Kathleen Lynch (Cork North Central, Labour) | Oireachtas source

I thank the previous speaker for the suggestion, but I think from the content of my speech the Senator will realise that the issue of fluoridation is under continual review. I thank Senator Mary Ann O'Brien for tabling the motion and I acknowledge that some Senators have a particular interest in it. Unlike others, I have been listening to the debate about fluoridation all my life. My father had a particular interest in it, as did my father-in-law after that, so it is a debate I have been listening to for many years.
I acknowledge and thank the Senators for holding this debate. I commend everyone who contributed. I know others are yet to contribute, but I have to leave early. The Government will not support the motion in its current form, but the Government has proposed an amendment that provides for the continuing review of this important issue of public interest and concern. I commend the Government amendment before the House and I hope everyone has read it.
Water fluoridation is the adjustment of the natural concentration of fluoride in drinking water to the recommended level for the prevention of tooth decay. Fluoride is a natural mineral used by the body to strengthen teeth and bones. Fluoride occurs naturally in all water supplies at different levels and is found in soil, fresh water, seawater, plants and many foods. As the Senator pointed out, fluoridation began in Ireland in 1964 on foot of the Health (Fluoridation of Water Supplies) Act 1960. The Act and the Fluoridation of Water Supplies Regulations 2007 provide for the making of arrangements by the HSE for the fluoridation of public water supplies. The local authorities, acting on behalf of Irish Water, act as agents for the HSE in providing, installing and maintaining equipment for fluoridation and in adding the fluoride to water and in testing the fluoride content of water to which fluoride has been added.
In Ireland, naturally occurring levels of fluoride tend to be so low that they do not provide sufficient dental benefits. However, there are exceptions. Among the evidence presented to the Oireachtas prior to the introduction of fluoridation 50 years ago was the discovery that the public water supply serving the village of Patrickswell, County Limerick, had a fluoride content of around 0.7 to 1 parts per million. No other water supply in the city or county of Limerick was found to contain fluoride to that significant effect. The then Medical Research Council of Ireland carried out a special examination of children attending Patrickswell national school. It found that the teeth of the children who had been using the naturally fluoridated water supply in that village since birth or the greater part of their lives had less dental decay than the other children attending schools in the rest of the city and county of Limerick.
Artificial water fluoridation replicates a natural benefit by making good a fluoride deficiency in some water supplies. The benefits to oral health brought about by fluoridation have been experienced all over the world. It is hardly surprising that water fluoridation is recognised by the Centers for Disease Control and Prevention of the United States Public Health Service as one of the ten greatest public health achievements of the 20th century. As Senator Colm Burke has already outlined, in the case of Ryan v.Attorney General in 1964, the Supreme Court did not accept that the fluoridation of water was, or could be described as, the mass medication or mass administration of drugs through water, as suggested by the Senators.
The Health Products Regulatory Authority is the competent authority for the licensing of human and veterinary medicines and medical devices in Ireland. The HPRA considers that neither drinking water itself nor the fluoride added to drinking water in the form of fluoride salts or silica fluoride, as defined in the Health (Fluoridation of Water Supplies) Act 1960, should be categorised as medicinal products. The HPRA considers that the fluoridation of drinking water should be seen as a measure consistent with general public health management. Fluoridation can be likened to adding vitamin D to milk or folic acid to cereals. More than 370 million people worldwide receive the benefits of water fluoridation. All EU states have fluoride, in one form or another, at the centre of their public policy approach.

For some European countries, water fluoridation is impracticable due to the large number of separate water sources. Many of them choose salt fluoridation or milk fluoridation as an alternative to give the health benefits of fluoride exposure to their citizens. Several countries have opted to use other approaches to fluoridation such as investing in large public dental services, as in the Netherlands and in Nordic countries. In such cases, fluoride is administered to children in school clinics. There is evidence, however, that other methods of fluoridation such as milk fluoridation or topical applications are not as clinically effective or as cost effective. There is some evidence too that water fluoridation may have particular benefits for persons on lower income.

Major fluoridating countries include the USA, Australia, New Zealand, Canada, Malaysia, Singapore, Hong Kong, Colombia, Chile and several others. Fluoridation coverage in the USA is approximately 200 million people. Almost 6 million people in the UK have fluoride added to their water with another 330,000 having naturally fluoridated water. Approximately 10% of the population in Spain has fluoridated water. Salt fluoridation is practised in many South and Central American countries, as well as in the EU, notably in France, Germany and other central European countries.

In Ireland, approximately 3 million people have fluoridated water supplies. Fluoride strengthens the teeth. Strong teeth result in fewer fillings, fewer extractions, fewer visits to the dentist and lower dental bills. To date, there has been a highly significant reduction in the proportions of decayed, missing and filled teeth of people living in areas supplied by fluoridated drinking water when compared to those in non-fluoridated areas. Even with a background of widespread availability of fluoridated toothpastes, the difference between fluoridated and non-fluoridated communities remains. A further factor is Ireland's high level of sugars consumed and the poor tooth brushing habits of our children and adolescents compared to their European counterparts. Accordingly, the use of fluoridated toothpastes alone is insufficient to prevent tooth decay.

By comparing similar fluoridated and non-fluoridated populations, we can assess the benefits of fluoridation. The study, Oral Health of Irish Adults 2000 to 2002, showed decay scores were lower among fluoridated groups for all age groups and particularly in the 35 to 44 age group. A 2014 study by Public Health England compared fluoridated and non-fluoridated parts of England. It found that in fluoridated areas there were 45% fewer hospital admissions of children aged one to four for dental caries than in fluoridated areas. The recently published Queensland study, Child Oral Health Survey 2010 to 2012, commissioned by the Queensland Government in Australia, shows substantial differences between the levels of primary tooth decay in long-term fluoridated Townsville at 39% and the previously non-fluoridated rest of north Queensland at 57%.

Consumers sometimes express concerns about potential negative effects of drinking fluoridated water. Such concerns are not allayed by scaremongering and misinformation used by opponents of fluoridation. I accept, however, that the arguments on both sides have not been fully fleshed out.