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Guardian, 19th September, 1995.

Water Soluble? Anne-Lise Gotzsche takes issue with the fluoride lobby over their claims to benefit our dental health.

IT IS 53 years since a paper first appeared in the Journal of the American Dental Association suggesting that fluoride, when used as a dental treatment, was most effective when applied directly to the tooth surface rather than ingested with food or water. By then the fluoridation bandwagon was up and running, spurred on by the increase in the use of industrial fluorides in wartime production. Yet now this observation is gaining ground: fluoride works best when applied directly.

The fluoride promoters have been in retreat for years. At first they announced that children should consume 1 milligram a day, which corresponds to 1 mg per litre of water or 1 ppm (parts per million). Then it because half a milligram for young children, then a quarter of a milligram and, finally, some scientists - especially paediatricians - suggested that very young children should not have any fluoride at all.

The dental fluoride promoters had simply not done their homework carefully. For instance, a baby eating an infant formula prepared with fluoridated hater will be getting 100 times the fluoride dose of a breastfed baby, and four times the dose of an adult, per kilogram of body weight.

Last year, Dr Peter Rock, of Birmingham University, warned that even a pea-sized quantity of fluoride toothpaste might be too toxic for young children. The year before, a scientist at the Poison Information Centre in Vienna published figures showing that there were 450 cases of fluoride poisoning in children in Austria every year and one death. In Britain, these figures would translate into 3,000 cases of fluoride poisoning and seven deaths. But no such records seem to be kept in Britain.

Today, people consume so much fluoride from many different sources-food, insecticides, drugs, beverages and dental products-that fluoridation statistics have become meaningless.

In the 1960s, there was research already showing that people might be getting 5 mg of fluoride a day from all sources, which some would regard as 4 mg too much. British doctors and dentists do not seem to be aware of the warning, first published 25 years ago by John Marier, a leading fluoride author at the National Research Council of Canada, that the effects of fluoride in the body depend on the level of magnesium. Where dietary magnesium is plentiful, fluoride can be relatively innocuous, while a low magnesium intake can make fluoride unexpectedly toxic, especially in the young.

Last year the International Society for Fluoride Research held its 20th international conference in Beijing, co-sponsored by the World health Organisation and the Chinese Ministry of Health. The talk was all about the negative effects of fluoride such as fluoride-induced bone fragility, slow bone healing, osteoporosis and skeletal and dental fluorosis, cardiovascular effects cerebrovascular disease and lowered intelligence, muscular malfunctions, chromosomal abnormalities and birth defects. Foreign delegates were taken out to surrounding villages to inspect Chinese defluorination plants, with large slogans saying in translation: "Improve water quality, reduce the fluoride level. It makes us happy."

There were no British television cameras there to record the events. The issue will remain a hot political potato in this country until the press decides to report such research. Until then, the only advice one could give people is to make sure they eat plenty of magnesium.

Sound bites

  • ABOUT 70 per cent of children are registered with a dentist. There are wide regional variations. Figures show the number of people under 18 registered with an NHS dentist as 48 per cent in London; 54 in Liverpool; 51 in Sunderland; 44 in Wolverhampton; 70 in West Sussex; 67 in Avon; 68 in Hertfordshire; and 71 in Dorset.
  • THERE are further variations within cities between poor and more affluent area. Only 42 out of every 100 children In the London areas of Lambeth, Southwark and Lewisham are registered with a dentist compared to 63 in neighbouring Richmond and Kingston.
  • ALMOST a million NHS dental patients have been deregistered in the past five years, according to the General Dental Practitioners Association.
  • BLACK children in Britain are only half as likely as white children to suffer from tooth decay, according to a survey of pre-school children in south London. More than a third of the white children had decay. The researchers were unable to explain the difference.

Anne-Lise Gotzsche has spent over 20 years investigating fluoride. She is the author of The Fluoride Question, Davis-Poynter Ltd., London and Stein and Day Inc., NY 1975

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