Hants & IOW SHA reply in regard to total fluoride intake
Dear Dr Lewis
Water Fluoridation
Thank you for your letter dated 28 June addressed to Gareth Cruddace. May I begin by explaining that Gareth has taken up a long-term secondment at the Department of Health in London, and I am now the Chief Executive for the Hampshire and Isle of Wight Strategic Health Authority, a role I am combining with that of Chief Executive for the Dorset and Somerset Strategic Health Authority.
On reviewing the points raised, it is not the case that the World Health Organisation (WHO) has "warned" dental and public health administrators to "be aware of the total fluoride exposure of the population before introducing additional fluoride programmes for caries prevention". The WHO recommends water fluoridation without any such reservation.
Although the words "Dental public health administrators should be aware of the total fluoride exposure in the population before introducing any additional fluoride programme for caries prevention" are indeed contained in the WHO 1994 report Fluorides and Oral Health, unfortunately they are frequently quoted out of context. Indeed, in 1998, as a result of the National Pure Water Association's persistent misinterpretation of its report the Chairman of the WHO Expert Committee on Oral Health Status and Fluoride Use, Professor Brian Burt, issued a statement. Professor Burt's statement makes clear that:
. exposure to appropriately fluoridated drinking water and routine tooth brushing with a fluoride
toothpaste is considered a basic level of protection against caries; and that
. the "additional programmes for caries prevention" referred to in their report are over and above the basic level of protection of fluoridated water and routine use of fluoridated toothpaste;
. such additional programmes might include fluoride mouth rinses or supplements, and "the
population" referred to would include some patient groups whose medical conditions are such that the risk of tooth decay or its treatment would be considered to outweigh the risk of dental fluorosis.
In the UK, the Food Standards Agency undertakes regular surveys to obtain information on the concentrations of metals and other elements in food. This information, together with food consumption data, is used to estimate dietary exposures and assess the safety of foods consumed in the UK. The Total Diet Study (TDS) is an Important part of - the Food Standards Agency's surveillance programme for chemicals in food. It has been carried out on a continuous annual basis since 1966 (by JFSSG and MAFF prior to the establishment of the Agency). Results from the TDS are used to estimate dietary exposures of the general UK population to chemicals in food, such as nutrients and contaminants, to identify trends in exposure and make assessments on the safety and nutritional quality of the food supply. The 1997 Total Diet Study, reported in 2000, provided information on dietary exposures to fluoride of the general UK population (http://www.food.gov. uklscience/surveillance/fsis-2000/5tds). Estimated exposures (population
average, 1.2 mg/day) were similar to those estimated for 1978-1980 (1.8 mg/day).
On 28 June 2004, in a Parliamentary Written Answer, Lord Warner, Parliamentary Under-Secretary of State for Health, reported that the Chief Medical Officer and Chief Dental Officer in their advice on the implications of the Medical Research Council. Report Water Fluoridation and Health (bttP:/ /www.mrc.ac. uklindex/public-interest/publ ic-news-4/public-news archive/public-news-
archive sep oct 02/public-fluoridation report-2.htm) had recommended (inter alia) continued monitoring of fluoride exposure using data already collected as part of the National Diet and Nutrition Survey.
In conclusion, neither the World Health Organisation, nor the Chief Medical Officer and the Chief Dental Officer; recommend that health-authorities undertake studies of the total fluoride exposure in the population before introducing community water fluoridation.
I hope that this letter clarifies the points raised but if you or your constituent requires any further information, please let me know.
Yours sincerely
SIR IAN CARRUTHERS OBE
Water Fluoridation
Thank you for your letter dated 28 June addressed to Gareth Cruddace. May I begin by explaining that Gareth has taken up a long-term secondment at the Department of Health in London, and I am now the Chief Executive for the Hampshire and Isle of Wight Strategic Health Authority, a role I am combining with that of Chief Executive for the Dorset and Somerset Strategic Health Authority.
On reviewing the points raised, it is not the case that the World Health Organisation (WHO) has "warned" dental and public health administrators to "be aware of the total fluoride exposure of the population before introducing additional fluoride programmes for caries prevention". The WHO recommends water fluoridation without any such reservation.
Although the words "Dental public health administrators should be aware of the total fluoride exposure in the population before introducing any additional fluoride programme for caries prevention" are indeed contained in the WHO 1994 report Fluorides and Oral Health, unfortunately they are frequently quoted out of context. Indeed, in 1998, as a result of the National Pure Water Association's persistent misinterpretation of its report the Chairman of the WHO Expert Committee on Oral Health Status and Fluoride Use, Professor Brian Burt, issued a statement. Professor Burt's statement makes clear that:
. exposure to appropriately fluoridated drinking water and routine tooth brushing with a fluoride
toothpaste is considered a basic level of protection against caries; and that
. the "additional programmes for caries prevention" referred to in their report are over and above the basic level of protection of fluoridated water and routine use of fluoridated toothpaste;
. such additional programmes might include fluoride mouth rinses or supplements, and "the
population" referred to would include some patient groups whose medical conditions are such that the risk of tooth decay or its treatment would be considered to outweigh the risk of dental fluorosis.
In the UK, the Food Standards Agency undertakes regular surveys to obtain information on the concentrations of metals and other elements in food. This information, together with food consumption data, is used to estimate dietary exposures and assess the safety of foods consumed in the UK. The Total Diet Study (TDS) is an Important part of - the Food Standards Agency's surveillance programme for chemicals in food. It has been carried out on a continuous annual basis since 1966 (by JFSSG and MAFF prior to the establishment of the Agency). Results from the TDS are used to estimate dietary exposures of the general UK population to chemicals in food, such as nutrients and contaminants, to identify trends in exposure and make assessments on the safety and nutritional quality of the food supply. The 1997 Total Diet Study, reported in 2000, provided information on dietary exposures to fluoride of the general UK population (http://www.food.gov. uklscience/surveillance/fsis-2000/5tds). Estimated exposures (population
average, 1.2 mg/day) were similar to those estimated for 1978-1980 (1.8 mg/day).
On 28 June 2004, in a Parliamentary Written Answer, Lord Warner, Parliamentary Under-Secretary of State for Health, reported that the Chief Medical Officer and Chief Dental Officer in their advice on the implications of the Medical Research Council. Report Water Fluoridation and Health (bttP:/ /www.mrc.ac. uklindex/public-interest/publ ic-news-4/public-news archive/public-news-
archive sep oct 02/public-fluoridation report-2.htm) had recommended (inter alia) continued monitoring of fluoride exposure using data already collected as part of the National Diet and Nutrition Survey.
In conclusion, neither the World Health Organisation, nor the Chief Medical Officer and the Chief Dental Officer; recommend that health-authorities undertake studies of the total fluoride exposure in the population before introducing community water fluoridation.
I hope that this letter clarifies the points raised but if you or your constituent requires any further information, please let me know.
Yours sincerely
SIR IAN CARRUTHERS OBE
posted by Bill at
6:18 PM
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