I propose to take Questions Nos. 183 to 186, inclusive, together.
Water fluoridation and the use of appropriate fluorides is a major plank of public health policy in Ireland in the prevention and management of tooth decay. In 2002 the Forum on Fluoridation, which was established to review this policy, concluded that the fluoridation of public piped water supplies should continue as a public health measure.
Fluoride may be added to public water supplies either in the form of hydrofluosilicic acid complying with the specifications for that substance in Schedule 1 to the Fluoridation of Water Supplies Regulations 2007 (SI 42 of 2007) or in such other form as may be approved by the Minister. Chemifloc Ltd. is the company contracted by the HSE for the supply and delivery of hydrofluosilicic acid for the purpose of water fluoridation. Fluoride is sourced as a primary product in Spain, mined directly from a raw material source - the mineral fluorospar. It goes through a purification process to conform to tightly controlled specifications under the requirements of CEN Standard I.S.EN 12175:2001 to produce hydrofluosilicic acid, specifically used as the mineral additive, fluoride, to water. This process is conducted by a company in Spain - Derivados del Fluor. The fluoride is added to the public water supplies at water treatment plants throughout the country by the local authorities acting as agents for the health authorities as provided for in the Health (Fluoridation of Water Supplies) Act 1960.
The Fluoridation of Water Supplies Regulations 2007 requires that a daily test is carried out at water treatment plants by the local authority water services staff to determine fluoride content. Monthly fluoride testing is carried out by the HSE and the Environmental Protection Agency also carries out testing which requires monitoring of fluoride levels in water supplies.
Some European countries use an alternative systemic approach to fluoridation such as salt fluoridation or milk fluoridation in their public health programmes. Others use fluoride mouth-rinses and/or tooth-brushing or painting of teeth with fluorides. Additionally, all European countries promote the widespread use of fluoride toothpastes.
The USA, Canada, Australia, New Zealand, United Kingdom, Israel, Malaysia, Singapore, Hong Kong, Argentina, Chile, and Colombia actively fluoridate water supplies. Over 204 million people (approximately 66% of the population) in the USA receive fluoridated water with coverage having increased by around 24 million people between 2002 and 2012.
No claim associating water fluoridation at the optimal level with negative health effects has been substantiated. A known side effect at this level is enamel fluorosis, which is a cosmetic or aesthetic condition which refers to the way teeth look and is generally easy to treat. This is in contrast to the treatment of tooth decay which may on occasion involve the use of general anaesthesia and hospitalisation. Fluorosis has been rigorously monitored in Ireland and changes in fluorosis levels were responded to by lowering the levels of fluoride in water from 2007 and advising on the appropriate use of fluoride toothpaste.
The European Commission Report 2011 to which the Deputy refers is presumably the Report of the Scientific Committee on Health and Environmental Risks (SCHER). It states that a narrow margin exists in children between achieving the beneficial effects of fluoride in reducing dental decay and the potential adverse effect of dental fluorosis. This is true regardless of the source of fluoride, whether from water fluoridation or other sources, such as ingested toothpaste. The maximum fluoride concentration allowed in fluoridated water in Ireland is 0.8 mg/l. The SCHER conclusions derive from concentrations exceeding 0.8mg/l; 1.5mg/l and 3mg/l. It cannot be inferred from these conclusions that children here are exposed to unsafe doses of fluoride on a daily basis.
The impact of water fluoridation on caries levels in Ireland has been regularly assessed in both national and local surveys since its introduction in the mid 1960s. The national studies which have been undertaken are Children's Dental Health in Ireland 1984; Oral Health of Irish Adults 1989-1990; Oral Health of Irish Adults 2000-2002; North South Survey of Children's Oral Health 2002. In addition, regional studies were undertaken in the 1990s and a cross border study in 2006. All show a substantial benefit of fluoride in terms of a reduction in tooth decay. At present a research project "Fluoride and Caring for Children's Teeth " (FACCT) is being conducted by the Oral Health Services Research Centre, University College Cork and supported by the HSE.
The Irish Expert Body on Fluorides and Health, established in 2004, continuously monitors new and emerging issues on fluoride and its effects. It advises that the balance of scientific evidence worldwide confirms that water fluoridation, at the optimal level, does not cause any ill effects and protects the oral health of the population. The opinion of the Expert Body is supported by major international scientifically validated reviews. The effects of fluoride on health and related matters are kept under constant review.