Pacific Scoop
09/30/2010

Fluoridation row in Fiji splits health officials and activists over oral health

By Jessica Tasman-Jones

A move to bring back fluoridated water across the Fiji Islands for the first time in three decades has a lobby group up in arms claiming the mineral is “toxic”.

A controversial debate over fluoridation of water supplies has sprung up in Fiji in the past few months with plans to reintroduce the public health measure.

Last month, the Ministry of Health revealed it is working with the Water Authority of Fiji to fluoridate water supplies across the country.

According to the World Health Organisation (WHO) fluoride is beneficial for oral health when consumed in limited concentrations.

But international lobby group Fluoride Action Network says the mineral is toxic and campaigns for non-fluoridated water.

However, the ministry website says the measure is the most cost effective way of reducing dental decay.

According to a 2004 survey on oral health, 88.3 per cent of Fijian children suffered from tooth decay.

History

In the late 1970s and 1980s, parts of Fiji’s water supply were fluoridated by the Public Works Department.

However, due to population growth and increased demand for water supplies the fluoridation plant eventually stopped operating.

But last month the Ministry of Health revealed it was talking with the Water Authority of Fiji to fluoridate water.

Tap water in Suva is already fluoridated but the ministry is looking to extend this programme across Fiji.

Dr Joan Lal of the Fiji Medical School’s Oral Health Department says she has been lobbying for the move since 2001.

She says Fiji has “huge levels of decay in children”.

According to the Ministry of Health, 88.3 per cent of children experience decay in their primary teeth and 79.3 per cent show signs in their permanent teeth.

Fluoride

In 2006, the WHO issued a report Fluoride in drinking-water.

The purpose of the report is to provide information for regions to set their own standards, taking into account social, cultural, environmental and economic conditions.

The American Dental Association (ADA) says fluoride reduces cavities in children and adults and repairs the early stages of tooth decay –known as dental caries.

A report on caries prevalence in urban school children says infrequent brushing, snacking on high sugar goods and only visiting a dentist when in pain are the main factors that cause dental decay.

Fluoride can be applied to teeth in toothpastes and mouth rinses or consumed in tablets, lozenges or through fluoridated water.

The ADA says for best results fluoride should be applied to the teeth directly and ingested.

Both organisations warn against ingesting the chemical in high concentrations.

The WHO reports mottling of the teeth is an early sign of excessive fluoride consumption.

The report says fluoride is associated with “crippling skeletal fluorosis” when consumed in concentrations of 10 parts per million.

The FDI World Dental Federation says human health is not adversely affected by fluoride at concentrations required for dental decay.

Fiji’s Ministry of Health says communities with fluoridated water have a 15 per cent increase in caries-free children.

Anti-fluoridation groups

Dr Lal says she has not encountered resistance to the moves by anti-fluoride groups.

International lobby group Fluoride Action Network does not have a Fijian chapter but links to news items about the measures on their website reveal the group is monitoring the situation.

A spokesperson from Fluoride Action Network New Zealand says the group will be communicating their concerns to Fijian locals.

“They sell Fiji Water because it’s pure,” she says. “Fluoridation would mean they’d have to import toxins into Fiji.”

The group says consumption of fluoride is linked with arthritis, thyroid problems and lowered IQ.

The group does not have a blanket opposition to the mineral but says consumption of fluoride should be the choice of the consumer.

Fijian consumers

But Dr Lal says fluoridated toothpaste is expensive in Fiji and consumers buy the cheaper, non-fluoridated options as a result.

Fijian consumers have more access to refined sugar products than in the past and this is not matched by a concurrent rise in oral health awareness, a 2004 study found.

Consumer Council of Fiji chief executive Premila Kumar supports plans to fluoridate the country’s water supply.

She says reports from WHO are based on “scientific research and experiences of other countries around the world”.

But she says the Water Authority of Fiji should monitor fluoride levels to ensure they are within the recommended concentrations.

“[It’s] just like salt or iron which is needed by the body but in right amounts. Too much salt causes high blood pressure and salt deficiency has other adverse effects.”

As a result it is important the concentration of fluoride in water supplies is kept within the range recommended by WHO.

Public consultation

Kumar says the Ministry of Health has not mentioned any public consultation on water fluoridation.

However, she says past experience shows these often have a poor response from the public.

“We don’t think public consultation on fluoridation of water will be any different,” she says.

Kumar says a “stakeholder consultation” with health experts, dental experts, nutritionists, experts from organisations like WHO and interested consumers would be “more rewarding and fruitful”.

She says in addition to water fluoridation the council would like other effective solutions to teeth decay to be sought.

Nutrition

A spokesperson from the University of the South Pacific food unit says international guidelines dictate the level of fluoride needed for oral health reasons will be fine.

He says side effects occur with many medicines but it’s important to look at the bigger picture.

When it comes to fluoridation he says WHO recommendations suggest the benefits outweigh the potential harm.

But the Fluoride Action Network says WHO recommendations are outdated.

According to their spokesperson, communities nowadays are exposed to more fluoride than in the past through pesticides and medications.

However, the WHO website states a revision of 1984 data in 2004 revealed the guidelines and standards did not need to be revised.

They say the value guideline of 1.5 ppm was not a “fixed” value and should take environment, dietary and cultural values into account.

Jessica Tasman-Jones is a Postgraduate Diploma in Communication Studies student on the Asia-Pacific Journalism course at AUT University.

CAPTION UNDER PHOTO:
'They sell Fiji Water because it’s pure.' (Photo: PMC.)