Australasian Science: Australia's authority on science since 1938

Stepping out of the Dental Dark Ages

By Michael Foley

Water fluoridation has been one of the country’s most effective public health measures, but parts of Australia don’t have that benefit and may even strongly resist it. Why?

Beaconsfield, Tasmania, is best known as the site of the 2006 mine collapse, but it was also Australia’s first fluoridated town in 1953. The decay-fighting dental health benefits of water fluoridation were quickly realised, and most states and territories jumped on board in the 1960s and 70s. The exception was Queensland, where successive state governments regarded fluoridation as a local government water treatment issue to be ignored rather than a public health issue to be encouraged.

Only in recent years has this changed. Australia’s National Oral Health Plan 2004–2013 urged all state and territory governments to increase the spread of fluoridation as a matter of urgency to reduce the levels of tooth decay across the country. The Queensland Government, with unanimous support from the State Opposition, finally mandated widespread fluoridation in 2008. Queensland newspaper editorials praised the decision.

But things changed dramatically in 2012 when the newly elected State Government rushed legislative amendments through Parliament on the final sitting day of the year to once again place responsibility for water fluoridation in the hands of local councils. Health professional groups, parliamentary committees and the Queensland Fluoridation Committee were not consulted. There may have been very good reasons for the Queensland Government to place the decision-making power on water fluoridation in the hands of local councils, but the health of Queenslanders was not one of them.

Despite Queensland’s Chief Health Officer urging all councils to obtain a health briefing prior to any decision on fluoridation, most did not, and many opted out of fluoridation. Some argued on the basis of cost, despite fluoridation being one of the most cost-beneficial of all public health interventions. One councillor voted against fluoridation because of the risk of dementia, even though the Alzheimer’s Australia website clearly indicates its support for fluoridation. Another voted “no”, claiming that fluoridated water damaged hydrangeas and gerberas despite these plants flourishing in the rest of Australia. Another regional mayor confidently stated that “your bones go brittle so you end up with a real lot of old people who might have good teeth but they can’t move anywhere because their bones are fractured”.

I use these examples not to disparage local councillors, but to emphasise that detailed knowledge of population health and the ability to assess complex scientific arguments are rarely found at council level.

How do people develop these irrational beliefs? Partly through media outlets feeling an obligation to provide “balanced” views, but mostly through superbly organised anti-fluoridation lobby groups with no ethical restraints that are eager to spread misinformation.

In 2012, the ABC’s Media Watch host Jonathan Holmes was blunt when talking about the vaccination “debate” in the media, and his comment applies equally to fluoridation:

To put it bluntly, there’s evidence, and there’s bulldust. It’s a journalist’s job to distinguish between them, not to sit on the fence and bleat “balance”, especially when people’s health is at risk.

And the lack of ethical restraints? Recent discussion of fluoridation in northern NSW saw their Chief Medical Officer being threatened with sarin gas and an anti-fluoridation activist urinating on the doorstep of a local dentist. Councils considering water fluoridation are invariably bombarded with ignorant scaremongering e-mails and letters from around the world, all with outlandish claims aiming to sow a seed of doubt in the minds of decision-makers or pressure them into submission.

All elected governments have an obligation to legislate in the best interests of their communities. Indeed, Queensland’s 2012 legislative amendments specify that councils are to make any decision on fluoridation “in the best interests of their community”. But are the best interests of the 500,000 Queenslanders now without community water fluoridation really any different to the best interests of the vast majority of Australians?

Outside the halls of academia, high-level population health skills are found almost entirely within state and federal government departments. Australians expect that major public health programs will be developed, promoted and managed by those with the greatest expertise. Water fluoridation must be treated no differently.

Michael Foley is a Queensland-based dentist. He holds Masters degrees in public health and epidemiology, and lectures at the University of Queensland and Griffith University.