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Journal of the Canadian Dental Association Article Cited
Fluoridation may be immoral with benefits exaggerated and risks minimized, say Howard Cohen, Ph.D., and David Locker, BDS, Ph.D., professor and director of the Community Dental Health Services Research Unit, Faculty of Dentistry, University of Toronto in the November 2001, Journal of the Canadian Dental Association, reports the New York State Coalition Opposed to Fluoridation.
"Ethically, it cannot be argued that past benefits, by themselves, justify continuing the practice of fluoridation," write Cohen and Locker.
Fluoridation is a scientific controversy and substantial benefits recorded in early fluoridation trials, 50 years ago, are no longer found today, they write.
"Although current studies indicate that water fluoridation continues to be beneficial, recent reviews have shown that the quality of the evidence provided by these studies is poor," report the authors. The few sound studies that exist indicate small differences in decay between fluoridated and nonfluoridated child populations, they found. Studies on Canadian populations show even less evidence that systemic fluoride reduces tooth decay, they report; further, studies on adults are largely absent.
Fluoridation does have risks. "Fluoridation increases the prevalence and severity of dental fluorosis" (white spotted, yellow or brown permanently stained teeth), they report.
"Currently, the benefits of water fluoridation are exaggerated by the use of misleading measures of effect, such as percent reductions," write Locker and Cohen. "The risks are minimized by the characterization of dental fluorosis as a 'cosmetic' problem."
"The impact of dental fluorosis from water fluoridation should not be underestimated," says Hardy Limeback, PhD., DDS, head of Preventive Dentistry, University of Toronto. "The percentage of the population with severe enough dental fluorosis requiring costly dental restorations to repair defective tooth structure has been steadily increasing. Dental fluorosis should never have been classified as a simple 'cosmetic' side effect -- it is a biomarker for systemic fluoride poisoning during early childhood. Research being conducted at the University of Toronto has shown that low daily doses of systemic fluoride from drinking water and other sources permanently affect bone and tooth growth and the mechanical properties of these hard tissues," says Limeback.
"Standards regarding the optimal level of fluoride in the water supply were developed on the basis of epidemiological data collected more than 50 years ago. There is a need for new guidelines for water fluoridation that are based on sound, up-to-date science and sound ethics. In this context, we would argue that sound ethics presupposes sound science," they write.
"In the absence of comprehensive, high-quality evidence with respect to the benefits and risks of water fluoridation, the moral status of advocacy for this practice is, at best, indeterminate, and could perhaps be considered immoral," write Locker and Cohen. "In the absence of a full account of benefits and risks, communities cannot make a properly informed decision whether or not to fluoridate."
Locker and Cohen also recognize that fluoridation doesn't allow individuals to opt out, thereby eliminating their freedom to choose. In addition, they explain, psychological studies on adolescents show effects of dental fluorosis are as serious a concern as overbite and overcrowded teeth.
"Cohen and Locker's investigation does not address other risks of fluoridation that researchers report, but most dentists ignore, including increased lead absorption in children, bone fractures, neurological impairment, thyroid dysfunction and more," says lawyer Paul Beeber, President, New York State Coalition Opposed to Fluoridation.