Advising on fluoridation

The disbandment of the Irish Expert Body on Fluorides and Health led to concerned letters to the Minister for Health about future plans to monitor the area. David Lynch reports

There will soon be a “new model for fluoridation monitoring” in line with “modern developments in public health surveillance”, the Medical Independent (MI) has been told.

A Department of Health spokesperson told MI that it is convening a working group “staffed from Departments and agencies, which will develop proposals for a new model for fluoridation monitoring in line with modern developments in public health surveillance”.

This change follows the official expiration in the term of office of the Irish Expert Body on Fluorides and Health (IEBFH) at the end of last year.

Since 2004, the body had monitored new and emerging issues on fluoride and its effects on health and related matters. For almost two decades it had provided advice to the Minister for Health on all aspects of fluoride.

However, as reported by MI in February, in late 2022 the IEBFH stated it was “extremely disappointed” with the lack of “engagement” and “succession plan” from the Department over its future. At its meeting on 14 December, discussion centred on the fact that the body’s terms of office were due to expire on 31 December.

However, the IEBFH had not been informed of any succession plan.

“It was noted that this is the last meeting of the body and another will not be arranged due to work schedules/Christmas holidays of the members,” according to the minutes of the meeting.

Letters

The IEBFH wrote a number of letters to the Minister raising these concerns. The letters have been obtained by MI following a Freedom of Information request.

In a letter to the Minister on 11 November, Mr Ray Parle, then interim Chair of the IEBFH, wrote that the body was “concerned about the lack of clarity regarding a succession plan and would respectfully ask if there is a strategy for a handover period to a successor group”.

“We would also like to highlight the need for a continued IEBFH into the future,” according to the letter.

“The public should be reassured of the safety of fluoride in the public water supply and that effectiveness is being constantly evaluated by independent experts and a multidisciplinary body comprehensively reviewing emerging research.”

Mr Parle added that extensive research was “ongoing and is continuously published concerning the potential chronic toxicity of fluoride exposure” in humans and animals.

“To date, there is no change to the advice from the IEBFH to the Minister regarding water fluoridation policy in Ireland. Nevertheless, given the pace of research growth in this area, it requires constant vigilance by an independent body in the future, as previously promised to the public.”

In a follow-up letter to the Minister in December, Mr Parle again noted that the IEBFH had unanimously agreed to voice the “disappointment and frustration” of members “at the lack of communication as to whether there will be a successor to the IEBFH and how the IEBFH role would be allocated from January 2023”. 

Mr Parle also pointed out that the IEBFH had “written on a number of occasions in recent months seeking clarification as to how the current role of the IEBFH would be fulfilled once its term finished”.

“Thus far no clarification has been received,” he wrote.

‘Constant review’

In response to questions from this newspaper regarding these concerns, the Department spokesperson said the policy of community water fluoridation (CWF) remains under constant review.

“As part of this monitoring approach, since 2015 the Department has been requesting the Health Research Board (HRB) to complete periodic systematic reviews of the evidence regarding water fluoridation and systemic (non-oral) health,” the spokesperson told MI.

“The latest of these reviews was published in November 2022 and indicates there is no need to change the current fluoridation policy. The HRB is also currently completing a further in-depth evidence review of fluoridation and
oral health, which will be published later this year.”

The independent IEBFH has advised the Minister on fluoridation issues since 2004 and has been “another important component of the Department’s monitoring approach”, the spokesperson said.

“The Minister for Health extends sincere thanks to the members of the Irish Expert Body on Fluorides and Health, whose term of office expired on 31 December 2022, for their valuable contributions to public service.”

The spokesperson added that the Department is building on the previous monitoring approaches and combining it into a “single programme”.

“This will require additional elements that can’t be accommodated within the expert body model, which was voluntary and done in addition to the members’ full-time roles.”

The spokesperson added that the Department is convening a working group “staffed from Departments and agencies, which will develop proposals for a new model for fluoridation monitoring in line with modern developments in public health surveillance”.

“At the request of the Department, the HRB has assessed international monitoring systems to inform the development of a modern monitoring system of water fluoridation and its impacts.”

The national oral health policy (Smile agus Sláinte) supports the continuation of water fluoridation, which has been in place in Ireland since the 1960s.

It is “a key component of our preventive strategy to reducing dental decay and improving the oral health of the population”, according to the Department.

HRB document

The HRB review from November 2022, referenced by the spokesperson, is a 411-page document titled Impact of community water fluoridation on systemic health excluding oral health: An evidence review.

The review noted that CWF was introduced in 1964 following the Health (Fluoridation of Water Supplies) Act, 1960. In 2000, water fluoridation policy in Ireland was the subject of a major review by the forum on fluoridation. The Fluoridation of Water Supplies Regulations 2007 stipulate that fluoride may be added to public water supplies, either in the form of hydrofluorosilicic acid, or in such other form as may be approved by the Minister for Health.

According to the HRB review, in 2017 just over 71 per cent of people living in Ireland had access to publicly provided CWF at an average annual cost to the State of €2.15 per capita of population receiving fluoridated water. Water supplied by local government (which services all urban areas) is required to be fluoridated; however, private water supplies from wells or local community “group schemes” are not required to be fluoridated.

In its conclusion, the review noted that it examined 30 studies from nine countries, including Ireland, between 1990 and September 2021.

The review of these studies “indicates that there continues to be no definitive evidence that CWF has negative health effects. We found no conclusive evidence for a link between CWF and most conditions we examined, for which research was available, including bone health, cancer, kidney stones, birth and infant abnormalities, and death rates.”

“While bone health and cancer have previously been primary areas of concern for researchers, the findings of this review point to generally mixed or null findings in relation to these outcomes,” it stated.

“However, neuropsychological and endocrine outcomes emerged as areas requiring further monitoring; as the existing research in this area is currently limited in scope and interpretation is hampered by methodological problems, further high-quality research is now needed in order to shed light on the impact, if any, of artificial water fluoridation on these aspects of systemic health.”