DEBATE SIMMERS ON PUBLIC WATER FLUORIDATION
Source: DrBicuspid.com | December 20th, 2013 | By Rosemary Frei, MSc, contributing writer
December 20, 2013 — The ADA calls water fluoridation “the single most-effective public-health measure to prevent dental caries,” the U.S. Centers for Disease Control and Prevention (CDC) hails it as “one of 10 great public health achievements of the 20th century,” and the 2000 Surgeon General’sreport on oral health stated that “community water fluoridation [is] an effective, safe, and ideal public health measure [that] benefits individuals of all ages and socioeconomic strata.”
In the U.S., the debate about fluoride in public water supplies was seemingly settled some time ago. American authorities have held for more than 65 years that fluoridation of community water supplies is a safe and effective strategy for reducing dental caries. Now, however, some groups and individuals are calling for a rethink of this policy. One example is the May 2013 election in Portland, OR, where the citizens voted solidly against fluoridation of their water supply.
The U.S. Environmental Protection Agency (EPA) sets the maximum contaminant level (MCL), or the highest level of fluoride that is allowed in American public water supplies; it currently is 4.0 mg/L. The EPA is currently reviewing available information about fluoride to determine whether to revise the drinking water standards.
A steady accumulation of data shows some possible drawbacks to fluoridation, including the most extensive examination to date of fluoride’s toxicity: the 508-page report released in 2006 by members of the National Research Council (NRC), and funded by the EPA, entitled “Fluoride in the Drinking Water. A Scientific Review of EPA’s Standards.”
One of the NRC report’s authors is Hardy Limeback, DDS, PhD, former president of the Canadian Association for Dental Research, and former head of the department of preventive dentistry at the University of Toronto. In a May 2012 email to city officials in Windsor, Ontario, who were considering whether to continue water fluoridation, he wrote:
I have looked at this from all angles and I have to conclude that all fluoridated cities would save money on fluoridation costs, parents would save on costly dental bills treating dental fluorosis, dental decay rates would remain unchanged or even continue to decline (as has been demonstrated in many modern fluoridation cessation studies) and the health of city residents would improve when industrial waste products are no longer added to the drinking water.
Windsor’s councilors voted in January 2013 to stop adding fluoride to the water supply.
Even before the decisions in Windsor or Portland, the U.S. Department of Health and Human Services (HHS) announced in January 2011 a proposed optimal fluoridation level recommendation of 0.7 mg/L of water, to replace the current recommendation of 0.7-1.2 mg/L; a final recommendation is expected in early 2014.
The ADA’s website has a comprehensive booklet on the benefits of fluoridation, “Fluoridation Facts,” that was issued in 2005. ADA media relations staff told DrBicuspid.com that the booklet will not be updated until after the HHS issues its final notice on the “optimal fluoridation level” for community water fluoridation.
We present a sampling of information brought forward by those who question the wisdom of fluoridating community water supplies, together with the official responses from the ADA and CDC.
SEE BELOW an accompanying table that details the concerns, facts, and counterpoints of the fluoridation debate.
This table examines the drawbacks of public water fluoridation and the current stances of the ADA and U.S. Centers for Disease Control and Prevention (CDC).
Possible drawbacks of community water fluoridation ADA stance Based on “Fluoridation Facts“ CDC stance
The level of fluoride added in water fluoridation programs is far higher than in almost all unpolluted fresh surface water, according to FluorideAlert.org’s
In addition, about 90% of fluoride added to community water supplies is hydrofluosilicic acid, a byproduct of the manufacturing of phosphate fertilizers. These industrial-grade chemicals are contaminated with heavy metals such as lead, arsenic, and radium.
A recent citizens’ petition asking the Environmental Protection Agency (EPA) to stop the adding of hydrofluosilicic acid to community water supplies, headed by a former EPA senior scientist, points out that hydrofluosilicic acid meets U.S.-government criteria for classification as a hazardous waste.
In the U.S., the natural level of fluoride in ground water varies from very low levels to more than 4 parts per million (ppm). Fluoridation of community water supplies is simply the precise adjustment of existing naturally occurring fluoride levels in drinking water to an optimal fluoride level recommended by the U.S. Public Health Service (0.7-1.2 ppm) for the prevention of dental decay.
Byproducts are simply materials produced as a result of producing something else — they are by no means necessarily bad, harmful, or waste products. For example, in addition to orange juice, various byproducts are obtained from oranges during juice production that are used in cleaners, disinfectants, flavorings, and fragrances. Additives used in water fluoridation meet standards of the American Water Works Association and NSF International. Nearly all naturally occurring water sources containfluoride, a mineral that has been proved to prevent, and even reverse, tooth decay.
Byproducts are simply materials produced as a result of producing something else — they are by no means necessarily bad, harmful, or waste products. For example, in addition to orange juice, various byproducts are obtained from oranges during juice production that are used in cleaners, disinfectants, flavorings, and fragrances. Additives used in water fluoridation meet standards of the American Water Works Association and NSF International. Nearly all naturally occurring water sources containfluoride, a mineral that has been proved to prevent, and even reverse, tooth decay.
There has been a significant increase in dental fluorosis rates in step with expansion of U.S. community water fluoridation; the rate among 12- to 15-year-olds increased from 22.6% in 1986-1987 to 40.7% in 1994-2004, including a sharp rise in the rate of moderate and severe fluorosis from 1.3% to 3.6% in that period (National Center for Health Statistics, November 2010, Data Brief, No. 53). In assessing the risks of dental fluorosis, scientific evidence indicates it is probable that approximately 10% of children consuming optimally fluoridated water, in the absence of fluoride from all other sources, will develop very mild dental fluorosis. Approximately 10% of dental fluorosis is attributable to water fluoridation. Most investigators regard even the more advanced forms of dental fluorosis as a cosmetic effect rather than a functional adverse effect.
The inappropriate use of fluoride-containing dental products is the largest risk factor for increased fluorosis, as fluoride intake from food and beverages has remained constant over time.
The vast majority of dental fluorosis in the U.S. can be prevented by limiting the ingestion of topical fluoride products (such as toothpaste) and the appropriate use of dietary fluoride supplements without denying young children the decay prevention benefits of community water fluoridation. Increases in the occurrence of mostly mild dental fluorosiswere recognized as more sources of fluoride became available to prevent tooth decay. These sources include drinking water with fluoride, fluoride toothpaste — especially if swallowed by young children — and dietary prescription supplements in tablets or drops (particularly if prescribed to children already drinking fluoridated water).
The NRC’s 2006 “Fluoride in the Drinking Water” report found the following:
More research is needed to clarify the relationship between fluoride ingestion, fluoride concentrations in bone, and stage of skeletal fluorosis; there is scientific evidence that under certain conditions fluoride can weaken bone and increase the risk of fractures; more research is needed to clarify the effect of fluoride on brain chemistry and function; further research is needed to explore the possibility that high levels of fluoride intake associated with community-water fluoridation, especially in infants and children with high water intake, are linked to changes in thyroid function, increased calcitonin activity, increased parathyroid hormone activity, secondary hyperparathyroidism, impaired glucose tolerance, and possible effects on timing of sexual maturity; and may initiate or promote bone cancers.
Some subsequent research has added to these concerns, such as a 2012 study on developmental fluoride neurotoxicity concluded that their “results support the possibility of an adverse effect of high fluoride exposure [from water with fluoride of 'substantially above' 1 mg/L] on children’s neurodevelopment.
Future research should include detailed individual-level information on prenatal exposure [and] neurobehavioral performance” (Environmental Health Perspectives, October 2012, Vol. 120:10, pp. 1362-1368). In August 1993, the NRC released a report prepared for the EPA that confirmed that the currently allowed fluoride levels in drinking water do not pose a risk for health problems such as cancer, kidney failure, or bone disease. After 60 years of research and practical experience, the preponderance of scientific evidence indicates that fluoridation of community water supplies is both safe and effective. The ingestion of optimally fluoridated water does not have an adverse effect on bone health.
A small faction continues to speak out against fluoridation of municipal water supplies. Some individuals may view fluoridation of public water as limiting their freedom of choice; other opposition can stem from misinterpretations or inappropriate extrapolations of the science behind the fluoridation issue. While the arguments against fluoridation have remained relatively constant over the years, those opposed to fluoridation have used different approaches that play upon popular public concerns at the time.
A small faction continues to speak out against fluoridation of municipal water supplies. Some individuals may view fluoridation of public water as limiting their freedom of choice; other opposition can stem from misinterpretations or inappropriate extrapolations of the science behind the fluoridation issue. While the arguments against fluoridation have remained relatively constant over the years, those opposed to fluoridation have used different approaches that play upon popular public concerns at the time.
For example, in the 1950s fluoridation was a Communist plot. Opinions are seldom unanimous on any scientific subject. In fact, there may be no such thing as “final knowledge,” since new information is continuously emerging and being disseminated. Thus, the benefit evidence must be continually weighed against risk evidence.
Opponents have repeatedly claimed fluoridation causes various human illnesses, including AIDS, Alzheimer’s disease, cancer, Down syndrome, genetic damage, heart disease, lower intelligence, kidney disease, and osteoporosis (hip fractures). These allegations are often repeated so frequently during campaigns that the public assumes they must be true. CDC media relations told DrBicuspid.com: “The current levels set by EPA, which are set to protect against severe dental fluorosis, likely are also protective against other fluoride-related adverse effects in adults, including risk of bone fractures.
Concerning its review of studies of low IQ and endocrine disruption, the NRC report noted that current studies have limitations — including problems related to their methods and consideration of potential confounding factors — and thus the significance of some of the studies was uncertain. As a result, they recommend that future studies have better measurement of factors/variables such as actual fluoride exposure.”
The Institute of Medicine recommends that babies up to 6 months of age consume only 0.01 mg/day of fluoride. Infants living in areas of the U.S. where the community water supply is fluoridated are exposed to up to 0.20 mg/kg/day and 0.23 mg/kg/day (Environmental Health Perspectives, January 2005, Vol. 113:1, pp. 111-117). Bottled “infant”or “nursery” water contains 0.5-0.8 mg/L (“Fluoride in Drinking Water: A Scientific Review of EPA’s Standards,” National Academy of Sciences, 2006, table 2-1, p. 28), while in addition, toothpaste use adds 0.1 mg/day to infants’ fluoride intake and 0.15-0.3 mg/day to children’s fluoride intake.
While ‘individuals could have substantially higher intakes’ (ibid, table 2-7, p. 42), these values significantly exceed the EPA’s safe reference dose (the Integrated Risk Information System [IRIS] value) of 0.06 mg/kg/day. For very young children, water fluoridation of the community water supply is the only means of prevention that does not require a dental visit or motivation of parents and caregivers. Recent evidencesuggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of mild or very mild fluorosis. Parents and caretakers should consult with their dentist or physician about the type of water to use to reconstitute infant formula.
Decay rates are declining in many population groups because children today are being exposed to fluoride from a wider variety of sources than decades ago. Many of these sources are intended for topical use only; however, some fluoride is ingested inadvertently by children.
Decay rates are declining in many population groups because children today are being exposed to fluoride from a wider variety of sources than decades ago. Many of these sources are intended for topical use only; however, some fluoride is ingested inadvertently by children.
In appropriate ingestion of fluoride can be prevented, thus reducing the risk for dental fluorosis without jeopardizing the benefits to oral health. You can use fluoridated water for preparing infant formula. However, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula; these bottled waters are labeled as deionized, purified, demineralized, or distilled.
World Health Organization data indicate that rates of dental caries have been declining significantly since the mid-1970s in both regions and countries that have nonfluoridated and fluoridated water. Furthermore, in many countries that do not have community water fluoridation and never have (for example, 97% of Western Europeans do not drink fluoridated water and only five nations have any fluoridated salt), the rates of decayed, missing, and filled teeth in 12-year-olds in those countries are far lower than in the U.S. Water fluoridation continues to be effective in reducing dental decay by 20% to 40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.
Over time, dental decay can be expected to increase if water fluoridation in a community is discontinued, even if topical products such as fluoride toothpaste and fluoride rinses are widely used.
Over time, dental decay can be expected to increase if water fluoridation in a community is discontinued, even if topical products such as fluoride toothpaste and fluoride rinses are widely used.
Studies from outside of the U.S. that have reported no increase in dental decay following the discontinuation of fluoridation all coincided with the implementation of other measures to prevent dental decay, such as topical fluoride programs, free dietary fluoride supplements, and fluoridated salt. Even today, with other available sources of fluoride, studies show that water fluoridation reduces tooth decay by about 25% over a person’s lifetime.
The widespread availability of fluoride through water fluoridation, toothpaste, and other sources, however, has resulted in the steady decline of dental caries throughout the U.S.
There are very high rates of dental caries in U.S. cities such as Boston, Chicago, and Cincinnati despite decades of water fluoridation, and the people in the lowest socioeconomic strata have the highest caries rates, with children having the highest rates of all. Dental decay continues to be a significant oral health problem. Despite progress in reducing dental decay, individuals in families living below the poverty level experience more dental decay than those who are economically better off.
The widespread availability of fluoride through water fluoridation, toothpaste, and other sources, however, has resulted in the steady decline of dental caries throughout the U.S.
There are very high rates of dental caries in U.S. cities such as Boston, Chicago, and Cincinnati despite decades of water fluoridation, and the people in the lowest socioeconomic strata have the highest caries rates, with children having the highest rates of all. Dental decay continues to be a significant oral health problem. Despite progress in reducing dental decay, individuals in families living below the poverty level experience more dental decay than those who are economically better off.
Some of the risk factors that increase an individual’s risk for decay are inadequate exposure to fluoride, irregular dental visits, deep pits and fissures in the chewing surfaces of teeth, inadequate flow of saliva, frequent sugar intake, and very high oral bacteria counts. Dental decay is one of the most common childhood diseases — five times as common as hay fever in 5- to 17-year-olds.
Adding fluoride to community water supplies benefits all people — regardless of age, income, education, or socioeconomic status. A person’s income and ability to get routine dental care are not barriers since all residents of a community can enjoy fluoride’s protective benefits just by drinking tap water and consuming foods and beverages prepared with it.
"It is apparent that fluorides have the ability to interfere with the functions of the brain."
Fluoride’s ability to damage the brain is one of the most active areas of fluoride research today. In the past three decades, over 100 studies have found that fluoride exposure can damage the brain. This research includes:
Over 40 animal studies showing that prolonged exposure to varying levels of fluoride can damage the brain, particularly when coupled with an iodine deficiency, or aluminum excess;
In 2006, the National Research Council (NRC) stated that “it is apparent that fluorides have the ability to interfere with the functions of the brain.” In addition to calling for U.S.-based research on fluoride’s IQ effects, the NRC expressed concern about fluoride’s possible contribution to dementia. According to the NRC:
“Studies of populations exposed to different concentrations of fluoride should be undertaken to evaluate neurochemical changes that may be associated with dementia. Consideration should be given to assessing effects from chronic exposure, effects that might be delayed or occur late-in-life, and individual susceptibility.”
EPA’s Neurotoxicology Division Review (2007)
In 2007, scientists from the Neurotoxicology Division of the U.S. Environmental Protection Agency identified fluoride as having “substantial evidence” of “developmental neurotoxicity.” A developmental neurotoxin is a chemical that can damage the young, developing brain.
The EPA scientists based their conclusion on studies showing that fluoride exposure during pregnancy can damage the brain of the offspring. Consistent with EPA’s assessment, three studies from China have found that the brain of the human fetus can be significantly damaged by the mother’s high fluoride intake. While the safe dose for preventing this effect is not yet known, some adults in western countries have higher urinary fluoride levels of fluoride than the mothers in the Chinese studies (=4.3 ppm). (Mansfield 1999; Yu 1996; Dong 1993).
Harvard Review (2012)
In July of 2012, a team of Harvard researchers published a “meta-analysis” of 27 studies that have investigated the relationship between fluoride and human intelligence. (Choi 2012)
"It is apparent that fluorides have the ability to interfere with the functions of the brain."
(National Research Council, 2006)
Fluoride’s ability to damage the brain is one of the most active areas of fluoride research today. In the past three decades, over 100 studies have found that fluoride exposure can damage the brain. This research includes:
Over 40 animal studies showing that prolonged exposure to varying levels of fluoride can damage the brain, particularly when coupled with an iodine deficiency, or aluminum excess;
- 37 human studies linking moderately high fluoride exposures with reduced intelligence;
- 19 animal studies reporting that mice or rats ingesting fluoride have an impaired capacity to learn and remember;
- 12 studies (7 human, 5 animal) linking fluoride with neurobehavioral deficits (e.g., impaired visual-spatial organization);
- 3 human studies linking fluoride exposure with impaired fetal brain development.
The NRC Review (2006)
In 2006, the National Research Council (NRC) stated that “it is apparent that fluorides have the ability to interfere with the functions of the brain.” In addition to calling for U.S.-based research on fluoride’s IQ effects, the NRC expressed concern about fluoride’s possible contribution to dementia. According to the NRC:
“Studies of populations exposed to different concentrations of fluoride should be undertaken to evaluate neurochemical changes that may be associated with dementia. Consideration should be given to assessing effects from chronic exposure, effects that might be delayed or occur late-in-life, and individual susceptibility.”
EPA’s Neurotoxicology Division Review (2007)
In 2007, scientists from the Neurotoxicology Division of the U.S. Environmental Protection Agency identified fluoride as having “substantial evidence” of “developmental neurotoxicity.” A developmental neurotoxin is a chemical that can damage the young, developing brain.
The EPA scientists based their conclusion on studies showing that fluoride exposure during pregnancy can damage the brain of the offspring. Consistent with EPA’s assessment, three studies from China have found that the brain of the human fetus can be significantly damaged by the mother’s high fluoride intake. While the safe dose for preventing this effect is not yet known, some adults in western countries have higher urinary fluoride levels of fluoride than the mothers in the Chinese studies (=4.3 ppm). (Mansfield 1999; Yu 1996; Dong 1993).
Harvard Review (2012)
In July of 2012, a team of Harvard researchers published a “meta-analysis” of 27 studies that have investigated the relationship between fluoride and human intelligence. (Choi 2012)
The overwhelming majority of these studies found that fluoride exposure was associated with reduced IQ in children. In fact, 26 of the 27 studies that met the Harvard team’s inclusion criteria found a relationship between elevated fluoride and reduced IQ.
The Harvard team thus concluded that fluoride’s effect on the developing brain of children should be a “high research priority” in countries like the U.S. where, despite mass fluoridation programs, no studies have yet been conducted to investigate the issue.
As noted by Dr. Philippe Grandjean, an environmental health scientist at the Harvard School of Public Health:
As noted by Dr. Philippe Grandjean, an environmental health scientist at the Harvard School of Public Health:
“Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain. The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.”
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