Forum Minutes of Meetings
Minutes of meeting of the Forum on Fluoridation on 12 July
The Boardroom, Dublin Dental Hospital
Ms Nessa O’Doherty (Forum Secretariat)
Dr Miriam Owens (Rapporteur)
Dr Margaret Shannon (Forum Secretariat)
Apologies were given for the members who could not
attend this meeting.
Minutes of Meeting of 10 May 2001
The minutes of the meeting of Thursday 14 June 2001
were agreed with the following amendment to be made:
Dr Elizabeth Cullen asked that paragraph 14 be amended
to reflect the fact that she expressed concern that the ethical issues in
relation to fluoridation have not yet been adequately discussed by the
- Dr Cullen again expressed her concern that the Forum has not yet met
with a toxicologist, a paediatric nephrologist and an ethicist. Ms
Gallagher stated that the Consumers’ Association of Ireland is also
concerned that the expertise of a renal expert be acquired. Dr Owens
clarified that a paediatric nephrologist has recently agreed to look at
relevant issues and will submit a paper to the Forum – she is also
willing to meet the Forum in August 2001 if required. Dr Owens will
arrange this meeting and will liaise with the members of the relevant
sub-group – Ms Gallagher is to join this sub-group.
- Dr Richard Hull of the National University of Ireland, Galway, has
agreed to meet the Sub-Group on Ethics – this meeting will take place
in the next ten days. A copy of relevant documentation including
Professor Binchy’s paper and Dr Cullen’s list of questions have been
forwarded to Dr Hull in order to aid preparation for this meeting.
- Professor O’Mullane explained that the Sub-Group working on Dr
Connett’s "50 Reasons" are working hard and hope to be able
to circulate a draft response to the members of the Forum shortly.
- It was noted that a press release by a group entitled "Fluoride
Free Water" quoted only part of a sentence from the Forum’s
meeting of 5 April 2001. This press release may have given a misleading
impression of what was actually minuted – see below.
Extract from the minutes of the Forum’s meeting of 5
"Mr Moyles mentioned that tests done so far by the
Regional Analysts’ Laboratory suggest that the hydrofluosilicic acid
used is pure but further tests are being carried out; he will give the
Forum additional details at a future meeting. It was agreed that this is
important in view of the fact that a number of submissions received
mentioned the alleged existence of substances such as cadmium and arsenic
in the acid."
Extract from press release issued by the group entitle
"Fluoride Free Water"
"…..This pro-fluoride forum, like the others,
seems more interested in hiding the truth and withholding information from
the public than looking at fluoridation.
An example of this occurred at a recent meeting of the
Forum on Fluoridation on 5/4/2001. At this meeting, closed to the public,
Mr. Kevin Moyles, Head Public Analyst, stated that "…tests
done so far by the Regional Analysts’ Laboratory suggest that the
hydrofluosilicic acid (fluoridating agent) used is
pure…." Fluoride Free Water recently obtained a
full chemical analysis of this acid under FOI. This confidential document…,
dated 14/2/2001, was forwarded to Mr. Kevin Moyles but did not indicate
the acid as "pure". In fact, one quarter of the H2SiF6 (acid) is
contaminated, including carcinogens such as arsenic, chromium, nickel and
mercury. As Micheál Martin misled the Dail regarding the contents of this
toxic cocktail last year, it is no great surprise that members of his
"fluoride farce" continue to mislead the public and put all our
health at risk."
(NB The presentation made by Mr Tom Reeves of the CDC
is also relevant to this – details below.)
- A list of the fifteen submissions received from professional
groups/organisations was read to the Forum. It was decided to have a
sub-group look at them:
Dr Flanagan (convenor)
A meeting of this sub-group will be organised by Dr
Flanagan, ideally before the end of July 2001.
- The Progress Report, drafted by the Rapporteur, which details the
Forum’s progress to February 2001 is now on the web site.
- Subsequent to the query from the Irish Times which was discussed at
the June 2001 meeting of the Forum, Dr Flanagan spoke to the journalist
in question, Ms Alison Healy, at the request of the Secretariat, and the
relevant article concerning the views expressed by respondents was
printed shortly thereafter.
- It was noted that Dr Gary Whitford, who earlier this year had to
decline the Forum’s invitation to make a presentation due to a very
heavy schedule, might now be able to meet the Forum, possibly in
- Dr Cullen asked how rigid is the October 2001 deadline for the Forum’s
Report; the Chairman strongly recommends that this deadline be complied
- Monaghan County Council contacted the Secretariat recently regarding a
meeting on 3 September 2001 to which an anti-fluoridation speaker has
been invited. They also plan to invite a dentist from the local health
board. They requested that a member of the Forum attend. The Secretariat
explained to the representative of the Council that a Forum
representative would only be able to detail progress to date made by the
Forum and that a neutral stance on the issue would be maintained until
after the Final Report is presented to the Minister – the Council was
satisfied with this. It was decided after much discussion by the Forum
that it would not be appropriate for a Forum member to attend such a
meeting until after the Final Report is presented to the Minister;
however, a letter will be sent to the Council outlining progress to
- It was noted that the Secretariat has been receiving a number of irate
and/or abusive telephone calls from members of the public and
organisations who are opposed to water fluoridation. Two of the members
of the Forum also mentioned that they had received calls of a similar
nature. Members of the Forum expressed their concern and regret at this.
While such persons/organisations are welcome to express their views this
should be done in writing, if possible.
- Dr Cullen has written to Professor Mike Gibney of TCD (regarding total
fluoride intake) and Dr Paul Dowding of TCD (regarding environmental
issues) but has not as yet had a reply from either. It was agreed that
the Forum should get advice on these issues so if a response is not
forthcoming from the two aforementioned experts due to their very busy
schedule, it will be necessary to contact other experts in their field.
- A letter has been drafted to inform County Councils of the Forum’s
progress to date – this will be circulated and finalised shortly.
- Professor O’Brien has been unable to contact Dr Connett as yet (with
regard to his email concerning a comment made by him in relation to
osteoporosis) but will do so as soon as her extremely busy schedule
- Dr Flanagan has circulated a draft summary of views contained in the
submissions received by the Forum. Dr Cullen and Ms Gallagher have not
yet completed their examination of the submissions and will convey their
views to Dr Flanagan as soon as possible. Professor O’Brien thanked Dr
Flanagan for the enormous amount of work that he put into drawing up
this draft summary. Comments/requests for amendments in this draft
should be forwarded to Dr Flanagan as soon as possible. It was noted
that while all of the views submitted are important and will be
considered by the Forum, it is important to explain (a) the differences
between a qualitative and a quantitative study and (b) it was not a
random sample – a select group volunteered their views and (c) this
was not a scientific study.
- The Secretariat is to contact the Minister’s Office regarding the
presentation of the Final Report.
Presentation by Dr Jacinta McLoughlin, Dublin Dental
Hospital: "An Evaluation of Water Fluoridation Systems in
The presentation was followed by a Q&A session.
Following a question, Dr McLoughlin explained what
Q. Is the research contract looking at levels of
fluoride in the body?
A. This is not in the remit of the study.
Comment: UCC is currently studying methods of examining
total fluoride intake.
Professor O’Mullane mentioned that he got several
interesting papers on the changing patterns of water consumption at recent
conferences and will supply them to the Forum if required.
Q. Will the team be making recommendations regarding
levels under 0.7ppm?
A. It is crucial to comply with the legislative
limits so the team will be looking at both under-dosages and
Comment: the data collection and results of this
research contract will be useful to the Forum in identifying areas to be
- Are under-dosages linked to size of water plants?
- This looks quite likely but exact details have yet to be attained.
Comment: the larger the plant the better the results
are likely to be; however, small plants can also be very accurate.
Comment: this has public health implications.
Dr McLoughlin undertook to forward a copy of the terms
of reference of Fluoridation Monitoring Committees to the Secretariat.
- Have you considered if 0.8-1ppm is the appropriate level for today’s
- This is not in the remit of this study.
- When will the research project be finished?
- They are starting to draft their report now.
Comment: health boards tend to regard fluoridation as a
more important issue than the Local Authorities do but changes in
regionalisation of roles will be very beneficial.
The Chairman thanked Dr McLoughlin for a very
Presentation by Mr Tom Reeves, Centre for Disease
Control and Prevention, Atlanta, entitled "Engineering Aspects of
A Q&A session followed the presentation.
- What is the current situation regarding fluoridation in other
- Japan was very anti-fluoridation in its views but is now moving
towards introducing water fluoridation. Korea is also considering
introducing water fluoridation. Will send on relevant documentation to
- Is there a relationship between size of water plants and accuracy of
dosage in the USA?
- Will send on documentation with relevant details. There is a problem
with lack of training in some of the smaller systems/plants in the
- Most public water supplies in countries in Western Europe are not
fluoridated but many of these countries still have good oral health
levels, so why has the USA proceeded with fluoridation?
- The USA does not have universal health care. Many Western European
countries invest heavily in alternative methods of fluoridation eg
Switzerland uses four different types of salt, some of which are
fluoridated. The CDC is of the view that if there is a good water
system in place then water fluoridation is the best method but, if
not, then alternatives can be effective.
- A lot of the claims made by anti-fluoridationists state that the EPA
in the USA are anti-fluoridation – is this an accurate reflection
and, if so, why do they feel this way?
- There are 3,000 scientists in the EPA – only 3 are
anti-fluoridation but they are very vocal.
- Is there a danger of over-dosage from fluoridated toothpaste?
- There are 1,000ppm fluoride in fluoridated toothpaste (in comparison
with 1ppm in fluoridated water) so there is a possible danger
of over-dosage with toothpaste.
- What is the level of fluoride in fluoridated salt?
- Fluoridating salt is not an effective method due to health awareness
for the need to cut down salt consumption – would you agree?
- Yes, that is one of the reasons why the USA does not use fluoridated
- What are the views on fluorosis in the USA?
- There is no consensus in the USA as to whether fluorosis is a
problem or not; however, it should be noted that most fluorosis there
is at mild or very mild levels and is likely to be due to misuse of
Extensive discussion took place regarding the presence
of contaminants in hydrofluosilicic acid, particularly the claims made in
relation to arsenic and lead. It was clarified that the levels are so
minute as to be virtually meaningless.
Mr Reeves offered to send copies of "Abuse of The
Scientific Literature in an Antifluoridation Pamphlet" (2nd
Edition, American Oral Health Institute) to the Forum for any member who
might be interested in reading it.
Mr Reeves explained that many cities in the USA have
fluoridated public water systems including New York, Los Angeles, Chicago,
Detroit, Houston, Philadelphia, Phoenix, Dallas, San Francisco, Washington
and Boston. He went on to say that, according to 1992 fluoridation census
figures, 62% (*) of the people in areas where there are public water
systems are drinking fluoridated water (artificial and natural) – this
equates to a population of 144.6 million people. The CDC is preparing to
announce the 2000 census figures which will see a slight increase in those
statistics. (*These figures do not include California – however, when
the relevant legislation in that state is implemented the overall level in
the USA will increase to approximately 70%).
The Chairman thanked Mr Reeves for his very interesting
Presentation by Dr Caswell Evans, National Institute of
Dental and Craniofacial Research, National Institutes of Health,
Department of Health and Human Services, USA, entitled "Fluoridation
- Recent Developments in the USA"
A Q&A session followed the presentation.
Q. Why was water fluoridation introduced in California?
A. The level of oral health of children in
California was found to be much lower than that of other states in the
USA where water was fluoridated. There was a desire to bring
California to the same dental health level as the high-achieving
Q. Was there an anti-fluoridation lobby in
A. There was certainly an anti-fluoridation group
there but while it was vocal it was not particularly effective despite
being given opportunities to present its case to the public.
Q. What is the impact of the halo effect? Is there
a noticeable difference between one side of the USA and the other?
(The "halo effect" refers to the diffusion of fluoride from
fluoridated areas to surrounding nonfluoridated areas via bottled
beverages and processed foods manufactured in the fluoridated areas.)
A. There is a high level of mobility in the USA (an
average of one move per person/family every five years) which includes
a large number of coast to coast movements so it is very difficult to
gauge the halo effect.
Q. How many states have ceased public water
A. No states have ceased fluoridation of public
water supplies but some small communities have done so.
Comment: the impression which was given to the Forum by
Professor Limeback and Dr Connett during their presentations on 13 October
2000 on public attitudes to water fluoridation in the USA was completely
different to that given during today’s presentations.
Comment: the Surgeon General’s Report (quoted by Dr
Evans) links oral and general health with quality of life – this
is a very important point to the general public in the USA and influences
their attitudes to water fluoridation.
Comment by Dr Evans: he had not realised until recently
that there are so many parallels between USA and Ireland eg levels of
poverty, huge investment in orthodontic appliances and huge amount
of sugar consumption. From a public health perspective, water fluoridation
is the best method of improving dental health in the poorer sections of
society and, in particular, in poor children who may have high sucrose
Comment: the observation made by Dr Evans as to the
huge consumption of sugar in Ireland has been borne out by scientific
evidence. There is a very high sugar consumption in Ireland compared to
- Kildare County Councillors recently had their urine tested to
measure levels of fluoride – is this an important issue? Is there a
danger of over-dosage?
- Found the issue a very curious one. The tests would not appear to
have been carried out in a scientific manner. Urinary excretion is the
body’s normal way of ridding itself of what it does not need so
spikes in levels of particular substances are not unusual nor should
it be the cause of anxiety.
Comment: As per Dr Gary Whitford, when one drinks
something with a high fluoride level the body will excrete what it does
not need very quickly which can cause a spike in the level if measured. If
there is only a once-off over-dosage of fluoride it is not a problem but
constant overdosing could possibly be.
- Qualitative research in Ireland shows that Irish people do not show
a high level of awareness or concern with the issue of fluoridation
but there is a degree of confusion. What is the feeling in the USA
public? Is there an effort to raise awareness?
- The USA population appears more knowledgeable on the subject as it
is constantly in the media; however, confusion is still possible due
to conflicting and inaccurate claims in the literature and media.
- Are there any campaigns in the USA for fluoride free toothpaste?
- Over the counter dentifrices without fluoride are available in many
outlets across the country and are easily accessible but the majority
of toothpaste is fluoridated because this is what the market forces
demand. However, work has been done to reduce the level of fluoride in
paediatric toothpastes which is an appropriate move.
- One acknowledged side effect of fluoridation is fluorosis – are
there any steps being taken in the USA to reduce fluorosis levels?
- The CDC Report due shortly will examine the issue of fluorosis. He
would not personally categorise fluorosis as a public health issue per
se but rather as a cosmetic issue. One should consider to what extent
does dental disfigurement due to caries compare with possible dental
disfigurement due to fluorosis. On a personal level, he would view the
ability to reduce dental caries as preferable even at the possible
cost of some cosmetic effects. It is also important to realise that
most fluorosis is not detectable by the lay public/untrained eye.
The Chairman thanked Dr Evans for his very interesting
Sub-Groups and Related Issues
Sub-Group on Public Consultation
This group will try to finalise their summary shortly.
Any comments on the draft should be sent to Dr Flanagan by the end of July
Sub-Group on Dr Connett’s "50 Reasons"
See (3) above. It has been noted that several of the
original questions have been removed from Dr Connett’s web site.
Dr Cullen stressed the importance of getting answers on
toxicological issues. The Chairman noted that Dr Cullen was more than
welcome to invite responses from toxicologists and also encouraged other
members to nominate known experts in the toxicological field. If Dr Gary
Whitford can meet the Forum in September 2001 this will also be arranged.
The Rapporteur stated that Dr Joe Treacy would write to the Forum on
toxicological issues as soon as possible. Professor Keith Tipton is
looking at the issues regarding enzymes which were raised by Dr Connett.
The Chairman stressed that it is important that the toxicological issues
be followed up.
NB The Chairman emphasised the need for all relevant
areas and issues of concern to be addressed before the Forum makes its
recommendations to the Minister; as the time for presenting the Forum’s
Final Report is rapidly approaching he urged all members of the Forum to
do their utmost to address the outstanding issues.
It may be useful to have a short "executive"
summary in addition to the main report to aid access and understanding.
Professor O’Mullane mentioned a paper entitled
"Factors affecting caries levels amongst 5 year old children in
County Kerry, Ireland" which may be of interest to members – he
will forward a copy to the Secretariat for circulation.
There will be no meeting of the Forum during August
2001 as a number of members will be on holiday. The Forum will resume its
discussions in September 2001.
The minutes of the meeting of Thursday 12 July 2001
(above) were agreed by the Forum on 3 September 2001 but with the
following amendments to be made.
The two relevant paragraphs from the section on the
presentation by Dr Caswell Evans and the subsequent Q&A session should
read as follows:
Comment: the observation made by Dr Evans as to the
high levels of consumption of sugar in Ireland has been borne out by
scientific evidence. The frequency of consumption of foods and drinks
sweetened with sugar is very high in Ireland compared to other countries.
Comment: Dr Gary Whitford’s research shows that when
one drinks a liquid with a high fluoride level the body will excrete what
it does not need very quickly which can cause spikes in the plasma and
urine levels if measured. Such a once-off spike is not a problem but
continuous excessive intake could be.
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