Teething trouble for kids using fluoride

by Emma Burns, The Max, (Glasgow) Daily Record, May 24th, 2000.

SMILES WORSE: FEARS ARE GROWING THAT WE COULD DO MORE

LOOK at the picture on the right and you see a pretty girl with a lovely smile. What you can't see is the agony behind it. Carena Smith's teeth have been horribly damaged by fluoride - the substance that was meant to protect them. When her adult teeth came through they were mottled, lacking in enamel and were soon stained brown by food and drink.

ALL SMILES NOW: Dawn with her children Carena and David Carena Smith had to have lengthy dental treatment after her front teeth were ruined by the stuff that was supposed to make them strong

Carena hated them so much that she begged her parents, Dawn, 42, and Mark, 41, to let her have them removed.

They were horrified. Dawn had been giving Carena and her brother David 16 fluoride supplements to ensure they had strong teeth.

Carena, 14, was persuaded to try a less drastic but expensive and lengthy dental treatment. She can smile happily again after having veneers stuck over her two front teeth, the worst affected.

But it was a complicated procedure that took three attempts.

Dawn, of Linlithgow, feels guilty that it was her own dedication in giving Carena the recommended dose of fluoride drops, tablets and mouthwashes that led to her teeth being spoiled.

But it was all recommended by the authorities and she is shocked that the debate about putting fluoride into Scotland's water has been reopened.

Last summer, Health Minister Susan Deacon wrote to the chairmen of all the health boards asking for ideas on how they might consult the public on fluoridation.

Since last autumn, the NHS Centre for Reviews and Dissemination at the University of York has been carrying out an in-depth study of the evidence for and against fluoridation of public water supplies.

Its report has been completed and is due to be published next month. If it comes out in favour of fluoride, the pressure will be on to introduce it in Scotland for the first time since since 1982, when a 17-month legal hearing ended with judge Lord Jauncey supporting battling Scots granny Catherine McColl's attempt to have it banned.

Alastair MacLean, secretary of the British Dental Association in Scotland, is 100 per cent pro-fluoridation and expects the York academics to come out in favour.

He said: "It would be extraordinarily strange if they didn't."

He believes the benefits to teeth outweigh any disadvantages and points out that around the Moray Firth, where fluoride occurs naturally in the water, 87 per cent of five-year-olds have perfect milk teeth compared with 32 per cent in other areas.

At 12, 76 per cent of the children with fluoridated water had perfect adult teeth compared with 46 per cent from other areas.

He said: "The positively-charged fluoride ion becomes incorporated into the enamel of the teeth, making it harder.

"When the surface of the tooth is attacked by sugar - which happens several times a day-the fluoride makes the area much much tougher."

He says the benefits are not just for children - they last throughout life. This is because fluoride gives a big boost to the body's natural ability to repair teeth every time they are attacked by sugar in food or drink.

He added: "People don't develop tooth decay later on. They have a much lower level for the rest of their lives.

"Older people are less likely to develop decay on the roots of their teeth exposed by receding gums, which is extremely difficult to treat."

Compared with those advantages, Alastair MacLean believes the downside of fluoride is negligible.

He said: "Dental fluorosis is a comparatively minor problem which is unusual in areas where the amount of fluoride in the water is set at one part per million.

"In its most common form, it is small white stains on the teeth. I personally would rather have small white spots on my front teeth than big decayed holes m my back ones."

Surveys of 26,011 12-year-olds and 14-year-olds in Scotland over the last 10 years have found that 10 per cent of them have marks on their teeth which may be fluorosis - probably caused by eating toothpaste. But only three per cent of them are aware of it.

Professor Len Stephen, of Glasgow Dental Hospital, is another staunch supporter of fluoridation and claims it is children from poorer families who will benefit most if is introduced to the water supply. He said: "Children from social classes one and two have dramatically less tooth decay. Their parents make them brush their teeth and don't let them eat sugary snacks all the time.

"Parents from social classes four and five either don't know the advice or ignore it.

"Their children would benefit twice as much from fluoride in the water.

"I believe it is wrong that a minority who shout loudest are stopping something of benefit to the majority."

But there are downsides with fluoride.

In parts of India and Africa, where fluoride occurs naturally at 10 parts per million -10 times as much as is permitted in this country - and where, because of the heat, high quantities of water are drunk daily, around 10 per cent of the population can be seen on X-rays to have skeletal fluorosis, according to Professor Stephen.

Fluoride builds up in their bones, making them thicker but more brittle. The worst affected can develop holes in their bones, making them more vulnerable no osteoporosis and fractures. Anti-fluoride campaigners claim that as well as skeletal fluorosis, an excess of fluoride can cause gut problems, depression of the immune system, bone cancers particularly among boys and men, lower IQ in children and even Down's Syndrome.

Margaret Cooper, who runs the National Register of Children with Dental Fluorosis, said: "If fluoride is introduced to the water supply, people with kidney problems and certain cancers who cannot tolerate fluoride, will have to buy all their water in bottles, even for cooking and brushing their teeth.

They will effectively be barred from using tap water, in the name of reducing the number of filings in teeth. I find that outrageous and unacceptable."

It is particularly questionable as there are studies which show that teeth are no better in fluoridated towns than ones without fluoride.

One report, by the late Dr John Colquhoun, former Principal Dental Officer of Auckland, New Zealand, stated: "Surveys showed that there is little or no differences in tooth decay rates between fluoridated and non-fluoridated places throughout America.

"From other lands - Australia, Britain, Canada, Sri Lanka, Greece, Malta, Spain, Hungary and India - a similar situation has heart revealed - either little or no relation between water fluoride and tooth decay, or a positive one (more fluoride, more decay)."

He argued that the real reason why our dental health has improved over the past 50 years is nothing to do with fluoride in the water or in the toothpaste.

He believed it is because we eat a much healthier diet with more fruit, vegetables and cheese, and brush our teeth more.

Dr Sheila Gibson, research physician at the Glasgow Homeopathic Hospital, who is an the advisory panel to the York review, said: "Fluoride is a very powerful poison one of the most toxic substances found in the Earth's crust.

"It has an adverse effect on the brain, the nervous system, the immune system, the pancreas, the stomach and kidneys.

"It can be particularly detrimental for older people with kidney failure who cannot excrete as much of it as a healthy person would, leading to it building up rapidly in their bones.

"Adding fluoride to the water supply is medicating people without their consent, with no knowledge of their medical condition. It is highly dangerous and profoundly unethical."

Around 27 substances, including carbon, acids and manganese, are already added to the water in Strathclyde.

With both sides so adamant that they are in the right and the other side is totally mistaken, it is hard to tell where the truth lies and hopefully, the York review should clarify things.

But it is certainly acknowledged by both sides that too much fluoride in children under seven can cause dental fluorosis.

Professor Stephen says the real danger lies in children eating fluoride toothpaste. He maintains that it is better to give them tablets or drops which you can measure, and no toothpaste or the merest smear of it on their brush, than risk them swallowing a daily overdose.

He recommends 0.25mg from when the first teeth come through until eight months, 0.5mg from eight to 16 months, 0.75mg from 16 to 24 months, lmg until six years, and 2mg thereafter.

He said: "It is higher than other people recommend but you don't get fluorosis with that dose, if you control the dentrifrice."

Fluoride works by interfering with the crystalline structure of enamel as it is forming on the teeth still buried in the gums. It replaces a molecule which has a similar structure. In moderation, that makes the teeth harder.

But if too much fluoride gets into the enamel while the teeth are still forming, it can develop fine pores, leading to the mottled look.

Where there are lots of pores, the entire surface of the teeth can be stained by food and drink, making the teeth look dirty and diseased.

That is what happened to Carena and David Smith. Mum Dawn, a former primary school teacher, was scrupulous in following the advice she was given by her local dentist and health centre.

They told her to give fluoride drops to Carena from three months and to start David, then two, now 16, on fluoride tablets.

She said: "I did it exactly as prescribed. I never questioned it. My dentist said I must give fluoride daily because otherwise the effect would be lost.

"Other mothers may not have bothered or may have forgotten. I did as I was advised because I believed it was the right thing to do.

"And I supervised them every day as they brushed their teeth twice a day with children's fluoride toothpaste."

David's adult teeth showed some signs of mottling. But the real shock came with Carena's front teeth.

They were brown, mottled and seemed to have very little enamel.

Dawn said: "She was very upset about her teeth looking like that.

"Children at school kept asking why her teeth were dirty and we had a few tears over it. For a while she wanted them taken out and to have false teeth. She thought anything was better than those brown teeth."

At first, however Carena was prescribed more fluoride, in a mouthwash.

It was only two years later, when she was nine, that she was diagnosed as having fluorosis.

Eventually, when she was 11, she was treated by having part-porcelain veneers fixed to her two front teeth. And one molar was removed because the fluoride had led to it being malformed.

Dawn is angry and distressed that she unwittingly gave her daughter daily doses of something that was doing her harm.

She is worried about the long-term expense for Carena of having replacement veneers, particularly once she is an adult and no longer qualifies for free NHS treatment.

And she hates the thought of Carena being exposed to more fluoride.

Dawn said: "I worry about the long-term effects. The only thing I can do is to try and make sure she doesn't ingest any more fluoride in any way.

"We have fluoride-free toothpaste and she doesn't drink tea - fluoride is found naturally in tea.

"But I worry about reconstituted fruit juice. What if the water in that has fluoride?

"I'm 100 per cent against having fluoride introduced into our water and not just from my own point of view. How could people avoid it if they need to?

"No government should put something that has known risks into the water."

• National Register of Children with Dental Fluorosis. Tel: 0115 965 2948.

• Safe Water Information Service. Tel: 01568 615702.

MORE DAMAGE THAN GOOD BY TRYING TO GET HEALTHY MOLARS ON TAP [Top left] SORRY SIGHT: Careen's front teeth ended up badly stained by food and drink [Bottom left] COVER-UP JOB: After having porcelain veneers fitted over her existing teeth, Carena [immediate left] now has a lovely smile again