Declan Waugh pushes another anti-fluoride myth

DeclanWaugh_photo

Declan Waugh – Champion cherry-picker

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).

Dear Sir.

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?

Yours sincerely

  • 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.”

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12 responses to “Declan Waugh pushes another anti-fluoride myth

  1. Declan Waugh has been so completely discredited, it is a mystery as to why any intelligent person accords him any credibility whatsoever.

    Steven D. Slott, DDS

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  2. Ashburton NZ – New Plymouth NZ Just two examples of communities where decay rates declined when fluoridation stopped. There are others!
    Another myth exploded is the often repeated claim that fluoridation is expanding – in the US in 2011 17 start-ups, same figure in 2012 but only 2 in 2013. Compare that with the over 150 communities that gave fluoride the flick. In Ireland 5 counties have rejected fluoridation along with Dublin, Cork and Kerry.
    The tide is running out guys and you will soon be stranded!

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  3. Trevor, read the article again and in particular look at the Scottish studies.

    You refer to “other” studies showing decay rates declined when fluoridation ceased. Could you please provide citations and (if possible) links?

    PLEASE NOTE TREV€“ IF YOU DO NOT RESPOND TO THIS QUESTION I WILL INTERPRET YOUR CLAIM AS BEING FALSE.

    As my article shows the papers cherry-picked by Declan Waugh do not show what he claims because other inputs of F continued (and no comparisons with fluoridated towns where included).

    The Ashburton data you refer to is pathetic – try analysing it statistically. It might be lapped up by the Fluoride Free Facebook pages but it could not be published in a credible research journal.

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  4. Trevor, according to the latest CDC report, fluoridation increased in the US from 73.4% in 2011 to 74.6% in 2012. When three quarters of the country is already fluoridated, obviously you will not see large numbers of “start-ups”. There simply aren’t that many areas left that need to “start-up”. That there are still communities so doing should make even you understand that fluoridation in the US is thriving and growing.

    The following is a list of US communities that have either begun fluoridation, or turned back attacks on fluoridation from antifluoridationists, over the past 2 years.

    Bronson, MI
    Boyne City, MI
    Salina, KS
    Healdsburg, CA
    Kalama, WA
    Richland, GA
    Albany, WI
    Hinesville, Ga
    Madison, WI
    Valparaiso, Ind
    Loveland, CO
    Austin, TX
    Houston, TX
    Jesup, Ga
    Schuylkill Haven, PA
    Durham, NC
    Brooksville, Fl
    Wayland, Mass.

    Steven D. Slott, DDS

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  5. Ken – You may interpret my claims as you please – the data is from the dental division of the Taranaki and Canterbury DHBs. I suspect the same trend from Hamilton when I get the data. Using emotive claims to scare the population is not the preserve of protest groups, the fluoridation lobby have developed it to a fine art and have the deep pockets of taxpayers to promote it. In regard to Scotland I suggest cherry picking data from one area is hardly indicative of the state of play over the whole country.
    Mr Slott – I stand by my statement. Given that only a very small minority of the global community ingests artificially fluoridated water and that proponents of the practice haven’t succeeded in nearly a century to have it universally accepted as safe, beneficial and effective surely its time to step back and reconsider it.
    Virtually every study done over the past 50 years have identified two things in common and that is the lack of consistent evidence and the need for more research.
    In the US in 2011 there were 17 communities who started fluoridation while 21 stopped. In 2012 there were 17 start-ups and 24 stopped. In 2013 there were 2 start-ups and 18 stopped. Up to September 2014 there were 11 communities who stopped. If that is ‘thriving and growing’ you must be deluded.

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  6. Trevor – I asked a simple question of you and provided a warning:

    “You refer to “other” studies showing decay rates declined when fluoridation ceased. Could you please provide citations and (if possible) links?

    PLEASE NOTE TREV€“ IF YOU DO NOT RESPOND TO THIS QUESTION I WILL INTERPRET YOUR CLAIM AS BEING FALSE.”

    You have not responded to this question, so I declare your original claim to have been false.

    No suprise, I guess.

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  7. Trevor,

    “stand by” whatever you please. The facts are the facts. Fluoridation in the US is increasing. According to the lasted CDC report, US fluoridation was 73.4%. In 2012 it was 74.6%. With 75% of the country fluoridated already, one will not see large numbers of new “start-ups” as there simply are not enough unfluoridated areas left that need to be “started up”.

    The argument that “little Johnny doesn’t do it, so why should I?” belongs on the elementary school playground, not in scientific discussion. The constant attempts by antifluoridationists to use this argument is clearly demonstrative of the void of any valid evidence to support their position. If you have any valid, peer-reviewed scientific evidence of adverse effects of water fluoridated at the optimal level, then present it, properly cited to its primary source. “Information” filtered and edited through antifluoridationist websites does not qualify as such.

    Steven D. Slott, DDS

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  8. Ken – as you well know there are many instances from reputable sources that show a decline in decay rates when fluoridation stops. That you choose to rubbish them is understandable given your blinkered view on the subject but here is an example out of PubMed, or are they also persona non gratia in your view? http://www.ncbi.nlm.nih.gov/pubmed/11842782.
    Steven – I conclude you are incapable of engaging in a reasoned argument given your absolute dismissal of any science presented by anyone who questions fluoridation.
    I have requested plain English scientific evidence supporting adding artificial fluoride to drinking water and the response has been zilch.
    If there are so few un-fluoridated areas left in the USA why is tooth decay still an unresolved issue? That indicates to my simple mind that fluoridation is more part of the problem rather than any part of the solution.

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  9. Thanks for the citation, Trev. You may have noticed the authors of your citation are the same as the paper I cited (and Waugh cited) in my article. It appears to be a Dutch version of the paper we cited so I won’t bother hunting down the full text but rely on the English version of the paper.

    If you read my article I quoted from Kalsbeek et al:

    ““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.”

    They are of course pointing to the problems of drawing conclusions from longitudinal studies like this. The comparison between two communities in the Scottish study is a more reliable basis for conclusions because fluoridated and non-fluoridated communities were compared side to side.

    So the authors are more or less refuting your claim of their paper as evidence for your case.

    So much for “blinkered!”

    It is perfectly true that one can find plenty of studies showing a decline in decay rates continuing even after CWF ceases. This simply reflects the multifactorial nature of the constraints on tooth decay. Usually when these studies are consulted properly (as I have done in my article) instead of simply cited without proper consideration (as you and Waugh have done) one finds that the continued improvement in oral health can be related to other forms of fluoridation (salt, milk, dental applications, mouth rinse), improvements in social dental health policies, etc.

    I keep repeating this but it seems appropriate to repeat it to you again:

    One must approach the scientific literature critically and intelligently.

    >

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  10. Gee, Trevor, here’s a suggestion……..why don’t you try something different for a change and provide some valid science. If you ever would do that, I might not be so dismissive of you. So far, you’ve presented nothing, so it’s impossible to tell whether I would dismiss any such science, or not.

    You hit the nail on the head with your self-description of your “simple mind”. Only a simple mind would conclude that the overwhelming problem with untreated dental disease is in any manner caused by water fluoridation. That is a perversion of facts if there ever has been one. The “logic” in that thinking is so twisted that it would be impossible to sort out. Fluoridation was never promoted, or expected to be, a cure for all of dental disease. It is simply one, very valuable, preventive measure to combat the problem. That there is still a problem in the United States, and most other countries, with untreated dental disease is a reason for fluoridation, not against it.

    Allow me to present, in “plain English”, yet once again, but a few of the peer-reviewed scientific studies which clearly demonstrate the effectiveness of water fluoridation. Perhaps the problem is not that you have asked in “plain English”, but that you cannot read “plain English”.

    1) Results
    Children from every age group had greater caries prevalence and more caries experience in areas with negligible fluoride concentrations in the water (<0.3 parts per million [ppm]) than in optimally fluoridated areas (≥0.7 ppm). Controlling for child age, residential location, and SES, deciduous and permanent caries experience was 28.7% and 31.6% higher, respectively, in low-fluoride areas compared with optimally fluoridated areas. The odds ratios for higher caries prevalence in areas with negligible fluoride compared with optimal fluoride were 1.34 (95% confidence interval [CI] 1.29, 1.39) and 1.24 (95% CI 1.21, 1.28) in the deciduous and permanent dentitions, respectively.

    ——Community Effectiveness of Public Water Fluoridation in Reducing Children's Dental Disease
    Jason Mathew Armfield, PhD

    2) CONCLUSIONS:
    Children with severe dental caries had statistically significantly lower numbers of lesions if they lived in a fluoridated area. The lower treatment need in such high-risk children has important implications for publicly-funded dental care.

    ——Community Dent Health. 2013 Mar;30(1):15-8.
    Fluoridation and dental caries severity in young children treated under general anaesthesia: an analysis of treatment records in a 10-year case series.
    Kamel MS, Thomson WM, Drummond BK.
    Source
    Department of Oral Sciences, Sir John Walsh Research Institute, School of Dentistry, The University of Otago, Dunedin, New Zealand.

    3). CONCLUSIONS:
    The survey provides further evidence of the effectiveness in reducing dental caries experience up to 16 years of age. The extra intricacies involved in using the Percentage Lifetime Exposure method did not provide much more information when compared to the simpler Estimated Fluoridation Status method.

    —–Community Dent Health. 2012 Dec;29(4):293-6.
    Caries status in 16 year-olds with varying exposure to water fluoridation in Ireland.
    Mullen J, McGaffin J, Farvardin N, Brightman S, Haire C, Freeman R.
    Source
    Health Service Executive, Sligo, Republic of Ireland.

    4) Abstract
    The effectiveness of fluoridation has been documented by observational and interventional studies for over 50 years. Data are available from 113 studies in 23 countries. The modal reduction in DMFT values for primary teeth was 40-49% and 50-59% for permanent teeth. The pattern of caries now occurring in fluoride and low-fluoride areas in 15- to 16-year-old children illustrates the impact of water fluoridation on first and second molars.

    —-Caries Res. 1993;27 Suppl 1:2-8.
    Efficacy of preventive agents for dental caries. Systemic fluorides: water fluoridation.
    Murray JJ.
    Source
    Department of Child Dental Health, Dental School, University of Newcastle upon Tyne, UK.

    5). CONCLUSIONS:
    Data showed a significant decrease in dental caries across the entire country, with an average reduction of 25% occurring every 5 years. General trends indicated that a reduction in DMFT index values occurred over time, that a further reduction in DMFT index values occurred when a municipality fluoridated its water supply, and mean DMFT index values were lower in larger than in smaller municipalities.

    —-Int Dent J. 2012 Dec;62(6):308-14. doi: 10.1111/j.1875-595x.2012.00124.x.
    Decline in dental caries among 12-year-old children in Brazil, 1980-2005.
    Lauris JR, da Silva Bastos R, de Magalhaes Bastos JR.
    Source
    Department of Paediatric Dentistry, University of São Paulo, Bauru, São Paulo, Brazil.

    Steven D.Slott, DDS

    Liked by 1 person

  11. Actually Trev, you should really read the abstract of the paper you referred me to.mhe is the English version:

    “In December 1973 water fluoridation was discontinued in Tiel, the Netherlands. Six years later an epidemiological study was started, with the aim to investigate the consequences. In the period from 1979 to 1988 a yearly caries investigation was carried out in 15 year old children born and living in Tiel and children living in the control town of Culemborg, where the drinking water had never been fluoridated. The 15 year old children in 1979-1980 in Tiel had a 18% higher caries experience than the same age group in 1968-1969, to whom fluoridated water had been available from birth onward. In the same period a 28% decrease of the caries was found in Culemborg. In 1979-1980 the DMFS-index in Tiel was still 36% lower than in Culemborg. Between 1979-1980 and 1987-1988 the caries experience decreased in both towns.”

    How the hell did you take from this that CWF is ineffective or that oral health always I proves after CWF ceases?

    I think it says exactly the opposite.

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  12. My thoughts, exactly, Ken. I searched to find the full text of this study just to see if I was missing something, but have been unable to access anything but the abstract. Based on the abstract, the study demonstrates the opposite of what Trevor concludes.

    This is ecactly the problem with antifluoridationists. They mindlessly copy/paste information posted on “fluoridealert” or other such dubious sources, without even bothering to read it, much less make any effort to understand it. They then proclaim that science supports their position, when obviously it doesn’t.

    Steven D. Slott, DDS

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