Joy Warren made this Freedom of Information request to Public Health England

Dear Public Health England,

When water fluoridation was first proposed in the USA in the 1940s, scientists established an optimum of 1 mg fluoride/litre of water. This level was accepted as being the level at which fluoride would be effective at preventing dental decay but which would not cause moderate dental fluorosis.

In the past 5 years, the concentration of added fluoride has been reduced to 0.7 mg fluoride/litre of water in the USA because too many children are experiencing Moderate Dental Fluorosis. Thus the US Health Authorities have been able to move with the times and have acknowledged the causation between too much fluoride and Moderate Dental Fluorosis.

In the 1940s – 1950s, the use of fluoride by dentists was not widespread and it was considered to be safe to add 1mg fluoride/litre drinking water. These days, we are being assailed with rather more fluoride in our environment: fluoridated toothpaste, fluoridated bathwater, fluoridated varnish, fluoridated foods and drinks, fluoridated floss, fluoridated mouthwash, fluoridated dental cement and fluoridated pharmaceutical drugs.

Fluoridated toothpaste is instrumental in causing Dental Fluorosis if swallowed. Unfortunately, according to Rock and Sabieha (1997), young unsupervised children swallow their toothpaste and this, together with swallowing fluoridated water, contributes to Dental Fluorosis. The York Review (2000) estimated the prevalence of Moderate Dental Fluorosis as being 12.5% of the population where the water is fluoridated at 1mg fluoride/litre water and 48% Dental Fluorosis of all types at the same concentration. Even at 0.7 mgF/litre, the estimate is 10% and 42% respectively. Estimates were arrived at by examining all the research on Dental Fluorosis which met the Review’s researchers’ quality checks and criteria. The York Review was commissioned by the Department of Health in 1999, so its conclusions should be respected and not ignored.

Dental fluorosis is damage to tooth enamel and was regarded by the UK Government in 1999 as being a manifestation of systemic toxicity (Hansard, 20 Apr 1999 : WA 158). Seventeen years later, the prevalence of Moderate Dental Fluorosis is bound to be higher because of the increased use of fluoride varnish in schools and dental surgeries. The fluoride varnish will inevitably erode and be swallowed, thus adding to the toxic body burden of this developmental neurotoxin.

Please answer these questions: 
1. Has PHE considered reassessing the need to fluoridate drinking water at 1 mg fluoride/litre of water in view of the increased and increasing prevalence of fluoride in a child’s environment? Note that the USA and the Republic of Ireland have both reduced the concentration down to 0.7mg F/litre. Why is the UK lagging behind?

2. Has PHE thought to observe the recommendation of the World Health Organisation and aggregate all sources of fluoride before setting or continuing with the original 'optimum' concentration of fluoride which is currently added to drinking water?

3. Because the application of fluoride varnish is increasing throughout areas of England where small disadvantaged children are being given fluoride treatments, has PHE yet thought to review the need to add fluoride to our drinking water? There can only be one reason for adding fluoride to our drinking water and that is to prevent dental decay in small disadvantaged children and they are increasingly receiving fluoride varnish treatments. Older children, teenagers, adults and those who have no teeth do not have enamel capable of being influenced by systemic fluoride and, according to Childsmile, (http://www.child-smile.org.uk/profession... permanent teeth are not capable of being damaged by fluoride after the age of 4: “There would also be very little chance of fluorosis, even with two doses given in quick succession as, after the age of 4 years, most of the adult teeth [under the gum] will have already calcified.” The implication is that if the teeth have calcified under the gum, systemic fluoride cannot have any influence on strengthening the surface of the enamel organ either.

4. In fact, the saliva theory is currently favoured by dental professionals and researchers and when saliva comes into contact with teeth, this is a topical effect and not a systemic effect. Thus the original reason for water fluoridation has disappeared. Now, the saliva theory is all very well but when, according to the NDNS 2014, small children only drink one-third of a litre of water a day, they are circulating a mere 0.0067 mg fluoride/litre saliva, this being 224,000 times lower concentration than in toothpaste at 1,500 ppm fluoride. Is UK Government via PHE content to go along with Local Authorities spending Council Tax on ensuring that small children circulate fluoride at a concentration of fluoride which is 224,000 times less than that found in fluoridated toothpaste?

Yours faithfully,

Joy Warren