How fluoride in water helps prevent tooth decay

The most effective way to prevent tooth decay is delivered to most Australian homes every day through their water pipes. It is, of course, fluoride distributed via the water supply. Dental decay occurs when acid destroys or demineralises the outer surface of the tooth – the enamel. Bacteria in the mouth…

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Fluoridated water protects against the tooth decay from acid produced by bacteria in the mouth. T. Faltings

The most effective way to prevent tooth decay is delivered to most Australian homes every day through their water pipes. It is, of course, fluoride distributed via the water supply.

Dental decay occurs when acid destroys or demineralises the outer surface of the tooth – the enamel. Bacteria in the mouth from food and drinks containing sugar produces acid and fluoride repairs demineralisation before it becomes permanent. It does this by encouraging remineralisation or repair of the enamel surface. Fluoride also helps strengthen the mineral structure of developing teeth.

Fluoride is a naturally occurring compound found in plants and rocks and, in very low levels, in almost all fresh water. Sometimes, fluoride is found naturally in the water supplies of Australian communities at exactly the level recommended to reduce dental decay, but this is rare and happens by chance.

Community water fluoridation is the adjustment of fluoride in drinking water to a level that helps protect teeth against decay. Drinking water in many parts of Australia has been fluoridated since the early 1960s.

Fluoride helps strengthen the mineral structure of developing teeth. Jens Gyldenkærne Clausen

Although widely accepted and applauded as a crucial public health policy, fluoridation has attracted some vocal critics. Fluoridation opponents over the years have claimed that putting fluoride in water causes health problems, is too expensive and is a form of mass medication. Some go as far as to suggest that fluoridation is a communist plot and affects children’s IQ.

Despite these claims, fluoridation is supported by many national and international organisations including the World Health Organization, World Health Assembly, World Dental Federation, Australia’s National Health and Medical Research Council (NHMRC), Australian Dental Association and the Public Health Association of Australia.

In 2006, the WHO and the International Dental Federation and the International Association for Dental Research, released a statement endorsing community water fluoridation.

And the Centers for Disease Control and Prevention (CDC) in the United States includes water fluoridation in its list of the top ten health initiatives of the twentieth century, alongside immunisation, compulsory seat belt wearing and smoking bans.

In November 2007, the NHMRC completed a review of the latest scientific evidence in relation to fluoride and health. Based on this review, the NHMRC recommended community water fluoridation programs as the most effective and socially equitable community measure for protecting the population from tooth decay. The scientific and medical support for the benefits of fluoridation certainly outweighs the claims of the vocal minority against it.

Luc De Leeuw

The recommended level varies around Australia and depends on the annual average maximum daytime temperature. In Victoria, for instance, the maximum level of fluoride added to drinking water is one milligram per litre or one part per million as recommended by the World Health Organization.

In hotter climates where people drink more, the recommended level can drop to around 0.7 parts per million. As a comparison, the amount of fluoride in children’s toothpaste is 400 to 500 parts per million. In regular toothpaste, it’s 1,000 parts per million.

We’ve known about the role of fluoride in reducing dental decay since the early part of the twentieth century and some countries, such as the United States, have been adding it to water and toothpastes since the 1950s.

Canberra was the first Australian capital city to be fluoridated – back in 1964. Melbourne has had community water fluoridation since 1977. And other parts of Australia have had fluoridated drinking water for more than 50 years.

Joost Nelissen

Some communities in regional and rural Australia, previously without optimal water fluoridation, have recently started to receive fluoride through their drinking water as part of a program to prevent tooth decay and improve oral health. Australia has now achieved overall population coverage of 90%.

But tooth decay remains significant problem. In Victoria, for instance, more than 4,400 children under 10, including 197 two-year-olds and 828 four-year-olds, required general anaesthetic in hospital for the treatment of dental decay during 2009-10. Indeed, 95% of all preventable dental admissions to hospital for children up to nine years old in Victoria are due to dental decay.

Children under ten in non-optimally fluoridated areas are twice as likely to require a general anaesthetic for treatment of dental decay as children in optimally fluoridated areas.

Community water fluoridation remains a vital public health activity and has a key role to play in preventing dental decay and improving oral health for all Australians. The provision of drinking water through our pipes was never more important.

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98 Comments sorted by

Comments on this article are now closed.

  1. Bruce Moon

    Bystander!

    Mike

    Your observations are important. But, they are only half the story.

    Clearly, evidence supports the fact that tooth decay is diminished with the addition of fluoride to drinking water.

    But, adding fuoride to drinking water is but a means to mask a problem.

    The problem is that people 9children especially) are being exposed to factors that promote tooth decay.

    Aside from the poor dental hygiene issue (a dominant attribute in some poor and emerging nations), the factors that promote…

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    1. Ben Heard

      Director, ThinkClimate Consulting

      In reply to Bruce Moon

      Fat kids with tooth decay or fat kids without tooth decay.

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Bruce Moon

      Bruce Moon - I would suggest that fluoride is not "masking" anything - it is one factor - along with heredity, diet and dental hygiene, that affects the rate of tooth decay.

      Should we avoid one good - and safe - risk minimiser in order to see how bad the other risk factors can be?

      This makes no sense - it is like the illogic of taking away seat belts and air bags in order to focus on bad driving, speed and drink driving - aren't the safety features just "masking" bad driving habits?

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  2. John Kerr

    IT Education

    Fluoride is only useful as a topical treatment - it must come into contact with the teeth to be effective. What worries me is that the tons of fluoride that is put in the water is ending up in our bodies and science seems to now be discovering that it may not be as good for us as the fluoride lobby seems to suggest. Surely supplying topical treatment for teeth or free fluoride toothpaste would be far cheaper and far safer than mass medication of what is, after all, a rather problematic waste substance.

    I would ask the questions:

    Why are many of the countries in Europe stopping fluoridation? I cannot believe that they are idiots, there must be solid reasons.
    What is being done in terms of research that seems to indicate that fluoride may be a contributor to dementia?
    Who actually makes the money out of fluoridation?

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    1. Richard Windsor

      Mycologist

      In reply to John Kerr

      The cost of renaming an intractable industrial waste as a health promoting trace element has reaped enormous profits for the aluminium and phosphate industries.

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    2. Stephen Prowse

      CEO at Wound CRC

      In reply to Richard Windsor

      It doesn't matter where the fluoride comes from, the real issue is what does the data say, the NH&MRC review has a lot of references providing data.

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    3. Sue Ieraci

      Public hospital clinician

      In reply to John Kerr

      There are a range of water fluoridation strategies in various parts of the world, John Kerr.

      At the same time, there are widely varying amounts of naturally-occurring fluoride in natural water supplies - which is very low in Australia but higher in soils or rocks of volcanic origin.

      Why are some European nations stopping (or never started) fluoridation. From my reading, this is because the "individual right not to be medicated" argument has won out (ideologically, not scientifically) over the public benefit argument.

      I guess this reflects the same European culture that limits controls on smoking in public places - more emphasis is placed on the right to smoke than on the exposure of others.

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    4. Richard Windsor

      Mycologist

      In reply to John Kerr

      Regarding European countries ceasing fluoridation. It seems that there are only two experiences, Finland and Germany. The reason, very few European countries adopted water fluoridation.

      The Finnish experience
      “The fact that no increase in caries was found in Kuopio despite discontinuation of water fluoridation and decrease in preventive procedures suggests that not all of these measures were necessary for each child.”
      SOURCE: Seppa L, Karkkainen S, Hausen H. (2000). Caries Trends 1992-1998…

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  3. Paul Rogers

    logged in via Twitter

    I don't regard myself as a fluoride radical, but the whole business seems very odd and something of an anachronism. For what other public health endpoint do we mass medicate through the water supply?

    There are several possibilities -- calcium and magnesium for heart and bones, iodine for IQ. Would you recommend other water supply solutions for public health? One could speculate that optimum levels of calcium and magnesium in drinking water could provide far greater public health benefit than fluoride…

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    1. Stephen Prowse

      CEO at Wound CRC

      In reply to Paul Rogers

      While not quite the same, we do conduct a number of other public health measures at a community level where it is difficult to opt out and it is reasonable to ask why would you. The two that spring to mind are the chlorination of water and pasteurisation of milk, both of which play a key role in controlling infection and preventing disease despite making water and milk taste terrible. Fluoridation also plays a key role in preventing disease.

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    2. Paul Rogers

      logged in via Twitter

      In reply to Stephen Prowse

      Quite correct. Implementing food and water safety methodologies is not the same as medicating people en masse when only a small percentage of that population benefit from it, and then only modestly.

      And regarding dental fluorosis, when does the first class action start against a local government authority?

      Incidentally, seeing that posters here are keen to quote the NHMRC fluoride report (which I've read), anyone like to quote a similar NHMRC report from the 1970s regarding the safety of asbestos?

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    3. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Paul Rogers

      "My main objection is that you can't control the dose with this type of distribution, and as any well-trained pharmacologist would admit, dose is the essence of therapeutic substance application."

      Yes, and to be more precise, the therapeutic window of the substance is the essence of application. I assume the concentration of fluoride in drinking water is such that to get a toxic effect one would have to consume such large quantities of water that the water itself would be dangerous.

      As you mentioned, vitamin C is added to foods, as is calcium, folate, and other vitamins and minerals. We don't consider the addition of vitamins as "mass medication" but of course the distinction between 'vitamins' and 'medication' is more philosophical than chemical.

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  4. Gary Cassidy

    Interesting article, however only the second paragraph relates to the title.

    So how does fluoride in water helps prevent tooth decay?

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  5. Ben Smith

    logged in via Facebook

    Well done Mike on the article. I have read the 2007 NHMRC report on fluoridation. There is no denying that the fluoride prevents dental decay, the key question is how? Thus far I have not seen any studies comparing topical application (brushing teeth) to ingestion of fluoride. Whilst fluoridation of water is socially equitable, it is mass medication. We owe it to the community to verify whether consumption or topical application is more efficacious in preventing tooth decay.

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  6. Russell Camel Wattie

    logged in via Facebook

    Though there are alternate views on Fluoridisation, I can offer my personal experience with tooth decay issues amongst my 6 children. All except the last one have strong healthy teeth, what is the difference with the last one? She is the only one not to have had the experience of “Raw Milk”. Now take from that what you will but it is clear to me that there is a very negative effect of processed milk. Some of my kids only experienced “Raw Milk” for short periods, it would appear that 1 to 2 years…

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  7. rory robertson

    rory robertson is a Friend of The Conversation.

    former fattie

    Thanks for your piece, Professor Morgan. You note that dental decay is driven by "food and drinks containing sugar", and that the NHMRC supports water-fluoridation programs to lessen tooth decay. And most assume that's a reasonable approach.

    Not only does the NHMRC support water-fluoridation programs to lessen tooth decay, Professor Morgan, but it also is seeking to toughen official nutrition advice against added sugar to lessen tooth decay, as well as to combat obesity and diabetes, against…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to rory robertson

      Mr Robertson, you may be old enough to recall that the fluoridation of town water in Australia in the 1960's and 70's. A small amount of Australia ground water also has naturally-occurring fluoride content.

      Try as you might, there is no way to associate systemic water fluoridation in Australia to your bete noir publication.

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  8. Mario Bono

    Mario Bono is a Friend of The Conversation.

    Health/Nutrition Coach

    Previous comments have highlighted that it's the *topical* application of fluoride that probably has the greatest effect in preventing tooth decay. Unfortunately, most people end up swallowing some via the toothpaste they use every day

    Can someone (anyone?) explain the decay prevention mechanism via the *ingestion* of fluoride through drinking water. Fluoride (through drinking water) is transported to every organ in our body!! Is it good that every organ gets loaded up with this toxic chemical?

    Studies have shown that too much ingested fluoride affects:
    - skeletal fluorosis & bone fractures
    - impaired neurological functions
    - impaired thyroid function
    - etc.

    We should really look at diet - sugar content in processed foods/drink is way too high.

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    1. tim mande-jones

      doctor

      In reply to Mario Bono

      Mario you only have ask a dentist to know that flouride is probably one of the best public health measures ever carried out. Ask your doctor if he has ever seen a significant downside from flouridation .

      We need people such as yourself to focus on the real issues, >obesity , fast foods , soft drinks etc....excess salt and sugar

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    2. Sue Ieraci

      Public hospital clinician

      In reply to Mario Bono

      Mario - here is a 2009 review of the potential for fluoride toxicity:
      http://www.ijdr.in/article.asp?issn=0970-9290;year=2009;volume=20;issue=3;spage=350;epage=355;aulast=Dhar
      Physiology and toxicity of fluoride

      It's important to note that fluoride is naturally present in many water sources - that's how the original discovery was made about fluoride and dental decay.

      Most of the literature about fluoride toxicity relates to Fluorosis - which leads only to tooth discolouration. The majority of cases are mild, and aesthetic only.

      Systemic fluoride toxicity from ingestion is rare. Excess absorbed fluoride is very efficiently removed by the kidneys.

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    3. Mario Bono

      Mario Bono is a Friend of The Conversation.

      Health/Nutrition Coach

      In reply to Mario Bono

      Agree with you 100% re: "the real issues" - no argument there.

      My dentist is slightly biased, as he is the state ADA rep and recommended the fluoridation of water. He also provides lots of 'free' toothpaste give-aways (fluoridated, of course!) in his waiting room. (Thank you manufacturers! :-) )

      So those documented cases of skeletal fluorosis (leading fractures, bone cancers, etc) can be ignored/dismissed?

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    4. Suzy Gneist

      logged in via Facebook

      In reply to Mario Bono

      Personally, I would consider some substances (aspartame, GMOs for example) as unwanted 'medication' (if I believe 'food is medicine') but have the choice to avoid these - access to water is much more universal. In the end, it is a personal view of what I consider an intrusion of my rights and you do not and neither is right or wrong, yet I do not impose my view through action on others, only on myself, whereas medicating water supply is a decision by some (scientists/gov) implemented on others without their consent. If this becomes an accepted way to 'police' the masses 'for their own good', this can also be mis-used and used for harm.

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  9. Peter Sommerville

    Scientist & Technologist

    I was heavily involved in the design, construction, commissioning and operation of Melbourne's fluoridation plants during the 1970's. I was also involved in the evaluation of the literature on its effectiveness. I don't intend to rehash all the arguments pro & con - that has been done to death and nothing new has emerged in the interim. Those concerned about its efficacy and the mechanisms behind this should visit the literature. Suffice to say its efficacy was initially recognised in studies on…

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    1. Paul Rogers

      Manager

      In reply to Peter Sommerville

      Peter, how is the quality of the fluoride product assessed, and how is the process controlled for quality?

      Is each batch analysed? How is homogeneity of quality across large batches guaranteed? What contaminants are looked for in batches? Are any batches rejected? If contaminants are found, what are they - arsenic, nickel, cadmium etc?

      What level of contaminants are allowed to be input to water supplies and how is this decided? Who is responsible for this quality control in councils? Do small councils have the expertise?

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    2. Paul Rogers

      Manager

      In reply to Peter Sommerville

      Peter, I would really like to know the details (see my other post) of the fluoridation 'quality' process. Seeing that you designed the plants, perhaps you can elaborate . . .?

      You will know that in at least one instance in Queensland there was a huge error in fluoride distribution; eg from Brisbane Times:

      "The State Government has ordered an investigation into a malfunction at the North Pine water treatment plant which resulted in 20 times the regulated level of fluoride being added to household water supplies north of Brisbane."

      Controlled dose, eh?

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  10. Suzy Gneist

    logged in via Facebook

    1. Forced medication without consent is a human rights abuse.
    2. Many industries benefit from producing products that affect dental health yet carry no responsibility in funding negative impacts, the public purse has to.
    3. Natural fluoride in water is not the same as the toxic industry by-product that is added to the public water supply.
    4. How exactly does ingested fluoride get into your tooth enamel? And where else does it end up and with which health impacts?
    5. As mentioned elsewhere today already, publicly funded continued action and allowing industries that cause health impacts to continue both increase GDP while prevention and changing the underlying problem of increased tooth decay in first world countries impacts GDP - so no-one deals with the fundamental issue! Luckily, I have personal agency to choose my own way of prevention - not everyone does.

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    1. Tim Scanlon

      Debunker

      In reply to Suzy Gneist

      Suzy you are being mislead by someone.

      1) It isn't forced medication, it is a health initiative. Societal benefits are had easily this way, and we don't have people dying of dental decay the way we did a few generations ago.
      2) What negative impacts? Please reference them. To what extent are these occurring? Again, with references. Are people uninformed about these ill effects? Again, with references.
      3) Incorrect. Fluoride is an element. In aqueous solution the F dissociates and thus is available for further chemical interactions. Using a substance like Hexafluorosilicic acid allows for a more aqueous agent than calcium based (thus more crystalline) fluoride substances. This means the fluoride is not needed in as large a quantity to be beneficial.
      4) http://en.wikipedia.org/wiki/Water_fluoridation#Mechanism
      5) We had tooth decay long before we had modern industry.

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    2. Bob Buick

      Retired medical consultant

      In reply to Daniel Boon

      It's appropriate to Suzy Gneist and Dqaniel Boon to note the following:

      1. If adding safe amounts of fluoride to drinking water is human rights abuse, are filtration and sterilisation of natural water also abuses? Are having to wear a seat-belt or bicycle helmet, drive on the left side of the road, or stop at red lights also human rights abuses?
      2. How would you rectify that?
      3. How many different types of fluoride ion did you learn about in your science education?
      4. Ingested fluoride becomes…

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    3. Suzy Gneist

      logged in via Facebook

      In reply to Suzy Gneist

      @Bob Buick
      1. If adding safe amounts of fluoride to drinking water is human rights abuse, are filtration and sterilisation of natural water also abuses? Are having to wear a seat-belt or bicycle helmet, drive on the left side of the road, or stop at red lights also human rights abuses? < Are any of your examples mass medications without consent? Does filtration add medication to water? Does a red light? I think you're missing the point with your comparisons.

      2. How would you rectify that? < Rule…

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    4. Sue Ieraci

      Public hospital clinician

      In reply to Suzy Gneist

      Ms Gneist - it's hard to imagine how one could be "forced" to drink fluoridated water. If anything, less town water is now being consumed in favour of plastic-bottled water.

      Fluorine is an element - you can find it on the periodic table. At room temperature, it is a gas. It readily forms compounds with hydrogen, silica and sodium.

      Natural water sources have highly variable fluoride content. High levels of fluoride in ground water are associated with soils and rock of volcanic origin.

      The advantage of systemic fluoridation of town water is that the levels are measured, consistent and safe.

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    5. Suzy Gneist

      logged in via Facebook

      In reply to Suzy Gneist

      ...it's hard to imagine how one could be "forced" to drink fluoridated water. If anything, less town water is now being consumed in favour of plastic-bottled water. < Ms Ieraci, you say this as if it was a good thing, the plastic waste issue aside, doesn't that say something about people's choices if they can afford to buy water? What of those who can't? Are they not 'forced' to drink what is provided by governments - whatever is in it? Please don't tell me that 'forced' means a person makes you…

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    6. Suzy Gneist

      logged in via Facebook

      In reply to Suzy Gneist

      @Sue In your opinion, since when has town water been fluoridated in Australia and since when has the diet included detrimental foods (like added sugar)?
      I understand your argument is that 'we've been fluoridating water since before we ate sugary foods' - yet my view is that we've had the choice to use fluoridated toothpaste or topical applications for some time, maybe before sugary foods were so widespread here (I didn't grow up in Australia, so can't be sure).
      The difference is CHOICE. You may not value this, but I do.

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    7. Suzy Gneist

      logged in via Facebook

      In reply to Suzy Gneist

      @Tim, I'm not interested in chemistry - I go to a doctor if I want to treat something - not to the tap.
      We differ on a completely different point:
      I argue that one needs to question the fundamental causes of increased dental decay and deal with them - not put a plaster on them and go 'there, there' then continue to consume sugar, etc.
      Treating people like children - as some of the commentators also do with those they consider 'uninformed/uneducated' - does not create a better educated and responsible population and in whose interest is it to continue this? Eliminate the causes of tooth decay inherent in our lifestyle and you eliminate the need for mass medicating, chemistry does not come into this.

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    8. Paul Savage

      Theme Leader, Biotechnology at CSIRO

      In reply to Suzy Gneist

      "1. Forced medication without consent is a human rights abuse."

      Why do you consider fluoridation to be medication? Is the addition of calcium to orange juice medication? What about the restoration of nutrient losses due to processing, or additions to prevent nutritional problems - e.g. thiamin, riboflavin, pantothenate, folic acid, magnesium, vitamin D, vitamin B12, beta- carotene, vitamin C, vitamin B6, vitamin E, niacin... all these things are added "without consent" to all manner of foods and drinks. Is this all forced medication? Where do you draw the line?

      3. Natural fluoride in water is not the same as the toxic industry by-product that is added to the public water supply.

      That's misleading. The fluoride ion (F-) is the same whether it comes from "nature" or by other means. Julst like synthetic vitamin C is identical to plant-derived vitamin C.

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    9. Suzy Gneist

      logged in via Facebook

      In reply to Suzy Gneist

      @Paul what is the reason given for adding fluoride to the water supply? I believe it is argued to be medical and therefore 'medicates'. If I have a headache, I can choose to take a tablet - the same should be the case if I believe my teeth need added fluoride... I wouldn't take headache tablets every day of my life because I might get a headache. Where's the difference?

      I really do not subscribe to any benefits of processed food. My orange juice comes from oranges and does not require nature-identical additives as they are already present naturally. Nevertheless, since the processing destroys the natural vitamins, adding them back in is not actually changing the composition. I'm sure you are an expert in this and the fact that this is part of our modern food supply creates jobs for many specialists like yourself to add additives to food that has had them removed through processing or needs to have an unnaturally long shelf life...

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  11. Richard Windsor

    Mycologist

    Firstly, show me a single study that meets todays requirement for evidence based medicine, ie a double blinded , placebo controlled trial, and I might be tempted to listen to your argument. I do not know of any!
    Secondly, evidence from the early population studies was looking at the toxicity of calcium fluoride in natural waters and the upper limits that adversely affected health. This morphed into studies on the toxicity of sodium fluoride, a chemical with quite different dynamics. Now we have…

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    1. Russell Camel Wattie

      logged in via Facebook

      In reply to Richard Windsor

      The whole gist of this "article" and I use the term loosely sounds like nothing more than a propaganda campaign for the Fluoride industry. There has been no recent studies that meet today’s standards until such time there is strong argument for the discontinuance of Mass medication without medical supervision of individuals needs.
      By any measure the continued Fluoridation of town’s drinking water is wrong. Thank God I live in the bush.

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    1. Richard Windsor

      Mycologist

      In reply to Stuart Khan

      Stuart, it's disappointing to see, of all people, you muddy the waters regarding correlation and causality. Brant and Todd's pearly whites play no part in this debate. The issue is whether ALL of Beaconsfield's residents have better dental health and, even more importantly, whether fluoride had ANY beneficial role . They might have good teeth for a thousand reasons and despite fluoride.

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  12. Ian Donald Lowe

    Seeker of Truth

    Fluoride that is added to water is poison and it is toxic waste from the alluminium and fertilizer industries. The reductions in tooth decay are fantasy. The only study done was stopped after it became obvious that as children developed their adult teeth, dental cavity rates returned to the same as those in areas without fluoridated water, so the study only published the first 5 years of results to present things in the best possible light. The ADA recieves a huge amount of funding from the producers…

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    1. Tim Scanlon

      Debunker

      In reply to Ian Donald Lowe

      It didn't take long to get a conspiracy theorist in here.

      Ian, you are quite simply wrong. If your claims are true then explain the Flynn effect and the decreased rates of dental decay issues and death.

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    2. Bob Buick

      Retired medical consultant

      In reply to Stephen Prowse

      Yes, I think that Ian Donald Lowe should keep seeking.
      It's not always easy to separate the truth from the many ignorant, or paranoid postings that abound outside the reputable scientific literature
      I believe that the best solution to this problem would be for our school-teachers to be more skilled in teaching scientific analysis.

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  13. Bob Buick

    Retired medical consultant

    This is only anecdotal and hardly a controlled study, but my first two children were born in New Zealand in the late 1950s. At the time, local water was not fluoridated, but we were fortunate to enter a fluoride trial in which my wife took fluoride tablets through her pregnancy and the children took them after birth. They have excellent teeth and dental visits are decades apart. Our third and fourth children were born in the early 1960s, when we were living in southern Ontario, where the early work on fluoride had been done and the water was fluoridated. They also have excellent teeth, with the same dental history. My grandchildren were born on the Gold Coast, where ignorant opinion prevented fluoridation and they need frequent conservative dentistry, just like other unfortunate children here.

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  14. Suzy Gneist

    logged in via Facebook

    @Tim Scanlon:
    "1) It isn't forced medication, it is a health initiative." < Medicating individuals without prior consent is forced. Health is an individual state and requirements are also individual, not one-size-fits-all.

    "Societal benefits are had easily this way, and we don't have people dying of dental decay the way we did a few generations ago." < Are you suggesting other reasons have played no part in this development? (education, hygiene, access to care…) and why do people in less developed…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Suzy Gneist

      "supposedly we are now having an 'epidemic' which requires mass medicating "

      That mis-interprets history, Ms Gneist.

      Fluoridation began reducing tooth decay long before fast foods and sugary drinks became commonly consumed.

      Now that sugary diets are more common, however, all the more reason to minimise the other risks for tooth decay, like low fluoride in drinking water.

      IF we all replaced bottled sweet drinks with tap water, both purposes would be served, with a monetary saving as well.

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    2. Tim Scanlon

      Debunker

      In reply to Suzy Gneist

      I don't think there is much point in me discussing your points further until you have read some more on the chemistry involved. You are not understanding those basic principles adequately to have an informed discussion about the health measures arising. The fact that you mention fluorosis yet ask about the action of fluoride on teeth only strengthens my point.

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  15. Suzy Gneist

    logged in via Facebook

    Systematic review of water fluoridation, BMJ 2000;321:855
    "Conclusions
    Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken. As such, this review should provide both researchers and commissioners of research with an overview of the methodological limitations of previous research.
    The evidence of a reduction in caries should be considered together with the increased prevalence of dental fluorosis…

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  16. Paul Rogers

    Manager

    Regarding fluoride's efficacy in tooth decay, here is a summary from the York University systematic review here: http://www.york.ac.uk/inst/crd/fluores.htm

    "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score. The studies were of moderate quality (level B), but of limited quantity. The degree to which caries is reduced, however…

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    1. Paul Rogers

      Manager

      In reply to Paul Rogers

      Note the incidence of dental fluorosis also:

      "With both methods of identifying the prevalence of fluorosis, a significant dose-response
      relationship was identified through a regression analysis. The prevalence of fluorosis at a
      water fluoride level of 1.0 ppm was estimated to be 48% (95% CI 40 to 57) and for fluorosis of
      aesthetic concern it was predicted to be 12.5% (95% CI 7.0 to 21.5)."

      Anyone think that's an acceptable adverse effect for benefits derived?

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    2. David Sun

      CDO

      In reply to Paul Rogers

      "and for fluorosis of aesthetic concern it was predicted to be 12.5% (95% CI 7.0 to 21.5).""

      Paul, you might like to check Google images for 'bad tooth decay' and 'bad fluorosis'.

      Which is the most undesirable condition?

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  17. David Sun

    CDO

    In emails to three Australian health ministers, I have offered to eliminate all tooth decay (and most - all oral - halitosis) in Australia.

    Yet my emails go unanswered.

    Why?

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  18. rory robertson

    rory robertson is a Friend of The Conversation.

    former fattie

    Sue, the link is not complicated, but I am not surprised you missed it completely. The topic of the day is tooth decay and one widespread response to it - the fluoridation of community water supplies. The cause of the problem is, as Professor Morgan explained, "food and drinks containing sugar". I simply made the point that just as the NHMRC supports water-fluoridation programs to lessen tooth decay, the NHMRC also supports tougher official nutrition advice against added sugar to lessen tooth…

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  19. Richard Windsor

    Mycologist

    Tuesday, October 16, 2012
    Mechanism of Fluoride Toxicity on Biological Systems
    N. Agalakova and G. Gusev, Molecular Mechanisms of Cytotoxicity and Apoptosis Induced by Inorganic Fluoride. Russian Academy of Sciences, International Scholarly Research Network, Journal of Cell Biology, Volume 2012, Article ID 403835

    http://www.isrn.com/journals/cb/2012/403835/

    Summary
    While a lot has been written about the potential beneficial effect of low levels of fluoride for dental health, however the…

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    1. Peter Sommerville

      Scientist & Technologist

      In reply to Richard Windsor

      All very interesting. But in the case of Melbourne and Sydney, both of which having been supplied fluoridated water (1 mgm/l) for over 40 years, where is the evidence for all these effects?

      Perhaps it is explained by this quote from the introduction to this paper:

      "Although low fluoride concentrations are beneficial for normal tooth and bone development, acute or chronic exposure to high fluoride doses results in adverse health effects."

      It pays to read what you cite, and more importantly to understand it. Fluoride can be toxic, so can water. It boils back to the quantity ingested.

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  20. Mike Morgan

    Professor, Colgate Chair of Population Oral Health, Melbourne Dental School & Program Leader, Oral Health CRC at University of Melbourne

    Many salient and informed arguments have been provided in the discussion of this article. That's excellent - it was intended to inform and raise awareness. The evidence is clearly supportive of the efficacy, safety and cost-effectiveness of this public health activity. It also has the support of all leading public health agencies in Australia and around the world. Community water fluoridation, as has been pointed out in this discussion, is not a complete panacea for dental caries; there are many…

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    1. Paul Rogers

      Manager

      In reply to Mike Morgan

      One could only agree regarding the value of scientific literacy, although there are several posters here claiming the high ground without a flash of adequate analysis, or perhaps even expertise.

      Incidentally, for those touting NHMRC (est 1937) expertise and their lead role in public health, I can only ask why we are now facing 60,000 dead from asbestos-related diseases by 2030 (more Australians killed than in Wold War 1) when the evidence was available in the 1960s and mainstream in the 1970s when I was involved in asbestos-related occupational health and safety campaigns.

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  21. Diane Lorna Drayton Buckland

    logged in via Facebook

    Mainstream Media Tell The Truth

    If the mainstream media started being honest, instead of using the words 'water fluoridation' they should be telling the truth that ‘water fluoridation chemicals’ are the hazardous waste from the phosphate fertilizer industries dangerously corrosive potent neurotoxins fluorosilicic acid/silicofluorides and co-contaminants of lead, mercury, arsenic, cadmium, etc., and also add aluminium sulphate !

    The extensive evidence of harm from world experts is unquestionable…

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  22. Paul Rogers

    logged in via Twitter

    The scientific case against the fluoridation of water supplies is based on four sound toxicological and pharmacological principles:

    1. Certain knowledge of adverse effects. Dental fluorosis NOAEL: <1 ppm water (0.06 mg/kg/day). Skeletal fluorosis, likely NOAEL less than 2 ppm water. (See 2012 BMJ study: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3467640/)
    2. Inadequate safety factors to account for individual susceptibility and uncertain exposures (difference between lowest observed effect level and proposed dose.)
    3. Inability to control dose or ensure safe levels over totality of lifetime exposures.
    4. Mostly inescapable treatment of individuals for which there is no therapeutic value (adults).

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Paul Rogers

      Paul Rogers - have you ever seen or managed a case of systemic fluorosis?

      It is a very rare condition, other than for massive industrial exposures, because fluoride is so readily excreted by the kidney. Even dialysis patients can clear fluoride.

      What actual clinical evidence of harm have you seen from regulated town water supplies?

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    2. Paul Rogers

      Manager

      In reply to Paul Rogers

      Sue Ieraci wrote: "Paul Rogers - have you ever seen or managed a case of systemic fluorosis? Even dialysis patients can clear fluoride. What actual clinical evidence of harm have you seen from regulated town water supplies?"

      Sue, no I've not seen a case of systemic fluorosis, but having been familiar with the literature on fluoridation for around 30 years, I'm certainly aware of the condition and its presentation. I'm not sure of your implication. However, I challenge your assertion regarding…

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  23. Diane Lorna Drayton Buckland

    logged in via Facebook

    If fluoride "prevented cavities" as the CDC and other government pharmaceutical branches imply, they would be shining a light on the Commonwealth of Kentucky. According to the NIH "Community Water Fluoridation Status by State" 2002 report (reportedly updated in March of 2010), the state of Kentucky ranks #1 in having the highest percentage of fluoridated water of all states in the US. According to Kentucky Oral/Dental Health, the state has received awards for achieving this feat. "The American Dental…

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  24. Peter Sommerville

    Scientist & Technologist

    Carl Sagan, in his book "This Demon Haunted Earth" stated that less than 5% of the US population is scientifically literate. It would be odd if Australia was any different. Some of the commentary on this thread confirms that this is true. So many statements without any evidence. It is a bad sign for public policy.

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  25. Laurie Willberg

    Journalist

    The fact remains that the public was never apprised of research substantiating any benefits of treating our drinking water with fluorosilic acid or sodium fluoride from industrial waste... which is also contaminated with other substances. This is just another case of political and other "authorities" pulling a fast one on the unsuspecting public with that "trust us we're experts" attitude.
    It's disgusting that those of us who have actually read the research have to spend money out of pocket to buy filters to get rid of this toxic crap.

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Laurie Willberg

      Here is a chemical analysis of drinking water from various filtration plants in the Sydney region:

      http://www.sydneywater.com.au/Publications/Reports/TypicalWaterAnalysis.pdf

      Concentrations of sodium, fluoride and silica are all listed.

      We know that sodium is essential to the body, and fluoride helps prevent dental decay. Nanoparticles of silica have been found in tiny amounts in homeopathic "remedies" that have been "succussed" (banged on a hard surface while in a glass bottle) - so they must be not just safe, but also therapeutic, according to Laurie.

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  26. Diane Lorna Drayton Buckland

    logged in via Facebook

    FLUORIDE TOXIC TO HUMAN KIDNEY CELLS

    Cittanova, ML, Lelongt, B., Verpont, MC, Geniteau-Legendre, M, Wahbe, F.,
    Prie, D, Coriat, P. and PM Ronco. Fluoride ion toxicity in human kidney
    collecting duct cells. Anesthesiology. 1996 Feb;84(2):428-35.

    BACKGROUND: Several halogenated anesthetics induce a urinary concentrating
    defect, partly related to fluoride ion toxicity in collecting duct cells.
    The aim of this study was to investigate the effects of fluoride ion in
    human kidney cells.

    METHODS…

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  27. Diane Lorna Drayton Buckland

    logged in via Facebook

    FIRST DO NO HARM

    THE PRECAUTIONARY PRINCIPAL

    PEOPLES' RIGHTS TO CHOOSE WHETHER OR NOT TO CONSUME HAZARDOUS WASTE CONTAMINATED WATER aka 'WATER FLUORIDATION CHEMICALS' and as a consequence all foods and drinks etc. grown, produced or manufactured using hazardous waste contaminated water supplies aka 'water fluoridation' also contaminated.

    Dental health crisis proves not effective and extensive evidence of cumulative harm proves not safe.

    This debate has to end with peoples' rights…

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  28. Lisa Hodgson

    Director

    From the VIC Health Fluoridation Act (1973) “The purpose of fluoridation is to adjust the natural fluoride content of drinking water to the optimum level to provide a dental health benefit. The optimum fluoride concentration in a water supply is based on water consumption, which has been shown to correlate best with ambient air temperature.“

    Recommended F concentrations depend on annual average maximum daily air temperatures From 14.7C – 17.6C the recommended dose is 1ppm, and from 26.3C – 32…

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    1. Sue Ieraci

      Public hospital clinician

      In reply to Lisa Hodgson

      Lisa Hodgson, Director, Fluoride does not "accumulate" in the body - it is efficiently renally excreted. Even in dialysis patients fluoride toxicity is rare.

      The reported cases of chronic toxicity do not occur in regulated town water areas in developed countries - they occur in the setting of either unusually high local water levels or high soil levels (mainly in areas of volcanic origin).

      "What of individuals sensitive to F?" What do you mean by "sensitive"? Do you mean type I hypersensitivity, as in acute allergic reaction? I've not seen any evidence that that exists.

      "Are we all OK with the possibility that we are literally dumbing down our children with F"

      Conspiracy enough?

      Perhaps the unit you direct could undertake some research in this area.

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    2. Paul Rogers

      Manager

      In reply to Lisa Hodgson

      Sue wrote: "Fluoride does not "accumulate" in the body - it is efficiently renally excreted. "

      How about a reference? I quoted a fluoride metabolism review in a dental journal that showed 50% is stored in calcified tissue. Challenge it if you like, but don't just repeat your conclusion. There's also a NAS document. I doubt this is even contentious.

      Full text - http://tinyurl.com/argrblt - Adv Dent Res 8(1):5-14, June, 1994

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    3. Paul Rogers

      Manager

      In reply to Lisa Hodgson

      Sue wrote: "What do you mean by "sensitive"? Do you mean type I hypersensitivity, as in acute allergic reaction? I've not seen any evidence that that exists."

      Bone. 2008 Dec;43(6):1067-74. Fluoride effects on bone formation and mineralization are influenced by genetics. Mousny M, Omelon S, Wise L et al.

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  29. Bob Buick

    Retired medical consultant

    I made a couple of comments early on in the piece, but bailed out when the food neurotics flew in. I just had to add that it's depressing to see how many of them there are and it reinforces my opinion that teaching of logical thought and scientific method is sorely lacking in our schools.

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  30. Sue Ieraci

    Public hospital clinician

    For those who honestly want to understand systemic fluoride metabolism, I gave a good reference below, which I'll copy again here:
    Physiology and Toxicity of Fluoride
    http://www.ijdr.in/article.asp?issn=0970-9290;year=2009;volume=20;issue=3;spage=350;epage=355;aulast=Dhar

    It's worth reading through the entire article.

    As outlined in the paper, very high ingested levels from water have been found from naturally fluoridated water sources, not regulated town water supplies.

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  31. Daniel Zalec

    logged in via Twitter

    For those interested in further reading on the topic of water fluoridation, I suggest a 2010 book titled, 'The Case Against Fluoride' by Dr. Paul Connett, Dr. James Beck & Dr. Spedding Micklem. ISBN: 9781603582872

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  32. Sapphire Eyes Productions

    Producer

    http://www.bookworld.com.au/book/the-case-against-fluoride-how-hazardous-waste-ended-up-in-our-drinking-water-and-the-bad-science-and-powerful-politics-that-kee/9524856/

    The only book worth reading. Anyone care to give a Scientifically, fully referenced book review, please give it.

    Also watch, www.firewaterfilm.com -- an Australian perspective, on what, and how, this toxic waste is made from.

    Readers, do you know what this stuff is made FROM? And what ELSE is bagged up with it???. Do some research of your own... not even 'Pharmaceutical grade' toxic waste!

    Start with, Incitec Pivot's safety MSDS for Hydrofluorosilic Acid: http://data.rmt.com.au/msds/3082468.pdf

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  33. Sapphire Eyes Productions

    Producer

    Listen to the PEOPLE's CHOICE: http://www.fluoridealert.org/articles/wichita-victory/ NOT to the industries making a right ripping quid for dumping their toxic industrial waste into our drinking water.

    Brush your teeth, floss, keep away from sugary products, and drink clean spring water. That should assist with the lazy excuses of putting hydrofluorosilic acid into our water to fix dental problems!

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  34. Colin Bishop

    Manager


    "Dental and Public health administrators should be aware of the total fluoride exposure in the population before introducing any additional fluoride programme for caries prevention." - World Health Organization. (1994). Fluorides and Oral Health. WHO Technical Report Series 846.

    Stop and apply a little thought!

    If the WHO (presented as an authority by pro-water fluoridation promoters) could issue such a statement in 1994 why is it that there have never been any environmental assessments…

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  35. Colin Bishop

    Manager

    A recent decision by several Australian federal politicians to support a parliamentary review of artificial water fluoridation has an intensified debate on the public health intervention. While there is a majority agreement among Australian dentists and other health professionals that adequate enamel fluoride is essential for dental health, the ethics of artificial fluoridation of public water supplies as a contemporary vehicle for facilitating adequate supply of fluoride to teeth is highly contested…

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  36. Colin Bishop

    Manager

    Released a number of years ago now was this campaign poster:

    Fluoridation: FUQ (Frequently Unanswered Questions)

    Would you like to know what health authorities base their "fluoridation is safe and effective" claim on? Whether you support fluoridation or not, these questions shine a bright light on authority and get to the facts.

    The following questions have never been answered by various governments, dental and health authorities in Australia - or in any fluoridated country.

    After 50…

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  37. Colin Bishop

    Manager

    Queensland Health/Environmental Health makes the following statement:

    I note the concerns you have raised in your email and can assure you that the safety and effectiveness of water fluoridation at optimal levels has been frequently re-evaluated, and the weight of evidence consistently shows that fluoridated water is safe.

    I have spent many years providing Queensland Health with information showing that fluoridation of water supplies is not safe as it is an unregulated dose.

    www.drinktap

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  38. Colin Bishop

    Manager

    Queensland Health:

    "The fluoridating agents used in Queensland for drinking water supplies are sourced from manufacturers who supply it for the purpose of water fluoridation. It is neither "pharmaceutical" nor "industrial waste" grade,"

    Definition: Therapeutic refers to healing, such as a medicine or therapy that has healing or curative capability for treatment of disease or disability.

    Definition: Medicinal Product, a substance administered to humans or animals through injection, application, oral ingestion, inhalation, and so forth, whose purpose is to ultimately restore health or eliminate disease in an individual.

    "The introduction of water fluoridation reiterates the Queensland Government's commitment to preventative health"

    If this “chemical fluoride” is not pharmaceutical and Queensland Health say it is not “medicinal” why is it being put into drinking water for “preventative health”?

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  39. Colin Bishop

    Manager

    A Congressional investigation also revealed the following:

    * EPA confirmed that the two compounds used almost exclusively in the U.S. for fluoridation have never, ever been studied for their effect on health or behavior.

    * NSF International, the private organization certifying fluoridation chemicals, confirmed that it is doing so in violation of its own standard requiring manufacturers to submit any available published and unpublished toxicological studies on both the fluoride compound and any contaminants contained in the product. NSF disclosed in the investigation that they have no such studies on file

    http://www.keepersofthewell.com/diligence_pdfs/2003_Due_Diligence.pdf
    http://www.thenhf.com/article.php?id=1112

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  40. Colin Bishop

    Manager

    "Please be advised that the position of Queensland Government is to fluoridate appropriate water supplies within Queensland. The Queensland Government does not intend to reconsider this important public health decision."

    This is an absolutely preposterous statement to make by persons who are responsible for health. Where is the professional responsibility and the professional duty of care?

    If the government do not intend to reconsider this important public health decision then it is obvious that they will not even bother reading new research and therefore will not be re-evaluating. This makes the following statement rather suspect.

    "I note the concerns you have raised in your email and can assure you that the safety and effectiveness of water fluoridation at optimal levels has been frequently re-evaluated, and the weight of evidence consistently shows that fluoridated water is safe."

    Yeh right - not.

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  41. Colin Bishop

    Manager

    http://www.iaomt.org/articles/files/files187/IAOMT%20Fluoridation%20Position.pdf

    This current policy position by IAOMT confirms those earlier assessments and asserts that there is no discernible health benefit derived from ingested fluoride and that the preponderance of evidence shows that ingested fluoride in dosages now prevalent in public exposures aggravates existing illnesses, and causes a greater incidence of adverse health effects.

    Ingested fluoride is hereby recognized as unsafe, and…

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  42. Colin Bishop

    Manager

    The Queensland Government based its decision to implement drinking water fluoridation on advice provided by peak health authorities such as the National Health and Medical Research Council, the Australian Dental Association, the Australian Medical Association and the World Health Organization. The research considered by these organisations has been through rigorous scientific reviews by qualified researchers and the weight of evidence has consistently found that water fluoridation is a safe and effective method of reducing tooth decay.

    http://www.fluoridealert.org/carton-cross.pdf

    http://www.slweb.org/bibliography.html

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  43. Colin Bishop

    Manager

    European Court Ruling Ends
    Water Fluoridation
    By Doug Cross
    www.ukcaf.org

    7-21-09

    Fluoridated water must be treated as a medicine, and cannot be used to prepare foods! That is the decision of the European Court of Justice, in a landmark case dealing with the classification and regulation of 'functional drinks' in member states of the European Community. (HLH Warenvertriebs and Orthica (Joined Cases C-211/03, C-299/03, C-316/03 and C-318/03) 9 June 2005)...

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  44. Daniel Zalec

    logged in via Twitter

    "This article utilizes Childress’ ‘justificatory conditions’ to evaluate the ethical appropriateness of artificial water fluoridation in Australia. The author concludes that there is insufficient ethical justification for artificial water fluoridation in Australia." – 'Ethics of Artificial Water Fluoridation in Australia' (2012) in Public Health Ethics; by Niyi Awofeso (School of Population Health, University of Western Australia, and School of Public Health, University of New South Wales, Australia.) http://sapphireeyesproductions.wordpress.com/2012/08/24/fire-water-cited-in-public-health-ethics-journal/

    Additional discussion on ethics in the following video: 'Professional Perspectives on Water Fluoridation' available for free at: http://www.youtube.com/watch?v=88pfVo3bZLY

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  45. Daniel Zalec

    logged in via Twitter

    Dear Tim Scanlon (below), regarding your comment:

    "1) It isn't forced medication, it is a health initiative. Societal benefits are had easily this way, and we don't have people dying of dental decay the way we did a few generations ago."

    You may be interested in viewing the videos on the following playlist:

    http://www.youtube.com/playlist?list=PL53E25EFBF102EF37

    Specifically, parts 1, 2 and 3.

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  46. Daniel Zalec

    logged in via Twitter

    In September 2009, the Victorian Health Department was challenged by a number of professionals, including a former Australian Minister for Health, regarding some key arguments against fluoridation; the challenge was published in the Sunraysia Daily newspaper. I hereby share the article on this forum, to contribute to further discussion: http://www.fluoridealert.org/news/opinion-citizens-are-being-misled/

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  47. Sonja Hardy

    Teacher

    It's not surprising this "article" looks more like an ad for fluoridation, considering the author's connection to Colgate.

    You only have to look at dental health statistics to realise that fluoridation doesn't work. For example, Tasmania was the first state to introduce fluoridation, yet has Australia's worst dental health records. Around the world dental health in countries that do not fluoridate is as good as, and in some cases better than, in any fluoridating country.

    For case studies of people harmed by fluoridation, and how their health improved after fluoride exposure was eliminated as much as possible, download Dr Bruce Spittle's book, "Fluoride Fatigue". It's free.

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  48. Sandra Camm

    logged in via Facebook

    As a lay person I only know that there are thousands of people suffering as a result of this in the city where I live. 2009 fluoridation began, we are already an industrial city with airshed fallout extreme. If testing of water quality is only done by the Barwon Water retailer, wouldn't this be vested interest? There are no pathology tests available to monitor adverse fluoride re-action. When one speaks to dentists and doctors they are horrified when they see other data showing Incitec Pivot -MSDS…

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