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Fluoridation row in Fiji splits health officials and activists over oral health

A move to bring back fluoridated water across the Fiji Islands for the first time in three decades has a lobby group up in arms claiming the mineral is “toxic”.

Pacific Scoop:
Report – By Jessica Tasman-Jones.

A controversial debate over fluoridation of water supplies has sprung up in Fiji in the past few months with plans to reintroduce the public health measure.

Last month, the Ministry of Health revealed it is working with the Water Authority of Fiji to fluoridate water supplies across the country.

According to the World Health Organisation (WHO) fluoride is beneficial for oral health when consumed in limited concentrations.

But international lobby group Fluoride Action Network says the mineral is toxic and campaigns for non-fluoridated water.

However, the ministry website says the measure is the most cost effective way of reducing dental decay.

According to a 2004 survey on oral health, 88.3 per cent of Fijian children suffered from tooth decay.

History

In the late 1970s and 1980s, parts of Fiji’s water supply were fluoridated by the Public Works Department.

However, due to population growth and increased demand for water supplies the fluoridation plant eventually stopped operating.

But last month the Ministry of Health revealed it was talking with the Water Authority of Fiji to fluoridate water.

Tap water in Suva is already fluoridated but the ministry is looking to extend this programme across Fiji.

Dr Joan Lal of the Fiji Medical School’s Oral Health Department says she has been lobbying for the move since 2001.

She says Fiji has “huge levels of decay in children”.

According to the Ministry of Health, 88.3 per cent of children experience decay in their primary teeth and 79.3 per cent show signs in their permanent teeth.

Fluoride

In 2006, the WHO issued a report Fluoride in drinking-water.

The purpose of the report is to provide information for regions to set their own standards, taking into account social, cultural, environmental and economic conditions.

The American Dental Association (ADA) says fluoride reduces cavities in children and adults and repairs the early stages of tooth decay –known as dental caries.

A report on caries prevalence in urban school children says infrequent brushing, snacking on high sugar goods and only visiting a dentist when in pain are the main factors that cause dental decay.

Fluoride can be applied to teeth in toothpastes and mouth rinses or consumed in tablets, lozenges or through fluoridated water.

The ADA says for best results fluoride should be applied to the teeth directly and ingested.

Both organisations warn against ingesting the chemical in high concentrations.

The WHO reports mottling of the teeth is an early sign of excessive fluoride consumption.

The report says fluoride is associated with “crippling skeletal fluorosis” when consumed in concentrations of 10 parts per million.

The FDI World Dental Federation says human health is not adversely affected by fluoride at concentrations required for dental decay.

Fiji’s Ministry of Health says communities with fluoridated water have a 15 per cent increase in caries-free children.

Anti-fluoridation groups

Dr Lal says she has not encountered resistance to the moves by anti-fluoride groups.

International lobby group Fluoride Action Network does not have a Fijian chapter but links to news items about the measures on their website reveal the group is monitoring the situation.

A spokesperson from Fluoride Action Network New Zealand says the group will be communicating their concerns to Fijian locals.

'They sell Fiji Water because it’s pure.' (Photo: PMC.)

“They sell Fiji Water because it’s pure,” she says. “Fluoridation would mean they’d have to import toxins into Fiji.”

The group says consumption of fluoride is linked with arthritis, thyroid problems and lowered IQ.

The group does not have a blanket opposition to the mineral but says consumption of fluoride should be the choice of the consumer.

Fijian consumers

But Dr Lal says fluoridated toothpaste is expensive in Fiji and consumers buy the cheaper, non-fluoridated options as a result.

Fijian consumers have more access to refined sugar products than in the past and this is not matched by a concurrent rise in oral health awareness, a 2004 study found.

Consumer Council of Fiji chief executive Premila Kumar supports plans to fluoridate the country’s water supply.

She says reports from WHO are based on “scientific research and experiences of other countries around the world”.

But she says the Water Authority of Fiji should monitor fluoride levels to ensure they are within the recommended concentrations.

“[It’s] just like salt or iron which is needed by the body but in right amounts. Too much salt causes high blood pressure and salt deficiency has other adverse effects.”

As a result it is important the concentration of fluoride in water supplies is kept within the range recommended by WHO.

Public consultation

Kumar says the Ministry of Health has not mentioned any public consultation on water fluoridation.

However, she says past experience shows these often have a poor response from the public.

“We don’t think public consultation on fluoridation of water will be any different,” she says.

Kumar says a “stakeholder consultation” with health experts, dental experts, nutritionists, experts from organisations like WHO and interested consumers would be “more rewarding and fruitful”.

She says in addition to water fluoridation the council would like other effective solutions to teeth decay to be sought.

Nutrition

A spokesperson from the University of the South Pacific food unit says international guidelines dictate the level of fluoride needed for oral health reasons will be fine.

He says side effects occur with many medicines but it’s important to look at the bigger picture.

When it comes to fluoridation he says WHO recommendations suggest the benefits outweigh the potential harm.

But the Fluoride Action Network says WHO recommendations are outdated.

According to their spokesperson, communities nowadays are exposed to more fluoride than in the past through pesticides and medications.

However, the WHO website states a revision of 1984 data in 2004 revealed the guidelines and standards did not need to be revised.

They say the value guideline of 1.5 ppm was not a “fixed” value and should take environment, dietary and cultural values into account.

Jessica Tasman-Jones is a Postgraduate Diploma in Communication Studies student on the Asia-Pacific Journalism course at AUT University.

7 comments:

  1. Lesley McMillan, 30. September 2010, 14:47

    n Dec 2007, I was diagnosed with Hashimoto’s disease, a common form of hypothyroidism which I found through Paul Connett’s website can be caused by fluoride. I started to avoid fluoridated water and all products containing it and 6 months later my thyroid hormone levels had returned to normal. With high antibody counts, my battle with the disease is ongoing and it requires great discipline to maintain a fluoride free diet in Australia. Last year my health deteriorated again so I also began to avoid all physical contact with fluoridated water. A month later my health improved once again.

    According to Thyroid Australia, hypothyroidism affects 6-10% of the population and can result in the ultimate destruction of your thyroid gland so this is by no means insignificant.

     
  2. Jim Schultz, 30. September 2010, 14:58

    Burt Detroit 2007 showed almost 100% of kids had cavities by age 5. Detroit like almost all big poor inner cities has been fluoridated for decades. Most over 50 years and cavities are increasing in those poor kids. Dental fluorosis forever discolored fluoride toxic teeth is skyrocketing and about double in blacks over whites. This was known from the first study. CDC data still proves this but the CDC refuses to inform even after formal ethics charges in 2007. There sole job is to promote fluoridation no matter how useless or harmful.
    The Burt data clearly showed poor nutrition was the issue with f waTER, SODA AND CHIPS ,no vegetables or fruits. No dentists to treat the poor either as most refuse medicaid poor kids. 80% of the cavities happen to 25% of the population and fluoridation does not change that at all. You have been punked by dentists who want to trezt rich people and make real money correcting ugly teeth damaged by fluoride toxicity in kids. Dental incomes have soared in the US with them making far more then doctors now working often half the hours. That is the real gift of fluoridation. Yoder K.M. 2007 proven when tested most dentists fluoride ignorant and a risk to patients. They trust blindly what they were taught. http://www.fluoridealert.org http://www.iaomt.org
    http://www.waterloowatch.com Watch a video by a real expert or one of the EPA science experts of the 11 Unions that asked congress to halt fluoridation. Ingested fluorides have no benefit. They do have much risk of harm. The precautionary principle should be followed and informed consent must happen for every drug treatment.

     
  3. jwillie6, 30. September 2010, 15:56

    Isn’t it strange in the U.S., doctors cannot force one person to take a drug, yet the government wants to put it in our drinking water and force everyone to be drugged with fluoride, a prescription drug, against their will and with no medical supervision, no control over how much you consume and no treatment for side effects.
    The fluoridation of drinking water is one of the cruelest hoaxes ever perpetrated against the public in the history of mankind. Fluoride used is actually an industrial waste product from the manufacture of fertilizer and aluminum, and is second to mercury as the most toxic substance known. It contains lead, arsenic, mercury, radium, and other contaminants. Most of Europe (16 countries) has rejected fluoridation and is 98% fluoride free. and the WHO reports that they have a better tooth decay rate than any fluoridated country.
    There is no scientific evidence to support the idea that drinking fluoridated water has any effect on cavity reduction — NONE! The best source for information on the health hazards and ineffectiveness of fluoridation can be found here: (www.fluoridealert.org).

     
  4. Alan Freshwater, 30. September 2010, 21:48

    What a load of foolish misinformation and pseudoscience. Fluoride has been proven time and again to be effective against dental caries, and the only slight risk in the case of excess use in mottling in developing teeth. That is why the dose is kept down to effective levels with safety margins.

    All this talk of industrial waste, toxicity and lead, arsenic, mercury, radium, and other contaminants. is rubbish. The claim that Europe is 98% fluoride free is rubbish, and wishful thinking on the part of tyhe brainless antifluoride lobby.

    Ordinary table salt (Sodium Chloride) is fatally toxic if taken in excessive quantities – about 5 teaspoons for a child. Yet if you do not eat enough in the diet, you will be very unwell.

    Is there a difference between fluoride found naturally in water and fluoride that is added to water?

    This is an often-asked question and it is important to know there is no difference. The fluoride ions in water are exactly the same regardless of whether they come naturally from rocks or are added as calcium fluoride or sodium silicofluoride. The dental benefits of fluoridated water occur no matter the source of the fluoride.

    Is non-fluoridated water more pure than fluoridated water?

    No. All natural waters contain many different minerals and compounds, including fluoride. The amount of each mineral and compound depends on where the water comes from.

    Fluoride occurs naturally in most waters and cannot be considered an impurity. This was confirmed by a Privy Council decision in 1963 that stated ‘the addition of fluoride adds no impurity and the water remains not only water but pure water and becomes greatly improved and still natural water containing no foreign elements’.

    How does fluoride help my teeth?

    Fluoride works in three ways.

    * Fluoride makes teeth more resistant to decay by strengthening the tooth surface.

    * Fluoride interferes with the growth of the bacteria that cause cavities.

    * Fluoride helps to repair the early stages of tooth decay.

    Fluoride can help strengthen baby teeth before they come through the gums by building fluoride into their structure. The main effect is when teeth erupt through the gums. If fluoride is present in saliva, teeth will continually be exposed to small levels of fluoride, which helps strengthen the tooth surface. Fluoridated water is the best way to achieve this.

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    Is tooth decay a serious problem?

    Internationally, decay rates have been decreasing over the last 20 years. However, tooth decay is still a significant health problem, particularly in communities with insufficient fluoride in their water.

    Tooth decay will result in the life-long repair of teeth or tooth loss. Decay causes pain and loss of self-esteem and it also costs individuals and the community to treat it. Approximately $500 million is spent in New Zealand on dental treatment. The largest proportion of this is treating dental decay.

    Dental pain can stop a person from eating, working and sleeping which affects their whole wellbeing. Decayed teeth can affect people’s self-esteem and confidence about the way their teeth look or their bad breath.

    Although tooth decay remains a common disease, it is largely preventable. Dental decay does not have to be a fact of life – prevention is possible and fluoridation, along with a healthy diet, is the most cost-effective way to achieve this.

    Where else can I get fluoride from?

    Common sources of fluoride for people include food and drink, toothpaste and fluoride supplements such as tablets.

    Some countries use fluoridated salt, others fluoridated milk. The World Health Organization says fluoridated water is the most effective and safest way of providing the benefits of fluoride.

    Go to information about sources of fluoride

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    Do fluoride tablets work as well as fluoridated water?

    No. The benefit of fluoride tablets is limited as they don’t provide constant small doses throughout the day and are more expensive over time than water fluoridation.

    The fluoride in the saliva from a tablet lasts only three hours, and would give less than 1 percent of the fluoride available from food and drink in a fluoridated area.

    To be effective, fluoride tablets must be taken every day and preferably chewed. Even well-motivated parents can find it difficult to ensure children receive tablets regularly. At a public research level, water fluoridation is more effective because it is taken regularly throughout the day in the water used to drink and cook with irrespective of the consumer’s social, economic or physical status.

    How do we know fluoridation is effective?

    The effectiveness of water fluoridation has been documented in scientific literature for well over 50 years. Data from the 1930s and 1940s shows that even before fluoridation, children drinking naturally fluoridated water had lower decay rates than children consuming water without fluoride.

    Studies have also shown that when communities stop fluoridation, there is a reversal of the benefits, an increase in decay rates and a large increase in the number of baby teeth extracted.

    It is true that over the years, decay rates have declined in both fluoridated and non-fluoridated areas. This can largely be explained by the use of fluoride toothpaste and the cross-over effects of food and water containing products from fluoridated areas. Most recent studies continue to show that the difference between fluoridated and non-fluoridated areas continues to be significant throughout life.

    The World Health Organization has reviewed the data available and the Public Health Commission (PHC) in New Zealand published an extensive review of water fluoridation in 1994 and supports fluoridation.

    In September 2000 the Ministry of Health released a report, written by Environmental Science and Research Ltd (ESR), evaluating recent evidence of the fluoridation of water supplies. This report provides further support for the safety and effectiveness of water fluoridation.

    In 2003 the Public Health Advisory Committee (PHAC) also reviewed evidence of the effect of water fluoridation with respect to reducing inequalities in oral health. It strongly recommended increasing the proportion of the New Zealand population receiving fluoridated water.

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    Does fluoridation cause health problems?

    The weight of scientific evidence supporting the safety and effectiveness of fluoridation is overwhelming and it is clear the majority of reputable health, scientific and medical bodies agree with its use.

    Many parts of the world have received naturally fluoridated water for thousands of years. Large human populations have now been exposed to community water fluoridation for many decades and no persuasive evidence links optimal fluoridation with any adverse health effects. With hundreds of millions of people continuing to receive the benefits of fluoride in drinking-water, the absence of documented adverse health effects is particularly convincing.

    Information about water fluoridation and safety

    Information about fluoride and health

    Can fluoridated water cause toxic effects?

    It is impossible to experience fluoride toxicity from drinking-water optimally fluoridated at levels between 0.7 ppm to 1 ppm. It would require drinking more than 5000 glasses of fluoridated water at one time.

    Anything is toxic if you take too much of it, including many common substances that are essential to health, for example, water, iron, vitamins A and D or even oxygen.

    In excessive quantities fluoride too can be toxic, but, at the very low concentrations (0.7 ppm to 1 ppm) used in water fluoridation it is not toxic, even when used over a lifetime.

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    Why do some communities not accept fluoridation?

    A community may not accept fluoridation for many reasons. Often a referendum is held where low voter turnouts are common and sometimes communities are not provided with accurate information. However, it is important to note that fluoridation has never been discontinued because it was proven harmful in any way.

    Why does opposition to community water fluoridation continue?

    A lot of opposition is based on the question of freedom of choice, which can be a very emotional issue. Some people feel very strongly that they should not have to receive fluoridated water if they do not wish to.

    Society often makes decisions or rules based on the benefits to the community as a whole (for example, putting iodine in salt or wearing seat-belts). Some people believe that these decisions limit our personal choice. Public health organisations encourage communities to adopt fluoridation because the benefits to everyone with natural teeth are so worthwhile that the whole community should have access to those benefits.

    The option remains for people who are particularly opposed to fluoride in the water to install a filter to remove it if they wish.

    There is also evidence that several groups opposed to water fluoridation use ‘fear tactics’ to raise safety concerns within the community. No ‘scare claims’ are generalisable to water fluoridation at the recommended levels.

    A very large body of scientific literature supports fluoridation as a safe means of reducing rates of tooth decay.

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    What is the Ministry’s official response to Dr Connett’s “50 Reasons to Oppose Fluoridation”?
    A response to Dr Connett’s 50 Reasons to Oppose Water Fluoridation was prepared by ESR for the Ministry of Health. It is authored by an independent expert, Dr Terry Cutress PhD, and peer reviewed by ESR toxicologist Paul Fitzmaurice. It was prepared in response to a request for comment from a medical practitioner. The review describes Dr Connett’s 50 Reasons to Oppose Water Fluoridation as “a selection of published findings … with no balance of evidence…’. The review further states that “the list of reasons and other material supporting claims … opposing water fluoridation are contentious. Some stated reasons … are statements or comments without scientific content. … some of the reasons are … personal subjective viewpoints, some of which lack literal or factual substance. Many of the references are from doubtful publications.”

    Given the findings of the review, health officials see no evidence that requires any change to the policy on water fluoridation. The Ministry believes that there is overwhelming evidence of the effectiveness and safety of water fluoridation in improving the dental health of New Zealanders, and in preventing dental decay. The Ministry considers that the fluoridation of water supplies at levels between 0.7 and 1.0 mg/litre is safe and effective in promoting oral health. The Ministry will continue to monitor New Zealand and international fluoridation research to ensure its policy is safe and effective for all New Zealanders.

    What is the optimal level of fluoridated water a person should drink on a daily basis?

    An estimated 75–90 percent of ingested fluoride is absorbed by the alimentary tract (NRC 1993). Fluoride in drinking-water accounts for about half of the total intake in young children and half the total intake in adults (NHMRC 1991).

    The rest of the intake is from dietary sources, especially from tea, which contains fluoride in the range of 1 – 3 ppm (Murray et al 1991). Some heavy tea drinkers may even have intakes of 8 – 10 mg/day (refer to Water Fluoridation In New Zealand). Drinking-water with 0.7 – 1.2 ppm, together with a normal diet, provides safe and appropriate levels of fluoride intake.

    What if people have health conditions like kidney disease?

    There is no research evidence of increased kidney disease or dysfunction in humans drinking up to 8 ppm fluoride; nor is there any evidence that existing kidney disease is made worse.

    What if people use a fluoridated toothpaste as well, will that be too much fluoride?

    Studies show that water fluoridation provides benefits above and beyond those from other fluoride vehicles alone (for example, toothpaste or tablets). Conversely, fluoride toothpastes provide additional benefits beyond water fluoridation.

    Water fluoridation is not a replacement for tooth brushing with fluoride toothpaste, as brushing helps to remove the bacteria (found in plaque) and keeps gums healthy. Rather, the two work hand in hand to help prevent tooth decay, and provide an additional benefit above that of fluoridated water alone.

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    Can a person have too much fluoride in their body?

    Yes, in the same way that a person can have too many vitamins and other dietary supplements. In other parts of the world, where there are extremely high levels of fluoride, it can cause skeletal fluorosis. This requires the ingestion of much larger amounts of fluoride than anyone in New Zealand would be exposed to.

    What is the benefit of fluoride to teeth when it is ingested instead of applied topically?

    Fluoride ingested and applied topically, such as drinking-water and brushing teeth with a fluoridated toothpaste, go hand in hand as effective measures to help prevent tooth decay.

    Sugar intake constantly flowing past teeth needs good levels of fluoride in plaque and saliva to be the ‘first line’ in tooth decay prevention.

    Human beings are well adapted to living in an environment with natural fluoride. Some of the fluoride we ingest is taken up by bones and teeth. The fluoride taken in to the teeth also helps to prevent dental decay by strengthening the teeth and reducing enamel demineralisation.

    Our kidneys excrete excessive fluoride from the body, so to protect teeth over our lifetime it is important to have small, regular amounts such as is provided in fluoridated water and fluoridated toothpaste.

    When fluoride is ingested regularly when teeth are developing, it is deposited across the tooth’s entire surface and this slows down decay. Because of this, tooth decay in fluoridated areas progresses more slowly.

    The most recent study is that commissioned by the City of Fort Collins, US. The Fluoride Technical Study Group found that adding hydrofluorosilicic acid did not increase any contaminants levels into the water quality so it was unlikely community water fluoridation poses a health risk’. Fluoride Technical Study Group report (www.healthdistrict.org)

     
  5. Coralia, 5. October 2010, 9:47

    Its a free country…why should we all be forced to drink fluoridated water???

    Some people have allergies, some are merely concerned with the fact that its a prescription drug, some are concerned with how much they have to drink now in order to keep the right dose while others like me can’t simply comprehend why we have to have fluoridated water forced down our throats.

    I mean of course its all for a good cause…but its a drug olright and people should at least have a choice of wether they want to take it or not. Its not only a matter of public health…to look at it from a wholistic approach it all comes down to people’s rights and freedom to choose what’s best for themselves!

     
  6. Jorge, 13. November 2010, 10:08

    Flouridated water was introduced in the US and was ONE BIG LIE. I am a dentist and Flouride does nothing positive for teeth, rather the complete opposite. They flouridate the water because it makes you ill and stupid. That way you do what their governments tell you and you are easy to control. The Soviets used flouride in the water in their goulags and found the prisoners turned to a sort of zombie like state and did not fight. WAKE UP PEOPLE!

     
  7. sam, 27. January 2014, 2:38

    you have got to be kidding me Jorge: You are a dentist and you believe fluoride (yes you can’t even spell fluoride)… doesn’t do anything for teeth? I AM a dentist unlike you. It seems you perhaps got your degree from the back of a weetbix box?