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33
Most of the fluoridation projects aim at maintaining concentrations
of 0.9 to 1.0 p.p.m. Dental fluorosis which results from heavier concentrations
appears only when these are quite outside the range of the amounts
deliberately added. It seems that amounts even of only 1 p.p.m. can
cause very mild mottling in ten per cent. of those exposed, though this
mottling can be detected only by expert examination ; even the mild
fluorosis produced by levels of 1.5 to 2 0 p.p.m. is inconspicuous. It was
not until concentrations of 6 p.p.m. were consumed that the mottling
became severe and conspicuous.
The opposition to fluoridation mainly is on one of two grounds : the
one that compulsory medication is repugnant, the other that insufficient
is known about the chronic toxicity of fluorides. Fluoridation has limited
value in those over sixteen years of age and it is maintained by some that
it is unjustifiable to expose the whole adult population to any possible
risk of chronic fluoride intoxication. Apart from skeletal fluorosis, some
fear the effect of fluoride in stimulating cancer. New growths, particularly
gastric carcinomas, are reported to be commoner in areas where the
water is naturally fluoridated. On the other hand, the Ministry of Health
declare that there is no scientific evidence that fluoridation at a level of
1 p.p.m. has any deleterious effect on the health either of adults or of
children. The Chief Officer of the Ministry of Health in his report for 1959
referring to this subject, said—"Fluoridation, to make good a natural
deficiency of fluoride, has been in operation in three centres in Great
Britain (Anglesey, Kilmarnock and Watford) for four years. Though it is
still too early to assess its effect, there is no reason to suppose that it will
differ in any way from that observed in America and other countries. It
may therefore be timely to consider the bearing of fluoridation on the
future, in terms of dental health and care.
It is not to be supposed that dental caries will entirely be eliminated but,
on the experience in the United States, the incidence will be less, the
attack rate will be much less severe, and we may expect to find about onethird
of the children aged twelve to fourteen completely free from caries.
With the decrease in rampant caries it should follow that fewer extractions,
fewer dentures, crowns or bridges will be needed. Carious cavities
will be fewer in number and smaller in extent, therefore more manageable,
It is probable that fewer teeth will be lost through periodontal disease
since the supporting tissues will be less subject to stress.
The possibility that there may be a decreased incidence of malocclusion,
and therefore less need for orthodontic treatment, is foreshadowed
by studies carried out recently in Turkey and in this country.
Despite the careful scrutiny to which fluoridation has been subjected
in various parts of the world by special commissions and professional
bodies of standing, no evidence has been found of any hazard to health
at a concentration as low as 1 p.p.m. Nevertheless, fluoridation is still the
subject of controversy, albeit confined to a comparatively small section of
the population, and follows a pattern familiar to public health workers
who remember the opposition to the introduction of chlorination of water,
pasteurization of milk and vaccination against smallpox."