As an expat living in the States it’s hard not to compare the US with my native country, Belgium. When people ask me “What is it that you dislike the most in America? ,” I answer without hesitation “the bad taste and smell of the water.” I’m not really sure of the cause, but looking into it made me aware of the water fluoridation problem. With this blogpost I’m hoping to raise more awareness about water fluoridation in the US, because I think a lack of awareness might be the main reason why water is still being fluoridated here, while it is not anymore in Europe.
Water fluoridation initiated in the 1940s, but since then has been banned in the majority of non-English speaking countries (e.g. China, Japan, most of Europe). Fluoride is thought to reduce tooth decay. The bacteria in our mouth love to eat our leftovers (esp. sugars). The acids they produce during digestion demineralize our tooth enamel. Some of the mineral loss can be recovered—or remineralized, a process that is boosted by fluoride ions (but not dependent on it). Caries are formed when the rate of demineralization exceeds the rate of remineralization. It is widely accepted that fluoride’s helping function only works by topical means. The reasoning behind water fluoridation is that tap water with fluoride added will end up in our saliva, thus helping to prevent caries.
The benefits and downsides of water fluoridation have been debated since its introduction, but I’m a scientist, not a dentist so I’ll reserve comment on the effectiveness of fluoride on reducing tooth decay and instead simply share some facts I learned when reading about it:
– Topical application of fluoride is what prevents caries so, only topical fluoride products (e.g. toothpaste) are likely to provide optimal benefits. However, there are no known naturally occurring compounds of fluorine in the human body, showing that there is actually no requirement for it at all.
– In 1975, the U.S. Food and Drug Administration (FDA) labeled fluoride as “not generally recognized as safe” and prohibited the addition of fluoride to food or to dietary supplements. Strangely, the Department of Health, Education and Welfare (now Health and Human Services) exempted fluoridated water from this ban, including fluoridated water used to process food.
– Usually, the natural mineral fluorite, calcium fluoride (CaF2), is the source of fluoride ions. At the start of water fluoridation they introduced sodium fluoride (NaF) into our municipal water systems, but today they are almost exclusively using hexafluorosilicic acid (H2SiF6) and its sodium salt (Na2SiF6). This is actually a byproduct from the phosphate fertilizer industry. It is recovered in an unrefined form by scrubbing the gaseous emissions from the treatment of phosphate ores with sulfuric acid. The resulting fluorides are not pure, but contain variable amounts of lead, arsenic, beryllium, vanadium, cadmium, and mercury. Because of this change in fluoridation agent, studies based on the use of natural calcium fluoride or on chemically pure sodium fluoride are irrelevant, even had they been done correctly.
– Many corporations benefit from water fluoridation, including US Steel, DuPont, Alcoa, Alcan, Reynolds Metals, Kaiser Aluminum, Allied Chemical, and the Florida phosphate fertilizer industry. They are able to profit by selling 155,000 tons of fluoride byproducts per year for water fluoridation instead of having to dispose of them as toxic waste at great expense.
– In the US, fluoride is also present in bottled water. However, you might not realize it, as the label on your bottle won’t specify. Also, filtration does not eliminate fluorides because the diameter of these ions is too small to be captured by the filter. Only reverse osmosis or distillation removes them from water.
– Both beneficial and harmful side effects of water fluoridation have been highly disputed. There are difficulties in interpreting studies done to test the effect of fluorides. For example, the multiple pathways of dental caries development make it difficult to accurately ascertain the contribution of fluoride ingestion to dental caries prevention. When reading about this topic, questions to ask yourself include: Who did the research? Was it sponsored by industry/organizations? How long was the testing period? What was the source of fluoride? How did they address other possible contributing factors such as diet, calcium uptake, age, natural population variation (and genetics), mouth hygiene, etc.
Even if, in the best scenario, added fluoride does help reduce tooth decay, this is just one possible benefit versus many possible side effects (e.g. dental fluorosis, joint problems, weaker bones, cancer, decreased thyroid function, neurologic damage and even impaired brain development in children). Would you “gamble” on something with those odds?
– The majority of the studies showing the benefits of fluorides are focused on tooth caries of deciduous (baby) teeth. But… don’t we lose them anyway?
– If fluorides do reduce tooth decay they should be considered a medicine. By introducing fluorides into our tap water this medicine is forced upon people who do not want it. This is arguably a violation of law, because in the United States, people may not be medicated without their permission. Moreover, no single dosage works for everyone. If, for example, 4 ppm is acceptable for an adult, this might only be 2 ppm for a developing child, and less than 1 ppm for a baby. By adding fluoride in the public water supply, the intake of this “medicine” is involuntary and the dosage uncontrollable.
A question to ask ourselves: are there alternatives for fluorides that could help prevent tooth decay, thus relieving the need for water fluoridation? How are remineralization processes promoted in biological systems? Could those provide a model for a replacement strategy that employs more life friendly chemistry?
Please feel free to react, raise questions, and share your knowledge of this topic; but most of all please help raise awareness and trigger action. We can stop water fluoridation!
– McDonagh, Marian S., et al. “Systematic review of water fluoridation.” Bmj 321.7265 (2000): 855-859.
– Wei Sheng Yan Jiu “Effect of fluoride in drinking water on children’s intelligence.” (1999): 337-8.
– Kauffman, Joel M. “Water fluoridation: a review of recent research and actions.” Journal of American Physicians and Surgeons 10.2 (2005): 38.
– Harrison, Paul TC. “Fluoride in water: a UK perspective.” Journal of Fluorine Chemistry 126.11 (2005): 1448-1456.
– Cartona, Robert J. Review of the 2006 United States National Research Council report: Fluoride in drinking water. Technical Report, 2006.
– Peckham, Stephen, and Niyi Awofeso. “Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention.” The Scientific World Journal 2014 (2014).