Why water fluoridation?!

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!

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Sources:

– 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).
http://fluoridealert.org

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4 comments

    • Daphne Fecheyr-Lippens

      Yes “caries” and “cavities” are the same. Sorry Emily, I should have listened to your suggestion to change it.

  1. Steve Slott

    The author of this piece claims to be a scientist, yet then goes on to do nothing but regurgitate the same garbled nonsense gleaned from the same antifluoridationist websites, as do most other uninformed antifluoridationists.

    So, let’s go through this mess, item by item.

    Fluoride at the optimal level as utilized in water, is colorless, odorless, and tasteless. It causes no “bad taste and smell of the water”.

    Water is fluoridated in many areas of Europe. The United Kingdom and Ireland both have widespread fluoridation. The reasons that some countries do, and some don’t are myriad, few related to concerns with effectiveness or purported adverse effects. Some countries fluoridate salt, some fluoridate milk, some have water systems that are not conducive to cost-effective fluoridation, some offer excellent access to dental care and have no need for fluoridation, just to name a few. Countries which fluoridate salt include France, Switzerland and Germany. Some countries have optimal levels of fluoride in their water naturally, thus have no need to add any further. It is estimated that 39.5 million people around the world have access to water with natural levels of fluoride at the optimal concentration.

    Neither China, Japan, nor “most of Europe” has “banned” fluoridation. As stated previously, the reasons countries may or may not fluoridate water, are myriad, few related to any concerns with effectiveness or adverse effects.

    Fluoride is not “thought to reduce dental decay”. It is a scientific fact that it does reduce dental decay. Countless, peer-reviewed scientific studies clearly demonstrate this. I will gladly cite as many as the author would reasonably care to see.

    It is not “widely accepted” that fluoride only works topically, by any who understand fluoridation. Fluoride works both systemically and topically to reduce dental decay. Mild dental fluorosis is a barely detectable effect of the teeth which causes no adverse effect on cosmetics, form, function, or health of teeth. Kumar, et al. have demonstrated mildly fluorosed teeth to be more decay resistant, a definite benefit. Mild dental fluorosis can only occur systemically, on developing teeth. Fluoride becomes incorporated into saliva which then bathes the teeth in a consistent manner with a low concentration of fluoride all during the day, a very effective means of dental decay prevention. Incorporation of fluoride into saliva occurs systemically.

    There is no debate about the “benefits and downsides of water fluoridation” amongst respected science and healthcare. The only “debate” is from antifluoridationists who disseminate a constant barrage of unsubstantiated claims. They then proclaim there to be a “controversy” based on these claims.

    As addressed previously, fluoride acts both topically and systemically to reduce dental decay.

    No one with any real understanding of fluoridation has ever claimed that its purpose is to correct any sort of fluoride “deficiency” of the human body. It is simply a very effective means of dental decay prevention.

    There has never been any “ban” on water fluoridation in the US. The DHHS would not have the authority to “exempt” fluoride from any such “ban” even if one did exist. Fluoride at the optimal level as added to water is under the complete regulatory authority of the US EPA, not the US FDA, not the US DHHS. There is requirement, nor any need for FDA approval of fluoridated water. Fluoridated water easily meets all EPA mandated certification requirements for safety under Standard 60 of the National Sanitary Foundation.

    Fluorine is an element that occurs in nature. Calcium fluoride is a compound composed of fluoride and calcium. It is not the “natural mineral fluorite” whatever that is supposed to mean. As groundwater courses over rocks, it picks up the compound CaF from those rocks. Once incorporated into the water, CaF releases a certain amount of fluoride ions into that water. These fluoride ions are to what is commonly referred as being “naturally occurring fluoride”. The compound most widely utilized to fluoridate water systems is hydrofluorosilic acid (HFA). Due to the pH of drinking water (~7), once added to this water, HFA immediately and completely hydrolyzes (dissociates). The products of this hydrolysis are fluoride ions identical to those released by CaF or any other compound, and trace heavy metal contaminants in barely detectable, minuscule amounts that fall far short of EPA mandated maximum levels of safety. After this point, HFA no longer exists in this water. It does not reach the tap. It is not ingested. It is of no concern, whatsoever. As elementary chemistry teaches, a fluoride ion is a fluoride, regardless the source compound.

    HFA is extracted from naturally occurring phosphorite rock as a co-product of the process which extracts the other co-product, phosphoric acid. The phosphoric acid co-product is utilized in soft drinks we consume and in fertilizers which become incorporated into foods that we eat. The HFA co-product is carefully diluted to a 24% aqueous solution which is used to fluoridate water systems whose “natural” level of fluoride is below the optimal. To irrationally fear the HFA co- product is to irrationally fear the phosphoric acid co-product. A complete, detailed listing of all contaminants in fluoridation including their minuscule concentration levels which fall far below EPA mandated maximum safety levels, can be found on the website of the National Sanitary Foundation.

    Sodium fluoride is not “chemically pure” and is not desirable to use for the large volumes required for water systems. The manufacture of sodium fluoride is for single use applications. This application falls under the jurisdiction of the FDA. While the contaminants in NaF fall well below FDA mandated maximum levels of safety for single use, when multiplied by the vast amount necessary for fluoridation of water systems, the NaF could actually contain more arsenic and other contaminants than does HFA. It certainly contains no less. As NaF is for single use applications, the control and reporting of contaminants is left up to the manufacturer, not the EPA. For large volume fluoridation of water systems, HFA is not only far more cost-efficient than NaF, but is also safer.

    Conspiracy nonsense about “big corporations, corruption”, etc. are irrelevant and indicative of the anti-government, anti-authority paranoia which has always been the driving force behind antifluoridationists, since the very beginning of this initiative.

    “Both beneficial and and harmful side effects of water fluoridation” have never been ” highly disputed” by anyone but antifluoridationists seeking to impose their personal ideology on entire populations. The basis they claim for these “disputes” has never been anything but unsubstantiated claims, half-truths, out-of-context quotes, misrepresented study conclusions, and misinformation. There is no “dispute” amongst respected science and healthcare. Countless, peer-reviewed scientific studies clearly demonstrate the effectiveness of fluoridation, while there is no valid scientific evidence of adverse effects. If the author cares to belabor this point, I challenge him to provide valid, peer-reviewed scientific evidence to support his claims. To the list of those things to “ask yourself” should be added a query as to the reliability of the source of information. The journal “Fluoride” is a “scientific” journal from which a significant amount of scientific “evidence” is quoted by antifluoridationists. In reality, “Fluoride” is nothing but an antifluoridationist outlet for studies so flawed and biased that respected journals will not publish them. “Fluoride” is so biased that PubMed does not even list it in its broad database. Antifluoridationist webstes, blogs, non peer-reviewed books, and “YouTube” videos are also favorite sources of “information” put forth by antifluoridationists. The filtered and edited “information” of such sources is proof of nothing other than the foolishness of those who accord it any credence.

    With the exception of mild to very mild dental fluorosis, a barely detectable effect which causes no adverse effect on cosmetics, form, function, or health of teeth, there is absolutely no valid, peer-reviewed scientific evidence to support the unsubstantiated, nonsensical claims of linkage of fluoridated water to “dental fluorosis, joint problems, weaker bones, cancer, decreased thyroid function, neurologic damage and even impaired brain development in children)”. If the author cares to belabor this point, I challenge him to provide valid, peer-reviewed scientific evidence to support his claims.

    Fluoridation provides dental decay protection for the primary and permanent dentition. First of all, the comment of “don’t we lose them anyway?” demonstrates a clear ignorance of facts. The health of primary teeth is a strong determinant of the health of the permanent teeth which replace them. Aside from the obvious extreme pain and life-threatening infection of untreated dental decay in primary and permanent teeth, badly decayed primary teeth can cause malformation, and malocclusion of the permanent dentition. Second, fluoridation strengthens developing permanent teeth systemically, a strengthening which protects these teeth for a lifetime. The constant decay prevention by low levels of fluoride protects teeth throughout the life of individuals of all ages, not just that of children.

    The “forced medication” ruse has been attempted by antifluoridationists repeatedly in US courts through the decades. It has been rejected each and every time by those same courts….for obvious reasons. Fluoride at the optimal level us simply a mineral identical to that which has existed in water since the beginning of time. Attempting to exploit the sufferings of those throughout history who have truly undergone the horrors of forced medication is yet one more despicable tactic utilized by antifluoridationists to further their personal ideology.

    There is no valid concern with “dose” in regard to fluoridated water. 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.

    At less than $1 per person per year for fluoridation, there is no other dental decay preventive measure that even comes close to the cost-effectiveness of fluoridation. As far as “more life friendly chemistry”, I once again challenge the author to provide valid, peer-reviewed scientific evidence that fluoride at the optimal level is, in any manner, not life friendly.

    Steven D. Slott, DDS

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