Since its inception in the 1940s, the idea of fluoridating water has given rise to fear and suspicion with claims ranging from evil Nazi/Commie/government mind control conspiracies to cancer causation to decreased IQ and a cheap way to dispose of toxic waste (http://www.skepdic.com/fluoridation). The implication that Big Pharma is out to poison you and that the scientific consensus is proof of a massive worldwide conspiracy of scientists/dentists makes reasoning with conspiracy theorists particularly difficult. But as we always do in The New Horsemen we’ll let the science decide what is “true” and what is “woo”!

What Is Fluoride?

(http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm)
Fluoride compounds are salts that form when the element, fluorine, combines with minerals in soil or rocks. Fluoride is widely distributed in the lithosphere mainly as fluorspar, fluorapatite and cryolite, and is recognised as the thirteenth most common element in the earth’s crust. It is found in seawater at a concentration of around 1.2 – 1.4 mg/litre, in ground waters at concentrations up to 67 mg/litre, and in most surface waters at concentrations less than 0.1 mg/litre. Fluoride is also found in foods particularly fish and tea (http://www.who.int/water_sanitation_health/dwq/nutrientschap14.pdf)

While almost all foodstuffs contain at least traces of fluoride, water and non-dairy beverages are the main sources of ingested fluoride, accounting for 66 to 80% of fluoride intake in US adults according to the concentration of fluoride in the public drinking water. Other significant sources of ingested fluoride are toothpaste in very young children (who tend to swallow most of their toothpaste), tea in tea-drinking communities, and inhaled fluoride in some communities in China where coal containing very high levels fluoride is burned indoors. Absorption of ingested fluoride is via the stomach and small intestine (http://apps.who.int/iris/bitstream/10665/42415/1/WHO_EHC_227.pdf).

Fluoride works by converting the outer layer of tooth enamel made of hydroxylapatite, Ca5(PO4)3OH, to fluoroapatite, Ca5(PO4)3F. The latter chemical is less soluble in acidic solutions. The three most commonly added fluoride chemicals are sodium fluoride, fluorosilicic acid, and sodium fluorosilicate (http://stacks.cdc.gov/view/cdc/13103).

History Of Fluoridation
(http://www.quackwatch.org/03HealthPromotion/fluoride.html)

The history of fluoridation in the United States underlines its unique standing as a public health measure copied from a natural phenomenon. In the early 1900s, Dr. Frederick S. McKay began an almost 30-year search for the cause of the staining of teeth that was prevalent in Colorado, where he practiced dentistry. In his investigation, McKay found the condition common in other states, including Texas, where it was known as “Texas teeth.” By 1916 he had identified excessive amounts of fluoride occurring naturally in water supplies as the cause of the dental staining. In 1928, he concluded that such teeth, although stained, showed “a singular absence of decay,” and that both the staining and the decay resistance were caused by something in the water. In 1931, the “something” was identified as fluoride. Soon, scientific data from thirteen countries confirmed these findings.

In 1945, the U.S. Public Health Service began four  studies, testing the hypothesis that artificial fluoridation to 1.0 ppm would produce healthier teeth without causing mottling. By 1950, the experiment was declared a success. The communities with fluoridated water supplies had 50% fewer cavities. The recommendation was made that communities without naturally occurring fluoride add it to their water supplies at a concentration of 1.0 ppm. The American Dental Association, the American Medical Association, the American Association of Public Health Dentists, and the National Research Council concurred with the recommendation (not a mandatory governmental requirement).

There are three periods concerning the history of water fluoridation (http://rationalwiki.org/wiki/Water_fluoridation):

1. Before 1933, the study of mottled tooth enamel, later known as fluorosis. (https://en.wikipedia.org/wiki/History_of_water_fluoridation)
2. From 1933 to 1945, the study of the relationship between fluoride and tooth decay.
3. From 1945 onward, which focused on deployment of water fluorides

In the United States, the Safe Drinking Water Act (SDWA) of 1974 confers the authority for ensuring the safety of public drinking water to the Environmental Protection Agency.( http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm )

What Are Fluoride’s Potential Health Effects?

Exposure to EXCESSIVE consumption of fluoride over a lifetime may lead to increased likelihood of bone fractures in adults, and may result in effects on bone leading to pain and tenderness. Children aged 8 years and younger exposed to excessive amounts of fluoride have an increased chance of developing pits in the tooth enamel, along with a range of cosmetic effects to teeth.

Like many things in our water supply, chlorine for example, the amount determines whether it is safe or harmful (the dose makes the poison!). For that reason, the EPA recommends that the amount of fluoride in a water supply not rise above certain levels. The Centers for Disease Control and Prevention (CDC) provides recommendations for the optimal levels of fluoride in drinking water in order to prevent tooth decay.

In January 2011, the U.S. Department of Health and Human Services proposed to change its recommended limit for fluoride to 0.7 mg/L, replacing the current recommended range of 0.7 to 1.2 mg/L. (Parts per million, ppm, and milligrams per liter, mg/L, are nearly equivalent. E.g., 1.2 mg/L = 1.201370764 ppm) The U.S. Environmental Protection Agency simultaneously announced that it will take a fresh look at the maximum allowable level, currently set at 4 mg/L, for fluoride that occurs naturally in drinking water (http://www.skepdic.com/fluoridation).

How Does Fluoride Get Into My Drinking Water?

Some fluoride compounds, such as sodium fluoride and fluorosilicates, dissolve easily into ground water as it moves through gaps and pore spaces between rocks. Most water supplies contain some naturally occurring fluoride. Fluoride also enters drinking water in discharge from fertilizer or aluminum factories. Also, many communities add fluoride to their drinking water to promote dental health.

How Can Fluoride Be Removed From My Drinking Water?

The following treatment method(s) have proven to be effective for removing fluoride to below 4.0 mg/L or 4.0 ppm: distillation or reverse osmosis. There are several independent American National Standards Institute (ANSI) certified organizations that test and certify home water treatment units. More information about these organizations and other issues related to your water safety can be found at http://water.epa.gov/aboutow/ogwdw/upload/2005_11_17_faq_fs_healthseries_filtration.pdf

Arguments For Fluoridation

Reasons Why Fluoride in Water is Good for Communities
(http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/5-reasons-why-fluoride-in-water-is-good-for-communities) (http://www.cdc.gov/fluoridation/basics/index.htm)

1. Prevents tooth decay. Fluoride in water is the most efficient way to prevent one of the most common childhood diseases – tooth decay. An estimated 51 million school hours and 164 million work hours are lost each year due to dental-related illness. Community water fluoridation is so effective at preventing tooth decay that the Centers for Disease Control and Prevention named it one of 10 great public health achievements of the 20th century.
2. Protects all ages against cavities. Studies show that fluoride in community water systems prevents at least 25 percent of tooth decay in children and adults, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.
3. Safe and effective. For 70 years, the best available scientific evidence consistently indicates that community water fluoridation is safe and effective. It has been endorsed by numerous U.S. Surgeons General, and more than 100 health organizations recognize the health benefits of water fluoridation for preventing dental decay, including the Centers for Disease Control and Prevention, the American Medical Association, the World Health Organization, the American Dental Association, and the American Academy of Pediatrics.
4. Saves money. The average lifetime cost per person to fluoridate a water supply is less than the cost of one dental filling. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. Another study found the estimated return on investment for community water fluoridation (including productivity losses) ranged from $4 in small communities of 5,000 people or less, to $27 in large communities of 200,000 people or more (http://www.cdc.gov/fluoridation/pdf/griffin.pdf).
5. It’s “natural”. Fluoride is naturally present in groundwater and the oceans. Water fluoridation is the adjustment of fluoride to a recommended level for preventing tooth decay (http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/ada-applauds-hhs-final-recommendation-on-optimal-fluoride-level-in-drinking-water). It’s similar to fortifying other foods and beverages, like fortifying salt with iodine, milk with vitamin D, orange juice with calcium and bread with folic acid.

Centralised fluoridation is a safe, simple, and effective way to improve the dental health of the population at large (especially children in the candy cavity-prone years). It is also extremely cost-effective: one study estimated that for every $1 a city invested in fluoridation it saved the average citizen (with a mean dental health cost) $38 on dental care (http://www.politifact.com/oregon/statements/2012/aug/23/nick-fish/do-cities-really-save-38-every-1-they-spend-fluori/) (http://www.fairbanksalaska.us/wp-content/uploads/2011/07/20010000Griffin-Econ-Eval-Fluoridation.pdf)

The Centers for Disease Control and Prevention considers water fluoridation to be one of the top 10 public health advances of the 20th century (http://www.cdc.gov/about/history/tengpha.htm) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm) and the American Dental Association “unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay.” (http://www.oda.on.ca/personal-oral-care/fluoride-in-your-tap-water). The World Health Organization states that “fluoridation of water supplies, where possible, is the most effective public health measure for the prevention of dental decay.” (http://ilikemyteeth.org/fluoridation/health-experts-on-fluoride/)

Having been around for 70+ years and having been the focus of much research, water fluoridation has been studied extensively (the number of studies seems to peak around the late 1960s followed by a general decline http://www.ncbi.nlm.nih.gov/pubmed/?term=water+fluoridation). Arguments along the lines of “the jury is out” or “the science is incomplete” are wrong. Thousands of studies and years of actual implementation have not upset the scientific consensus.

Arguments Against Fluoridation

Many of the arguments against fluoridation are based on ethical and moral issues, namely that water fluoridation is medicating large numbers of people without their explicit consent (even though fluoride is a naturally occurring substance and not technically a medicine). The freedom issue, however, has become muddled because freedom to choose is pointless if people can’t get truthful, straightforward information about what it is they are making a choice. Getting truthful information about fluoridation is about as straightforward as getting truthful information about vaccinations and electromagnetic radiation ( http://www.skepdic.com/fluoridation).

1) Appeal To Nature. Despite fluoride naturally occurring in food and water (http://ilikemyteeth.org/fluoridation/health-experts-on-fluoride/), a common argument against it is the appeal to nature. Fluoride is widely distributed in the lithosphere mainly as fluorspar, fluorapatite and cryolite, and is recognised as the thirteenth most common element in the earth’s crust. It is found in seawater, groundwater, and in most surface waters. Fluoride is also found in foods particularly fish and tea (http://www.who.int/water_sanitation_health/dwq/nutrientschap14.pdf).

2) Cancer: In the mid-1970s, John Yiamouyiannis, PhD (http://www.quackwatch.org/11Ind/yiamouyiannis.html) began issuing a series of reports claiming that fluoridation causes cancer. Experts concluded that these reports were based on a misinterpretation of government statistics. They had compared cancer death rates in fluoridated and non-fluoridated cities but failed to consider various factors in each city (such as industrial pollution) that are known to raise the cancer death rate. By 1977, independent investigations by eight of the leading medical and scientific organisations in the English-speaking world had refuted the claims, but they still surface today in many communities that consider fluoridation.

In 1990, the cancer charge was raised again following an unauthorised release of data from an experiment in which rats and mice were exposed to high dosages of fluoride. The experiment was conducted by the National Toxicology Program, a branch of the National Institute of Environmental Health Sciences. The agency’s final report stated that there was no evidence of cancer-causing activity in female rats or in male and female mice and only “equivocal evidence” in male rats. A subsequent review by a U.S. Public Health Service panel concluded that the data were insignificant and that fluoridation posed no risk of cancer or any other disease. 50 epidemiological studies done in different populations at different times have failed to demonstrate an association. These studies were done by the United States, Japan, the UK, Canada and Australia. (http://www.dentalwatch.org/fl/phs_1991.pdf)

Studies done on the toxicity of fluoride have also been done (http://health.skepticproject.com/articles/health/fluoride/). Two animal studies were conducted by the National Toxicology Program of the National Institute of Environmental Health Sciences and The Proctor and Gamble Company. (http://www.ncbi.nlm.nih.gov/pubmed/2071234) (http://jnci.oxfordjournals.org/content/82/13/1118.short) There were eight groups of animals each with its own sex and species. The animals were given 25, 75 and 175 ppm of fluoride respectively. The studies concluded that “Taken together the two animal studies fail to establish an association between fluoride and cancer.” Additional studies on links between fluoride and cancer and fluoride and bone fractures have been shown to be invalid (http://health.gov/environment/ReviewofFluoride/default.htm).

3) Fluoridated Water Causes Osteosclerosis And Other Bone Altering Illnesses: This claim is true but misleading. In a survey of 170,000 people’s x-rays from Texas and Oklahoma, who had lived in communities whose water supply contained 4 ppm – 8 ppm of fluoride, only 23 cases of osteosclerosis had been found. Not one case of the more severe skeletal fluorosis. (Stevenson CA, Watson AR. Fluoride osteosclerosis. American Journal of Roentgenology, Radium Therapy and Nuclear medicine 1957; 78 (1) 13-18) Other studies have determined that toxicity may occur 10 years after exposure to HIGH levels. (over 5 ppm) (http://www.ncbi.nlm.nih.gov/books/NBK109825/) Note that this is much higher than the optimal safety guidelines. The reason that there are still communities today with more than 5 ppm in their water supply is due mainly to the fact that they use natural water supplies (rivers, lakes).

4) The US IQ Average Has Dropped In The Past 50 Years: According to most IQ researchers, the national IQ has actually been rising since the 1930’s. This increase has been observed all around the world, and not just with IQ tests but with episodic and semantic memory tests. (http://www.americanscientist.org/issues/feature/rising-scores-on-intelligence-tests/1) This observation has been called the “Flynn effect”. Some explanations for the “Flynn effect” are improved nutrition and better education. This claim is closely related to…

5) The 2012 Harvard Study: In 2012, some news organisations transmitted a press release by the “NYS Coalition Opposed to Fluoridation, Inc.” which suggested that a 2012 Harvard meta-study of studies on the effects of water fluoridation and child IQs found “significantly lower IQ” in children. However, if you actually read the paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/) and look at Table 1, the study compared children in areas with recommended levels of fluoride in water — the same levels that are introduced in the process of water fluoridation (0.5 to 1.5 mg/L) — to children in areas with high fluoride levels (above 1.5 mg/L). In other words, and yet again, this paper documents the risks of chronic fluoride toxicity, not water fluoridation.

In 2014, a study conducted in New Zealand examined the relationship between fluoridation and IQ directly on a cohort of people born in Dunedin in the 1970s. It found no statistically significant link. The authors suggest that the earlier Harvard study might have been affected by confounding variables, especially urban or rural status (http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301857). This leads into…

6) Chinese Studies Indicate That High Levels Of Fluoride Can Lower IQ
(http://health.skepticproject.com/articles/health/fluoride/): This claim is partially true, but misleading. There have been about a dozen studies done in China that may show a potential link. But China’s water supply was not very safe to begin with, as its contains high levels of fluoride.

“Drinking water with high levels of fluoride is widespread in China and has been seen in all provinces, municipalities and autonomous regions with the exception of Shanghai, and it has been estimated that there are over 1,200 counties and almost 150,000 villages affected by fluorosis (including coal pollution derived fluorosis).”
Dental fluorosis in China has been recognised for some time (http://jdr.sagepub.com/content/12/4/591.extract).” (http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf)

China has also had high rates of fluorosis, a clear sign that their citizens are consuming too much fluoride. “It has been estimated that over 26 million people in China suffer from dental fluorosis due to elevated fluoride in their drinking water, with a further 16.5 million cases of dental fluorosis resulting from coal smoke pollution (Liang et al., 1997).” (http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf)

China does not fluoridate its water, so they get their water from natural sources. It’s also worth mentioning that the lower IQ link may be from fluoride gases coming from coal/clay pollution, or from arsenic which is also in the water supply. (http://www.scidev.net/en/news/fluoride-poisoning-in-china-due-to-clay-not-coal.html) (http://phys.org/news/2008-01-alarmed-mercury-arsenic-chinese-freshwater.html)

In conclusion, the claim that high levels of fluoride cause a decline in IQ is inconclusive. The Chinese water supply is very different than the US water supply and contains other toxic elements that correlate with the cognitive decline. This is likely considering the studies done on rats indicated that cognitive decline required up to 75 times the EPA limit. When you look at the totality of the evidence on water fluoridation safety, a link between lowered IQ and fluoridated water becomes unlikely.

7) Dental Fluorosis: Dental fluorosis is a scary-sounding but rather a benign condition in which the teeth become slightly stained. It is a cosmetic issue that does not lead to tooth decay, whereas removing fluoride from water does if individuals do not brush their teeth regularly. In all but the most severe cases, the mottling is barely noticeable, and it’s only significant in children whose teeth have not finished developing. (By comparison, drinking a lot of coffee or tea can also make your teeth yellow, though this is reversible.)

Fluoridation opponents like to cite CDC statistics showing that the incidence of fluorosis(http://www.dentalwatch.org/fl/fluorosis.html) among adolescents aged 12-15 rose from 22.6% in 1986-87 to 40.7% in 1999-2004 (http://www.cdc.gov/nchs/data/databriefs/db53.pdf). Taken by itself, that statement is factual but misleading. As stated questionable, very mild, and mild fluorosis and most cases of moderate fluorosis are barely visible and pose no problem whatsoever. In addition, it’s been shown that teeth with fluorosis are more resistant to decay than teeth without fluorosis. The teeth may appear whiter than otherwise, but they are neither unattractive nor structurally damaged. Severe fluorosis that adversely affects both appearance and function is close to zero among people who drink water that is optimally fluoridated.

Some Prominent Figures Against Fluoridation

• John Yiamouyiannis – until his death in 2000.
• Paul Connett – executive director of the Fluoride Action Network (an anti-fluoridation activist group).
• Joseph Mercola – quack internet doctor and supplement peddler.
• Ralph Nader – consumer advocate
• Jedi Mind Tricks – semi-underground hip-hop artist, conspiracy theorist, and homophobe.
• Mike Adams – operator/editor of Natural News, an infamous alternative medicine website. Claims that proponents of water fluoridation are “psychopathic criminals,” “mad scientists,” and “some of the most life hating people you’ll ever meet.”
• Ludwik Gross, most famous for showing viruses can cause cancers in animals, also believed that fluoridation was “an insidious poison, harmful, toxic and cumulative in its effect, even when ingested in minimal amounts.”
• Yolanda Whyte, M.D. – Yolanda M. Whyte, M.D. has been actively opposing fluoridation during the past few years. She speaks at community meetings, has testified at legislative hearings, and is currently appearing in a video sponsored by the Fluoride Action Network (FAN), the primary U.S. antifluoridation organization. This article dissects some of her views and indicates why they should be disregarded.

MORE INFORMATION

Excellent blog about fluoride myths: https://openparachute.wordpress.com/fluoridation/

Questions And Answers On Fluoride
This fact sheet provides information on community water fluoridation as well as current federal activities to update guidance and regulations concerning community water fluoridation. The Department of Health and Human Services (HHS) oversees the national water fluoridation program.
http://water.epa.gov/lawsregs/rulesregs/regulatingcontaminants/sixyearreview/upload/2011_Fluoride_QuestionsAnswers.pdf

How Fluoride In Water Helps Prevent Tooth Decay
The most effective way to prevent tooth decay is delivered to most Australian homes every day through their water pipes. It is, of course, fluoride distributed via the water supply.
https://theconversation.com/how-fluoride-in-water-helps-prevent-tooth-decay-6933

American Dental Association: Fluoridation Facts
Fluoridation Facts is the ADA’s premier resource on community water fluoridation. This 71-page booklet is a comprehensive encyclopaedia of fluoridation facts taken from over 350 scientific references. Fluoridation Facts includes information from scientific research in an easy to use question and answer format on the topics of effectiveness, safety, practice and cost-effectiveness of fluoridation.
http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/fluoridation-facts

More than 125 “National and International Organizations That Recognise the Public Health Benefits of Community Water Fluoridation for Preventing Dental Decay.”
http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/fluoridation-facts/fluoridation-facts-compendium

Medical Testimonials About Fluoridation
http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/medical-testimonials-about-fluoridation

Cochrane Review Of Water Fluoridation To Prevent Tooth Decay
Tooth decay is a worldwide problem affecting most adults and children. Untreated decay may cause pain and lead to teeth having to be removed.
http://www.cochrane.org/CD010856/ORAL_water-fluoridation-prevent-tooth-decay

Review Of Cochrane Review On Community Water Fluoridation
A new systematic review from the Cochrane Collaboration was recently released, its goal being “to assess the effects of water fluoridation (artificial or natural) for the prevention of tooth decay. It also evaluates the effects of fluoride in water on the white or brown marks on the tooth enamel that can be caused by too much fluoride (dental fluorosis).”
https://www.sciencebasedmedicine.org/cochrane-review-on-your-precious-bodily-fluids-community-water-fluoridation/

Fluoride: Still Not Poisoning Your Precious Bodily Fluids!
We, dentists, are an evil group of sociopaths. When we’re not trying to kill you or give you chronic diseases such as multiple sclerosis with our toxic mercury saturated fillings, we are advocating for the placement of rat poison/industrial waste (i.e. fluoride) in your water supply by our governmental overlords. What is up with us?
https://www.sciencebasedmedicine.org/fluoride-still-not-poisoning-your-precious-fluids/

Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers
https://www.sciencebasedmedicine.org/preventing-tooth-decay-in-kids-fluoride-and-the-role-of-non-dentist-health-care-providers/

EPA and HHS Announce New Scientific Assessments and Actions on Fluoride / Agencies working together to maintain benefits of preventing tooth decay while preventing excessive exposure
The U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) today are announcing important steps to ensure that standards and guidelines on fluoride in drinking water continue to provide the maximum protection to the American people to support good dental health, especially in children. HHS is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and EPA is initiating a review of the maximum amount of fluoride allowed in drinking water.
http://yosemite.epa.gov/opa/admpress.nsf/d0cf6618525a9efb85257359003fb69d/86964af577c37ab285257811005a8417!OpenDocument

New Fluoride Risk Assessment And Relative Source Contribution Documents
EPA has completed and peer-reviewed a quantitative dose-response assessment based on the available data for severe dental fluorosis as recommended by NRC. Additional research will be necessary to obtain dose-response data amenable to a quantitative risk assessment for Stage II skeletal fluorosis and/or skeletal fractures. The dose-response assessment provides a reference dose based on the critical health effect of pitting of the enamel in severe dental fluorosis.
http://water.epa.gov/action/advisories/drinking/upload/fluoridefactsheet.pdf

U.S. Public Health Service Recommendation For Fluoride Concentration In Drinking Water for the Prevention of Dental Caries
Through this recommendation, the U.S. Public Health Service (PHS) updates and replaces it’s 1962 Drinking Water Standards related to community water fluoridation—the controlled addition of a fluoride compound to a community water supply to achieve a concentration optimal for dental caries prevention.
http://www.publichealthreports.org/documents/PHS_2015_Fluoride_Guidelines.pdf

Surgeon General’s Perspectives
Based on this comprehensive, multi-year assessment, PHS now recommends that community water systems use a single concentration of 0.7 mg/L of fluoride in drinking water to maintain cavity prevention bene ts and reduce the risk of dental fluorosis. This new recommendation revises and replaces the previously recommended range of 0.7–1.2 mg/L.
http://www.publichealthreports.org/documents/Surgeon_General_Perspective_FG.pdf

THE DEBATE OVER FLUORIDATED WATER
The debate over fluoridation goes back roughly 70 years to when communities began fluoridating water to prevent tooth decay. The issue: Is fluoridated water better for your health or not?
http://ilikemyteeth.org/fluoridation/

IN THEIR OWN WORDS: What Respected Organizations Say About the Safety And Effectiveness Of Community Water Fluoridation
http://ilikemyteeth.org/wp-content/uploads/2011/03/RespectedOrgs-noPics_v2a.pdf

CDC. 2012 Water Fluoridation Statistics Website
http://www.cdc.gov/fluoridation/statistics/2012stats.htm

Is Fluoride In Water A Good Thing Or A Danger?
http://www.straightdope.com/columns/read/2692/is-fluoride-in-water-a-good-thing-or-a-danger

Oral Health In America: A Report Of The Surgeon General
http://profiles.nlm.nih.gov/ps/access/NNBBJT.pdf

American Cancer Society: Water Fluoridation And Cancer Risk
Many decades after fluoride was first added to drinking water in some parts of the United States, there is still controversy about the possible health effects of drinking water fluoridation.
http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/water-fluoridation-and-cancer-risk

National Cancer Institute: Fluoridated Water
A possible relationship between fluoridated water and cancer risk has been debated for years. The debate resurfaced in 1990 when a study by the National Toxicology Program, part of the National Institute of Environmental Health Sciences, showed an increased number of osteosarcomas (bone tumours) in male rats given water high in fluoride for 2 years. However, other studies in humans and in animals have not shown an association between fluoridated water and cancer.
http://www.cancer.gov/about-cancer/causes-prevention/risk/myths/fluoridated-water-fact-sheet

Cancer Council Of Wester Australia, Cancer myth: Fluoride And Cancer
Fluoridation is considered by many to be a major public health success. The addition of fluoride to drinking water has led to a significant reduction in dental caries. There is no consistent evidence of fluoride from drinking water increasing cancer risk. At very high doses – much higher than in drinking water – fluoride can have some adverse health effects on teeth and bones.
https://www.cancerwa.asn.au/resources/cancermyths/fluoride-cancer-myth/

Anti-fluoride Activists Should Put Their Tinfoil Hat Theories To Rest
Politics and religion are the classic topics to avoid if you want to enjoy a dinner party. In Australia, you can now add water fluoridation to that list.
http://www.theguardian.com/commentisfree/2013/sep/19/anti-fluoride-science-australia

Fluoridation: Don’t Let the Poisonmongers Scare You
Fluoride is a mineral that occurs naturally in most water supplies. Fluoridation is the adjustment of the natural fluoride concentration to about one part of fluoride to one million parts of water. Although fluoridation is safe and effective in preventing tooth decay, the scare tactics of misguided poisonmongers have deprived many communities of its benefits.
http://www.quackwatch.org/03HealthPromotion/fluoride.html

THE RESEARCH

Over 2000 Peer Reviewed Studies On Water Fluoridation
http://www.ncbi.nlm.nih.gov/pubmed/?term=water+fluoridation

The York Review – A Systematic Review of Public Water Fluoridation: A Commentary
The best available evidence (from studies that met inclusion criteria) suggests that fluoridation of drinking water supplies reduces caries (decay and crumbling of a tooth or bone) prevalence but is associated with dental fluorosis. The balance of the evidence did not show an association between any fractures and water fluoridation. No associations between water fluoridation and human cancer were found.
http://www.nature.com/bdj/journal/v192/n9/abs/4801410a.html

NHS Centre For Reviews And Dissemination. A Systematic Review Of Water Fluoridation.
http://www.nhs.uk/conditions/fluoride/documents/crdreport18.pdf

Systematic Review Of Water Fluoridation
http://www.ncbi.nlm.nih.gov/pubmed/11021861

Effectiveness Of Fluoride in Preventing Caries In Adults
Abstract: To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults. The objective of this meta-analysis was to examine the effectiveness of self and professionally applied fluoride and water fluoridation among adults. We used a random-effects model to estimate the effect size of fluoride (absolute difference in annual caries increment or relative risk ratio) for all adults aged 20+ years and for adults aged 40+ years. Twenty studies were included in the final body of evidence. Among studies published after/during 1980, any fluoride (self and professionally applied or water fluoridation) annually averted 0.29 (95%CI: 0.16-0.42) carious coronal and 0.22 (95%CI: 0.08-0.37) carious root surfaces. The prevented fraction for water fluoridation was 27% (95%CI: 19%-34%). These findings suggest that fluoride prevents caries among adults of all ages.
http://www.ncbi.nlm.nih.gov/pubmed/17452559

The Community Preventive Services Task Force, Preventing Dental Caries: Community Water Fluoridation, 2000, 2013
The Community Preventive Services Task Force recommends community water fluoridation based on strong evidence of effectiveness in reducing dental caries across populations. Evidence shows the prevalence of caries is substantially lower in communities with CWF. In addition, there is no evidence that CWF results in severe dental fluorosis.
http://www.thecommunityguide.org/oral/fluoridation.html

National Research Council, Fluoride in Drinking Water: A Scientific Review of EPA’s Standards, 2006
That review focused only on potential unwanted effects of naturally occurring fluoride at concentrations of 2–4 mg/L, much higher than 0.7 mg/liter, the new recommendation for community water fluoridation. Even at these higher concentrations, the NRC panel found substantial evidence only for an increased likelihood of severe dental fluorosis and noted that severe fluorosis remains near zero in communities where the level of fluoride in drinking water is less than 2 mg/L.
http://www.nap.edu/catalog/11571/fluoride-in-drinking-water-a-scientific-review-of-epas-standards

DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride
These guidelines describe the dietary reference intakes for specific nutrients known to be beneficial to health, including fluoride.
http://www.nap.edu/read/5776/chapter/1

NHMRC Public Statement: Efficacy and Safety of Fluoridation
Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride. It is recommended that water be fluoridated in the target range of 0.6 to 1.1 mg/L, depending on climate, to balance reduction of dental caries and occurrence of dental fluorosis.
http://www.nhmrc.gov.au/guidelines-publications/eh41

CDC STATEMENT ON THE EVIDENCE SUPPORTING THE SAFETY AND EFFECTIVENESS OF COMMUNITY WATER FLUORIDATION
In the seminal report, Oral Health in America: A Report of the Surgeon General, Surgeon General David Satcher observed a “‘silent epidemic’ of dental and oral diseases […] with those suffering the most found among the poor of all ages.”1 The report affirms that community water fluoridation is “an inexpensive means of improving oral health that benefits all residents of a community, young and old, rich and poor alike.” Because of its contribution to the dramatic decline in tooth decay over the past 70 years, CDC named community water fluoridation 1 of 10 great public health achievements of the 20th century.
https://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/Documents/hck1ocv.@www.surgeon.fullrpt.pdf

Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults
Systematic reviews produce conflicting conclusions regarding dental caries-preventive effects of water fluoridation in adults. The authors investigated the relationship using data from the nationally representative 2004−2006 Australian National Survey of Adult Oral Health. Effects were compared between the pre-fluoridation cohort born before 1960 (n = 2,270) and the cohort born between 1960 and 1990 (n = 1,509), when widespread implementation of fluoridation increased population coverage from < 1% to 67%. Residential history questionnaires determined the percentage of each person’s lifetime exposed to fluoridated water. Examiners recorded decayed, missing, and filled teeth (DMF-Teeth) and decayed and filled tooth surfaces (DF-Surfaces). Socio-demographic and preventive dental behaviors were included in multivariable least-squares regression models adjusted for potential confounding. In fully adjusted models, > 75% of lifetime exposure to fluoridation relative to < 25% of lifetime exposure was associated with 11% and 10% fewer DMF-Teeth in the pre-1960 (p < .0001) and 1960–1990 cohorts (p = .018), respectively. Corresponding reductions in DF-Surfaces were 30% (p < .001) and 21% (p < .001). Findings for intermediate fluoridation exposure suggested a dose-response relationship. Results were consistent in sensitivity analyses accounting for missing data. In this nationally representative sample of Australian adults, caries-preventive effects of water fluoridation were at least as great in adults born before widespread implementation of fluoridation as after widespread implementation of fluoridation.
http://www.ncbi.nlm.nih.gov/pubmed/23456704

Results And Conclusions Of The National Toxicology Program’s rodent carcinogenicity studies with sodium fluoride.
Abstract: The US National Toxicology Program (NTP) has conducted toxicity and carcinogenicity studies with sodium fluoride administered in the drinking water to F344/N rats and B6C3F1 mice. The drinking water concentrations used in the 2-year studies were 0, 25, 100, or 175 ppm sodium fluoride (equivalent to 0, 11, 45 or 79 ppm fluoride). Survival and weight gains of rats and mice were not affected by fluoride treatment. Animals receiving sodium fluoride developed effects typical of dental fluorosis, and female rats given 175 ppm had increased osteosclerosis. There were no increases in neoplasms in female rats or in male or female mice that were attributed to sodium fluoride administration. There was equivocal evidence of carcinogenic activity of sodium fluoride in male rats based on the occurrence of a small number of osteosarcomas in treated animals.
http://www.ncbi.nlm.nih.gov/pubmed/2071234

Two-Year Carcinogenicity Study of Sodium Fluoride in Rats
Abstract: To determine the carcinogenic potential of sodium fluoride (NaF), we fed Sprague-Dawley rats a diet containing NaF for up to 99 weeks. Rats receiving NaF at a dose of 4,10, or 25 mg/kg per day added to a low-fluoride diet were compared with controls receiving either a low-fluoride diet or laboratory chow. Each treatment group consisted of 70 rats of each sex. A 30% decrement in weight gain occurred at an NaF dose of 25 mg/kg per day. Evidence of fluoride toxicity was seen in the teeth, bones, and stomach, and the incidence and severity of these changes were related to the dose of NaF and the duration of exposure. Despite clear evidence of toxicity, NaF did not alter the incidence of preneoplastic and neoplastic lesions at any site in rats of either sex. Results from this study indicate that NaF is not carcinogenic in Sprague-Dawley rats.
http://jnci.oxfordjournals.org/content/82/13/1118.short

National Research Council. Carcinogenicity of fluoride. In: Subcommittee on Health Effects of Ingested Fluoride
The National Academy of Sciences, conducted an extensive literature review concerning the association between fluoridated drinking water and increased cancer risk. The review included data from more than 50 human epidemiological studies and six animal studies. The Subcommittee concluded that none of the data demonstrated an association between fluoridated drinking water and cancer.
http://www.nap.edu/read/2204/chapter/2#10

Fluoride-Related Skeletal Effects: Evaluations of Key Studies
At low intake levels, fluoride has been shown to have therapeutic value in the prevention of dental caries; however, slightly higher levels, particularly in children during the period of enamel development can lead to dental fluorosis, a condition in which the enamel covering of the teeth fails to crystallize properly. Possible resulting problems include enamel defects ranging from barely discernable markings to brown stains and surface pitting. Prolonged high intake of fluoride, at any age, can result in skeletal fluorosis, a condition which may increase bone brittleness, and in a potential increase in risk of bone fracture. In high-dose cases, severe bone abnormalities can develop, crippling the affected individual.
http://water.epa.gov/action/advisories/drinking/upload/Fluoride_dose_response.pdf

An Assessment of Bone Fluoride and Osteosarcoma
Abstract: The association between fluoride and risk for osteosarcoma is controversial. The purpose of this study was to determine if bone fluoride levels are higher in individuals with osteosarcoma. Incident cases of osteosarcoma (N = 137) and tumor controls (N = 51) were identified by orthopedic physicians, and segments of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. Logistic regression adjusted for age and sex and potential confounders of osteosarcoma was used to estimate odds ratios (OR) and 95% confidence intervals (CI). There was no significant difference in bone fluoride levels between cases and controls. The OR adjusted for age, gender, and a history of broken bones was 1.33 (95% CI: 0.56-3.15). No significant association between bone fluoride levels and osteosarcoma risk was detected in our case-control study, based on controls with other tumor diagnoses.
http://jdr.sagepub.com/content/90/10/1171.abstract

Fluoride In Drinking Water And Osteosarcoma Incidence Rates In The Continental United States Among Children And Adolescents
Conclusion: Our ecological analysis suggests that the water fluoridation status in the continental U.S. has no influence on
osteosarcoma incidence rates during childhood and adolescence.
https://www.ncbi.nlm.nih.gov/pubmed/22189446

Drinking Water Fluoridation And Osteosarcoma Incidence On The Island Of Ireland.
Abstract: The incidence of osteosarcoma in Northern Ireland was compared with that in the Republic of Ireland to establish if differences in incidence between the two regions could be related to their different drinking water fluoridation policies. Data from the Northern Ireland Cancer Registry (NICR) and the National Cancer Registry of Ireland (NCRI) on osteosarcoma incidence in the respective populations were used to estimate the age-standardised and age-specific incidence rates in areas with and without drinking water fluoridation. One hundred and eighty-three osteosarcoma cases were recorded on the island of Ireland between 1994 and 2006. No significant differences were observed between fluoridated and non-fluoridated areas in either age-specific or age-standardised incidence rates of osteosarcoma. The results of this study do not support the hypothesis that osteosarcoma incidence in the island of Ireland is significantly related to public water fluoridation. However, this conclusion must be qualified, in view of the relative rarity of the cancer and the correspondingly wide confidence intervals of the relative risk estimates.
http://www.ncbi.nlm.nih.gov/pubmed?term=Drinking%20water%20fluoridation%20and%20osteosarcoma%20incidence%20on%20the%20island%20of%20Ireland

Age-specific fluoride exposure in drinking water and osteosarcoma (United States).
CONCLUSIONS: Our exploratory analysis found an association between (higher) fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females. Further research is required to confirm or refute this observation.
http://www.ncbi.nlm.nih.gov/pubmed?term=Age-specific%20fluoride%20exposure%20in%20drinking%20water%20and%20osteosarcoma%20

The post Debunking Anti-Fluoride Woofuckery and Pseudoscience appeared first on Making Sense of Fluoride.

Rita’s original paper here. My first response here. Rita’s first response here.

You can read the PDF version here.

Compulsory Water Fluoridation: Second Response To Rita Barnett-rose

Written by Daniel Ryan

Introduction

This is my second response to Associate Professor Rita Barnett-Rose to her paper “Compulsory water fluoridation: justifiable public health benefit or human experimental research without informed consent”. It is a response to her document “RE: CWF Working Paper Article” (hereafter referred to as “Rita’s reply.”). I wish to thank Rita for acknowledging in that papers should be referenced accurately by using citations to the original sources rather than simply referencing activist sources. I am also pleased she is getting experts to review the science in her paper and am interested to know who the independent reviewers are.

In this response I have collected a number of comments to consider under separate headings.

Objectively looking at the science.

Rita’s reply:

“…you object to my failure to include contrary studies that reaffirm the (English speaking countries’) public health agencies’/dental lobby positions on the safety and benefits of compulsory water fluoridation.”

“…with respect to your complaint or desire that I cite to contrary (i.e., pro-fluoridation) studies in addition to (or in lieu of) the published studies that I cite that tend to weigh against fluoridation”

“It is not meant to be an exhaustive examination of all studies on fluoridation and is specifically and accurately identified for what it is”

“…you are just as guilty of ‘cherry picking’ your sources and your studies as you suggest I am.”

“I am not interested in a battle of the studies debate”

“These reasons would remain even if compulsory water fluoridation were proven to be entirely safe, which it most definitely has not, despite the presumed “majority” view in the English speaking countries”

My reply:

Rita implies I only use ‘pro-fluoridation’ or ‘English speaking countries’ papers. This is incorrect – I cite papers which provide the best weight in regards to evidence. Science doesn’t take sides (good papers are neither “anti-fluoridation” nor “pro-fluoridation”, they present data and reasoning) and these are international. To clarify, my issue is not that Barnett-Rose (2014) was not using ‘pro-fluoridation’ papers, it was the quality of the studies themselves. Reviewers of the science should attempt to understand and evaluate the quality of the research.

I also look at the quality of journal. And I try to cite papers which are in high quality journals more as those journals attract the best scientific papers. Journals use a metric called “impact factor” that basically states how many times an average paper is cited by other papers. It is an independent, objective method to judge the quality of published research.

The hierarchy of scientific evidence in the literature is also important I illustrate this in the image below.

Secondary reviews published in peer-reviewed, high-impact journals and high quality randomised controlled trials with definitive results should be the preferred sources. For consideration of human health effects I consider that animal studies would be placed above “expert opinion” in this hierarchy.

Overall one needs to approach the literature intelligently and critically – considering the evidence provided in the individual papers and also considering other published material.

Instead I saw that Barnett-Rose (2014) did not evaluate the evidence well, only selecting evidence of harm in order to persuade the audience to accept her position. There is no reason to use low validity papers when there is plenty of high quality papers but unfortunately this happens when trying to “price” a preconceived idea.

An example of this is Barnett-Rose (2014) used an opinion article from the Scientific American many times as her source. This is not a scientific paper, it is not peer-reviewed or in a research journal; furthermore the writer is not a scientist and definitely not an expert on the subject. This type of evidence would come below “expert opinion” on the image above. I hope such problems would be given as feedback from the independent reviewers.

Rita accuses me of cherry picking but fails to back this up. I do try to use only the best sources of evidence – usually systematic reviews. A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question.

The evidence shows

Rita’s reply:

“However, what I do believe is that the burden of proving safety and effectiveness lies with the pro-fluoridation side”

“It also appears to me that the pro-fluoridation side is playing “whack a mole” with the studies weighing against CWF – often trying to hammer down/marginalize the opposition each time a negative study pops up, rather than trying to consider the evidence objectively.”

“However, to me, if even one strong study exists, then the entire compulsory practice must be re-evaluated.”

My Reply:

The scientific consensus is that fluoridation works, it is safe and it is cost effective. We have evolved with fluoride and had it adjusted in our water for over 60 years in some countries. Developed countries where natural fluoride levels are low but choose not to use community water fluoridation (CWF) generally use other methods such as milk and salt fluoridation, which again are both safe and effective, or have very effective public health and dental systems. Over 5,500 papers have been systematically reviewed and no consistent association between fluoridation and illness has been found that has been confirmed through later research.

Using the latest evidence: Public Health England just released their water fluoridation review this month – “Water fluoridation Health monitoring report for England 2014” and it concluded:

“This monitoring report provides evidence of lower dental caries rates in children living in fluoridated compared to non-fluoridated areas. Similarly, infant dental admission rates were substantially lower. There was no evidence of higher rates of the non-dental health indicators studied in fluoridated areas compared to non-fluoridated areas. Although the lower rates of kidney stones and bladder cancer found in fluoridated areas are of interest, the population-based, observational design of this report does not allow conclusions to be drawn regarding any causative or protective role of fluoride; similarly, the absence of any associations does not provide definitive evidence for a lack of a relationship.”

Last month a review “Health effects of water fluoridation: A review of the scientific evidence” written on behalf of the Royal Society of New Zealand and the Office of the NZ Prime Minister’s Chief Science Advisor concluded:

“Councils with established CWF schemes in New Zealand can be confident that their continuation does not pose risks to public health, and promotes improved oral health in their communities, reducing health inequalities and saving on lifetime dental care costs for their citizens. Councils where CWF is not currently undertaken can confidently consider this as an appropriate public health measure, particularly those where the prevalence and severity of dental caries is high. A forthcoming study from the Ministry of Health is expected to provide further advice on how large a community needs to be before CWF is cost-effective (current indications point to all communities of 1000+ people).

It is recommended that a review such as this one is repeated or updated every 10 years – or earlier if a large well-designed study is published that appears likely to have shifted the balance of health benefit vs health risk.”

Looking at the many other systematic reviews you will find a similar pattern. CWF is shown to be safe and effective. So the “burden of proof” really is on those claiming evidence of harm. They need to produce well supported and peer-reviewed studies which back up their claims.

If there is a strong evidence for health risks of fluoridation then I totally agree with Rita that it needs to be re-evaluated. Every year many studies are written on fluoridation and continued monitoring of the scientific findings occurs in many countries with the precautionary principle of being alert to any possible negative effects.

Health organisations

Rita’s reply:

“Please also note that any and all of your cites to the ADA lobby, or to the CDC (which, though its oral health division, works hand in hand with the ADA promoting fluoridation and thus has a serious conflict of interest/credibility problem) are unpersuasive to me – as they should be to anyone conducting even a minimum level of research into the history of and politics behind fluoridation (some of which is chronicled in my article, including the story of the EPA’s NTEU battle).”

“it does not take long to discover how politically motivated many “public health agencies” and “professional dental associations” are — or how willing they are to obscure, minimize, or bury contrary evidence or to marginalize the anti-fluoridation messengers, regardless of the evidence or the credentials of those messengers (e.g., Waldbott, Taylor, Marcus, Mullenix, Bassin, Hirzy).”

My reply:

I think Rita is placing her own bias on these judgments. One could equally say: “It does not take long to discover how politically motivated Dr Paul Connett and FAN are — or how willing they are to obscure, misinform, or bury contrary evidence or to marginalise the pro-science messengers, regardless of the evidence or the credentials of those messengers.”

If Rita has a specific problem with the CDC or the ADA, I can use some of the many other hundreds of health organisations around the world. They all have similar conclusions about fluoridation. As I said in my first response, there is not one reputable health organisation that is against fluoridation. We already have Dr Paul Connett suggesting a massive conspiracy, I hope you do not agree with his accusations as this is generally the last resort for people who cannot find reasonable faults in the evidence but still refuse to believe it.

NRC Report

Rita’s reply:

“However, I believe that its review of fluoride toxicology is highly relevant to exposures from fluoridated water (and its exposure data itself suggests that some people drinking fluoridated water can, indeed, receive doses that can cause adverse health effects, including severe dental fluorosis and bone fractures).”

“In addition, in a number of health risk areas, the NRC panel concluded that there was not enough data, and/or that more research needed to be conducted, before definitive statements could be made with respect to other potential adverse health effects due to excess exposure to fluoride.”

My reply:

I will not repeat what I said in my earlier reply. The review itself said that it was not relevant to exposures to concentrations used for fluoridated water and to say it is “highly relevant” is spreading misinformation. The NRC report furthered shows the safety of fluoridation. As for the “more research needed”, that is always the case with science. That is why responsible public health agencies continue to monitor research findings.

Ethics

Rita’s reply:

“I would genuinely be interested in knowing why you feel so strongly that imposing this practice on everyone is ethically justifiable.”

“Thus, I am very curious as to why there appears to be such an aggressive campaign on the pro fluoridation side to impose this practice on the world – and why anyone believes that personal liberties and rights to bodily integrity should be sacrificed for a public health practice addressing a non-contagious disease.”

“I would also be interested in understanding where you personally believe compulsory public health practices should begin and end (e.g., do you believe governments should mandate compulsory flu shots? What about the HPV vaccine that the Governor of Texas tried to mandate for girls? Where should the personal right to bodily integrity begin and end, in your opinion? And how comfortable are you with public health officials mandating what is good for you?…)”

My reply:

I don’t see how you conclude that I “feel so strongly that imposing this practice on everyone”. I, myself, could say I am strongly against misinformation. The MSoF society is here to help explain what the actual scientific evidence shows to the public, not to advocate for CWF at any cost. It is up to the communities if they want to use CWF and we, the MSoF Society, support their democratic right to decide.

But regarding ethical aspects, you might be interested in what the Nuffield Council on Bioethics decided. It:

• Rejected the prohibition of water fluoridation based on the argument of mass medication and restricting personal rights.
• Affirmed that water fluoridation should be accepted based on the quantified risks and benefits, the potential alternatives, and, where there are harms, the role of consent.

They also used a ‘stewardship mode’ to analyse the acceptable degree of state intervention to improve population health, concluding that water fluoridation can be justified based on its contribution to the goals of stewardship: the reduction of health inequalities, the reduction of ill health, and the concern for children, who represent a vulnerable group.

The New Zealand High court this year ruled that fluoridation of the water supply:

• is not a medical treatment,
• does not violate the right to refuse medicine,
• is not in breach of the Bill of Rights,

And that

• the Council was thoughtful and responsible in making their decision to begin fluoridation, and had no obligation to consider “controversial factual issues” (anti-fluoride propaganda).

You could say there is an aggressive campaign on both sides, but people are pushing for fluoridation simply because it works – reducing up to 40% of caries over a whole population.

Dental caries is a serious chronic disease, it makes no difference if it is contagious or not. The Royal Society Review pointed out that

“…tooth decay (dental caries) remains the single most common chronic disease among New Zealanders of all ages, with consequences including pain, infection, impaired chewing ability, tooth loss, compromised appearance, and absence from work or school. Tooth decay is an irreversible disease; if untreated it is cumulative through the lifespan, such that individuals who are adversely affected early in life tend to have pervasive decay by adulthood, and are likely to suffer extensive tooth loss later in life. Prevention of tooth decay is essential from very early childhood through to old age”.

The Royal Society Review also suggested that removing fluoridation would have direct and indirect costs to society.

“Tooth decay is responsible for significant health loss (lost years of healthy life) in New Zealand. The ‘burden’ of the disease – its ‘cost’ in terms of lost years of healthy life – is equivalent to 3/4 that of prostate cancer, and 2/5 that of breast cancer in New Zealand. Tooth decay thus has substantial direct and indirect costs to society.”

I am all for protecting the vulnerable. If individuals do not consent, they can simply choose not to partake of the community water supply (bottled water, filters, rain water, etc.). I feel this is starting to head slightly off-topic but to answer your question, if the vaccine given out is safe and effective for the general public then I have no problems with compulsory shots for children. While choice is nice thing to have, you cannot always get it, especially if it is going to lower the quality of life in children.

The New Zealand High court summarised some ethical aspects in the decision I referred to above:

“Provided it does not have consequences for public health a person has the right to make even the poorest decisions in respect of their own health. But where the state, either directly or through local government, employs public health interventions, the right is not engaged. Were it otherwise, the individual’s right to refuse would become the individual’s right to decide outcomes for others. It would give any person a right of veto over public health measures which it is not only the right but often the responsibility of local authorities to deliver.”

The World Health Organization

Rita’s reply:

“Data published by the WHO suggests that the decline in dental caries is similar in both fluoridated and unfluoridated countries, and I have heard of no massive outbreak of a worldwide dental carie epidemic that has been attributed to a lack of fluoridated water (rather than to poverty, poor nutrition, or a lack of access to proper dental care).”

My reply:

Petersen & Lennon (2004), a WHO funded study showed dental caries remain a major public health concern, affecting 60–90% of schoolchildren and the vast majority of adults. While fluoride is not a silver bullet, it is just part of the problem, it should not be ignored when it can clearly help very effectively. Their study goes into a number of suggestions for alleviating tooth decay, one being fluoridation.

“Water fluoridation, where technically feasible and culturally acceptable, has substantial advantages particularly for subgroups at high risk of caries. Alternatively, fluoridated salt, which retains consumer choice, can also be recommended. WHO is currently in the process of developing guidelines for milk fluoridation programs, based on experiences from community trials carried out in both developed and developing countries.”

As for the similar DMFT decline between fluoridated and unfluoridated countries Rita claims this needs to be considered critically. Fluoride occurs naturally everywhere and it is very hard to compare one country to others because of the many other contributing factors such as; history, culture, ethnic differences, as well as differences in health services, dental practice and assessments. The graphical evidence FAN promotes on their website and elsewhere they do not account for naturally occurring fluoride or other programs (fluoride vanish, mouth rinse programs, etc.) and different history and social practices. Their graphs also use only 2 data points for each country. There is no consideration of also changing fluoridation amounts over time and their graph is very confusing. It does not enable proper consideration of different DMFT declines in different countries. The stats show Denmark having the lowest DMFT and FAN marked them as not fluoridated, but they actually have high levels of naturally occurring fluoride.

If you look at the WHO data in more detail (graph left does this for the Irish Republic using the same WHO data) you will find that fluoridated areas show faster declines in DMFT than unfluoridated areas.

Making Sense of Fluoride

Rita’s reply:

“…you complain about FAN not being a legitimate source of credible scientific information, but your organization is also a political advocacy (pro-fluoridation) group”

“I urge you to conduct such a battle with a more appropriate sparring partner, such as FAN-NZ.”

My reply:

Like yourself, I am not a scientist – I am a software developer; my responses get checked by scientists but I would always look into the evidence in scientific studies. I avoid political or activist organisations (legitimate or not). The Making Sense of Fluoride society is not a pro-fluoridation group, we are a pro-science group. We will go with what the scientific consensus says and will spread warnings, if for example: sometime in the future, CWF was really found to be harmful.

The objectives of the MSoF incorporated society are:

1. To foster awareness and dispel misinformation regarding fluoride with a focus on CWF.
2. Use the scientific method as the foundational platform upon which this awareness is promoted.

FANNZ, now known as Fluoride Free NZ (and a close partner of FAN), will always be anti-fluoride no matter what the evidence shows. For that reason it is usually not fruitful debating them. Their incorporated society main purposes make clear their opposition to CWF irrespective of the science:

1. To bring about the permanent end to public water fluoridation (“fluoridation”) in New Zealand.
2. To provide resources, both personal and material, to others opposing fluoridation in New Zealand.
3. To provide a central contact point for those opposing fluoridation in New Zealand.

Apology

Rita’s reply:

“This statement about “mounting scientific evidence” at the start of my paper (near fn. 2) actually references an entire section of my article – (“See discussion infra Sec. II-B”) — and not an opinion piece by Colquhoun, which is only referenced – appropriately – at footnote 65 (referring to “formerly avid fluoride proponents” who have changed their minds). I have no desire to engage with insincere zealots, so I hope that you simply made a mistake there.”

My reply:

I apologise for mistaking you and any offense it may have caused you. It was clearly a simple mistake that anyone could have made and I had no intention to twist your words.

Wrapping up

Rita’s reply:

“After this exchange, however, I am only interested in a private discussion with you, which is something you may not be interested in as it may not advance your organization’s agenda”

“However, your Facebook posting has generated some contact to me by a few rude (and seemingly unbalanced) pro fluoridation folks”

My reply:

MSoF is always happy to have private discussions if you are willing to listen to our feedback. A lot of our work is outside of what the public sees but we always up for public exchanges to share to our followers.

You will find that your paper got sent all over Facebook and the media; because it was publicised in a press release from FAN. That is how I found out about it. It is a pity you were subjected to insults because of that publicity. That said I was also hit with insults on Fluoride Free NZ Facebook pages because of my response to you. These insults are common and something I have gotten used too; in either case it is a shame that people feel it best to engage in debate in disrespectful ways. Fluoridation is an emotional topic for some – personally I do my best to stick with the science and keep my emotions out.

Thank you Rita for making time in reading our feedback and responding to us.

The post Discussion – Compulsory Water Fluoridation: Second Response To Rita Barnett-rose appeared first on Making Sense of Fluoride.

You can read Part 1 of the public exchange here.

Rita’s reply in PDF here.

To: Daniel Ryan, Making Sense of Fluoride
From: Rita Barnett-Rose
RE: CWF Working Paper Article
Date: 9/25/14

Dear Daniel,

I have now had a chance to consider your comments to my draft article. In some respects, I am flattered that you have devoted so much time to an unpublished working paper, and I thank you for giving me some of your opinions. I absolutely want to make sure that I have cited to sources accurately and have not mischaracterized any particular study I reviewed. To that end, I have now engaged independent review of my article from several highly qualified scientists/researchers with the specific request that they review my article for scientific accuracy. After I have received their comments, I will revise my draft accordingly.

Unfortunately (or fortunately for me), I did not find in your review any specific places where I actually mischaracterized any cited study. Instead, your primary points of contention seem to be twofold: (1) you object to my use of Fluoride Action Network’s (“FAN”) website as a cited source; and (2) you object to my failure to include contrary studies that reaffirm the (English speaking countries’) public health agencies’/dental lobby positions on the safety and benefits of compulsory water fluoridation. First, with respect to my reliance on FAN. Of the 209 footnote references in my article, I believe only 17 of them are cites to FAN. Of those 17 cites, I am citing to the FAN website primarily as an easy way to get to the primary source material (e.g., studies or newspaper articles from around the world). For example, in footnotes 85-87, I could have listed the primary source studies, but I have found that many of these studies are hard to get on the internet for those who do not have paid subscriptions to the various science databases. I myself had to order a number of the primary sources from my University intra-library loan system and felt that it would be better to simply provide a link so that the reader could see the names of the studies and determine for himself/herself how to get to those primary sources. Nevertheless, your point is well-taken that I should not give the appearance of relying upon an advocacy group (including yours), and I will review those 17 cites to see if I should instead cite to primary sources.

Second, with respect to your complaint or desire that I cite to contrary (i.e., pro-fluoridation) studies in addition to (or in lieu of) the published studies that I cite that tend to weigh against fluoridation, as I have already indicated to you on two occasions: I am not interested in a battle of the studies debate, and I urge you to conduct such a battle with a more appropriate sparring partner, such as FAN-NZ. Specifically: you complain about FAN not being a legitimate source of credible scientific information, but your organization is also a political advocacy (pro-fluoridation) group, and, from your critique, you are just as guilty of “cherry picking” your sources and your studies as you suggest I am. Moreover, and in stark contrast to you, the section of my article where the studies are discussed is specifically entitled: “Scientific Evidence Against Compulsory Water Fluoridation.” It is not meant to be an exhaustive examination of all studies on fluoridation and is specifically and accurately identified for what it is. I am well aware of many of the pro-fluoridation studies — as well as the criticisms of many of those studies (in terms of who funded them, flaws in methodology, conflicts of interest, etc.) by those opposed to fluoridation. I do not believe either side has definitively proved their case with respect to safety/benefits or lack thereof. However, what I do believe is that the burden of proving safety and effectiveness lies with the pro-fluoridation side, as it is your side that is insisting on imposing this “public health measure” on everyone else, even in the face of substantial objection and despite existing studies suggesting serious risks of harm. It also appears to me that the pro-fluoridation side is playing “whack a mole” with the studies weighing against CWF – often trying to hammer down/marginalize the opposition each time a negative study pops up, rather than trying to consider the evidence objectively. I note throughout your critique that you often refer to studies that weigh against fluoridation as “flawed” or “debatable” or as somehow lacking in proper control mechanisms – while studies that support fluoridation are “quality studies.” (p.8). You also minimize any existing evidence weighing against fluoridation by qualifying it: “there is no quality research” (p. 4) “there is no robust evidence” (p. 4), “there is no strong evidence” (p. 6). However, to me, if even one strong study exists, then the entire compulsory practice must be reevaluated.

Please also note that any and all of your cites to the ADA lobby, or to the CDC (which, though its oral health division, works hand in hand with the ADA promoting fluoridation and thus has a serious conflict of interest/credibility problem) are unpersuasive to me – as they should be to anyone conducting even a minimum level of research into the history of and politics behind fluoridation (some of which is chronicled in my article, including the story of the EPA’s NTEU battle). Incidentally, as someone who did not have a pony in this race before doing the actual research (i.e., I am not a long-time anti-fluoridation advocate), it does not take long to discover how politically motivated many “public health agencies” and “professional dental associations” are — or how willing they are to obscure, minimize, or bury contrary evidence or to marginalize the anti-fluoridation messengers, regardless of the evidence or the credentials of those messengers (e.g., Waldbott, Taylor, Marcus, Mullenix, Bassin, Hirzy).

With respect to the NRC Report, I agree with you that it did not specifically address compulsory water fluoridation. However, I believe that its review of fluoride toxicology is highly relevant to exposures from fluoridated water (and its exposure data itself suggests that some people drinking fluoridated water can, indeed, receive doses that can cause adverse health effects, including severe dental fluorosis and bone fractures). In addition, in a number of health risk areas, the NRC panel concluded that there was not enough data, and/or that more research needed to be conducted, before definitive statements could be made with respect to other potential adverse health effects due to excess exposure to fluoride. This is hardly a ringing endorsement of the safety of fluoride or fluoridation. Nor is the NRC Report irrelevant to the fluoridation debate.

I see no point in going through your critique page by page to point out various flaws in it, as mostly you seem to be trying to persuade me with contrary evidence rather than identifying any mischaracterizations of the studies I did cite. I will, however, point out that your opening accusation on p. 2 that my “paper starts off by saying there is mounting scientific evidence against fluoridation” and that I used an opinion piece by John Colquhoun as my “evidence” to support this statement is outrageously incorrect, and it almost prompted me not to respond to you at all, as I do not appreciate my words being twisted or my cites misused to inflate your argument. This statement about “mounting scientific evidence” at the start of my paper (near fn. 2) actually references an entire section of my article – (“See discussion infra Sec. II-B”) — and not an opinion piece by Colquhoun, which is only referenced – appropriately – at footnote 65 (referring to “formerly avid fluoride proponents” who have changed their minds). I have no desire to engage with insincere zealots, so I hope that you simply made a mistake there.

As I said to you privately, I am more than willing to revise my article where I have misstated any of the cited scientific evidence. However, I disagree with you that a discussion on the legal and ethical aspects of CWF would be “confusing” or “pointless” at this point and I would genuinely be interested in knowing why you feel so strongly that imposing this practice on everyone is ethically justifiable. Data published by the WHO suggests that the decline in dental caries is similar in both fluoridated and unfluoridated countries, and I have heard of no massive outbreak of a worldwide dental carie epidemic that has been attributed to a lack of fluoridated water (rather than to poverty, poor nutrition, or a lack of access to proper dental care). Thus, I am very curious as to why there appears to be such an aggressive campaign on the pro-fluoridation side to impose this practice on the world – and why anyone believes that personal liberties and rights to bodily integrity should be sacrificed for a public health practice addressing a non-contagious disease. I would also be interested in understanding where you personally believe compulsory public health practices should begin and end (e.g., do you believe governments should mandate compulsory flu shots? What about the HPV vaccine that the Governor of Texas tried to mandate for girls? Where should the personal right to bodily integrity begin and end, in your opinion? And how comfortable are you with public health officials mandating what is good for you? Do you contend that they haven’t been wrong on a public health issue before?).

As for me, I remain convinced that CWF is legally and ethically unjustifiable. My article sets forth my reasons, so I won’t repeat those arguments here. These reasons would remain even if compulsory water fluoridation were proven to be entirely safe, which it most definitely has not, despite the presumed “majority” view in the English speaking countries. You will also find many of my reasons articulated by dissenting justices in fluoridation cases over the last 60+ years, when presumably even less “science” was available to support their nevertheless valid legal/ethical objections to CWF. I include some of these cases and dissenting opinions in my article.

Daniel, I thank you for your (heretofore) civilized exchange with me and I do welcome your thoughts if you have any on the legal and ethical justifications of CWF. After this exchange, however, I am only interested in a private discussion with you, which is something you may not be interested in as it may not advance your organization’s agenda. However, your Facebook posting has generated some contact to me by a few rude (and seemingly unbalanced) pro-fluoridation folks, and I have no interest in entertaining their rants (which certainly do nothing but convince me that the pro-fluoridation side has something to hide). In any event, I do thank you for reaching out and for your interest in my article. I hope to ensure that my final draft will address any legitimate criticisms/issues.

Sincerely,

Rita

Daniel’s second response to this. 

The post Discussion – RE: CWF Working Paper Article appeared first on Making Sense of Fluoride.

Feel free to comment on any side of the discussion.

You can grab the PDF version here.

Compulsory Water fluoridation: A Response to Rita Barnett-Rose

Written by Daniel Ryan

Introduction

I have contacted Associate Professor Rita Barnett-Rose about her unpublished paper “Compulsory water fluoridation: justifiable public health benefit or human experimental research without informed consent” (you can read a copy here: http://works.bepress.com/rita_barnett/3/). It concluded that “The evidence continues to suggest that compulsory water fluoridation is no longer justifiable as a public health benefit” and “human rights burden and economic costs are not reasonable or justifiable”.

There were claims about the science which (presumably) are important for the legal/ethical conclusions. We at Making Sense of Fluoride (MSoF) felt there was misinformation on the science and a public exchange would be a good way to engage in a discussion of the claims – even withdrawing those claims if found wrong. We thank Rita for listening to us and hope that we find common ground even if it’s just in the science.

Discussion

For the most part of this discussion I will stick to pages 13-19 with the header “Scientific Evidence against Compulsory Water Fluoridation” and breaking down into the sub-headers.

First off, looking at the sources used, there are many that are comments and articles from political activists rather than primary research sources. For example Fluoride Action Network is not a credible scientific organisation. This is not a good way of reviewing the scientific literature; in fact it is very poor practice. This is a fundamental problem with this paper.

The paper starts off saying there is mounting scientific evidence against fluoridation. The evidence used was an opinion piece from John Colquhoun. Dental Watch has a paper “Why We Have Not Changed Our Minds about the Safety and Efficacy of Water Fluoridation: A Response to John Colquhoun” that critiques his paper.

“His paper rehashed earlier criticisms of water fluoridation, using selective and highly biased citations of the scientific and non-scientific literature”.

“Why I Am Now Officially Opposed to Adding Fluoride to Drinking Water” from Dr. Hardy Limeback and “Dr. William Hirzy Portland letter” are also opinion pieces. It is important to note that Dr. Hardy Limeback is a member of the Advisory Board of Paul Connett’s Fluoride Alert Network. Dr. William Hirzy works for Fluoride Action Network as a paid political lobbyist. “Mounting scientific evidence”- nothing could be further from the truth. There is not one reputable health organisation that is against fluoridation.

1: Dental Fluorosis

There is no argument that having too much fluoride when the teeth are forming will cause dental fluorosis but this isn’t the case for fluoridation. There is little difference in frequency and severity of fluorosis between non-fluoridated and fluoridated areas, something which Barnett-Rose (2014) seems to ignore. The CDC source given was looking at fluorosis as a whole and not at fluoridated vs non-fluoridated, but it states that:

“community water fluoridation programs were developed to add fluoride to drinking water to reach an optimal level for preventing tooth decay, while limiting the chance of developing dental fluorosis”.

If there were any large differences in fluorosis then I would be all for another look into balancing the levels of fluoride in those areas. In fact health authorities in many countries continually monitor research findings for this very reason and that was the reason for the National Research Council (2006) review which did recommend reducing the primary MCL of 4 ppm.

Any increase in fluorosis due to CWF would be in the very mild to mild fluorosis range. The dental fluorosis about which they speak in Warren’s et al. (2009) “Iowa study” is overwhelmingly of the barely detectable nature. The 2009 New Zealand Oral health Survey found very little difference between fluoridated and non-fluoridated areas, in terms of the levels of mild to very mild fluorosis (which has no effect on appearance, form or function of teeth), as shown on the graph below. In fact, Lida & Kumar (2009) have demonstrated mildly fluorosed teeth to be more decay resistant.

The statement that fluorosis is “the first sign of fluoride toxicity” is debatable. What sign of which particular toxicity? Just because there might be other effects which have not yet been shown is not proof that there are other effects. It presumably has been a common feature of teeth through the centuries and is harmless.

The American Dental Association website says,

“Yes, it is safe to use fluoridated water to mix infant formula. If your baby is primarily fed infant formula, using fluoridated water might increase the chance for mild enamel fluorosis, but enamel fluorosis does not affect the health of your child or the health of your child’s teeth”.

The recommendation by health authorities that parents use unfluoridated water to make up formula is a peace-of-mind suggestion, not a firm recommendation. For example the CDC says:

“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”.

For infants and children in their tooth-developing years of 0-8, the upper limit (UL) for fluoride is lower, but only due to a risk of development of mild dental fluorosis. That’s why the UL for daily fluoride jumps to 10mg/day after age 8, once the teeth are formed.

The rest of the “Dental Fluorosis” section in Barnett-Rose (2014) talks about moderate to severe dental fluorosis, which is not caused by community water fluoridation and so is pointless to discuss.

2: Skeletal Fluorosis and Bone Fractures

Again, there is no disagreement that chronic exposure to high levels of fluoride can cause skeletal fluorosis and increase the risk of bone fractures. But you don’t see these problems at levels of 0.7-1.2 ppm in community drinking water. The Institute of Medicine has established that the daily upper limit for fluoride intake from all sources, for adults, before adverse effects will occur, short or long-term, is 10 mg. There is no quality research to show skeletal fluorosis can develop at the levels of 0.7-1.2ppm. Even the source used in Barnett-Rose (2014) says “Crippling skeletal fluorosis may be produced by levels of 10-20 mg/day over 10-20 years”.

National Fluoridation Information Service has released a report this month on fluorosis and concluded:

“There are no known health risks associated with CWF in New Zealand, and no severe dental fluorosis, or skeletal fluorosis, has been found. While fluoride is incorporated into teeth and bones, there is no robust evidence of toxic accumulation of fluoride in other tissues in the body”.

It also noted in its conclusion:

“As with many vitamins and minerals, such as iron, and vitamins A and D, fluoride intakes at high levels can be toxic. However, it is impossible to experience acute fluoride toxicity from drinking water optimally fluoridated at levels between 0.7 mg/L to 1.0 mg/L (MoH, 2009), and there is no evidence of skeletal fluorosis resulting from CWF in New Zealand. It makes sound clinical sense to ingest a substance at a level that achieves maximum benefit with minimal adverse effects (Bowen, 2002)”.

One needs to be careful of cherry picking scientific studies. When you look at all the data you will find bone fracture is not an issue. Vestergaard et al. (2007), in a meta-analysis that used 25 studies, came to the conclusion that

“there was no effect on hip or spine fracture risk”. He also noted that “in subgroup analyses a low fluoride dose (< or =20 mg/day of fluoride equivalents) was associated with a significant reduction in fracture risk”.

This showed that fluoridation can help bones when at the optimum fluoride levels.

Ingestion of some fluoride is necessary as the bioapatites in our body contain both fluoride and carbonate as normal, natural components. The incorporation of ions like fluoride into bioapatites can change their solubility product by several orders of magnitude according to Driessens (1973). Posner et al. (1963) attribute the improved stability of bone to “the isomorphous substitution of fluoride in the apatite structure”.

3. Pineal Gland and Endocrine Disruption Studies

Fluoride can accumulate in the pineal gland. Calcification of the pineal gland is caused by calcium, phosphate and old age. Because the bioapatites in calcified tissues are actively undergoing mineralisation and remineralisation they easily incorporate fluoride into their structure and this leads to higher concentration of fluoride in calcified tissues than in bones generally. No evidence of harm has been found.

There is no known link to hypothyroidism at the levels we get in water fluoridation. I’m not sure where the evidence for “The fluoride dose capable of reducing thyroid function is low – just 2 to 5 mg per day over several months” from Barnett-Rosie (2014). Her source, the Fluoride Action Network website, points to a study Galletti & Joyet (1958), which says

“Our aim was to elucidate the inhibitory effect of chronic administration of fluoride upon thyroid function in cases of hyperthyroidism. It was demonstrated that such an action appears only occasionally among persons subjected to massive doses of this substance”.

The study was working with prolonged administration of a daily dose of 2-20 mg (on top of their diet). This was also a very small study of 15 people who suffered from hyperthyroidism. Galletti also noted that

“Despite the relatively large amounts administered (up to 20 mg. of F~ for one injection), neither immediate nor delayed toxic manifestations were observed”.

This demonstrates my point that primary sources should be used, and definitely not activist websites.

The ADA concludes on its fluoridation facts document,

“There is no scientific basis that shows fluoridated water has an adverse effect on the thyroid gland or its function”.

It also states:

“The researchers concluded that prolonged ingestion of fluoride at levels above optimal to prevent dental decay had no effect on thyroid gland size or function. This conclusion was consistent with earlier animal studies”

4. Cancer Studies

Bassin (2006) data presentation did not show how many cases and controls were included in each of the models; and fluoride exposures were estimated rather than measured directly. The authors commented that “Further research is required to confirm or refute this observation”.

The NHMRC (2007) observed that:

“Shortcomings in their study mean the results should be interpreted with caution pending publication of the larger study results. Co-investigators of Bassin point out that they have not been able to replicate these findings in the broader Harvard study that included prospective cases from the same 11 hospitals”.

There is no demonstrable link between fluoride and cancer. The American Cancer Society says:

“The general consensus among the reviews done to date is that there is no strong evidence of a link between water fluoridation and cancer”.

The National Cancer Institute says

“Fluoride in water helps to prevent and can even reverse tooth decay. More than 60 percent of the U.S. population has access to fluoridated water through public water supply systems. Many studies, in both humans and animals, have shown no association between fluoridated water and cancer risk”.

This is backed up by systematic reviews e.g. the York Review (2000) reported:

“No clear association between water fluoridation and osteosarcoma”.

National Research Council (2006) commented,

“Assessing fluoride as a risk factor for osteosarcoma is complicated by the rarity of the disease and that population is all generally exposed to some level of fluoride”.

SCHER (2010) reported:

“a possible link between fluoride in drinking water and osteosarcoma, but studies are equivocal. No evidence from animal studies to support the link, and thus fluoride cannot be classified as to its carcinogenicity”.

5. Lower IQ’s in Children

It is debatable that Mullenix et al. (1995) interpretation on the study was flawed, it doesn’t matter if it was in a “well-respected peer reviewed journal” or not. Plenty of well-respected journals have released poor papers. One such example was Wakefield’s (1998) claim of a link between vaccines and autism, published in The Lancet.

The study by Mullenix et al. (1995) was refuted by Ross & Daston (1995):

“In summary, much of the ambiguity in the interpretation of these results could have been avoided with information from two concurrent or historical control groups: 1) a group to define the behavioral signature resulting from long term adulteration of the drinking water, and 2) a group to define the behavioral signature of animals with hippocampal damage in this testing system. Such controls are an essential feature of test validation and experimental design. Novel behavioral chemicals of unknown toxicity are dosed, and all possible results interpreted as neurotoxicity. Instead, both positive and negative control materials should be evaluated, and the results linked with well-characterized functional and morphological indices of neurotoxicity.

We appreciate the opportunity to provide our interpretations of this study. We do not believe that the study by Mullenix et al. can be interpreted in any way as indicating the potential for NaF to be a neurotoxicant”

On top of that, it is also debatable if plasma levels in rodents due to high levels of fluoride are equivalent to those in humans. The National Research Council (2006) discussed the contradictory data used for attempting to show a ratio between humans and rats for blood plasma levels and concluded:

“Dunipace et al. (1995) concluded that rats require about five times greater water concentrations than humans to reach the same plasma concentration. That factor appears uncertain, in part because the ratio can change with age or length of exposure. In addition, this approach compares water concentrations, not dose. Plasma levels can also vary considerably both between people and in the same person over time (Ekstrand 1978)”.

Choi (2012) described 27 studies found majority in obscure Chinese scientific journals. China is not artificially fluoridated and the studies used high levels of naturally occurring fluoride in the well water of various Chinese, Mongolian, and Iranian villages. The concentration of fluoride in these studies was as high as 11.5 ppm. By the admission of the Harvard researchers, these studies had key information missing, used questionable methodologies, and had inadequate controls for confounding factors. These studies were so seriously flawed that the lead researchers, Anna Choi, and Philippe Grandjean, were led to issue a statement in September of 2012. Anna Choi said:

“These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S. On the other hand, neither can it be concluded that no risk is present“.

Broadbent et al. (2014) used data from the Dunedin Multidisciplinary Study, which is world-renowned for the quality of its data and rigour of its analysis, and found no significant differences in IQ by fluoride exposure, even before controlling for the other factors that might influence scores. It controlled for childhood factors associated with IQ variation, such as socio-economic status of parents, birth weight and breastfeeding, and secondary and tertiary educational achievement.

6: Benefits from Systemic Fluoride Intake?

For this section I’ll limit the discussion to the benefits of systemic and topical intake of fluoride.

Even if the primary role of fluoride was topical, water fluoridation has a beneficial effect and makes a good delivery system. Consumption of fluoridated food and water enables transfer of fluoride to saliva and biofilms on the teeth. This fluoride, together with calcium and phosphate on the saliva, reduces acid attack on the teeth and so helps prevent tooth decay. Because fluoride concentrations in saliva decrease within an hour or so after brushing, fluoridated water complements use of fluoridated toothpaste. Our teeth are in more regular contact with food and water than they are with toothpaste.

Buzalaf et al. (2011) reports:

“More than 60 years of intensive research attest to the safety and effectiveness of this measure to control caries. In this case, however, it should be emphasized that despite being classified as a ‘systemic’ method of fluoride delivery (as it involves ingestion of fluoride), the mechanism of action of fluoridated water to control caries is mainly through its topical contact with the teeth while in the oral cavity or when redistributed to the oral environment by means of saliva. Since fluoridated water is consumed many times a day, the high frequency of contact of fluoride present in the water with the tooth structure or intraoral fluoride reservoirs helps to explain why water fluoridation is so effective in controlling caries, despite having fluoride concentrations much lower than fluoride toothpaste, for example. This general concept can be applied to all methods of fluoride use traditionally classified as ‘systemic’. In the light of the current knowledge regarding the mechanisms by which fluoride control caries, this system of classification is in fact misleading”.

Featherstone (2000) also demonstrated that:

“The cariostatic effects of fluoride are, in part, related to the sustained presence of low concentrations of ionic fluoride in the oral environment, derived from foods and beverages, drinking water and fluoride-containing dental products such as toothpaste. Prolonged and slightly elevated low concentrations of fluoride in the saliva and plaque fluid decrease the rate of enamel demineralization and enhance the rate of remineralization”.

The main benefit is from topical application but systemic ingestion still plays a role. Buzalaf et al. (2011) also states that:

“Evidence also supports fluoride’s systemic mechanism of caries inhibition in pit and fissure surfaces of permanent first molars when it is incorporated into these teeth pre-eruptively”.

Quality studies continue to show fluoridation to be effective today. Newbrun (1989), Brunelle & Carlos (1990) and Griffin et al. (2007) have proven water fluoridation continues to be effective in reducing dental decay by 20-40%.

National Research Council Report

I will touch on the National Research Council (2006) report as Rita has asked me to give my assessment and it is used throughout her paper. The 2006 NRC Committee was charged with evaluating the adequacy of the US EPA primary (4 ppm) and secondary (2 ppm) MCLs for fluoride to protect the public against adverse effects, it did not look at the benefits. The EPA’s guidelines are not recommendations about adding fluoride to drinking water to protect the public from dental caries. Guidelines for that purpose (0.7 – 1.2ppm) were established by the U.S. Public Health Service. It reported:

“this report does not evaluate nor make judgments about the benefits, safety, or efficacy of artificial water fluoridation. That practice is reviewed only in terms of being a source of exposure to fluoride”.

After the Committee looked at all relevant fluoride literature, it recommended that the EPA primary MCL for fluoride be lowered from 4.0 ppm. The stated reasons for this recommendation were the risk of severe dental fluorosis and bone fracture with chronic ingestion of water with a fluoride content of 4.0 ppm or greater. No other reasons. Had this Committee had any other concerns with fluoride at this level, it would have stated so and recommended accordingly. Additionally, this Committee made no recommendation to lower the EPA secondary MCL for fluoride, 2.0 ppm which water fluoridation at 0.7ppm is 1/3 of this value.

In March of 2013, Dr. John Doull, the internationally respected toxicologist who chaired the NRC committee, made the following statement:

“I do not believe there is any valid, scientific reason for fearing adverse health conditions from the consumption of water fluoridated at the optimal level.”

Final recommendation of this Committee showed nothing that doubt on the safety of fluoride at the recommended optimal level. It also has no bearing on water fluoridation so using the NRC report to as a reason to stop fluoridation would be misguided.

Conclusion

I have outlined major flaws of the science of this paper, with the major criticism being not using primary sources. There was no assessment of the quality of the evidence. One should start with secondary reviews published in peer-reviewed, high-impact journals, including meta-reviews, review articles, and Cochrane Collaboration reviews; otherwise, high quality clinical trial reports with fairly large number of subjects.

Any further discussions on the ethics or legal matters with fundamental flaws in the science would make any exchange confusing and pointless.

Rita’s response to this.

The post Discussion – Compulsory Water fluoridation: A Response to Rita Barnett-Rose appeared first on Making Sense of Fluoride.

The point that “many at risk adults are exceeding the upper toxic limits” seems to be partly a rehash of their previous post 2 months back.

Dr Steve Slott DDS debunked the claims made, which are below.

1. The only result of children 0-8 years old exceeding the daily upper limit of fluoride intake, as a result of the minuscule amount of fluoride in fluoridated water, is mild to very mild dental fluorosis, a barely detectable effect which causes no adverse effect on cosmetics, form, function, or health of teeth. Fluoride has been in water since the beginning of time. If Dr. Litras has any valid, peer-reviewed scientific evidence of adverse effect of fluoride at the optimal level, on unborn children, he should present it instead of making lame, unsubstantiated implications such as “its effects on the unborn child are unknown”.

2. The total fluoride intake at the individual is indeed known and controlled. Simply put, water is fluoridated at 0.7 mg/liter (ppm=mg/liter). Thus, for every liter of fluoridated water consumed, the “dose” of fluoride intake is 0.7 mg. The average daily water consumption by an adult is 2-3 liters per day. So, let’s go to an extreme and double that to an excessive 6 liters of fluoridated water consumption per day. This translates to 4.2 mg “dose” of fluoride intake per day from the water. The CDC estimates that of the total daily intake, or “dose”, of fluoride from all sources including dental products, 75% is from the water. Thus as 4.2 mg is 75% if the total daily intake from all sources, the total daily intake, or “dose” from all sources would be 5.6 mg for an individual who consumed an excessive 6 liters of fluoridated water per day.

The Institute of Medicine has established that the daily upper limit for fluoride intake from all sources, for adults, before adverse effects will occur, short or long-term, is 10 mg. Thus, even the excessive 6 liter per day consumer of water will still only take in a daily “dose” of fluoride that is slightly more than half the upper limit before adverse effects.

The range of safety between the miniscule few parts per million fluoride that are added to existing fluoride levels in your water, is so wide that “dose” is not an issue. Before the UL of 10 mg could be reached, water toxicity would be the concern, not fluoride.

3. “HFA, a class 6 toxin” does not exist in fluoridated water at the tap. HFA when added to drinking water, immediately and completely hydrolyzes (dissociates). The products of the hydrolysis are fluoride ions identical to those which have existed in water since the beginning of time, and trace contaminants in barely detectable amounts far below EPA mandated maximum levels of safety. After this point, HFA no longer exists in that water. It does not reach the tap. It is not ingested. It is of no concern, whatsoever.

4. There is no valid evidence of any lack of safety of fluoride at the optimal level. In the 69 year history of this initiative, there have been no proven adverse effects.

5. The 12 member 2006 NRC Committee on Fluoride included 3 long time, outspoken fluoridation opponents. This Committee reached the same conclusion as did the NZ panel… that fluoride at the optimal level is safe and effective.

This 2006 NRC Committee was charged with evaluating the adequacy of the US EPA primary and secondary MCLs for fluoride, 4.0 ppm and 2.0 ppm respectively, to protect the public against adverse effects. After an exhaustive 3 year review of all relevant fluoride literature, the Committee recommended that the EPA primary MCL for fluoride be lowered from 4.0 ppm. The sole stated reasons for this recommendation were the risk of severe dental fluorosis and bone fracture with chronic ingestion of water with a fluoride content of 4.0 ppm or greater. No other reasons. Had this Committee had any other concerns with fluoride at this level, it would have stated so and recommended accordingly.

Additionally, this Committee made no recommendation to lower the EPA secondary MCL for fluoride, 2.0 ppm. Water is fluoridated at 0.7 ppm, one-third the EPA secondary MCL, which the 2006 NRC Committee on Fluoride made no recommendation to lower.

In March of 2013, Dr. John Doull, Chair of the 2006 NRC Committee on Fluoride, made the following statement:
“I do not believe there is any valid, scientific reason for fearing adverse health conditions from the consumption of water fluoridated at the optimal level”
—John Doull, MD, PhD, Chair of the National Academy of Sciences, National Research Council 2006 Committee Report on Fluoride in Drinking Water

6. Fluoridation was “banned” in Israel by the irresponsible actions of one, single individual, the misguided Israeli Minister of Health, a long time anti-fluoridationist who put her own personal, ideology above the health and wellbeing of her citizenry. Her action was in direct contradiction to the Israeli healthcare community which vehemently objected to her unilateral action. Given the amount of opposition to her decision, by her own health care experts, it is hard to imagine that this Minister will not be required to either correct her grievous action, or be replaced by one who understands that it is the obligation of public health officials to put the best interests of his/her citizenry above his/her personal ideologies and biases.

–Dr. Steve D. Slott, DDS

Thank you, Steve, for your comments.

The post Guest Post: Dr Steve Slott debunks “Review confirms fluoridation must end” appeared first on Making Sense of Fluoride.