Yet another misrepresentation of a dental health study

You should not trust what you read on the web – especially if you read it on a site like Free Thought Project.com. And if the article is citing a scientific paper to give it authority you can be certain it misrepresents the paper.

Here is yet another example of this. An article citing a research paper as “proof” that fluoridation does not work – yet the paper doesn’t even include the word fluoride or fluoridation!

The Free Thought Project.com article is Study Shows Brits Have Way Better Teeth than Americans – And Far Less Fluoride in the Water
and it cites, but misrepresent this paper:

What did the paper report?

This is the paper:

CC Guarnizo-Herreño, G Tsakos, A Sheiham et al. Austin Powers bites back: a cross sectional comparison of US and English national oral health surveys.

It’s available in full text so you can check for yourself.

It examines “the longstanding belief in the United States that the British have horrible teeth, much worse than US citizens.” And it concludes:

“The oral health of US citizens is not better than the English, and there are consistently wider educational and income oral health inequalities in the US compared with England.”

So – nothing about fluoride, but information on social inequalities which are known to be a factor in oral health. But this will not stop anti-fluoride campaigners using this in their campaigns – while ignoring the important conclusions about the role of socioeconomic inequalities in oral health.

What was measured?

The study considered only one clinical measure of oral health status – the number of missing teeth. The other two outcomes considered were “self-rated oral health” and “oral impacts on daily life.” Only participants 25 years and older were selected. The study used data from the English Adult Dental Health Survey and the US National Health and Nutrition Examination Survey.

The influence of dietary fluoride intake was NOT considered, but socioeconomic factors were. In particular educational attainment and household income.

What was found?

In summary:

  • The number of missing teeth were significantly higher in the US than in England.
  • Self-rated negative oral impacts on daily life were more prevalent int England than the US
  • Self-rated less than good oral health was not significantly different between the two countries.

There was an interesting difference with age. The number of missing teeth and the numbers with no teeth were higher in the US for the age group 25-64. Yet the number of missing teeth were higher in England for the over 65 age group.

Socioeconomic factors showed statistically significant effects on all three outcomes as illustrated in this figure from the paper. The “relative index of inequality” was effectively a measure of how the outcome increased as inequality in education or income increased in each country.

Austin Powers

Conclusions

Given the prevailing beliefs in the US it may be a little surprising that the study found English oral health better than in the US – at least for measurements related to missing teeth. However, it is not suprising that socioeconomic inequalities influence the oral health of a nation – with, of course, those at the bottom of the heap having the poorer oral health.

I guess it is also not surprising to find that there are “consistently wider educational and income related oral health inequalities in the US compared with England.”

So, there is probably an argument there for improved welfare policies and better access to, and provision of, dental treatment systems. But it its misleading to use this study as “evidence ” against community water fluoridation.

Don’t believe everything you read on the web – especially on sites like Free Thought Project.com.

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8 responses to “Yet another misrepresentation of a dental health study

  1. I see Pat has already plastered it all over the facebook page, I suppose any story to fill the page is good. Fact or fiction It really does not matter. I bet they start screaming it from the rooftops on the blogs now {Sigh}. Mind it will be a change from the Peckham paper

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  2. This critic needs a more open mind. Of course socio-economic differences are important, and dental treatment policies–if people have teeth pulled instead of root canals, for instance–that’s a whole other discussion. But pro-fluoridation folks claim that it plays a significant role in reducing the incidence of tooth decay for everyone, and that is demonstrably false. Fluoridation has had no statistically significant impact on tooth decay anywhere any time. Don’t get your knickers in a twist, there, dear. Fluoridation is a violation of human rights and bioethics. Check out the Nuremberg Code and UNESCO Universal Declaration on Bioethics… Fluoridation is an antiquated early 20th century notion and a failed human experiment. Long past time to shut it down.

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  3. Janet, you claim that “fluoridation has had no statistically significant impact on tooth decay anywhere any time.” You cloaim that tbhed reduction of tooth decay with CWF “is demonstrably false.”

    Care to provide some evidence?

    I ask because there are plenty fo studies showing the efficacy of CWF so there needs to be some outstanding work out there to support your claims. I have yet to see it.

    As is understandable, I will interpret any refusal to respond with a sensible answer to my questions as an admission that you are wrong and are misrepresenting the situation.

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  4. But fluoridation has always been touted as fixing the teeth of the poor.

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  5. “But fluoridation has always been touted as fixing the teeth of the poor.”

    Fixing?

    As in removal of decay, fillings, extractions, etc?

    Always been touted?

    This is the only time I have encountered the (magical) idea that fluoride can “fix” teeth.

    Dentists fix teeth, not fluoride. All CWF does is reduce the incidence of dental decay. Less decay results in less teeth that need fixing by dentists.

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  6. David Fierstien

    Janet Nagel, your quote: “Fluoridation is a violation of human rights and bioethics. Check out the Nuremberg Code and UNESCO Universal Declaration on Bioethics…”

    Now, the only people I hear parroting this mantra is the fringe anti-fluoride sect. I don’t see a condemnation of water fluoridation from the U.N., which is what you would expect if CWF really was a violation of UNESCO. I don’t see anything from Amnesty International, nothing from the U.S. Supreme Court, nothing from the High Court of New Zealand, only something from you. Why do you think that is?

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  7. Stuartg wrote: “Dentists fix teeth, not fluoride. All CWF does is reduce the incidence of dental decay. Less decay results in less teeth that need fixing by dentists.”

    Fluoridation is touted to reduce the amount of work dentists need to do to the teeth of the poor. So if UK is so much less fluoridated than USA it should be expected that the poverty effect should not show so much.

    Poverty gap index UK: 24.78 fluoridation 10% (partially natural CaF2)
    Poverty gap index USA: 38.3 fluoridation at least 66%. (Wikis)

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  8. Fluoridation is touted to be important for the poor since they get more tooth morbidity than the non-poor.

    So since USA is so much more fluoridated than UK, but the greater poverty their is not being overriden dentally, that could mean that fluoridation is not being effective in the way claimed.

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