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Water fluoridation

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Water fluoridation is the act of adding fluoride ions to water, in order to reduce tooth decay in the general population.

Where used in very low concentrations (on the order of parts per million), fluorides are used in human health applications; specifically, fluorides such as sodium fluoride (NaF), sodium fluorophosphate (SMFP), tin (II) fluoride (SnF2), and amine fluoride are common ingredients in toothpaste. Many dentists also give their patients semiannual fluoride treatments if they do not have a fluoridated water supply.

Many North American municipalities fluoridate their water supplies, citing effectiveness in reducing tooth decay, safety of fluoridation, and the low cost to do so. The American Dental Association (ADA), World Health Organization (WHO), and some other health organizations recommend fluoridation of municipal water supplies to a level between 0.7 and 1.2 ppm.


The fluoridation debate

Possible side effects of low concentration intake

Higher blood-lead-levels are found in children who live in silicofluoridated communities (at accepted levels) than in sodium or non-fluoridated communities in studies conducted by Masters and Coplan. Silicofluorides, used by over 91% of U.S. fluoridating communities, were never safety tested in humans or animals, either alone or together with other drinking water chemicals. [1]

Other scientific studies suggest that the use of fluorides, (H2SiF6 and Na2SiF6), even at levels injected into water supplies to reduce tooth decay, 1 ppm in water, has been implicated as a possible contributing factor in cases of fetal damage, dental fluorosis, skeletal fluorosis, hypothyroidism, weakened bones and Alzheimer's Disease and more. [2] [3] [4]

At least four separate large-scale studies totalling nearly half a million persons showed no net reduction in caries by fluoridation; other studies have shown the decline in caries has been occurring at statistically the same rate in fluoridated and unfluoridated areas.[5] [6] [7] This is in contradiction to the great majority of studies and reviews on this subject. A few examples: [8] [9] [10] [11] [12] [13] [14] [15] [16] [17] [18]

A large majority of epidemiological studies of fluoridation have found no adverse health effects. Critics point out these studies are often funded by institutions with an interest in continuing fluoridation and, they say, that researchers such as Phyllis Mullenix have been fired for coming up with "fluoride is harmful" results. However Dr. Charles Vorhees, editor-in-chief of the journal Neurotoxicology and Teratology said of Mullenix, "Nobody else could ever produce (results) consistent with Phyllis'" even though non-US researchers have done so, including finding the effect in humans.[19] Critics also contend that others, such as William Marcus (reinstated with back pay and interest in 1992 by a court order, the judge noting "the reasons given for Dr. Marcus' firing were a pretext…his employment was terminated because he publicly questioned and opposed EPA's fluoride policy.") and John Colquhoun , have been fired for poking holes in attempts to show fluoride is safe. They go on to say that this discourages objectivity and that studies have been repeatedly shown to have flawed techniques or to have misrepresented or massaged their data.[20] [21]

Industrial conspiracy

Critics of fluoridation charge that fluoride is deliberately associated with good health to protect many major industries, especially uranium, aluminium, and steel smelting, from the massive lawsuits that began to be filed in the 1930s for fluoride related damage to livestock, farms, and community health. One noted critic, Dr. Robert Carton of the US EPA said "Fluoridation is the greatest case of scientific fraud of this century, if not of all time." (Marketplace CBC 1992 Nov 24).

It is, however, true that the volte-faces on fluoridation by the ADA, AMA, and PHS occurred coincidentally with the heading of the FSA by Oscar Ewing , a highly-paid lawyer for Alcoa. Alcoa had been connected to fluoride study since the discovery of fluorosis in the town of Bauxite, Arkansas as part of the "brown stain" mystery.[22]

Current source and production of fluoridation agents

The phosphate fertilizer industry requires phosphoric acid to produce a variety of phosphate salts for agricultural use. In the manufacture of phosphoric acid, the reaction of sulfuric acid on phosphate rock yields silicofluoride gas. The process called "scrubbing" dissolves this corrosive, toxic gas in water to comply with air quality standards. The resultant liquid is hydrofluorosilicic acid (hfsa). The precipitate from the reaction of sulfuric acid with phosphate bearing rock is called phosphogypsum. This powder is stacked in mounds which are used to contain hfsa. The industrial uses of hfsa include feedstock for synthesis of sodium silicofluoride, aluminum fluoride, and polysilicones. As the forementioned uses of hfsa do not provide a market for all that is produced, the remainder sits in holding ponds on phosphogypsum mounds or is sold to municipalities for use in drinking water supplies.

Court cases

The issue of fluoridation has been the basis for many court cases. Anti-fluoride activists have sued cities for infringing upon their rights, and on the claim that fluoridation is a form of involuntary medication.[23] Individuals have sued cities for a number of illnesses that they blamed on fluoridation of the city's water supply. In general courts have found in favour of cities in such cases and have not found a connection between health problems and fluoride(this in part because even if a statistical connection to illness is proven, it doesn't prove the individual is sick of this illness because of the connection. Courts have an extremely high standard of proof when the illness may have other causes).

The FDA has never approved water fluoridation, fluoride toothpaste for tooth decay, or fluoride supplements; fluorides were in fact grandfathered into acceptance because they were accepted before the 1938 law for mandatory testing of medications. The only previous utilisation that caused the grandfathering of fluorides is as the active ingredient of rat poison. The FDA has come under heavy criticism in the US for not questionning the sale of nontested fluoride despite opposition in an ADA brochure in 1951:

From a 1951 American Dental Association brochure: "There is no proof that commercial preparations such as tablets, dentifrices, mouthwashes or chewing gum containing fluorides are effective in preventing dental decay. Unfortunately such preparations are being offered to the public without adequate scientific evidence of their value."

In 1973 Jason Burton, a boy in Melbourne, Australia died after swallowing six fluoride tablets; four were recovered after a stomach pumping while the other two had already been absorbed into the body. The hospital staff had assumed it would take well over 100 tablets to be fatal, making the Burton case an object lesson in high concentration fluoride intake.[24]

Currently one court case is ongoing in New Jersey. State Assemblyman John V. Kelly has requested the ban of children's fluoride supplements; supplements that duplicate the 'ideal' fluoride levels set for water fluoridation.

Cities and countries' choices on fluoridation

A 1998 ADA study asked the question Do you believe community water should be fluoridated? 70% said 'yes', and 18% said 'no', with the rest undecided. Health organizations and dentists that recommend water fluoridation point to the great majority of studies which show statistically significant decreases in cavities where water fluoridation is done. A handful of other studies show no reduction or even increases in cavities.

The idea to fluoridate public water supplies goes back to study of "Colorado brown stain", a condition of the first settlers wherein their teeth were severely stained, sometimes chocolate colored. This was eventually identified as severe fluorosis. Unusual resistance to dental decay was also noted. This was attributed to the fluorine content of the water;[25] the water also had high calcium and magnesium content which was apparently overlooked.[26]

Fluoridation was first introduced in the late 1940s. Debates began in many communities; ultimately, most decided to accept fluoridation. The first city to fluoridate its water was Grand Rapids, Michigan in 1945, as part of a ten year evaluation of fluoridation. The experiment was effectively terminated early, in 1951, with the imposition of fluoridation in the control group, Muskegon, Michigan.[27]

Unlike North America, less than 2% of Europe's population has fluoridated water. Sweden banned fluoridation in 1971 by mandate of their Supreme Court; Holland banned it constitutionally in 1976. West Germany rejected it in 1971; Norway, 1975; Denmark, 1977; France, 1980. In other places in the world, Chile rejected fluoridation in 1977; India and Egypt also have. Finland maintains an "experimental program" covering only 1½% of its people.[28] In Switzerland, only Basel's water was fluoridated, and that was stopped in April 2003 on the advice of their Health and Social Commission.[29],[30] Diesendorf "Mystery of Declining Tooth Decay" Nature 1986 points out "in western Europe where there is little fluoridation...large reductions in caries had been occurring in unfluoridated areas". (emphasis added). However, the dental public health systems in most European countries are significantly different from North America. Many countries have school-based programs offering free dental care to children, some offer free and low fee care to all citizens.

In the United States, 45 cities abandoned the practice between 1990 and 1996. Gov. Pataki of New York signed on July 2, 1996 a law transferring the decision to fluoridate water from bureaucrats to elected officials.[31])

In Canada, Calgary began fluoridating in 1991 after the fifth plebiscite on the prospect finally approved it in 1989--although a 1984 study showed that fluoridated Edmonton had a statistically identical rate of tooth decay <note the 1984 result was from a provincial survey which did not report results by city - it only compared rural to urban>. Whitehorse, watching Calgary review the decision in 1998, ended its 30 years of fluoridation.[32]

Health Canada's current stance is that fluorides are beneficial to teeth, but that other physiological benefits are unproven [33]. The National Academy of Sciences generally agrees with Health Canada's opinion; from a November 1998 letter: "First, let us reassure you with regard to one concern. Nowhere in the report is it stated that fluoride is an essential nutrient. If any speaker or panel member at the September 23rd workshop referred to fluoride as such, they misspoke. As was stated in Recommended Dietary Allowances 10th Edition, which we published in 1989: 'These contradictory results do not justify a classification of fluoride as an essential element, according to accepted standards. Nonetheless, because of its valuable effects on dental health, fluoride is a beneficial element for humans.'"

Secondary effects of fluoridation

In 1970, Grand Rapids, Michigan and Newburgh, New York had twice the United States average of dentists per capita (Anne-Lise Gotzsche The Fluoride Question, Panacea or Poison? p8). The ADA found in 1972 that dentists make 17% more profit in fluoridated areas as opposed to non-fluoridated areas (Douglas et al. "Impact of water fluoridation on dental practices and dental manpower" Journal of the American Dental Association 84:355-67, 1972). This could simply be a correlation between cities with fluoridated water having larger populations to serve, on the assumption that larger cities or water supplies are more likely to fluoridate their water.

Scientific issues rarely raised

Water fluoridation may be done with non-pharmaceutical grade material; it may contain substances that would never be added in toothpaste such as lead, arsenic or other industrial by-products(in some cases, radionucleides). The quantities of such substances is however low and within the safety standards set for each of these substance individually (even if detectable effects occur at those levels).

One should remember that arsenic and lead may be more toxic by themselves than the sodium fluoride at the dosages found in typical fluoridation, and the combination is known to be more toxic than the parts. Fluoridation is therefore potentially toxic even if fluorides were at a safe dose! This argument alone would ban fluoridation as it is done today, but unfortunately it is little-studied in combination with fluoridation.

Many scientific facts could be tested by studying pure pharmaceutical-grade water fluoridation on humans without association to other substances – whether the associated substances are beneficial, toxic, neutral, or untested. A better scientific assessment of fluorosis/benefit/fluorosis dosage is the likely benefit.

Most of the studies and regular media fail to ask those questions because it doesn't fit the 'prove fluoridation is toxic/useless' or 'prove fluoridation works' political agendas which are the end result of typical politics. The 'find the safest fluoridation kind' scientific goal is usually ignored by both sides of the controversy for reasons completely out of the scope of the scientific method.

All other medications had to answer those two questions before scientific acceptance. The scientific standards used to approve of water fluoridation should be no different. The current FDA position of tolerating the ingestion of an untested, non FDA approved(*) medication as de facto compulsory and costly to avoid is without parallel in the FDA's history.

As fluorides are necessary ingredients in some medications (in order to cross the blood-brain barrier), one cannot set aside the idea that fluoridation might amplify the effect/interact with a few medications without doing some research.

Another baffling question: since the Varner et al. study and its peer review and replications found a surprising 80% early death rate for rats in a sodium fluoride and aluminium study (in the lowest dosage group and NOT in the high dosage group - as opposed to expectation), using the same fluoride and aluminium ppm range as used by aluminium-industry based fluoridation providers, why didn't the scientists plainly see that humans don't have a 80% death rate from same and declare the rats to be a bad model of fluoride+aluminium effects on humans? Why didn't they mention the nonlinear and not clearly dose dependant nature of fluoride+aluminium poisoning in rats isn't proven to be absent in humans? This study has two consequences:

  • All studies on rats may be badly misleading as rats are not a good animal model for fluoride+aluminium studies. Without a good animal model (one that is not known to react very differently than humans) no animal study may scientifically claim fluorides are safe or unsafe for humans. In similar cases at least one monkey study is done but it is not the case with fluorides.
  • The overwhelming number of studies on rats or humans make no attempt to detect the nonlinear effect of the toxicity of sodium fluoride with aluminium; they assume sodium fluoride toxicity at fluoridation levels will simply add with aluminium toxicity at fluoridation levels without synergy, or only in a one-sided fashion (i.e. the belief that adding more toxin can't reduce death rate). This assumption is replicatedly demonstrated to be false for rats, and cannot be scientifically claimed to be present (perhaps in a different form and dosage) or absent in humans before more research is done.

Conclusion on controversy

Most fluoridation studies examine teeth but not the body. Most show that water fluoridation reduces cavities with no significant risk of other effects, when done at prescribed levels because other health effects are seldom part of the study. Since ingested fluoride delays eruption of teeth, those studies may be totally invalid. Some show a statistically significant increase in fluorosis when fluoridation is done (even while cavities are decreased). Still others show fluoridation providing no benefits at all.

Some of the early fluoridation studies which show large improvements in dental health are scientifically invalid. Cavity decline could be attributed to vitamin D and other nutrient fortified foods, better health awareness, better diets and/or better dental care. Non-fluoridated countries also experience a decrease in cavities during the same period.

In any case the results aren't replicable by trying the same thing today, so many early studies cannot be trusted as much as previously claimed. Considering how many fluoride studies have been discredited for being contested by peers, a recursive medical literature search about each and every study's contestation is basic prudence regardless of the side you take.

In any event, the controversy over fluoridation's effects (positive, useless, or negative) on the public health is unlikely to end soon.

See also

External links

Pro fluoridation

Anti fluoridation

Last updated: 08-31-2005 13:02:01
Last updated: 09-12-2005 02:39:13