Forum on Fluoridation Interim Report

19 December 2000

The Forum has produced one document to date - an Interim Report. This is reproduced here in full, so that visitors to the site may be aware of developments.

The Forum on Fluoridation was established by Mr Micheál Martin, TD, Minister for Health & Children on 29th May 2000 and held its first meeting on 6th September 2000.

Terms of Reference

To review the fluoridation of public piped water supplies and the programme of research being undertaken on behalf of the health boards in the area

To report and to make recommendations to the Minister for Health & Children

Membership of the Forum on Fluoridation

  • Professor Patrick Fottrell, Chairperson, Former President of NUI, Galway
  • Dr Gerard Gavin, Chief Dental Officer, Department of Health & Children
  • Ms Dora Hennessy, Principal Officer, Department of Health & Children
  • Dr Dominique Crowley, Deputy Chief Medical Officer, Department of Health & Children until 15/09/00, now Lecturer, University College Dublin
  • Mr Oliver Fogarty, Department of the Environment & Local Government
  • Dr Wayne Anderson, Food Safety Authority of Ireland Professor
  • John Clarkson, Dublin Dental School and Hospital Professor
  • Denis O'Mullane, Dental School, Cork
  • Dr Maire O'Connor, Specialist in Public Health Medicine, South-Eastern Health Board and Faculty of Public Health Medicine
  • Dr Howard Johnson, Specialist in Public Health Medicine, Eastern Regional Health Authority
  • Dr Patrick Flanagan, Environmental Protection Agency Professor
  • Moira O'Brien, Trinity College, Dublin
  • Mr Kevin Moyles, Regional Public Analyst, Dublin
  • Professor William Binchy, Trinity College, Dublin
  • Professor Cecily Kelleher, National University of Ireland, Galway
  • Dr Joe Mullen, North Western Health Board
  • Dr Carmel Parnell, Irish Dental Association
  • Professor Miriam Wiley, Economic & Social Research Institute, Dublin
  • Ms Dorothy Gallagher, Consumers' Association of Ireland
  • Dr Elizabeth Cullen, Irish Doctors' Environmental Association

  • Ms Nessa O'Doherty, Forum Secretariat, Department of Health & Children
  • Dr Margaret Shannon, Forum Secretariat, Department of Health & Children

The above members represent a broad spectrum of interests covering areas such as dental health, environmental health, food safety, public health, health promotion, ethics and consumerism.

A rapporteur, Dr Miriam Owens, formerly Department of Public Health, Eastern Regional Health Authority, has been appointed to assist in the drafting of the report on behalf of the Forum.

Ms Darina Allen and Mr Dick Warner, appointed by the Minister to the Forum declined to attend for personal and other reasons. The organisation VOICE declined to send representatives to participate in the Forum. Ms Allen, however, has agreed to make a presentation to the Forum at a later date.

The Forum has met on four occasions: 6th September 2000, 13th October 2000, 9th November 2000 and 14th December 2000.

Summary of four meetings held to date

The main purpose of the Forum meetings has been to discuss the terms of reference and decide on the optimum strategies to deal with them in a comprehensive, balanced and fair manner.

Speakers with positive and negative views gave oral presentations at the first two meetings of the Forum, which were followed by extensive discussion.

First Meeting on 6th September 2000

Professor Denis 0'Mullane and Dr Gerard Gavin presented papers, which they had previously presented to a Joint Oireachtas Committee on Health and Children in July 2000.

Professor O'Mullane covered the background to fluoridation and its current status worldwide; he provided data on its effectiveness in improving dental health of children in Ireland and on the issue of fluorosis. He presented survey results, which demonstrated that the dental health of residents of fluoridated communities is considerably better than that of residents living in non-fluoridated communities.

While acknowledging, in his opinion, that dental health has improved in non-fluoridated areas mainly due to the use of fluoridated toothpaste, and the "halo" effect of water fluoridation (the consumption of drinks and foods manufactured in fluoridated areas), he pointed out that the main risk factors for dental caries, i.e. the frequent consumption of foods and drinks sweetened with sugar, persist, and indeed may be becoming more prevalent over time.

Dr Gavin discussed the marked decline in dental caries achieved in recent decades that has been attributed to the fluoridation of public water supplies and to the increased use of other fluoride products. He concentrated on the questions of efficacy and safety of fluoridation.

For the former he presented results of studies carried out in Ireland showing differences in dental caries Ievels of between 39% and 50% in children living in fluoridated areas over those residing in non-fluoridated areas.

He also referred to a comparative study of dental caries in Dublin, where the water is fluoridated and in Glasgow, where the water is not fluoridated. The similar demographic structure and similar levels or deprivation facilitated meaningful comparisons to be made. There was a difference of 45% in the level of dental caries between the two cities indicating that there was significantly more dental decay in the non-fluoridated city.

On the question of safety, he made reference to the many authoritative organisations and international agencies that have studied this aspect of water fluoridation, and that such work strongly supported both effectiveness and safety of the process.

However, in light of the importance of ensuring the optimal fluoridation of populations, Dr Gavin supported the need for ongoing research so as to inform future policy decisions. He concluded by referring to the contract for oral health services research on all aspects of fluoride use, awarded by the Eastern Regional Health Authority on behalf of all the health boards.

Second Meeting on 13th October 2000

Mr Micheál Martin TD, Minister for Health & Children, addressed the Forum at this meeting. He highlighted the importance of wide consultation on the subject so as to ensure a fair and balanced report. Presentations were made by two internationally renowned speakers who discussed the "negative" view of water fluoridation.

Professor Limeback, Associate Professor, Faculty of Dentistry, University of Toronto, focussed on the topic of dental fluorosis and offered the view that the benefits of fluoridation no longer outweigh the debits caused by unsightly fluorosis. He presented case histories and photographs of teeth with fluorosis, which he attributed to water fluoridation. Whilst acknowledging the subjective aspects in determining the degree of fluorosis he outlined the expense that can sometimes be incurred in its treatment in Canada. He indicated that he was of the opinion that fluorosis was the result of water fluoridation rather than fluoridated toothpaste and tablets etc.

Dr Connett, Professor of Chemistry, St Lawrence University, New York, delivered a presentation on a wider range of issues including genotoxicity, cancer, reproductive problems, neurotoxicity, thyroid and skeletal effects. He presented the key points in written format - "50 Reasons to Oppose Water Fluoridation" - and requested that the Forum should respond to the questions raised. Unlike Professor Limeback, Dr. Connett opposed all uses of fluoride. He discussed the York Review published in the British Medical Journal on 7th October 2000, and expressed the opinion that it was too focused on human epidemiology and that the chemical and biological issues warranted further attention.

Despite the diverse nature of their presentations concern was expressed by the four speakers around the issue of dental fluorosis.

Third Meeting on 9th November 2000

At this meeting the presentations made at the previous meeting were discussed.

Dr Flanagan from the Environmental Protection Agency made a presentation on water quality and referred to the manner in which the Environmental Protection Agency compile their reports.

Ms Gallagher, of the Consumers' Association of Ireland, spoke of the concerns of her colleagues in the organisation about the perceived pro-fluoridation bias of the Forum members as a whole. She expressed the view that the appointment of an anti-fluoridationist to the Forum would help to allay some of these anxieties. To address this issue a decision was made to invite Dr Elizabeth Cullen of the Irish Doctors' Environmental Association to join the Forum.

Fourth Meeting on 14th December 2000

Professor Moira O'Brien made a presentation on the epidemiology, aetiology and treatment of osteoporosis.

Drury Research in conjunction with the Dental Health Foundation presented findings of a recent population survey in which public awareness of and attitudes to a number of environmental issues, including fluoridation, were explored. The Forum will consider the implications of the findings of this survey.

Dr Elizabeth Cullen of the Irish Doctors' Environmental Association joined The Forum at this meeting.

The above meetings have been marked by active participation by all Forum Members and further presentations by individuals/groups with diverse views are planned. Given the complexity of the topics, speakers are requested to submit their views in written format, and to substantiate their key points with reference to the evidence base, such as peer-reviewed articles in recognised journals.

The Forum realises the importance of eliciting the views of the public and interested bodies alike throughout the course of The Forum's work. Interested members of the public, professional or voluntary organisations have been invited to make presentations and written submissions to the Forum. Advertisements inviting views of members of the public have been placed in the national newspapers and similar advertisements will soon be broadcast on both national and local radio. A web site has been registered to provide information about the Forum.

[End of Report]