Fluoridation, fractures, and teeth
BMJ 2000; 321 doi: https://doi.org/10.1136/bmj.321.7265.844 (Published 07 October 2000) Cite this as: BMJ 2000;321:844All rapid responses
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Somewhere we seem to have forgotten one of the first things student
doctors are taught, namely "The patient has the absolute right to refuse
treatment"
Whether or not fluoridation is good for the population or not, is
irrelevant ( although having read extensively on the subject, including
the far more objective and scientifically more valid research papers on
animals, I am convinced it is not good), the real issue is simple.
The real issue is "What right has anyone to insist a person takes
fluoridated water?"
If a doctor is taught the patient has the right to refuse, then
surely to God, no one else has the right to insist that all individuals,
too poor to buy their own fluoride filter or to buy their own fluoride
free spring water, have to drink fluoridated water.
Water fluoridation is nothing other than an attempt depending on
which way you look at it, at mass medication or mass poisoning.Either way,
it contravenes our basic human rights.
Competing interests: No competing interests
EDITOR - It is a pity that your comments in This week in the BMJ
on 7 October, as well as the editorial by Prof. Hausen , treated the study
by Phipps et al on Community water fluoridation, bone mineral density, and
fractures , which you published alongside the systematic review of water
fluoridation by McDonagh et al at the York Centre for Reviews and
Dissemination , as introducing "new evidence" which "should alleviate
remaining concerns about the safety of fluoridation".
In fact Phipps's paper, which appeared to show a slightly lower risk of
fractures, had been fully accounted for in the systematic review by the
York Centre, where it achieved a level C rating ("lowest rating, high risk
of bias") in common with all but one of the studies on bone problems in
the world literature. It is therefore premature to suggest that we know
all the answers about fluoride and bones, let alone about the safety of
fluoridation overall.
Earl Baldwin of Bewdley
House of Lords,
London SW1A OPW.
1. Hausen HW. Fluoridation, fractures, and teeth. BMJ 2000;
321:844-845.
2. Phipps KR, Orwoll ES, Mason JD, Cauley JA. Community water
fluoridation, bone mineral density, and fractures: prospective study of
effects in older women. BMJ 2000; 321:860-864.
3. McDonagh MS et al. Systematic review of water fluoridation.
BMJ 2000; 321:855-859.
Competing interests: No competing interests
You may consider this response to be rather vague, but I have - as
yet - been able to trace the orignial piece of research to which I refer
below.
When I was a medical student in the early/mid 1950s, the County
Medical officer of Health for the Isle of Anglesey,Gwilym Wynne Griffith, carried out a piece of
research on the effects of Fluoridated water on the teeth of all of the
primary school children on the island.
He had the island divided in half, and had the Education Dept. supply
tooth brushes to all the children, as well as having the teachers
supervise them cleaning their teeth thoroughly every lunchtime Mondays to
Fridays. The water supply to half the island was fluoridated and the
other half was not.
I seem to remember that this experimant took place over a period of
?5 or ?7 years, and the work was reported in??BMJ or a Public Health
Journal. As I say, I have not - as yet found the article.
I was quite amazed that I could not find any reference to this work
in your article in this week's BMJ
John Griffiths
Competing interests: No competing interests
Sir, the issue of fluoridation of drinking water has become an
extremely heated and polarised debate. The predictable response as so
often is more research. I have however the impression that the probable
most important contributing factor to dental decay, excess intake of
dietary sugar, has been pushed aside by the percieved remedy, fluoride.
Should we not turn our attention to improving diet in children and address
not only dental decay but also obesety and execise?
Competing interests: No competing interests
Fluoridation, fractures, and teeth
Dear Sir - I have read the editorial on ”Fluoridation;
fractures and teeth in BMJ No. 7265, of 7th
October 2000. Fluoride, as we know is a double
edged sword in which the excess fluoride intake
develops fluorosis and deficiency leads to
dental caries/ osteoporosis. It is appreciable
and helpful for the scientists that BMJ takes
active steps to bring this public health problems
to light. I am happy to note that “urgently these
issues are under thorough scrutiny, and a
systematic review is to be published in the near
future” of BMJ
Fluorosis is reported to be endemic in fifteen
states in India. We have conducted a study on the
prevalence of dental fluorosis and risk factors
in our state by conducting survey among 1142
school children in the age group of 10-17 years.
The overall prevalence was 35.6 per cent. We
noted a step wise increase in the prevalence of
dental fluorosis with a corresponding increase in
water fluoride content in different places in the
study area. (National Medical Journal of India,
volume 12, number 3 May/June 1999., p.99-103. E-
mail: nundy @ medlaro.delhi.net.in). The
community fuorosis index was 0.69, which
indicates a necessity of water dethioridation
here.
In the paper “systematic review of water
fluoridation” by Marian S McDonagh et al (Page
855, 7th October 2000 BMJ) in which 214 studies
were included for ariving at the result. In this,
it is revealed that “at a fluoride level of 1 ppm
an estimated 12% of exposed people would have
fluorosis”. Hence to prevent fluorosis, the
optimum level of water fluoride content should be
less than 1 ppm. This is particularly relevant in
tropical countries including India where the
quantity of water consumed is comparatively more.
The views of BMJ in this regard would be helpful
for researchers and scientists involved in the
study of water fluoridation/defluoridation and
its impact on Dental Caries/Osteoporosis and
fluorosis.
P.Gopalakrishnan . MPH,
Asst. Professor,
Dept. of Community Medicine,
T.D. Medical College,
Alappuzha. 688005
Kerala, India.
Competing interests: No competing interests