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Water fluoridation by country

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Fluoridation of water, salt, and milk varies from country to country. Water fluoridation has been introduced to varying degrees in many countries, including Australia, Brazil, Canada, Chile, Ireland, Malaysia, the U.S., and Vietnam,[1] and is used by 5.7% of people worldwide.[2] Continental Europe largely does not fluoridate water, although some of its countries fluoridate salt; locations have discontinued water fluoridation in Germany, the Netherlands, and other countries.[2] Although major health and dental organizations support water fluoridation in the countries that practice water fluoridation, or have found no adverse effects, there has been a considerable opposition to water fluoridation whenever it is proposed.[3]

Percentage of population receiving water artificially or naturally fluoridated to levels recommended for preventing tooth decay.[1]
  80–100%
  60–80%
  40–60%
  20–40%
    1–20%
  < 1%
  unknown


Africa

South Africa

South Africa's Health Department recommends adding fluoridation chemicals to drinking water in some areas. It also advises removal of fluoride from drinking water (defluoridation) where the fluoride content is too high.[4][5]

Legislation around mandatory fluoridation was introduced in 2002, but has been on hold since then pending further research after opposition from water companies, municipalities and the public.[6]

Asia

China

In China, water fluoridation began in 1965 in the urban area of Guangzhou. It was interrupted during 1976–1978 due to the shortage of sodium silico-fluoride. It was resumed only in the Fangcun district of the city, due to objections, and was halted in 1983. The fluoridation reduced the number of cavities, but increased dental fluorosis; the fluoride levels could have been set too high, and low-quality equipment led to inconsistent, and often excessive, fluoride concentrations.[7]

Hong Kong

In Hong Kong, water is fluoridated[8], at an average level of 0.49mg/L[9] .

Japan

Less than 1% of Japan practices water fluoridation.[10]

India

Water fluoridation is not practiced in India.[11][12] Fluorosis is endemic in at least 20 states, including Uttaranchal, Jharkhand and Chhattisgarh.[13] The maximum permissible limit of fluoride in drinking water in India is 1.2 mg/L.[14]

Singapore

In 1956, Singapore was the first asian country to institute a water fluoridation program that covered 100% of the population. [15] [16] Water is fluoridated to a typical value of 0.4-0.6 mg per litre. [17]

Europe

Austria

Austria has never implemented fluoridation.[10]

Belgium

Belgium does not fluoridate its water supply, although legislation permits it.[10]

Croatia

Croatia does not fluoridate its water.[18]

Denmark

Denmark does not fluoridate its water, although the National Health Board is in favour.[10]

Finland

The Finnish government supports fluoridation, although only one community of 70 000 people was fluoridated, Kuopio. [10]Kuopio stopped fluoridation in 1992.[19]

France

France fluoridates salt.[10]

Netherlands

The Netherlands supplements with fluoride drops and pills.[10] Water was fluoridated in large parts of Holland from 1960 to 1973, when the Supreme Court declared fluoridation of drinking water unauthorized. [20] Drinking water is no longer fluoridated in any part of Holland since 1973.

Germany

Drinking water is not fluoridated in any part of Germany. The GDR used to fluoridate drinking water, but it was discontinued after the German reunification.[1]

Ireland

In the Republic of Ireland the majority of drinking water is fluoridated; 71% of the population in 2002 resided in fluoridated communities.[21] The fluoridation agent used is hydrofluosilicic acid (HFSA; H2SiF6).[22] In a 2002 public survey, 45% of respondents expressed some concern about fluoridation.[23]

In 1957, the Department of Health established a Fluorine Consultative Council which recommended fluoridation at 1.0 ppm of public water supplies, then accessed by c.50% of the population.[24] This was felt to be a much cheaper way of improving the quality of children's teeth than employing more dentists.[25] The ethical approval for this was given by the "Guild of Saints Luke, Cosmas and Damian", established by Catholic Archbishop of Dublin, John Charles McQuaid.[24] This led to the Health (Fluoridation of Water Supplies) Act 1960, which mandated compulsory fluoridation by local authorities.[26][27] The statutory instruments made in 1962–65 under the 1960 Act were separate for each local authority, setting the level of fluoride in drinking water to 0.8–1.0 ppm.[28][29] The current regulations date from 2007, and set the level to 0.6–0.8 ppm, with a target value of 0.7 ppm.[30]

Implementation of fluoridation was held up by preliminary dental surveying and water testing,[31] and a court case, Ryan v. Attorney General.[32] In 1965, the Supreme Court rejected Gladys Ryan's claim that the Act violated the Constitution of Ireland's guarantee of the right to bodily integrity.[32][33] By 1965, Greater Dublin's water was fluoridated; by 1973, other urban centres were.[34] Dental surveys of children from the 1950s to the 1990s showed marked reductions in cavities parallel to the spread of fluoridation.[35]

Spain

Around 10% of the population receives fluoridated water.[36][37]

Sweden

In 1952, Norrköping in Sweden became one of the first cities in Europe to fluoridate its water supply.[38] It was declared illegal by the Swedish Supreme Administrative Court in 1961, re-legalized in 1962[39] and finally prohibited by the parliament in 1971,[40] after considerable debate. The parliament majority said that there were other and better ways of reducing tooth decay than water fluoridation. Four cities received permission to fluoridate tap water when it was legal.[38]: 56–57  An official commission was formed, which published its final report in 1981. They recommended other ways of reducing tooth decay (improving food and oral hygiene habits) instead of fluoridating tap water. They also found that many people found fluoridation to impinge upon personal liberty/freedom of choice, and that the long-term effects of fluoridation were not sufficiently known. They also lacked a good study on the effects of fluoridation on formula-fed infants.[38]: 29 

Switzerland

In Switzerland since 1962 two fluoridation programmes had operated in tandem: water fluoridation in the City of Basel, and salt fluoridation in the rest of Switzerland (around 83% of domestic salt sold had fluoride added). However it became increasingly difficult to keep the two programmes separate. As a result some of the population of Basel were assumed to use both fluoridated salt and fluoridated water. In order to correct that situation, in April 2003 the State Parliament agreed to cease water fluoridation and officially expand salt fluoridation to Basel.[41]

United Kingdom

Around 10% of the population of the United Kingdom receives fluoridated water;[36][37] about half a million people receive water that is naturally fluoridated, and about 6 million total receive fluoridated water.[42] The All Party Parliamentary Group on Primary Care and Public Health recommended in April 2003 that fluoridation be introduced "as a legitimate and effective means of tackling dental health inequalities".[citation needed] The Water Act 2003 required water suppliers to comply with requests from local health authorities to fluoridate their water.[42]

The following UK utilities companies fluoridate their water: Anglian Water Services Ltd., Northumbrian Water Ltd., South Staffordshire Water plc, Severn Trent plc and United Utilities Water plc. Earlier schemes were undertaken in the Health Authority areas of Bedfordshire and Hertfordshire, Birmingham and the Black Country, Cheshire and Merseyside, County Durham and Tees Valley, Cumbria and Lancashire, North and East Yorkshire and Northern Lincolnshire, Northumberland, Tyne and Wear, Shropshire and Staffordshire, Trent, and West Midlands South whereby fluoridation was introduced progressively in the years between 1964 and 1988.[43] The South Central Strategic Health Authority carried out the first public consultation under the Water Act 2003, and in 2009 its board voted to fluoridate water supplies in the Southampton area to address the high incidence of tooth decay in children there.[42] Surveys had found that the majority of surveyed Southampton residents opposed the plan, but the Southampton City Primary Care Trust decided that "public vote could not be the deciding factor". A judicial review has been initiated.[44]

The water supply in Northern Ireland has never been artificially fluoridated except in two small localities where fluoride was added to the water for about 30 years. By 1999, fluoridation ceased in those two areas, as well. Scotland's parliament rejected proposals to fluoridate public drinking water following a public consultation.[citation needed]

Middle East

Israel

Water supply in Israel is artificially fluoridated since the 1970's. About 67% of Israel's population receives flouridated water.

North America

Canada

The decision whether to fluoridate lies with local governments, with guidelines set by provincial, territorial, and federal governments. Brantford, Ontario became the first city in Canada to fluoridate its water supplies in 1945.[45] In 1955, Toronto approved water fluoridation, but delayed implementation of the program until 1963 due to a campaign against fluoridation by broadcaster Gordon Sinclair.[46] The city continues to fluoridate its water today.[47] In 2008 the recommended fluoride levels in Canada were reduced from 0.8–1.0 mg/L to 0.7 mg/L to minimize the risk of dental fluorosis. Ontario, Alberta, and Manitoba have the highest rates of fluoridation, about 70–75%. The lowest rates are in Quebec (about 6%), British Columbia (about 4%), and Newfoundland and Labrador (1.5%), with Nunavut and the Yukon having no fluoridation at all.[45] Overall, about 45% of the Canadian population had access to fluoridated water supplies in 2007.[45]

United States

U.S. residents served with community water fluoridation, 1992 and 2006. The percentages are the proportions of the resident population served by public water supplies who are receiving fluoridated water.[48]
Main article: Water fluoridation in the United States

As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation.[49] According to a 2002 study,[50] 67% of U.S. residents were living in communities with fluoridated water at that time.

Australasia

Australia

Australia has fluoridation in all but one state, Queensland, in which water fluoridation is under local government control. However, on 5 December 2007 Queensland Premier Anna Bligh announced fluoridation of most of Queensland's water supply will begin in 2008.[51]

On May 2nd 2009 an accident occurred at the North Pine Dam treatment plant where 300,000 litres of contaminated water was pumped into up to 4000 Brisbane homes in the northern suburbs of Brendale and Warner for three hours. The water contained 30 to 31mg/L of fluoride instead of the maximum allowable 1.5mg/L. Anna Bligh expressed her concerns stating "This is unacceptable and I, like other Queenslanders, have questions about it, and I'm not happy,".[52][53]

An exception exists in Western Australia where approximately 20,000 residents within the Busselton, Vasse and Wonnerup townsites, do not receive artificially fluoridated water.[54]

The first town to fluoridate the water supply in Australia was Beaconsfield, Tasmania in 1953.[55]

New Zealand

New Zealand has fluoridated nearly all water-supplies except those in remote areas. A notable exception to this is the city of Christchurch, the third largest city in the nation. The use of water fluoridation first began in New Zealand in Hastings in 1954. A Commission of Inquiry was held in 1957 and then its use rapidly expanded in the mid 1960s.[56] The Waitaki District voted against Water Fluoridation in a 2007 referendum.

South America

Chile

In Chile 70.5% of the population receive fluoridated water (10.1 million added by chemical means, 604,000 naturally occurring).[57]

References

  1. ^ a b c The British Fluoridation Society; The UK Public Health Association; The British Dental Association; The Faculty of Public Health (2004). "The extent of water fluoridation". One in a Million: The facts about water fluoridation (2nd ed.). pp. 55–80. ISBN 095476840X. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)CS1 maint: multiple names: authors list (link)
  2. ^ a b Cheng KK, Chalmers I, Sheldon TA (2007). "Adding fluoride to water supplies". BMJ. 335 (7622): 699–702. doi:10.1136/bmj.39318.562951.BE. PMC 2001050. PMID 17916854.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  3. ^ Armfield JM (2007). "When public action undermines public health: a critical examination of antifluoridationist literature". Aust New Zealand Health Policy. 4: 25. doi:10.1186/1743-8462-4-25. PMC 2222595. PMID 18067684.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  4. ^ "Water Fluoridation - The Facts", from South Africa's Department of Health website, page accessed April 29, 2006.
  5. ^ The Water Page - Rand Water and Fluoridation
  6. ^ http://www.iol.co.za/index.php?set_id=1&click_id=125&art_id=vn20030108054021972C918779
  7. ^ Petersen PE, Kwan S, Zhu L, Zhang BX, Bian JY (2008). "Effective use of fluorides in the People's Republic of China—a model for WHO Mega country initiatives" (PDF). Community Dent Health. 25 (4 Suppl 1): 257–67. PMID 19202775. Retrieved 2009-03-08.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  8. ^ Water Treatment Process, Water Supplies Department, The Government of Hong Kong Special Administrative Region.
  9. ^ Drinking Water Quality for the Period of April 2008 - March 2009, Water Supplies Department, The Government of Hong Kong Special Administrative Region
  10. ^ a b c d e f g NCFPR. Fluoridation Facts: Antifluoride Assertion - "Advanced Countries Shun Fluoridation". Drawn from the ADA [www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf Fluoridation Facts] document. Cite error: The named reference "NCFPR" was defined multiple times with different content (see the help page).
  11. ^ Ingram, Colin. (2006). The Drinking Water Book. pp. 15-16
  12. ^ Control of Fluorosis in India
  13. ^ Fluoridation and Fluorosis Disaster - India: Fluoride in water takes its toll in Assam - La Leva di Archimede (ENG)
  14. ^ WHO | Naturally occurring hazards
  15. ^ Thirty-eight years of water fluoridation--the Singapore scenario., Community Dent Health. 1996 Sep;13 Suppl 2:47-50. http://www.ncbi.nlm.nih.gov/pubmed/8897751
  16. ^ Fluoridation of public water supplies in Singapore., Ann Acad Med Singapore. 1984 Apr;13(2):247-51. http://www.ncbi.nlm.nih.gov/pubmed/6497322?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
  17. ^ Water Treatment, Public Utility Board. http://www.pub.gov.sg/general/Pages/WaterTreatment.aspx
  18. ^ Newspaper article in Vjesnik.hr
  19. ^ name=Caries Research Caries Occurrence in a Fluoridated and a Nonfluoridated Town in Finland: A Retrospective Study Using Longitudinal Data from Public Dental Records
  20. ^ -Bram van der Lek, "De strijd tegen fluoridering", in De Gids, v.139, 1976
  21. ^ Report of the Forum on Fluoridation 2002, p.76 - Dept of Health and Children - Ireland
  22. ^ Report of the Forum on Fluoridation 2002, pp.29–30
  23. ^ Report of the Forum on Fluoridation 2002, p.37
  24. ^ a b Report of the Forum on Fluoridation 2002, p.71
  25. ^ Report of the Forum on Fluoridation 2002, p.72
  26. ^ Report of the Forum on Fluoridation 2002, p.72
  27. ^ Health (Fluoridation of Water Supplies) Act, 1960, Irish Statute Book
  28. ^ Report of the Forum on Fluoridation 2002, p.170
  29. ^ A full list is in "Schedule 2: Revocations". S.I. No. 42 of 2007: Fluoridation of Water Supplies Regulations 2007. Irish Statute Book. 2 February 2007. Retrieved 2009-10-12.
  30. ^ "S.I. No. 42 of 2007: Fluoridation of Water Supplies Regulations 2007". Irish Statute Book. 2 February 2007. Retrieved 2009-10-12.
  31. ^ Report of the Forum on Fluoridation 2002, p.73
  32. ^ a b Ryan v. Attorney General [1965] IESC 1 (3 July 1965)
  33. ^ Report of the Forum on Fluoridation 2002, pp.74–76
  34. ^ Report of the Forum on Fluoridation 2002, p.76
  35. ^ Report of the Forum on Fluoridation 2002, pp.76–78
  36. ^ a b Mullen, Joe. "History of Water Fluoridation", British Dental Journal, 2005, page accessed April 29, 2006.
  37. ^ a b [1] British Dental Journal (2005); 1-4. doi: 10.1038/sj.bdj.4812863Help History of Water Fluoridation by Dr Joe Mullen
  38. ^ a b c Larsson, Gerhard (1981). Fluor i kariesförebyggande syfte - Betänkande av fluorberedningen (in Swedish). Stockholm: Statens offentliga utredningar / Socialdepartementet. p. 12. SOU 1981:32. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  39. ^ "Fluoreringsfrågan avgjord". Västmanlands läns tidning (in Swedish). 1962-11-22.
  40. ^ "Stopp för fluor". Västmanlands läns tidning (in Swedish). 1971-11-19. p. 1.
  41. ^ J. MEYER and P. Wiehl in Schweiz Monatsschr. Zahnmed 2003; 113: 702 (in French) and 728-729 (in German)
  42. ^ a b c Gibson-Moore H (2009). "Water fluoridation for some—should it be for all?". Nutr Bull. 34 (3): 291–5. doi:10.1111/j.1467-3010.2009.01762.x.
  43. ^ British Medical Association
  44. ^ Southampton fluoridation challenge launched. (2009-6-30). Dentistry.co.uk.
  45. ^ a b c Rabb-Waytowich D (2009). "Water fluoridation in Canada: past and present" (PDF). J Can Dent Assoc. 75 (6): 451–4. PMID 19627654.
  46. ^ "Gordon Sinclair's rant", from the Canadian Broadcasting Corporation Archives website, page accessed March 27, 2006.
  47. ^ "Water supply - R. L. Clark Filtration Plant", from Toronto's website, page accessed March 27, 2006.
  48. ^ Klein RJ (2008-02-07). "Healthy People 2010 Progress Review, Focus Area 21, Oral Health". National Center for Health Statistics. Retrieved 2009-01-05.
  49. ^ The Benefits of Fluoride, from the Centers for Disease Control and Prevention website, accessed 19 March, 2006.
  50. ^ Fluoridation Status: Percentage of U.S. Population on Public Water Supply Systems Receiving Fluoridated Water, from the Centers for Disease Control and Prevention website, accessed 19 March, 2006.
  51. ^ Qld to get fluoridated water - ABC News (Australian Broadcasting Corporation)
  52. ^ Courier Mail - Damage control after fluoride blunder hits homes
  53. ^ Courier Mail - Brisbane given Fluoride overdose on May 2
  54. ^ Busselton Water (Understanding our Natural Groundwater Resource)
  55. ^ Editors: Graham Aplin, S.G. Foster and Michael McKernan, ed. (1987). "Tasmania". Australians:Events and Places. Sydney, NSW, Australia: Fairfax, Syme & Weldon Associates. pp. page 366. ISBN 0-521-34073-X. {{cite book}}: |editor= has generic name (help); |pages= has extra text (help)
  56. ^ New Zealand Ministry of Health
  57. ^ Information from the Oral Health Department of the Chilean Ministry of Health. December 2004.
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