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There's something in the water ...

Fluoride has just been removed from Hamilton's water following sustained pressure from a lobby group. Who will be affected?

Poor people and children benefit the most from fluoridation and will suffer the most when it is removed from water supplies, according to a New Zealand dentistry expert.

Jonathan Broadbent, a senior lecturer at Otago University's faculty of dentistry and member of the Dental Public Health and Epidemiology Research Group at the university's Sir John Walsh Research Institute, said he supported fluoridation "because it is a very basic and important first step we can take to improve the oral health of New Zealanders and address inequalities".

He said fluoride made the enamel of the teeth less soluble, protecting against acid attack. "Everyone can benefit from a reduced rate of tooth decay simply by consuming foods and drinks prepared with fluoridated water.

"Treatment of decay among children under general anaesthetic is necessary all too often in New Zealand but rates are lower than they would be if there was no fluoridation."

He made these comments a month after antifluoridation lobby group Fluoride Action Network persuaded the Hamilton City Council to ditch fluoride from that city's water. The group has now moved its campaign to Auckland.

Antifluoride Claims

It makes many claims about the dangers of fluoride in the water supply, including that it is toxic, that it causes damage to bones, brain and thyroid and can cause cancer, that it is particularly damaging to children and minorities and that it is unethical to "mass medicate" the population. (1)

Broadbent said the antifluoridationists did not make valid science-based arguments. "A critical appraisal of their writings reveals they frequently misquote research, rely on poor quality research or pseudoscience. They utilise fear and apply political pressure."

He said the main risk from fluoridation at the levels in New Zealand (0.7-1.0 parts per million) was a small chance of fluorosis--a mottling of dental enamel. "A much bigger risk is that of not fluoridating as.... that increases a person's risk of dental decay."

Broadbent said the Fluoride Action Network had "hijacked" the Hamilton City Council's decision-making process by running a campaign to lodge as many anti-fluoride submissions as they could.

He said fluoride was food fortification, not a medicine, and fluoridation could be compared to adding iodine to salt to prevent the disease goitre. He said everyone could benefit from fluoridation to some degree and that the public health benefit outweighed individual complaints. "Even where fluoride is also available from other sources, such as toothpaste, a 30-40 per cent reduction in decay rates can still be gained through drinking fluoridated water." (2)

The Government strongly promotes fluoridation through the Ministry of Health, but is sensitive to the choice argument, putting fluoridation decisions in the hands of local authorities, who are accountable to voters. However, this is not a responsibility the local authorities want.

The Hamilton council made its decision in the face of strong advice to the contrary from the Waikato District Health Board which looks after the health of the same people. However, after the vote, the council said it planned to write to the Minister of Health to say it should not have been responsible for making that decision, a view shared by Local Government New Zealand.

The ministry's chief adviser on child and youth health, Pat Tuohy, has expressed his concern at the pressure tactics used on councils. "I think that there is a global, very strong advocacy to remove added fluoride from water from a range of people who have very strong feelings about it ... they are very well organised and use ... scare tactics to scare councils into making this decision."

Nelson Marlborough District Health Board clinical director of hospital dental services Geoff Lingard said last month that one in eight children aged four to six in Marlborough needed to be put under general anaesthesia to repair extensive tooth decay. (3) That would be a lot lower if Marlborough had fluoridated water supply.

Lingard, who is also president of the New Zealand Dental Association, said it was disappointing the decision to fluoridate lay with local authorities. Central government was abrogating its responsiblities to district councils which were often swayed by "pseudoscience" and public emotion, and ignored medical research and the perspective of health professionals.

For Hamilton, he predicted an increase in tooth decay, particularly in lower socio-economic groups. "A percentage of New Zealand might not clean their teeth twice a day, go to the dentist regularly or use a fluoridated toothpaste. They struggle to pay the rent, clothe and feed themselves. But they have to drink water and fluoridation will give them greater protection against decay."

NZNO, in its 2011 manifesto of policy advice for the new government to be elected later that year, identified fluoridation as a health equity issue: "The higher proportion of Maori living outside main centres where there is less access to fluoridated water supplies means that Maori have not benefited equally from what is widely accepted as the safest most effective intervention in reducing the level of dental caries." (4)

A Herald Digipoll survey released at the start of July found 48 per cent of those polled supported fluoridation, 25 per cent were against, while 24 per cent thought the decision should be left to local councils.

About 50 per cent of New Zealanders have a fluoridated water supply.


(1) Fluoride Action Network. (2012) 50 reasons to oppose fluoridation. Retrieved 4/7/13.

(2) Lee, M. & Dennison, P.J. (2004) Water fluoridation and dental caries in 5- and 12-year old children from Canterbury and Wellington. NZ Dental Journal; 100: 1, pp10-15.

(3) Allen, I. (2013) Fluoride would 'lower children's tooth decay'. Marlborough Express, June 11. Retrieved 11/6/13.

(4) New Zealand Nurses Organisation. (2011) Manifesto 2011. Wellington: NZNO.
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Title Annotation:water fluoridation; news focus
Author:Stodart, Kathy
Publication:Kai Tiaki: Nursing New Zealand
Geographic Code:8NEWZ
Date:Jul 1, 2013
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