Fluoride benefits and risks: Lessons from 70 years of water fluoridation in Singapore
Fluoride is well proven to prevent caries. In controlled amounts, its benefits outweigh its risks. A recent systematic review and meta-analysis investigating fluoride exposure and children’s intelligence quotient (IQ) scores found limited data and uncertainty in the dose-response association betwee...
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| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
| Published: |
Academy of Medicine Singapore
2024-06-01
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| Series: | Annals, Academy of Medicine, Singapore |
| Online Access: | https://annals.edu.sg/fluoride-benefits-and-risks-lessons-from-70-years-of-water-fluoridation-in-singapore/ |
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| Summary: | Fluoride is well proven to prevent caries. In controlled amounts, its benefits outweigh its risks. A recent systematic review and meta-analysis investigating fluoride exposure and children’s intelligence quotient (IQ) scores found limited data and uncertainty in the dose-response association between fluoride exposure and children’s IQ at water concentrations less than 1.5 ppm. Notably, 1.5 ppm is the World Health Organization’s threshold for water fluoridation, which is 3 times more than Singapore’s current level of 0.5 ppm. The study’s methodology, interpretations and limitations have been questioned. It reignited debate surrounding fluoride use, particularly in community water. The major adverse effects of excessive fluoride exposure are dental and skeletal fluorosis. Skeletal fluorosis is associated with chronic exposures typically from high fluoride levels in drinking water, often in communities dependant on groundwater. This does not apply to Singapore where its sole water agency regulates and fluoridates the water supply. Fluoride use in children must be supervised by parents to maximise benefits and minimise risks. This commentary revisits the history of fluoride uses in Singapore, as well as to present a balanced view and risk-benefit analysis of fluoride use. Physicians and nurses are often the first healthcare professionals that parents consult regarding concerns on their child’s health and intelligence. Therefore, interprofessional education can help empower them to educate, identify, and refer persons in need early. Future studies could investigate benefits and risks of water fluoridation in contemporary Singapore, a developed country with one of world’s highest average IQ and widespread access to fluoride toothpastes. |
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| ISSN: | 2972-4066 |