Declan Waugh seems a bit of a late developer. He has only just got around to finding those papers that anti-fluoride propagandists like to cite as evidence that oral health does not decline when community water fluoridation is stopped. Of course, he cherry-picks the appropriate papers and is then careful not to give the full evidence.
But he has whipped up a Letter to the Editor promoting his new “discovery” – and encourages his fans to use the same information for their own letters to the editor.
Here’s Waugh’s claim in his letter to the editor (which he encourages his fan’s to duplicate).
In recent decades in four seperate countries notably Finland, the Netherlands, Germany and Cuba dental health professionals warned of the grave dangers to public health from discontinuation of water fluoridation. Yet ironically peer reviewed published scientific research demonstrated that dental health significantly improved among children when fluoridation of water ended. Scientific evidence proved in every case that the views and opinions of profluoridationalists among dental health professionals were misguided and errorneous. So why are we still listening to them?
- Seppa L, Karkkainen S, Hausen H. Caries frequency in permanent teeth before and after discontinuation of water fluoridation in Kuopio, Finland. Commuity Dent Oral Epidemiol 1998;26:256 – 262.
- Seppa L, Karkkainen S, Hausen H. Caries trends 1992 – 1998 in two low-fluoride Finnish towns formerly with and without fluoridation. Caries Res 2000;346:462 – 468.
- Künzel W, Fischer T. Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Res. 2000 Jan-Feb;341:20-5.
- Künzel W, Fischer T, Lorenz R, Brühmann S. Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dent Oral Epidemiol. 2000 Oct;285:382-9.
- Kalsbeek H, Kwant GW, Groeneveld A, Dirks OB, van Eck AA, Theuns HM. Caries experience of 15-year-old children in The Netherlands after discontinuation of water fluoridation. Caries Res. 1993;273:201-5
What these papers really say
I refered to this little myth in my article What happens when fluoridation is stopped? and will briefly repeat the information these propagandists always omit here.
L. Seppä, S. Kärkkäinen, and H. Hausen, “Caries Trends 1992–1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation.” Caries Research 34, no. 6 (2000): 462–68. The abstract for this paper concluded:
“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.”
The authors commented further on this research in Seppa et al (2002). They found their “longitudinal approach did not reveal a lower caries occurrence in the fluoridated than in the low-fluoride reference community.” But commented:
“The main reason for the modest effect of water fluoridation in Finnish circumstances is probably the widespread use of other measures for caries prevention. The children have been exposed to such intense efforts to increase tooth resistance that the effect of water fluoridation does not show up any more. The results must not be extrapolated to countries with less intensive preventive dental care.”
W. Künzel and T. Fischer, “Caries Prevalence after Cessation of Water Fluoridation in La Salud, Cuba. Caries Research 34, no. 1 (2000): 20–25. Again this study found no increase in caries after stopping fluoridation but the authors suggested why:
“A possible explanation for this unexpected finding and for the good oral health status of the children in La Salud is the effect of the school mouthrinsing programme, which has involved fortnightly mouthrinses with 0.2% NaF solutions (i.e. 15 times/year) since 1990.”
W. Künzel, T. Fischer, R. Lorenz, and S. Brühmann, “Decline of caries prevalence after the cessation of water fluoridation in the former East Germany Community Dentistry and Oral Epidemiology 28, no. 5 (2000): 382–89. These authors found no increase of caries in two German cities after fluoridation of water was stopped. But again the authors suggest why:
“The causes for the changed caries trend were seen on the one hand in improvements in attitudes towards oral health behaviour and, on the other hand, to the broader availability and application of preventive measures (F-salt, F-toothpastes, fissure sealants etc.).”
Kalsbeek, H., Kwant, G. W., Groeneveld, A., Dirks, B., van Eck, A. A. M. J., & Theuns, H. M. (1993). “Caries Experience of 15-Year-Old Children in The Netherlands after Discontinuation of Water Fluoridation.“ Caries Research, 27(3), 201–205. Tooth decay continued to decline after discontinutation of fluoridation in both the areas previously not fluoridated and fluoridated. But the authors say:
“The question as to whether water fluoridation would have had an additional effect if it had been continued (presuming the application of existing preventive measures) cannot be answered, as there are no remaining communities with fluoridated water in The Netherlands.”
Tooth decay is complex because it involves several factors. Improvements in public health, especially dental health availability, and alternative fluoridation options have produced a general improvement irrespective of the availability of community water fluoridation (CWF). However, where comparisons are made between fluoridated and unfluoridated areas in the absence of other differences the benefits are seen.
Studies do show increase in tooth decay when fluoridation stopped
Of course there are other studies which Declan Waugh and his anti-fluoride mates will refuse to cite because they do not support their claims. In Fluoride debate: Ken Perrott’s closing response to Paul Connett? I discussed a paper which did show an increase in tooth decay – Attwood and Blinkhorn (1991), “Dental health in schoolchildren 5 years after water fluoridation ceased in South-west Scotland.” They measured dmft and DMFT – decayed, missing and filled teeth in primary and permanent teeth respectively.
The figures below illustrate the data from this paper which compared changes in oral health of two Scottish towns in both 1980 and 1988. One town, Annan, had never had fluoridated water while the other, Stranraer, had it until 1983. This enabled the effects of both cessation of fluoridation and the generally observed improvement in oral health due to other factors to be compared and considered. The graphics show the results for 5 year old and 10 year old children.
Decayed missing and filled deciduous teeth for 5 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.
Decayed missing and filled teeth for 10 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.
The plots indicate aspects of the complexity of these sort of studies. Because 2 neighbouring towns were compared it was possible to measure the decline in oral health after discontinuation of fluoridation against a background of the general improvement in oral health, even in a non-fluoridated situation.
The moral here is don’t accept at face value the claims made by anti-fluoridation propagandists – even if they, like Declan Waugh, carry a self-endorsement of “scientist and fluoride researcher.”