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DENTAL FLUOROSIS
Smile, please - but don't say 'Cheese'
George Glasser and Jane Jones
ABSTRACT
At least THREE MILLION
people in England suffer from dental fluorosis. The Government's York Review
on water fluoridation showed that about THREE QUARTERS OF A MILLION people
have dental fluorosis which is "of concern". No studies have ever been done
on the psychological damage caused by fluorosed (stained) teeth. A 1998
survey showed that people with defective teeth are more likely to experience
social and employment discrimination. Half of the respondents saw
unattractive teeth as a sign of poor personal hygiene. International
scientists concur that dental fluorosis is a FORESEEABLE event from
fluoridating drinking water, and the victims are at increased risk for
psychological and behavioural problems and difficulties. This can be the
subject of litigation against those who promote and implement water
fluoridation.
Those involved in the
promotion and implementation of water fluoridation are vulnerable to
significant legal liability. Reparations for the foreseeable consequence of
dental disfigurement are likely to be further compounded by punitive damages
which can be awarded for subsequent psychological pain and suffering
experienced by the Plaintiff.1
"After a handshake, a friendly
smile is one of the most important elements in creating a good first
impression. However, it's hard to smile if you're self-conscious about teeth
that are yellow or stained." (School of Dental Medicine at the University of
New York).2
A 1998 survey by the American
Academy of Cosmetic Dentistry showed that:
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more than 92% of adults
agree that an attractive smile is an important social asset;
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85% believe that an
unattractive smile makes a person less appealing to the opposite sex;
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75% believe that an
unattractive smile can be detrimental to a person's chances of career
success; and
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half of the respondents see
unattractive teeth as a sign of poor personal hygiene.
Overall, the survey found that
people with unattractive smiles are more likely to experience social and
employment discrimination.
According to the UK
Government's systematic scientific review on water fluoridation, carried out
at York University, about forty eight per cent of people living in
fluoridated areas are affected by dental fluorosis.
In England, this translates to
nearly three million individuals who have fluorosed teeth to some degree.
For three quarters of a million people, dental fluorosis is of the "moderate
to severe" degree. The condition is characterised by white chalky spots or
brown staining and pitting of their teeth.3
In 1985, following a review
commissioned by the United States Environmental Protection Agency, an
independent panel of behavioural scientists found that people with moderate
to severe fluorosis are at increased risk of experiencing psychological and
behavioural problems.4,5
People afflicted with dental
fluorosis are more likely to experience discrimination from an early age.
Teachers often prejudge a child's intellect and personality based on
appearance alone. These children are more often likely to be considered as
troublemakers or non-scholars. Such biased views reinforce a negative
stereotype, with self-fulfilling results.6
Thousands of official
documents confirm that artificial fluoridation of drinking water can, and
does, produce the "aesthetically objectionable" effect of moderate to severe
dental fluorosis. The psychological damage suffered by millions of victims
of dental fluorosis is given little attention.
Moreover, in the persistent
drive to extend fluoridation schemes across the country, dental and public
health officials dismiss this distressing condition as an acceptable public
health trade-off, insisting that "the benefits outweigh the risks."
The Department of Health
asserts that water fluoridation is the most cost-effective means of reducing
tooth decay. However, the Department turns a blind eye to the huge financial
burden on individual patients who require remedial treatment for unsightly
fluorosed teeth.
Cosmetic veneers provide an
extremely lucrative spin-off for the privatised dental profession. In
England, charges range from £150 to £450 per tooth and repeat treatments are
required every five or six years throughout the victim's life. People who
cannot afford cosmetic veneers, professional bleaching or micro-abrasive
treatment have no option but to live with their fluoride-damaged teeth and
the attendant social stigma and psychological trauma.
While the York Review panel of
experts acknowledged that dental fluorosis affects up to 48% of the British
population, they signally failed to address the economic, social and
psychological impact on the victims.
However, more perceptive
scientists and dentists are sensitive to the social stigma of dental
fluorosis.
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Irish dental surgeons, Donal McAuley, wrote in the British Medical
journal: "Fifty per cent of our population has dental fluorosis. I see
patients daily in my surgery who are damaged by fluoride. They do not
smile, they are teased at school, and they are traumatised by having
'rotten' teeth." Drinking water in Ireland is artificially fluoridated.7
-
In
1994, a Kenyan survey noted that between 60 and 84% of respondents viewed
dental fluorosis as an important problem because of its unfavourable
effects on an individual's personality.8
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A
later Canadian study examined the influence of fluoride exposures on the
widespread "aesthetic problems" caused by dental fluorosis. It
acknowledged that forty six per cent (nearly half) of the participants had
dental fluorosis. The effect on personal appearance, as defined by the
participants themselves, was more prevalent in the over-11 age group.9
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The trauma experienced by young people with dental fluorosis is
depressingly apparent in a South African study conducted by the NW
Province Department of Health: "The psychological effect in terms of the
unsightly, brown-stained teeth, has induced the adolescents with fluorosed
teeth to demand that these teeth be extracted and replaced with
dentures."10
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"The prevalence of dental fluorosis appears to be on the increase.
Although in its mild form the condition is not considered to be of
cosmetic significance, the more severe forms can cause great psychological
distress to the affected individual."11,12
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An
Australian Health Department analysed society's perceptions of dental
fluorosis, based on over 3,000 responses. Lay and professional observers
recognised that higher degrees of fluorosis increasingly embarrass the
child. All observers, except the dentists, felt that the more severe
fluorosis indicated neglect on the part of the child.13
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Egyptian researchers
observed that friends and relatives ridicule the patient by inferring that
these stains are associated with smoking and/or poor oral hygiene. They
noted that such personal remarks lead an individual into severe
psychological depression.14
Parents, too, commonly
experience feelings of anguish and guilt over their children's fluorosed
teeth.
For thirty years until she
discovered the scientific literature, Anita Knight endured a private agony
over her son's lack of self esteem and emotional problems. "I was outraged,"
she said. "It was immediately obvious to me that so-called scientists and
public health officials had arrogantly and callously written off my son as a
laboratory rat in their inhuman experiment.14
Dental fluorosis is
extensively described by toxicologists as the first visible sign of
chronic fluoride poisoning. The result of over-exposure to fluoride was
well understood by the dental profession until the early 1950s.
Some prominent researchers
have pointed out that dentists who knowingly promote treatment which leads
to dental fluorosis is a foreseeable, "objectionable cosmetic effect"
that can and does occur following artificial fluoridation.
Despite anti-discrimination
laws, the unattractive appearance of people with dental fluorosis can
severely limit their academic performance, employment choices and future
prospects. Teeth which appear "dirty" can seriously affect an individual's
ability to interact and form relationships with members of the opposite sex,
leading to exclusion, loneliness and long-term depression. Such conditions
can precipitate feelings of frustration and anger which could, in turn, lead
to criminal behaviour.
Promoters of water
fluoridation are aware of, but do not warn the public about the
foreseeable adverse effect of dental fluorosis or the foreseeable
psychological damage which can and does occur to subsections of the
population. When a plaintiff suffers harm, whether physical or
psychological, it is only necessary for him to show the court that the
injury was reasonably forseeable.15
Meanwhile, three million English cases of
dental fluorosis are officially ignored and three quarters of a million
people have been severely, and foreseeably damaged.
References:
1. Page v Smith, House of Lords [1996] 1 AC
155; [1995] 2WLR 655 [1995] 2All ER 736.
2. University of New York, School of Dental
Medicine, Oral Health Letter.
3. McDonagh MS, Whiting PF, Wilson PM, Sutton
AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J,
Systematic review of water fluoridation. BMJ 2000; 321: 855-9.
4. Drinking Water Regulations; Fluoride. 50
Fed. Reg. 220, 47144 (1985).
5. Welbury, P., Shaw, L. A simple technique
for removal of mottling, opacities and pigmentation. Dental Update 1990; 17:
161-3.
6. Tauber, Robert T. Good or Bad, What
Teachers Expect from Students They Generally Get! ERIC Digest, 1998-12-00,
Source: ERIC Clearinghouse on Teaching and Teacher Education Washington DC.
7. Water fluoridation, Letters; RMJ2001; 322:
1486.
8. Mwaniki DL, Courtney JM, Gaylor ID, Endemic
fluorosis: an analysis of needs and possibilities based on case studies in
Kenya. Soc Sci Med 1994; 39; 807-13.
9. Clark DC, Berkowitz, J. The influence of
various fluoride exposures on the prevalence of aesthetic problems resulting
from dental fluorosis. J Public health Dent 1997; 57: 144-9.
10. Mothusi, B. Psychological Effects of
Dental Fluorosis, Department of Health, North West Province, South Africa.
11. McKnight CB, Levy SM, Cooper SE, Jakobsen
JR. A pilot study of aesthetic perceptions of dental fluorosis vs selected
other dental conditions. ASDC J Dent Child 1998; 65: 233-8, 229.
12. Rodd and Davidson. The aesthetic
management of severe dental fluorosis in the young patient. Dent Update
1997; 24:408-11.
13. Riordan PI., Perceptions of dental
fluorosis. J Dent Res 1993; 72: 1268-74.
14. Rahmatulla. Clinical evaluation of two
different techniques for the removal of fluorosis stains. Egypt Dent J 1995;
41 :1287-94.
15. Whitford, G.M. Physiological and
Toxicological Characteristics of Fluoride, Journal of Dental Research 1990;
69, Spec No: 539-49; discussion 556-7.
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