The government's controversial plan to dose public drinking water supplies with fluoride has been delayed considerably, pending further research on several issues from cost to the effects on human health and the environment.
Although half a dozen municipalities will soon be chosen as pilot projects for rapid fluoridation, some sources believe that the nationwide implementation of the new fluoride laws could be delayed for between one and five years.
Durban, along with more than 100 other towns and cities, has already asked the government to exempt it from the fluoride plan for at least two years.
The department of health - which argues that adding fluoride to water is a cheap and safe way to reduce tooth decay among the South African public - had hoped to compel all major towns and cities to fluoridate their water before September this year.
However, the plan has sparked widespread opposition and concern from many organisations, including water utility companies like Umgeni and Rand Water, municipalities and citizen groups.
Water suppliers and municipalities have mainly argued about the costs, technical issues and legal ramifications of the plan, while public interest groups argue that fluoride can cause major long-term health problems ranging from bone damage to cancer, kidney and muscular disease.
It emerged this week that between five and seven towns and cities would be selected later this month to begin fluoridating water supplies as soon as possible, but that the majority of the country would be excluded from the plan for the time being, pending a research and monitoring exercise convened by the Water Research Commission and other expert groups.
Water Research Commission chief Rivka Kfir was nominated last year as a "neutral player" to chair a series of round-table committee meetings on the implementation of fluoride and to oversee the new research initiative.
Kfir could not be reached for comment on Tuesday to explain the scope of the research and monitoring project, although Durban water services chief Neil Macleod said he understood this would include potentially negative effects on people, environment and industry.
"Several questions have been raised to which there are no answers," said Macleod, noting that Durban was particularly concerned about the implications of fluoride because of its geographical location.
Macleod said the fluoride added by inland towns and cities would eventually end up in rivers and dams which supplied drinking water to coastal areas - possibly increasing cumulative fluoride levels above the recommended limit.
If this happened, Durban might be placed in the position of having to remove fluoride at great cost. Macleod said the fluoride plan had not been put on ice, but the speed of implementation had been reduced substantially. "It is now moving in a much slower and more measured manner."
Macleod believed the research project would take at least nine months to complete, although Association of Water Utilities chief executive John Connolly said he understood this exercise could last up to five years.
Connolly said major water utilities such as Rand Water believed the department of health had not demonstrated that water fluoridation was the most cost-effective way of providing fluoride to poor communities.
"We would argue that fluoridation is not a priority, and that the public health benefits would be far greater if the money was spent on extending clean water supplies to isolated communities to reduce waterborne diseases such as cholera."
The department of water affairs has also insisted that environmental impact assessments be done before fluoridation begins.
Department of health oral hygiene chief Johan Smit, an outspoken proponent of fluoridation, said on Tuesday that he was not prepared to speculate on revised fluoridation timetables but confirmed that at least 50 water providers had been exempted so far on the basis that they already provided water with sufficient levels of naturally occurring fluoride.