Many studies and published documents have demonstrated that increased fluoride exposure is directly linked to increased periodontal disease. From a public health perspective, any study that demonstrates increased fluoride exposure may increase the risk of developing periodontal disease or other illnesses are of major importance. This is especially the case when Ireland has globally one of the highest prevalences of periodontal disease combined with the highest number of premature deaths from ischemic heart disease in the EU and periodontal disease is associated with increased risk of cardiovascular disease.
2. Historical evidence
3. Recent literature
The CDC as with the Health Department in Ireland have claimed that community water fluoridation is the most effective method for preserving oral health. If tooth loss is a measurement of oral tooth health, then one would expect to see much lower rates of edentulism (tooth loss) in fluoridated communities. This has not occurred in the U.S nor coencidentally has it occurred in Europe (Fig 1) where much higher rates of tooth loss are also reported in fluoridated communities.
Generally speaking, it is apparent that when the percentage of fluoridated individuals increases, so does the percentage of people with missing teeth. There appears to be no life long reduction in dental decay that can be directly attributable to water fluoridation and instead there appears to be an increase in tooth loss associated with fluoridation amongst the older population who have the longest exposure compared to non fluoridated communities.
The CDC report findings would support this in noting:“The prevalence of edentate persons (i.e., those who have lost all their natural teeth) ranged from 13% in Hawaii and California to 42% in Kentucky.” The lowest rates of tooth loss in people over 60 years of age occur in the states with the lowest rates of water fluoridation.
While in Europe the prevalence ranged form 48% in fluoridated Republic of Ireland to 17% in Sweden, 18% in Denmark, 15 % in Italy, 36% in the UK and 40% in Northern Ireland. In other words, the highest rates of tooth loss in people over 60 years of age occur in the regions with the highest rates of water fluoridation.
It is likely that the higher incidence of dental fluorosis recorded in fluoridated communities, itself a visible sign of overexposure to fluoride, is also a contributor to this phenomenon. However it should be noted, that this in itself is not an accurate reflection of fluoride exposure generally in the population, as the teeth of children over 8years of age will not develop dental fluorosis regardless of fluoride dietary exposure.
A further study in 2011 published in the Indian Journal of Dental Research concluded that “the association between degree of fluorosis and periodontal status is statistically significant.”
4. ConclusionBased on these facts, fluoridation does not appear to have helped prevent tooth loss and clearly it is evident that fluoridation does not benefit those without teeth. What is known is that during the last 80 years a clear association between periodontal disease and fluoride exposure was identified and reported, however considering the significance of the disease it is also apparent that it was not studied in the detail one would expect. The bulk of the research has been on dental caries not periodontal disease.
It is clear however that evidence demonstrating a link between total dietary fluoride exposure and periodontal disease is available if you look for it. It is further evident that based on the current information available and on the understanding of the ‘precautionary principle’ that a cessation of the policy of mandatory fluoridation of public drinking water supplies should be undertaken immediately to assist in reducing the exposure of the population to fluoride to acceptable safe levels. One cannot control the dietary exposure to fluoride compounds for all sectors of the population by fluoridation of public water supplies. It is certain for large sectors of the population that fluoridation of water supplies only increases the risk of potential harm.