Summary: The Politics Of Water Fluoridation

The politics of water fluoridation
Oct 22 2009

→areas where older ppl had mottled teeth and the young did not,
→fluoride cause of the mottling and the change in the caries prevalence
→caries decline with increasing fluoride level up to 1 part per million, more than 1ppm fluoride leads to little change in the caries prevalence,
→diag: bottom fluoride in the water supply, y axis is DMF of children 12-14 yrs old, after 1ppm fluoride there is little change in the level of tooth decay, 1ppm small proportion of children have small mottling, above that the mottling increases, very mild mottling is small white spots on the teeth, mild mottling is larger white spots, moderate is small brown, severe mottled is larger brown marks and hyperplasia,
→graph:
north has low, south has high fluoride, south have half the caries
→level of tooth decay is half in high fluoride areas
→adjust fluoride level where its deficitient, dec in caries was the same as if it occurred naturally
→1955 first schemes established in the UK, wales, south east eng and Scotland, Birmingham first big city
→non fluoridated Dudley
→surveys stopped there, little diff in Newcastle and northumb
→politicians make the decision not dentists, don’t understand what the DMFT of 2 and 4 mean? Proportion of children suffering from toothache, benefits water flueoridation brought to Newcastle
→or proportion of tooth extraction, Newcastle has less percentage
→can show in the diff in the percentage of children of getting general anesthetic, it caries a risk, Newcastle has less children needing general anesthetic
→not just young children that receive the benefits, adults do as well
→ what proportion of children are caries free until 14 yrs,
→ older adults also benefit, not just coronal caries that is reduced its root caries as well
→few fluoridation studies where the examiner carried the examiner blind, dnt know who lived where, carried on mothers, water fluoridation has reduced the level of tooth decay
→tooth decay is the result of social deprevation, deprived on the right, the left are the more rich
→ in NF Northumberland the DMF was 5, in fluoridated Newcastle the children 2.5 affected teeth, social I-II professional class, NF had same level of decay as social classes 4-5, fluoridation gave the children from the poorer homes the same level of tooth decay as the NF children in northumb. That were more rich, fluoridation gives poor kids rich kids teeth,
→systematic review uni of york 2000, meta analysis of all results that met the criteria,
→black vertical line, results to the left favor the non fluoridated, results to the right of the line indicate a benefit to the fluoridated areas, most studies show a benefit to the fluoridated areas, one study where the whole bar is to the left of the vertical line
→john murray: left hand side show decideaous teeth and right hand side is permanent teeth, two types of studies, shaded compares the same area before and after fluoridation, the non shaded ones there is an adjacent or similar area used as the control, mode for primary teeth is 40-50% reducation and permanent dentition is 50%
→demonstrating measures to politicians, 3 diagrams produced for MP, red line is the governments target no more than one by 2003, →ivette coper (MP) want a DMFT b/w 2-2.5 twice the national target
→another area that is also deprived, sandwell, in 1985 its DMF was similar to pont in 1986 the water was fluorinated, there is a gradual reduction in the level of tooth decay,
→small number of surveys that shows when fluoridation ceases, Kilmarnock was fluorination in 1956, in 1968 fluoridation ceased, showed same DMF
→1979 wick was fluoridated, in 1984 children that never received fluoridation had a DMFT of 4,
→arran was unfluoridated, water fluoridation ceased in stramraer, in stram no longer fluoridated there was a small inc in the level of tooth decay
→york systematic review, when water fluoridation ceases, to the left of the black line favors fluor.
To the rght favors non fluor. The overall benefits to the areas that have been fluor.
→so far: the benefits where it is naturally to 1ppm, shows same benefits if adjusted artificially,
→benefits for children and adults,
→research against water fluoridation, need to look to see if articles are properly published
→post hoc: after the event therefore b/c of
it
→effects of water fluoridation was seen b/c it dec tooth decay but also b/c it cased mottling, in burm fewer children with no opacities,
→in Scotland early 1980’s, lead to mottling of teeth,
→dental fluorosis of aesthetic concern, as the level of fluoride inc so does the prop of pop with fluorosis of aesth concern,
→in fluoridated Newcastle the prop with aesth relevant fluorosis was 3%, parents should only allow small amounts of toothpaste for children, since they might swallow it, major cause of the general reduction in the level of dental fluorosis,
→if fluoride accumulates in the body it goes into bones as well
→no association b/w water fluoridation and cancer,
→post york review of the medical research council, showed no evidence
→sir richard doll discovered the link b/w smoking and lung cancer,
→systematic review by york uni, results from all studies that looked at bone fracture incidence related to water fluoridation, if the black diamond is on the right means there is more fractures in the fluorated area, on the left means there are fewer fractures, no association b/w water fluoridation and any study in bones in various parts of the body
→any diff b/w the way fluoride is absorbed in artificial or natural, any diff if the water is hard or soft, no difference in the bio availability in hard or soft water
→ fluoridation might affect the immune function? No evidence of any deleterious effect on the human immune function,
→ effect of the cost of dental treatment on children eligible for medicade (deprived sections)
→if fluoridation was harmful it would not be in salt, it provides an element of choice for the consumer, but its in most processed food so choice not so great
→scottish woman to court, prevent water fluoridation, 3 allegations, 1. Not affective to reduce tooth decay, 2. Harmful 3. Water undertacked did not have the legal power to cause fluoridation the judge said it was affective, it was safe, dnt cause harm, the water undertaker did not have the power to commence water fluoridation scheme, gov undertook the water fluoridation act
→water act, local support, water companies should implement it, it could not chose to they had to implement it. NHS pays for it, nt a direct charge on water rates,
→1.5 ppm optimal level of 1ppm is in that conc
→need to adopt other preventative and health promotion measures to improve dental health and reducing inequalities.