Understanding Concerns About Community Water Fluoridation

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Understanding Concerns About Community Water Fluoridation
by Patricia Dines
Pacific Health Magazine
May 2013
(c) Copyright Patricia Dines, 2013. All rights reserved.  
The claims for community water fluoridation are certainly appealing. We'd all surely like to believe that putting a material into our shared water supply could improve everyone's dental health; save us more money that it costs; and harm no people, pets, livestock, crops, wildlife, or ecosystems.

Unfortunately, there is a body of scientific evidence that contradicts this idyllic scenario. Among the many public opponents to fluoridation of public water supplies are thousands of top scientific experts, dentists, doctors, former public health ministers, Nobel Laureates, and more. Many of them were formerly proponents of community water fluoridation until they reviewed the science and saw that their positions needed updating. Many industrialized countries have rejected this practice. [NOTE 1]

The scientific method requires a willingness to re-examine our premises in light of the evidence. Surely we only want to add a chemical to everyone's water if this is the best option and there is incontrovertible evidence of its 100 percent safety and efficacy. Does community water fluoridation (CWF) really meet those standards?

Eight Key Facts about Community Water Fluoridation

Note: This article, with citations and links to further resources, is available online at patriciadines.info/PHMF.html [that's this page!].

1) The use of fluoride compounds in dentistry is fundamentally different from CWF. Knowledge and beliefs about the first do not automatically apply to the second.

With the former, scientifically tested, pharmaceutical grade fluorine compounds are applied to specific people's teeth by their informed choice, in controlled and supervised doses. [NOTE 2]

In the case of CWF, an entire population is exposed via the water supply, without their consent, to uncontrolled and unmonitored doses of different fluorine compounds -- usually hydrofluorosilicic acid known to be contaminated with toxics and with no testing and approval by the U.S. Food and Drug Administration (FDA). [NOTE 3]

2) Fluoride's primary mode of action is known to be topical, not systemic. The benefits of fluoride are realized when applied directly to tooth surfaces, not through ingestion. Even the Centers for Disease Control and National Research Council agree with this. [NOTE 4]

3) Both fluoridated and non-fluoridated regions have seen the same overall decline in tooth decay over the past 40 years. Some non-fluoridated countries have experienced even lower decay rates. [NOTE 5]

4) Studies have not proven public water fluoridation to be safe and effective. In 2000, the British government's Final Fluoridation Study (conducted by York University and nicknamed "The York Review") was touted as "the study to end all studies into fluoridation" and was expected to confirm the claimed benefits of CWF. Instead, its systematic review found that none of the studies purporting to demonstrate the safety and effectiveness of water fluoridation met their grade A criteria -- defined as "high quality, bias unlikely" -- and committed basic data analysis errors such as failing to make double-blind assessments or adjust for confounding factors.

York Professor Trevor Sheldon said, "Until high quality studies are undertaken providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation." [NOTE 6]

5) No minimum daily requirement is set for fluorine. It is not an essential nutrient; there is no such thing as a fluorine deficiency. This is clearly stated by the U.S. FDA, U.S. Public Health Service, and the National Academy of Sciences Institute of Medicine (IOM), which indicates that its 1997 report is being used incorrectly to claim otherwise. [NOTE 7]

6) Many Americans are already exposed to fluoride amounts beyond safe levels through dental products, food, soda, tea, pharmaceuticals, pollution, and pesticides. Children can go over the threshold just in the way they brush their teeth, for instance, by using too much toothpaste, failing to rinse thoroughly, or swallowing the toothpaste. [NOTE 8]

7) Many studies have connected fluoride to health threats, even at common U.S. exposure levels. These include significant increases in thyroid tumors, bone cancers, bone fractures, arthritis-like symptoms, decreased fertility, lower IQ, and dementia-like effects. Excess fluoride also causes dental fluorosis, a condition where fluoride disturbs dental enamel, leading to permanent stains and/or pitting, and reflecting damage happening to bones throughout the body, according to experts. In 2010, 41 percent of America's children had fluorosis, a dramatic increase from fewer than 10 percent in the 1940s. People with compromised nutrition are also more vulnerable to excess fluoride. [NOTE 9]

8) Fluorine compounds are essentially drugs that produce a range of responses, can cause harmful side effects, and require dosage limits and individualized treatment. They are not suitable for everyone. For example, infants and kidney patients are directed not to ingest fluoridated water. But removing fluorine from water is difficult, requiring expensive whole-house reverse osmosis systems that are especially inaccessible to community water fluoridation's primary target audience: low-income people and children. [NOTE 10]

Additional information and links to the sources referenced in this article are available online [at this webpage!], including a link to "A Response to Pro-Fluoridation Claims," from The Case Against Fluoride, by Dr. Paul Connett, et al. [www.fluoridealert.org/uploads/proponent_claims.pdf] Dr. Connett, a chemistry professor at St. Lawrence University, believed that CWF was effective until he looked at the science contradicting it. He is now the director of the Fluoride Action Network.

About the Author
Patricia Dines has been an independent freelance author, journalist, and public speaker for more than 25 years, covering health and environment issues through books, newsletters, articles, workshops, and more.

© Copyright Patricia Dines, 2013. All rights reserved


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NOTE 1. For a summary of the countries and experts who oppose fluoridation -- and their reasons -- see www.fluoridealert.org/issues/water/opposed

Also see:
* Position Against Water Fluoridation by LULAC (The League of United Latin American Citizens, the oldest and largest Latino organization in the U.S.)

* Statement About Water Fluoridation from the EPA Professionals Union (NTEU Chapter 280)

* Professionals Statement to End Water Fluoridation. Signed by over 4,000 medical, dental, scientific, and environmental professionals

* Civil Rights Leaders Call for Halt to Water Fluoridation

NOTE 2. Fluoride can promote dental health in topical dental products. For instance, see this review of studies -- "Fluoride toothpastes for preventing dental caries in children and adolescents." Marinho VC, Higgins JP, Sheiham A, Logan S., 2003, U.S. National Library of Medicine, National Institutes of Health.

NOTE 3. The fluoride used in water fluoridation is not pharmaceutical grade but industrial waste.
"The chemicals used to fluoridate water are not pharmaceutical grade. Instead, they largely come from the wet scrubbing systems of the phosphate fertilizer industry. These chemicals (90% of which are sodium fluorosilicate and fluorosilicic acid), are classified hazardous wastes contaminated with various impurities. Recent testing by the National Sanitation Foundation suggest that the levels of arsenic in these silicon fluorides are relatively high (up to 1.6 ppb after dilution into public water) and of potential concern (NSF 2000 and Wang 2000). Arsenic is a known human carcinogen for which there is no safe level. This one contaminant alone could be increasing cancer rates -- and unnecessarily so."
"50 Reasons to Oppose Fluoridation," Dr. Paul Connett, www.fluoridealert.org/articles/50-reasons

Dr. John Lee notes that "the fluoride compound used in most animal studies is pure sodium fluoride (NF) and purified water, not industrial grade hydrofluorosilicic acid as is commonly used in public water fluoridation. The fluoride compounds used in public water fluoridation are contaminated with a number of toxic chemicals such as lead, mercury, and aluminum which, by synergy, are known to increase the toxicity of fluoride with the potential of brain damage and other health problems." This design serves "to obscure the true toxic risk of the fluoride exposure humans face." www.johnleemd.com/store/essay_fluoride.html

"Absence of safety studies on silicofluorides. When asked by the U.S. Committee on Science for chronic toxicity test data on sodium fluorosilicate and hydrofluorosilic acid, Charles Fox of the EPA answered on June 23, 1999, "EPA was not able to identify chronic toxicity data on these chemicals." From:
"Statement About Water Fluoridation from the EPA Professionals Union" (NTEU Chapter 280), www.nteu280.org/Issues/Fluoride/NTEU280-Fluoride.htm

NOTE 4. Fluoride works by being applied topically to teeth, not by being ingested (systemically).

"When water fluoridation first began in the 1940s, dentists believed that fluoride's main benefit to teeth came from being swallowed during the tooth-forming years. This belief that fluoride's primary benefit was 'systemic' and 'pre-eruptive.' … Although this 'systemic' paradigm was the premise that launched water fluoridation and fluoride supplementation programs, it has now been discarded by the dental research community. Today, as noted by the following studies, the overwhelming consensus by dental researchers is that fluoride's primary effect is topical, not systemic... As the Centers for Disease Control (CDC) stated in 1999 'fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.' The National Research Council has concurred, stating in 2006 that 'he major anticaries benefit of fluoride is topical and not systemic.'
"Fluoride & Tooth Decay: Topical Vs. Systemic Effect", By Michael Connett, June 2012. www.fluoridealert.org/studies/caries04

"The process of fluoride absorption works only by direct contact (topical treatment). Fluoride ions that are swallowed do not benefit the teeth.[126]" ^ Pizzo G.; Piscopo, M. R.; Pizzo, I.; Giuliana, G. (2007). "Community water fluoridation and caries prevention: a critical review". Clinical Oral Investigation 11 (3): 189-193. doi:10.1007/s00784-007-0111-6. PMID 17333303.

The "FDA has never approved systemic use of fluoride. The U.S. Food and Drug Administration in Dec. 2000 stated to the U.S. Committee on Science [that] they have never provided any specific approval for safety or effectiveness for any fluoride substance intended to be ingested for the purpose of reducing tooth decay.
"Statement About Water Fluoridation from the EPA Professionals Union" (NTEU Chapter 280), www.nteu280.org/Issues/Fluoride/NTEU280-Fluoride.htm

"The FDA has never approved any fluoride supplement as safe and effective. In fact, the only two products... that FDA ruled on were both rejected."

NOTE 5. For a good summary of the trends, including many expert and survey citations -- which show that tooth decay has declined at the same rate in fluoridated and non-fluoridated countries -- see "Tooth Decay Rates in Fluoridated vs. Non-fluoridated Countries," by Michael Connett. www.fluoridealert.org/studies/caries02

NOTE 6. CWF is not proven safe. The York Review found no grade A studies.

Her's more from the official statement of York Professor Trevor Sheldon: "The review did not show fluoridation to be safe... The review found water fluoridation to be significantly associated with high levels of dental fluorosis which was not characterised as as "just a cosmetic issue.".... There was little evidence to show that water fluoridation has reduced social inequalities in dental health... Until high quality studies are undertaken providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation."

The organization which did the study has more recently noted, "Since the report was published in October 2000 there has been no other scientifically defensible review that would alter the findings of the York review. As emphasised in the report, only high-quality studies can fill in the gaps in knowledge about these and other aspects of fluoridation. Recourse to other evidence of a similar or lower level than that included in the York review, no matter how copious, cannot do this."

COMMENT: The York Review does have limitations in some aspects. For more on this, see this letter from Dr. Paul Connett, who was a peer reviewer of the study, to the British Medical Journal. www.fluoridealert.org/content/in-response-to-paul-wilson-and-the-york-review

• • •

The National Research Council (NRC) came to the same conclusion. Although fluoridation advocates have claimed for years that the safety of fluoride in dentistry is exhaustively documented and "beyond debate," Dr. John Doull (Chairman of the NRC's comprehensive fluoride review) says, "when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on. I think that's why fluoridation is still being challenged so many years after it began."

• • •

This article walks through the studies, both those used by proponents and those that disprove them.
"Fluoride: A Statement of Concern," by Dr. Paul Connett, Waste Not #459, January 2000

NOTE 7. The Food and Drug Adminstration (FDA) says, "Sodium fluoride used for therapeutic effect would be a drug, not a mineral nutrient. Fluoride has not been determined essential to human health. A minimum daily requirement for sodium fluoride has not been established." www.fluoridealert.org/researchers/fda/drug

Also, (the late) Dr. John Lee said, "fluoride is not an essential nutrient. That means there is no known minimum requirement for fluoride…. no matter how little the fluoride intake is, no deficiency state occurs. Unlike the other items listed in the Food and Nutrition report, there simply is no such thing as fluoride deficiency." www.johnleemd.com/store/essay_fluoride.html

See "Fluoride is not an essential nutrient," by Michael Connett, for more quotes and citations from other sources. www.fluoridealert.org/studies/essential-nutrient

NOTE 8. See "Sources of Fluoride," which gives an overview of the many ways we're all exposed to fluoride, through our food, beverages, dental products, and more. This has links to more details on each source. www.fluoridealert.org/issues/sources

Children are exposed during brushing their teeth. For instance, see Item 2) on this list:

No health agency in fluoridated countries is monitoring fluoride exposure or side effects in the population overall or the sensitive subsets. www.fluoridealert.org/articles/50-reasons

NOTE 9. Excess fluoride can cause many health problems, even at exposure levels we commonly have in the U.S.

"Dental fluorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development. The risk of fluoride overexposure occurs between the ages of 3 months and 8 years." http://en.wikipedia.org/wiki/Dental_fluorosis

Although some experts minimize dental fluorisis as "just cosmetic," it can quite dramatically impact the look of teeth, permanently. It is not just a minor thing! See pictures here. Also, if the goal of fluoridating is to help teeth -- shouldn't it matter that it's harmful to teeth? http://www.google.com/search?q=dental+fluorosis&hl=en&client=safari&tbo=u&rls=en&tbm=isch&source=univ&sa=X&ei=L3UJUdyHOJHRigLzr4DgBw&ved=0CEYQsAQ&biw=1280&bih=829

• • • 

"Conclusion: All studies of fracture rates relative to long-term fluoridation exposure indicate a significant increase in fracture risk from fluoridation. The increased fracture risk due to fluoridation appears to range from 40-100%, depending on the age of the subjects studied. For women in their seventh decade who have been exposed to life-long fluoridation, the risk of hip fracture is approximately doubled. The risk increases with fluoride concentration at all levels over 0.11 ppm....

"The costs and health effects of osteoporotic fractures in the US are enormous. The total cost of fracture care is now about $9 billion/year. It is estimated that about 350,000 hip fractures occur per year and the incidence is rising…."

- Dr. John R. Lee. From his article published in the research journal, Fluoride (Vol. 26 No. 4, pages 274-277, 1993).
Quoted at, Fluoridation and Hip Fractures, by John R. Lee, M.D. www.nofluoride.com/Hip_fractures_Lee.cfm

• • • 

"A review of recent scientific literature reveals a consistent pattern of evidence -- hip fractures, skeletal fluorosis, the effect of fluoride on bone structure, fluoride levels in bones and osteosarcomas -- pointing to the existence of causal mechanisms by which fluoride damages bones…. [Fluoridation] proponents must come to grips with a serious ethical question: is it right to put fluoride in drinking water and to mislead the community that fluoride must be ingested, when any small benefit is due to the topical action of fluoride on teeth?"
- Australian and New Zealand Journal of Public Health, 1997. www.nofluoride.com/Hip_fractures_Lee.cfm

• • • 

Fluoride accumulates in the body, "largely in calcifying tissues such as the bones and pineal gland, and steadily increases over a lifetime." (NRC, 2006). www.fluoridealert.org/articles/50-reasons

• • • 

A recent Harvard study confirms concerns that fluoride in water lowers IQ. "July 24, 2012 -- Harvard University researchers' review of fluoride/brain studies concludes "our results support the possibility of adverse effects of fluoride exposures on children's neurodevelopment." It was published online July 20 in Environmental Health Perspectives, a US National Institute of Environmental Health Sciences' journal."

• • • 

See this webpage for "overviews of the scientific and medical research that implicates fluoride exposure as a cause or contributor to various chronic health ailments."

NOTE 10. For instance, it is generally recommended that babies not get fluoride in the first year of their life.

It is recommended that people with kidney problems not consume fluoridated water, including those on dialysis. That's because their kidneys are compromised in their ability to excrete fluorine in the urine, and thus it builds up in the bones and other parts of the body at a faster rate, which can cause various specific health problems for them. Fluoride can also worsen the kidney disease, creating a negative spiral.

"It is well known that individual susceptibility to fluoride varies greatly across the population.

Only certain water filters can remove fluoride from water, and even then only probably up to 90% of the material. [Because it is so difficult and expensive to remove, the easiest way to avoid fluoride is not to put it in the water in the first place, and instead distribute it in more targeted ways to people who can choose if they want to be exposed.]

Water fluoridation is especially harmful to the lower-income people it claims to serve. That's for two key reasons:
1) Fluoride is more harmful to people with inadequate nutrition intake; and
2) Low-income people can least afford the time and money needed to avoid fluoride, for instance to protect vulnerable members of their families.
www.fluoridealert.org/articles/fluoride-facts (See #9)
www.fluoridealert.org/issues/ej (Environmental Justice)

• • •

"[Water fluoridation] is against all principles of modern pharmacology. It's really obsolete. No doubt about that. I think those nations that are using it should feel ashamed of themselves. It's against science….

"In modern pharmacology it's so clear that even if you have a fixed dose of a drug, the individuals respond very differently to one and the same dose. Now, in this case, you have it in the water and people are drinking different amounts of water. So you have huge variations in the consumption of this drug. So, it's against all modern principles of pharmacology. It's obsolete, I don't think anybody in Sweden, not a single dentist, would bring up this question anymore."

- Dr. Arvid Carlsson, famed pharmacologist at Gothenburg University, 2000 winner of the Nobel Prize in Medicine/Physiology

Good general resources on this topic

Fluoride Action Network www.fluoridealert.org

Movie: Fluoridegate: An American Tragedy, by Dr. David Kennedy. This engaging and informative documentary film shares the experiences of scientists who sought to ring the alarm about Community Water Fluoridation. (65 minutes) www.youtube.com/watch?v=LrWFnGpX9wY

Book: The Case Against Fluoride, By Dr. Paul Connett, et al

Book chapter: "A Response to Pro-Fluoridation Claims," from The Case Against Fluoride, by Dr. Paul Connett, et al. Dr. Connett is a scientific professional who supported CWF until he looked at the science. Hopefully more health professionals and decisionmakers will also reconsider their opinions based on what we know today. www.fluoridealert.org/uploads/proponent_claims.pdf


"My father was a dentist. I formerly was a strong believer in the benefits of water fluoridation for preventing cavities. But many things that we began to do 50 or more years ago we now no longer do, because we have learned further information that changes our practices and policies. So it is with fluoridation."

Andrew Young, former U.N. Ambassador, former Atlanta Mayor Inductee International Civil Rights Walk of Fame
Quoted in: "Civil Rights Leaders Call for Halt to Water Fluoridation," Black Politics On The Web, April 15, 2011

• • •

"It is time for the U.S., and the few remaining fluoridating countries, to recognize that fluoridation is outdated, has serious risks that far outweigh any minor benefits, violates sound medical ethics and denies freedom of choice. Fluoridation must be ended now."

- Professionals Statement to End Water Fluoridation, signed by over 4,000 medical, dental, scientific, and environmental professionals. www.fluoridealert.org/researchers/professionals-statement


Patricia Dines is a professional freelance writer, editor, graphic artist, and public speaker. She's written seven books on local organics; is Editor and Lead Writer for The Next STEP newsletter (which gently educates readers about toxics and alternatives); and writes the Ask EcoGirl column (which cheerfully empowers constructive action for the earth). She writes articles for a range of periodicals, as well as various projects for business and government entities. For more information about her work, see www.patriciadines.info.

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