How close are we to compulsory fluoridation in Britain? In July 1997, a regional UK health authority was given High Court permission to launch a judicial review to challenge the local water authority's refusal to fluoridate the water supply (Northern Echo, July 1, 1997). This followed demands in November 1996 by the British Dental Association (BDA) supported by the British Medical Association (BMA), health authorities and the British Fluoridation Society (BFS) for legislation to make fluoridation mandatory on request by a health authority.

Last February, a UK Government Consultation Paper suggested that fluoridation of the water supply to the optimum level of one part in a million can substantially reduce the extent of tooth decay in children from similar backgrounds (Comm Dent Health 1997; 14: 30-54). Under current UK legislation, the water industry can decide whether to agree to local Health Authority requests for fluoridation schemes. Nevertheless, at the moment the UK government believes this situation needs to be reviewed.

Despite the World Health Organisation's 1969 adoption of a resolution favouring fluoridation, most European countries, including France, Switzerland, Sweden, Holland and Germany, have resisted or abandoned such schemes. Only Britain and Ireland fluoridate water supplies. In the US more than half the water supplies are fluoridated; schemes also exist in Argentina, Australia, Canada, Hong Kong, Mexico and Singapore.

During a House of Commons debate, Dr Peter Mansfield, president of the National Pure Water Association (NPWA), revealed that results of his studies on 600 patients tested routinely for fluoride levels suggested that in non fluoridated areas 2 million people could have symptoms of skeletal fluorosis by mid life. This includes stiffness and backache, progressing to osteoporosis and osteoarthritis. Artificial fluoridation throughout the UK, in his view, would affect another 3.6 million people. According to government figures, up to eight million people could have crippling fluorosis by the age of 70 or 10 per cent of people over 60.

But there is new evidence that fluoride may damage more in the body than simply bones. Since 1990, studies have demonstrated that fluoride exposure first damages the central nervous system. In one laboratory study, fluoride caused behavioural problems in animals not unlike hyperactivity and learning deficits (Neurotoxicol and Teratol, 1995; 17: 169-77). The authors noted that fluoride exposure could be linked to "subtle brain dysfunction."

Fluoride has also recently been linked with infertility. One study, which compared the total fertility rate in areas whose water supplies had at least 3 ppm fluoride, found that the greater the fluoride concentration, the lower the fertility rate (J Toxicol and Environ Health, 1994; 42: 109-21, as reported in Townsend Letter, April 1998).

The most disturbing finding concerns evidence of neural degeneration in rats, caused by aluminium but greatly enhanced when the animals were fed low doses of fluoride (Brain Research, 1998; 784: 284-98). Fluoride appears to increase the bioavailability of fluoride; aluminium in the fluoride treated group of animals was double that of controls. These changes were similar to those of people with Alzheimer's disease. Although these two studies of rats may have no bearing on humans, two Chinese studies have shown that the IQ of children exposed to fluoride is adversely affected (Fluoride, 1995; 28; 4:189-192; and Fluoride, 1996; 29; 4: 190-2). In two studies, children in high fluoride areas have lower IQs in all age groups examined. These studies suggest that the influence of fluoride on intelligence may occur in infancy or even during embryonic development when brain growth is more rapid. Furthermore, studies of the brains of aborted foetuses in areas of where fluoride toxicity is widespread show that brain development is delayed (Fluoride, 1995; 28; 4: 189-92).

To counteract a recent adjournment debate about forcible fluoridation under health authority request, the NPWA is now calling for a full independent public enquiry, and an All Party Group Against Fluoridation has been reconvened.

Meanwhile, plans are afoot in the US to halt unreined fluoridation. The Washington Lodge of the National Federation of Federal Employees (mainly government scientists, including many from the Environmental Protection Agency) has unanimously condemned fluoridation.

As Dr Robert Carlton, a US EPA scientist, put it, "Fluoridation is the greatest case of scientific fraud of this century if not of all time."

"Fluoride consumption in the United States is out of control. Organised dentistry has lobbied for fluoride, unchallenged, for years. Now we have a glut of fluoride in our water, foods and beverages, along with fluoridated dental products," said Paul Beeber, president of the New York State Coalition Opposed to Fluoridation (Townsend Letter, April 1998).

The worry is that the British dental lobby will be allowed to follow suit.

!ADoris Jones