Yes; they admit that. They say it was the investigation of the relationship between fluorides and the mottling of dental enamel that directed attention to the very significant fact to which I am just coming. They say:
The very mild mottling of teeth found in communities where fluoride is in the range of 1½ parts per million is of no cosmetic signicance——
I hope the Leader of the Opposition will note the words "cosmetic significance".
—and can be detected only by careful dental examination as a light white flecking of the enamel.
They say later, however:
Imperfections of enamel development occur frequently and may be caused by a wide variety of factors.
This is not of very great significance at this stage, but, if this controversy is prolonged much further, I venture to predict that you will certainly hear of the appalling effect fluorides have in conducing to the mottling of dental enamel. The Commission in its report points out that the imperfections of enamel development occur frequently and may be caused by a wide variety of factors. Therefore, excessive fluoridation is not the sole cause—and, mark you, I say "excessive fluoridation"—of mottling.
They say:
In reporting the studies on mottled enamel an impression that the difficulty was accompanied by a low prevalence of dental caries was noted. This impression stimulated further studies on fluorides in drinking water as a factor in dental health.
It is with those studies that our present knowledge of the subject begins. The W.H.O. experts go on to say:
Wide variations in the enamel according to the fluoride content of communal drinking waters in many countries in the world provided exceptional opportunities for studying and determining the relation between the prevalence of dental caries and fluoride concentration.
We heard Deputy Ryan speak at length about how this fluoridation process has been based on the conclusions derived from a few experiments concentrated within a few years; that, really, there had not been enough investigation into this whole problem to tell us whether we were doing right or wrong in adopting this measure. Deputy Manley admitted he had greatly been influenced by that type of argument.
Here is the Expert Committee of the World Health Organisation telling us that on the contrary:
Wide variations in the naturally occurring fluoride content in communal drinking-waters in many countries of the world provided exceptional opportunities for studying and determining the relation between the prevalence of dental caries and fluoride concentration. Notable among these countries is the United States of America, where more than 3 million people live in communities where the natural fluoride concentration of the drinking-water is 1.0 p.p.m. or greater.
So we are embarking upon a scheme which has been subjected to a great deal of research and investigation. As the Expert Committee found:
These studies demonstrated that there was an inverse relationship between the fluoride level in the water and the incidence of caries. With low levels, the caries was severe, but with about 1 p.p.m. fluoride children had only one-third as much caries as had those of the same age in areas where there was very little fluoride in the water. With levels of more than 1 p.p.m. fluoride there was very little further reduction in caries.
They went on to say:
The pattern of the initial series of investigation has been followed by a long and increasing list of independent investigators in other parts of the U.S.A. and in many countries of the world. These countries include Argentina, Canada, England and Wales, Greece, Hungary, India, Kenya, Norway, Sweden, Switzerland, Turkey, Union of South Africa, and U.S.S.R. With a remarkable degree of uniformity, the different observers reported the fact that there is an inverse relationship between the prevalence of dental caries and the fluoride concentration in drinking-water up to approximately 1 p.p.m. This fact was important.
First of all, a remarkable degree of uniformity is observed, and then the establishment of a co-relation which the experts conclude is important.
Maximum dental caries benefits were associated with a concentration of fluoride which is below the minimum threshold established for mottling of the teeth or dental fluorosis.
The public health significance of the striking difference in caries prevalence among children in fluoride and fluoride-free areas was further enhanced by a study of adult populations which demonstrated that the effect of fluoride continues into adult life without any appreciable diminution with age. Groups of adults aged 20-44 years were examined in an area where the water contained 2.5 p.p.m. fluoride and compared with similar groups in a fluoride-free area. It was found that in each group studied, and up to 44 years of age, caries experience in the fluoride area was only about one-third as much as in the non-fluoride area.
Deputies heard Deputy Ryan this morning and I think Deputy Manley, too, to some extent, saying that after all this fluoridation was only going to be beneficial for a few years; that it was true that it would defer the onset of dental caries; but that the advantages and benefits of the treatment would not be carried over into adulthood. But here is what this Expert Committee had to say: that the beneficial effects are carried over and continue into adult life without any appreciable diminution with age. Then they go on to say about this "deadly poison" that Deputy Ryan was so rhetorical about this morning:
As a logical sequence to all the knowledge which had been gained, it was decided in the USA. in 1944 to add fluorides to some water-supplies as a means of preventing dental caries.
The potential significance of the dental effects of fluorides in drinking-water stimulated broad interest in the physiological effects.
Fluorine in a combined state in nature is found almost everywhere throughout the world, and is a constituent of certain minerals found in rock and soil. There is a substantial volume of literature reporting the world-wide geographical distribution of fluorides contained in domestic water-supplies where a fluorine dental-caries relationship has been found.
The Almighty must be very wicked for, according to the Deputy Ryan, He proposes to poison one part of the world's population by ensuring that through the structure of this our earth a great many people will have to ingest much more than one part per million of fluorine every time they take a drink of water. Again, as the Commission points out, fluorine is also found in teeth and bones and in many of the foods which are commonly eaten.
I said in my opening speech that if anybody wanted to live on a diet free from fluorine, he would have to confine himself to beets and cauliflowers, and make certain that these were cooked in distilled water. The Commission go on to say:
It had been established, too, that the use of drinking-water containing several times the optimum fluoride concentration does not affect skeletal development or height and weight; that most of the fluoride ingested is eliminated; that fluoride has an affinity for calcified tissues and especially for teeth; that the first signs of having used drinking-waters contaning fluoride during the period of tooth formation are found in the teeth; and that the rate of bone fractures among young adult males is no higher for those using fluoridated drinking-water than for others.
I think that disposes most effectively of certain of the arguments which we heard from Deputy Ryan this morning.
Then the report proceeds:
The controlled fluoridation of community drinking-water supplies was started in 1945, at Grand Rapids, Mich., USA., and shortly afterwards at Newburgh, N.Y., USA., and Brantford, Ontario, Canada.
"The controlled fluoridation", not the mere natural fluoridation, of community drinking-water supplies was started in 1945. That is the origin of the 15 years we have heard about.
In each case, fluorides were added to the water to bring the concentration up to 1.0-1.2 p.p.pm., and for each fluoridation city a control area was selected. These studies were planned to extend over a period of 10 years so that the deciduous dentition and most of the permanent dentition would be subjected to fluoride during the whole period of development and calcification, and would be exposed for some years to caries-attack.
This was the procedure adopted:
Detailed dental examinations were carried out on children between 4 and 15 years of age before fluoridation started and were repeated each year. Dental caries experience in the fluoridation areas was compared with that in the control areas, and also with caries experience among similar groups of children in Aurora, I11., a natural fluoride area with 1.2 p.p.m fluoride in the water. This was done to determine whether the added fluoride was as effective in reducing dental caries as fluoride which occurred naturally.
This was the result:
Reports of the results after 10 years of controlled fluoridation in three cities, two in the USA and one in Canada, show a remarkable uniformity. The prevalence of dental caries in the permanent teeth of continuously resident children who had used the fluoridated drinking-water throughout life was decreased by some 60 per cent....
It will be recognised from this that if we had had the fluoridation process in operation here during the past 15 year the incidence of dental caries among boys and girls of 12 and 13 years of age in our cities, towns and villages would now be lower by almost two-thirds. Surely that is a very considerable fact to place against any of the statements which have been used here by Deputy Ryan?
The report goes on:
The results obtained in the three studies confirmed the hypothesis that the use of drinking water with 1 p.p.m. fluoride produces identical dental and general effects whether the fluoride occurs naturally or is added by mechanical means.
Dental caries experience in the teeth of children born prior to fluoridation was also appreciably reduced.
It continues:
Observations on growth and development, calcification of bones, elimination of fluorine in the urine, dysplasia of the teeth, gingivitis, hearing, sight, and blood were made in one or more of the study projects...
I do not want to go through all those because I am sure the House would be bothered unnecessarily. Several copies of this Report will be made available in the library. Here is one passage, however, which I must quote:
In this section, those biological properties of inorganic fluorides that are reasonably well established are described in general terms to furnish evidence that the knowledge of the effects of fluorides is sufficiently extensive and detailed to guarantee adequately the safety of water fluoridation.
I hope Deputy Manley who made a thoughtful speech—a speech, I think, which showed he was really disturbed, will read this report and ponder on the significance of that. After all, these persons who are competent to judge do know a great deal about the subject. Nobody in the world knows everything about anything but these well-informed and expert-persons do say that the knowledge of the effects of fluorides is sufficiently extensive and detailed to guarantee adequately the safety of water fluoridation. Then they go on to deal with another point which I think was referred to by Deputy Ryan in his conclusion. They go on to deal with this:
No evidence of enzyme inhibition by fluoride is known in persons ingesting fluoridated water with concentrations optimal for dental health.
We all know the important part bacteria and enzymes play in the digestive processes.
They then go on to say:
"Oral bacteria in media containing 1 p.p.m. fluoride in vitro have shown no reduction in acid production”.
They then proceed to say how fluorides are rapidly absorbed from the gastrointestinal tract and how they are with almost equal rapidity evacuated therefrom.
They then give another finding which, I think, I ought to quote having regard to the statements made by Deputy Ryan:
No effects whatsoever have been detected on the mineral metabolism, specifically of calcium, phosphorus and magnesium, when the drinking water contains 1 p.p.m. fluoride.
They further say:
An increasing body of evidence testifies to the absence of any effect on somatic and psychic growth of children in areas in which drinking water contains optimal amounts of fluoride.
Then they proceed to deal with all these bogies about the effects of fluoridisation upon certain conditions with which Deputy Ryan regaled the House this morning. I think, again, that it would be only fair to the House that I should not burden them with these. passages I can assure the House that they are conclusive and that they can be studied in the Libary. The report proceeds:
The most convincing evidence of the safety of water fluoridation comes from the numerous population groups (3 million in the U.S.A., 0.5 million in England) who have drunk naturally fluoridated water containing 1 p.p.m. or more during their lifetimes. In these groups water-drinking has been, of course, uncontrolled, and there have been well and ill babies as well as healthy young adults and frail elderly people. Medical practitioners and specialists in these areas have never detected and defined a systematic aberration in health of any kind related to the fluoride consumer (except mottled enamel in endemic areas). Large-scale epidemiological tests are lacking. The long-range detailed paediatric study of the Newburgh-Kingston children, including observations on growth, blood count, X-ray of bones, etc., offers convincing evidence of the normal health of children drinking 1 p.p.m. in their water. The Bartlett-Cameron survey, a 10-year longitudinal study of 168 individuals, demonstrated no adverse health effects with even 8 p.p.m. in the drinking-water, although tooth mottling and a low incidence of osteosclerosis were found. Mortality and morbidity rates are comparable for fluoridated and non-fluoridated population groups: the mortalities from five leading causes of death-heart disease, cancer, cerebral accidents, nephritis and liver cirrhosis— were the same in 32 pairs of American cities, one of each pair receiving fluoridated water, the other not.
The report continues:
All these findings fit together in a consonant whole that constitutes a great guarantee of safety—a body of evidence without precedence in public health procedures.
That is the finding. That is what exhaustive investigation by the most expert committee that could be brought together in the world has found in regard to this process which Deputy Ryan wishes us to believe has been foisted upon the medical, dental and public health professions by interested persons for the most venal motives.
This is the summary which the Committee of Experts give of their findings:
Dental caries is one of the most prevalent and widespread diseases.
There is no hope of controlling the diseases by present treatment methods alone.
Among the numerous preventive methods, the fluoridation of drinking-water is the most promising.
The effectiveness, safety, and practicability of fluoridation as a caries-preventive measure has been established.
1 p.p.m. fluoride has been shown to give maximum benefits: first, by epidemiological studies where fluoride occurs naturally in the water, and, secondly, where fluoride has been added at optimum concentrations through mechanical means.
Hundreds of controlled fluoridation programmes are now in operation in many countries. Some have been in progress for the past 12 years, so that conclusions are based on experience. No other public health procedure, during the initial stages of its application, has had such a background in time or extent.
The biological effects of fluoride have been described in nearly 3000 clinical and experimental reports in the past 20 years. This literature is not only extensive but of broad scope.
Then they say a few other things which I do not think I need bother about.
But they also go on to say this:
Growth and development, somatic and psychic, are normal in children drinking water containing 1 p.p.m. fluoride.
The formation of teeth and even their resistance to caries and their appearance are improved when water containing optimal concentrations of fluoride is consumed.
Over 3 million, people in the USA, over half a million in England, and large population groups in other countries have, during their life time, consumed water containing 1 p.p.m. fluoride or more. Mortality and morbidity rates for five leading causes of death are comparable for cities in the USA with fluoride and non-fluoride public water-supplies. No relation between fluoride and arthritic changes in bone has been found, nor have confirmed cases of allergy to water containing 1 p.p.m. fluoride been described.
The addition of fluorides to public water-supplies has proved to be similar to other routine mechanical procedures widely employed in waterworks practice. Suitable equipment has been developed, reliable analytical procedures are available, and appropriate safeguards have been established.
No other vehicles or techniques for the prophylactic application of fluorides can at present replace the fluoridation of drinking-water as a public health measure. Where water fluoridation cannot be used, research into other vehicles and improved methods of local fluoride application should, however, be encouraged.
There is a summary of their conclusions. In submitting this Bill, I think I can rely on that report, on the very exhaustive investigation of the problem by the Royal Commission of Inquiry set up in New Zealand, and alst but not least, on the findings of the Consultative Council on the Fluoridation of Water Supplies set up by my predecessor, Deputy T. F. O'Higgins.
I would ask any person who has been influenced by the sort of thing we heard here, alleging ulterior motives on the part of dentists, alleging that some people were making millions of pounds out of this fluoridation process, charges made so recklessly by Deputy Ryan this morning, to consider the names of the people who signed the report of the consultative council, to consider their eminence in our society, to consider their established reputations and ask if these gentlemen, who heard the evidence and the statements made on behalf of the Pure Water Association by its chosen representatives, who heard everything that Deputy Ryan said this morning, could be swayed by the unworthy motives that Deputy Ryan seems to ascribe to every person who has been driven to the conclusion that for the benefit of the nation, for the benefit of future generations, we ought to require those who supply water to the people to supply it in a form which will make it an effective preventative against a very serious disease.
These men are eminent in their own walks of life. They were chosen by my predecessor as persons who were competent to advise him and on whose judgment he was confident to rely. I accept absolutely his position and view in that regard. The report of the consultative council has shown that its members have given a great deal of time and much care to this matter, and it also shows that our position in regard to caries is among the gravest in the world. When I got the report, I had to ask myself: "Am I going to allow their efforts to go for nought?" I had to ask myself: Am I going to have a decision on this matter, which affects the general health of our people, from the responsible authority, that is, this House, this legislature? And as the Minister chosen by the majority in this House to carry responsibility for our health services, am I going to shoulder that responsibility: am I going to try to make these findings effective, or am I going to pass the buck to county councils and some obscure district councils and say: ‘You are responsible; you will be responsible for defying the sort of demagogy which will be hurled against you. You will be told that you will be responsible to the people if you put this ‘deadly poison' (sic) into their pure water. You will be responsible for defying the ethical principle involved in this matter."
The commission had the ethical aspects of this matter examined and their findings were that they were advised that such a problem did not arise in this context. Notwithstanding, Deputy Ryan this morning trotted out an Encyclical of the late Holy Father in regard to quite a different matter. If he had his way we may be sure that he would strive to mislead the urban councils in the same way, and that the Encyclicals of the Pope would be used for a vile purpose, to defeat something for the welfare of our children. I think that it is up to the House not to facilitate that sort of campaign, that it should carry its responsibility, as I am prepared to carry mine.
As regards control, I want to make it clear that there are safeguards against the unwarranted abuse of powers given to the Minister by this Bill. It is implied in Section 6 that he must conduct certain surveys, before making fluoridisation compulsorily, he must see that surveys are conducted periodically, so that, before any public water supply is fluoridated, he shall see to it that a survey is conducted as envisaged in Section 6. There is also further provision in Section 8 that the regulations requiring authorities to fluoridate their water supplies will be laid on the Table of the House and I shall guarantee they will be laid there in ample time to allow the House to consider them. That is as far as I can go to meet the points which were made by the Leader of the Opposition.
