1. This report has been structured to reflect the sequence in which the Taskforce tackled the many issues arising from the fluoridation debate, and also attempts to capture the dynamic nature of Taskforce discussions and deliberations. As the report shows, Taskforce members were able to reach a consensus on a broad range of the less contentious issues. However, in relation to fundamental questions concerning the efficacy, effectiveness and safety of water fluoridation, the Taskforce was deeply divided between those who were strongly committed to water fluoridation as a public health measure, and those who remained unconvinced by the arguments that fluoridation was necessary, effective and safe.

A small majority of Taskforce members (52%) stated that they were opposed to the fluoridation of Brisbane’s water supply. A significant proportion of members (23%) who had initially been supportive of fluoridation had changed their opinion to opposition by the end of the Taskforce process.

2. The Taskforce was satisfied that the weight of scientific evidence overwhelmingly supported the decay-reduction effect of water fluoridation. However, there was considerable disagreement about the extent of the benefits and the use of percentages to express reductions in dental decay.

3. Many Taskforce members were unconvinced by assurances that serious risks to health were negligible or non-existent. In particular, there was concern about ambiguous scientific evidence of an association between water fluoridation and higher levels of hip fracture.

The Taskforce noted that the National Health and Medical Research Council (NHMRC) Working Group, which had supported fluoridation, had expressed considerable concern about the fact that it could not point to a single Australian study which had monitored adequately the impact of possible adverse consequences of fluoridation (NHMRC) 1991, Section 8). The majority of the Taskforce was concerned that these inadequacies have still not been addressed. Many Taskforce members were also concerned that the pro-fluoridation case had relied heavily on studies from abroad which do not take account of aspects particular to Brisbane e.g. its sub-tropical climate.

4. There was also concern about the lack of scientific research on the lifetime effects of an accumulation of fluoride in the body, in spite of the 1991 NHMRC Working Group statement that ‘it was imperative that public health recommendations in the future be based on accurate knowledge of the total fluoride intake of Australians (NHMRC 1991, Section 8.3). This aspect was highlighted by most Taskforce members as an area which required further scientific investigation.

5. Many Taskforce members had doubts that the available evidence proved that the dental decay problem in Brisbane was serious enough to warrant water fluoridation:

• dental decay rates have been falling for three decades in both fluoridated and unfluoridated communities.
• there was a lack of contemporary dental evidence on the scale of the problem in Brisbane, particularly in relation to adults.
• research evidence showed the complexity of trying to separately identify the benefits of water fluoridation alone, as illustrated by the recent comparison study of children in Brisbane and Townsville (University of Adelaide).
• dental decay rates (DMFT for 12 year olds) amongst children in Queensland (1.37 in 1995) appear to be similar to the Australian average (1.01 in 1995), as illustrated in the tables below:
• the widespread availability and use of other sources of fluoride.

DMFT rates (National Oral Health Survey, 1987 p.45 Table 20)

Capital city	Brisbane	Sydney	Canberra	Hobart	Perth	Adelaide	Melbourne
Age 10-14	2.3	1.4	1.1	1.0	1.8	2.4	2.1
Age 15-19	5.3	2.8	3.2	3.4	4.4	4.8	5.0

DMFT rates (School of Dentistry, University of Adelaide, 1995)

State or Territory	New South Wales	Victoria	Queensland	South Australia	West Australia	Tasmania	Northern Territory	Australian Commonwealth Territory
12-yr-olds	0.93	1.02	1.37	0.64	1.04	0.86	0.82	0.61
National Average: 1.01

6. The Taskforce accepted that the effectiveness of water fluoridation in reducing dental decay has declined in the last 20 years as a result of the advent of other sources of fluoride, as well as other factors. However, the Taskforce was sharply divided on the current level of effectiveness of water fluoridation, in the light of falling decay rates.

The effectiveness of water fluoridation varies with the concentration of fluoride in the water supply. At the optimal concentration for a temperate climate of 1 ppm, effectiveness in decreasing dental decay would be greater than at the 0.7 ppm level recommended by USPHS for a sub-tropical climate.

The majority of Taskforce members, however, agreed with the WHO recommendation that 0.5 ppm would be the appropriate level for a sub-tropical climate. This would further reduce the effectiveness of fluoride while also reducing the risk of dental fluorosis.

7. There was considerable concern amongst many Taskforce members that water fluoridation could increase the total intake of fluoride in excess of a safe level for babies and young children.

8. The evidence relating to what constituted a safe or a toxic dose of fluoride was uncertain and confusing. A majority of Taskforce members were concerned that the margin of safety between a safe and toxic dose may not be sufficiently wide.

9. The majority of the Taskforce accepted the findings of Dr Miller’s limited study of the environmental impact of a fluoridated water supply on the Brisbane area. The majority agreed that the study had raised concerns about the possibility of adverse effects on some sensitive plant and marine species, and that further experimental studies and other biological assessments would be required to reach more definite conclusions. The majority of the Taskforce accepted that there had been little examination of the environmental effects of water fluoridation world-wide.

10. The Taskforce agreed that dental decay is not a disease which is spread equally throughout the population, and that there are clearly many individuals and groups who are more susceptible and at more risk. Water fluoridation is particularly aimed at those who do not or are unable to look after their teeth, for example, young children and those in lower socio economic groups. Although the Taskforce did not discuss the options for tackling the problem in detail, there seemed to be scope for more effective targeting of those at risk, and for obtaining the benefits of using different fluoride treatments in combination.

11. The Taskforce concluded from the evidence, and from correspondence with the Australian Dental Association and NHMRC, that the recommendations of the 1991 NHMRC Working Group for an immediate increase in Australian dental public health research, and for improved dental health monitoring, have not been implemented.

The majority of Taskforce members would not support the introduction of water fluoridation to Brisbane until the recommended Australian research has been carried out. However, if the required data gathering and research were carried out, the Taskforce could be reconvened to consider any new evidence.

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Background note: The above Taskforce was established in January 1997 in response to debate in the media and the political arena about whether Brisbane’s water supply should be fluoridated. Brisbane is the only State capital in Australia to remain unfluoridated. In his Foreword to the Final Report, the Lord Mayor stated: "The Taskforce was structured to provide a forum to hear both sides of the argument. The 17 members included experts from professional organisations which support fluoridation, such as the Australian Dental Association and the Australian Medical Association, and also representatives from other professional bodies with opposing views. I considered that it was particularly important that the Taskforce include representatives of the public and also those other local governments which share Brisbane’s water supply. Both of these groups came to the Taskforce without predetermined or fixed views and, as such, were able to consider the issue from a more neutral perspective. .... Throughout this six month process, the representatives of the community listened to the experts argue the case. These community representatives came down clearly against the fluoridation of Brisbane’s water at this time."

FLUORIDE 31(4), 1998, pp 232-234	International Society for Fluoride Research
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