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Lose, Lose Choice!
New figures for the admission to hospital of children suffering from dental caries related health problems show amazing differences for fluoridated and non-fluoridated water. This has always been a controversial area of debate and the new stats are only heating up the argument. At one end of the spectrum, in Rotherham, 584 youngsters (1,550 per 100,000) under five years were admitted to hospital for treatment due to decay. At the other end, in Leicestershire, only six children (7 per 100,000) required hospital treatment. Overall, the presence or absence of fluoride made a 45% difference to admissions.
I could be unfair and take the emotive tack of saying that thousands of children are being subjected to life-threatening general anaesthetic procedures in order to tackle a problem which could be controlled through a very simple means. Unfortunately, from time to time, children do die under anaesthetic just for a dental extraction, and fluoridation is simple and cost effective.
However, I can also hear and appreciate the argument about compulsory mass medication and how unfair that is. After all, how many other medications do we take without consent? The evidence base for safe fluoride is very strong, but the issue of consent is profound and very important.
The main opposition to fluoridation started in the USA in the 1940s before we were considering the issue here in the UK. It is really unfortunate that the protagonists used conspiracy theory as their main ground for argument. Does anyone remember the story line to Stanley Kubrick's 1964 film Dr. Strangelove, in which the character General Jack D. Ripper initiates a nuclear war in the hope of thwarting a communist plot to "sap and impurify" the "precious bodily fluids" of the American people with fluoridated water?
The other argument is based on possible toxicity of fluoride, and particularly the increased risk of bone fractures. However, the mainstream medical opinion is that there is no risk from this angle. In fact, a recent systematic survey found a decreased risk of fracture at the same optimum level as that for preventing decay. (Yeung CA. A systematic review of the efficacy and safety of fluoridation. Evid Based Dent. 2008;9(2):39–43)
There is nothing wrong with continuing the debate concerning this, as I see the importance in arguing both sides. However, I would encourage everyone to concentrate on either evidence-based clinical issues or the moral arguments about medication. Anecdotal evidence and conspiracy theory only get in the way of a reasoned approach.
Dr John Shapter – QCS Expert Dental Contributor