Http://www.jpands.org/vol10no2/kauffman.pdf

Water Fluoridation:a Review of Recent Research and Actions antifluoridation activists of promoting water fluoridation as a Joel M. Kauffman, Ph. D.
method of toxic waste disposal.2,3 Information concerning the
ABSTRACT
quantities of the waste and the proportion used in fluoridation hasbeen unobtainable. The purported value of fluoridation for dental Fluoridation of drinking water began 60 years ago in the United health has, however, served to mitigate concerns about the toxicity States, and it continues in 60% of public water supplies in the country today. Much of Australia, Canada, Ireland, and New The Manhattan Project made use of uranium hexafluoride gas, Zealand have fluoridated water, but most developed non-English fluoroorganic lubricants for metal bearings, and other fluorine- speaking countries have rejected this practice as nonbeneficial and containing materials. Aluminum production, which increased greatly in World War II, utilized cryolite (Na AlF ). Zinc and Current fluoridating agents, sodium hexafluorosilicate and fluorocarbon production also soared with emissions of fluoride ion hexafluorosilicic acid, which replaced sodium fluoride by 1980, differ from the calcium fluoride in naturally fluoridated water, which An Alcoa-sponsored biochemist, Gerald J. Cox, fluoridated was the basis for claims of tooth decay prevention in early some laboratory rats in a study and concluded that fluoride reduced epidemiologic studies. Studies reported in the past 15 years support only possible slight benefits from water fluoridation for the cavities, writing that: “The case should be regarded as proved.” deciduous teeth of 5-year-old children, although topical fluoride On Sept 29, 1939, at a meeting of the American Water Works Association in Johnstown, Pa., “…Cox proposed that America Harmful effects may include bone and tooth fractures and should now consider adding fluoride to the public water supply.” In the 1940s, certain major figures in the Manhattan Project and Complex legal maneuvers have been used in an effort to in fluoride-waste-producing industries succeeded in using some prevent or stop fluoridation. The case against it has been weakened epidemiologic studies, now discredited,5 to allow public water
by opponents’ condemnation of all organofluorine compounds.
supplies to have sodium fluoride added in order to prove that 1 ppm Individuals can use several methods to remove fluoride from of fluoride ion would “prevent tooth decay in children.” None of these or later studies followed other dental or medical outcomes offluoride consumption over long periods, a flaw that remains in Essential Chemistry
many medical trials to this day.6
Henry Trendley Dean, D.D.S., a U.S. Public Health Service Fluorine (F or F—F) is element #9 in the Periodic Table. The researcher, at first opposed the addition of fluorides to city water supplies because of toxicity. He later changed his mind, perhaps accompanied by a cation such as sodium (Na ), believing that mottled teeth were a small price to pay for less decay, - or NaF). Other inorganics, such as liquid hydrofluoric acid or perhaps for other reasons. He later became the first Director of (HF, often called hydrogen fluoride as a gas), hexafluorosilicic acid the National Institute of Dental Research (NIDR), and then, in (H SiF ), and compounds with a P—F bond, such as the sodium 1953, a top official of the American Dental Association (ADA), two monofluorophosphate (Na PO F) used in toothpaste, as well as organizations that remain unshakably committed to fluoridation.
organics, such as methansulfonyl fluoride (CH SO F) and acetyl They claim the credit for the drop in tooth decay in the United States fluoride (CH COF), also form F- in water or alkali.
The trifluoromethyl group (CF —) or the fluorophenyl group Once opposition by professionals was overcome, largely (FC H —) are often incorporated into drug molecules to make them through the ADA and NIDR, the selling of fluoridation to the public more resistant to being metabolized. Organic polymers (Teflon) was aided by hiring Edward L. Bernays, often called “the father of and refrigerants with —CF — groups are usually extremely stable public relations,” who had been hired earlier by the tobacco industry to persuade women to take up smoking.
Fluoridation with sodium fluoride (NaF) was begun in the Brief History of Fluoridation
United States in 1945. Today, fluoridation uses hexafluorosilicicacid (H2SiF6) and its sodium salt (Na2SiF6) almost exclusively.
By the early 1900s it was noticed that inhabitants of some areas These are not pure, but recovered in crude form by scrubbing the of the United States, especially parts of Colorado and Texas, had gaseous emissions from the treatment of phosphate ores with mottled teeth (dental fluorosis), and that children with fluorosis sulfuric acid. They contain variable amounts of lead, arsenic, tended to have fewer cavities.1 Usually the natural mineral fluorite,
beryllium, vanadium, cadmium, and mercury.1 Because of this
calcium fluoride (CaF ), is the source of fluoride ion.
change in fluoridation agents, old studies based on the use of Industries that produced large quantities of fluoride byproducts natural calcium fluoride or on chemically pure sodium fluoride are were especially interested in this effect and have been accused by irrelevant, even had they been done correctly. Calcium is a strong Journal of American Physicians and Surgeons
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Children
%
ppm Fluoride
Figure 1. Tooth decay rates in 5-year-old children (left scale) vs. water
Figure 2. Study of tooth decay in 29,000 elementary schoolchildren in
fluoridation percentage (right scale) and fluoride toothpaste percentage Tucson, Ariz., vs. fluoride content of their drinking water. Reprinted from (right scale). From Colquhoun,9 cited in Groves,1 reprinted with permission.
5 with permission.
antagonist of fluoride, reduces its concentration in plasma, and While the ADA, the Centers for Disease Control and Prevention inhibits its absorption from the intestine.7
(CDC), and the NIDR of the National Institutes for Health (NIH) Fluoridation at 1 ppm fluoride reached its current extent by still support fluoridation, some 17 U.S. organizations have 1965. The proportion of fluoridated public water supplies is about withdrawn their support since 1990, including the American 60% in the United States, 66% in Ireland, 55% in Canada, and 10% Academy of Allergy and Immunology, the American Academy of in England. Australia and New Zealand also use fluoridation Diabetes, the American Cancer Society, the American Diabetes extensively. At present almost none of the public water supplies in Association, the American Nurses Association, the American Austria, Germany, Luxemburg, Denmark, Finland, Norway, Psychiatric Association, the National Kidney Foundation, and the Sweden, the Netherlands, Switzerland, France, Italy, Belgium, Society of Toxicology.1
Switzerland, Spain, Hungary, Portugal, Greece, Japan, and China Discussion of the scientific studies on fluoridation, as presented are fluoridated. About half of these countries tried fluoridation, saw in the following sections, has been neglected by most of the media no benefit, and stopped it.1
in the United States. The unique journal Fluoride is not covered by U.S. studies on the toxicity of fluorine compounds, not PubMed. Michael Easley, M.P.H., national spokesman on necessarily the ones used to fluoridate water, have reportedly been fluoridation for the ADA, posted the following on the internet for suppressed, classified, censored, and removed from the National dentists in 1996: “.anti-fluoride cultists will not be dissuaded by Archives.2 Some of this activity has been traced to Harold
the truth.… Let them spew their garbage, ignore them, and go on Carpenter Hodge, Ph.D., a biochemist and toxicologist at the with your discussions as if they weren’t there…. [T]heir twisted University of Rochester, where he supervised experiments for the minds have accepted the notion that it is OK to lie, slander, libel, Manhattan Project involving the injection of unsuspecting exaggerate, misquote.… [S]ee what kooks they really are.”1 Some
hospital patients with uranium and plutonium compounds. He of the purported “lies” are presented in the next sections.
later became chairman of the National Research Council’s Committee on Toxicology and the leading promoter of Does Water Fluoridation Prevent Tooth Decay?
fluoridation in the United States during the Cold War. In 1953,
Hodge, using data from a European study,1 estimated that the
Dean ran the first trial of fluoridation in Grand Rapids, Mich., in amount of daily fluoride intake for 10-20 years that would not 1945, declaring it a success in comparison with nonfluoridated cause crippling skeletal fluorosis was 20-80 mg/day. It was later Muskegon, Mich. Since that time, he twice confessed in court that found that he had confused mg/kg with mg/lb. An American statistics from the early studies were invalid.1
antifluoride campaigner, Darlene Sherrell, used the same Newburgh, N.Y., next to be fluoridated in 1945, was compared European study from 1937 to estimate that skeletal fluorosis might with Kingston, N.Y., as a control. Early reports were favorable. But be avoided with intakes of no more than 10-25 mg/day.1
by 1989 workers at the New York State Department of Health found In 1975, the U.S. Food and Drug Administration (FDA) a difference of less than 1 fewer teeth decayed in 7-14–year-old explicitly designated fluoride as “not generally recognized as safe” children in Newburgh, favoring fluoridation. And by 1995 and permitted no fluoride whatsoever to be added to food or to over- children’s teeth in Kingston had slightly less tooth decay and half as the-counter dietary supplements. Nevertheless, the Department of much damage from fluoride.1 This negative result was possibly
Health, Education and Welfare (now Health and Human Services) caused by a change in the fluoridation agent, or possibly by more exempted fluoridated water from this ban, including fluoridated water used to process food.1
North Shields, England, has no natural fluoride in its water, In 1985, the U.S. Environmental Protection Agency (EPA) set 4 while South Shields has 1.4 ppm. While children of the same age ppm (up from 2 ppm) as the safe level for fluoride in drinking water had fewer decayed teeth in fluoridated South Shields, it was noticed and prevailed in a lawsuit challenge.1
that the onset of decay was merely delayed 3 years.1 This finding
Journal of American Physicians and Surgeons
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Children
Decay increase with 1ppm fluoride increase = 7%
Children
ppm Fluoride
ppm Fluoride
Figure 3. Study of tooth decay in 22,000 Japanese schoolchildren vs.
Figure 4. Study of tooth decay in 400,000 Indian schoolchildren vs. fluoride
fluoride content of their drinking water. Reprinted from Judd,5 with
content of their drinking water. Reprinted from Judd,5 with permission.
may invalidate the early Michigan and New York trial results and 4). The percentage of children with decay was 23% at 0.0 ppm F-; confirm the findings by Yiamouyiannis8 that fluoride lowers decay
35% at 0.7 ppm; and 75% at 2.75 ppm.5, 7 Other studies over a 30-
year period prompted Teotia and Teotia to write: “.dental caries A favorable report on fluoridation from New Zealand was were caused by high fluoride and low dietary calcium intakes, found to be biased by the deliberate choice of the nonfluoridated separately and through their interactions.… The only practical and communities with the highest tooth decay rate in comparison with effective public measure for the prevention and control of dental the two fluoridated communities with the lowest decay rates. When caries is the limitation of the fluoride content of drinking water to all decay rates for all children in that area of New Zealand were <0.5 ppm, and adequate calcium.(> 1 g/day).”7
compared, there was no difference with respect to fluoridation.9
Over a 20-year period from 1965-1985, the average number of Also, in New Zealand the number of decayed teeth per 5-year-old decayed, missing, or filled teeth (DMFT) in 12-year-old children child has decreased steadily from 12 teeth in 1930 to 3 teeth in 1990.
dropped by 50% in the United States. Proponents of fluoridation Neither the introduction of fluoridated water nor fluoridated and vendors of fluoridated dental rinses and toothpastes took credit toothpaste changed the downward slope of the graph of decay (see for this. However, the following nonfluoridated countries had even Figure 1). Because of this, John Colquhoun, appointed to promote greater reductions in DMFT during similar 20-year periods: the fluoridation in New Zealand, now opposes it.9
Netherlands, 72%; Sweden, 82%; Finland, 98%.5,10 No adjustments
According to World Health Organization (WHO) figures, the were made for some of the obvious confounders, such as most fluoridated country in the world, Ireland at 66%, does not have consumption of refined carbohydrates and the other mineral the least tooth decay. The five countries with less tooth decay contents of water supply.5,7 Native Americans on reservations in this
(Finland, Denmark, UK, Sweden, and the Netherlands) had little or country have by far the most decay of any ethnic group in the United no water fluoridation (the rate was 10% in the UK).1
States, despite forcible fluoridation of their water and free dentistry Chile began fluoridating water in 1985, but stopped it when the for more than 50 years.5
average of 6.0 decayed teeth per 12-year-old child, which dropped There was an overall increase in children 5-17 years old to 5.3 by 1991, increased to 6.7 in 1995.1
(median age 13) with tooth decay after initiation of water A study of 29,000 elementary school children in Tucson, Ariz., fluoridation. The tooth decay rate of children living in showed much more tooth decay when the fluoride level in the nonfluoridated American cities with average decay rates was 65% drinking water was higher (see Figure 2).5 The extremes ranged
with natural fluoride levels of 0.4 ppm fluoride. This increased to from 6% of children with some decay in areas with water 67% with fluoridation to 1 ppm. In high-decay cities, the decay rate containing 0.0 ppm fluoride to 40% of children with some decay in of 71% with 0.4 ppm fluoride increased to 75% with fluoridation to areas with water containing 1.0 ppm fluoride.
1 ppm, according to a 1990 study of 39,207 children, aged 5-17, in Fluoridation was forced on parts of Japan during its occupation by the United States. A study reported in 1972 on 22,000 schoolchildren (median age 13, range 5-17) showed 90% with 1986-1987 study by dentists trained by the NIDR showed that the some tooth decay at 0.0 ppm fluoride. This high number was decay rate of deciduous teeth in 5-year-olds was significantly lower attributed to the absence of calcium in the water. A minimum in in fluoridated areas (1.5 teeth per child) than in nonfluoridated decay (38% of children) occurred with 0.3 ppm fluoride and more areas (2.0 teeth per child), as shown in Figure 5. However, the calcium content. This increased to 44% at 1.0 ppm fluoride and decrease was no longer significant in 6-year-olds, and did not exist further to 55% with decay at 3.0 ppm fluoride and still more in children age 7 or older. Moreover, decay rates in permanent calcium (see Figure 3). Japan subsequently reduced the maximum teeth in children aged 5-17 did not differ significantly at any age in allowed fluoride level to 0.05 ppm.5
areas with no, partial, or total fluoridation of water supplies (see The largest study on fluoridation and tooth decay involved Figure 6).8 Earlier, widely accepted claims of caries reduction of
400,000 students (median age 13, range 5-17) in India (see Figure 60% by fluoridation, published in the Journal of the American Journal of American Physicians and Surgeons
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Medical Association and the Journal of Dental Research using datafrom the same source, were not substantiated by Yiamouyiannis.
On the basis of observational studies, Hardy Limeback, B.Sc., Ph.D., D.D.S., head of the Department of Preventive Dentistry for the University of Toronto and President of the Canadian Association for Dental Research, announced a reversal of his earlier profluoridation views. In an April 1999 interview, Limeback, once the primary promoter of fluoridation, stated: “Children under three should never use fluoridated toothpaste or
drink fluoridated water. And baby formula must never be made up
using Toronto tap water. Never.” He remarked that “Vancouver,
never fluoridated, has a lower cavity rate than Toronto, which has
been fluoridated for 36 years [through 1999].”11,12
In a recent article in the Journal of the American Dental Association, Featherstone wrote that: “Fluoride incorporated Figure 5. Decay of deciduous teeth in 39,207 white children in 84 areas in
during tooth development is insufficient to play a significant role in the United States. F, fluoridated; PF, partially fluoridated; NF,
caries protection.”13 In fact, fluoridation of municipal water
nonfluoridated areas. Reprinted from Yiamouyiannis,8 with permission.
supplies increases tooth decay overall in some studies and has notbeen demonstrated to be effective in prevention of decay in themost convincing studies, such as those of Colquhoun, Kalsbeek,and Yiamouyiannis, he concluded.
The effects of fluoridation were praised in a 2004 book, Fluorides in the Environment: Effects on Plants and Animals by
L.H. Weinstein and A. Davison, but expert reviewers considered
the book to be blatantly biased.14
Fluoride Supplements and Topical Application
No adequate evidence for the effectiveness of fluoride supplements as pills or drops, or topical application of fluoride by means of toothpaste or dental rinses, had ever been presented.1
Colquhoun’s study concluded there was also no benefit from
fluoridated toothpaste.9
“Until recently, the rationale for most caries preventive programs using fluoride was to incorporate fluoride into thedental enamel. The relative role of enamel fluoride in cariesprevention is now increasingly questioned, and based on rat experiments and reevaluation of human clinical data, it appears to
be of minor importance…”.15 In fact, “…the prevalence of dental
caries in a population is not inversely related to the concentration
of fluoride in enamel, and a higher concentration of enamel
fluoride is not necessarily more efficacious in preventing dental
caries.”16 Limeback found on reexamining the literature that
topical effects of fluoride on newly erupted teeth were more likely
to explain any benefit of fluoride than swallowing it in water or pill form.13 In vitro experiments showed that topical fluoride
might protect tooth enamel by inhibition of bacterial metabolism, limiting acid generation.17
Is Fluoridation Safe for the General Population?
In a report authored by Perry D. Cohn, Ph.D., M.P.H., for the New Jersey Department of Environmental Protection and the NewJersey Department of Health, the rates of bone cancer in fluoridated and nonfluoridated areas were compared. Both by counties or bymunicipalities, males under the age of 50 had 3 to 7 times as many Figure 6. Decay of permanent teeth in 39,207 white children in 84 areas in
bone cancers in the fluoridated areas. Males 10-19 years old fared the United States. F, fluoridated; PF, partially fluoridated; NF,
nonfluoridated areas. Reprinted from Yiamouyiannis,8 with permission.
the worst.18 An external review panel found no serious flaws with
the study.
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Cancer rates in the ten largest fluoridated cities in the United propellants, and many drugs. Drugs that contain fluorine include: States and in the ten largest nonfluoridated cities were found to be fluoxetine (Prozac), ciprofloxacin (Cipro), flunitrazepam the same before fluoridation began. After 20 years, the ten (Rohypnol), fluconazole (Diflucon), fluticasone (Flixonase or fluoridated cities had 10% more cancer deaths than the Flixotide), trifluoperazine (Stelazine), flucoxacillin (Floxapen), nonfluoridated cities. The cancers were found in the tongue, mouth, cerivastatin (Baycol), cisapride (Propulsid), astemizole pharynx, esophagus, stomach, colon, rectum, pancreas, larynx, (Hismanal), and fenfluramine (Pondimin). In fact, none of these bronchi, and lungs.1
materials either contain fluoride ion or are metabolized to generate Hip fractures in two cities in Utah were compared: fluoridated any significant amount of fluoride ion. All contain the very stable Brigham City and nonfluoridated Cedar City. In the fluoridated (1 carbon-fluorine bond in the form of trifluoromethyl (CF3—), ppm) city, the hip fracture rate was twice as high as in the difluoromethylene (—CF2—), fluoroalkane (—CHF—), or nonfluoridated city, in women around age 75. Men aged 80-85 also fluorophenyl (FC6H4—) groups. The fluoro groups are chosen for had twice the hip fracture rate in fluoridated Brigham City.19 The
the drugs to retard their metabolism, increasing the duration of insidious nature of fluoride toxicity is that it does not cause bone effective drug levels in the body. Judd, a chemist, did not make the density loss as found in osteoporosis by bone scans, but causes an mistake of confusing fluorine with fluoride in his book.5
increase in bone density with no clinical benefit. Fluoride makes For Teflon, the maximum continuous service temperature is both bones and teeth more brittle.1,20 Early reports of supposed
listed as 260°C or 500°F in the Chemical Rubber Co. Handbook of benefits of fluoridation to bone were quoted without citing later 1976-1977. Overheating Teflon may produce an irritant, perhaps corrections or retractions.20
perfluorooctanoic acid, but the irritant is unlikely to be fluoride ion.
Dr. A. K. Susheela of the India Institute of Medical Sciences in Asked for evidence on the toxicity of Teflon, the scientific advisor New Delhi found that fluoride severely disrupts formation of bone to one of the antifluoridation groups sent citations to four papers on matrix, inhibiting the hardening of bones. She found that about 20 the decomposition of Teflon by ionizing radiation. Clearly this is countries in the world have serious health problems due to excess irrelevant to ordinary use in cooking.
fluoride. Her work showed that high levels of fluoride in drinking Fluorocarbon refrigerants and propellants such as R12, and water were associated with birth defects, stillbirths, and early flourine-containing general anesthetics such as halothane and infant mortality.1
methoxyflurane, are metabolized very slowly or not at all.
Excess fluoride may also have detrimental neurologic effects.
However, some of the fluorine in the general anesthetics enflurane, Rats given sodium fluoride in their drinking water at a concentration desflurane, and isoflurane is metabolized to fluoride ion.26
producing a plasma level of fluoride equivalent to that found in Asked for evidence on the toxicity of fluorinated drugs, the humans consuming water with 4 ppm of fluoride developed scientific advisor to one of the antifluoridation groups provided symptoms resembling attention deficit-hyperactivity disorder. 21
citations to 13 papers. Ten of the 13 were published in 1952 or Gerard F. Judd, Ph.D., lists 113 ailments reportedly caused by earlier. Some concerned analytical methods and methods of fluoride, all with literature citations to studies, of which 13 were synthesis of fluorine-containing compounds. Citations from the double-blinded.5 So far, there are no known naturally occurring
1930s showed the toxicity of sodium fluoride from its interference compounds of fluorine in the human body.22 Fluorine is not listed as
with thyroid hormone biosynthesis.27 Another from 1949 showed
even a trace element in whole body assays,23 showing that there is
that that 3-fluoro-5-bromo(or iodo)tyrosine was toxic in mice, and five other fluorophenyl compounds less so.28 The toxicity of 3-
Water fluoridated to 1 ppm fluoride is not safe in the general fluorotyrosine and 3,5-difluorotyrosine was confirmed, including population. How much of the toxicity results from the arsenic and in humans,29-31 but this is a special case in which these amino acid
heavy metal contamination in the newer fluoridating agents is not derivatives interfere with thyroid hormone biosynthesis.
yet known. Additionally, certain populations such as patients with Ciprofloxacin, like all drugs, is associated with some diabetes or renal impairment are at increased risk, especially if they toxicity—but not from fluoride. The scientific advisor to one of the drink more than average amounts of water.24 A study comparing 25
antifluoridation groups cited a report showing elevated serum and young adults with fluorosis against 25 matched controls showed urine levels of fluoride in children after administration of this very significant impairment of glucose tolerance in those with drug.32 The actual elevation of fluoride in serum was from 0.08 to
fluorosis, which, however, was reversible when water with low 0.21 ppm in 12 hours, and could not account for more than a fraction fluoride levels was given.25
of the fluorine (23 mg) in the 400 mg doses used of ciprofloxacin;moreover, there was no follow-up measurement. The elevation of How Antifluoridationists Have Weakened Their Case
fluoride in urine from 0.97 to 1.12 ppm after a week was notstatistically significant. The authors did not try to measure Groups such as Parents for Fluoride Poisoned Children (PFPC), fluorinated metabolites or unchanged drug, and after MRI scans based in British Columbia, Canada, and the National Pure Water and about 2 years of follow-up by physical examinations, they Association Ltd. in the UK justifiably attempt to prevent pronounced short courses of ciprofloxacin safe in children.
fluoridation of water. Unfortunately, they suffer from Although ciprofloxacin liberates fluoride under UVB illumination chemophobia, which is not only a fear of all “chemicals,” but a fear in vitro, it is metabolized in vivo mostly by hydroxylation and N- of consulting with chemists. As a result, they list any material that sulfation, not by loss of fluoride ion.26
contains fluorine in any form as a danger by claiming that it The risk of rhabdomyolysis, the major toxicity of the statin contains “fluoride,” and certain book authors and many website drugs, is about the same with atorvastatin and pravastatin, which authors opposing fluoridation repeat this unsound assertion. The contain fluoro groups, and simvastatin, which does not.33 A group at
list includes Teflon and Tefal non-stick pan coatings, fluorocarbon Duke University Medical Center searched the literature from Journal of American Physicians and Surgeons
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November 1997 to February 2002 to find 60 cases of statin-induced Since fluorides have been shown in some studies to increase the memory loss, of which 36 were due to simvastatin, 23 to risk of cancer, addition of any of them in any amount to water atorvastatin, and 1 to pravastatin.34 Clearly, there is no correlation
violated the Delaney Clause of the 1958 Amendment to the Food, with the presence of a fluoro group.
Drug, and Cosmetic Act of 1938.37 The Delaney Clause was
Thus, the scientific evidence presented by members of certain repealed in 1996 with passage of the Food Quality Protection Act. A antifluoridation groups and by others does not support their stronger argument based on the cancer issue is that adding fluoride assertion that all fluorinated organic compounds are toxic because violates the EPA policy on setting drinking water standards under they contain fluorine. The case against fluoridation needs to be the Safe Drinking Water Act. Under this provision, the Maximum made solely on the basis of the effects of fluoride ions and their Contaminant Level Goal (a pure health-based standard) for carcinogens is zero, so adding any fluoride should be banned. Thisis apparently why the 1990 National Toxicology Program bioassay Who Benefits from Fluoridation?
on sodium fluoride was “revised” so that the findings went from“clear evidence of carcinogenicity” to “equivocal” evidence.
Groves’s book does not explain how water fluoridation can be Without that change, the fluoridation program would have been continued despite all the evidence against it. Bryson’s book, unsustainable under law. Bottled water in a local supermarket however, suggested that many corporations benefit. These sports an FDA-style food label, making it a food under the law. The included: US Steel, DuPont, Alcoa, Alcan, Reynolds Metals, Kaiser FDA position that fluoride is neither an essential nor probably Aluminum, Pennsalt Chemicals (now ELF Atochem), Allied essential nutrient and is not safe at any level is inconsistent with its Chemical, and the Florida phosphate fertilizer industry.
allowing fluoride to be added to a food.1
Philadelphia, Pa., obtains its hexafluorosilicic acid from Solvay Fluoride in water is also a medication that is forced upon people Fluoride. A dozen other manufacturers of hexafluorosilicic acid are who do not want it. This is arguably a violation of law, because in the listed on an antifluoridation website sponsored by the Fluoride United States, people may not be medicated without their Action Network Pesticide Project. It is stated that industry is able to permission. Fluoridation is different from chlorination of water profit by selling 155,000 tons of fluoride byproducts per year for because the chlorine is used to kill microbes, not to medicate people.
water fluoridation instead of having to dispose of them as toxic In India, the government constructed defluoridation plants and waste at great expense.2 Another consideration might be avoiding
attempted to end sales of fluoridated toothpaste, based on enormous tort liability that could be incurred if toxicity were Susheela’s work on the toxicity of fluoride.1 Unfortunately, in the
officially recognized (especially in the absence of the EPA’s “safe” United States, class-action lawsuits may be the only way to influence municipal authorities, who are operating on the basis ofold, erroneous information on which legal precedent rests.
How Can Fluoridation of Water Be Stopped?
Removal of Fluoride Ion from Tap Water
Despite evidence for negligible benefit and considerable risk, the ADA, the American Medical Association (AMA), the CDC, the Since prevention or ending fluoridation of public water supplies NIDR, the British Fluoridation Society, the WHO, and others have is so difficult, your patients may wish to remove fluoride ion from not retreated from their support for fluoridation. Because their drinking water. Filters do not work because the diameter of a opposition has been marginalized, primarily by ignoring it, the only fluoride anion is 0.064 nm. Activated carbon “filters” are not route to change appears to be through litigation.
effective, nor are water-softeners based on cation exchange resins Had there been only one or two failed lawsuits over the years, designed to take out calcium, magnesium, and iron, not anions. It one might conclude that the antifluoridation cause is hopeless. In might be possible to make effective anion exchangers.
fact, lawsuits have met with some success. Antifluoridation There are three effective methods: use of a cartridge containing lawsuits were argued by attorney John Remington Graham in non- activated alumina adsorbent, the most expensive because the jury trials in Pittsburgh, Pa., in 1978; Alton, Ill., in 1980; and cartridge must be changed so often; reverse osmosis; and Houston, Tex., in 1982. In all cases, the judges found for the distillation, the least expensive method. Distillation costs about 7 plaintiffs and issued injunctions against fluoridation on the grounds cents per liter for electricity and about 2 cents per liter for that it caused cancer and other ailments in humans. Based on the depreciation of a distiller costing $135 at Sears, assuming a 5-year injunction in the Pittsburgh case, the Province of Quebec, Canada, life. Distilled water is often passed through an activated carbon stopped fluoridating. However, all three cases were overturned on filter to remove volatile organics, and aerated for flavor.38,39
appeal on trivial legalistic grounds. In spite of the appellate actions,however, the judicial findings of fact, namely that fluoridation is an Conclusions
unreasonable risk to public health, remain on the record andunchallenged. After the Alton case, an attorney for the ADA, who Artificial fluoridation of drinking water by municipalities at 1 was a member of the Rules Committee of the Illinois Supreme ppm of fluoride ion probably does not reduce tooth decay, except Court, told an audience that he was the one who had secured a stay for a minor effect on deciduous teeth. Hexafluorosilicic acid and its of the execution of the nonfluoridation injunction.35
sodium salt, which contain other toxic substances because they are There have been five lawsuits resulting in judgments against not purified, certainly have no significant benefit.
fluoridation: two in Pennsylvania and one each in Indiana, Ohio, Proponents of fluoridation have censored most media, ignored and Missouri. None were decided on the merits of fluoridation, only intelligent discussion of fluoridation, slandered most opponents of on legal technicalities.36
fluoridation, and overturned legal judgments against fluoridation in Journal of American Physicians and Surgeons
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a manner that demonstrates their political power. Many published Centers for Disease Control and Prevention. Recommendations for usingfluoride to prevent and control dental caries in the United States. MMWR studies that had conclusions favoring fluoridation were later found 16 Fejerskov O, Thylstrup A, Larsen MJ. Rational use of fluorides in caries
There is evidence that fluoridation increases the incidence of prevention: a concept based on possible cariostatic mechanisms. Acta cancer, hip fractures, joint problems, and that by causing fluorosis it Odontol Scand 1981;39: 241-249.
damages both teeth and bones. Other medical problems may also Vanloveren C, Buijs JF, Tencate JM. Protective effect of topically applied fluoride in relation to fluoride sensitivity of mutans streptococci. J Dental Antifluoridationists compromise their credibility by 18 Cohn PD. An Epidemiologic Report on Drinking Water and Fluoridation,
unwarranted assertions that many stable fluorine-containing New Jersey Department of Health, November 1992.
19 Danielson C, Lyon JL, Egger M, Goodenough GK. Hip fractures and
The EPA should set the enforceable Maximum Contaminant fluoridation in Utah’s elderly population. JAMA 1992;268(6):746-748.
Level at 0.4 ppm fluoride in drinking water.
20 Lee JR. Editorial: fluoride and osteoporosis. Fluoride 1990;22(2):51-53.
21
The FDA should reverse its position on permitting sale of Mullenix PJ, Denbesten PK, Schunior A, Kernan WJ. Neurotoxicity of products containing fluoride that claim dental benefit without proof sodium fluoride in rats. Neurotoxicol Teratol 1994;17(2):169-177.
Lehninger AL, Nelson DL, Cox MM. Principles of Biochemistry. 2nd ed.
New York, N.Y.: Worth Publishing Group; 1993.
Fluoridation of municipal water should cease. Defluoridation 23 Minoia C, Sabbioni E, Apostoli P, et al. Trace element reference values in
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25
Joel M. Kauffman, Ph.D., is Professor of Chemistry Emeritus at the
Trivedi N, Mithal A, Gupta SK, Godbole MM. Reversible impairment of University of the Sciences in Philadelphia, 600 S. 43rd St., Philadelphia, PA, glucose tolerance in patients with endemic fluorosis. Diabetologia 19104-4495. E-mail: [email protected].
Acknowledgements: Frances Eleanor Heckert Pane, M.S.L.S., and Alayne
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Journal of American Physicians and Surgeons
Volume 10
Summer 2005

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