The most important element of water fluoridation

The subject of water fluoridation in New Zealand can turn a casual conversation at a typical summer BBQ into a parliamentary debate complete with petty comments, unrepentant fallacies and the raising of blood pressure on both sides. Pro fluoridation and anti fluoridation advocates alike tend to take their stances quite firmly and proudly. And so they should, this is New Zealand, the little island known for being adept at navigating the waters of social change and allowing citizens to retain their right of choice.

But there are elements about water fluoridation that poses a real quandary for both sides of the controversy. Does water fluoridation equate to forced mass medication and therefore does the consideration to fluoridate New Zealand water diminish our rights as individuals to choose what we ingest? If we minus the arguments surrounding the safety, efficacy and cost effectiveness of water fluoridation from the debate the one remaining facet is that of the ethics of water fluoridation.

I guess I need to admit something before continuing. I believe that water fluoridation could be incredibly helpful in New Zealand.  The scientific research I found completely dismissed anti fluoridation’s arguments that water fluoridation causes cancer, kidney problems, and oh of course, the mildly humorous proposition that fluoridated water drops the I.Q of people drinking it. However mention the ethical stance that water fluoridation results in a “nanny state” and I leap right over to the side of anti fluoridation, proudly waving my placard renouncing the medication of the masses by our over bearing government.

I doubt I differ from most pro fluoridation advocates.  I suppose many of them would agree that forcing strategies like water fluoridation on people sounds slightly archaic. And then they could swiftly justify the ethical element by stating that the benefits outweigh the risks.  But it is that need to disprove the other side and swift justification that will hinder the debate in the long run.  The ethical implications that are faced by water fluoridation need to be discussed by both sides.  Not just used as a tool to support their respective arguments. But to be used to start a conversation about what is good for all of New Zealanders.

New Zealand has long been a front-runner in advancing the rights of its citizens.  We were one of the first countries to give women the right to vote, to legalize prostitution, and to legalize gay marriage.  Why should we turn our back on human rights now to incorporate a strategy that essentially removes our right to choose? I am confident that New Zealand can make the right decision but only if we choose to identify the most import factor in this debate: Is water fluoridation ethical?

Does water fluoridation cause bone cancer?

For my position paper I argued that all community water resources should be fluoridated in New Zealand. There were vast amounts of literature and primary research arguing that water fluoridation is safe and effective, and that community water fluoridation provided the best defense against dental caries and improving oral health. On the other hand it was not easy to find good research that supported the opposing side of my argument.

I was pleasantly surprised to find opposing journal articles about primary research on the relationship between water fluoridation and bone cancer. I felt that it was important to address this claim, which has predominately come from the anti fluoridation side, in order to address the claim that water fluoridation is harmful.

The first article supports the anti fluoridation argument and researched the link between bone cancer and water fluoridation in the United States and was conducted by Elise Bassin, David Wypij, Roger Davis and Murray Mittleman (2006). This study compared the incidences of bone cancer against the individual’s exposure to fluoridated water. They used logistic regression; method of finding statistical probabilities, to show that males under 20 years of age residing in areas of community water fluoridation have an increased risk of developing bone cancer and concluded that there was an link present. This conclusion was reached due to the fact the authors had to estimate what level of fluoride each subject would have been exposed without being able to obtain actual fluoride levels from each respective area. Bassin et al. (2006) clearly had confidence in their findings, however, no causal relationship was found during this research meaning that they did not prove that water fluoridation causes cancer.

The opposing argument to the previous research study is that there is no link between bone cancer and fluoridation water and that water fluoridation plays no part in causing the occurrence of bone cancer. This second research article substantiates this claim and was completed in Ireland by Harry Comber, Sandra Deady, Erin Montgomery, and Anna Gavin (2011). The research compared bone cancer occurrences and whether the patient had resided in a fluoridated or non-fluoridated area. The data shows no difference in the number of bone cancer diagnosis of those living in an area with water fluoridation present and those living in no fluoridated areas. Therefore, Comber et al. (2011) reached the conclusion that there was no relationship between ingesting fluoridated water and the development of bone cancer, causal or otherwise. The data used in this study was easy to understand and clearly showed no relationship which I believe strengthened the authors’ findings that there was no link between water fluoridation and bone cancer.

Bassin, E. B., Wypij, D., & Davis, R. B. (2006). Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes Control, 17, 421-428.

Comber, H., Deady, S., Montgomery, E., & Gavin, A. (2010). Drinking water fluoridation and osteosarcoma incidence on the island of Ireland. Cancer Causes Control, 22, 919-924.