Advice to diabetics and infants using fluoridated water

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Miss K Williams

Dear Birmingham East and North Primary Care Trust (PCT),

Please could you list for me the current advice to diabetics and also infants using formula feed regarding the use of public tap water with added fluoride?

Could you also list for me all the advice you have used regarding diabetics and infants using the fluoridated tap water?

Yours faithfully,

Miss K Williams

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Probert Jane,

Dear Miss Williams

We acknowledge your Freedom of Information request.
Your request is being dealt with under the terms of the Freedom of
Information Act 2000 and will be answered within 20 working days.
If you have any queries please do not hesitate to contact me, quoting
reference 10/244

Kind regards

Jane Probert
FoI Coordinator and PAA to -
Tina Gallagher - Deputy Director of Performance and Information
NHS Birmingham East and North
Telephone 0121 380 9213
[email address]

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Probert Jane,

1 Attachment

Dear Miss Williams

Further to your Freedom of Information request, please see our response
attached.

If you have any queries about this request, please do not hesitate to
contact me, quoting reference 10/244.

Kind regards

Jane Probert

FoI Coordinator and PAA to -

Tina Gallagher - Deputy Director of Performance and Information

NHS Birmingham East and North

Telephone 0121 380 9213

[email address]

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Dear Probert Jane,

You have not answered the question "Could you also list for me all the advice you have used regarding
diabetics and infants using the fluoridated tap water?

The American dental association has changed it's advice regarding infants and diabetics using water with added fluoride. Please remember that fluoride is a poison grater than led and Birmingham deserves an NHS that cares or a public consultation as the new law requires.

Also I have checked the dental statistics against non fluoridated area's such as Derby and found Derby to be fractionally better than Birmingham.
http://www.apho.org.uk/resource/view.asp...

Yours sincerely,

Miss K Williams

Dear Probert Jane,

I can assure you that giving fluoride to diabetics and infants against their will is against many professionals advice. Also mass medicating a known poison to everyone is against our human rights.

Yours sincerely,

Miss K Williams

Probert Jane,

Dear Miss Williams

Just to let you know that I have referred back to the health
professionals concerned and will provide further information as soon as
possible.

Kind regards

Jane Probert
FoI Coordinator and PAA to -
Tina Gallagher - Deputy Director of Performance and Information
NHS Birmingham East and North
Telephone 0121 380 9213
[email address]

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Probert Jane,

1 Attachment

Dear Miss Williams,

Following your further enquiry about Freedom of Information request no.
10/244, please see our response below.

We explained in our previous response to your FOI request that we do not
routinely give advice about the consumption of fluoridated water to
mothers who bottle-feed their babies or to people who have diabetes, as
there is no health reason for us to do so. We do, however, recommend
mothers to breast-feed wherever possible and we offer advice and support
to them to facilitate that.

We also explained in our response that our policy is based on an analysis
of the available scientific evidence. We reiterate what we have
previously said: there is no scientific evidence to suggest that there are
harmful effects on people's health from fluoridated water. On the other
hand, there is evidence that fluoridated water benefits dental health.

Systematic reviews of safety and effectiveness

Two major systematic reviews of the worldwide evidence on the safety and
effectiveness of water fluoridation have been conducted in the past 10
years, one by the Centre for Reviews and Dissemination at the University
of York (published in 2000) and one by the Australian National Health and
Medical Research Centre (published in 2007). Neither review found
evidence of harm to health. Both found dental benefits.

Two further systematic reviews of the worldwide evidence on the dental
benefits of fluoridation have been conducted in the United States. A US
Task Force (Truman et al, published in 2002) reviewed studies of
children's dental health and found that those who lived in fluoridated
areas had significantly lower levels of tooth decay. Another group of
researchers (Griffin et al, 2007) reviewed studies of adults' dental
health. They found significant benefits for adults who had lived in
fluoridated areas for all or most of their lives.

Comparing the dental health of children

You allude in your last email to children's dental health statistics for
Birmingham and Derby in health profiles published by the Association of
Public Health Observatories, from which you infer that fluoridation is not
effective. It is important to remember that there is a strong association
between levels of social deprivation and the prevalence of tooth decay
among children. The more socially deprived the community, the higher the
level of tooth decay is likely to be.

Parts of Birmingham are very socially deprived. For example, Heart of
Birmingham Primary Care Trust has been classified as the most deprived in
England. Birmingham East and North PCT is among the most deprived.
However, even when Birmingham as a whole, including its more affluent
areas, is compared with Derby, you will see from their respective health
profiles that Birmingham has much higher levels of social deprivation.
Despite this, the average number of decayed, missing and filled teeth
(dmft) among 5-year olds in Birmingham is slightly lower than among Derby
children of this age.

Furthermore, if you compare like with like (South Birmingham Primary Care
Trust with Derby City Primary Care Trust - both with similar levels of
social deprivation), you can see that South Birmingham children have over
30% less tooth decay. Furthermore, if you compare Birmingham as a whole
with a major city with similar levels of social deprivation, such as
Manchester, you can see that Birmingham children have around 40% less
tooth decay.

Overall, our experience in Birmingham since the commencement of water
fluoridation in 1964 is that our city's children have benefited from lower
rates of tooth decay than they would otherwise have had. It has meant
fewer children suffering from toothache, fewer teeth having to be filled
or extracted and fewer children experiencing general anaesthesia for
extractions. Figures for 2002/03 show that six times more children aged
10 and under from non-fluoridated Greater Manchester underwent general
anaesthesia for tooth extractions than children of the same age in the
whole of fluoridated Birmingham and the Black Country.

The dental benefits have also been replicated in other fluoridated parts
of the West Midlands.

Diabetes

You refer to diabetes. We are aware of no scientific data to suggest that
diabetes is either caused or exacerbated by the consumption of water with
1mg/L fluoride, whether naturally occurring or added. We have had no
reports from diabetes specialists in Birmingham to suggest that
fluoridated water may cause problems for people with diabetes.

You say in your email that the American Dental Association has changed its
advice regarding people with diabetes and consumption of fluoridated
water. You do not say how or why it has changed its advice. We have
contacted the ADA on this matter. The ADA publishes an information sheet
for people with diabetes entitled "Diabetes and Oral Health", which
stresses the importance to them of maintaining good oral health. It
contains no advice to people with diabetes to avoid fluoridated water.
The ADA has confirmed to us that it has not issued any new advice to
people with diabetes and it has reiterated its support for water
fluoridation as an effective means of reducing the total burden of tooth
decay on a population.

Infants

With regard to infants, the American Dental Association encourages mothers
to breast-feed. However, for those who bottle-feed with an infant
formula, it has issued interim guidance to those who are concerned about
reducing the already low risk of enamel fluorosis (a cosmetic condition)
in their children's developing permanent teeth. We have examined the ADA
guidance and, in addition, have considered the findings of a systematic
review of studies on the use of infant formula that was published in
October 2009 in the Journal of the American Dental Association (JADA). In
the general context of infant formula, we have also examined a statement
by the US Centers for Disease Control and Prevention (CDC), issued in May
2010, which emphasises that community water fluoridation poses no known
health risks for infants.

The American Dental Association has expressed concern at attempts by those
opposed to water fluoridation to `mischaracterise' both its interim
guidance on infant formula and the October 2009 report on the systematic
review of infant formula studies.

The American Dental Association says that, in the vast majority of cases,
the effect of fluorosis is so subtle that only dental experts can spot it,
whilst one study in the scientific literature (Hawley et al, 1996)
suggests that some people think teeth with mild enamel fluorosis may be
more attractive than teeth without fluorosis.

We have no indications that fluorosis is perceived to be a problem of
aesthetic concern among Birmingham residents. In any event, the Medical
Research Council estimates that the prevalence of fluorosis of possible
aesthetic concern is as low as 3% to 4% in fluoridated communities and 1%
in non-fluoridated communities. To put this into perspective, it must be
borne in mind that decayed teeth can be very unsightly, as well as
painful. Water fluoridation has, over more than 45 years, significantly
reduced the amount of tooth decay that Birmingham children would otherwise
have experienced. The public health benefits are therefore significant.

If you have any further queries about this request, please do not hesitate
to contact me, quoting reference 10/244.

Kind regards

Jane Probert

FoI Coordinator and PAA to -

Tina Gallagher - Deputy Director of Performance and Information

NHS Birmingham East and North

Telephone 0121 380 9213

[1][email address]

.......................................................................................................

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Miss K Williams

Dear Probert Jane,

Mother’s milk contains fluoride at between 4-10 parts per billion. Using fluoridated water a bottle-fed baby will receive up to 250 times more fluoride than Mother Nature intended. In 2006, the American Dental Association warned its members (dentists) not to recommend fluoridated water for mixing infant formula.

The York Review (2000) found that fluoridation increases dental fluorosis of aesthetic concern from 6.3% (F at 0.1ppm) to 12.5% (F at 1ppm) in those who drink fluoridated water. Fluoridation doesn’t make ethical, legal, medical, dental, scientific or common sense.

Fluoride’s acute toxicity lies between that of lead and
arsenic (Gosselin et al, 1984). Yet, with fluoridation it will be added at 100 times the level permitted for arsenic!

You are currently adding fluoride to water without consultation as the law requires you to do. Do you intend to inform everyone that you are adding fluoride to their tap water? Are you sure you don't want to give advice regarding over consumption of fluoride to at risk people?

Placing a known poison on your teeth may well have positive effects, however it was never ever supposed to be consumed internally at the amounts that a diabetic or infant using formula with tap water does.

Yours sincerely,

Miss K Williams

Hindle Linda,

Dear Miss Williams

Thanks for your recent email. We feel that we have answered your FOI
request thoroughly and do not have any further information to add.

Linda Hindle

Consultant Dietitian

NHS Birmingham East and North

0121 380 9287

07971 662 385

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