Fluoride Vol. 32 No. 4 199-200 1999 Editorial
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UNRAVELING THE FABRIC OF FLUORIDATION,
THREAD BY THREAD
A paper by Betty de Liefde 1 (see abstract on page 255) notes that in New
Zealand, as elsewhere, caries prevalence has declined since the 1950s together
with a change in the intra-oral pattern of the disease. “When the timing of various forms of fluoride supplementation is correlated with the decline in caries,
the decline continues beyond time of maximum population coverage with
fluoridated water and fluoridated toothpaste.”
The paper shows that a convergence in the prevalence of decayed, missing
and filled permanent teeth (DMFT) has occurred between fluoridated and nonfluoridated areas. In the 1995 national survey of 12-year-old New Zealand
children, the difference was 0.3 DMFT. This represents a 20 percent difference which is “clinically meaningless” given the low prevalence level of 1.4
DMFT. The author stated that “…an explanation of the convergence of caries
prevalence in fluoridated and non-fluoridated areas since the 1970s may require a re-assessment of the fluoride effect. This convergence, and the overall
decline during the last decade without additional fluoride supplementation,
suggest that factors other than fluoride, such as food additives and antibiotics,
have contributed.” Dietary improvements might also be a factor.
Similar re-evaluations of the New Zealand pre- and post-fluoridation data
have already been published. Colquhoun2 found that national data collected in
New Zealand over a 50-year period indicated that the decline in tooth decay
commenced before and independently of the introduction of fluoridation and
other uses of fluoride. He found that while the data on permanent teeth are
“consistent with the substantial introduction of water fluoridation in 1966 and
the increase in the use of fluoride toothpaste and other fluoride uses”, it “seems
probable that, because the caries disease process is essentially the same for both
primary and permanent teeth, a real decline in permanent tooth decay occurred
in the earlier years, independently of fluoridation and fluorides.”3 The data from
New Zealand are robust because national total population surveys have been
used. They indicate that tooth decay has declined since the 1950s and that the
inverse relationship postulated to exist in the 1930s between fluoride availability and the prevalence of dental caries has ceased to exist in the last decade.
The main point raised by de Liefde 1 is that factors other than fluoride have
contributed to the decline in dental caries in New Zealand. She mentions that
attempts to attribute the change in caries prevalence mainly to fluoride divert
attention from other investigations which are urgently needed. The time has
come to acknowledge that fluoride supplementation is at best only a partial
cause of the decline in prevalence.
de Liefde does not believe that all change in the prevalence of dental caries
in fluoridated (F) areas is due to fluoridation and the changes in non-fluoridated
(NF) areas to a "halo" effect. However, despite the “clinically meaningless” difference in the DMFT rate for 12-year-old children between F and NF areas,
nowhere in the paper does she suggest that fluoridation should be discontinued.
If a wider perspective of the fluoridation issue is taken by a dispassionate
observer, a different conclusion would be reached. The supposed benefits of
water fluoridation as reflected in a “clinically meaningless” difference in the
Fluoride 32 (4) 1999
200
Editorial
DMFT rate for 12-year-old children have to be weighed against the costs including concerns over freedom of choice 4 and adverse effects.5 My opinion is
that fluoridation should, in fact, cease.
Whatever benefits fluoride might give can be obtained by topical application
with toothpaste without the need for swallowing fluoride and absorbing it systemically.6 After ingestion, only half the fluoride is excreted and the remainder
is retained in the body where it can have a cumulative toxic effect on parts of
the body other than teeth. The concerns about toxicity are not about “clinically
meaningless” effects. Serious questions are being raised by reputable scientists5
about the effect of fluoride on the development of the brain and intelligence, the
onset of sexual maturity, reproduction and fertility, endocrine function including the production of melatonin and thyroid hormones, the development of cancer including osteosarcoma in young men, and the occurrence of hip fractures in
the elderly. These are major health effects.
Where doubt exists over safety, the Precautionary Principle argues that the
benefit of the doubt should be given to those at risk. The level of evidence
raising concern has now passed that of just raising doubts. It has reached a
level where momentum is gathering for a concerted international effort to urgently stop fluoridation. The obstacles in the way of this have less to do with
the strength of the evidence about the lack of benefit and the presence of toxicity and more to do with the difficulties of changing one’s mind and adopting
a new paradigm after many years of having a different viewpoint. In the words
of Leo Tolstoy:
“I know that most men, including those at ease with problems of the
greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of
conclusions which they have delighted in explaining to colleagues,
which they have proudly taught to others, and which they have woven,
thread by thread, into the fabric of their lives”.
Bruce Spittle
REFERENCES
1 de Liefde B. The decline of caries in New Zealand over the past 40 years. N Z
Dent J 1998;94;109-13. Abstract in Fluoride 1999;32(4):255.
2 Colquhoun J. Fluorides and the decline in tooth decay in New Zealand. Fluoride 1993;26:125-34.
3 Colquhoun J. Possible explanations for decline in tooth decay in New Zealand
[letter]. Community Dent Oral Epidemiol 1992;20:161-4.
4 Diesendorf M. How science can illuminate ethical debates: a case study on water fluoridation. Fluoride 1995;28:87-104.
5 The National Treasury Employees Union. Why EPA’s headquarters union of
scientists opposes fluoridation. Fluoride 1999;32:179-86.
6 Limeback H. A re-examination of the pre-eruptive and post-eruptive mechanism of the anti-caries effects of fluoride: is there any anti-caries benefit from
swallowing fluoride? Community Dent Oral Epidemiol 1999;27:62-71. Abstract in Fluoride 1999;32:111-2.
Fluoride 32 (4) 1999
Fluoride Vol. 32 No. 4 201-203 1999 Announcements
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NOTICE TO AUTHORS
Authors should prepare manuscripts in accordance with the “Uniform Requirements for Manuscripts Submitted to Biomedical Journals”. The fifth edition (1997) of these were published in the N Engl J Med 1997;336:309-15. The
following is an abbreviated summary of those requirements. Please consult the
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References
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examples as follows:
Articles in Journals (no italics)
Standard journal article: List the first six authors followed by et al.
1 Parkin DM, Clayton D, Black RJ, Masuyer E, Friedl HP, Ivanov E, et al.
Childhood leukaemia in Europe after Chernobyl: 5 year follow-up. Br J Cancer 1996;73:1006-12.
Organization as author:
2 The Cardiac Society of Australia and New Zealand. Clinical exercise stress
testing. Safety and performance guidelines. Med J Aust 1996;164:282-4.
Volume with supplement:
3 Shen HM, Zhang QF. Risk assessment of nickel carcinogenicity and occupational lung cancer. Environ Health Perspect 1994;102 Suppl 1:275-82.
Books and other monographs
Personal author(s):
4 Ringsven MK, Bond D. Gerontology and leadership skills for nurses. 2nd ed.
Albany (NY): Delmar Publishers; 1996.
Editor(s), compiler(s) as author:
5 Norman IJ, Redfern SJ, editors. Mental health care for elderly people. New
York: Churchill Livingstone; 1966.
Organization as author and publisher:
6 Institute of Medicine (US). Looking at the future of the Medicaid program.
Washington (DC): The Institute; 1992.
Chapter in a book:
7 Phillips SJ, Whisnant JP. Hypertension and stroke. In: Laragh JH, Brenner
BM, editors. Hypertension: pathophysiology, diagnosis, and management.
2nd ed. New York: Raven Press; 1995. p. 465-78.
Conference Proceedings:
8 Kimura J, Shibasaki H, editors. Recent advances in clinical neurophysiology.
Proceedings of the 10th International Congress of EMG and Clinical Neurophysiology; 1995 Oct 15-19; Kyoto, Japan. Amsterdam: Elsevier; 1996.
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Conference paper:
9 Bengtsson S, Solheim BG. Enforcement of data protection, privacy and security in medical informatics. In: Lun KC, Degoulet P, Piemme TE, Rienhoff O,
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XXIIIrd CONFERENCE of the
INTERNATIONAL SOCIETY FOR FLUORIDE RESEARCH
June 11-14, 2000
Hosted by Professor Zygmunt Machoy and the Department of Biochemistry
and Chemistry of the Pomeranian Medical Academy, the XXIIIrd ISFR conference will emphasize recent studies on diverse biological effects of fluoride
and their implications for industrial, agricultural, medical, environmental, and
other concerns and activities.
Venue: Hotel Radisson SAS, Centre Szczecin
Plac Rodła 10, 70-419, Szczecin, Poland
Lodging: Hotel Radisson 1-2 persons, $82-101US (includes breakfast and
local tax).
Transportation: Szczecin Goleniów Airport, with bus service to Hotel Radisson SAS. Twice daily flights from Warsaw and one from Copenhagen. Rail from Warsaw (6 hr) or Berlin (2 hr) is also available.
Conference Registration:
Participant/delegate
Student/guest
Banquet (June 14)
Before March 1
250 USD
150 USD
35 USD
After March 1
300 USD
200 USD
45 USD
Registration Fee: Must be submitted in US dollars only by money order to:
Bank Przemysłowo-Handlowy in Szczecin sent to ISFR-XXIIIrd
Conference (address below). The registration fee for participants includes the welcome reception, conference program and abstract book,
participation in the scientific program, lunches, coffee breaks, and a
chartered bus tour and picnic. The fee for guests includes the wel-
Fluoride 32 (4) 1999
Announcements
203
come reception, three lunches, two guided bus tours of local sites, and
the chartered bus tour and picnic.
Abstract: Participants wishing to present either a platform (15 min) or a poster paper must submit (before February 28th) a single-space abstract
not exceeding 350 words with a maximum of 20 words in the title.
The title should be in CAPITALS.
Further Information and registration/abstract forms can be obtained from:
Prof. Dr. Zygmunt Machoy
Chairman, XXIIIrd ISFR World Conference
Department of Biochemistry and Chemistry
Pomeranian Medical Academy
72 Powstańców Wlkp. Street
70-111 Szczecin, Poland
Phone/fax: (+ 4891) 482-4057
THIRD INTERNATIONAL WORKSHOP ON FLUOROSIS
AND DEFLUORIDATION OF WATER
Chiangmai, Thailand, November 20-24, 2000
The Third International Workshop is being organized by the International Organizing Committee under the auspices of the ISFR, in collaboration with the
Intercountry Centre for Oral Health (ICOH), and the Environmental Development Co-operation Group (EnDeCo). Further Information can be obtained from:
Dr S Rajchagool, Chairperson, Local Organizing Committee, ICOH
548 Chiangmai-Lumphun Road,
Nong Hoi, Muang,
Chiangmai 50000, Thailand.
Email: srajchagool@hotmail.com; Website: http://www.icoh.org/
or
Professor Eli Dahi, Thulevej, Chairman, International Committee,
16, DK-2860 Soborg, Denmark.
Email: endeco@image.dk
Abstracts: A provisional title and a 100-word abstract of scientific papers and
discussion papers must be submitted to Dr S Rajchagool by March 31 2000.
Registration fee is $200 US or $150 US for presenters.
Proceedings copies: The proceedings of the First International Workshop held
in Ngurdoto, Tanzania, 1995 (103 pp) and the Second International Workshop
held in Nazreth, Ethiopia, 1997 (197 pp) are available from the ISFR for $20
and $25 US respectively, plus postage. See Fluoride 32(2):45 for postal rates
and send money order payable to the ISFR to: Dr Bruce Spittle, Managing Editor, Fluoride, 17 Pioneer Crescent, Dunedin 9001, NZ. Email: spittle@es.co.nz
Fluoride 32 (4) 1999