Forum Minutes of Meetings

Minutes of meeting of the Forum on Fluoridation on 3 September 2001
The Boardroom, Dublin Dental Hospital

Present

  • Professor Pat Fottrell (Chairman)

  • Dr Wayne Anderson

  • Professor John Clarkson

  • Dr Paddy Flanagan

  • Mr Oliver Fogarty

  • Ms Dorothy Gallagher

  • Dr Gerard Gavin

  • Mr Kevin Moyles

  • Dr Joe Mullen

  • Professor Moira O’Brien

  • Professor Denis O’Mullane

  • Dr Carmel Parnell

  • Professor Miriam Wiley

  • Ms Nessa O’Doherty (Forum Secretariat)

  • Dr Miriam Owens (Rapporteur)

Apologies

  • Professor William Binchy

  • Dr Elizabeth Cullen

  • Dr Howard Johnson

  • Dr Máire O’Connor

  • Professor Cecily Kelleher

  • Dr Margaret Shannon (Forum Secretariat)

Meeting

The Chairman expressed sincere condolences, on behalf of the Forum, to Dr Cullen on her recent bereavement.

Apologies were given for the members who could not attend this meeting.

Minutes of Meeting of 10 May 2001

The minutes of the meeting of Thursday 12 July 2001 were agreed but with the following amendments to be made.

The two relevant paragraphs from page 6 should read as follows:

Comment: the observation made by Dr Evans as to the high levels of consumption of sugar in Ireland has been borne out by scientific evidence. The frequency of consumption of foods and drinks sweetened with sugar is very high in Ireland compared to other countries.

Comment: Dr Gary Whitford’s research shows that when one drinks liquids with a high fluoride level the body will excrete what it does not need very quickly which can cause spikes in the plasma and urine levels if measured. Such a once-off spike is not a problem but continuous excessive intake could be.

Dr Mullen asked that the Rapporteur make two minor amendments to the Summary of Presentations (April 2001) concerning comments made by him in relation to the presentations made to the Forum by Dr Paul Connett and Professor Paul Limeback. Dr Mullen stated that he regretted having omitted to bring this to the attention of the Forum before now. Dr Owens will carry out the requested amendments as soon as possible.

Matters arising

  1. A conference call with Dr Gary Whitford, a world authority on fluoride metabolism and biomarkers (ie total body burden of fluoride), has been arranged for Tuesday 18 September 2001 – members who are interested in participating were asked to let the Secretariat know. In view of time restraints in relation to Dr Whitford forwarding a written submission, it was agreed that this call would suffice as his contribution. Members who have specific questions for Dr Whitford are asked to forward them to the Secretariat as soon as possible in order to assist in the preparation for this call. Professor O’Mullane agreed to chair the call.
  2. Professor Don Barry’s report on the "York Review" was circulated prior to this meeting. Dr Kevin Balanda’s report is yet to be received. The members of the Forum found Professor Barry’s paper very interesting, particularly when compared to the critique forwarded some time ago by Ms Catherine McNamara, Economics Lecturer. It was agreed that the comments made by Professor Barry in relation to epidemiology were particularly valuable – Professor Kelleher is to be asked for her comments on this aspect in view of her experience of this type of work. The Forum is very grateful to Professor Barry for his valuable input.
  3. Dr Owens mentioned that a meeting has been arranged with Dr Mary Waldron, Paediatric Nephrologist.
  4. Dr Owens explained that a further progress report (detailing the remainder of the presentations to date) is almost complete and will be put on the Forum’s web site shortly.
  5. In response to the invitation from Monaghan County Council for a member of the Forum to attend a meeting on 3 September 2001 (as discussed at Forum’s meeting on 12 July 2001), the Secretariat replied to the Council that after due consideration the Forum felt it would be more appropriate to await its final report. The County Engineer (who issued the invitation) mentioned that the North Eastern Health Board had also decided to await the Forum’s report before sending a representative to any such meeting.
  6. Ms Claire Chambers of the Irish Society of Toxicology has been in contact with the Forum – the Society’s submission will be forwarded shortly.
  7. The Chairman explained that an editorial sub-group has been established to assist the Rapporteur in drafting the Forum’s final report. All members of the Forum are asked to comment on the draft reports (which will be circulated by the Rapporteur) but it will also be helpful to have guidance and assistance from a smaller group. All comments on drafts should be forwarded directly to the Rapporteur. The members were invited to volunteer if they were interested in participating in this sub-group. The sub-group is now as follows:
  • Professor Fottrell

  • Professor Clarkson

  • Dr Flanagan

  • Ms Gallagher

  • Dr Gavin

  • Dr Johnson

  • Professor O’Mullane

  • Dr Owens.

The Secretariat will advise of the date for a meeting of this group shortly.

(8) Dates for future meetings of the Forum were agreed.


Project in Dublin Dental Hospital on Fluoride Content of Infant Formula

Comments have been made in recent statements by "Fluoride Free Water" regarding a paper on fluoridation written by students of Dublin Dental Hospital – Professor Clarkson explained the background to this and rejected the allegations made by FFW that the Dublin Dental Hospital had withheld information. The Chairman asked that Professor Clarkson put this in writing to the Secretariat – the text of Professor Clarkson’s letter follows:

Professor Patrick Fottrell
Chair
Forum on Fluoridation
c/o Department of Health & Children
Hawkins House
Dublin 2

11th September 2001

RE: Project in Dublin Dental School on Fluoride Content of Infant Formulas

Dear Professor Fottrell

At the meeting of the Forum on September 3rd I mentioned recent publicity in the press and in the Senate on the above project. I was requested to outline my views on the project. The following are my comments.

Fourth year undergraduate students in the Dental School carry out community projects each year as part of a programme to give the students experience in planning, implementing, evaluating and presenting a research project in the community.

These projects are not intended or designed as definitive research projects nor are they intended to be published or would they be accepted as a paper in a peer reviewed journal.

Eight students in the class of 1997/98 carried out this particular project. The title of the project was "To examine the fluoride content of popular formulas and milks and to study the fluoride dose that infants are receiving from these various sources". Essentially the students found that there were variations between the products and with some formulas there was a possibility that the recommended fluoride threshold could be exceeded, if these products were prepared with fluoridated water. The only possible consequence of this is that some children, who used these products, could develop mild dental fluorosis on their teeth. The students also made recommendations for future infant feeding practices, research and changes to the design of future studies.

There has been some suggestion in the press and by the "Fluoride Action Network" that this project was not made public and also that the Dental Hospital and I did not release or publish the results of the project. There suggestions are not correct. All student projects, including this one, are presented to the staff in the Dental School and Hospital as part of the examination process. In addition the projects are presented at the Health Board Dental Surgeons meeting, which public health dentists in Ireland attend. In addition an abstract of each project is published in the Journal of the Irish Dental Association which is received by most dentists in Ireland and is available to the media. This schedule was followed for this project and it was published as an abstract in the Journal in 1998 (Vol. 44 (3) 1998). A copy is attached. So there was no question of keeping the results of the project from the public.

I want to emphasis again that this student project was not carried out as research study. Any implications from the project should be seen in this context.

The "Fluoride Action Network" also quoted me as stating "the issue of tooth fluoride exposure needs to be addressed and monitored". My views on the need for ongoing research have been made clear in recently published papers in peer reviewed journals and to the Forum.

I hope this clarifies this matter.

Yours sincerely

Professor John Clarkson
Dean of the Dental School & Hospital & Professor of Public Dental Health

J.Dent.Res 79,893-904;2000
International Dental Journal 50,119-126;2000


Relevant documentation received and discussed

Mr Tom Reeves, CDC, forwarded a substantial amount of documentation to the Secretariat, following his recent presentation - Professor Clarkson gave a summary of a sample of the papers (see below), including information on proposed water fluoridation in Japan and Korea. A major meeting on the issue of water fluoridation will be held in Japan at the end of September 2001 – Professor Clarkson undertook to convey details on this to the Forum after that date.

"Water Fluoridation in Korea" (T Reeves)

"Japan to embrace fluoridation for first time" (www.watertechonline.com)

"Quantifying the diffused benefit from water fluoridation in the United States" (Griffin et al, 2001)

"Salt fluoridation and dental caries in Jamaica" (Estupinán-Day et al)

"An Overview of Salt Fluoridation in the Region of the Americas, Part I: Strategies, Cost Benefit Analysis, and Legal Mechanism utilized in the National Programs of Salt Fluoridation" (Estupinán-Day)

The Chairman thanked Professor Clarkson for summarising the documents.


Hydrofluosilicic acid

Dr Anderson and Mr Moyles prepared a document detailing the level of alleged contaminants in hydrofluosilicic acid and this was circulated prior to this meeting. Dr Anderson gave a brief summary of the details contained therein. The Forum agreed that the contents of this document are very important and that it would be useful to have comparative examples in everyday language so as to have the information in a form readily accessible to the public. The Chairman thanked Dr Anderson and Mr Moyles for the work they put into preparing the table.


Reports from Sub-Groups

Alternatives to Water Fluoridation

Professor O’Mullane explained that this group’s initial paper had been circulated for comment – amendments have been requested by Professor Clarkson and Ms Gallagher and these will be incorporated. Comments from other members would be very welcome. A lengthy discussion took place in this regard. It was agreed that it is important to have a short summary of the available alternatives and conclusions drawn. It was also agreed that cost factors of each of the alternatives need to be considered and stated, as well as the possible advantages and disadvantages of each alternative. Dr Gavin and Professor O’Mullane agreed to draw up a comparative chart eg staff complements in public health sector areas required for each of the various alternatives, funding required, etc.

Public Consultation

Dr Flanagan explained that the sub-group’s draft report was circulated for comment and several members requested amendments which will be made. Ms Gallagher went through all of the submissions independently and checked for accuracy in the summary – some minor amendments resulted; Dr Flanagan thanked Ms Gallagher for the time devoted to this task. Dr Flanagan will incorporate some further changes and will circulate the revised draft by email – any member who wishes to make comments on the draft should do so as soon as possible. The final version will then be circulated by the Secretariat as the completed document. It was agreed that it is important to stress that this was not a scientific study – a select group volunteered their views and while all contributions are very important it has to be borne in mind that the results are not necessarily representative of the population at large.

Ethical Issues

This sub-group met with Dr Richard Hull of the National University of Ireland, Galway, in July 2001. The minutes of this meeting were circulated to the Forum for their information and comments. Dr Cullen has suggested that there is need for a second meeting with Dr Hull and would like this to take place after meeting with a Toxicologist. Dr Hull has indicated that he is willing to meet the sub-group again if required. It was agreed that it would be appropriate to leave the decision as to whether to have a second meeting with Dr Hull until the next meeting of the Forum.

Dr Owens has been in contact with Dr Joe Tracey in Beaumont Hospital in relation to toxicological issues – the relevant correspondence will be circulated to the Forum by Dr Owens shortly. As mentioned at (4) above, Dr Owens has arranged a meeting with a paediatric nephrologist and it would be important to have this meeting before a decision is made regarding whether to have another meeting with Dr Hull on ethical issues.

Ms Gallagher had to leave at this point due to another engagement.

County Councils

A letter (drafted by Dr Mullen), which is to be sent to County Councils which have been in contact with the Forum in relation to the issue of water fluoridation, was circulated prior to this meeting – comments/amendments were requested from the Forum. It is hoped to issue this letter shortly.

Dr Connett’s "50 Reasons"

Dr Owens will email the draft responses to the "50 Reasons" to the members shortly and it will be discussed at the next meeting of the Forum. A huge amount of work has gone into this task so far.

Submissions from professional bodies/organisations

The relevant submissions have been circulated to the members of the sub-group – it was agreed that each member should examine the documentation and forward any views/comments to Dr Owens. Professor Clarkson has made a list of the issues raised and will forward it to Dr Owens.


The Chairman thanked all of the sub-groups for their hard work and stressed that it is important that the views of a toxicologist be received as soon as possible. He also awaits the draft response to Dr Connett’s "50 Reasons" with interest.


Final Report

The Rapporteur will be circulating draft copies of the Final Report over the coming weeks - the Chairman invited members to comment freely and frankly on such drafts. Comments on the current draft should be forwarded to Dr Owens before 13 September 2001. It is crucial to have input from everyone in this process. It was proposed that the Forum consider having an editor look at the final draft to ensure that it is in language which will be easily accessible and understood by members of the public – this will be discussed further at a future meeting of the Forum.


AOB

Dr Mullen stated that he has responded in writing to Dr Andrew Rynne in relation to his recent article concerning the Forum on Fluoridation.


PLEASE NOTE:

The minutes of the meeting of 3 September 2001 above were agreed by the Forum on 27 September 2001 but with the following amendment to be made, ie the relevant paragraph should read as follows:

Hydrofluosilicic acid

Dr Anderson and Mr Moyles prepared a document detailing the level of contaminants in hydrofluosilicic acid and this was circulated prior to this meeting. Dr Anderson gave a brief summary of the details contained therein. The Forum agreed that the contents of this document are very important and that it would be useful to have comparative examples in everyday language so as to have the information in a form readily accessible to the public. The Chairman thanked Dr Anderson and Mr Moyles for the work they put into preparing the table.


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