Fluoridation: A Violation of Medical Ethics and Human Rights

Cross, Douglas W.; Carton, Robert J.

doi:10.1179/oeh.2003.9.1.24

Cited by 15 publications

(4 citation statements)

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“…It has been argued that the exclusion of crosssectional studies, defined by the Cochrane review method, may have led to these findings. 9 The CWF debate appears to polarize and galvanize people, with opponents often arguing that it is an infringement of medical ethics and individual rights. 10 A central tenet of these anti-CWF arguments is that fluorides are unlicensed medicinal substances administered to large populations without informed consent or supervision by qualified medical practitioners.…”

mentioning

confidence: 99%

Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children

Schlüter

Hobbs

Atkins³

et al. 2020

JAMA Pediatr

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IMPORTANCE Robust contemporary epidemiologic evidence for the population-wide efficacy of reticulated community water fluoridation is required.OBJECTIVE To evaluate whether community water fluoridation is associated with the national rates of severe caries among 4-year-old children in New Zealand after accounting for key sociodemographic characteristics. DESIGN, SETTING, AND PARTICIPANTSThis was a near whole population-level, natural, geospatial cross-sectional study of 4-year-old children who had a health and development assessment as part of the nationwide B4 School Check screening program conducted in New Zealand between July 1, 2010, and June 30, 2016. The extracted database included 391 677 children. However, geospatial information was missing for 18 558 children, another 32 939 children were unable to be geospatially matched, 5551 children resided in areas with changing fluoridation status, and 58 786 children had no oral health screen recorded, leaving 275 843 (70.4%) eligible children. Data were released in August 2019; statistical analysis was performed from September 2019 to December 2019.EXPOSURES Community water fluoridation status from 2011 through 2016. MAIN OUTCOMES AND MEASURESSevere caries experience derived from the "lift the lip" oral health screening. Analyses were adjusted for age, sex, ethnicity, area-level deprivation, and residential location differences. Multilevel mixed-effects logistic regression models were used. Sensitivity analyses based on multiple imputed data were undertaken to measure any differential influence of missing data. RESULTSIn the eligible sample of 275 843 children, the median age was 4.3 years (interquartile range, 4.1-4.6 years), 141 451 children (51.3%) were boys, and 153 670 children (55.7%) resided within fluoridated areas. Severe caries were identified for 24 226 children (15.8%) in fluoridated and 17 135 children (14.0%) in unfluoridated areas, yielding an unadjusted odds ratio of 0.93 (95% CI, 0.90-0.95). However, in the adjusted analyses, children residing in areas without fluoridation had higher odds of severe caries compared with those within fluoridated areas (odds ratio, 1.21; 95% CI, 1.17-1.24). The population attributional fraction associated with unfluoridated community water was 5.6% (95% CI, 4.7%-6.6%) in a complete case analysis.CONCLUSIONS AND RELEVANCE This study finds that community water fluoridation continues to be associated with reduced prevalence of severe caries in the primary dentition of New Zealand's 4-year-old children.

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confidence: 99%

Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children

Schlüter

Hobbs

Atkins³

et al. 2020

JAMA Pediatr

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“…5,6 Those opposed argue that fluoride in water has no or little cariostatic benefits, may cause serious health problems. 7 In hilly areas like Rudraprayag, groundwater occurs as localized, disconnected bodies and has a varying range of fluoride concentrations in water. Dental fluorosis can be observed in some localized parts of the district whereas some areas show a high prevalence of dental caries and, absence of fluorosis.…”

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confidence: 99%

Dental caries and its association with increasing water fluoride concentration in district Rudraprayag, Uttarakhand

Sharma

Saxena

Naithani

2021

Int J Community Med Public Health

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Background: Evidence from scientific literature confirms both beneficial and detrimental effects of fluoride on human health with only a narrow range between intakes associated with these effects. The limits of this range have been controversial among researchers since the 1930s. Considering this, the World Health Organization (WHO) permissible limit of fluoride in India has been reduced from 1.5 to 1.0 mg/l in 1998. This study aimed to evaluate the association between increasing water fluoride levels and dental caries prevention on permanent teeth.Methods: This cross-sectional study involved 1400 children (aged 6–19 years). Caries experience and dental fluorosis were recorded using DMFT/deft and Dean's index respectively. Also, fluoride concentration in drinking water was analyzed. Around 14.4% of children had dental caries with maximum frequency among 9-10 years of age. A significant negative correlation between caries experience and water fluoride level was found (p<0.05), with the lowest DMFT scores at the fluoride level of 0.61–2 mg/l and the highest at 0.0–0.3 mg/l. Whereas, high prevalence of dental fluorosis was observed above 0.7 mg/l.Results: The study revealed that the presence of 0.3-0.7 mg/l fluoride in drinking water reduces dental caries, without an objectionable rise in dental fluorosis.Conclusions: It can be suggested that fluoride has anticaries property but due to a ‘narrow therapeutic window’ of 0.3-0.7 mg/l, in a country like India where endemic fluorosis is prevalent, its topical application should be encouraged which is almost equally effective with less systemic adverse effects.

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“…A restrição da liberdade individual e a violação do direito à livre escolha também são argumentos utilizados pelos opositores da fluoretação da água para consumo (CROSS; CARTON, 2003;COHEN;LOCKER, 2001). Há ainda quem veja a medida como um procedimento de medicação em massa, violando os direitos humanos dos indivíduos de não serem submetidos a intervenções médicas sem consentimento prévio (CROSS;CARTON, 2003). Mendoza (2007), entretanto, se opõe a esse pensamento, uma vez que a fluoretação das águas é uma tecnologia de saúde pública que visa tão somente ajustar o teor de fluoreto existente em qualquer água, com a finalidade de que esse teor seja compatível, em águas de abastecimento público, com a prevenção da cárie.…”

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Aspectos éticos e o uso de produtos fluorados na visão de lideranças de saúde

Ferreira

Marques

Menezes

et al. 2014

Physis

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IntroduçãoA palavra "ética" vem do grego ethos, que significa "morada; lugar onde vivemos". Mais tarde, ela passou a significar o "caráter", o "modo de ser" que uma pessoa ou grupo adquire ao longo da vida. Diz respeito aos costumes, condutas, regras de comportamento, modo de ser, como resultado de se pôr em prática determinados costumes ou hábitos considerados bons (FORTES;ZOBOLI, 2008).A ética da saúde, enraizada no terreno dos direitos humanos, se preocupa com valores relacionados com a manutenção da saúde e a qualidade de vida das pessoas, o que implica deveres e obrigações individuais e institucionais (FORTES;ZOBOLI, 2008). Nesse contexto, Schramm e Kottow (2001) definem a bioética da proteção como "uma ética da responsabilidade social, em que se deve basear o Estado para assumir suas obrigações sanitárias para com as populações humanas, consideradas em seus contextos reais" (PONTES; SCHRAMM, 2004, p. 1.321).Para proteger a coletividade, muitas vezes as ações de saúde pública restringem liberdades e direitos individuais, como é o caso da fluoretação das águas para o consumo humano. Não obstante essa medida ter reconhecida eficácia para prevenir a cárie dentária (HOROWITZ, 1996), ela pode provocar fluorose dentária, e vem sendo objeto de intensas discussões éticas (MENDOZA, 2007;KALAMATIANOS;NARVAI, 2006). O princípio utilitarista afirma que as ações são eticamente corretas quando tendem a promover a maior soma de prazer a todos aqueles cujos interesses estão em jogo. Tem como paradigma: o alcance do "maior bem-estar para o maior número possível de pessoas ou para a maximização do seu bem-estar." Nessa visão utilitarista, a saúde pública, que não dispõe tecnicamente de meios simplificados e práticos para separar água com flúor e água sem flúor, impõe a primeira a todos, em prol da coletividade, ponderando os benefícios para muitos e os riscos de danos para alguns (FORTES; ZOBOLI, 2008).As medidas de vigilância sanitária também seguem esse princípio, ajustando os interesses da coletividade em nome da supremacia do interesse público sobre o individual, priorizando os princípios da beneficência e da não maleficência sobre outros princípios éticos, como o da autonomia individual (FORTES;ZOBOLI, 2008). Coggon e Cooper (1999) enfatizam, entretanto, que como os mais beneficiados com a fluoretação da água nem sempre são os mais necessitados (os

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Fluoridation: A Violation of Medical Ethics and Human Rights

Cited by 15 publications

References 0 publications

Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children

Association Between Community Water Fluoridation and Severe Dental Caries Experience in 4-Year-Old New Zealand Children

Dental caries and its association with increasing water fluoride concentration in district Rudraprayag, Uttarakhand

Aspectos éticos e o uso de produtos fluorados na visão de lideranças de saúde

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