"Dental Practice", June 2002. Book Review.

FLUORIDE: Drinking ourselves to death?
By B. Groves
pp.329; £12.99
Dublin: Newleaf 2001
ISBN 0-7171-3274-9

ELECTIVE fluoridation of water supplies in order to achieve a targeted biologic response from the population occurs mainly in the USA and Britain but also in some other English-speaking countries.

Fluoridation gives rise to emotive argument from within, but largely outwith, the medical and dental establishments and professions, such debate encompassing issues relating to the veracity and ethics of its use.

The accepted opinion from within the profession traditionally passes on to generation after generation of graduates - some eventually to become teachers - a usually positive view. How many professionals reading this book review, like myself, have ever stirred themselves to read the literature in any depth or to question the received wisdom? How many dentists currently set aside a significant amount of time related to treating iatrogenic modification/damage of tooth tissue (tetracycline discoloration, fluorosis, etc).

This soft cover book, which reads well, becomes addictive after a few minutes into its text. It is structured around the questioning and refutation - only by available scientific evidence from the literature - of statements made by the British Fluoridation Society (BFS) in support of fluoridation. The author postulates that this format will by such juxtaposition . . . "serve to put in stark relief the apparent evasive nature or clear bias of the BFS suggested responses".

Does this approach give the reader a picture that seems fair to both profession and laity? I have to say that it does. Any statements used by the author are based on references from the literature in refereed journals and, as far as I am concerned, were certainly contributing to a level playing field.

It is always wrong to entirely dismiss out of hand any reasoned argument for or against any particular issue. This book offers a wealth of detailed discussion and reference on this important topic, presented in an unemotional way. It has certainly added to my personal evidence base for opinion forming. The unique nature of fluoridation in delivering a substance to whole populations that produces bioactive response will remain a subject that generates hugely differing opinion as to justification and validity.

I commend this book to all active clinical practitioners as deserving a place in the practice library, and would go further and say it should be essential reading for all undergraduates. "You pays yer money and takes yer choice" has never been more applicable in these times of effective alternatives.

I can't help feeling that it would be interesting to read a similar work published by the BFS and the appropriate gurus in the profession that refuted the reasoned arguments of this book and opened up the debate to a higher level of scientific input to justify the status quo. There could well be some difficulty with this!

Science is about a search for truth and dogma does not have a place let alone political expediency. There is more than a whiff of both which this author addresses well in this book.

Keith Marshall.
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Fluoride Vol. 34 No.4: 264-266; 2002; Book Review

FLUORIDE: DRINKING OURSELVES TO DEATH?

by Barry A Groves^(a) Reviewed by Albert W Burgstahler^(b)

As might be expected from the title, the author makes no secret of his concern about the health risks of water fluoridation. Writing primarily for the general reader, he nevertheless has assembled an impressive array of referenced information of interest to anyone engaged in research concerning important biomedical and environmental aspects of fluoride and fluoridation. In a very orderly way, he marshals clear evidence that the substantial decreases in dental caries seen in many developed countries during the Last 50 years have occurred to about the same extent without fluoridation as in locations with fluoridation. Likewise, he records telling examples, contrary to prevailing expectations, of tooth decay rates continuing to decline in places that have discontinued fluoridation.

And what about the author? Now residing in Oxfordshire, England, after 27 years as an electronic engineer in the Royal Air Force, Barry Groves has been looking into the connection between modern diets and modern diseases, a subject about which he has written two valuable books. In the present book he has turned his attention to the seemingly never-ending discussion of the pros and cons of water fluoridation. His central theme is the disturbing contradiction of classifying industrial silicofluoride by-products as too hazardous to release into the air, rivers, or lakes but calling them safe and beneficial when they are metered into municipal drinking water, where their intake is unregulated and often excessively high and toxic. Another concern is the fact that most dentists and other health professionals are generally taught that the recommended uses of fluoride are safe and effective, even though their own journals often report otherwise.

Adding to its utility, the book is organized according to questions posed and answered by the British Fluoridation Society for dentists and dental hygienists who might be asked about fluoridation by their patients. The suggested and often evasive reply by the BFS to each question is then given in full, followed by a counter response from Groves, which he then expands with pertinent information.

Besides the dental caries aspects mentioned at the beginning of this review, topics raised by the BFS questions that are discussed include:

organizational and official endorsements of fluoridation that are contradicted by unrefuted research findings;

endorsements of fluoridation that have been withdrawn;

effects of fluoride on the brain and neuromuscular system; .fluoride-cancer connections;

risk of infant overdose of fluoride from fluoridation;

increased disfiguring dental fluorosis from fluoridation and fluoride use.

hypersensitivity to fluoride;

effects of fluoride on bone strength;

acute toxic episodes in fluoridation and fluoride dental treatment; .position against fluoridation by scientists at the us Environmental Protection Agency;

diminishing public and international support for fluoridation;

ethical and legal challenges to fluoridation, especially in the Human Rights Act of the European Union;

pivotal events in the history of fluoridation;

the source and toxic composition of fluoridation chemicals;

the dispute over the essentiality of fluoride in human nutrition;

the origins and outcome of the recent National Health Centre, University of York review of water fluoridation.

With such a wide array of topics, readers will find much useful information and fresh insight in the author's treatment of these and related items. In the concluding chapter, the author very ably summarizes the case against fluoridation and then comments:

"This relentless promotion of fluoride as a 'dental benefit', and refusal to listen to any who say otherwise, is responsible for the huge neglect in proper assessment of its toxicity, an issue that has become a major concern of many nations. ...As the toxicity of fluoride is undisputed, why are its adverse effects disputed?

"This myopic mentality also means that the real causes of dental caries are not addressed."

b. Professor AW Burgstahler, Editor Fluoride, 1620 Massachusetts Street, Lawrence, KS 66044-4254, USA.