Denis O'Donovan (Fianna Fail)
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I welcome the Minister of State, Deputy Alex White.

David Norris (Independent)
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I move:

That Seanad Éireann calls on the Minister for Health to review the situation concerning fluoridation of water in the Republic of Ireland.

I am sure the Minister of State will agree the motion is not contentious. It simply seeks a review of the position concerning fluoride and I think I am correct in stating the Government does not propose to amend it or at least I was not given information to that effect. Consequently, Members will pass this motion and will request such a review of the Government. That is healthy because it shows the manner in which Members can-----

Denis O'Donovan (Fianna Fail)
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To clarify, I understand a Government amendment has been tabled.

David Norris (Independent)
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Has it?

Denis O'Donovan (Fianna Fail)
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Yes, I believe so. I do not want the Senator to be under the illusion there is no amendment.

David Norris (Independent)
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I very much regret that because if one cannot use this House to seek a review of an issue that requires review, it shows an unnaturally defensive stance. It is not my intention in any sense to impugn the reputation or motives of any of those on either side, including those who consider it to be extremely important to have fluoridation in the water. However, never in 25 years of raising these issues have I received such a volume of correspondence from people from all walks of life and all parts of the country. I have to hand some of the e-mails I have received in this regard, including one that I found very charming, from Mercy Secondary School, Mounthawk, Tralee, County Kerry, which is organising a puppet show to examine the issue. It is very interesting to have the engagement of young people. I am really sorry that the Government parties, the senior Government party in particular, have decided, presumably, to call a vote on this motion. This appears to be stifling debate, particularly in light of the fact that in 2001, Fine Gael gave a clear and absolute promise that immediately on entering government, it would end fluoridation of water in Ireland. There has been a complete turnaround in this regard and that is very regrettable.

I am old enough, as I hit 70, to remember the dental situation that obtained here when the state of teeth was extremely bad. I looked, for example, at the evidence given by Dr. O'Mullane, who was one of the principal proponents of fluoridation, who stated:

I worked in the School Dental Service in West Cork for a number of years in the mid 1960's. Children constantly had gum boils and toothaches and I spent all of my time travelling from town to town extracting teeth. That was all I could do. ... [extracting] ... the teeth of frightened children.

Another point is that section 6 of the Health (Fluoridation of Water Supplies) Act 1960 has never been implemented. It mandated that there should be continuous general health reviews. This has not happened and I wonder what is the reason. My first call would be for the need for baseline data on fluoride impacts. In this context, consideration must be given to bone effects, immuno-compromised people in respect of cancer, endocrine effects, thyroid effects, pineal gland effects, insulin secretion effects, neurological effects and renal effects. I do not wish to do this simply to cause a scare of any kind but these are the areas that may be affected.

I am not in a position to make a scientific determination on these matters but I will simply point to some of the evidence, including from Dr. Hans Moolenburgh, a scientist who persuaded the Dutch authorities not to introduce fluoridation under any circumstances. In fact, they have introduced a constitutional prohibition on it. I also refer to the work from the National Research Council,Fluoride in Drinking Water: A Scientific Review of EPA's Standards, published by the National Academies Press in America.

It has a very serious track record in dealing not just with this issue but with traces of arsenic in water, with environmental pollution through the atmosphere and so on. It is a reputable body. There are also Dr. Waugh's interventions in his publications. I wrote to the Minister for Health about a year ago and we had a desultory correspondence about it which I did not find satisfactory, ultimately, so I decided to investigate further. I came across the Fluoride (Repeal of Enactments) Bill 2002, produced by the former Deputy John Gormley, subsequently the Minister for the Environment, Heritage and Local Government. He is a senior person and a man of considerable intellect. In the explanatory memorandum, he states:

There is now a scientific consensus that fluoride works topically and does not need to be ingested to protect teeth. All the evidence shows that too much fluoride in the body gives rise to fluorosis, which is on the increase, and to other health effects. When water fluoridation has been stopped in other countries, there has been no increase of dental caries as a result. This Bill means that no fluoride will be added by local authorities to Irish drinking water supplies.

This matter is topical because last night we passed the Water Services Bill, which established Uisce Éireann, with Bord Gais given the task of putting in meters. We are now going to pay for water and when one is paying for a substance it is at least reasonable to expect that one gets it in a pure state or is at the very least consulted as to what kinds of chemicals or medicines are put in it.

I ask that the Oireachtas Committee on Health and Children revisits the report which was provided to that committee. I also wish to put on the record the comments of Professor John Doull, chairman of the 2006 National Research Council review, Fluoride in Drinking Water: A Scientific Review of the EPA's Standards, who said:

What the committee found is that we?ve gone with the status quo regarding fluoride for many years - for too long really - and now we need to take a fresh look? In the scientific community people tend to think this is settled. I mean, when the US surgeon general comes out and says this is one of the top ten greatest achievements of the 20th century, that?s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on.

The review team was surprised that in spite of the large number of studies carried out over several decades there is a dearth of reliable evidence with which to inform policy. Until high quality studies are undertaken providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation.

I read the report of the forum on fluoridation which accepts that 95% of the public is opposed to fluoridation, which raises questions about a democratic deficit. The public responses included anger or displeasure over perceived involuntary mass medication of the public, concerns over the origins and chemical contaminants in fluoride additive, fear of involuntary intake of excess fluoride from multiple sources, great concern over a lack of choice for consumers to use or avoid fluoride, a perception that Ireland is virtually unique in fluoridating drinking water and a widespread perception that many medical ailments are due to fluoride. Perhaps these are only perceptions but the questions need to be answered and this is a forum in which they can be.

We are alone, of all of the countries in Europe, in having mandatory inclusion of fluoride in drinking water. Furthermore, the whole process is one of bullying. In the 1960s, the then Minister for Health, Sean McEntee threatened to dissolve the city councils of Cork and Dublin because they were opposed to fluoridation. The councillors were bullied. The Fine Gael Party led the attack with superb speeches from James Dillon and Richie Ryan, indicating that there was a democratic deficit and that this was a kind of tyranny. A lot more could be said but I will now make my final point. It is important that we have a clear understanding of dental caries, which is defined by the Dental Health Foundation, Ireland thus:

Caries begins with a small patch of demineralised (softened) enamel at the tooth surface, often hidden from sight in the fissures (grooves) or in between the teeth. The destruction spreads into the dentine (the softer, sensitive part of the tooth beneath the enamel). The weakened enamel then collapses to form a cavity and the tooth is progressively destroyed.

The other question is what is fluoride? This is not to necessarily impugn fluoride as a chemical.

Denis O'Donovan (Fianna Fail)
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I ask the Senator conclude.

David Norris (Independent)
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I will finish on this. It is something that originates from the wet scrubbing systems of the super-phosphate fertiliser industry. We import it from the Netherlands, a country that has banned fluoridation, along with so many other countries in Europe.

Denis O'Donovan (Fianna Fail)
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The Senator will have four minutes to respond at the debate's conclusion.

David Norris (Independent)
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There is a vast amount of scientific literature to consider.

Feargal Quinn (Independent)
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I second the motion. I welcome the Minister of State, who is an old friend of this House. Senator Norris should be commended for introducing this topic. I have two celebrations this weekend. One is my granddaughter's seventh birthday and the other - also on Sunday - will mark my 20th anniversary in this House. I mention this because in my first few weeks, this topic arose and I remember becoming involved in the fluoridation debate. I supported the practice because of the existing evidence but I will now question whether the practice needs the same deserving attention it got in those days.

All policies should be reviewed regularly and the practice of adding fluoride to the national water supply is no different. I am delighted to have a discussion today, although I am disappointed there is a Government amendment, which I have not seen. I am glad the Seanad has taken the lead in the review process and is examining this issue, which is of national importance. I will consider the matter from both the philosophical and practical perspectives. We should also try to avoid exaggeration and scare stories, doing our best to consider the issue in a detached matter, weighing up why the Minister for Health should review the process of adding fluoride to the national water supply.

The basic argument for adding fluoride to water is that it helps to improve the dental condition of citizens, especially those who do not look after their own teeth very well. Various studies have pointed to a much reduced incidence of tooth decay in fluoridated areas compared with those which are not fluoridated. The World Health Organization supports the use of fluoridation, as does the United States Centre for Disease Control and Prevention, which calls it one of the top ten public health achievements of the 20th century.

Nevertheless, there are many arguments against adding fluoride to the water supply, and the Minister of State should consider these. Many studies consider the dental benefits of fluoride and that improving diets would have a greater impact on dental health. Many experts argue that the positives do not outweigh the negatives, and we should consider whether we need as much fluoride in our water. Since the 1960s, when fluoridation was introduced in Ireland, a range of products containing fluoride have come to the market and dental care has much improved. Health care has made massive strides since.

Many studies advocating fluoridation do not mention the improvement of dental health that correlates with increasing incomes. It seems that the argument for fluoridation could stand up in the 1960s because of socio-economic difficulties but it is hard for it to do so in 2013. Senator Norris has indicated that most countries in Europe have discontinued the practice of fluoridation so why do only Ireland and 10% of the UK and Spain continue the practice? Some of the countries to ban the use of fluoridation include Austria, Belgium, Denmark, France, Finland, Luxembourg, Norway, Switzerland, Germany, the Netherlands and Italy. Switzerland stopped fluoridation after 20 years, indicating it was ineffective, and Belgium went as far as to ban tablets and chewing gum containing fluoride because of fears it might increase the incidence of brittle bone disease. Is Ireland right on the issue and the rest of Europe wrong?

There is a range of side-effects linked to excessive fluoride use, with the most common being a condition called dental fluorosis. With this condition, there is a change in the appearance of teeth caused by a change in enamel formation. That occurs during teeth development. In addition, various studies have pointed to lowered intelligence quotient levels in children, increased incidence of bone cancer in teenage boys, as well as increased risk of bone fractures and thyroid dysfunction.

Can we ignore or put up with these many documented side effects? The Lancet, which is considered one of the world's leading medical journals, describes fluoride as "an emerging neuro-toxic substance" that may damage the developing brain. Should we act now or wait for more evidence? In addition, fluoride can potentially affect the nervous system, the kidneys, the bones and other tissues in young children during their critical stage of organ development. We were to discuss children's early development in the Seanad today and we have deferred that debate for the time being. Can we be serious about this commitment if we do not consider such effects on babies and children?

It is interesting to note that the European Commission Directorate General for Health and Consumers notes that European Union-wide trends show a reduction in tooth decay in children of 12 years of age, regardless of whether water is fluoridated. It states there is no obvious advantage in favour of water fluoridation compared with application via toothpaste, mouthwash or gel. It goes on to state that the effect of continued exposure to fluoride from whatever source is questionable once the permanent teeth have erupted. This information is all new. It certainly did not exist 20 years ago when I spoke about it. The Government is very quick to take on any EU legislation. I wonder why it is not as quick to consider findings such as these. Is it just being selective about what we should do about this?

We should also consider what our neighbours are doing. In 2004, following a public consultation, Scotland's Parliament rejected proposals to fluoridate public drinking water on ethical grounds. Other countries, including France, Greece and Denmark, have already put high taxes on sugary drinks. In other words, they have taken other action to aim at achieving the same benefits.

This issue is worthy of discussion. I hope we will have that discussion this afternoon. I congratulate Senator Norris for raising it and look forward to hearing the opposing views also.

Denis O'Donovan (Fianna Fail)
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Before I call Senator Colm Burke I would like to acknowledge the presence in the Visitors' Gallery of the mayor of Bandon, Councillor Sean O'Donovan, and his young friends.

Colm Burke (Fine Gael)
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I move amendment No. 1:

To delete all words after "Seanad Éireann" and substitute the following:
"notes that water fluoridation is a major plank of public health policy in Ireland in the prevention of tooth decay;
notes that water fluoridation is recognised by the U.S. Centers for Disease Control (CDC) as one of 10 great public health achievements of the 20th Century;
notes that water fluoridation, at the optimal level, does not cause any ill effects to human health; but
notes also that fluoridation, and its effects on health and related matters, is kept under constant review.".

Senator Quinn stated earlier that fluoridation of water was one of the ten great public health achievements of the 20th century. That is what is contained in information made available to us.

A Forum on Fluoridation was set up in 2002 and a comprehensive review was undertaken at that stage. I have not read all of the report but I read the main part of it and it appears that a comprehensive review was undertaken in 2002. I am aware that some experts will disagree with that but to give a brief summary of the structure of the report, it dealt with issues of public concern, dental decay and the methods employed in its prevention and control, and the delivery of oral health care services to the Irish population along with international comparisons. It gave an account of the history of water fluoridation from both an Irish and an international perspective and a description of fluoridation status on a worldwide basis. It examined the public water supply system which includes an account of the various standards with which treatment processes must comply. It also examined the current legislation. It examined the benefits and risks of water fluoridation with particular reference to dental fluorosis.

The report is comprehensive about what was done in 2002, which was only ten years ago. I imagine research has not changed substantially in the meantime. An expert body on fluoridation was set up in 2004 and the issue continues to be under review but there has been no major policy change because all the available information indicates there are advantages to maintaining the current policy.

The 60th assembly of the World Health Organization explicitly recommended "for those countries without access to optimal levels of fluoride and which have not yet established systematic fluoridation programmes to consider the development and implementation of fluoridation programmes giving priority to equitable strategies such as the automatic administration of fluoride, for example, in drinking water and to the provision of affordable fluoride toothpaste". The WHO, therefore, recommended this in countries where such programmes were not operational. I agree with Senator Norris that some countries have decided to opt out of this policy and have voted on it. In one Canadian state assembly, the vote was 50.3% against water fluoridation. There is a divided view on the issue but the facts that have been established in Ireland, particularly in the 2002 report, suggest the advantages outweigh the disadvantages and there is no evidence, scientific or otherwise, to suggest that the current policy is having a detrimental effect on people's health. We have had this policy for more than five decades and it would benefit the population if it were continued. The issue should be kept under review and if further research becomes available, we can review it at that stage. To date, I have not read of new research.

Paschal Mooney (Fianna Fail)
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I thank Senators Norris and Quinn for tabling this important motion on an issue that has generated a great deal of controversy. I would like to outline the Fianna Fáil position on this. We believe that fluoridation is a public health measure that is good for the oral health of all age groups in society. The then Minister for Health and Children, Deputy Micheál Martin, launched the final report of the forum on fluoridation in September 2002, to which Senator Burke referred. He established the forum in 2000 to independently review the fluoridation of public pipe water supplies and a programme of research was undertaken on behalf of health boards in the area and to make recommendations. The forum largely comprised people with expert knowledge from a diverse range of backgrounds such as public health, dental health, food safety, environmental protection, ethics, water quality, heath promotion and the consumer and environmental sectors. The forum took a participatory and evidence-based approach, striving to ensure balance between participants on both sides of the debate, and it went out of its way to engage those opposed to water fluoridation.

The former Minister subsequently established the Irish expert body on fluorides and health in April 2004. The body monitors new and emerging issues in fluorides and its effect on health and related matters. It is satisfied, having studied current peer reviewed scientific evidence worldwide, that water fluoridation causes no ill effects to the health of adults or children. Given the policy has been reviewed by the forum on fluoridation and the expert body continues to provide impartial, evidence-based expert advice on fluoridation, some people suggest it is not necessary to commission a further review but because of the controversy generated by the issue, I am leaning towards the wording of the motion, which is about the review of, as opposed to the cessation of, the practice of fluoridation.

On the issue of testing for fluoride in Ireland, under the Fluoridation of Water Supplies Regulations 2007, water service authorities are required to arrange for the testing on a daily basis of the fluoride content of water to which fluoride has been added. There is much more going on in the context of tests on which I am sure the Minister of State will elaborate. To date there has been a significant reduction in the proportions of decayed, missing and filled teeth in children living in areas supplied by fluoridated drinking water in Ireland. The balance of scientific evidence worldwide confirms that water fluoridation at the optimal level does not cause any ill effects and continues to be safe and effective in protecting the oral health of all age groups. However, water fluoridation is less common in Europe where fluoridated salt is often available as an alternative, although some populations are supplied with naturally fluoridated public water.

Perhaps I can deal with what has been the water fluoridation controversy. It arises from moral, ethical, political and safety concerns regarding the fluoridation of public water supplies. It occurs mainly in English speaking countries as continental Europe has ceased water fluoridation. That those opposed argue that water fluoridation may cause serious health problems is not effective enough to justify the costs and has a dosage that cannot be precisely controlled. Opposition to fluoridation has existed since its initiation in the 1940s. I am thankful to Wikipedia for this information. During the 1950s and 1960s some opponents of water fluoridation suggested that fluoridation was a communist plot to undermine public health. It was more or less people who might have been on the far right of American politics who saw the communist plot as being an introduction to socialism - that awful thing they sometimes talk about in America. I can never quite understand what it is our friends on the Republican side are getting at.

Alex White (Dublin South, Labour)
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One could not have that.

John Gilroy (Labour)
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No, one could not have that.

Paschal Mooney (Fianna Fail)
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Citing impacts on the environment, the economy and on health the Green Party of Canada seeks a ban on artificial fluoridation products. The 2000 Nobel Prize winner for medicine, Arvid Carlsson, who opposes water fluoridation took the debate to the Swedish Parliament where he helped to convince it that it should be illegal on ethical grounds. The US National Kidney Foundation has updated its position on fluoridation by saying that individuals with CKD should be notified of the potential risk of fluoride exposure by providing information on its website. However, in favour of fluoridation the US Centres for Disease Control and Prevention said the fluoridation of public water has been hailed as one of the top medical achievements of the 20th century which has been mentioned by earlier speakers. It ranks 9th on this list, ahead of recognition of tobacco use as a health hazard. The American Dental Association said water fluoridation is unquestionably-----

David Norris (Independent)
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That shows how imbalanced it is.

Paschal Mooney (Fianna Fail)
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-----one of the safest and most beneficial cost-effective public health measures for preventing and controlling and, in some cases, reversing tooth decay. Health Canada supports fluoridation. The World Health Organization said fluoridation is an effective way to prevent tooth decay in poor communities, that in some developed countries the health and economic benefits of fluoridation may be small but particularly important in deprived areas.

A flyer issued in May 1955 by the Keep America Committee alleging a conspiracy theory that water fluoridation was a communist plot stated that it is said that it had frequently been the subject of conspiracy theories during the red scare and, to a lesser extent in the 1960s, activists on the far right of American politics routinely asserted that fluoridation was part of a far-reaching plot to impose a socialist or communist regime. I ask the Minister of State to take note, he is under pressure.

Alex White (Dublin South, Labour)
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Careful now.

David Norris (Independent)
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The Labour Party also-----

Paschal Mooney (Fianna Fail)
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They also opposed other public health programmes, notably mass vaccination and mental health services. Can anyone imagine putting fluoridation in with those very important issues? Water was fluoridated in large parts of the Netherlands from 1960 to 1973 but the supreme court declared fluoridation of drinking water unauthorised. As a barrister, the Minister of State is probably aware that the Supreme Court in Ryan v. Attorney General in 1965 held that water fluoridation did not infringe the plaintiff's right to bodily integrity. However, the court did find that such a right to bodily integrity did exist, despite the fact that it was not explicitly mentioned in the Constitution, thus establishing the doctrine of unenumerated rights in Irish constitutional law. In the US to date, no federal appellate court or state court of last resort, that is, the state supreme court in America, has found water fluoridation to be unlawful.

Water fluoridation is used in the US, UK, Ireland, Canada, Australia and in a handful of other countries. In the United Kingdom, the strategic health authority can direct a water company to fluoridate the water supply in an area if it is technically possible. The strategic health authority must consult with the local community and businesses in the affected area.

The water company will act as a contractor in any new schemes and cannot refuse to fluoridate the supply. In the context of the legislation to establish Irish Water, there may be some flexibility if this debate is to be opened up. Perhaps the Minister of State is not inclined to open it up because the overwhelming evidence seems to suggest that everything is fine in this regard. I share and empathise with the points my colleagues have made. I support the view in light of the controversy. Despite what I have said about the pros and cons of this argument, technology is constantly evolving. Even though the forum reported in 2004 that there is continuing monitoring, I share the concerns of my fellow Senators and would therefore not necessarily want to oppose their aspirations for having a review.

John Gilroy (Labour)
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I welcome the Minister of State back to the Chamber. I point out to Senator Mooney that the Minister of State responded privately to me and said that socialists always have whiter teeth.

David Norris (Independent)
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That is why Members of the Labour Party have such poor teeth.

Alex White (Dublin South, Labour)
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They have whiter hair or greyer hair anyway.

Denis O'Donovan (Fianna Fail)
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The clock is ticking, Senator.

John Gilroy (Labour)
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The motion tabled by Senator Norris on the subject of the fluoridation of public drinking water is an interesting one. Up to several days ago it was not something that disturbed my sleep, as I did not know very much about it. In the past week since it came to my attention through the motion, I have done a great deal of reading on it and find it fascinating, which probably says more about the life I live than anything else.

Senator Norris attributes his information to the work of Mr. Declan Waugh. I believe the Senator referred to him as Dr. Waugh in his contribution. While perhaps I am being pedantic, I have details of his accreditations before me and I do not see mention of a PhD.

David Norris (Independent)
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I conferred it on him.

John Gilroy (Labour)
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The purported health risk inherent in fluoridation gives rise to public concern. In seconding the Government amendment to the motion, it is important to state clearly that it is the opinion of the Government and our health advisers that there is no health risk involved in the fluoridation of the public drinking water. For us to agree to a review would certainly undermine public confidence and therefore the Government will not be supporting Senator Norris's proposed review. However, as Senator Mooney mentioned, the expert group on fluoride and health has the situation under continual review. We will be advised by this impartial and expert group. Fluoride was first added to public drinking water 65 years ago and the undoubted benefits have been alluded to already. I have received some representations on the motions in recent days. Some of them exhorted me to ignore the advice given by the expert group and Government advisers on the matter and perhaps come up with some other independent advice. I read the expert group report and the report of the then Minister for Health and Children, Deputy Martin. The argument needs to be made in the most robust terms that apart from some evidence of dental fluorosis, there is no known health risk through the use of fluoride in the public drinking water.

Some of the evidence used in Mr. Waugh's report is said by the expert group to be selective and to misinterpret much of what has been said. It goes so far as to state that it appears that some of the views expressed in Mr. Waugh's report are at variance with those of the authors of the same reports. While I acknowledge that at more than 300 pages, it is a substantial body of work and must be commended, it might not be as complete as perhaps it should be.

Senator Mooney referred to the pros and cons of the argument and I will not repeat what he said.

I will merely compare areas where there is fluoridation of water and areas where such is not public policy. One place very close to home where there is fluoridation of water is here in the South of Ireland and, as Senator Cullinane will undoubtedly tell us, there is no fluoridation of water as public policy in the North of Ireland. The evidence of the benefits is quite clear, that even today there are between 30% and 50% fewer dental caries in the South than there are in the North.

We need to look at the evidence provided by the authorities. Senator Norris stated that dietary sugar is the cause of dental caries. No doubt it is a significant cause of dental caries. We must look at the context in which fluoridation is used to combat the adverse effects of a high dietary intake of sugar in countries such as Ireland, which has a dietary intake of over 40% more than countries such as Norway, for instance, where they do not-----

David Norris (Independent)
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It has gone up by 50% in the past two years.

Denis O'Donovan (Fianna Fail)
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Senator Gilroy has one minute.

John Gilroy (Labour)
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One minute already.

Denis O'Donovan (Fianna Fail)
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Yes.

John Gilroy (Labour)
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They do not fluoridate water in Norway. The reasons for this are that there is no requirement to do so because the dietary sugar intake is very small and its public dental service is very good compared to Ireland. Our own dental service is perhaps not as developed as it should be and the dietary intake of sugar is at a greater elevated level than one would find in other countries.

There are some suggestions that fluoride in water interferes with metabolism pathways of calcium and magnesium. There is no demonstrable evidence to suggest that this is so. Also, the assertion that other toxins and arsenic are the by-products of this is categorically untrue because the fluoride used by the Irish authorities is sourced from pure fluoride and is not a by-product of any other industrial process as it might be in some other countries.

David Norris (Independent)
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I would have to challenge that. That is completely incorrect.

Denis O'Donovan (Fianna Fail)
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Senator Norris will have a chance to respond at the end.

John Gilroy (Labour)
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This is the report.

David Norris (Independent)
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It does not matter.

John Gilroy (Labour)
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This is not me-----

David Norris (Independent)
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I have parliamentary answers.

John Gilroy (Labour)
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This is not me asking this.

David Norris (Independent)
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It used be bought in Holland and now it is bought in Spain.

Denis O'Donovan (Fianna Fail)
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Tá an t-am istigh.

John Gilroy (Labour)
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Senator Quinn mentioned that there are several countries which have banned the use of fluoride. There are not. They stopped the use of fluoride, which is a little different from banning the use of it. They recommend that they do not use it. It is important that we make that distinction because to state that certain countries have banned fluoride indicates that there is a public health risk that required legislative banning of the adding of fluoride. That is not the case. They have stopped it.

There are many other points I would make about this. There is legislative underpinning in Ireland, not in other countries, but that does not involve the mandatory adding of fluoride of water. It is a legislative underpinning of the adding of fluoride to water. There is a nuance in this. It is different and it can be interpreted that it is compulsory by law. The legislative underpinning allows us do this and that is the difference. It is a nuance, but it is a difference. We must maintain public confidence in this matter and our use of language in this debate is key to doing so. I thank the Leas-Chathaoirleach for indulging me.

Denis O'Donovan (Fianna Fail)
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I grant Senator Gilroy a slight indulgence for establishing that socialists have whiter teeth. While interesting, it is sort of ultra vires this debate.

David Cullinane (Sinn Fein)
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I welcome the Minister of State at the Department of Health, Deputy Alex White. I thank Senator Norris for tabling this Private Members' motion today to allow us review the position on fluoridation of water in the State.

It is an interesting issue and it has provoked continual debate not only in this country, but around the world. One could argue that there are many issues that we could be discussing here today which, on a scale or hierarchy, would be more important that this issue but that does not mean that we should not be having this debate. Private Members' time is an opportunity for us to have these kind of discussions, both in the Lower House and in this House as well. These are matters of public concern which are being discussed outside of this House. It is important for Senator Norris to bring forward this motion so that the House can be part of that debate because while this debate is happening in the scientific sphere, it is important it happens in the political sphere as well. I commend Senator Norris.

The point has been made already that there are many different opinions on this issue. For every report, either nationally or internationally, that the fluoridation of water is good, there are counter reports which say something else. We then must make up our minds and make judgments. There are many different points of view on this issue among health care professionals. That is obvious given the many different reports.

An important point made by Senator Norris which needs to be taken on board was that this process was put in place at a time when even the industrialised world had very poor dental health mechanisms.

The sole reason for its introduction was the danger of tooth decay and cavities. We must acknowledge we have come a long way on the journey of ensuring we have very good dental health and oral hygiene in the State and in most industrialised countries. Given the massive improvements in this area it is timely to review the process. It is also important to ensure we continue to put in place resources so young children in particular have access to dentists and proper treatment, and that they have the appropriate level of dental health care to avoid the incidence of tooth decay.

The question we are asked to discuss in the motion is whether the fluoridation of water is appropriate or necessary for the oral health of citizens. This is the fundamental question. In particular, it is generally believed that although water fluoridation can cause dental fluorosis, which can alter the appearance of developing teeth, the extent of this can vary. People have very clear concerns and not only in Ireland but throughout the world. Only this week the Australian city of Cairns ceased to fluoridise its water on the basis it constitutes the mandatory medication of its citizens. According to a spokesperson for Cairns council, if people want to have access to fluoride they should take it up with their dentist and that the decision has been made that it should not be forced on people without consent. I broadly share this view. I do not think it should be a mandatory process but a matter of choice. I agree with Senator Norris on this issue.

The issue of cost is not the only issue. If I felt this genuinely benefitted citizens and ensured a reduction in decay it would be worth it. According to a response to a parliamentary question from the former Minister of State, Deputy Róisín Shortall, it costs approximately ¤4.78 million a year. This was the amount spent in 2010. Of this, ¤1.36 million was spent on the acid or chemical used as part of the process. At the time, the then Minister of State said the Government had no plans to discontinue the policy. I assume this is still the position of the Government.

It is a matter of choice and we must reflect on the wealth of reports and knowledge and information we have on the issue. Ultimately it is a matter for the Government, the Minister for Health and the Cabinet to reflect on it and decide whether they believe continuing the policy is best for citizens. It is worthwhile to table a motion such as this to give us an opportunity as public representatives to reflect the fact that even though many important issues exist people are interested in this issue and have very strong views on it. I was very surprised that I was lobbied and received many e-mails about this debate. Many of the e-mails were very technical and scientific and contained very well thought out and well argued points of view on both sides.

To summarise the views of those against, it is not so much an issue of cost but of choice and the potential dangers they feel are associated with the process. Even if such dangers are mild, and some clinicians and dentists have the view it can cause problems but they recognise these problems are mild, it is still an issue for the citizens who believe they should have a choice in the matter. For me this is at the heart of the issue. I thank Senator Norris for tabling the motion. I look forward to hearing the response of the Minister.

Caít Keane (Fine Gael)
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Like Senator Quinn I can also go back quite a few years with regard to this issue, as I tabled a motion in South Dublin County Council on the matter.

I have four pages to read but I do not know whether to read out two pages for or two pages against fluoridation. I am no wiser now than 15 years ago about fluoridation because there is scientific evidence to support both sides. I shall scrap my four pages and take up the current debate. I welcome Dr. Waugh. I heard his valuable contribution but valuable comments have been made by both sides.

It should be easy for the Minister of State to tell us what agent is used in the fluoridation of water here. The expert working group says that the product used here is no different from natural fluoride and that which is added to the water supply. That is one scientific view but there is an opposing scientific view that the agent is a highly corrosive acid which is a waste component of the Dutch and Flemish. It is said to be much more toxic than the sodium fluoride found in toothpaste that was referred to by Senator Mooney. We need an immediate answer to that scientific question. We have laboratories so we should be able to get an answer.

David Norris (Independent)
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The Senator said that it was hydrofluosilicic acid.

Caít Keane (Fine Gael)
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Yes.

David Norris (Independent)
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It is a by product of a chemical process.

John Gilroy (Labour)
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That is not-----

Caít Keane (Fine Gael)
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We need an expert to work with the expert group because it does not accept that finding.

David Norris (Independent)
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It is a commercial transaction and the records have been placed.

Denis O'Donovan (Fianna Fail)
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I remind Senator Norris not to interrupt Senator Keane. Perhaps the Senator will address her comments to the Chair then she might avoid provoking other Senators.

Caít Keane (Fine Gael)
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I support the Government's action because, as I said earlier, I am no wiser today than I was 15 years ago when I tabled a motion at a meeting of South Dublin County Council to ban fluoride. I got the same answers then that I got today in terms of scientific research. I want the expert working group to answer the question. We have heard both sides of the argument but we, as parliamentarians, need a scientific answer on the fluoride product used.

There is no fluoridation in Northern Ireland, Scotland or Wales, and only 10% in England. Ireland is sixth in the World Health Organization league for dental decay and four of the countries with a ban on fluoridation are ahead of us on the league table. Why?

I support the Government's motion. I am not a scientist but I respect the scientists that have submitted their views to us. I also respect the expert working group on fluoridation. I ask the Minister of State to ask the scientific working group to update its information on its website because it is quite old and needs to be reviewed. The motion also seeks a review. When I looked at the website I discovered that the last report covered the period of 2004-08. I want a new factual report on fluoridation prepared that consists of the latest scientific research.

The expert group submitted a report in 2004. The group was established in 2004 to monitor new and emerging issues on fluoride, its effects on health and related matters. It advised that the balance of scientific evidence worldwide confirmed that water fluoridation at the optimal level - and it is important to note that term - does not cause any ill effects and is the safest and the most cost-effective method of protecting the oral health of the population. I refer to the scientific report of the group that the Government established in 2002 which submitted its first report in 2004. We need new information that is up to date because science has moved on. I could not find current information on the website. Perhaps it does exist. All I found was information that dated back to 2008 but science moves very fast.

I support the Government's motion because I am no wiser now about water fluoridation than I was 15 years ago. The health programme has improved the oral health of the population, especially in children. However, the other side of the campaign states that fluoride is corrosive and leads to bad dental enamel and everything else that goes with it. People also endorse the view that fluoride is the best available and most reliable option because scientific evidence has indicated that the maximum permitted level of fluoridation of water is safe. I shall not repeat the figure because Members have already heard it.

Northern Ireland is our nearest neighbour but it does not add fluoride to water. Irish Water will be known as Uisce Éireann when the legislation is enacted. It will soon be established. River basin districts will be divided regionally.

With the establishment of Uisce Éireann we must have a commonality of approach, given the fact that river basin districts are divided regionally, and that one of our river basin districts straddles the Border with Northern Ireland. I am a member of the British-Irish Parliamentary Assembly and what is good for the goose is good for the gander. They have decided, for some scientific reason, to ban it in Northern Ireland.

Deirdre Clune (Fine Gael)
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It is not banned.

Caít Keane (Fine Gael)
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I meant to say that it is not imposed on people there. I am seeking basic information because I cannot be a hypocrite on this issue. I cannot have one view on South Dublin County Council, yet have another one in here. I am totally confused by the issue.

David Norris (Independent)
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The Senator is very honest.

Caít Keane (Fine Gael)
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That is what I hope to be. I have learned a lot in 15 years but I have learned very little about fluoridation of water. I do know, however, that more countries are banning it now than 15 years ago when I researched it. The question I am asking is why this is the case.

Sean Barrett (Independent)
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I welcome the Minister of State to the House. I am grateful that Senators Norris and Quinn have tabled this motion because, as has been said on both sides of the House, all policy should be reviewed. However, this policy has been reviewed. It used to be a test case example of public policy that we did the research before introducing fluoridation of water. We found that where fluoride was naturally present, such as in Patrickswell, County Limerick, and Gyles' Quay, County Louth, dental health was far better in those locations. Therefore, this is not a poison, as some of the extreme critics would say. It is present naturally and is seen to have positive benefits for dental health.

In response to Senator Keane's point, there are many studies to support superior dental health in terms of the DMFT - decayed, missing or filled teeth - oral health index in the Republic of Ireland compared with Northern Ireland. It has been a success therefore. Senator Cullinane mentioned the sum of ¤5 million out of a ¤17 billion health budget. If one can get the level of benefits we have had from fluoride for such a small amount it is well worth continuing with it. The research also shows that the doubts cast about water fluoridation have been rebutted fairly recently.

The first finding of the expert group was that water fluoridation has been very effective in improving the oral health of the Irish population, especially of children but also of adults, including the elderly. Professor O'Moore of TCD led the group that did the original research and even at that stage she was saying that the amount of fluoride one would have to consume to damage soft tissue was beyond the capacity of any individual.

Legitimate concerns have been raised, however, and they are worth dealing with. It is a credit to this House that my two colleagues tabled the motion before us. In 2010, the European Commission's Scientific Committee on Health and Environmental Risks report stated that fluoride in drinking water does not appear to hamper children's neural development. Neither does fluoride cause gastro-intestinal complaints or bone ailments. The report's authors also said that it does not damage children's IQ test scores. They have gone through all those points.

While I appreciate that my learned friend has adduced information on how Scotland feels, the rest of the UK is strongly of the view that fluoridation has been a benefit.

In 1985, Professor Knox reported:

We have found nothing in any of the major classes of epidemiological evidence which could lead us to conclude that either fluoride occurring naturally in water, or fluoride added to water supplies, is capable of inducing cancer, or of increasing the mortality from cancer. This statement applies both to cancer as a whole, and to cancer at a large number of specific sites. In this, we concur with the great majority of scientific investigators and commentators in this field.

Another finding is that there were benefits to bone structure. A US study in the British Medical Journal from 2000 found that exposure to fluoridation was associated with an increase in bone mass at the lumbar spine and proximal femur and a slight decrease in the risk of hip and vertebral fractures. The dental school in Trinity College Dublin strongly favours fluoridation, which, it could probably be argued, is against its own interests because if we did not do it and did not have the large improvement in the DMFT ratio, dentists would be busier. Dentists support this policy even though it might be said it reduces the income of dentists.

It is important these issues are debated. The weight of evidence is so overwhelmingly in favour of the Government's amendment to the motion, I will be supporting it.

John Whelan (Labour)
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I welcome the opportunity to contribute to the debate on this motion. I welcome the Minister of State and look forward to his considered response, which will, perhaps, arbitrate on what is an informative debate. I have enjoyed listening to the healthy, non-partisan and open-minded contributions made from both sides of the House.

I thank Senator Norris for tabling this motion. During the past few months I have been contacted by numerous people throughout the country who have genuine concerns about fluoridation of the public water supply. These concerns are not vexatious and are not made by people wishing to stir up trouble for the sake of it. It is, therefore, incumbent on us, in terms of our input to public policy, to address it in an informed way. If the Government and Department of Health are minded to persist with current policy, they have a responsibility to assuage genuine public concerns by way of a public information campaign and so on. It is not acceptable to dismiss these concerns out of hand. I am not an expert in this matter. We are at the mercy of the scientific evidence and expert reports available in this regard. The phrase "doctors differ" comes to mind. It is incumbent on us also not to cherry-pick the scientific data and evidence which supports our argument and suits our needs.

I am of two minds on this matter. I am not persuaded one way or the other. It appears to me that there are genuinely strong and persuasive arguments on both sides. It is of concern that many EU countries have chosen to cease the practice of automatic fluoridation of public water supplies. I am sure they are not doing so without good cause. I find it a little ironic that Ireland, a country which takes so much of its lead from Europe on so many other matters and is so compliant and obedient with regard to virtually everything suggested by the EU, continues to with the practice of fluoridation. If in the morning someone were to take a case to the European Court of Justice and win it, would the Government and Department of Health would be as strong and robust in its insistence on continuation of fluoridation of our water? What would they do if Ireland were subjected to an EU directive in this regard? I do not believe the case for fluoridation is cut and dried.

I ask that the Minister of State as part of his response at least consider assuaging public concerns by way of, as I suggested earlier, a public information campaign. As pointed out by Senator Mooney and other Senators, this is an opportune time, in the context of the passing by this House earlier in the week of the legislation establishing the new Irish Water company, for Government to revisit and at least consider the latest evidence and concerns being expressed. Nobody in this House or, I am sure, in the Department of Health would do anything to damage or put public health in danger.

David Norris (Independent)
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Absolutely.

John Whelan (Labour)
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I am sure everybody has the public interest at heart. However, I do not believe we should proceed just because this is what has always been done. We must keep this under constant review.

Michael Mullins (Fine Gael)
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I, too, welcome the Minister of State to the House. I compliment Senator Norris on tabling this motion. It is only right and proper that such a significant public policy relating to the treatment of water is kept under constant review. The Government amendment does not differ much from the motion tabled by Senator Norris in this regard.

I raised this issue some weeks ago on the Order of Business following receipt of extensive documentation on the matter from a chartered environmental scientist, Dr. Declan Waugh. My attention was drawn to Dr. Waugh's reference in that correspondence to his ten year journey of discovery in relation to water fluoridation, from which he had drawn the conclusion that the science behind water fluoridation is deeply flawed and that the evidence of risk greatly outweighs the minor benefits associated with this policy. Dr. Waugh pointed out that it is commonly known that while the World Health Organization endorses water fluoridation, it does so only where health authorities have demonstrated that the dietary intake of fluoride for all sectors of society, including the most sensitive subgroups of the population, are known and quantified.

Dr. Waugh subsequently forwarded further documentation to me which drew a link between water fluoridation and many of the significant health problems being experienced by people in this country, including cardiovascular disease and diabetes. Dr. Waugh states that in the North of Ireland, where fluoridation does not take place, only 4% of the population suffers from diabetes, whereas 8.9% of the population in the Republic suffer from diabetes. Other health problems identified were obesity, respiratory conditions, thyroid and cancer. I am concerned about the availability of this information in the public domain and our not being able to prove one way or the other whether there is any link between water fluoridation and those particular health problems. They are the negatives of this issue.

I will now address some of the positives. In this regard, I refer to the Department of Health and the expert group on fluoridation and health which state that water fluoridation is the adjustment of the natural concentration of fluoride in drinking water to the optimal recommended level for the prevention of dental problems.

According to them, water fluoridation is the "adjustment of the natural concentration of fluoride in drinking water to the optimal recommended level for the prevention of dental caries". The levels are controlled and are set at between 0.6 parts per million, ppm, and 0.8 ppm. We have a strict monitoring regime of levels. This monitoring is carried out within each local authority area by the HSE, which is charged with ensuring that all issues pertaining to public health are at the safest levels possible.

Like other Senators, I have a difficulty in reconciling the considerable divergence of opinion between those who oppose fluoridation and those who see it as a significant contributor to public health. Senator Norris has done the House a great service by tabling this motion, as we need to keep this matter under constant discussion and review. As has been stated, technology is improving and other countries throughout Europe are moving away from this system. Perhaps we should consider the issue further.

I have confidence in the HSE and believe that we are receiving good advice, yet I recognise the fact that experts in this field hold other opinions. It is important that this issue be given a full airing at the Oireachtas health committee. I would welcome further debate on this matter of significant public interest.

I would not like the House to divide on this motion. Senators are as one. Although views differ, everyone has the same objective, in that we want to ensure the best possible outcomes for our people. I hope we will keep the matter under review and discussion.

Deirdre Clune (Fine Gael)
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I recall this matter being debated in 1997 when I was first elected to the Lower House. There have always been concerns about fluoridation. The then Minister, Deputy Martin, set up the forum on fluoridation in 2000. This resulted in the establishment of an expert body to advise the Minister on all aspects of fluoride and its delivery methods as an established health technology. Several Senators have acknowledged this.

The forum's overall conclusions were that water fluoridation had been effective in improving the oral health of the Irish population, especially that of children, and that the best available and most reliable scientific evidence indicated that, at the maximum permitted level of fluoride in drinking water, human health was not adversely affected. We have since established an expert body that continues to meet and advise the Minister. It draws on national and international expertise. This is a satisfactory situation and is how we should operate, that is, set up expert groups and leave them to discuss issues. None of us in this House is a scientist or an engineer. While I was an engineer in a previous existence, I would not claim to be an expert in any area. The group has been set up and will examine reports as information becomes available. This is satisfactory. We should leave it at that.

Reference has been made to an individual who has e-mailed many of us, but I do not know whether his or her report has been published for peer review in the journals. I would not expect the expert body to consider any report or information unless it was satisfactorily reviewed and accepted in the broad scientific community. Until then, we should not publicly quote claims about linkages between health and the ingestion of fluoride or any substance. We have a responsibility to act prudently in this and in all matters.

I am satisfied by our community's oral health and fluoride's impact on dental decay. Senator Norris correctly stated that the consumption of sugary foods caused decay, but fluoride prevents dental decay, particularly in children. Children from certain areas or economic backgrounds are more at risk. We can speak lightly of decay, but children carry tooth decay into adulthood. Repair work and fillings become necessary, teeth are lost, etc. We should not underestimate oral and dental health, as they can have a significant effect on physical health. They are important. It is not just getting a filling. Rather, it is a life-long impact on an individual's oral and dental health. Surveys have consistently shown that, since the introduction of fluoride into drinking water, children in fluoridated areas have considerably lower levels of dental caries.

We have debated this matter and an expert group has been established with cross-field representation in the form of dentists, toxicologists, engineers, environmentalists, public representatives and public health experts. I am regularly in contact with UCC's dental hospital, which is supportive of fluoridation. It sees the results of fluoridation through its surveys. To make a personal claim, I am married to a dentist who is committed to this matter. He has worked with children who have not had the benefit of fluoridation. The impact on them is stark, as is the contrast between fluoridated and non-fluoridated areas in Cork.

I am a supporter of fluoridation and am confident in the medical evidence that shows that fluoridated water has no impact on people's health. It is a positive public policy that we should support and we should be confident that the issue has been debated and that the expertise supports our policy.

Alex White (Dublin South, Labour)
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I acknowledge and thank the Senators for holding this debate. I commend everyone who contributed, including Senators Norris and Quinn, who tabled this motion. The Government will not support it 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. As such, the amendment seems to cover the point about the need for these matters to be kept under review.

I wish to address a comment made by Senator Cullinane. He was not necessarily being critical, but it is important that I address his point. Senator Barrett and others on all sides of the argument also touched on it. It is not the Government's intention, wish or belief that there would not be a debate on this issue or that raising and considering it in a motion of the House would not be appropriate. As a Minister of State in the Department, I would not be entitled to have an objection to the Seanad doing so. The Government has no objection to there being informed public debate, as has been the case with this discussion.

Most of those present in the Chamber are not scientists. Irrespective of what side of the House we are on, we must all rely on the expert opinion, scientific evidence and the reports that have been prepared.

On issues of public health or particularly issues which involve scientific or technical matters, we as politicians do not have that particular expertise to bring to the table in the way, for example, that Senator Barrett would have economic expertise or others would have different elements of expertise to bring to the table. This is a serious point; most of us do not have that kind of experience, therefore, we have to rely on the evidence. I think it was Senator Whelan who emphasised the importance of not being selective, not selecting this or that piece of evidence that might support an argument that we instinctively feel is right and then leap on one particular study and think it is the one I like most because it seems to accord with my thinking. We have to examine the evidence. What I would ask the House to do, and this is what the Government is doing with the Department of Health's approach to this, is to look at the preponderance of evidence. No one is saying there are no studies that are critical of the policy or that there are no interventions that do not criticise or question the policy. There are such studies and certainly there are such claims, but I suggest in the strongest terms to colleagues that the preponderance of evidence supports a continuation of the policy of the Government while keeping it under continuing review. That is what I would ask colleagues to agree to in the course of this discussion and, I respectfully ask, in the decision they will make on foot of the motion before them.

I support the Government's amendment to the motion which will come as no surprise. Many of the Senators have already outlined the original rationale for fluoridation, namely, fluoride at the optimal level in the water supply provides what has been described as a repair kit for teeth, making teeth more resistance to decay in people of all ages. I am very taken by the points that have been made in respect of the importance of dental health and it is not something that is a "by the way" comment or that can be treated lightly. It is a vitally important element of public health.

An all-Ireland study on children's oral health in 2001-02 has shown that children and adolescents residing in fluoridated areas have fewer caries than those in non-fluoridated areas. The Oral Health of Irish Adults Study 2000-2002 also showed decay scores were lower among fluoridated groups for all age groups and particularly in the 35 to 44 age group. This is a study that puts clear evidence before us.

Water fluoridation is recognised by the Centers for Disease Control and Prevention of the United States public health service, as has been stated in the amendment to the motion, as one of the ten great public health achievements of the 20th century. Some 350 million people in 35 countries around the world have fluoridated water and 70% of the US population has water fluoridation.

The background to this, on which Senator Norris or others have touched, is that fluoridation began in Ireland in 1964 on foot of the Health (Fluoridation of Water Supplies) Act 1960. That Act provides that the health authorities shall arrange for the fluoridation of public piped-water supplies and that local authorities act as agents for the health authorities in providing, installing and maintaining equipment for fluoridation, in adding the fluoride to water and in testing the fluoride content of water to which fluoride has been added. These functions are provided for in the Fluoridation of Water Supplies Regulations 2007which revokes previous fluoridation regulations. Currently approximately 68% of the population receives fluoridated public water supplies.

The policy of fluoridation, as was mentioned on a number of occasions in this debate, was the subject of a major review in 2000. A Forum on Fluoridation was established by the then Minister for Health and Children which comprised largely of persons with expert knowledge from the fields of public health, dental health, food safety, environmental protection, law and ethics, water quality and health promotion, together with a consumer representative. The report of the forum was published in 2002. Its main conclusion was that the fluoridation of public piped water supplies should continue as a public health measure. The forum also recommended that given the increased access to fluoridated toothpaste and in light of the best available scientific evidence, the optimal level of fluoride in water should be redefined from the then level of 0.8 to 1 parts per million to between 0.6 and 0.8 parts per million with a target value of 0.7 parts per million. The parts per million is equivalent to milligrams per litre. This change was implemented by the Fluoridation of Water Supplies Regulations 2007, to which I have referred. It is worth noting that EU law defines a maximum permitted concentration of 1.5 parts per million for public water supplies through its drinking water directives. The Irish levels are set at less than half that permitted by EU legislation.

Another important recommendation of the forum was that an expert body should be established to implement the recommendations of the forum and to advise the Minister and evaluate ongoing research on all aspects of fluoride. I emphasise the vital necessity of having a reliable source of scientific evidence that can be available for public consumption and for the information of public representatives such as ourselves in order that we can evaluate and assess the correctness or otherwise of the policy position being adopted. That export body is an important element and support for our work as public representatives and as a Government.

The expert body on fluorides and health was established in 2004. The expert body and its sub-committees have broad representation from areas such as dentistry, biochemistry, environmental health, public health medicine and food. The expert body also has a consumer input in terms of members of the public and representatives of consumer interests. The sub­committees of the expert body may also co-opt members as the need arises. Of the expert body's 17 members, five are members of the dental profession. These include two former chief dental officers in the Department of Health, two senior academics, one of whom is also a former chief dental officer, and two from the public dental health service. They have extensive experience in areas of public health, dental epidemiology, statistics, fluorides and health promotion.

In evaluating ongoing research on all aspects of fluoridation, the expert body accepts the fundamental scientific tenet, and this is important, that any single piece of scientific evidence by itself remains essentially hypothetical unless it can be repeated or confirmed by other scientists or other studies. Therefore, it considers scientific evidence that has been submitted to examination by other scientists, usually by publication in recognised peer reviewed scientific journals, after such publication has been approved by independent referees, which is entirely in line with the practice that has been adopted for many years internationally in relation to the evaluation of scientific evidence. This ensures that the advice provided by the expert body is impartial and evidence-based.

The expert body is satisfied, having studied current peer reviewed scientific evidence worldwide, that water fluoridation at the optimal level does not cause any ill effects and continues to be safe and effective in improving the oral health of all age groups. These views are supported by reputable international agencies and valid scientific articles and reviews.

I am aware that consumers sometimes express concerns about potential negative effects on health of drinking fluoridated water, on the composition and source of fluoride or on the fact that some countries do not fluoridate their water supplies. I wish to assure the Senators that drinking fluoridated water with the optimal amount of fluoride is not harmful to human health. The opinion of the expert body on this matter is supported by the World Health Organization, the Centers for Disease Control and Prevention, the public health service and the surgeon general of the United States, the World Dental Federation, the International Association for Dental Research, the Royal College of Physicians of England and by major international scientifically validated reviews in many countries. A major review was conducted by the European Union in 2011. The main conclusions of the report of the EU's Scientific Committee on Health and Environmental Risks are that there is no known health implications from fluoridating water at levels used in the EU.

The only known side effect of optimal water fluoridation is mild dental fluorosis. This has been known about since the 1930s. Dental fluorosis is a cosmetic or aesthetic condition which refers to the way teeth look. It is not considered to be an adverse health effect. At the levels of fluoride present in Ireland's water supplies, any occurrence of dental fluorosis is very mild or mild and in most cases is only detectable by a dentist as faint white flecks on the surface of the teeth. In the majority of cases dental fluorosis generally does not require any treatment. Regularly conducted studies on dental health in Ireland, carried out when the upper limit for fluoridation was 1 parts per million - it is lower now - confirm the low level of dental fluorosis in Ireland.

The non-treatment of dental fluorosis has no health consequences. The non-treatment of tooth decay, on the other hand as was mentioned, can lead to pain, trauma, disfigurement, loss of teeth and function, problems with nutrition and growth, absenteeism from school or work and significant financial and social costs across the life cycle of an individual.

The fluoride added to our water supplies is in the form of hydrofluosilicic acid and is in compliance with the specifications for that substance, which are set out in the 2007 regulations. This issue was raised by Senator Keane. It is sourced as a primary product in Spain, mined directly from a raw material source, the mineral fluorospar. It then goes through a purification process to produce the acid. Representatives of the expert body on fluorides and health conducted a site visit to Spain and were satisfied that the production is in compliance with the quality, environmental and safety systems and procedures in place and that the company, Derivados del Fluor, strives to ensure these systems and procedures are maintained and continually reviewed.

It is sometimes claimed that the product used in Ireland is a waste product from the fertiliser industry; this is not the case. Others issues such as the toxicity or corrosiveness of the product are also raised from time to time. These issues only apply to the raw undiluted acid and necessitate great care and suitable safety precautions for those handling it. When added to water in the correct amount, the acid dissociates or separates completely releasing fluoride ions into the water and is not toxic or corrosive.

A code of practice has been produced by the expert body with the support and co-operation of organisations such as the local authorities, Environmental Health Officers Association, Health and Safety Authority, EPA, HSE and others. The purpose of the code is to ensure the proper implementation by all personnel involved of the procedures for the fluoridation of the public water supplies to the prescribed standards and to minimise the risk of injury or damage to plant, personnel and environment. The code does not modify or set aside in any way, the obligations or requirements of the operator of the water treatment plant under other legislation such as health and safety statues. The code applies to all water treatment plants where the fluoridation of water supplies is, or will be, carried out. The expert body will continually review this code of practice. The legislation on water fluoridation requires that a daily test be carried out at water treatment plants by the local authority water services staff. Monthly fluoride testing is carried out by the HSE and the EPA also carries out testing which requires monitoring of fluoride levels in water supplies. If the fluoride levels are found to be outside the range specified in the legislation, those responsible are notified, prompt adjustments are made to the dosing equipment and a new test carried out.

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 in investing in large public dental services, as in Holland and the Nordic countries. In such cases, fluoride is administered to children in school clinics. This would require a significant investment in personnel and resources in Ireland. Water fluoridation is the most cost-effective method of preventing dental decay and thus overcoming the poor risk profile in Ireland. There is evidence also that other methods of fluoridation such as milk fluoridation or topical applications are not as clinically effective. There is also evidence that water fluoridation may have particular advantages for persons on lower income.

Major fluoridating countries include the USA, Australia, New Zealand, Canada, Malaysia, Israel, Singapore, Hong Kong, Colombia and Chile. Fluoridation coverage in the USA increased by approximately 24 million people between 2002 and 2012 and population coverage in Australia also increased in 2012. Almost 5.8 million people in the UK have fluoride added to their water and another 330,000 have naturally fluoridated water. Approximately 10% of the population in Spain have fluoridated water. Salt fluoridation is practised in many South and Central American countries and also in the EU, notably in France, Germany and other central European states.

Water fluoridation is one of the most widely studied public health policy initiatives in the world. The design and evidence is poor in some studies but the expert body only considers scientific evidence that has been peer reviewed and approved for publication in recognised scientific journals. Studies in Ireland and worldwide have found that water fluoridation has a significant benefit for dental health among both children and adults. Persons residing in fluoridated areas have better teeth with less disease than those residing in non-fluoridated areas. For example, in the last all-Ireland study conducted in 2001-02, there were approximately 40% fewer cavities in children living in fluoridated areas. Ireland is among the worst countries in Europe for high frequency consumption of sweets and confectionery by children and adolescents. Our children and adolescents have generally poor tooth brushing habits compared to their European counterparts. Accordingly, the use of fluoridated toothpastes alone is insufficient to prevent tooth decay.

The Health Research Board has recently approved funding for a study to be led by the Oral Health Services Research Centre of University College Cork and the Department of Health is a collaborator in the study. The study entitled, What Impact Have Major Policy Changes Had on Oral Health in Ireland? Establishing a Blueprint for Oral Health Surveillance, will consider the impact of changes on the oral health of children, following policy decisions relating to fluoride toothpaste use for infants and young children in 2002 and the reduced level of fluoridation in drinking water since 2007. Surveys on children's and adults oral health have been conducted on a regular basis to measure the effectiveness of water fluoridation in the State. These include national studies in 1984, 1990, 2001 and 2002, regional studies between 1990 and 1999 and a cross-Border study in 2006. All these studies showed a substantial benefit in terms of the reduction in tooth decay experience. The expert body is unaware of convincing scientific evidence to the contrary in Ireland.

I wish to emphasise the main issues are that use of fluoridated water has a substantial benefit for oral health over and above the use of fluoridated toothpaste; water fluoridation is the most cost-effective method of preventing tooth decay and overcoming the high risk of dental caries in the Irish population given our dietary habits, which include consuming a large volume of confectionery and fizzy drinks, regrettably, and generally poor tooth brushing habits; there is evidence that water fluoridation has particular advantages for reducing dental health inequalities for persons on lower income; and our water fluoridation systems are subject to ongoing quality assurance to ensure compliance with legislation and standards.

I draw the attention of Senators to additional studies that are publicly available, including a position paper from the expert body published on its website in 2012. It is essentially a survey and it does not purport to pull together all the material and evidence. It offers an important and timely survey of the current position on water fluoridation and the views and the conclusion of the expert body. It is very much up to date and it has the benefit of analysing reviews conducted in a considerable number of countries in recent years such as the York review of 2000 to 2002 in England, Australia in 2008, Canada in 2010 and the US in 2006. None of these reviews has established a basis for considering that artificially fluoridated water poses systemic health risks. The position paper also deals with report of the EU scientific committee on health and environmental risks. The expert body report is up to date and concludes that:

There continues to be overwhelming evidence that water fluoridation significantly benefits dental health. The expert body is satisfied having studied current peer reviewed scientific evidence worldwide that water fluoridation does not cause any ill-effects and continues to be safe and effective.

The expert body is satisfied, having studied current peer reviewed scientific evidence worldwide, that water fluoridation does not cause any ill effects and continues to be safe and effective. Senator Cáit Keane raised a fair question on public information. There is also to be found on the website a document with which we are all familiar nowadays, FAQs, frequently asked questions, which appears to turn up everywhere. A list of 25 frequently asked questions is available which deal in some detail with some of the issues Senators have raised, including Senator Cáit Keane who asked what additives are used to fluoridate Irish drinking water the acid concerned, which I will not attempt to pronounce, and its source. The science surrounding the entire issue is broken down and explained in clear terms in the frequently asked questions document.

The report to which Senators have referred, which was prepared by Mr. Waugh, has been considered. I do not want Members to go away from the debate with the view that the Government, the Department or the expert group close their eye to documents, submissions or interventions that, for some reason, go against the grain. These documents are read. I have read Mr. Waugh's report. The expert group has read his report and has published, again on the website, a detailed response dealing with each of the issues raised by Mr. Waugh. He raised some issues in respect of what he regards as legal objections. They are disposed of very clearly in the expert group's response. The European Commission has addressed any concerns that may arise in respect of any suggestion that the policy runs counter to EU directives. It does not and the view of the European Commission in that regard is set out very carefully in the expert group report. There is no legal impediment either as a matter of Irish law - that has been the case for almost 50 years - or as a matter of European Union law to a water fluoridation policy.

In regard to the alleged adverse health affects, I have read Mr. Waugh's report. I am a lay person in this regard; I am not a scientist. Even in those circumstances, one has to look for the evidence for some of the assertions made in that report. I can only rely on the expert group's responses where it states in respect of Mr. Waugh's report that the author does not include in the document the many reports and reviews from respected international agencies confirming that there are no known adverse affects on health from fluoridation. If a member of the public, including Mr. Waugh, or a Member of the House brings forward a report in good faith - I do not suggest anything other than good faith on his part - we would have an expectation that a scientific report would at least have regard to other evidence. The lifeblood of scientific research is that one puts forward one's own hypothesis but one must have regard to the evidence against and one has to weigh up the issue. The author, Mr. Waugh, might well say it was not his job to look at all the other evidence but it is our job to weigh up the evidence and what is being said and to examine the science. The question we have to ask is not if there are objections or if some people are unhappy or if some people have campaigned against it in good faith but what is the preponderance of the evidence as we weigh it up. Let us look at the evidence we are given and the studies done and at the conclusions drawn from those studies. I accept what Senator Norris said about the importance of this kind of public health policy being kept under review. That is why the amendment to the motion notes that it should be and is kept under review. However, I do not accept that there is a sufficiency of evidence or objection that could conceivably persuade the House that it should seek to change it or draw it into question, which a call for a review on its own does. The point was made by Senator John Gilroy that language is very important.

David Norris (Independent)
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Nuance.

Alex White (Dublin South, Labour)
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A simple bald call for a review in the manner in which the motion is drawn gives rise to the suggestion, if not the conclusion, that there is a problem with the policy. I do not accept we should form the view that the policy should be set aside. The policy is backed up by the strongest scientific evidence. That is not to say that other voices cannot be heard. They can be heard and they have been heard today. I urge Senators to support the amendment to the motion in the circumstances.

Denis Landy (Labour)
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I welcome the Minister of State to the House and apologise to him and the proposer of the motion for my late arrival due to other commitments.

I commend Senator Norris who tabled the motion as it gives us an opportunity to discuss the issue. Like many other members I have been inundated with representations on the issue through e-mail and face-to-face representation in recent months. This debate is an opportunity to clarify where we stand on the issue and debunk the myths.

I thank the Minister of State for his excellent response in which he dealt with the issue in great detail. As there are genuine concerns on the issue, an informed discussion is the only way forward. The Minister of State has clearly outlined that the levels of fluoride in Irish water are provided for optimal protection for the oral health of all the people. That is the safest and most cost-effective way of doing this. It strengthens our teeth and helps reduce the level of dental care. Just as important, it provides universal assistance to people who may not have the financial resources to deal with dental difficulties. The fluoridation of water provides protection for oral health. If such a method was available to the State to protect against, say, cancer, arthritis or diabetes, there would be no hesitation in using it. Water fluoridation provides mass protection and is supported by the World Health Organization and, as the Minister of State has outlined, it is supported by many countries across the globe.

In regard to the danger of over-exposure, it is ironic that when some people spoke to me about fluoridation of water, they said they had to buy bottled water. However, the reality is that there is as much fluoride in bottled water as there is in tap water. The myths need to be debunked. Fluoridation levels are tested daily. As a former member of a local authority I am aware that in my local town a particular system is in place, as in most local authority areas. In the event of a difficulty arising with the levels of fluoride, the matter is addressed immediately. The fluoridation levels are tested every month, notwithstanding the requirement of the local authority under the Health (Fluoridation of Water Supplies) Act 1960, and also on a monthly basis by the EPA.

Fluoridation is doing a good job. There is no need for concern in respect of this matter. It is important that we have had a debate as the genuine concerns I have received needed a discussion to clarify the issues. I commend Senator Norris who tabled the motion, the Minister of State on his response and those who contributed. It has been a good afternoon's work.

If some of the people who detract from the role of the Seanad were here this evening and had the patience to sit in the Gallery, where members of the press are supposed to be, and listen to this debate, including respecting the response that will come from all the various people who have contacted us and to whom we will now relay the information the Minister of State has given us and the result of this debate, perhaps not so many people would be scoffing at the role of the Seanad.

Ivana Bacik (Independent)
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I welcome the Minister of State to the House and I commend Senator Norris on tabling this motion which gave us a very valuable opportunity to debate an issue that is of pressing concern to many people as other colleagues have already said. I have some close friends who are very concerned about the matter and it was a good opportunity to air the views and genuine fears people have about fluoridation, and seek to address them.

Having considered the different points made in the debate, I strongly support the Government's amendment to the motion. The evidence is clearly there. I am very grateful to Professor Jacinta McLoughlin from the department of dental science in Trinity College who supplied me and other colleagues with material on the subject.

David Norris (Independent)
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I met her yesterday.

Ivana Bacik (Independent)
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I was sure Senator Norris would have. There have been some strong reviews. A comprehensive review was established by a Fianna Fáil Minister for Health and Children and reported in 2002. Even after public consultation and taking on board all the evidence, it concluded that water fluoridation has been effective in improving the oral health of the Irish population, especially that of children, and that human health is not adversely affected. Other colleagues have already said - I do not want to repeat it - that children in Ireland have a very high rate of consumption of sugary foods and sweetened drinks. As the Minister of State has pointed out, the Irish population has relatively poor dietary and oral hygiene practices and water fluoridation has been effective in preventing dental suffering and pain, and indeed other things such as infections and other health risks that poor dental hygiene can bring about.

It is useful for us to debate this and consider the arguments made in Declan Waugh's report - I know the Minister of State has addressed those. We need to consider the appraisal of those arguments and the answers given. We need to assess the scientific evidence on the matter. Having carried out that exercise very usefully in this session and being aware that a comprehensive review was carried out in the relatively recent past, we should conclude it is safe to support the Government's amendment to the motion.

The issue of language is important. Senator Norris has very carefully and correctly simply called for a review. However, even calling for a review can open the question, as Senator Gilroy and others have said, and perhaps contribute to fears that are unjustified when one considers the evidence. The amendment offers a better balance, given what we know about the risk to dental hygiene from poor nutrition and poor diet and from what we know about the benefits of water fluoridation.

David Norris (Independent)
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I regret that my modest request has been rejected on the grounds that there is no need to review it because we are reviewing it already. It reminds me of my good friend Kieran Hickey who made a film about Joyce using the glass slides from the Lawrence collection and he was refused permission to do so by the National Library of Ireland on the grounds that it was not possible. He said: "Since it is not possible, I couldn't be doing it, so let's go ahead and do it", and they did. That kind of circular reasoning is being applied here. If we are prepared to review it, why should we be so shy of even opening the question?

I will not have time to put on record the very strong rhetoric of senior Fine Gael politicians when this matter first came up. Richie Ryan and the then leader, James Dillon, were concerned about the democratic aspect of the matter.

The author of the paper who has been referred to - I do not want to keep putting his name on the record - actually responded to all the points raised in the review and sent it by registered post to the Department, but has not received a reply.

We need to look at the toxicological data. I am putting one side because it has been so underrepresented. I do so because I believe in getting at the truth whatever it is. I recognise that I am sacrificing a significant section of my vote, but I have always been prepared to take that type of risk because it is important that we see the result.

I am concerned about what happened to the report prepared very expertly containing page after page of shortlisted references of a very high scientific level, including a number of Nobel Prize-winning scientists by Mr. John Gormley. That report, which was agreed by the Oireachtas Joint Committee on Health and Children, was buried. That worries me because it does not sound like dialogue at all. It was never published and was rejected by the then Minister. An undertaking was given that there would be reviews and that the HSE would undertake a national study to determine the total fluoride intake of individuals. I am not aware that that has been done - I do not believe it has. If it has been done, it has not been published.

I am also concerned that of the 15 meetings of the original body charged by the Government to investigate this in the 1960s - I believe - some 14 disappeared, which is odd. There is a trail of curious things. I am not a conspiracy theorist. I certainly do not believe that fluoridation was a communist plot and referring to this did not add anything to the debate. I have scrupulously attempted to avoid any type of witch hunt or unduly alarming people. It was necessary that we had that. I compliment all my colleagues and friends on the way in which they handled this matter.

The Minister of State is correct in stating that since about 2000 this material has been sourced in Spain. However, before that it came from a Dutch industrial plant. It is not pure fluoride but hexafluorosilicic acid, which is registered as a serious toxin. Senator Barrett made an excellent contribution on which I compliment and thank him. I do not entirely agree with it. I believe he was gilding the lily somewhat when he said that one would need to ingest humanly impossible amounts of fluoride in order to do oneself any damage. If that is so, why is the maximum amount permitted 0.4 per 1 million-----

John Gilroy (Labour)
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Some 100 l of water is required.

David Norris (Independent)
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Whatever it is, it is a tiny, microscopic and practically immeasurable amount. I do not see anybody requiring to stuff themselves with large nuggets of fluoride in order to do themselves any damage. It is at least a little more toxic than that.

It is worth considering the other countries. In the past couple of days in Australia the district of Cairns has just voted it down. The night before last the city of Windsor in Ontario, Canada, voted to remove fluoride. This indicates a growing movement questioning it.

Paschal Mooney (Fianna Fail)
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The Senator is in extra time.

David Norris (Independent)
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I am very grateful to the Acting Chairman.

Such water treatment has never been in use in Belgium and will never be in the future because the fundamental position of the drinking water sector is that it is not its task to deliver medicinal treatment to people. Fluoride has never been added to the public water supply in Luxembourg and the authorities there believe the drinking water is not the suitable means to deliver medicinal treatment. Finland does not favour or recommend the fluoridation of drinking water because there are better ways of providing fluoride.

Paschal Mooney (Fianna Fail)
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We are now moving towards penalty shoot-outs.

David Norris (Independent)
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Not really because there are still three minutes in the debate.

Paschal Mooney (Fianna Fail)
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We are well over time.

David Norris (Independent)
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Since it was not used up I thought I might use it up.

Paschal Mooney (Fianna Fail)
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The Senator has four minutes.

David Norris (Independent)
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The Danish Ministry of Environment and Energy advises that toxic fluorides have never been added to the public water. Norway had a rather intense discussion on the subject some 20 years ago and the conclusion was that drinking water should not be fluoridated. Drinking water fluoridation is not allowed in Sweden because new scientific changes have not shown that it should be. The Supreme Court in the Netherlands decided there was no legal basis for fluoridation. The water supply in Northern Ireland has never been artificially fluoridated. In Austria toxic fluorides have never been added to the water supply. In the Czech Republic since 1993 drinking water has not been treated with fluoride.

There seems to be a more divided opinion that might have been reflected in the debate here. I am very concerned at the attitude to infant formula. Children are much more vulnerable because they have a much smaller body mass. We have fluoridation of water and have it from other sources.

In one of the reports, it was stated that water should not be fluoridated. This was changed, and it worries me when one changes established practice. It was stated that water should be boiled in accordance with the manufacturer's advice. No advice is given about fluoride whatever. No company ever did. It is obvious. One need not be a scientist to know but scientists will confirm it. One does not remove fluoride by boiling.

Paschal Mooney (Fianna Fail)
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I must insist, I am sorry.

David Norris (Independent)
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I thank the Acting Chairman for insisting. It is important to make those points.

Paschal Mooney (Fianna Fail)
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Senator Norris is completely ignoring me no matter what I say. I am merely trying my best here.

David Norris (Independent)
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The final point, because we all are so interested in this and I am sure the Minister of State, Deputy Alex White, will want to know-----

Paschal Mooney (Fianna Fail)
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Senator Norris has gone into double time now. He has had eight minutes instead of four.

David Norris (Independent)
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-----is where he spoke about dissociation. The Minister of State said that when added to water in the correct amount, the acid dissociates or separates completely. However, that was from a paper by Urbaski, published in 2000 and which was not peer reviewed. In 2002, he published a retraction, a paper that contradicted that and that was peer reviewed. I agree with the Minister of State that peer review is important.

The matter is not finished. We have not done any damage by opening it up. Everybody, whatever his or her point of view, and including my dentist who I attended this morning and who is quite passionate about it, is concerned about the welfare of persons, particularly children. I thank all my colleagues and the Minister of State for taking part in the debate. I hope it has not ended here and that we will keep an open mind.

Paschal Mooney (Fianna Fail)
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This is not creating a precedent. Senator Norris not only exceeded his time, but went so far over it that he went into the stratosphere. I merely alert the Senator. There are procedures of which he is fully aware and the House has other business.

David Norris (Independent)
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It is just 6 o'clock.