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DENTAL FLUOROSIS:
Smile, please - but don't say 'Cheese'
ABSTRACT
At least THREE MILLION people in England suffer from dental fluorosis.
The Government's York Review on water fluoridation showed that
about THREE QUARTERS OF A MILLION people have dental fluorosis
which is "of concern". No studies have ever been done
on the psychological damage caused by fluorosed (stained) teeth.
A 1998 survey showed that people with defective teeth are more
likely to experience social and employment discrimination.
Half of the respondents saw
unattractive teeth as a sign of poor personal hygiene. International
scientists concur that dental fluorosis is a FORESEEABLE event
from fluoridating drinking water, and the victims are at increased
risk for psychological and behavioural problems and difficulties.
This can be the subject of litigation against those who promote
and implement water fluoridation.
Those involved in the promotion
and implementation of water fluoridation are vulnerable to significant
legal liability. Reparations for
the foreseeable consequence of dental disfigurement are likely
to be further compounded by punitive damages which can be awarded
for subsequent psychological pain and suffering experienced by
the Plaintiff. (1)
"After a handshake, a
friendly smile is one of the most important elements in creating
a good first impression. However, it's hard to smile if you're
self-conscious about teeth that are yellow or stained."
- School of Dental Medicine at the University of New York (2)
A 1998 survey by the American
Academy of Cosmetic Dentistry showed that:
More than 92% of adults agree that an attractive smile is an
important social asset;
85% believe that an unattractive
smile makes a person less appealing to the opposite sex;
75% believe that an unattractive
smile can be detrimental to a person's chances of career success;
and
Half of the respondents see unattractive
teeth as a sign of poor personal hygiene.
Overall, the survey found that
people with unattractive smiles are more likely to experience
social and employment discrimination.
According to the UK Government's
systematic scientific review on water fluoridation, carried out
at York University, about forty eight per cent of people living
in fluoridated areas are affected by dental fluorosis.
In England, this translates
to nearly three million individuals who have fluorosed
teeth to some degree. For three quarters of a million people
, dental fluorosis is of the "moderate to severe" degree.
The condition is characterised by white chalky spots or brown
staining and pitting of their teeth. (3)
In 1985, following a review
commissioned by the United States Environmental Protection Agency,
an independent panel of behavioural scientists found that people
with moderate to severe fluorosis are at increased risk of experiencing
psychological and behavioural problems. (4) (5)
People afflicted with dental
fluorosis are more likely to experience discrimination from an
early age. Teachers often prejudge a child's intellect and personality
based on appearance alone. These children are more often likely
to be considered as troublemakers or non-scholars. Such biassed
views reinforce a negative stereotype, with self-fulfilling results.
(6)
Thousands of official documents
confirm that artificial fluoridation of drinking water can, and
does produce the "aesthetically objectionable" effect
of moderate to severe dental fluorosis. The psychological damage
suffered by millions of victims of dental fluorosis is given
little attention.
Moreover, in the persistent
drive to extend fluoridation schemes across the country, dental
and public health officials dismiss this distressing condition
as an acceptable public health trade-off, insisting that "the
benefits outweigh the risks."
The Department of Health asserts
that water fluoridation is the most cost-effective means of reducing
tooth decay. However, the Department turns a blind eye to the
huge financial burden on individual patients who require remedial
treatment for unsightly fluorosed teeth.
Cosmetic veneers provide an
extremely lucrative spin-off for the privatised dental profession.
In England, charges range from £150 to £450 per tooth
and repeat treatments are required every five or six years throughout
the victim's life. People who cannot afford cosmetic veneers,
professional bleaching or micro-abrasive treatment have no option
but to live with their fluoride-damaged teeth and the attendant
social stigma and psychological trauma.
While the York Review panel
of experts acknowledged that dental fluorosis affects up to 48%
of the British population, they signally failed to address the
economic, social and psychological impact on the victims.
However, more perceptive
scientists and dentists are sensitive to the social stigma of
dental fluorosis.
Irish
dental surgeon, Donal McAuley, wrote in the British Medical Journal:
"Fifty per cent of our population has dental fluorosis.
I see patients daily in my surgery who are damaged by fluoride.
They do not smile, they are teased at school, and they are traumatised
by having 'rotten' teeth." Drinking water in Ireland is
artificially fluoridated. (7)
In
1994, a Kenyan survey noted that between 60 and 84% of
respondents viewed dental fluorosis as an important problem because
of its unfavourable effects on an individual's personality."
(8)
A
later Canadian study examined the influence of fluoride
exposures on the widespread "aesthetic problems" caused
by dental fluorosis. It acknowledged that forty six percent (nearly
half) of the participants had dental fluorosis. The effect on
personal appearance, as defined by the participants themselves,
was more prevalent in the over-11 age group. (9)
The
trauma experienced by young people with dental fluorosis is depressingly
apparent in a South African study conducted by the NW
Province Department of Health: "The psychological effect
in terms of the unsightly, brown-stained teeth, has induced the
adolescents with fluorosed teeth to demand that these teeth be
extracted and replaced with dentures." (10)
American
and English researchers noted "The prevalence of
dental fluorosis appears to be on the increase. Although in its
mild form the condition is not considered to be of cosmetic significance,
the more severe forms can cause great psychological distress
to the affected individual." (11) (12)
An
Australian Health Department analysed society's perceptions
of dental fluorosis, based on over 3,000 responses. Lay and professional
observers recognised that higher degrees of fluorosis increasingly
embarrass the child. All observers, except the dentists, felt
that the more severe fluorosis indicated neglect on the part
of the child . (13)
Egyptian
researchers observed that friends and relatives ridicule the
patient by inferring that these stains are associated with smoking
and/or poor oral hygiene. They noted that such personal remarks
lead an individual into severe psychological depression. (14)
Dental fluorosis is extensively
described by toxicologists as the first visible sign of chronic
fluoride poisoning.(15) The result of over-exposure
to fluoride was well understood by the dental profession until
the early 1950s.
Some prominent researchers have pointed out that dentists who
knowingly promote treatment which leads to dental fluorosis place
themselves at risk of litigation. (16) All researchers and government
agencies acknowledge that dental fluorosis is a foreseeable,
"objectionable cosmetic effect" that can and does occur
following artificial fluoridation.
Despite anti-discrimination
laws, the unattractive appearance of people with dental fluorosis
can severely limit their academic performance, employment choices
and future prospects. Teeth which appear "dirty" can
seriously affect an individual's ability to interact and form
relationships with members of the opposite sex, leading to exclusion,
loneliness and long-term depression. Such conditions can precipitate
feelings of frustration and anger which could, in turn, lead
to criminal behaviour.
Promoters of water fluoridation
are aware of, but do not warn the public about the foreseeable
adverse effect of dental fluorosis or the foreseeable psychological
damage which can and does occur to subsections of the population.
When a plaintiff suffers harm, whether physical or psychological,
it is only necessary for him to show the court that the injury
was reasonably foreseeable. (1)
Meanwhile, three million English
cases of dental fluorosis are officially ignored and three quarters
of a million people have been severely, and foreseeably damaged.
References
1. Page v. Smith, House of Lords [1996] 1 AC 155; [1995] 2WLR
655 [1995] 2 All ER 736.
2. University of New York, School of Dental Medicine, Oral Health
Letter.
3. McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I,
Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J, Systematic
review of water fluoridation. BMJ 2000; 321: 855-9.
4. Drinking Water Regulations; Fluoride. 50 Fed. Reg. 220, 47144
(1985).
5. Welbury, P., Shaw, L. A simple technique for removal of mottling,
opacities and pigmentation. Dental Update 1990; 17: 161-3.
6. Tauber, Robert T. Good or Bad, What Teachers Expect from Students
They Generally Get! ERIC Digest, 1998-12-00, Source: ERIC Clearinghouse
on Teaching and Teacher Education Washington DC.
7. Water fluoridation. Letters; BMJ 2001; 322: 1486.
8. Mwaniki DL, Courtney JM, Gaylor JD,. Endemic fluorosis: an
analysis of needs and possibilities based on case studies in
Kenya. Soc Sci Med 1994; 39: 807-13.
9. Clark DC, Berkowitz J. The influence of various fluoride exposures
on the prevalence of esthetic problems resulting from dental
fluorosis. J Public Health Dent 1997; 57:144-9.
10. Mothusi, B. Psychological Effects of Dental Fluorosis. Department
of Health, North West Province, South Africa.
11. McKnight CB, Levy SM, Cooper SE, Jakobsen JR. A pilot study
of esthetic perceptions of dental fluorosis vs. selected other
dental conditions. ASDC J Dent Child 1998; 65: 233-8, 229.
12. Rodd and Davidson. The aesthetic management of severe dental
fluorosis in the young patient. Dent Update 1997; 24: 408-11.
13. Riordan PJ., Perceptions of dental fluorosis. J Dent Res
1993; 72: 1268-74.
14. Rahmatulla. Clinical evaluation of two different techniques
for the removal of fluorosis stains. Egypt Dent J 1995; 41: 1287-94.
15. Whitford, G.M. Physiological and Toxicological Characteristics
of Fluoride, Journal of Dental Research 1990; 69, Spec No: 539-49;
discussion 556-7.
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