Non-fluoridated Christchurch does not have better teeth than fluoridated Auckland

wrong

It seems every time anti-fluoride propagandists present data it is either cherry-picked, distorted or misleading. Often all three. So it is hardly a surprise to find local anti-fluoride propagandists are telling porkies again.

They have been promoting the above graphic claiming it shows people in “non-fluoridated Christchurch have “better teeth.” But the graphic is based on naive cherry-picking of the data, it ignores the effect different ethnic groups have on the data and it uses a single cherry-picked year which fits their bias.

On top of that, axis values have been chosen to exaggerate differences and the labels are incorrect. The “non-fluoridated Christchurch” category uses data for Canterbury and the “fluoridated Hamilton” category uses data of the Waikato.

It seems that several of the commenters on the Fluoride Free NZ Facebook page where this graphic was first used saw the problems and raised them. All they got is insults for their time. These organisations do not seem capable of a rational discussion.

The Ministry of Health data they use is freely available on the MoH website. It provides oral health data for 5-year-old children and year 8 children. The data is presented annually and for different regions.

So let’s have a look at what the data really says – using more normal axis ranges and separating out ethnic groups.

chch-real

The top graph here is still misleading because it does not take into account the effect of different ethnic groups. However, the correct categories are used and the more rational axis really cuts the exaggerated difference down to size.

In the second graphic the data for Māori and Pacifica have been removed – the MoH describes this group as “Other” – it is mainly Pakeha. We can see that the caries-free % is actually greater for fluoridated Auckland than it is for non-fluoridated Canterbury – exactly the opposite of what the anti-fluoride propagandists were claiming.

It is the same story for Māori – the caries-free % is actually higher in fluoridated Auckland than in non-fluoridated Canterbury.

The problem with the “Total” data is that Pacifica have a large effect – particularly in Auckland where Pacifica are concentrated. Pacifica generally have poorer oral health but are concentrated in fluoridated regions. This drives down the caries-free % figures for the fluoridated areas if the differences are not accommodated.

I referred to this effect of Pacifica on the data in my article A challenge to anti-fluoridationers to justify their misrepresentation of New Zealand research. There I was referring to a similar way anti-fluoride campaigners were misrepresenting data from recent New Zealand research. In this case, they were using data from a paper (Schluter & Lee 2016) and completely ignoring the distortions introduced by inclusion of Pacific – even though the authors had warned against the anomaly introduced by this.

There are other effects which should also be considered in a proper understanding of these data. It is easy to cherry-pick the data for a single year when differences are small – the anti-fluoride people do that a lot. OK if you want to confirm your biases but consideration of the data over multiple years helps indicate trends, identify anomalies and provide an idea of variations in the data. It is also important to consider the numbers in each region. For example, I have not included Pacific in the graphs above because they are concentrated in Auckland and the numbers in Canterbury and Waikato are very low (eg., 45 in Waikato in 2014).

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23 responses to “Non-fluoridated Christchurch does not have better teeth than fluoridated Auckland

  1. Yes CDHB is Canterbury DHB.Canterbury is mainly non-fluoridated including Christchurch. Hamilton, the main population centre of Waikato DHB is fluoridated. The news went out comparing the two. And you Ken say it is all to do with Pacifica, but then you say they are both low on Pacifica. So you don’t come through in shining colours.

    You are working hard with Auckland to make it look as if fluoridation has a tiny benefit.

    Maori in the Ureweras had excellent teeth, though a bit worn, until European diet and customs were brought there. That may have included children being clothed and indoors more so having less of the essential vitamin D for calcium metabolism.

    Would there be a threshhold for vitamin D sufficiency? I would suspect dark-skinned people to need more skin in sunlight to achieve dental health. Compared to Canterbury the Auckland DHB people will be getting more usable UVB because of the lower latitude. So fluoridation cannot claim all the effect for Auckland.

    No-one seemed to reply to me:
    soundhill1 | April 15, 2016 at 9:49 pm |
    Many people registered as Maori do not have skin as dark as Pacifica people so will not have such a vitamin D shortage as them.

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  2. So, Soundhill, your point is that the cause and prevention of dental is multifactorial. Exactly the problem when antis pluck a snap-shot of uncontrolled data from the WHO or somewhere else and claim it to be evidence that fluoridation is not effective.

    Too, what is your definition of “excellent teeth” of the Maori in the Urewas, and on what data do you base this assessment?

    Steven D. Slott, DDS

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  3. Brian. do you deny that Pacifica have a large effect in Auckland – because of their concentration there and in the fluoridated areas, and their poorer oral health? Come on, if you are attempting to discredit the explanation given by Schluter & Lee (2016) then you must provide some countering evidence.

    The FFNZ graphic is misleading, based on cherry-picked data and is simply aimed at confirmation bias. You are working hard to justify it and because it is unjustifiable it is you that does not “come through in shining colours.” 🙂

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  4. https://paperspast.natlib.govt.nz/newspapers/CHP19280301.2.45

    Steve there are fairly recent reprints of Pickerills book on Amazon

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  5. So, Soundhill, you do not dispute the fallacy of antifluoridationists using snapshots of uncontrolled data as their “evidence” of ineffectiveness…..and your source for your broad-sweeping claim in regard to the status of the dental health of the Maori in the Urewas, is anecdotal information in an old newspaper article.

    Exactly the type of sources antifluoridationists cite to support their claims…..if they bother to provide any sources, whatsoever.

    Steven D. Slott, DDS

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  6. Steve I thought that old paper to be an efficient means of quickly pointing to where to look for the data. You didn’t ask me to give the data. There is a bit more here: http://www.aapd.org/assets/1/25/Keene-07-04.pdf

    I am waiting for the Pickerill book.

    He received a special prize for a paper on the effects of civilisation on teeth. http://www.teara.govt.nz/en/biographies/3p25/pickerill-henry-percy

    If “cherry-picking” can bend the perception of the data the effect of fluoridation must be very small.

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  7. Ken, Schluter and Lee seem to be saying Maori (and presumably Pacifica) children are not getting their fair share of the free dental program and fluoridation is not making up for it. The contradicts your claim that it is for the poor.

    CCC: “There are 55 locations around the city where water is pumped into the pipe network. At each of these extraction sites there is at least one, and sometimes up to six, wells. These wells are typically 200mm and 300mm in diameter and are drilled down to depths ranging from 22–220 metres.”

    How much do you think it would cost ratepayers to install fluoridation equipment in so many wells compared to arranging non-whites get the same level of free care as whites?

    Then there is the small margin for whites F/NF. Scotland seem to have been doing better with education in that respect.

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  8. Soundhill

    1. I’m not disputing Pickerill’s findings and really have no opinion on them one way or the other. My point is with your blanket statement that the Maori had “excellent teeth”, with no definition of “excellent” in this context, and no substantiation initially. Without taking a detailed look at the study, it appears that you are defining “excellent” in terms of decayed/missing/filled teeth. First of all, dfmt is a less sensitive parameter than dmf surfaces. Under dmft, a person with 7 teeth rotted to the gumline, with 3 others having a large amount of decay, requiring major restoration, would be rated as having “better” teeth than one who has small, barely detectable carious lesions in 11 teeth, which are easily restored, if they even need restoration. Second, how solid are the teeth? You could have teeth with no caries waving in the wind, because of no bone support. Excellent teeth? Depends on how you define “excellent”. Third, diabetics often have perfectly good teeth with no caries, yet all requiring root canals because poor circulation has killed the nerves in each. Excellent teeth? Depends on how you define “excellent”.

    All of this goes to the blanket claims by antis that non-fluoridated country X has better teeth than fluoridated country Y, therefore “proving” fluoridation is ineffective. So, what is the definition of “better teeth”, and how many of the numerous variables have been controlled in the snapshot of data they used?

    2. Claiming that country X has better teeth than country Y because of an uncontrolled snapshot of data is not “cherry-picking. It is distortion and misrepresentation.

    You are the one who brought up vitamin d as a variable. If accounting for variables is uninportant, then why raise the question?

    Steven D. Slott, DDS

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  9. Soundhill

    If you are advocating replacing fluoridation with a program such as the Scottish “Childsmile” program, then hopefully you aren’t in charge of anyone’s finances but your own. If so, they will be in deep trouble given your financial “acumen”.

    From the British Fluoridation Society:

    In statement to the Scottish Parliament in July 2013, the Minister responsible reported that the total national Childsmile budget for 2013/14 was £14,956,000. This figure includes the cost of the toothbrushing programme, plus targeted varnish applications and associated oral health education initiatives. In other words, it covers everything attributable to Childsmile.

    That is a lot of money by any standards. Assuming that around 120,000 Scottish children aged between three and six are benefiting, it works out at a cost of around £125 per child per annum.

    By contrast, the entire fluoridation programme currently serving 6 million people in England is costing around £2.1 million a year and is benefiting everyone with natural teeth, regardless of age, education or socio-economic status. Importantly, it is benefiting all children. This works out to be around 35 pence, per person, per annum.

    In addition, the Scottish branch of the British Dental Association strongly recommends that Scotland fluoridate its water supplies. Given that the recognized dental authority of Scotland recognizes that Childsmile is not a viable substitution for fluoridation, your apparent belief that it is, does not carry much weight.

    Steven D. Slott, DDS

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  10. Brian, you are simply attempting a crude diversion. ASchluter and Lee (irrespective of other discussion in their paper) pointed to the anomaly introduce into the “non-Māori” data by the high concentration of Pacifica in the fluoridated areas.

    That is a sensible and important point – yet FFNZ blatantly ignored that qualification and completely misrepresented the paper’s findings.

    They continue to cherry-pick and misrepresent the data – despite knowing this important aspect of the data. That is dishonest.

    You are supporting their dishonesty.

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  11. Steve as Schluter and Lee pointed out fluoridation is not a substitute for dental care. The ChildSmile program is a better version of the free dental care for children in NZ. By how much do you think fluoridation would reduce the cost of ChildSmile?

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  12. Steve and Ken, what FFNZ are reporting: “In 2010, the 8th year of the program, it is estimated that the £1,873,335 yearly cost of Childsmile saved the
    government £5,793,983 in averted treatment costs. The targeted approach of this preventive program is
    expected to continue to save money and “further improve the oral health of children in the most deprived
    communities, who continue to carry an additional burden of dental disease.”8”

    http://fluoridefree.org.nz/wp-content/uploads/2016/06/Comparison-NZ-to-Scotland-Dental-Health-2000-2015.pdf

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  13. Soundhill

    The only ones of whom I’m aware that raise the ridiculous idea that fluoridation was somehow supposed to replace dental care are uninformed antifluoridationists. Fluoridation has never been promoted, or expected, to be a “substitute for dental care”. It is simply a very effective means of preventing a significant amount of dental infection in entire populations.

    Fluoridation would probably not reduce the cost of Childsmile, as the same services would still be provided to the limited number of children which benefit from it today. However, in providing limited dental services to but 120,000 children out of a Scottish population of 5 million people, at a cost of £125 per child per year, Childsmile could hardly be considered as a viable substitute for water fluoridation which would provide dental infection prevention for millions of Scottish citizens of all ages, at a cost of less than £1 per person, per year.

    Childsmile is a good program to run in conjunction with fluoridation, not in place of it………which is exactly what the Scottish branch of the. British Dental Association recommends.

    Steven D. Slott, DDS

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  14. Brian, you are just typically continuing to divert. The fact is FFNZ misrepresented Schluter and Lee. By not accounting for the distorting effect of Pacifica they have misrepresented their findings – and knowingly so.

    Elements of the Scottish ChildSmile, and the equivalent programmes in Sweden and Wales, are part of the dental health programs used in New Zealand – they just use different names. These programmes (which by the way include twice yearly F varnishes, are not alternatives to CWF – they are complimentary.

    No one is suggesting fluoridation is a substitute for healthcare – ever. that is another lie promoted by FFNZ

    It is silly to cite FFNZ figures to us – why not use the actual figures presented by the ChildSmile reports? FFNZ is well know for misrepresentation and outright porkies – they are not a credible source of information.

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  15. Sure, Soundhill, Childsmile probably does save the government money……as does fluoridation. Peer-reviewed science has demonstrated a cost savings of $15-$50, or more, per $1 spent on fluoridation, and it provides dental infection prevention for the entire population, not simply limited dental services for a limited number of children.

    If you and Mary Byrne are under the delusion that Childsmile is a viable substitute for fluoridation, you are both long overdue for a strong dose of reality.

    Actually, in Byrne’s case, she has been long overdue for years.

    Steven D. Slott, DDS

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  16. Steven Slott wrote: “The only ones of whom I’m aware that raise the ridiculous idea that fluoridation was somehow supposed to replace dental care are uninformed antifluoridationists.”

    Steven Slott had written: “That is a lot of money by any standards. Assuming that around 120,000 Scottish children aged between three and six are benefiting, it works out at a cost of around £125 per child per annum.

    By contrast, the entire fluoridation programme currently serving 6 million people in England is costing around £2.1 million a year and is benefiting everyone with natural teeth, regardless of age, education or socio-economic status. Importantly, it is benefiting all children. This works out to be around 35 pence, per person, per annum.”

    The uncritical reader could take that to mean alternatives.

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  17. Soundhill

    Sure there are alternatives to Childsmile. I never said there could not be. It is a good program, but given its enormous cost, and limited number of people served, certainly there could be alternatives to it. They may, or may not, be as good, or as effective as is Childsmile for those served by it, but they could be devised.

    On the other hand, fluoridation, with its minimal cost, and broad number of people served, has no such alternatives available. Childsmile and fluoridation can work well in conjunction with each each other. Fluoridation will provide benefits to the entire citizenry with or without Childsmile. Childsmile cannot do the same.

    Steven D. Slott, DDS

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  18. soundhill,

    “The uncritical reader could take that to mean alternatives.”

    And since you claim to be a critical reader, you already know that CWF is not an alternative to dental health schemes, but is in fact complementary.

    Of course, if you’re not a critical reader, then you just ignore the facts and try to divert away from them…

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  19. Sreven Slott Childsmile does benefit everyone since everyone is or was a child.Fluoride varnish is applied to teeth. The cost you state must only amount to a couple of visits per year to the dentist.

    You appear to imply that child-visits to dentist are too costly for government to fund. Then please keep your nasty idea away from New Zealand where they are funded except some people do not hear about them, it seems. Such as Pasifika and Maori.

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  20. Soundhill

    1. Yes, Childsmile does not benefit everyone. It benefits 120,000 Scottish children. Water fluoridation does benefit everyone, of all ages, within the fluoridated area……at a small fraction of the cost of Childsmile.

    2. The cost figures I provided are from the British Fluoridation Society, which obtained them from Scottish government reports.

    Once again…..in a statement to the Scottish Parliament in July 2013, the Minister responsible reported that the total national Childsmile budget for 2013/14 was £14,956,000. This figure includes the cost of the toothbrushing programme, plus targeted varnish applications and associated oral health education initiatives. In other words, it covers everything attributable to Childsmile.

    The cost for the toothbrushing aspect alone costs £1.87 million…..approximately £15-16 per child, per year. Fluoridation serves everyone, at a cost of less than £1 per person, per year.

    3. I have no idea what the NZ government can afford, nor have I made any implication, whatsoever, in that regard. What I have done is to demonstrate the complete fallacy of presenting Childsmile as a viable substitute for fluoridation, which it obviously is not.

    Here’s my take on hiw these things have evolved. Connett has knee-jerk reactions to criticisms of his ideology against fluoridation. It took him awhile, but it finally got through to him that he was not going to get away with just providing his speculations, personal opinions, unsubstantiated claims, and misinformation, without supporting it with valid scientific evidence. So, what did he do? He started working with others, such as Grandjean, who share his skewed ideology against fluoridation, in order to find anything within the scientific literature which would support his claims. The quality or validity of the literature was of little concern, as long as it provided him with citations. Then, when realized he was getting hammered for his cherry-picking, he put his son, Michael, to work combing through the literature for quanties of fluoride studies which could then be listed on the “FAN” website. Again, the quality, validity, or relevance of those studies was of little concern. He simply wanted numbers.

    Thr same thing occurred eith Childsmile. Connett was getting hammered for working to shut down a public health initiative while providing no alternatives to replace the benefits. So, when he caught wind of this Scottish program, that was it. He then started running around promoting Childsmile as a viable altetnative….with his mindless minions around the world doing the same. That Childsmile was far more expensive than fluoridation, and provided for only a small fraction of the population, was immaterial. He had his “alternative”…..which it obviously is not.

    Steven D. Slott, DDS

    Liked by 1 person

  21. Steve Slott wrote: “1. I’m not disputing Pickerill’s findings and really have no opinion on them one way or the other. My point is with your blanket statement that the Maori had “excellent teeth”, with no definition of “excellent” in this context, and no substantiation initially. Without taking a detailed look at the study, it appears that you are defining “excellent” in terms of decayed/missing/filled teeth. First of all, dfmt is a less sensitive parameter than dmf surfaces. Under dmft, a person with 7 teeth rotted to the gumline, with 3 others having a large amount of decay, requiring major restoration, would be rated as having “better” teeth than one who has small, barely detectable carious lesions in 11 teeth, which are easily restored, if they even need restoration. Second, how solid are the teeth? You could have teeth with no caries waving in the wind, because of no bone support. Excellent teeth? Depends on how you define “excellent”. Third, diabetics often have perfectly good teeth with no caries, yet all requiring root canals because poor circulation has killed the nerves in each. Excellent teeth? Depends on how you define “excellent”.”

    Which of those do you think fluoride prevents?

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  22. Steve Slott, I think at the some 1 -3% decay of pre-European Maori teeth there is not going to be much winning by going to dmfs to compare those teeth with current ones.

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  23. Steve Slott, do you mean rotted to the gum line or instead worn down to the gum line?

    Teeth worn to the gumline by a diet of roots (with maybe some soil in them)
    may expose the tooth pulp so that an abscess may form and show in the jaw bone, whereas the teeth may not be decayed in the way fluoride is said to prevent.

    Like

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