Public Meeting - Water Fluoridation

[Skeddan]

COMMUNITY WATER FLUORIDATION AND CARIES PREVENTION: A CRITICAL REVIEW

The aim of this paper was to critically review the current role of community water

fluoridation in preventing dental caries. Original articles and reviews published in English

from January 2001 to June 2006 were selected through MEDLINE database. Other sources

were taken from the references in the selected papers. For the past 50 years community water

fluoridation has been generally considered the milestone of caries prevention and as one of the

major public health measures of the 20th century. However, it is now recognized and accepted

that the primary cariostatic action of fluoride occurs after tooth eruption. Moreover, the caries

reduction directly attributable to water fluoridation has declined in the last decades as the use

of topical fluoride had become more widespread, whereas enamel fluorosis has been reported

as an emerging problem in fluoridated areas. Several studies conducted in fluoridated and

nonfluoridated communities suggested that this method of delivering fluoride may be

unnecessary for caries prevention, particularly in the industrialized countries where the caries

level has became low. Although water fluoridation may still be a relevant public health

measure in poor and disadvantaged populations, the use of topical fluoride offers an alternative

to water fluoridation to prevent caries among people living in both industrialized and

developing countries.

Authors: Pizzo G, Piscopo MR, Pizzo I, Giuliana G

Correspondence: Department of Oral Sciences, University of Palermo

[staaue]

Another grand contribution to this debate by ANS..?????????????? Keep it up yessir xx

 

You feel it's acceptable to accuse someone of discrediting their own point of view with snide remarks and then proceed to call someone a 'dick head'. By your own admission, you just discredited your own point of view.

 

If you genuinely can't see your own hypocrisy in this thread, get a grown up to explain it to you.

 

Another grand contribution to this debate by ANS..!!!!!!!!!!!!!!!! Keep it up

 

ANS, repeated aphorism doesn't make for a stronger case; you don't like what I say, so don't talk to me if you can't be civil. Hell we all have a snipe from time to time, but repeatedly so. Boring fella, get a life. That is all the rise you'll get, and to be honest, it's more for others watching this topic to have a laugh at... give it up. You're out of your league.

 

Slim. not really a fair, intelligent and balanced comment IMO; you discredit yourself with snide remarks like that IMO.

It's still conjecture, and it makes you look desparate enough to make future bogeyman stuff up to support your argument.

 

 

Wasn't being snide. You see this 'thin end of the wedge' claim a lot with this kind of resistance arguing, and it's pretty worthless. Stick to the facts, in my opinion.

 

If I truly believed the majority of the populous wanted their water compromised with a nasty substance, then I'd say fine, if that is what you want; lets hope you're right, and our children forgive you.

Resistance arguing, eh... and you're doing what!!!! I don't write this crap for the benefit of you personally, it's so that when someone comes along and reads what is being argued/debated etc.. they see some of us are standing fast and repeating the same thing over and over.

FLUORIDATION ISN'T GOING TO HELP, WE NEED A PROPER SOLUTION.

[Slim]

If I truly believed the majority of the populous wanted their water compromised with a nasty substance, then I'd say fine, if that is what you want; lets hope you're right, and our children forgive you.

Resistance arguing, eh... and you're doing what!!!! I don't write this crap for the benefit of you personally, it's so that when someone comes along and reads what is being argued/debated etc.. they see some of us are standing fast and repeating the same thing over and over.

FLUORIDATION ISN'T GOING TO HELP, WE NEED A PROPER SOLUTION.

 

Now your just being dim, which discredits you even more. I've not said a word for or against flouridation, I'm just questioning the methods used in the debate.

[ballaughbiker]

Staaue - I agree we need a proper solution and I further agree that we shouldn't put fluoride in the IOM water but you say it wouldn't help. Expain why it has helped in Birmingham for the last 45 years and don't refer me to the dozens of sites saying its only topical effect etc etc.

 

You can find sites on the net to agree with any view on anything. That doesn't mean that they are the end product of proper scientific research with established methods and techniques open to scrutiny. They're just opinions like mine that (jokingly of course) says fluoride/phone masts/Okells mild/whatever causes baldness. Its easy to say and round a big gang up who agree with you and shout everyone down but that doesn't make it a fact. (Not in the scientific community's eyes anyway).

 

Just explain why Birmingham has a statistically significantly lower DMF than a city that is not fluoridated and then explain why it wouldn't help. Just to repeat (and yes, not for the first time) I do not believe it is the answer here but years of research from respected authorities worldwide say it would help. People who live in naturally and artificially fluoridated areas are living proof of that, or is it something else?

 

 

Edited to say : ps no need to shout (big block capitals) it doesn't make any argument stronger.

[ans]

don't talk to me if you can't be civil.

 

Perhaps I should start calling you a 'dick head' then, seeing as that's your interpretation of civility.

 

Opposing voices in here have asked you questions which you have failed to answer, most often through ignoring them and sometimes through obfuscation. You've continually undermined your own position in the thread with your shouty, nonsensical and at times, downright offensive posting and the only thing you have successfully managed to do is discredit your whole argument with your hypocrisy. You, I'm sure, see this differently. However, the only people laughing at this thread are laughing at you.

[Skeddan]

Another grand contribution to this debate by ANS..?????????????? Keep it up yessir xx

 

You feel it's acceptable to accuse someone of discrediting their own point of view with snide remarks and then proceed to call someone a 'dick head'. By your own admission, you just discredited your own point of view.

 

If you genuinely can't see your own hypocrisy in this thread, get a grown up to explain it to you.

 

Maybe I’m missing the point here – and I’m a bit confused by the reference to ‘Dr Nic’, but I’m guessing this is a reference to Prof Michael Lennon (?).

 

From what I can gather IMO Prof Lennon walking out of the meeting in this manner was rude, insulting and arrogant. It suggests his resorting to a playground tactic of attempting to undermine the whole event as being of no worth or validity when he came to realise the overwhelming opinion was against his view.

 

I don’t think staaue’s criticism really hit the mark, but it was not misdirected. I don’t think the way he expressed this was ‘snide’; I think it was impassioned and forthright, rather than calm and detached, but that seems fair enough.

 

What I take from ans’s comments was a criticism of staaue for using an ad hominem argument and resorting to a personal attack (though this point could perhaps have been made in a less inflammatory way). On the other hand IMO it is legitimate to raise the issue of Prof Lennon’s personal character and integrity in addressing such issues: Prof Lennon is supposedly an expert and might be trusted as such. Such behaviour suggests arrogant dismissal of views contrary to those he holds and lack of respect for public concerns. Thus IMO staaue’s remarks about his character are legitimate, though I do think staaue could have made his point better and in a less inflammatory manner.

 

The ethical conduct of official representatives is also legitimate cause for concern. From what I understand Prof Lennon was invited to represent the case on behalf of Dr Emerson.

 

…public meeting began with a challenge to Dr Paul Emerson last April to debate this issue on the Island. He said he would debate but subsequently invited Prof Michael Lennon to present his case.

 

Professor Lennon announced to the audience, shortly after 9 pm, and much to the dismay of both the moderator and the audience, that he had had enough (he said that he was up at 8 am and was looking forward to eating some sea food) and that he was leaving.

 

If this is what took place, then it strikes me as arrogant and disrespectful. I would think there would be reason to call for a resignation if Dr Emerson conducted himself in this manner, and certainly some expressions of outrage such as given by staaue.

 

Out of interest does anyone know who paid Dr Lennon’s expenses to attend the meeting? (and whether this included the fine sea food dinner that he was so looking forward to).

 

On the issue of funding, it seems to me that this is a question that might be raised about the British Fluoridation Society, and the appropriateness of the choice of the chairman of this organisation to speak on behalf of Dr Emerson.

 

From what I can gather from their website, the British Fluoridation Society seem to be a lobby group with a fixed agenda to promote water fluoridation. The info I can find about their funding is from their website:

 

Funding: Since its establishment the Society's funding has been from membership subscriptions and Government (Departments of Health) grants.

...

Corporate members include many health authorities and professional organisations.

 

Though I have no idea about their corporate membership and could not find details of this, it would not completely surprise me if this included corporates or organisations associated with the sugar industry.

 

Personally I think there is a real problem with funded and payroll scientists serving big-business interests in a partisan way and who present biased and slewed research under the guise of being ‘scientific’. IMO contempt for those who use their status and credentials in this manner and prostitute their profession is far from unjustified. It does rather look like Prof Lennon might be one of those (though ‘dick head’ is not perhaps the best way to describe such persons – IMO ‘scum scientist’ would be a more appropriate term).

 

(BTW this isn’t meant to be the ‘grown up explanation’ that ans suggested might be needed – just a personal viewpoint that I think is relevant even if I have got the wrong end of the stick about the comments on ‘Dr Nic’).

[saveourwater]

Staaue - I agree we need a proper solution and I further agree that we shouldn't put fluoride in the IOM water but you say it wouldn't help. Expain why it has helped in Birmingham for the last 45 years and don't refer me to the dozens of sites saying its only topical effect etc etc.

 

You can find sites on the net to agree with any view on anything. That doesn't mean that they are the end product of proper scientific research with established methods and techniques open to scrutiny. They're just opinions like mine that (jokingly of course) says fluoride/phone masts/Okells mild/whatever causes baldness. Its easy to say and round a big gang up who agree with you and shout everyone down but that doesn't make it a fact. (Not in the scientific community's eyes anyway).

 

Just explain why Birmingham has a statistically significantly lower DMF than a city that is not fluoridated and then explain why it wouldn't help. Just to repeat (and yes, not for the first time) I do not believe it is the answer here but years of research from respected authorities worldwide say it would help. People who live in naturally and artificially fluoridated areas are living proof of that, or it it something else?

 

 

Edited to say : ps no need to shout (big block capitals) it doesn't make any argument stronger.

 

I don’t believe there are any easy answers to the questions you have raised Ballaughbiker.

 

However the following link may help: -

 

LINK

[ans]

Maybe I’m missing the point here

 

Yes you are. I'm trying to get him to understand why he can't, on one hand, criticise someone in this very thread for using snide and offensive comments and accuse them of undermining their position and argument with this approach, when he does exactly the same himself. Glass houses and all that.

 

He, unfortunately, can't see this double standard.

[saveourwater]

Funding: Since its establishment the Society's funding has been from membership subscriptions and Government (Departments of Health) grants.

...

Corporate members include many health authorities and professional organisations.

 

Though I have no idea about their corporate membership and could not find details of this, it would not completely surprise me if this included corporates or organisations associated with the sugar industry.

 

Personally I think there is a real problem with funded and payroll scientists serving big-business interests in a partisan way and who present biased and slewed research under the guise of being ‘scientific’. IMO contempt for those who use their status and credentials in this manner and prostitute their profession is far from unjustified. It does rather look like Prof Lennon might be one of those (though ‘dick head’ is not perhaps the best way to describe such persons – IMO ‘scum scientist’ would be a more appropriate term).

 

(BTW this isn’t meant to be the ‘grown up explanation’ that ans suggested might be needed – just a personal viewpoint that I think is relevant even if I have got the wrong end of the stick about the comments on ‘Dr Nic’).

 

Dr Emerson was a personal member of the British Fluoridation Society since 2002. The plan for fluoridation was announced to the Manx public in September 2003 and Dr Emerson led the campaign.

 

The IOM DHSS Public Health Directorate are 'corporate members' of the British Fluoridation Society.

 

At the public meeting in Port St. Mary last week Dr Emerson said that he had now resigned his personal membership of the British Fluoridation Society.

[Skeddan]

Maybe I’m missing the point here

 

Yes you are. I'm trying to get him to understand why he can't, on one hand, criticise someone in this very thread for using snide and offensive comments and accuse them of undermining their position and argument with this approach, when he does exactly the same himself. Glass houses and all that.

 

He, unfortunately, can't see this double standard.

ans, you might also consider that your remark “get a grown up to explain it to you” could also be criticised as snide and offensive, and you might also be criticised as discrediting your own point of view, and that you too are unable to see your own hypocrisy.

 

While this may be more to the point of “glass houses and all that”, I did not think that pointing that out would contribute to the debate, and anyway I doubt anyone is that interested in the squabble and attempts to score points and ‘teach people lessons’. If I’ve missed ‘the point’, then it is only because the points I am interested in within the thread are to do with water fluoridation.

 

To really stick my neck out here, I’d also say that I don’t think it reflects well for a Moderator to be making the kind of inflammatory remarks that seem to be going on in the thread. I have no problem with you giving viewpoints and arguing against people, but it might be better done by ‘ans’ in the Members group rather than with Moderator status. A snide remark such as ‘can a Moderator step in here please’ might have been justified given some of the abusive and anatagonistic comments that have been made and which undermine sensible discussion. However on a matter such as this I don’t think it does anyone any credit to have this degenerate into a flame war. There are serious issues involved. Can you take the snapping and mauling outside please – if you want to continue with that – or take up any of the points in this post - please do so in another thread.

[ans]

How interesting that you would dismiss the squabbling in the thread, yet see fit to launch into your own off topic tirade.

 

Rude and insulting? Moi? I don't think you'd find many who would disagree. My point is, was and still remains, that staaue attacked another user for what he perceived to be snide comments and then proceeding to call someone else a dickhead. I'm sorry you can't understand that, truly.

 

Mods on this forum post freely and always have done. We're only mods when we use, or threaten to use, moderator functions. If I wanted to put my moderator hat on, I'd have closed this thread a good few pages back because it's nothing more than a propaganda exercise. A debate usually has to have questions and answers from both sides and all I generally see from most of the anti fluoride people are a series of 'Nyah, nyah' posts. There are notable exceptions and there are some genuinely informative posts, but they're few and far between and none of them come from staau, who's most notable contribution is to deride any statistics quoted by a supporter of fluoride as being made up and part of some Government conspiracy.

[The Voice of Reason]

Bloody hell, all this aggravation over whether it is a good thing if they put some stuff in the water. People losing their manners all over the place.

How many people are seriously bothered about this? Certainly not a major topic in my circles

 

It won't kill us will it? (will it?)

[Skeddan]

My point is, was and still remains, that staaue attacked another user for what he perceived to be snide comments and then proceeding to call someone else a dickhead. I'm sorry you can't understand that, truly.

 

Point taken - I had indeed got the wrong end of the stick - I thought the ref was to Prof Lennon, not to another user in the forums. That's a different matter, and I had missed the point. I do understand that then.

 

Yes it was hypocritical to launch a criticism of the this squabble in this manner and I'm also a silly sausage on a bed of broken glass. Thinking about it I should have PM'd you instead. Please though, there are important and interesting issues with this, and it would be a shame for the discussion to get sidetracked into squabbles.

 

I wholly agree that a lot of the posts have not been very informative in factual terms, but characterising these as 'propaganda' appears to suggest that there is not a legitimate concern or feeling over this. However I think nearly all the posts are informative if only for the viewpoints that emerge from this.

 

 

As for statistics.... (warning - rant follows)

 

Statistics - there are ways of slewing these, and partisan scientists engage in that all too often (notably for tobacco companies, sugar industry, pharmaceutical companies etc.) That is something I am sufficiently convinced of from what I learned studying Research Methods at Uni.

 

To give an example - one might take a low socioeconomic status state primary school and compare dental health with average for a region of the UK matching for age and gender, but not socioeconomic status. One gets valid statistical results, but to what purpose? The turgid academic paper would not draw unjustified conclusions as such. Rather these conclusions are arrived at by others who do not critically examine the research.

 

One should also take into account findings may also be skewed because academic papers generally look to publish significant results. A study showing that there was not a statistically significant result (e.g. between F and -F treatments) might have less chance of being published, especially if it does not conclusively disprove other earlier findings which are significant.

 

One must also consider the amount of funding that goes to research to show beneficial effects of F vs those investigating harmful effects, and who conducts these. To give an even more slewed example, take a research team and have them do 20 studies of beneficial effects with p<0.05 and chances are one will come up trumps. They are not obliged to publish or mention their other studies, only the one showing significant results. Alternatively fund 20 different teams to do the same research and one has much the same. (something perhaps that inspired Darren Brown's recent doco on horse betting).

 

One should also take into considerations the alpha level - to say it is '95% significant' as mentioned in one post (p<0.05 ?) is ok for some things, and statistically significant, but for what purpose? A pharmaceutical treatment has to meet much stricter standards than this to meet approval. As the number of subjects increases one also expects to find significance. Boring stuff, but I would expect there to be results with p<0.001 for this to be compelling in favour of adopting a drug like this.

 

There is also weightings to take into consideration in a manner which has much in common with signal detection theory and what happens with Type I and Type II errors. If there is a 99% likelihood that something is safe, and it is assumed to be so, what is worst case scenario and the consequences which might occur if it proves unsafe? Is it a bit of a bad stomach at worst? Or is it a Chernobyl meltdown or a DDT disaster? Is this putting something in the water which is obviously safe - like sand - or putting in a substance into the water which is a neurotoxin which can cross the blood brain barrier, which is known to be able to cause long term DNA damage, sterility, auto-immune disorders, kidney and liver damage, calcify in areas of the brain such as the pineal gland, and which can interfere with neurotransmitters, learning, memory, growth, etc.

 

If this is the nature of the substance, then lack of conclusive evidence it is harmful in 'optimal' quantities is not good enough. (It's a bit like safe radiation levels - long term exposure must also be taken into account). Even if evidence showing it is safe with p<0.05 was good enough, there is not even this. Instead it is claimed that there are no harmful consequences as can be seen in places which have had water fluoridation over the long term - such as the USA (overlooking the fact that the US has had an unexplained explosion of sterility, auto-immune disorders, kidney disorders, and huge rate of ADHD and autism!).

 

What's the upside of taking this risk? Of course there is the statistical and laboratory evidence that fluoridation can reduce gingivitus and helps prevent caries (I know next to nothing about dentistry), and there seems no doubt about it reducing plaque formation (at least on teeth if not in parts of the brain). However there also seems to be evidence indicating it can increase periodontitis. An 'optimal level' might mitigate possibly harmful effects, but F accumulates in the body. It is also of note that periodontitis seems to be very prevalent in the USA, which presumably has fluoridation at an 'optimal level'.

 

You also need to consider the systems dynamics issues in the problem, and cause-effect. To give an example it was found that Ribena was high sugar and was being used in bottles, thus leading to high tooth decay. Those problems will show up for years in studies of DFMT (or whatever) in children. One can find the 'cure' is treating a 'problem' that has already dealt with - or that should be dealt with in a different way. An alternative measure might be new fillings in a given period, rather than a count of existing fillings, missing teeth etc.

 

Statistics don't lie any more than long division lies, but people often draw erroneous conclusions from them. When the BSF obtains funding from 'corporate members' I have every reason to be suspicious about the evidence they present, if only because it is likely to be selective. I am equally suspicious about evidence from anti-fluoride lobby. Even independent studies which are peer reviewed can be found to have flawed methods in a surprising number of cases, and to evaluate 'statistics' one has to actually pay close attention to the study itself, the methodology, the way the statistics are applied and pay attention to the conclusions that can or cannot be drawn from the study.

 

If nothing else the evidence and research ought to be up to date. I'm sure statistics once showed asbestos and DDT presented no harmful effects. Things move on. I say if only because I am surprised at how ill-equipped the anti-fluoride group appears to be, and how all round people seem to base a lot on the York Report which is now over 7 years old.

 

Maybe some here would think that a lot of the recent research on fluoride is just done by people wearing tinfoil hats who are bonkers and just 'scaremongering' for 'anti fluoride propaganda'. If one is 110% convinced and knows beyond any shadow of possible doubt water fluoridation is safe, then that is surely the right response to any study looking at possible harmful effects from this. To dismiss well conducted bona fide scientific research in this way - or to assume it doesn't exist or is partisan because the BSF with their funding from corporate membership don't mention it is a bit naive and eccentric IMO.

 

As it happens one of the independent journals and orgs on fluoride research is based in NZ - and has very good editorial panel, and publishes some very good papers on the topic. The April-June 2007 issue covers a lot of things relevant to anyone interested in this topic:

 

http://www.fluorideresearch.org/402/files/...n2_p00i-0vi.pdf

 

(Perhaps because my primary interest in this area is to do with cognitive neuroscience, the items I was particularly struck by were:

 

FLUORIDE NEUROTOXICITY AND EXCITOTOXICITY/MICROGLIAL ACTIVATION: CRITICAL NEED FOR MORE RESEARCH

and

DOSE-DEPENDENT EFFECTS OF FLUORIDE ON NEUROCHEMICAL MILIEU IN THE HIPPOCAMPUS AND NEOCORTEX OF RAT BRAIN

 

I'd suggest looking over these carefully before firing back criticisms that I am making wild speculations as to what might be potential adverse effects of water fluoridation.

 

Also many of the abstracts are well worth looking over, such as sterility and harmful effects on people where fluoride occurs naturally in water).

 

Of course until harmful effects are conclusively proved with 'ecological validity' with the same species in the specific population and with the exact substance, dosage etc. such considerations can be dismissed as just a "Nyah, nyah" post. You wouldn't play Russian Roulette to win $5 just because it wasn't conclusively proved there was a bullet in the chamber. You would consider a potential risk, the upside, the potential threat that might be posed and make a sensible evaluation.

 

I orignally believed water fluoridation was completely safe and didn't think twice about it. I also thought the risk was higher from mercury based fillings (though there are alternatives). Now I am thinking there could be a very grave risk from fluoridation which ought to be taken into account. I also don't think this is just a matter for dentists who should claim exclusive expertise on the topic, but something that also requires the expertise of neurobiologists, endocrinologists, etc. and also people to look at risk modelling, economic and legal liabilties, issues of medical ethics, etc. etc.

 

Alternatively one could use just plain common sense and find alternatives for the desired dental health outcomes - e.g. increasing primary health services, better education, topical fluoride for those who want it, and - dare I say it - measures to address the real cause of the problem - excessive sugar intake and poor oral hygiene. It might not be a 'no brainer', but it is a view that many people here have expressed - and which I think is the most sensible and rational approach to the question.

 

Anyway, that's my on-topic tirade.

[Skeddan]

Here’s the other half of my $0.02 worth.

 

I think this is an important principle:

I agree it should not be compulsory and although I want it in my water, I am prepared to say no as I have no right to add it to anyone else's water.

 

I also think there may be an even more serious ethical issue. Arguably water fluoridation may be subjecting persons such as saveourwater to medical treatment or scientific experiments without their informed consent and which is “not justified by the medical, dental or hospital treatment of the person concerned nor carried out in his or her interest”.

 

Such an argument would have to be fleshed out further, but potentially this borders on violation of fundamental human rights.

 

In doing so I also think it would be important to remember that water fluoridation involves artificially introducing a pharmaceutical substance as a medical/dental treatment. It is a ‘drug’. Moreover it is an experimental drug; while it is clear that there are some marginal benefits in reduction of gingivitus and caries prevention, it is not yet clear that there are no adverse health effects. If one wanted to conduct research in this manner with these kind of risks and lack of informed consent - for the proposed benefits - it would be thrown out by an ethics committee, regardless of how well designed the experiment is. To my mind the fact that this is not an 'experiment' or conducted as such has no bearing on the substantive ethical issues involved.

 

Thus IMO the potential threat posed by water fluoridation not only far outweighs the very marginal benefits, the ethical issues are such that IMO it is unacceptable that water fluoridation should be introduced.

[ballaughbiker]

Skeddan er, yes I agree that (I'm paraphrasing somewhat) you get the answer you want depending on the question you ask (or don't if you see what I mean). Statistics can be used in any way the statistician wants. However even if we fully accept all the potential risks of fluoridation, why have any/all of these perceived ills not happened in areas of natural fluoridation where people have drunk water containing fluoride ion for thousands of years? If it is a drug ( debatable but I understand where you are coming from) it has had the longest drug trials of any drug hasn't it?

 

I've asked this before, more than once, but can anyone explain why people living in areas of the UK that have natural fluoridation have no increased incidence of any disease than can be attributable to drinking water containing fluoride ion?