Paudge Connolly (Cavan-Monaghan, Independent)
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There are many implications for public health in the fluoridation of public drinking water. Far from protecting public health, it has been claimed that the fluoridation of public drinking water is damaging the health of children.

There is evidence that there is an epidemic of dental fluorosis. This was presented to Members last week by Dr. Don McCauley, who is chairman of a group of 100 dentists who oppose fluoridation. He indicated that during his training he was not made aware of fluorosis. A large number of European countries has either ceased to use fluoridation or never used it. Admittedly, in the late 1950s and 1960s, when fluoridation was introduced, the objective was to protect people's teeth. However, oral hygiene is more prevalent since then and it is now time to question the use of fluoridation.

It should also be a concern that dental fluorosis increased seven fold between 1984 and 2002, which is a short time. It is becoming a serious problem and it must be examined in the context of the fluoridation of public water supplies. The other concern is that it is a problem for 40% of 15 year olds according to an oral health services centre in University College Cork. There is also scientific evidence that fluoridation causes bone fractures in children.

The signs of fluorosis are white spots and lines in the teeth. It is caused by swallowing uncontrolled amounts of water. If somebody drinks three to four pints of fluoridated water per day, they are ingesting a high dose. There is no control on the amount of water people drink. That is one of the major difficulties. Fluorosis is an irreversible condition and is the result of previous chronic fluoride poisoning.

The other concern is bottle fed infants. They are particularly at risk because of their small size. They are consuming unsafe levels of fluoride in their formula milk, which is made up by using tap water. The Food Safety Authority of Ireland has produced some startling findings on babies and bottle feeding. In its risk assessment, it said the precautionary principle should apply. It recommended that the formula should not be constituted with fluoridated tap water. Telling mothers they should buy water for the baby milk formula is not an option. The chances are that they will continue to use tap water believing it to be safe.

The authority also found that bottle fed infants were ingesting unsafe levels of fluoride, thus increasing the risk of moderate dental fluorosis. Regrettably, however, the forum on fluoridation rejected the Food Safety Authority of Ireland's findings on technical grounds. It asked the FSAI to change its conclusions. That is unreal. The FSAI then absolved itself of all responsibility by stating that all babies should be breast fed. This is a way of evading the problem. The issue was left hanging. The research was conducted in Cork and fluoridation was found to be unsafe but there was no follow through. People are, therefore, being left at risk.

The forum recommended reducing the level of fluoride in drinking water by a quarter but nothing has been done. There is now talk of reducing the level of fluoride from 0.8 parts per million to 0.6 parts per million. However, the forum website states that there is no benefit from using less than 0.8 parts per million. Why bother reducing it? In a way, the forum is acknowledging that there are difficulties with fluoridation.

The Government should make a brave decision and do what many other European countries have done, that is, remove fluoride from the water supply. A compensation time bomb is being created. Court cases have been taken in recent weeks. Fluoridation is banned in Northern Ireland and dental fluorosis is three times worse in the Republic than in Northern Ireland.

This is a serious problem which must be addressed.

Seán Power (Kildare South, Fianna Fail)
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On behalf of my colleague, Deputy Harney, I am happy to have the opportunity to address the issue raised by Deputy Connolly. Fluoridation of public water supplies as a public health measure is accepted as being one of the most effective methods of ensuring against tooth decay. The World Health Organisation recommends fluoridation of public water supplies and has stated: "Fluoridation of water supplies, where possible, is the most effective public health measure for the prevention of dental decay." The WHO has also stated that "people of all ages, including the elderly, benefit from community water fluoridation".

Dental decay has a serious impact on oral and general health, not to mention the pain it causes to both children and adults. It can lead to cavities in teeth which may require fillings and-or extraction of teeth. This, of course, involves the use of local and sometimes even general anaesthetics.

The Health (Fluoridation of Water Supplies) Act 1960 makes provision for the fluoridation of public water supplies in Ireland. The constitutionality of the Act was upheld by the High Court in 1963 and this decision was confirmed by the Supreme Court. Fluoridation was first introduced in Ireland, as a public health measure, in 1964. Since its introduction surveys of oral health have been carried out on a regular basis, as is the monitoring of fluoridation levels in public water supplies.

The recently completed survey of oral health, covering the island of Ireland, shows that fluoridation of public water supplies continues to be a highly effective public health measure. It has contributed significantly to a major reduction in the incidence of dental decay in the Republic of Ireland. This compares favourably with the incidence of dental decay in Northern Ireland, where children are shown to have earlier access to dentists, where children, according to the research, brush more often and which does not have fluoridated water supplies. The benefits of fluoridation of water supplies are clear.

The research carried out shows that, at the levels of usage of fluoride in the Republic of Ireland's public water supply, there is no risk to health. Fluoridation of the water supply in Ireland is limited to a maximum of one part per million. In this regard, the WHO and the European Union have identified that fluoridation levels below 1.5 parts per million are acceptable. In the United States, the maximum limit is currently four parts per million.

A forum on fluoridation was established to review the fluoridation of public piped water supplies in Ireland. The main conclusion of the forum report was that the fluoridation of public piped water supplies should continue as a public health measure. The forum recognised that there has been some increase in the incidence of mild dental fluorosis in Ireland. Most dental fluorosis is only detectable by dentists. The forum, while recommending that fluoridation of water supplies continues, recommended a reduction in the levels of fluoride used from between 0.8 parts per million and one part per million to between 0.6 parts per million and 0.8 parts per million.

The report of the fluoridation forum made 33 recommendations covering a broad range of topics such as research, public awareness, policy and technical aspects of fluoridation and the establishment of an expert body to oversee the implementation of the recommendations. The expert body, to be known as the Irish expert body on fluorides and health, was set up in 2004. The terms of reference for the expert body are to oversee the implementation of the recommendations of the forum on fluoridation; to advise the Minister and evaluate ongoing research, including new emerging issues, on all aspects of fluoride and its delivery methods as an established health technology and as required; and to report to the Minister on matters of concern at his or her request or on its own initiative.

The expert body is overseeing the implementation of the wide-ranging recommendations of the forum and will advise on all aspects of fluoride. The body is currently examining the regulations governing the fluoridation of public water supplies and the Minister for Health and Children is awaiting its advice in this regard. Some legislative changes or amendments may be necessary arising from the recommendations of the expert body, for example, in respect of the reduction in fluoride levels recommended by the forum or in respect of the audit of the fluoridation plants currently being carried out by the expert body.

My Department will implement any necessary changes once the recommendations of the expert body have been received.