Complaints Board

5 July 2017

Fluoride Free NZ

P O Box 40, Featherston, South Wairarapa




Re: Fluoride Free NZ Out of Home- Complaint 17/210

I enclose a copy of correspondence received from COMPLAINANT 1 concerning the above advertisement.

The relevant section in the Advertising Codes of Practice appears to be:

Code of Ethics – Basic Principle 3, Basic Principle 4, Rule 11, Rule 2, Rule 6;

I would appreciate your comments in regard to this complaint so that we may place the matter before the Complaints Board for consideration. May I please have your written response by 12th July 2017 and would you advise if your response is on behalf of any other parties.


Please note: If you choose to alter or remove your advertisement in response to this complaint, send a copy of the altered advertisement to the ASA or advise us of its removal before the date given for your response. The Chairman may consider the complaint settled if she is satisfied the action taken resolves the issue at the centre of the complaint.


We ask that you do not make any direct contact with the primary Complainant or any duplicate Complainants. Any matters you wish to address to the Complainants should be directed to this office in the first instance.

Yours sincerely

Case Manager

T (04) 472 7852Po Box 10-675, Wellington 6143 June 2017
Complaints Board Advertising Standards Authority
PO Box 10-675

To whom it may concern,

Please find attached a complaint I wish to lodge about a billboard advertisement on Hutt Road, Petone by

I believe it is in breach of the ASA Code of Ethics Basic Principles Number 3 and Rules 2, 6 and 11.
I look forward to your response.

Yours sincerely,
COMPLAINANT 1 Clinical Director
Bee Healthy Regional Dental Service

Hutt Valley District Health Board
Private Bag 31907
Lower Hutt 5040
Telephone: 04 570 9023

Complaint to Advertising Standards Authority

Billboard Advertisement: By Fluoride Free NZ

Located at the railway end of Jackson Street, Petone facing traffic turning from Hutt Road into Jackson Street.

Complaint made by:COMPLAINANT 1, Clinical Director, Wellington Regional Dental Service and COMPLAINANT 2, Medical Officer of Health

We are:

    • Clinical Director of the Wellington Regional Dental Service. This Service provides publicly funded oral health care for 0-13 year olds and coordinates the publicly funded adolescent oral health
    • I am a registered Dentist with a registered specialist qualification in Public Health
    • I am designated by the Director-General of Health as Medical Officer of Health for the Hutt Valley Health District. This health district comprises the two territorial authorities: Hutt City Council; and Upper Hutt City
    • I am employed Clinical Head of Department by Regional Public Health which is part of Hutt Valley District Health Board. I commenced employment as Medical Officer of Health in January
    • I am a Registered Medical Practitioner and I am on the Vocational Register for the specialty of public health medicine.

We wish to complain about a large billboard placed, by Fluoride Free NZ, at the railway end of Jackson Street, Petone facing traffic turning from Hutt Road into Jackson Street.
Our overarching concern is that the billboard goes beyond advocacy and is intended to inappropriately scaremonger parents so as to engender guilt about poisoning their children.

Grounds for Complaint

We make this complaint with respect to the following grounds relating to the Advertising Code of Ethics:

  • Principle 3: the billboard advertisement is designed to mislead and deceive the observer;
  • Principle 4: the billboard advertisement was not prepared with a due sense of social responsibility;
  • Rule 2: the billboard advertisement contains statements and an image which portrays an exaggerated claim that is misleading and deceptive, and is otherwise not truthful;
  • Rule 3: the billboard advertisement uses research results and quotations from the 2009 National Oral Health Survey in a manner which is misleading and deceptive;
  • Rule 6: the billboard advertisement without a justifiable reason plays on fear;
  • Rule 11: the billboard advertisement does not meet the requirement for Advocacy Advertising. The information is expressed as fact rather than opinion and goes

beyond what is considered to be an essential and desirable part of a functioning democratic society.
And in terms of the Advocacy Principles:

  • Principle 1: the billboard advertisement expresses views as facts rather than clearly distinguishing the information as opinion;
  • Principle 3: the billboard advertisement uses language that is out of synch with spirit of the code;
  • Principle 4: the billboard advertisement presents information on a matter where the science is settled and there is no debate;
  • Principle 5: the identity of the advertiser is not clear and the advertiser’s position on the issue is not clearly

Description of Billboard

  • The billboard has a photograph of front teeth with large white demarcated opacities in the incisal one third of the upper permanent
  • The statement in bold text: “Fluoride poisoning staring you in the face” is placed above the teeth.
  • Below the top teeth and superimposed on the image, also in bold text is written; “41% of NZ children have some form of dental fluorosis according to MoH 2009 Oral Health Survey”. There is a website address in a blue shade superimposed on the image in the lower right
  • In the lower left corner in smaller letters “Photo 17 year old Wellington boy”.

Copy of the image

This advertisement breaches the standards under the advertising Code of Ethics Basic Principles Number 3 and 4, and under the Rules 2, 3, 6 and 11. 

  • The photograph is of large white demarcated opacities in the incisal one third to one half of the upper permanent incisors. Due to their demarcated rather than diffuse appearance and only located to two teeth rather than all the front teeth, the differential diagnosis of these demarcated opacities would be non-fluoride opacities’. They are most likely to be defects associated with a developmental condition called Molar-Incisor Hypomineralisation or a result of atypical trauma during These aetiological factors are distinct from fluorosis. The teeth in the picture do not show evidence of any fluorosis and therefore this picture is misleading and deceptive.


  • Examples of mild, moderate and severe fluorosis are included in the appendix. (Australasian Academy of Paediatric Dentistry website, 2017). A New Zealand example was not available as this level of fluorosis is rare in New Zealand (Ministry of Health, 2009). It is recommended that the Complaints Board seek independent advice on the differential diagnosis of the lesions in the  photograph  from  an expert in developmental dental defects of the
  • The use of a photograph on a billboard about fluoride poisoning with a picture of lesions not associated with fluorosis is a breach of Advertising Code of Ethics Basic Principle 3; “No advertisement should be misleading or deceptive or likely to mislead or deceive the consumer” and Advertising Code of Ethics Rule 2; Truthful presentation.


  • When associated with the statement that “41% of NZ Children have some form of dental fluorosis” it insinuates that all f/uorosis presents with equivalent severity to that displayed in the image when in fact the fluorosis reported in the 2009 New Zealand Oral Health Survey is mostly “questionable” or “very mild” according to Deans Index (1939). These levels of fluorosis bear no similarity to the large photograph thus is also deceptive and

1 1 Non-fluoride opacities: These include all categories of opacities not defined as fluorosis, They are commonly characterised as discrete demarcated white or coloured opacities often affecting a single tooth, and less frequently multiple teeth, with a symmetrical distribution. These opacities result from a wide variety of systemic or local causes during development (Cutress and Suckling,1990)

  • “Fluoride poisoning staring you in the face”.
  • This is Fluoride poisoning is not dental fluorosis. This is in breach of Advertising Code of Ethics Basic Principles 3 and 4 and Rule 2; Truthful presentation.


  • This statement is portrayed as fact. It is not fact but rather it is the advertisers opinion thus is in breach of Code of Ethics Rule number 11 Advocacy Advertising “opinion should be clearly distinguishable from factual information”, and Advocacy Principles 1, 3 and


  • By use of the word ‘poisoning’, suggests that all dental fluorosis is harmful. Almost all dental fluorosis in New Zealand is the milder form, which dentists agree is not

harmful. Here the word ‘poisoning’ conjures up an emotional perspective that has no foundation in reality. Therefore, the advertisement breaches Advertising Code of Ethics Rule 6 in that it plays on fear.

  • 41% of NZ children suffer from some form of dental fluorosis according to the Ministry of Health Oral Health Survey

This statement is misleading on its own and when used in conjunction with the image breaches Advertising Code of Ethics Rule 3. 

  • The use of the image suggests that fluorosis always presents in a form as severe as the image portrays. This is
  • Moderate and severe fluorosis are not common in New Zealand. In the 2009 Oral Health Survey, the prevalence of severe fluorosis for 8-30 year olds was 0.0%. Moderate fluorosis was observed among 2.0% of 8- 30 year olds (Ministry of Health, 2010). The difference was not significant. Moderate fluorosis is considered a cosmetic rather than a functional adverse effect, is rare in New Zealand, and is not a sign of ‘poisoning’.
  • The use of the word ‘suffer’, once again, invokes the false view that all dental fluorosis is considered to be a harm. In the 2009 Oral Health Survey the prevalence ‘questionable fluorosis’ for 8-30 year olds was 27.2%, ‘very mild fluorosis’ was 2%, and ‘mild fluorosis’ was 5.1%. Almost all dental fluorosis in New Zealand would not be considered to be a harm.
  • Photo of 17 year old Wellington boy
    • This statement implies that the alleged fluoride poisoning is linked to fluoride exposure that took place in the Wellington region. Poisoning from chemical contamination of the environment is a notifiable disease to the Medical Officer of Health and would include poisoning from Fluoride. Such notifications are required to be made on The Medical Officer of Health has not been notified.
  • Advocacy Principle 5 – identification of advertiser and the context of the advertisement
    • There is the expectation that the identity of the advertiser and their position on the issue is clearly communicated. Here a website address (“”) is not enough. The term “fluoridefree”, unless the observer had prior knowledge, could be interpreted in many different The observer would not automatically understand the context of the advertisement.

We are happy to provide further information and explanation if required by the Complaints Board.

Friday, 3 July 2017

References Australasian Academy of Paediatric Dentistry. 26/06/2017 Cutress TW and Suckling GW, 1990. Journal of Dental Research 69(Spec lss):714-720Dean HT, 1942. The investigation of physiological effects by the epidemiological method. Fluorine and dental health, American Association for the Advancement of Science, Washington, 19: 23-31.F.R. Moulton (Ed.).
Ministry of Health, 2010. Our Oral Health: Key findings of the 2009 New Zealand Oral health Survey. Wellington: Ministry of Health.

  • Criteria for Dean’s Classification System for Dental Fluorosis (1942)

Classification Normal Code Criteria -The enamel represents the usual translucent semivitriform type of structure. The surface is smooth, glossy and usually of pale creamy white colour

Questionable Code 1
Criteria – The enamel discloses slight aberrations from the translucency of normal enamel, ranging from a few white flecks to occasional white spots. This classification is utilised in those instances where a definite diagnosis is not warranted and a classification of ‘normal’ not justified

Very Mild(10-25% of surface)
Code 2
Criteria -Small, opaque, paper white areas scattered irregularly over the tooth but not involving as much as approximately 25 per cent of the tooth surface. Frequently included in this classification are teeth  showing  no more than about 1-   2mm of white opacity at the  tip of the  summit of the  cusps, of the bicuspids or second molars.Mild(25-50% of surface) Code3Criteria – The white opaque areas in the enamel of the teeth are more extensive but do involve as much as SO percent of the tooth.

Moderate(100% of surface)

Code4Criteria -All enamel surfaces of the teeth are affected and surfaces subject to attrition show wear. Brown stain is frequently a disfiguring feature

Severe(100% of surface)
Code 5
Criteria -All enamel surfaces are affected and hypoplasia is so marked that the general form of the tooth may be affected. The major diagnostic sign of this classification is discrete or confluent pitting. Brown stains are widespread and teeth often present a corroded-like appearance.

  • Examples of fluorosis

Photographs from Australasion Academy of Paediatric Dentistry website;

  • Severe Fluorosis
  • Moderate Fluorosis
  • Mild Fluorosis