Den­tists call for flu­o­ride in bot­tled wa­ter

The Weekend Australian - Travel - - Career One - Adam Cress­well Health ed­i­tor

BOT­TLED wa­ter should be flu­o­ri­dated to the same con­cen­tra­tions as pub­lic drink­ing wa­ter in or­der to re­duce tooth de­cay, ac­cord­ing to a re­vised pol­icy by Aus­tralia’s top den­tal body.

The Aus­tralian Den­tal As­so­ci­a­tion has re­in­forced its ex­ist­ing stance in favour of flu­o­ri­da­tion, say­ing there is now ‘‘ clear solid sci­en­tific ev­i­dence’’ that the prac­tice is ef­fec­tive at pro­tect­ing teeth.

‘‘ The claims of those op­pos­ing flu­o­ri­da­tion are based on out­dated in­for­ma­tion and se­lec­tive stud­ies that sup­port their case,’’ the ADA said. ‘‘ How­ever, no con­vinc­ing or cred­i­ble sci­en­tific ev­i­dence ex­ists that flu­o­ride, when sup­plied at the op­ti­mum level (one part per mil­lion) in drink­ing wa­ter, causes any ad­verse health ef­fects.’’

ADA pres­i­dent and Melbourne den­tist John Matthews says other changes in the re­vised pol­icy re­late to flu­o­ride sup­ple­ments, which the as­so­ci­a­tion no longer rec­om­mends in tablet form due to the risk of flu­o­ro­sis, or mot­tling of the teeth.

How­ever, Matthews says that al­though there has been a slight in­crease in the rate of den­tal de­cay among chil­dren, he does not be­lieve the the­ory that this is caused by chil­dren drink­ing bot­tled wa­ter, which cur­rently can­not be flu­o­ri­dated by law.

In­stead, he says it is more likely to be re­lated to a de­lib­er­ate re­duc­tion in the con­cen­tra­tion of flu­o­ride in­cor­po­rated into chil­dren’s tooth­pastes. This con­cen­tra­tion has been halved rel­a­tive to adult tooth­paste in or­der to be ‘‘ ex­tra safe’’ in re­duc­ing the risk of flu­o­ro­sis, but the flip side may well be that den­tal caries rise slightly as a re­sult.

‘‘ Flu­o­ride should be added to bot­tled wa­ter at the nor­mal level in retic­u­lated (town) wa­ter, which varies from 0.6 parts per mil­lion to 1 part per mil­lion (ppm), de­pend­ing on the hu­mid­ity and wa­ter con­sump­tion,’’ he says. ‘‘ In the bot­tom part of Aus­tralia the level (of added flu­o­ride) is dif­fer­ent to the top part.’’

Flu­o­ri­da­tion of drink­ing wa­ter re­mains con­tentious in some parts of Aus­tralia, par­tic­u­larly Queens­land, where less than 5 per cent of drink­ing wa­ter sup­plies are for­ti­fied with the min­eral — a stark dif­fer­ence to most other parts of Aus­tralia. Of­ten the de­ci­sion has been left to lo­cal coun­cils, lead­ing to emo­tive de­bates.

Al­though flu­o­rides are nat­u­rally oc­cur­ring com­pounds and are present in a wide variety of foods, usu­ally at low con­cen­tra­tions, op­po­nents of flu­o­ri­da­tion fo­cus on the fact that the el­e­ment flu­o­rine, from which they are de­rived, is toxic in its pure form.

Flu­o­rides them­selves can have harm­ful ef­fects at high doses. Ad­vo­cates of flu­o­ri­da­tion say this is not a rel­e­vant crit­i­cism when the con­cen­tra­tions in drink­ing wa­ter are less than 1 part per mil­lion, and plenty of other com­pounds nec­es­sary for hu­man health — in­clud­ing com­mon ta­ble salt, com­pris­ing sodium and chlo­rine which are both es­sen­tial for life — are also toxic in higher doses.

A cir­cu­lar about the new pol­icy dis­trib­uted by the ADA says re­cent Aus­tralian re­search has added to the weight of ev­i­dence in favour of the safety and ef­fi­cacy of flu­o­ride in drink­ing wa­ter. The cir­cu­lar says tooth de­cay is higher in Queens­land than other states that have higher rates of wa­ter flu­o­ri­da­tion. How­ever, in Townsville — one of the few Queens­land cities to be flu­o­ri­dated, since 1964 — chil­dren have 45 per cent less tooth de­cay than their coun­ter­parts in Bris­bane.

‘‘ To­day, it is es­ti­mated that 31 per cent of Aus­tralian adults re­main with­out ac­cess to flu­o­ri­dated pub­lic wa­ter,’’ the ADA says. ‘‘ Sadly, much of this is due to de­ci­sions made at lo­cal and state gov­ern­ment level which have be­come po­lit­i­cally mo­ti­vated rather than based on sci­en­tific fact.’’

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