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Minutes of meeting of the Forum on Fluoridation of 14 December 2000
The Boardroom, Dublin Dental Hospital

Present

  • Professor Pat Fottrell (Chairman)

  • Dr Wayne Anderson

  • Professor John Clarkson

  • Dr Dominique Crowley

  • Dr Elizabeth Cullen

  • Ms Dorothy Gallagher

  • Dr Gerard Gavin

  • Dr Howard Johnson

  • Mr Kevin Moyles

  • Dr Joe Mullen

  • Professor Moira O’Brien

  • Dr Máire O’Connor

  • Professor Denis O’Mullane

  • Dr Carmel Parnell

  • Professor Miriam Wiley

  • Ms Nessa O’Doherty (Forum Secretariat)

  • Dr Miriam Owens (Rapporteur)

  • Dr Margaret Shannon

Apologies

  • Dr Paddy Flanagan

  • Mr Oliver Fogarty

  • Ms Dora Hennessy

  • Professor Cecily Kelleher

Introduction

Professor Fottrell welcomed everyone. As this was Dr Cullen’s first attendance at a meeting of the Forum, she introduced herself and gave brief background information.

Professor Fottrell thanked Professor Clarkson for arranging for the Forum to have the Boardroom of the Dublin Dental Hospital for this meeting.

Professor Fottrell gave apologies for the members who could not attend this meeting.

Meeting

Joint presentation by Drury Research and the Dental Health Foundation, Ireland concerning the results of their recent survey on the public’s attitude to the issue of fluoridation. Main presenters:

- Ms Annette Bolger, Drury Research (DR), and
- Ms Deirdre Sadlier, Dental Health Foundation, Ireland (DHFI).

Contributions also made by:

- Dr Paul Beirne (Research Fellow, UCC)
- Ms Breeda Hyland (DHFI).

(The fifth participant in this research, Ms Fiona Barbagallo, was unavoidably absent but forwarded a synopsis of her recommendations which will be circulated by the Secretariat. It was agreed that the content of her submission will be discussed at a future meeting as engagement of the public is crucial to the work of the Forum.)

Documentation provided by DR and DHFI (i.e. text of presentation) will be circulated by Secretariat.

Presentation followed by discussion/ Q&A.

In response to a question, Ms Bolger stated that toothlessness was found to be higher in females with children than in males.

A member of the Forum indicated that in the member’s opinion the public dental service is in crisis at the moment due to lack of staff resources.

It was pointed out by a Forum member that in Northern Ireland the emphasis is on oral health promotion whereas in the Republic there is more reliance on water fluoridation to improve dental health/ lessen caries. There is a much lower level of caries in the Republic. The member of the Forum further stated that he is unsure of the extent to which people’s attitudes can be changed via health promotion/ education.

One point of interest from the presentation by DR and the DHFI was that a large number of the respondents were content to leave decisions regarding fluoridation to the Department of Health and Children regardless of any perceptions regarding possible bias etc.

One of the presenters made the point that there is a need for more interpretative analysis in the media - not just presentation of one side of the argument versus another - suggested that the Forum consider making a recommendation in this regard.

Agreement that the Forum needs to address the issue of consent in relation to fluoridation i.e. individual’s right to choose should be discussed. Following a suggestion by the Chairman, Professor O’Brien agreed to contact Professor Binchy to suggest that he make a presentation regarding ethics/ rights etc.

Professor Fottrell thanked the invited speakers for an interesting discussion and the latter then left.


Minutes of meeting of 9 November 2000

The minutes of the meeting of 9 November 2000 were discussed - the following changes to be made:

(i) no 13, page 5 - should read ".... would be willing to take on regular analysis of hydrofluosilicic acid" instead of "........analysis of water"

(Mr Moyles explained that this process has already commenced in conjunction with the Eastern Regional Health Authority.)

(ii) no 12, page 5 - Mr Moyles noted that he had been unaware that he was to participate in the drafting of recommendations regarding engineering but is willing to do so

(iii) no 11, page 5 - Professor Clarkson will give report on the epidemiology contract in relation to fluoridation; Dr Jacinta McLoughlin in DDH may also be contacted in this regard for further information

(iv) query on no 17, page 7 - when dealing with the press, are individual members of the Forum allowed to express their personal opinions on the issues under discussion? Clarification by Chairman - if/when interviewed in relation to fluoridation, a member should clearly express the Forum’s terms of reference and may give an outline of the Forum’s progress to date - if he/she wishes to then give a personal opinion they may proceed to do so but making it clear that it is their personal opinion.

(v) apologies to Professor O’Mullane whose name was accidentally omitted from the list of attendees at the meeting of 9 November 2000

(vi) paragraph entitled "Informal Presentation by Ms Gallagher", page 6 -"....... the extent of the anti-fluoridation view...." should read "... the extent of the pro-fluoridation view....".


Matters arising from the Minutes

(a) Where appropriate, summaries of scientific papers will be submitted/circulated in future rather than the complete documentation in order to allow members to cover more ground - those interested in more detail on a particular article may contact the Secretariat for a complete version

(b) Following on from the meeting of 9 November 2000, Dr O’Connor contacted the Secretariat with the name of a Principal Environmental Heath Officer who would be interested in giving a presentation to, or being a member of, the Forum; however, with regard to protocol should the Forum contact the Environmental Health Officers’ Association (i.e. their professional/ representative body) in order to elicit a nominee? Agreed that the PEHO in question should be invited to make a presentation to the Forum

(c) Asked members for nominations regarding bio-statistician (to be member or advisor) - while there are several members of the Forum who work with statistics, it was agreed that it would be preferable to have an expert available to advise on the complex issues at hand; Dr Johnson nominated two individuals and Professor O’Mullane indicated that he may also be able to nominate a suitably qualified and experienced individual. There was discussion as to whether it would be more helpful to have the bio-statistician as a member or advisor: consensus was reached that an agreed individual would be proposed to the Minister for membership

(d) In relation to previous suggestions that it would be useful to have a toxicologist as an advisor to or member of the Forum, Dr Gavin will liaise with Professor O’Mullane in order to nominate an individual - this will be discussed by the Forum at the next meeting. Dr Crowley suggested that it might be useful to contact the Irish Society of Toxicology - this was agreed - Dr Gavin undertook to do so. General consensus that Professor Gary Whitford would be a suitably qualified and experienced toxicologist - this will be discussed further at the meeting on 11 January 2001.


Presentation by Professor O’Brien

Professor O’Brien gave a presentation on osteoporosis.

Professor O’Brien undertook to give a copy of the slides used to the Secretariat for circulation.

As per Kanis (1994), moderate dose of fluoride increases bone strength but high dose decreases bone strength.

There is a need for information to be given to the public in relation to osteoporosis as it has reached epidemic proportions but is totally avoidable.

The Chairman thanked Professor O’Brien for an excellent and very interesting presentation.


Interim Report

The rapporteur circulated the draft interim report which she has been working on and comments from members were requested. The Chairman is meeting the Minister on Wednesday 20 December 2000 in order to present this report.


Seeking views from the public

Secretariat gave brief details on the advertisements placed in the national newspapers and response to date (approximately 100 requests for the information leaflet). Radio advertisements will be placed shortly. There was a discussion regarding the target audience for the radio advertisements - there was general consensus that the advertisements should be targeted at all adults - while this is significantly more expensive as it involves advertising at peak times, it was agreed that it is crucial that the maximum number of the public be engaged in the consultative process - Secretariat will implement this.

Submission from Ms Fiona Barbagallo of DCU (brought by the DHFI and DR in conjunction with their presentation) is relevant in relation to eliciting the views of the public - as mentioned above the ideas raised therein are to be discussed at a future meeting.


Web Site

Secretariat asked for advice as to what information should be put on the Forum’s web site. The following were agreed for inclusion:

  • names of members and name of nominating/representative organisation
  • terms of reference
  • documents circulated to Forum members (Secretariat to check re copyright etc.)
  • advertisement placed in the national newspapers
  • interim report (with the consent of the Minister) (suggestion from Chairman that another interim report be drafted and put on web site in March to keep the public updated)
  • general introduction regarding fluoridation i.e. "what is fluoridation?", "why do we have it in our water?" (Dr Flanagan will be asked to draft relevant section)
  • text of presentations made to the Forum
  • contact postal and e-mail address for the Forum (via Secretariat)

The web site is not a tool to educate but to elicit the views of the public - it is important that as many responses as possible be received in order to maximise engagement with the public.

Professor Fottrell stated that it is important that the web site be updated regularly once it is up and running - clarification needed as to who will perform this role.


Sub-group - ‘‘50 Reasons"

Professor O’Mullane is chairing this sub-group - draft replies to be completed before 11 January 2001. Rapporteur to circulate references as they become available.


Notes and Future Activities

(i) Ms Darina Allen will make a presentation to the Forum on February 2001

(ii) Despite several contacts by the Secretariat, VOICE has not yet conveyed their decision as regards whether they will make a presentation to the Forum; - following a request from the Chairman for suggestions as to how to elicit the views of VOICE, Dr Cullen offered to contact that organisation’s Chairman to discuss the matter

(iii) Dr Cullen was asked by the Chairman if she would be interested in making a presentation to the Forum on behalf of the Irish Doctors’ Environmental Association - Dr Cullen suggested that another member, Dr Philip Michael, might be interested in doing so instead - March 2001 meeting suggested for this - Secretariat to (a) liaise with Dr Cullen in order to contact Dr Michael and (b) write to him in order to ask if would be interested in making a presentation - if so, he is to be asked to submit a synopsis of his presentation to the Secretariat before the relevant meeting for circulation to the Forum

(iv) Dr Paul Beirne, Research Fellow, UCC, to make presentation to Forum regarding his research on the issue of fluoridation at meeting on 11 January 2001

(v) Agreement that Secretariat should contact Dr Don MacAuley to determine his interest in making a presentation to the Forum following his recent article in the Irish Medical Journal (Professor O’Mullane supplied a copy of his recent response to that article - this will be circulated to the Forum).

(vi) Professor Kelleher has forwarded some documentation via the rapporteur.

(vii) Dr Cyrus Cooper will be invited to give a presentation to the Forum (possibly March 2001 or April 2001 meeting depending on his availability), concentrating on fluoride studies - Secretariat will contact him - Professor O’Brien will give advice to Secretariat regarding wording of the letter i.e. focus to be on clinical trials.

(viii) Professor Hannu Hausen will be asked to make a submission - possibility of inviting him to give a presentation to the Forum to be discussed at the meeting on 11 January 2001 - it would be useful to get his advice/comments on the possible effects/outcomes of ceasing water fluoridation.

(ix) Dr Cullen had two questions which the Forum agreed to address:

- from an oral health point of view, what is the advantage of oral (fluoride) tablets in comparison with other methods of fluoridation?

- what is a person’s total exposure to fluoride? - to focus on individuals with kidney problems and premature babies

The Forum agreed that it would be useful to have a paediatrician and/or nephrologist as advisor to, or member of, the Forum in order to address the second question here - members to suggest names of suitably qualified and experienced individuals - Dr Gavin and Professor O’Mullane agreed to follow this up.

(x) Dr Liz Treasure will be contacted by Secretariat to invite her to give presentation regarding the methodology and findings of the York Review - for April meeting 2001 - to be asked to give information from "layman’s" point of view. Dr Connett made several criticisms of the York Review - Dr Treasure to be asked to discuss this

(xii) important that if a bio-statistician and/ or any other suggested individual is to be appointed to the Forum that this would be done as quickly as possible so that they be would present for as many of the presentations and Forum discussions as possible in order to maximise their contribution

(xiii) oral presentations should cease before May 2001 when drafting of the main report should commence. Members who wish to nominate/suggest someone for a presentation or give one themself should notify the Chairman and Secretariat as soon as possible

(xiv) Professor Clarkson has arranged for the Boardroom of Dublin Dental Hospital to be made available for Forum meetings from now until April 2001, inclusive; the following meeting (May 2001) may be held in Galway.

(xv) Professors Clarkson and O’Brien gave their apologies for the meeting on 11 January 2001.

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