Is Water Fluoridation in Singapore Still Necessary
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Is Water Fluoridation in Singapore Still Necessary
- 1. FLUORIDATION IN SINGAPORE Is it 100% safe? Is it really necessary now? A PRESENTATION BY: DENTY MEILIZA GOZALI KHAIRUNNISAA OTHMAN NOR WAHIDAH ARBA’IN NURUL ‘ADILAH JUMATI
- 2. CONTENT PAGE • Objectives • Introduction to Water Fluoridation • Pros and Cons • Relevance to OHTs • Summary • References
- 3. OBJECTIVES • To discuss the risks and benefits of fluoride • Understand further in depth about the significance of water fluoridation in Singapore • Gain insight into the problems occurring in the debate of water fluoridation • Correlate current local water fluoridation issues with our delivery of hygiene care
- 4. INTRODUCTION
- 5. WATER FLUORIDATION IN SING APORE • Singapore is the first country in Asia to fluoridate its water in 1958 • Fluoride range in Singapore • 1958- 0.7ppm • 1992- 0.6ppm • 2008- 0.5ppm Singapore Dental Journal, June 2011 Singapore Dental Journal, June 2011
- 6. PROS AND CONS OF WATER FLUORIDATION IN SINGAPORE
- 7. P R O S C O N S WAT E R F L U O R I DAT I O N I N S I N G A P O R E
- 8. ADVANTAGES
- 9. • Optimally fluoridated water • Low dosage over long period of time – CNA news Ann Acad Med Singapore. 1984 Apr;13(2):247-51. Fluoridation of public water supplies in Singapore. Teo CS. 1. Prevent caries
- 10. 1. Prevent caries Fluoride in water safe, The Straits Times, Nicholas Yong Singapore Dental Journal, June 2011
- 11. 2. Accessibility • Wide public reach • Non-users of fluoridated dental products • Children with parents with busy lifestyle Straits Times, Singapore Dr Hemalatha Nathan 31 Aug 2012 Straits Times, Singapore, Health Minister Khaw Boon Wan 27 April 2010
- 12. 3. Ease of controlling F- dosage • Central water supply • PUB Straits Times, Singapore, Health Minister Khaw Boon Wan 27 April 2010 Singapore Dental Journal, June 2011
- 13. 4. Cost and time effective • Cost saving • Do not require dental treatment • Less revenue to be set aside for dental needs (more economical) • Time saving • Labour • Labor-saving preventive measure (‘home care’) • Huge manpower not required to serve massive demand Singapore Dental Journal, June 2011 caries incidence dental treatment required = time wastage
- 14. DISADVANTAGES
- 15. 1. Unethical Issue • “Forced to drink” as 100% fluoridated • No option for refusal of F- in H20 • Fluoride is a form of ‘drug’ • not essential for all • ONLY Mass medication with uncontrolled dose • Unaware of the possible side effects The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking By Paul H. Connett, James S. Beck, H. S. Micklem Four Arguments Against the Fluoridation of Water Supplies Mark Diesendorf BSc, PhD
- 16. 2. Dental fluorosis • Long term effect caused by excessive ingestion of fluoride • Affects during the development stages of teeth Aust Dent J. 1990 Dec;35(6):530-5. Enamel defects in a fluoridated south-east Asian community. Chellappah NK, Vignehsa H, Lo GL. Singapore Dental Journal, June 2011
- 17. 2. Dental fluorosis • However, it is perceived as a negligible matter • Not a commonly raised public concern Dr Joyce Boudeville Dental Surgeon from Raffles Dental Fluoride in water safe, The Straits Times Straits Times, Singapore, Health Minister Khaw Boon Wan 27 April 2010 Community Dent Oral Epidemiol. 1996 Feb;24(1):25-7. Prevalence of dental fluorosis in children in Singapore. Lo GL, Bagramian RA.
- 18. 3. Harm to body
- 19. 3. Harm to body • Fluoride in water makes it available to all of the tissues in the body when ingested (systemic effect) • Bones (crippling skeletal fluorosis) • Nervous system – brain • Thyroid gland Four Arguments Against the Fluoridation of Water Supplies Mark Diesendorf BSc, PhD
- 20. 3. Harm to body Fluoride in water safe, The Straits Times By: Nicholas Yong, December 2010
- 21. 3. Harm to body Straits Times, Singapore Dr Hemalatha Nathan 31 Aug 2012 The Centers for Disease Control and Prevention (CDC, 1999, 2001)
- 22. 4. Individual F - Dosage • Impossible to control or measure total fluoride dosage consumed by every individual • More vulnerable individuals: • Infants • Children • Pregnant women • The elderly • Individuals with impaired renal function • Fluoride allergies http://clinicalnature.com/2011/03/why-i-changed-my-mind-about-water-fluoridation/
- 24. Relevance to us 1. incidence of dental fluorosis • Reduce usage of other fluoridated products • To be aware of swallowing fluoridated products • Monitoring of children’s brushing 2. Raise awareness of alternatives of caries prevention 3. High caries risk patients • Drink more water • Suggest fluoridated products 4. Parents who refuse any kind of fluoride treatment • Explain proposed treatment • Explain benefits and consequences • Provide alternatives • Respect their wishes
- 25. SUMMARY
- 26. In Summary • There are pros and cons of water fluoridation. • Pros: Prevent caries, accessible to all, easy to control dosage of F-, time • Cons: Unethical, dental fluorosis, risk of systemic problems, possible fluoride poisoning • Dental fluorosis is a concern, but it is only affecting children during the teeth development phases (aged 8 years or younger) • Water fluoridation outputs more risky disadvantages to the general public. However, no clear evidence has been found in Singapore.
- 27. IS PREVENTION REALLY BETTER THAN CURE OR IS DEPENDING ON FLUORIDATED PRODUCTS ALREADY SUFFICIENT?
- 28. References • http://www.healthxchange.com.sg/News/Pages/Against-Fluorides-in- Water.aspx • http://www.healthxchange.com.sg/News/pages/fluoride-in-water-safe.aspx • http://www.straitstimes.com/premium/forum-letters/story/dental-surgeons- back-water-fluoridation-policy-20120831 • http://www.channelnewsasia.com/stories/singaporelocalnews/view/10529 18/1/.html • http://www.sciencedirect.com/science/article/pii/S0377529112700111 • http://www.ncbi.nlm.nih.gov/pubmed/8897751 • http://www.qawf.org/UploadFiles/file/4_ARGUMENTS.pdf • http://www.sda.org.sg/sda_content/SDJ/June2011_Vol32_1.pdf • http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm
- 29. Thank you for your attention
Editor's Notes
- Why did singapore reduce the fluoride levels?
- Wide public reach regardless of socio-economic status Individuals who do not use fluoridated dental products Children with parents with busy lifestyle
- water essential part of diet, regardless of motivation to maintain OH/seek and pay for dental tx Cost saving Do not require dental treatment Less revenue to be set aside for population’s dental needs (fluoridation is cheaper than dental materials) Time saving Low caries incidence>lesser rendering of dental treatment>less time consumed Labour Labor-saving preventive measure (‘home care’) Huge manpower not required to serve massive demand/population
- NO FREEDOM TO CHOOSE Medications are supposed to be prescribed individually with a daily dose that takes account of the patient’s age, gender, exposure to other sources We argue that these risks are far too high when we are considering the mass medication of millions of people, the more so since the benefits are now seen to be so small and achievable by other means by dozens of non-fluoridating countries,” say the authors of The Case Against Fluoride. “Forced to drink” as 100% of Singapore water is fluoridated People cannot choose whether or not to have F- in water (informed consent?) Alternative ways to filter fluoride out (reverse osmosis is expensive) Fluoride is a form of ‘drug’ that is good for caries prevention but not ALL people require it/not essential) Mass medication with uncontrolled dose (depends on how much tap water you drink, fluoride is accumulated) Unaware of the possible side effects (no conclusive hard-based evidence)
- Primarily caused by excessive ingestion of fluoride Affects during the development stages of teeth for a long term Community Dent Health. 1996 Sep;13 Suppl 2:47-50. PMID: 8897751 Thirty-eight years of water fluoridation–the Singapore scenario. Loh T. Community Dent Oral Epidemiol. 1996 Feb;24(1):25-7. Prevalence of dental fluorosis in children in Singapore. Lo GL, Bagramian RA. A Review of the Uses of Fluoride and Outcomes of Dental Caries Control in Singapore Gabriel Tse Feng Chong and Patrick Tseng Dental Branch, Manpower Standards and Development Division, Ministry of Health, Singapore.
- Not bothersome enough What about Minority: moderate-severe fluorosis? Depends on control of diet and other fluoridated sources
- REFERENCES: http://www.healthxchange.com.sg/News/Pages/Against-Fluorides-in-Water.aspx
- REFERENCES: http://www.qawf.org/UploadFiles/file/4_ARGUMENTS.pdf http://www.fluoridealert.org/issues/health/
- REFERENCES: http://www.healthxchange.com.sg/News/Pages/Fluoride-in-water-safe.aspx
- Benefit is topical not systemic. The Centers for Disease Control and Prevention (CDC, 1999, 2001) has now acknowledged that the mechanism of fluoride’s benefits are mainly topical, not systemic. There is no need whatsoever, therefore, to swallow fluoride to protect teeth. Since the purported benefit of fluoride is topical, and the risks are systemic, it makes more sense to deliver the fluoride directly to the tooth in the form of toothpaste. Since swallowing fluoride is unnecessary, and potentially dangerous, there is no justification for forcing people (against their will) to ingest fluoride through their water supply
- REFERENCES: Main: http://clinicalnature.com/2011/03/why-i-changed-my-mind-about-water-fluoridation/ 1st pictrure: http://www.qawf.org/UploadFiles/file/4_ARGUMENTS.pdf 2nd picture: http://fluoride-class-action.com/districts/singapore
- Increased incidence of dental fluorosis Advise patient to reduce usage of fluoridated products Advise children to be aware of swallowing toothpaste/fluoridated products that may add on to cause fluorosis Advise parents to monitor children’s brushing Raise awareness of alternatives of caries prevention Limit water consumption, government may consider keeping at a minimum/omit F- from water if quality of public’s oral hygiene is improving High caries risk patients Drink more water Suggest fluoridated products Parents who refuse any kind of fluoride treatment Inform proposed treatment and reasonable alternatives Explain benefits and limitations Respect their wishes
- The only way to remove fluoride from tap water is with reverse osmosis systems (really expensive) or defluoridation filter (also expensive).
- Conclusion is yours to decide