The recent review, ‘New evidence on fluoridation’, by Diesendorf, Colquhoun, Spittle, Everingham and Clutterbuck (Australian & New Zealand Journal of Public Health 1997 21 187-90) claims a consistent pattern of evidence pointing to fluoride damaging bone, a negligible benefit in dental caries reduction from ingested fluoride, and any small benefit from fluoride coming from the action of fluoride at the tooth surface. Public health authorities are allegedly reluctant to pursue such evidence. In the interest of scholarly debate, invited by Diesendorf et al, this reaction paper examines six separate areas raised in the original paper: fluoridation and hip fracture; fluoridation and osteosarcomas; pre-eruptive and post-eruptive benefits in dental caries reduction; fluoride ingestion; benefit in dental caries reduction for contemporary Australian children; and bias of health authorities and responsible science. Numerous examples of bias in the identification, selection and appraisal of the evidence on water fluoridation presented by Diesendorf et al are developed. Further, this reaction paper puts forward both studies and appraisal indicating that water fluoridation should continue to be regarded as a safe and effective public health measure.

Key words: Dental caries; Fluoridation; Fluorosis; Hip fracture; Osteosarcoma.

Reprints: A J Spencer, University of Adelaide,
Department of Dentistry, Adelaide, SA 5005, Australia.

COMMENTS

The arguments advanced in Dr Spencer’s lengthy critique were mostly answered in our reply to earlier critics (see Fluoride 31 (3) pages 166-169 August 1998). In that reply we commented: "They list studies that, in their view, counterbalance the comprehensive data on which we based our conclusion that fluoridation should be discontinued. Such publications do not nullify the compelling evidence of harm represented by the comprehensive data we reviewed. In any case, even if the evidence is conflicting, so that conclusions remain in dispute, the precautionary principle is itself grounds for discontinuing the mass uncontrolled fluoride dosing of entire populations." We then dealt in detail with the various small-scale and inadequate studies which our critics, and now Dr Spencer, claimed were adequate rebuttals of our review. In his concluding section Spencer alleges bias because of our "rejecting the findings of groups tasked with reviewing and evaluating the evidence on the safety, effectiveness and efficiency of water fluoridation" – such groups being pro-fluoridation "health authorities" whose reviews he describes as "responsible science".

John Colquhoun

More needs to be said about the so-called "experts" who are alleged to do "responsible science". Perhaps readers could be reminded that earlier this century such experts in the field of medicine

1. treated pregnant women with stilboestrol which led to the development of vaginal cancers in their daughters;
2. prescribed large oral or intravenous doses of radium salts for circulatory, nervous, endocrine and psychiatric disorders;
3. encouraged the over-use of aspirin resulting in outbreaks of kidney disease and gastric ulcers;
4. x-rayed pregnant women routinely, resulting in an increase in childhood cancers.

   Mark Diesendorf

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   FLUORIDE 31(4),  1998, p 222	International Society for Fluoride Research
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