintains that fluoridation does not pose a risk to people's health.

"Apart from the issue of dental fluorosis, nothing has stood up to scientific study. We consider fluoridation safe at the levels it is being used in Ireland and of great benefit in the treatment of dental caries,'' he said.

Dr Gavin quotes a 1997 Southern Health Board survey which shows that in the incidence of tooth decay in children aged five, there was a 52 per cent difference between fluoridated and non-fluoridated water areas. "This kind of monitoring research shows that there are still substantial benefits in putting fluoride in our water system,'' he said.

Dr Don MacAuley, a Co Meath dentist and adviser to the Free Fluoride Water group, would not agree. While initially being pro-fluoridation, he changed his mind after being swayed by the weight of international research stating that fluoridation is unsafe. "The most damaging effect I see on a daily basis in my surgery is dental fluorosis,'' he said. "That is tooth damage caused by too much fluoride. It is seen as little white lines or specks on the tooth's surface or as brown staining and loss of enamel in severe cases, and I've seen children afraid to open their mouths to smile because of this. What I'm concerned about is that the teeth are the windows of the skeleton and if fluoride is damaging teeth, what is it doing to bones?''

Dr MacAuley also points out that Ireland is the only democracy in the western world which forces fluoridation upon its people and is demanding that the Government give us the right to choose whether or not we want it in our water.

One of his principal concerns is that the total amount of fluoride we are ingesting isn't being monitored by the Department of Health. "We are getting fluoride from so many sources at the moment, from water, from toothpastes and mouthwashes, and from every soft drink that is made with fluoridated water,'' he said. "Fluoride is a cumulative toxin, and if you are drinking several glasses of water a day over a 50-year period, will it cause damage in the long term? The Department of Health have no figures for that. Fluoridation is mass medication, as far as I am concerned,'' he added.

There is a lot of information to assimilate when studying the subject, with a view to making an informed decision. Fluoride Free Water Ireland claim that the incidence of hip replacement due to osteoporosis is 12 times higher in the Republic of Ireland than in Northern Ireland, for instance, where water is not fluoridated. Dr Gavin at the Department of Health refutes this. "There is very little difference between the figures,'' he claimed.

Another concern put forward by the Fluoride Free Water group is that small babies are getting far too much fluoride due to their bottles being made up with fluoridated water. `Because they are receiving so many bottles, it's an overload for their system, and that's when the damage is being done,' according to Fluoride Free Water Ireland. Dr Gavin said that the British government's nutritional committee investigated this claim and found no basis for it.

Fluoride Free Water also highlights the fact that Ireland only lies in sixth place in Europe in dental decay studies. This is surprising, they said, given that of the other five countries, four of them don't fluoridate their water at all, so why do they have better teeth than us?

The Department of Health counters that with EU results showing that of 23 countries, the Republic of Ireland has the lowest level of decayed, missing or filled teeth in five to seven-year-old children. Then there is the issue of where the fluoride that is put in our water comes from. Dr Don MacAuley's research claims that the hydrofluosilicic acid from which it is manufactured is a `waste product of the fertilizer industry, and is imported from Holland.'

The Department of Health said this acid comes from Spain and while the rock phosphate it is produced from is used in the fertilizer industry, the acid, in this case, is produced as a primary product for fluoridation. On the point of this acid containing high levels of heavy metals, like lead, Dr Gavin pointed out that the recent Environmental Protection Agency report on water quality in Ireland stated that there is no cause for concern about levels of heavy metals in our water supply.

On the issue of research, Dr Gavin conceded that constant monitoring and new studies are needed. "Several studies are going on at the moment, looking at consumption trends around the country and the way we fluoridate our water. We are also looking at the wider health issues as well as the dental one.''

And in response to concerns about fluoridation, a forum has been set up by the Minister for Health. Its report is due next September, with submissions invited from the public until March 31. Minister Micheál Martin said that it will perform a valuable function in looking into all aspects of the debate and making recommendations regarding the future use of fluoride in this country.

In the meantime, the Fluoride Free Water group are making presentations to county councils on this issue. Already Dublin City Council, Donegal, Sligo and Leitrim county councils have adopted motions asking the Minister to suspend fluoridation pending the outcome of an investigation into its effects.