In October people living in Hastings, Flaxmere and Havelock North will have the chance to vote on whether fluoride belongs in their drinking water. Jessica Soutar Barron reports two views.
Dr Paul Connett, author of The Case Against Fluoride and director of the Fluoride Action Network in the US visited Hastings earlier this year hosted by Fluoride Free Hastings. Connett holds a bachelor degree in Natural Sciences from Cambridge and a PhD in chemistry (completed at Dartmouth). He taught at St Lawrence University in New York for 23 years.
The Hawke’s Bay DHB’s campaign supporting fluoride will be led by Dr Robin Whyman, Clinical Director of Oral Health Services. Whyman is a dentist who trained at Otago University’s school of dentistry.
The issue of choice
For many, the issue with community water fluoridation is that it takes away an individual’s right to choose whether or not to consume fluoride.
They see fluroide as a medication, a drug, even a poison, and so it follows that imposing those things on the population through something as sacred as water supply is unethical.
“Fluoride is a medicine and dosing up the public without any thought for dosage violates the principles, practices and ethics of modern medicine. Doctors should be ashamed to support fluoride. You are doing to everyone what no individual doctor should do to anyone,” says Dr Paul Connett.
But for the District Health Board, oral health specialists and the National Fluoride Information Service (NFIS) fluoride is a mineral and a nutrient. All claims of mass-medication and administering drugs un-consented go out the window. They see fluoridation as a decision made by informed public officials for the greater good.
“You can choose to buy bottled water. You can choose to buy a filter to take the fluoride out,” says Dr Whyman. “You’re trading that off against the fact that there’s a benefit to the health of the population.”
Connett believes that low income communities are “trapped”. “They can’t buy filters or bottled water, and toxicity is worse with poor diet.”
Connett’s plea is that we “protect the most sensitive person in a large population” – those who have particular sensitivities to fluoride, those with ailing kidneys (as half the fluoride we drink leaves our bodies every day through our urine), diabetics, bottle-fed babies.
Paradoxically Whyman’s argument is the same, that through fluoride we protect our most vulnerable, those who eat sugary refined foods and don’t brush their teeth.
Connett calls for the battles against decay and obesity to be combined, and such a joint approach appeals to Whyman too.
Apart from the moral dilemma about forced intake of chemicals and a lack of choice, the fluoride argument revolves around competing claims about the efficacy of delivering fluoride to the ‘patient’s’ teeth via drinking water and the potentially harmful side effects of fluoride in the body.
It is hard to get inside the scientific and medical bumf.
On one matter both parties agree: fluoride works topically rather than systemically, you need to apply it directly to the teeth for it to have an effect on them.
“The understanding of how fluoride now works is that the vast and predominant effect is a topical one.” Says Dr Robin Whyman. “There is believed to be some residual effect from fluoride being incorporated in the enamel as the tooth develops but everyone’s of the agreement this is minor and most of the effect is day-to-day topical exposure of the tooth to fluoride.”
Dr Paul Connett: “Once you say it works topically then you have no right to enforce it on the whole body or on the people who don’t want it. It works topically so why put it in the water? That is the equivalent of swallowing suntan lotion.”
Connett proposes alternatives such as xylitol and giving free toothbrushes and paste to low-income families. He says that if you want fluoride, use fluoridated toothpaste (96% of toothpaste sold in NZ is fluoridated).
If drinking fluoride does help teeth, it only helps marginally by fluoridating saliva, which goes on to topically apply that fluoride to the teeth. Brushing and healthy eating are far more effective.
The big question is rather than being good for not much, once it is in the body is it in fact doing some harm?
Dr Whyman says no; Dr Connett says, “You won’t find what you’re not looking for”.
New Zealand studies on the effects of fluoride on the rest of the body are minimal.
“A lot of work to be done in that space is ongoing and there are a lot of health claims or concerns that have been made about whether health generally is affected by community water fluoridation,” Whyman says. “(All the studies published internationally over the last ten years) say there are ongoing questions around some of the health issues raised, and there are quite a number. The only consistently known health effect, and there is debate about whether you call this a health effect, is dental fluorosis.” [Dental fluorosis is staining and, in extreme cases, pitting of the teeth’s enamel.]
Health effects of fluoride can be seen in other scenarios though. For example fluoride tablets have traditionally been given to people with hyperthyroid conditions. Give fluoride to a ‘normal’ thyroid and it stands to reason it will tend towards hypoactivity, and this can lead to lethargy, tiredness, fatigue, depression, obesity.
Connett is concerned with the effects of fluoride on the rest of the body, including the thyroid, brain and connective tissue. As he says “We are more than just teeth.” He quotes authoritative overseas reports that say fluorides have the ability to interfere with the functions of the brain and that fluoride exposure is associated with lowered IQ.
But cause-and-effect thinking like this needs to account for the different types and concentration of fluoride in drinking water. Some of the research Connett cites looks at toxic effects from fluoride entering drinking water through runoff from fluoride that naturally occurs in rocks and soils, rather than fluoride deliberately added to water supply.
One of the pinch points in the debate is around dose, and the importance of differentiating between dose and concentration. Of course ‘dose’ suggests medicines and drugs, not ‘nutrients’.
One quoted study from China (2003) puts the threshold for lowering IQ at 1.9 ppm. Water in Hastings is fluoridated at between 0.7 and 1 ppm. That’s the concentration. Dosage is different for everyone because it depends on how much water you drink.
Connett: “A child drinking two litres of water at 1ppm would get a higher dose(2 mg/day) than one of the children drinking one litre of water at 1.9 ppm (1.9 mg/day).”
Dr Robin Whyman counters: “When you start to look at the range of other issues – neuro toxicity, cancer – the reports are consistently coming back and saying ‘No, there does not appear to be an effect associated with fluoride at the levels of community water fluoridation’. There is no doubt that you can get adverse health effects if you’re talking about people who have been exposed to higher levels of fluoride, either because the water that they’re drinking contains much more than that or because they’ve had industrial exposure, but that’s a completely different context.”
No one disputes that fluoride can cause dental fluorosis in children and skeletal fluorosis in adults.
“In adults fluorosis can present as pain in connective tissues, pains in joints and bones,” explains Connett. “In the US where 200 million people drink fluoridated water, 1 in 3 adults has arthritis and it’s on the increase. That at least deserves investigation.”
Whyman says there has been no evidence of the skeletal fluorosis in New Zealand. Of dental fluorosis he says: “From a patient point of view, most of the studies that have been done show that unless you are talking about severe fluorosis then the assessments of those teeth by people is they actually look better than completely normal teeth.”
Regarding bottle-fed babies, Whyman says the Ministry of Health and food standards in New Zealand state it’s safe to make up infant formula using fluoridated water. But Connett counters this: “You don’t want fluoride anywhere near your baby. When you bottle feed your baby in Hastings you are giving them 175 times more fluoride than mother nature intended.”
The debate over fluoride in Hastings’ drinking water will continue in BayBuzz. In the meantime, you can consult these sources for more information.
National Fluoride Information Service:
Fluoride Free Hastings:
Fluoride Action Network NZ: