Benefits of Public Water Fluoridation Well-Documented

MOH's reply

The Sunday Times, 26 April 2015

In his letter, Mr Wong Shih Shen called for a review of Singapore’s public water fluoridation policy “Review water fluoridation policy” (12 Apr).
 
Fluoride in drinking water may have contributed to Singapore having one of the lowest DMFT (Decayed, Missing and Filled Teeth) index of 0.46 (2013) for 12-year-olds in the world.
 
The merits of public water fluoridation are well-documented and scientifically robust, with many studies demonstrating the association between water fluoridation and a decrease in dental caries in populations. Water fluoridation has also been shown to have an effect over and above that of fluoridated toothpastes and other sources of fluoride.
 
As Mr Wong shared, other forms of fluorides, i.e. professionally applied fluoride varnishes and gels, self-applied fluoride toothpaste and mouth rinses can be effective in the control of dental caries. However, not all Singaporeans use or comply with the proper use of these fluoride modalities.
 
Water fluoridation therefore has unique advantages from the perspectives of distribution, equity, compliance and cost-effectiveness over other fluoride sources in benefiting the whole population and in reducing dental health inequalities.
 
The cessation of water fluoridation may therefore widen inequalities in oral health, particularly dental caries, between different socioeconomic strata in Singapore.
 
The Ministry of Health will continue to track new evidence regarding the benefits and risks of water fluoridation.  While there are some studies suggesting possible health impact at high concentrations of fluoride found in some water sources (e.g. well water in some places), there is currently no scientific evidence of real environmental or individual toxicity caused by water fluoridation at the low levels used in Singapore.
 
Associate Professor Patrick Tseng
Chief Dental Officer
Ministry of Health

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Forum Letter

The Sunday Times, 12 April 2015

Review water fluoridation policy

Singapore adopted fluoridation of our drinking water in 1954, as part of public health intervention to lower tooth decay for our children ("Water fluoridation safe, with dental benefits"; Aug 25, 2012).

On Aug 26 last year, Israel declared the end of mandatory fluoridation of drinking water, and joined the vast majority of countries in the world in which fluoridation is not mandatory.

According to data from the World Health Organisation, there has been a decline in tooth decay in countries that did not fluoridate their drinking water.

There is also scientific evidence that fluoride in large amounts can damage one's health.

In the United States, the Centres for Disease Control and Prevention as well as the Environmental Protection Agency have stated that children aged eight and younger, when exposed to excessive amounts of fluoride, show an increased chance of developing pits in their teeth's enamel.

Excessive consumption of fluoride over a lifetime may also increase the likelihood of bone fractures in adults. Whether there is a high risk of this in Singapore remains unknown until further local research is done.

There may be concern by governments that have adopted fluoridation that their citizens are not getting enough fluoride.

However, proper nutrition, adhering to the rules for brushing one's teeth twice a day with toothpaste containing fluoride, and regularly visiting the dentist can be mitigating strategies.

In addition, due to increased health awareness of drinking water free of chlorine and fluoride, many households, thanks to water filters, are already consuming unfluoridated water.

It is time for the Ministry of Health to review the appropriate and safe level of fluoride in our water supply, and to reconsider if Singapore should continue with its water fluoridation.

When fluoride is supplied via drinking water, there is no control over the amount of fluoride actually consumed, which might lead to excessive consumption.

Wong Shih Shen