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Draft NHMRC Information Paper: Effects of water fluoridation on dental and other health outcomes submission

This submission reflects the views of
Individual Background: 
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Specific Questions
Q1. A) Is the draft Information Paper presented in a manner that is easy to understand? : 
Q1. B) Please provide details regarding your response to Question 1A: 
Plain Language Summary

Page 1, of the NHMRC draft information paper it says 

‘The  findings add to a long history of research that shows water  fluoridation helps to reduce tooth decay in children and adults.’ 

However in the authors conclusions on the Cochrane paper published on 18th June 2015 they state ‘ We did not identify any evidence, meeting the review’s inclusion criteria, to determine the effectiveness of water fluoridation for preventing caries in adults.’  

On page 2  you cite the 2015 Cochrane review as one of the main studies you used, but you state again on page 3 that ‘All of the studies in previous reviews ….found that water fluoridation reduces tooth decay by 26-44% in children, teenagers and adults.’

This seems a contradiction. There is either no evidence for preventing caries in adults as per the Cochrane statement above, or there is evidence in ‘All of the studies’  

Evaluating the evidence

On page 21, 

There is consistent evidence that water fluoridation at current Australian levels is associated with decreased occurrence and severity of tooth decay by 26-44% in children, adolescents and adults.’

The wording here is not clear. Does the figure 26-44% relate also to adolescents and adults? Because that is how it is implied by the wording.  If not, then what is the figures separately for adolescents and adults? 

Q2. A) Is it clear how NHMRC reviewed the health and dental effects of water fluoridation? : 
Q2. B) Please provide details regarding you response to Question 2A: 

The only paper cited as regarding fluoridation reducing tooth decay in adults is
Grifin, SO, Regnier, E et al 2007. Effectiveness of Fluoride in Preventing Caries in Adults, Journal of Dental Research, 86 (5), 410-415.
However, this study included self or clinically applied fluoride, with a few studies to do with community fluoridation through the water supplies.
It is important to note though that the Cochrane review did not include this study, as it did not meet their inclusion criteria.
The Cochrane review states that ‘research of effectiveness among adults is needed.’ however in your review, you seem to have settled that there has been enough research to declare it as being effective. Therefore it seems that you are picking and choosing the ‘facts’ that you want to include, in order to back up your previous publications.

Q3. A) Is the Fluoride Reference Group’s interpretation of the evidence clearly described in the draft Information Paper?: 
Q3. B) Please provide details regarding your response to Question 3A: 

According to the Cochrane paper, there is no good evidence meeting their inclusion criteria that there is any change in caries when water fluoridation is stopped. If it is truely effective, shouldn’t there be a wealth of good evidence showing children’s teeth spiralling into a state of decay once fluoridation is stopped?
In your summary of ‘Water fluoridation and dental effects’ you mention hospital visits, stating that there is a suggestion that hospital admissions for dental treatment is lower in areas with water fluoridation.
Why mention this in the summary if you later say in the evidence statement that there is insufficient evidence. It seems that you are writing your own story here, rather than letting the facts speak for themselves.

Q5. Is there additional evidence on any other health effects of water fluoridation that should be considered in the draft Information Paper?: 
Q6. Is there any other supporting material relevant to making decisions on water fluoridation in the Australian context that should be considered in the draft Information Paper?: 

According to the studies you list, 3% of children, or 40,000 children in NSW have moderate fluorosis as a result of water fluoridation. Go ahead and google images of moderate fluorosis and see if that looks acceptable for 40,000 children, and whether it can be dismissed by simply stating that it is uncommon. It is not uncommon for those 40,000 children.

There is a big difference in stating that ‘there is no evidence that water fluoridation at Australian levels causes any health problems’ compared to something that you are not willing to state in this review that ‘water fluoridation is safe’.
The reason you cannot state that it is safe, is because the research required has not been done.
For example, no studies have been done using dental fluorosis as a bio marker that someone has been overexposed to fluoride, and to see if there are any changes in their bones, joints, ligaments, or if they are experiencing any of the very early symptoms of the first stages of skeletal fluorosis.

Page reviewed: 4 July, 2017