By Jessica Bozoky
Teeth are the hardest substance in the body, and are made up of a mineral called hydroxyapatite. When fluoride is absorbed into the tooth enamel, a stronger mineral called fluorapatite is formed which helps to protect from tooth decay and reinforces the strength of the teeth.
Since the human body is made up of around 55 per cent water, water is one of the most vital sources of life and is consumed daily by the majority of the world’s population. By making fluoride easily accessible in the diet of the public, water fluoridation has been hailed one of the world’s greatest health initiatives of the 20th century.
In Australia, Beaconsfield in Tasmania and Yass in New South Wales were the first towns to introduce water fluoridation in the 1950s. Quickly recognising the health benefits provided by water fluoridation, Australian legislation warranted the implementation of fluoride in the majority of Australia’s water supply by the 1960s and 70s. Because the Fluoridation of Public Water Supplies Act of 1963 considered water fluoridation to be a water treatment issue not a health issue, Queensland was the exception to this achievement, placing the decision making upon local councils.
Fluoridation of water in Australia has always been a controversial issue as the chemical can be harmful at high levels. However, Dr Frederic Leusch a member of the Society of Environmental Toxicology and Chemistry (SETAC) and National Research Centre for Environmental Toxicology (Entox) Australia disagrees. He says fluoride is a naturally occurring compound that is already found in water at varying concentrations as well as plants, rocks, soil, air, and some foodstuffs. He believes that there is a lot of miscommunication regarding the fluoridation of water in the drinking supply and that is why there is so much controversy.
“People are generally not familiar with the main axiom of toxicology, which states that ‘the dose differentiates a poison from a remedy’,” he says.
He uses drinking water as an example saying that too little will kill you, as will too much, but you need just the right amount to survive.
“It is the same with fluoride. Too little fluoride, less than 0.1 mg/L in drinking water, leads to poor dental health and high incidence of dental decay. Too much fluoride, more than 10 mg/L in drinking water, leads to dental fluorosis … But concentrations of 1 mg/L in drinking water are associated with healthier teeth,” he says.
Up until 2008, Townsville was the only place in Queensland that fluoridated its water supply. But during Anna Bligh’s reign as premier, a decision was made to make water fluoridation compulsory across the entire state. This decision sparked a lot of controversy among Queenslanders, who have long resisted fluoride in their drinking water. With the loss of Anna Bligh’s government in 2012, Campbell Newman overturned the legislation for mandatory water fluoridation, which gave local council back the power to choose whether or not to fluoridate their water.
Due to the pressure put upon local councils by anti-fluoride lobbyists, multiple councils around Queensland have since pulled the plug on water fluoridation in their area. An article by the ABC states that the first town to dump the fluoridation of water was Bundaberg.
According to a public statement given by the National Health and Medical Research Council (NHMRC) of Australia, water fluoridation has expanded to benefit around 90 per cent of the rest of the country, however Queensland’s statistics are dramatically lower. In 2007, less than 5 per cent of Queensland was fluoridated.
Sceptics of the health benefits of fluoride claim that water fluoridation is “mass medication” of the public by the government. But Queensland Health rejects the statement, saying they are simply adjusting the level of the substance that is naturally present in water to provide added health benefits to the public.
Digestion of fluoride through drinking water is the main concern that drives people to be cynical over the health benefits as there are potential risks associated with consuming the chemical. As it is used in direct contact with teeth and is not often digested, fluoride is added in large quantities to toothpastes.
Due to digestion and exposure to fluoride, a study conducted by researchers at Harvard school of Dental Medicine in 2006 found a significant association between the exposure to fluoride and the risk of developing osteosarcoma, a rare form of cancer. The NHMRC refuses to accept this along with Queensland Health that state “cancer rates in the rest of Australia (mostly fluoridated for decades) are no higher than in Queensland (largely non-fluoridated).”
Australians who feel very strongly against the implementation of fluoride are known as anti-fluoridation activists. They roam the state, town-by-town, giving presentations on the potential risks the chemical can cause. Their main fight against fluoride is that it is used as a schedule six poison that has been used as an insecticide, particularly for ants and roaches.
Another anti-fluoridation association based in New York, Fluoride Action Network, has a website dedicated to their cause. On there, they provide a list of 13 Nobel Prize winners in the field of chemistry and medicine who either oppose or have reservations about water fluoridation. Of these, Dr Arvid Carlsson, the 2000 Nobel Prize recipient in Medicine/Physiology, played a large part in Sweden staying fluoridation free.
Along with most of Western Europe, Sweden rejected water fluoridation and Dr Carlsson’s findings show that they have still experienced the same decline in tooth decay as countries like the United States, who have heavily fluoridate their water.
Adding to the fight against the chemical is one of the world’s most renowned peer reviewed journals. The Lancet published findings at the beginning of the 2014 from epidemiological studies that have officially classed fluoride as one of 11 neurotoxins that can cause brain development issues, especially in children.
With all this negative research towards the chemical, there is also research supporting the benefits that can be gained from water fluoridation, especially at the low levels that are used in accordance with the different state and territory acts.
As the NHMRC’s Australian Drinking Water Guidelines of 2011-2013 state, water fluoridation is effective in reducing the incidence of dental caries and has many advantages over alternative methods due to its cost-effectiveness, consistency of exposure, equal distribution to all socioeconomic groups and safety.
With many medical researchers endorsing the chemical, doctors from The Royal Children’s Hospital Melbourne believe that water fluoridation is so important to the development of children’s teeth that they recommend not drinking commercially bought drinking water as it doesn’t contain fluoride. Another medical professional supporter, Dr Michael Foley, the director of Brisbane’s Dental Hospital and the past president of the Australian Dental Association Queensland, agrees that fluoride is crucial in the maintenance of healthy teeth.
“Water fluoridation is the topping up of the levels of naturally occurring fluoride in the water to strengthen teeth against tooth decay,” he says. “Fluoride from toothpaste and fluoridated water is taken up by tooth enamel, and strengthens teeth against bacterial acid attacks that cause decay.”
Dr Foley says that everyone should include fluoride in his or her diets, especially children.
“Studies in Australia and overseas consistently report reduced tooth decay in children and adults who drink fluoridated water,” he says.
“Australian Child Dental Health Surveys are conducted every year or two, and invariably show that Queensland children (until recently largely non-fluoridated) have significantly more tooth decay than children from other states (largely fluoridated for decades).
“Water fluoridation… is one of the most successful public health initiatives ever undertaken, and is strongly supported by major health and scientific authorities and community groups in Australia and overseas.”
Professor Jurg Keller, Director of Advanced Water Management Centre at the University of Queensland is somewhat neutral towards the issue of water fluoridation, understanding both its health benefits and potential risks.
“Overall I do have to agree with it, and I think the benefits outweigh the potential risks,” he says.
However Prof Keller made an interesting suggestion in that he believes that the protection should be put where the damage lies.
“Why do we actually fluoridate water whereby we only drink a small percentage of it, where the rest of it is wasted… when potentially the risk is associated with sugar and obviously soft drinks particularly, in which case we could argue we should actually fluoridate the soft drinks,” he says.
“I think it’s potentially a better solution because if people just drink water they’re less likely to be effected by tooth decay issues than people who drink soft drinks.
“Let’s put the protection where the damage is likely to come from… that’s not a bad model at all.”
Though it may sound like a strange concept, the idea behind the model is potentially better suited to a society who consumes more soft drink than water in an average day. Perhaps this model could be presented to local councils to help with their decision-making.
With over 50 years of research into fluoride and its health benefits, it is evident that water fluoridation is an evolutionary technique to prevent and fight the signs of tooth decay. However, scientific evidence has also concluded that there are potential health risks that can to be harmful. It is also obvious why there is so much controversy surrounding the issue when scientific evidence isn’t swayed either way.
*Image taken by Eren Eris