http://www.ewg.org/issues/fluoride/20050606/index.php     http://www3.caringbridge.org/ut/jankini2/ 

Suggested Fluoride Use

Optimal prevention of Tooth Decay

Introduction

FDA, EPA, NIH, Courts and ADA positions

Nutrition, Safety, Ethics

Risks of Fluoride

Fluoride in foods and drugs, the “ubiquitous level

Summary of Suggested Fluoride Use: 2005. 

• Use fluoride toothpaste ONLY if current active decay.
• Do NOT ingest fluoride in any form. 
• Do NOT swallow tooth paste, if used for brushing rinse and spit it out.
• Do NOT use fluoride vitamins or drops.
• Do NOT use fluoride or fluoride tooth paste for children under the age of 6.
• Do NOT use fluoridated water for cooking, drinking, or food preparation.

Optimal Prevention of Tooth Decay:

• Cleaning after every meal by accurately brushing and flossing.
• Diet with a variety of unrefined foods.  Avoid carbonated beverages.  Eat fruit rather than fruit juice, foods without sugar added, vegetables raw or lightly cooked, whole grains, low fat foods, avoid fried and sticky foods. 

Most foods are acidic and should not stay in the mouth for long periods of time. Avoid putting a child to sleep with a bottle of milk or juice.

• Dental “check ups”.

Summary: Benefits of Fluoridation (fluoride added to water)

            We are ingesting too much fluoride.  Regardless of whether a person is pro or anti fluoridation, the harsh facts show the average person is getting too much fluoride and many are getting far too much.  There is good evidence fluoridation provides little or no benefit and any benefit is from topical sources at potentially hazardous concentrations such as toothpaste and fluoride rinses.

            The risks involved with water fluoridation are no longer just a slight coloring of teeth (fluorosis) but have risen to risks which include dental and bone fluorosis and fracture, thyroid damage, bone cancer, reproductive damage, decrease in intelligence, neurological damage and more. 

Introduction:

FDA required warning for over the counter fluoridated products since 1997 (flexible language).  Crest toothpaste, “Drug Facts 0.15% w/v fluoride ion:  “Keep out of reach of children under 6 yrs of age.  If you accidentally swallow more than used for brushing, seek professional assistance or contact a Poison control Center immediately.”  (Flexible wording)

The same warning should be on two glasses of fluoridated water.  The recommended amount of tooth paste is a pea size and has 0.5mg of fluoride ion, the same as 2 glasses of fluoridated water.

Children (30mo) swallow an average of 0.42mg/brushing of fluoride from toothpaste.  Bentley, BDJ 1999.  Children tend to swallow, then spit.

As a Nutritionist, General Dentist, Cosmetic Dentist and Educator for 30 years, I have seen an increase in dental fluorosis even for those who do not get water fluoridation.  Where is all the fluoride coming from?  Using USDA tables, independent evaluations, and my own testing, it becomes obvious, fluoride is in most foods, toothpaste, water, and many medications, industry, pesticides, herbicides, and dental products.  The FDA has appropriately used the term, “ubiquitous”.

Because of the patient’s lack of “will”, the Government throws a “pill” at the resulting “ill”.    Options for fluoride in salt and other sources are available for those in need.  We are not in eminent danger from tooth decay and do not need mass medication.

Consider:

• Research finding a reduction in tooth decay with fluoridation must be reviewed in the light of the probable delayed eruption of teeth caused by fluoride and decrease in decay in the industrialized countries. 
• Current research is compelling, water fluoridation is no longer effective (if it ever was) and water fluoridation is indeed harmful. 
• The “halo effect” of fluoride is now giving us too much fluoride in our foods, pesticides, water, drinks, medications, and environment.
• Fluoride has a hazard rating between lead and arsenic.  We all agree, too much fluoride can be hazardous. We are now getting too much fluoride.
• Fluoride research usually evaluates sodium fluoride rather than the main fluoride compounds used in fluoridation, hydrofluorosilicic acid and sodium fluorosilicate which have other toxins such as lead and can exacerbate the competition between calcium and lead for bone and soft tissue sites.
• Fluoride ion has an affinity for proteins and is known to modify enzyme action potentially disrupting a wide range of endocrine, immune and neural processes. Masters, RD et al NeuoroToxicology 2000.

This outline is not intended to be a complete literature review on water fluoridation but rather a call for caution and some reasons for the caution.  Although many medical, public health organizations and government agencies recommend water fluoridation, all defer to the ADA for scientific support.  Therefore, the ADA position is used in this paper for the “pro-fluoridation” position.  An honest disagreement with the science presented by the ADA on fluoridation should not detract from the good people or their Institutions. 

Thousands of fluoridation articles are in the literature with various conclusions, many support fluoridation.   “Might does not make right” and the articles should be viewed with traditional scientific rigor including co-founding factors, study date with the decrease in dental decay, comparing the time teeth have been in the mouth rather than age of the patient, other decay prevention practices in the communities, fluoridation hazards, and ethics. 

A cessation of fluoridation must not be the end of the discussion.  Other methods of decay prevention should be continued and implemented.  A “sin” tax on junk food to help pay for damage is reasonable.  The average American drinks a gallon of carbonated beverage a week. One of my patient’s was averaging two cases of Mt. Dew a day and expected someone else to pay for the damage to his teeth.   www.beveragemarketing.com

EPA Position:

"In summary, we hold that fluoridation is an unreasonable risk. That is, the toxicity of fluoride is so great and the purported benefits associated with it are so small - if there are any at all – that requiring every man, woman and child in America to ingest it borders on criminal behavior on the part of governments."

-          Dr. J. William Hirzy, Senior Vice-President, Headquarters Union,

-          US Environmental Protection Agency, March 26, 2001  

“There are no Federal safety standards which are applicable to drinking water additives” Tudor Davies, Director Office of Science and Technology, EPA 1998.

“EPA does not regulate drinking water treatment chemicals.” Congressional Investigation, 1999.  

 US Congress

Congress has given to the FDA the responsibility to control “articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease and articles intended to affect the structure or any function of the body of man.”  21 U.S.C. 321

FDA Position

“Fluoride, when used in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or animal is a drug that is subject to FDA regulation” and inexplicably the FDA abdicates this responsibility by continuing, “. . . the EPA regulates fluoride in the water supply.” Congressional Hearings 2000, Melinda Plaisier Ass. Com. For Legislation.

No fluoridation product has ever received FDA approval and fluorine-bearing supplements intended for ingestion are on the market as an “Unapproved New Drug.”  An unapproved new drug is a “violation of sections 505 and 502 of the Federal Food, Drug, and Cosmetic Act.”  www.fda.gov/cder/guidance/3602fnl.pdf   There are no studies to demonstrate either the safety or effectiveness of these drugs (fluoride products added to water). FDA 1993. 

“Various kinds of toxicity have been attributed to ingestion of fluoride, including dental fluorosis; bone fracture; reproductive, renal, gastrointestinal, and immunological toxicities, genotoxicity, and carcinogenicity.” http://www.fda.gov/cdrh/ost/section3.html

“Fluoride has become ubiquitous in the food supply.”  www.fda.gov/cder/offices/otc/FDA-CHPA%20seminar%20Oct%202/FDA-CHPA%20seminar%20Oct%202.PPT

NIH Position:

The Surgeon General supports fluoridation; however scientists at the NIH are not as confident. “The evidence (for fluoride use) was judged to be incomplete. . . But the need for better determination of efficacy is acute, since much of modern preventive dental practice is predicated on the assumed efficacy of these methods.”

National Institute of Health, Consensus Development Conference 2001

The Public Health Service National Toxicology Program

(PHS NTP)

The NTP found “equivocal evidence” of carcinogenicity associated with fluoride ingestion.  The CCEHRP called for more research.  http://www.fda.gov/cdrh/ost/section3.html

The Courts:

The Supreme Court in FDA v. Brown and Williamson 529 US. 120 (2000) ruled that it was Congress and the language of the statute that controls the jurisdiction of the FDA Act, not a statement by an agency, including the FDA.

Even under emergency conditions of war the US Government cannot force an individual to be medicated with a substance that has not been specifically approved for the purpose it is intended, and approved in the manner it is administered (Doe v. Rumsfield, 2003 U.S. Dist. Lexis 22990) The case involved the DOD and AVA a non FDA approved anthrax drug.

ADA position:

Fluoridation alone “reduces dental decay 20-40%” and is safe and does not pose a significant health risk. P. 22-25 

All ADA quotations and positions unless noted are from http://www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf

(See also World Wide Decay Decrease below)

Although seriously flawed, the most persuasive argument (and in their opinion peer reviewed) for fluoride safety of the ADA is “millions of people have lived in areas where fluoride is found naturally in drinking water in concentrations as high or higher than those recommended to prevent dental decay.” 

The same argument can be said for lead, arsenic and other toxic elements and chemicals; “two wrongs do not make a right”.  Just because it happens naturally in some areas, does not mean it is healthy or safe. 

Natural fluoride which does cause harm is not the same as the additives sodium silicofluoride or fluosilicic acid which have not been used in fluoridation safety tests and found safe. Masters 2000.     

The ADA and Ethics: 

The ADA Code of Professional Conduct Section 1 – Patient Autonomy, “self-governance” “The dentist has a duty to respect the patient’s rights to self-determination.” III section 1 and

Section 2 “Nonmaleficence (do no harm)

http://www.ada.org/prof/prac/law/code/ada_code.pdf  http://gsa.ada.org/search?q=Controlled+substance&site=ADAorg_Collection&client=ADAorg_FrontEnd&proxystylesheet=ADAorg_FrontEnd&output=xml_no_dtd&proxyreload=1&btnG.x=11&btnG.y=6&btnG=Go  Fluoride seems to be an exception, in part because the ADA considers fluoride to be a nutrient. 

NUTRITION:

Is Fluoride an essential Nutrient?  The ADA claims, “Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C.”  ADA Facts p. 4.

Fluoride is NOT an essential nutrient and has no MDR or RDA. 

A.                 Fluoride is NOT an essential nutrient like a Vitamin such as “C”, a lack of which causes Scurvy and death. Or like Protein, Fat or Carbohydrate, the absence of which eventually results in death.

B.                  The absence of fluoride does NOT cause any disease or death.

C.                 Nutrients are available off the shelf whereas fluoride for ingestion requires a prescription, is a controlled substance, a drug.

D.                 Decay is not the result of a fluoride deficiency. Fluoride is not an essential nutrient.

E.                  Neither is Iodine an essential nutrient.  Iodine is placed in salt to counter enlarged thyroids caused by fluoride. (See Hypothyroid)  Iodine is not dispensed without consent, a patient may choose.

“Benefits” of Fluoride 

World wide, decay has decreased in many fluoridated and non fluoridated countries.

http://www.fluoridealert.org/health/teeth/caries/who-dmft.html

The ADA agrees decay has decreased, and the ADA credits fluoridation. “Thanks in large part to community water fluoridation, half of all children ages 5 to 17 have never had a cavity in their permanent teeth.”  ADA Fluoride Facts p. 16 http://www.ada.org/prof/resources/positions/statements/fluoride2.asp  http://www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf http://www.whocollab.od.mah.se/expl/globalsugar.html

The ADA appears to be more “hopeful” than “fact-full” in crediting fluoridation for the decrease in dental decay.  If correct, we should see a difference in the decrease in decay between highly fluoridated countries and minimally fluoridated countries. Systemic ingestion, such as water fluoridation, provides little or no decay prevention.  (JADA 2000, CDC 2001, Armfield JM. Spencer AJ 2004, Seppa 2002). 

What happens to decay rates when a community stops fluoridation?

If fluoridation were currently reducing decay, a cessation of fluoridation would show an increase in decay.  In the 50’s to 70’s some cities stopped fluoridation and the decay rate increased, however newer studies did not find an increase in dental decay.  The ADA speculates the current lack of an expected decay increase when fluoride was discontinued is due in part to the implementation of other preventive programs. (ADA p 15).   Both sides apparently agree. Fluoridation is not necessary for decay reduction.  Other methods can be equally successful.

Cities such as Detroit, Cincinnati, and Boston and states such as Kentucky (96.1% water fluoridation) and Connecticut (87.5%) have had water fluoridation for 30 to 40 years and yet they have a crisis with decay.  If fluoride significantly reduced decay, they should not be having such a serious problem with decay. http://www.fortwayne.com/mld/newssentinel/7521679.htm?template=contentModules/printstory.jsp

http://www.enquirer.com/editions/2002/10/06/loc_special_report.html

http://www.fluoridealert.org/f-boston.htm

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=13678102&query_hl=1

http://www.nhregister.com/site/news.cfm?newsid=14472801&BRD=1281&PAG=461&dept_id=517515&rfi=8&xb=kasan

Without benefits, the side effects of any drug become unacceptable.

There appears to be no significant “life long” reduction in dental decay from water fluoridation.  (Komarek A,  et al.  Biostatistics.  2005 Jan;6 and www.med.uwo.ca/ecosystemhealth/education/casestudies/fluorosismed.htm, Brunelle, Angelilo, Clark, Ismail, Slade, Kumar and again in Australia by Armfield JM. Spencer AJ 2004, in a very large study found no difference in dental decay in permanent teeth with water fluoridation.)

Topical use, such as fluoride varnish and fluoridated tooth paste, appear to provide some decay protection for those at high risk such as those with radiation therapy and maybe adolescents who have current decay and adults with root decay. There maybe a 10 to 15 percent decrease in decay with topical fluoride. (Marthaler TM. Changes in dental caries. Caries research 2004, NIH 2001)   

How much Fluoride is Recommended?

“The Institute of Medicine (IOM, 1997) specified Adequate Intakes (AI) of 0.01 mg/day for infants through 6 months, 0.05 mg/kg/day beyond 6 months of age, and 3 mg/day and 4 mg/day for adult women and men (respectively), to prevent dental caries. Upper limits (UL) of 0.10 mg/kg/day in children less than 8 years and 10 mg/day for those older than 8 years are recommended for prevention of dental fluorosis. Similar levels have been endorsed by the American Dental Association (ADA, 1994) and the American Dietetic Association (ADA, 2000).

Each person is unique.  Body size, genetics, kidney function, host resistance and other toxic materials in the diet and air are a few compounding factors.  No research on toxicity in humans can be done for obvious reasons.

Research studies attempt to reduce the number of variables under investigation.  Real life seldom limits the variables and two low levels of toxins which would not cause problems by themselves can have a serious synergistic effect.

It will take time; however the AI and UL amounts will be reduced.

How much Fluoride are we getting?

Adults:

FDA is concerned with0.5 mg in toothpaste.  ADA, IOM, USDA have adequate amounts for decay reduction at 3-4 mg, upper limit is 10 mg

We should drink enough water so our urine, once a day, is clear.  This is usually 6 to 8 glasses of water.  

Fluoride from water             1.5 mg to 2 mg.

Fluoride from Food              2 mg    to 9 mg

Fluoride from toothpaste      0 mg    to 0.5mg

Medications add more

          Total                    3.5 mg to 11.5 mg, Over the Upper Limit

An adult working hard can drink 13 to 20 liters of water. www.nap.edu/nap-cgi/skimit.cgi?isbn=0309091691&chap=73-185

                   Fluoride 13 mg to 20 mg, over the upper limit. 

See details on foods below

Children:

0.05 mg/kg: a 30 pound child 0.7 mg AI and 1.4 mg UI

A 30 pound (14 kg) 30 month old, drinking 2 glasses of fluoridated water:

                   Fluoride from Water            0.5 mg

                   Fluoride from Food              0.7 mg to 2 mg

                   Fluoride from Toothpaste     0.42 mg to 0.84

                             Total                    1.6 mg to 3.3 mg, Over the Upper Limit

Warning: It would be hard for a child to get less than the upper limits (ADA, USDA, and IOM) of fluoride if they are drinking fluoridated water and using fluoridated toothpaste.

(Swallowing toothpaste: Bentley EM, et al, Br Dent. J. 1999; Cai YM, et al 1999)

Infants:  (0.01mg/day)  MAXIMUM, no UI.

          ONE (1) Tablespoon of fluoridated water (10 cc) contains 0.01 mg of fluoride.

          More than 1 Tablespoon of fluoridated water is Over the Upper Limit

Warning:

Never use fluoridated water with Infant formulas.

I0M, 1997, page 292), "The fluoride concentration in human milk ranges from 0.007 to 0.011 mg/liter (Ekstrand et al., 1984; Esala et al. 1982; Spak et al., 1982  Mother’s milk in 0.7ppm fluoridated areas has 0.024-0.172 ppm of fluoride.  Latifah R, et al J Pedod. 1989.

Avoid fluoridated water during pregnancy.

Fluoride Risks