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CDA @ Work Dental Organizations Professional Issues

No silence in the fluoride debate

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By Dr. John O’Keefe

ommunity water fluoridation must surely be among the most studied public health measures in history. The most recent published study to hit the headlines asserts that expectant mothers consuming fluoridated water will give birth to babies with lower IQ.

CDA has been handling media enquiries since the publication of this study in JAMA Pediatrics in August. Here are the key points in the CDA message to the media in relation to this story:

“While the study does not address the oral health benefits of fluoridated municipal water, the Canadian Dental Association is reviewing the findings in consultation with our colleagues in the scientific community. “

 “It is important to recognize that this is one study with small sample sizes within the context of more than 40 years of other research on the safety and health benefits of fluoridated water.”

 “Careful attention to oral health is particularly important during pregnancy, and CDA recommends that women see their dentist as part of maintaining their oral health.”

The CDA position is consistent with those recently articulated by the American Dental Association and the Academy of General Dentistry. The American Academy of Pediatric Dentistry in its response to the study states that its “current best practices statement on fluoride use remains solid and should be the starting point for our members when considering fluoride therapy for children.”

Perhaps your patients may be asking what you think of the latest findings and whether this JAMA article has changed your position on community water fluoridation. You might consider pointing them to a recent article in the Globe and Mail by health correspondent André Picard titled Fluoride won’t make you dumber, but the ‘debate’ about its safety might.

Mr. Picard, who is very highly regarded in the Canadian health community begins his piece with the statement that: there is no shortage of conspiracy theories in health care, but some of the most imaginative and enduring are about fluoridation. He ends with: but as health threats – real and imagined – go, the “government is poisoning us with fluoride” argument doesn’t hold any water.

18 Comments

  1. So the CDA says “It is important to recognize that this is one study with small sample sizes within the context of more than 40 years of other research on the safety and health benefits of fluoridated water.” Really? The sample size was large enough to find significant (and clinically relevant) effects on IQ. The investigators took into account all the confounders they could find from what was probably the best cohort of pregnant moms in the world. The Green et al study confirms the Mexican study by Bashash. Even the JAMA Pediatrics editors were impressed. On the other hand, there isn’t a single safety study conducted during pregnancy looking at fluoride effects on the offspring. Let’s not exaggerate with claims of “40 years of other research on the safety and health benefits of fluoridation.” Can you provide just one double blinded, randomized prospective clinical controlled trial on the safety OR efficacy of fluoridation?

    Reply
  2. Anonymous August 27, 2019

    I am not sure that a newspaper article would be the best for a patient to read in this debate

    Reply
  3. Dr. Paul Belzycki, DDS August 27, 2019

    I will start by saying that I have not read the article, nor will I. Life is too short.

    Indeed, I too have noticed IQ scores on the decline and blame it on fluoride. Here is how it works:

    The current crop of kids are less smart because they were given smartphones upon exiting birth-canal by not-so-smart parents, who are so hyper-consumed with parenting chat rooms discussing the myths of fluoridation, amalgam, vaccinations, etc. that they miss the fact that their little bundle of joy becomes an overindulged brat lacking any semblance of self-discipline or respect for authority.
    This results in a child lacking the ability to focus and the motivation to strive for competency at school. Intelligence is no longer internalized as Little Johnny can now retrieve the sum total of Global Chatter with the flick of a finger.

    The above was my very own singular thought, penned without sending it to Grammarly. Did not cut and paste. Did not Google it…Did not Youtube it…Did not Wikipedia it.

    And this is why I restrict my practice to those over 40.

    For the younger reader, allow me to translate.

    “Like OMG dude, I’m just like awesomely like stressed out by all this fluoride stuff, like ya know?”

    Finally, the reason I am not reading the article is because I assume it is flawed from the outset because those who produced it have probably been exposed to community water fluoridation; and hence, their IQ must be called into question 😊

    Reply
    1. Dr Andrew August 29, 2019

      LOVE IT!!!!!!

    2. K Bhalla August 31, 2019

      Wow great articulation of words and thoughts!!!!

  4. anonymous August 29, 2019

    Really. The “best cohort of pregnant moms in the world” There’s a claim that bears scrutiny

    Reply
    1. Hardy Limeback August 30, 2019

      The principle investigator Dr. Christine Till’s exact words were “the world’s best pregnancy cohort”.

      This interview is well worth hearing. https://podcasts.apple.com/ca/podcast/links-between-having-fluoride-in-drinking-water-during/id1066415321?i=1000447640915

  5. Jenny RDH August 30, 2019

    Got to love Dr Paul…straight shooter!! :))

    Reply
    1. Dr. Paul Belzycki, DDS September 1, 2019

      Dear Jenny. Would you expect anything less after my 30 years of Skeet Shooting? 🙂

      Straight Shooter

    2. Jenny Fodchuk September 13, 2019

      You have a good eye then and get to the point:)

  6. Dr. Kevin Mark September 3, 2019

    The fact that so many of my fellow dentists will not only completely ignore this study but mock those who are seriously concerned by it is truly shameful.

    Reply
    1. Hardy Limeback September 4, 2019

      Thank you for that comment Dr. Mark. It is becoming increasingly harder to earn the trust of patients. Ignoring good science is one of the reasons dentists in Canada are no longer on the top of the pile of most trusted professionals in Canada.

    2. Dr. Paul Belzycki, DDS September 4, 2019

      You are right Kevin and I agree that my comment was facetious. However, I stand by it unapologetically. Nonetheless, and with great respect to you, to other participants, and to Oasis, I must explain the serious motivation behind it.

      Admittedly, I am a 66-year-old clinical dentist. Long-practiced skills at restoring teeth and gums allow me to instantly judge the quality of work performed by other dentists. When I walk through a commercial lab and assess the impressions taken and restorations made by dentists, I am struck by the wide range of care and attention to detail…yet they are all labelled crowns…some destined to cause more problems for an unsuspecting patient. Unfortunately, I lack this ability in judging the merits and veracity of scientific literature because I am not immersed in it on a daily basis. For guidance, I rely on my own personal “braintrust” of academics and university-based clinicians. They stress that academic research and the resulting papers also suffer from a range of statistical and methodological correctness that I am at a loss to evaluate for lack of experience in reviewing articles.

      In addition, I am guided by my licensing authority and the agreed-upon consensus of other recognized entities, such as the Center for Disease Control, World Health Organization, government regulatory agencies, and university/hospital clinicians and faculty members.

      Hence, when I encounter sensational claims, I run them by the “braintrust” to measure their validity. Thus far, all endorse the use of fluoridated water to control tooth decay.

      As I have stated in many of my presentations on Oasis, I rely heavily on my extensive clinical experience. On the topic of fluoridated water, what springs to my mind is the difference in DMF between those of my cohort reared in Toronto with fluoridated water, compared to those I have treated from Montreal who were raised without fluoridated water. Although I have not formally documented the difference, my experience is that the Montreal cohort has required more dentistry. I could have used the adjective “group” or “age” or “generation”, but “cohort” makes me sound smarter. Therefore, I am pleased and not the least bit worried, that my family and I have been exposed to fluoridated water. Please note that one daughter graduated as an architect and the second graduated with an Honors Bachelor degree winning 3 gold awards for Science and Math from the University of Western Ontario; and has a Master’s in Neurosciences from McGill, a second Master’s in nursing, and is currently completing a degree as a Nurse Practitioner after raising three children. All these academic and social achievements have been accomplished with fluoride on board and only one amalgam filling between the two of them.

      In my lifetime, a fluoridated cohort, built CERN, corralled the Higgs Particle, mapped the human genome, gave us String Theory, found cures for so many diseases, etc. etc. I will even wager a few of the brilliant luminaries had amalgam fillings in place.

      With regards to standardized IQ tests, with or without differentiating factors, I will bet that there is a huge number of “scientific” articles debating their efficacy and ability to predict one’s intellectual performance in life. Just how significant are 4.49 IQ points in a 3- or 4-year-old child? And here, you may choose the IQ test of your heart’s desire. I am certain those immersed in designing and rendering IQ tests have their own warring factions. Akin to us dentists arguing as to what constitutes a true-Centric Relation.

      To drive this point home, allow me to argue “reductio ad absurdum”. Take all those “best cohort parents” and inform them that their child cannot attend the “best” school of their choice based on the results of this article. Let me pose the question with a personal tone. Based on the prediction of an IQ test rendered at four years of age, top academic schools now have a reasonable justification to deny admission to your child, should you have one, based on their exposure to fluoridated water. I mean it is just absurd. Can you envisage the outcry of all those “best cohort” parents, armed with lawyers, psychologists, and psychiatrists questioning the significance and predictive power of those 4.49 lacking points on some IQ test? And yet, we as dentists are to take the results of this study as the justification for stopping water fluoridation, or for removing fluoride application for cancer patients suffering from xerostomia and root decay?
      If you cannot envisage their outcry, I can. Suddenly, if Little Billy/Betty cannot attend dental school at Harvard, these tests are utterly meaningless. “What? 4.49 points down because of fluoride; and now my Billy/Betty is destined to be a janitor at the Faculty of Dentistry rather than the dean…are you kidding me?!!!”

      It was in this frame of mind that I penned my initial comment. It is without malice or criticism towards any one person.
      As far as I understand it, IQ testing is a subjective and culturally-biased method of assessment despite efforts to make it more objective. As such, the 24/7 media tsunami that is the Internet must have far more effect on IQ, whatever that may be, than fluoridated water. As evidence of that, I offer a TED talk on a subject that all new parents should view. Titled James Bridle: The nightmare videos of children’s YouTube — and what’s wrong with the internet today…
      Link https://www.ted.com/talks/james_bridle_the_nightmare_videos_of_childrens_youtube_and_what_s_wrong_with_the_internet_today

      In light of all of this, we are to worry about the impact of fluoridate water on the intellectual performance of children?
      Other dire consequences have been linked to water fluoridation, including problems with bone physiology. Yes, some of these papers can be found on PubMed, but I again find myself unable to judge what to believe. So, I emailed my patient, an orthopedic surgeon at Sunnybrook Hospital here in Toronto, and I asked him the following questions. After all who better to ask than somebody on the frontline dealing with bone pathology on a daily basis?

      My Questions:
      Seems that community fluoridated water is under attack again.
      One of the claims is that fluoride affects bone physiology.
      Is this a concern for orthopedic surgeons?
      Is there an increased incidence of bone fractures/pathology in jurisdictions with fluoridated water?
      I understand that toxic doses of any chemical or drug does have negative side effects.
      Is fluoridated water one of your worries when treating a patient?

      His reply:
      In my uneducated opinion, the benefits of fluoride outweigh any negative effects, if any. Arguably, none exist at the current levels of fluoridation. It’s not something we think about at all as orthopedic surgeons. There have been a few studies on risk of pathological fractures in populations exposed to fluoride which were mostly done 20 years ago and were of poor methodological quality. Nonetheless, the risk of fractures was not found to be higher in those studies.

      Example: Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women (https://www.ncbi.nlm.nih.gov/m/pubmed/11021862/?i=4&from=/8897754/related)

      The above link was provided by the orthopedic surgeon and I have not read it. I wish to avoid the exercise of producing one PubMed article to trump a previous PubMed article presented by someone with a differing point of view. It reminds me of children playing the card game War! Who can produce the final Ace?

      In addition, my nephew holds a PhD. in Clinical Psychology and heads a hospital department in Vancouver, focused on children’s mental health. He too is on the front-lines of caring for children. Therefore, he is in a better position to evaluate the JAMA Pediatrics article. Getting his opinion may take some time and I will report it to this thread when I get it. Still, his initial reaction to the question of water fluoridation and IQ was that he too was unaware of any correlation.

      I do not apologize for my initial tongue-in-cheek comment to this post and I stand by it. Here, I did want to explain its motivation in a timely fashion. I may be jocular a times, but I am respectful when it is warranted, and I am no buffoon. I have assumed my role as a caregiver with reverence and honesty.

      But sometimes, the things I come across in dentistry make me uncomfortably bemused…
      Then again, could be the mercury in my amalgam fillings…

    3. Dr. Paul Belzycki, DDS September 5, 2019

      I am compelled to add a final post-script to my comments.

      I am emotionally invested in providing the best care for my patients.

      Hence, I love amalgam and other time-proven methods and materials that allow me to provide long-lasting restorations that are trouble-free, recognizing that some of the methods and materials are no longer in vogue.

      However, I am not emotionally invested in community fluoridated water. If it is removed, all dentists would benefit financially, me included. Community fluoridation remains a testament of our professional ethics as we champion a cause that lowers our bottom-line. If it is eliminated, I assume patients can still obtain supplements as I did when I gave my kids Tri Vi Flor. I just Googled Tri Vi Flor to see if it is still available. I landed on a “parenting chatroom” claiming it was still around. However according to the thread, my two daughters have been irrevocably damaged…mentally and physically…Ah Dr. Google.

      My Worldview is framed by science. I am fully aware and accept the proposition that Scientific Truths we hold dearly are contingent upon the best guesses we currently have on the nature of Reality. Certainly, new findings may reverse recommendations on treatment modalities. I am prepared to comply when advised by licencing and governing bodies.

      I have no dog in the fluoridation fight.

      No disrespect to any individual is to be inferred from my comments.

      If I intended disrespect, all would have known as with a past post when I was taken to task.

      I am left exhausted by this topic.

      Dr. Paul Belzycki, DDS

    4. Chiraz Guessaier September 6, 2019

      This post is on behalf of Dr. Paul Belzycki, DDS

      In a previous comment. Dr. Belzycki promised to provide his nephew’s commentary on the study that he had shared with him. He is a clinical child psychologist in Vancouver. Here’s his response:

      This is an elegant study: comprehensive and thorough in its inclusion of relevant confounding variables, sophisticated data analysis, with a very interesting finding of a 4.5 point difference in IQ scores for 3 and 4 year-old boys (but not girls) who were exposed prenatally to fluoride.

      However, the meaning and interpretation of this finding remains highly unclear:

        Although the IQ difference is statistically significant, its clinical significance is not established, particularly for the age range sampled in this study: does an IQ score difference of this magnitude correspond to meaningful differences in neurocognitive strengths and weaknesses in preschool-age children? And if so, do these differences persist into the school-age years?

        Chiraz Guessaier, CDA Oasis Manager

  7. Dr Andrew September 4, 2019

    One study… exactly…..

    Reply
    1. Hardy Limeback September 4, 2019

      Actually, Dr Andrew, there have been hundreds of animal studies showing fluoride neurotoxicity, over 50 human epidemiology studies and at least 5 studies linking in utero fluoride exposure to lowered IQ (see https://www.prnewswire.com/news-releases/several-in-utero-fluorideiq-studies-should-provoke-a-nation-wide-fluoridation-moratorium-300909717.html). So how many studies are enough before the Canadian Dental Association issues a warning about the possible harm of fluoride ingestion, especially during pregnancy?

  8. Roger Richard September 6, 2019

    We as dentist do not read enough. We delegate our responsibility to study this issue to other professionals who may not have the same perspective as a health care worker would.

    One can start by reading the fluoride history. But, if you only have time for one article, I would suggest this one from British Dental Journal 216, E3 (2014): Fluoride intake of infants living in non-fluoridated and fluoridated areas. F. V. Zohoori1, G. Whaley1, P. J. Moynihan2,3,4 & A. Maguire2 http://www.nature.com/bdj/journal/v216/n2/full/sj.bdj.2014.35.html . This article concludes that « Infants living in fluoridated areas may receive a fluoride intake, from diet only, of more than the suggested optimal range for TDFI (total daily fluoride intake). This emphasizes the importance of estimating TDFI at an individual level when recommendations for fluoride use are being considered. » The topic about adding or not adding fluoride to water is an example of decisions to make to an infant’s diet.

    Reply

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