The ‘No’ case and our response

The following are statements made in the ‘NO’ case (not to stop fluoridation), with our responses appended in blue.

Abbreviations used:
Cochrane review (2015): Zipporah Iheozor‐Ejiofor et al; “Water fluoridation for the prevention of dental caries”; Cochrane Collaboration/Cochrane Database of Systematic Reviews; 18 June 2015. Full study available here.
NHMRC: National Health and Medical Research Council
PMHC: Port Macquarie-Hastings Council
TGA: Therapeutic Goods Administration
TG Act: Therapeutic Goods Act (1989)
FFA: Fluoride Free Australia

 I N F O R M A T I O N  S H E E T – For the No case (with our responses in blue)

“Having healthy teeth is really important for our overall health, wellbeing and quality of life. A healthy mouth enables you to eat, speak and socialise, without pain, discomfort or embarrassment ⁽¹⁾.”

Agreed.

“Tooth decay is one of the most common chronic health problems in Australia … “

Agreed

“… but rates of decay are much lower in communities with water fluoridation ⁽²⁾.”

That completely spurious statement (as we demonstrate below) has as its reference a report on sugar consumption, which is curious and of special significance for those interested in history.

In America, in the early 1950s, the sugar industry had a mission to find out how to control tooth decay without reducing sugar consumption and, along with the aluminium and nuclear industries, funded much of the early research into the idea that fluoridation reduced dental decay. Fluoridation quickly became a great friend of industry (not dental or general health), despite fluoride’s abysmal reputation as a general and accumulative protoplasmic poison, affecting and disrupting many biological processes from digestion, to enzymatic and endocrinal functions and neurology. 

It is time we stopped imagining that this potent industrial pollutant could ever be good to consume.

Many studies do indeed seem to support the idea that fluoridation reduces the incidence of decay. But such studies have been found to be in the main either old (conducted before toothpaste became widespread), or of generally poor quality (not well designed or controlled), or small in scale. Other studies of higher quality have found tooth decay in non-fluoridated countries and regions has fallen to levels equal to or lower than fluoridated locations. There are obviously other factors than fluoridation at play in falling decay rates, with better oral hygiene and better nutrition being the most likely influences.

We are fortunate now to have the Cochrane Review (2015), generally recognised as the best overall assessment of fluoridation dental research, and considered all relevant studies undertaken worldwide since 1951, when fluoridation began. (Note: See also below, regarding the Cochrane review conclusions concerning specific sectors of the community).

In its ‘Main’ findings concerning dental decay, the Cochrane review reported:

• Most studies are not of high quality, and there is insufficient information to determine the effect on caries levels of stopping water fluoridation programmes;
• The majority of studies (71%) were conducted prior to 1975 and the widespread introduction of the use of fluoride toothpaste;
• There is very little contemporary evidence that has evaluated the effectiveness of water fluoridation for the prevention of caries;
• Being based predominantly on old studies, these results may not be applicable today;
• There is a significant association between dental fluorosis and fluoride level.

Based on the finding of the highly respected Cochrane Collaboration 2015 review, it is now official: the quality of fluoridation dental research is at worst non-existent, and at best unreliable. In that context, it is of note that not one single Australian fluoridation efficacy study – on which NHMRC rely so heavily – met even the relaxed inclusion criteria for the Cochrane Review.

Globally, there is little to no evidence that fluoridation is dentally effective. Less than 5 percent of the global population and less than 98 percent of Europe is water fluoridated, and there is no discernible difference in WHO decay statistics for fluoridated versus unfluoridated countries. See this chart.

Moreover, as Australia is around 90 percent fluoridated (96% in NSW), how can fluoridation be described as effective when, according to the ‘No’ claim above, tooth decay remains chronic in Australia?

Fluoridation is a failed experiment!

“The consequences of tooth decay include dental pain, concern about appearance, costs due to dental treatment and time off school and work.”

Agreed. And what we need are real solutions to that problem, especially universal dental care, like Medicare, so that all Australians can visit a dentist regularly.

Many other countries manage dental care without recourse to fluoridation, usually achieving decay results as good or better than Australia. Forced fluoridation is not a healthy or effective answer.

“One of the safest and effective ways to reduce tooth decay is to fluoridate the water supply.”

The claim of efficacy is FALSE. The Cochrane review (2015), mentioned above and acknowledged as the best available systematic review on the topic, reports that fluoridation is not significantly effective in reducing tooth decay.

The other claim – of fluoridation ’safety’ – is not only misleading but also egregious with the relevant Australian authority, namely NHMRC, itself admitting never having conducted studies capable of determining whether fluoridation is safe or otherwise.

See this letter (NHMRC to PMHC, 2016) where on page 1 NHMRC admits that, apart from dental fluorosis, “there have been no projects funded by NHMRC that investigated potential negative health effects from fluoride or fluoridation.”

See this paper (#5b) that documents recommendations from NHMRC’s own 1991 and 1999 fluoridation reviews for significant health safety monitoring and studies to be done, and done urgently as fluoride accumulates in the body, especially over a lifetime.

See this letter (NHMRC to NSW Health, 2005), where on page 1 NHMRC admits to cancelling all its planned health safety studies in 2002.

See this paper (#5a) for examples of relevant toxicity studies that NHMRC have excluded from consideration by their fluoridation reviews.

Given that NHMRC – Australia’s supposedly responsible body on this topic – has never conducted studies to ascertain whether fluoridation is safe or not, it is either a lie or just unscientific wishful thinking for anyone to claim fluoridation ‘safe’.

Fluoridation is pursued in Australia as an entrenched, unquestioned policy, on the assumption that it is safe, but without anyone officially having looked to check (see #6 in ‘Yes’ case).

“Recent Australian research states that access fluoridated water from an early age is associated with less tooth decay in adults ⁽³⁾.”

Unfortunately neither this statement, nor its reference from the NHMRC document, identifies which studies it relies on. So FFA is unable to make a definitive response.

However, we can say that in the absence of a single randomised controlled trial having been conducted by fluoridation promoters or fluoridating governments in the 70 years since fluoridation commenced, FFA will continue to rely on the best available scientific evidence. The Cochrane review (2015) is widely recognised as the best available assessment of the evidence on fluoridation and dental decay, and this comprehensive meta-review reported no reliable basis for the claim that fluoridation significantly reduces tooth decay in any age or group.

 “The National Health & Medical Research Council (NHMRC) is an Australian Government agency that funds health and medical research.”

That statement is true but possibly misleading. NHMRC funds health and medical research in response to external applications for grant funding, but it does not initiate its own research (NHMRC letter to PMHC, 2016). Regarding water fluoridation, NHMRC has evidently only received applications to fund traditional fluoridation research, namely regarding the ‘effectiveness’ of water fluoridation and cost-benefit, and determinants of oral health (page 1, NHMRC letter to PMHC, 2015).

So, it is true to say that NHMRC is an agency that funds a certain type of health and medical research, namely, the research most desired by researchers. But NHMRC does not initiate investigations on actual health safety on behalf of the nation that NHMRC purportedly stands to serve, and as such it cannot continue to be accepted as the authority on whether fluoride and fluoridation is safe or not.

“The NHMRC regularly reviews the scientific evidence on this topic to make sure that research and evidence supports health advice.”

Firstly, as mentioned above, in 2002 NHMRC abandoned all its own planned research actions into fluoridation safety, and has conducted none before or since.

Since then, NHMRC has regularly reviewed some scientific evidence on this topic, but strictly filtered the available evidence to exclude studies other than those involving fluoridation conditions directly comparable to Australia (See #5a in ‘Yes’ case).

That approach has rejected from consideration a wealth of published, peer-reviewed fluoride studies from other countries, and evidence based on actual levels of daily fluoride consumption that could, had they been examined, have better informed NHMRC of the actual state of fluoride science.

NHMRC appears ignorant of even the existence of toxicology as a science, wherein we admit that humans are the same species wherever they live, and that a dose-response curve can be deduced by studying a range of chemical doses in order to establish a presumed safe dose.

NHMRC’s fluoridation reviews have been subject to scathing criticisms and even allegations of fraud concerning: their poor quality and lack of rigour; the extent and frequency of their exclusions; the many omissions and errors; bias in the composition of the review committee, and false and misleading statements.  See: Can the NHMRC be trusted?; and The bioaccumulation of fluoride.

In nearly 70 years of fluoridation, no fluoridating country (with the possible exception of Israel) has objectively considered fluoridation harms (and Israel ceased fluoridation soon after). There are now more than 2,000 published harms-related studies, that NHMRC seems intent on ignoring just so it can continue with its nearly 70-year position of fluoridation support, and say (quite falsely) that the research and evidence supports fluoridation.

“They (NHMRC) have released a public statement which concluded that water fluoridation safely and effectively reduces tooth decay across the population.”

It is true that NHMRC has released this statement, but could only do so based on excluding evidence that would contradict that claim.

“Fluoridated water is the primary source of fluoride exposure … “

True, if water was not fluoridated then we would consume relatively little fluoride.

“… and helps reduce tooth decay for all, at all stages of life. Fluoridation of drinking water particularly benefits children, and those on a lower income who tend to have higher rates of dental decay and less access to dental treatment.”

Such claims as those are often made, but they have been roundly refuted by many other studies, including the globally respected Cochrane review (2015) that was also mentioned above in regard to decay rates generally. The Cochrane review being the largest, most comprehensive review of the effectiveness of water fluoridation ever conducted.

Regarding specific sectors of the population, Cochrane’s ‘Main’ and ‘Key’ findings also report that:

• We did not identify any evidence, meeting the review’s inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults;
• There is insufficient evidence to determine whether water fluoridation results in a change in disparities in caries levels across Socio-Economic Status.

It is often said by its promoters that fluoridation helps prevent tooth decay in adults, and that fluoridation is essential because it reaches and helps especially the most socio-economically disadvantaged. But, as the Cochrane review reports, there actually is no sound evidence to support those claims, and they must be rejected as misleading and deceptive. 

 “The NSW Department of Health is the agency responsible in NSW for setting the amount of fluoride that should be added to town water supplies.”

That is true. However, NSW Health seems unable to justify on health grounds the reasons for the fluoride concentration it requires in water supplies. For instance, over a period from 2015 Port Macquarie-Hastings Council made several requests to NSW Health for the health studies that NSW Health relied on in setting the fluoride concentration, but NSW Health offered no reply. In the staff report to the 18 April 2018 PMHC Ordinary Council meeting, it was noted that “Council has been largely unsuccessful in its request for information on studies done into the potential for adverse health effects from fluoride consumption.”

NSW Health sets the fluoridation concentration, but evidently without any contemporary scientific justification to support the level imposed.

“Taking into consideration fluoride in other sources such as foods, drinks, and dental products only very small amounts of fluoride are needed in drinking water to protect teeth against decay.”

This statement is misleading and downplays both the concentration of fluoride in our water and the total dosage received from all sources. Fluoridated water is used in the processing of many foods and beverages and therefore the fluoride in these processed foods adds to the total exposure of fluoridation chemicals ingested.

Regarding the concentration of fluoride in our water – in April 2015, the US Department of Health & Human Services (HHS) admitted that the fluoride levels, which had been promoted and encouraged as safe for decades, have in fact damaged children’s teeth. With a huge increase in dental fluorosis, HHS stated that water fluoride levels should be lowered to 0.7 mg/L. This represented a 42 per cent decrease from the maximum 1.2mg/L and around 30 percent lower than Australia’s common 1mg/L.

Furthermore the issue of total fluoride intake or exposure from all sources is the most critical issue when it comes to fluoride toxicity. Small wonder, then, that the main official fluoridation endorser in Australia, NHMRC, has consistently declined to monitor daily fluoride intake from all sources, on the grounds that it is “very difficult to measure” (page 1, NHMRC to PMHC 19 August 2015).

FFA calls nonsense on that claim, especially regarding bottle-fed infants. It can easily be shown that infants fed with fluoridated tap water can consume, from the water alone, nearly three-times the level that has long been assumed a maximum safe fluoride dose for their weight and around 200 times the level of fluoride in breast milk.

Recent studies show fluoride consumption affects the body cumulatively, with higher intake having greater adverse health effect. From a health perspective that makes it imperative to consider all fluoride sources, not just from water fluoridation, and total fluoride intake is key to determining fluoride toxicity. Small wonder again, that NHMRC is focused solely on studies of fluoridation, excluding any studies that account for fluoride intake per se, from any source, for example toothpaste, food and beverages, some pesticides and some medications. That is nothing less than sleight of hand, manipulating the evidence to be considered in order to continue stating that fluoridation is safe.

Having endorsed fluoridation as ‘safe and effective’ since 1953, NHMRC is understandably reluctant to uncover contrary evidence and protects its public health reputation by only studying fluoridation, never fluoride as such. For the sake of the health of the nation, and the reputation of real science, the authority for making judgements about the safety of fluoride and fluoridation must be taken out of the hands of the NHMRC and given to a party that will look beyond fluoridation alone, and consider all sources of consumed fluoride. 

Therapeutic Goods Act

The only other authority in Australia that stands to assess chemical toxicity is the Therapeutic Goods Administration (TGA) and Therapeutic Goods Administration Act (TG Act).

The plot thickens in 2019 when PMHC sought legal advice on the status of fluoridation in relation to the Therapeutic Goods Administration Act. The legal advice of 17 April 2019 reports that, since the introduction of the TG Act in 1989, water fluoridation conducted without a TG Act licence is unlawful, exposing water authorities that do fluoridate without licence to civil and criminal penalties.

Objectors to fluoridation had for several decades attempted unsuccessfully to have TGA clarify its position regarding fluoridation, receiving instead a steady stream of contradictory declarative opinion from TGA.

The legal advice to PMHC stated, at clause 75, the reason behind TGA’s assertions that fluoridation did not come under its purview seemed “akin to a State Secret”.

PMHC promptly provided the legal advice to the public and all relevant agencies. Shortly thereafter – within six weeks – the Australian Parliament amended the TG Act to specifically “exclude” fluoridation from the operation of the TG Act. That effectively closed the door on use of the TG Act to ensure proper toxicity assessment of fluoride and fluoridation. Fluoride truly is a well-protected pollutant.

As best FFA can gather at this stage, the Australian Parliament contravened the requirements of the TG Act by making the exclusion order without recourse to any significant consideration of the safety of mass public fluoridation (probably except of course assurances from NHMRC and other fluoridation promoters). Our investigations in that respect are continuing.

FFA concludes that fluoridation is conducted in Australia on the basis of mere opinion, with no authority having responsibility for assessing actual health risks, or expressing willingness to do so.

On the other hand, there is mounting published scientific evidence of potential harms. It is now up to people themselves to make their own assessment and vote to tell PMHC and thus all Australian promoters of fluoridation that enough is enough and forced fluoridation must end.

“Information about fluorid(ation) can be found at

NSW Health – www.health.nsw.gov.au/environment/water/Pages/fluoridation.aspx

Australian Dental Association – www.adansw.com.au/Community/Fact-Sheets

References

1. NHMRC Water Fluoridation and human health in Australia: Questions and Answers https://www.nhmrc.gov.au/about-us/publications/2017-public-statement-water-fluoridation-and-human-health cited 25/6/21
2. World Health Organization. Guideline: Sugars intake for adults and children. Geneva : World Health Organization, 2015 cited in NHMRC above
3. www.nhmrc.gov.au/sites/default/files/documents/reports/fluoridation-public-statement.pdf cited 25/6/21

Additional notes

ALL three water fluoridation promoters referred to above – NSW Health, ADA and NHMRC – have conflicts of interest.

Most egregious is NHMRC, which purports to provide scientific health advice but has endorsed fluoridation since 1953 as perfectly ‘safe and effective’, despite themselves admitting never having conducted any studies to determine whether there are adverse effects on bodily health. NHMRC’s completely unsubstantiated support for fluoridation has paved the way for fluoridation being included into the National Oral Health Plan, and being imposed by law into various state government jurisdictions without any choice to citizens.

In 1957, the NSW Government (hence NSW Health) endorsed fluoridation to the extent of enforcing it into law, and has rigorously – often unethically – pursued the fluoridation of communities on pain of significant financial penalties. Their documented lies about fluoridation safety and efficacy are voluminous. For example, and directly relating to Port Macquarie-Hastings, in 2004 NSW Health determined to commence fluoridation on the grounds of a “local decay crisis”, despite the unfluoridated PMH area having lower rates of childhood decay than four of the five 100% fluoridated Sydney health regions.

Policy and even law are not science. Water fluoridation ‘science’ is 1950’s science, like tobacco and asbestos science, based on manipulating perceptions, denigrating, pursuing and even threatening objectors, and appealing to authority not facts. The actual published science demonstrates that fluoridation is neither safe nor effective. It has been perpetuated on misleading statements and deception, designed to support policy unrelated to science. That is ‘authoritarianism writ large’, and only the people’s vote can break this highly destructive tradition.

ADA is a trade organisation, not a scientific body. ADA has admitted many times in writing that it does not investigate the science of fluoridation, but has embraced this policy for a long time (perhaps since the 1980s?). The dental profession has established its ‘credentials’ as a modern profession on the use of fluoride, and its credentials in public health through fluoridation. While topical fluoride applications might assist in preventing some decay, science now shows there is no benefit, and even dental harm, from consuming fluoride. We suspect but cannot prove that the dental bureaucracy knew that consuming fluoride would damage teeth, all the while purporting to be so magnanimous as to support fluoridation to their own detriment for the common dental good. Many dentists now profit from that damage (admittedly perhaps unknowingly), selling veneers to hide ugly dental fluorosis, and highly concentrated topical fluoride treatments on the unproven supposition that teeth will benefit from even more of this toxin being applied to the mouth.

None of these bodies will give a guarantee of safety of fluoridation. Nor do they admit even the potential for risk. But the body of scientific evidence now clearly demonstrates there is risk, and highly significant risk for some sectors of the population. Where there is risk there must be choice, yet the policy and law of fluoridation denies people any free and fair choice and must be stopped.