Letter to Health Professionals on Fluoride

7/27/2019 Letter to Health Professionals on Fluoride

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Alison McKellar79#Mechanic#Street,#Camden,#Maine#04843#Phone:##(207)#619>1530##!#E>Mail:#:#[email protected]#

Dear Mid-Coast Health Professional,

Almost 50 years ago, in an effort to address high rates of tooth decay among children, thiscommunity made a decision to start adding fluoride to our tap water, which originates from Mirror Lakeand serves about half the residents in the towns of Camden, Rockport, Rockland, Thomaston, and smallparts of Owls Head and Warren. After spending some time reviewing the history of the scientific researchand public policies regarding fluoride, I believe its time for our community to re-examine what we havelearned and what has changed in the 44 years since fluoridation began here. I am writing to ask that, as alocal health professional, you take a moment to review the current literature on the subject so as to beprepared for any questions you might receive from patients in the coming months.

Like most people, I had never thought much about fluoride. Recently, I began to wonder if my 3-year-oldson should start using fluoridated toothpaste. A quick web search will tell you that children under the ageof 2 should not, and the instructions on the back of the tube that I use say that children from 2-6 should

use only a pea-sized amount and be monitored by an adult to minimize swallowing. The label also reads,"If you accidentally swallow more than used for brushing, seek professional help or contact a poison control centerimmediately." Well, even with constant monitoring, my 3 year old accidentally swallows almost all thetoothpaste that goes in his mouth, so I wanted to know exactly how much fluoride he would be likely toingest and how much would be too much. At that point, water fluoridation wasn't even on my radar. Ifound that a pea-sized amount of typical fluoride toothpaste (1000 ppm fluoride) contains about .25 mg offluoride, roughly the same amount of fluoride as 10.5 ounces of our tap water, which averages .8 mg perliter. This came as a surprise to me, so I wanted to know a little more.

What is fluoride? How much is enough for a 3 year old? How much is too much?

It turns out that these are not easy questions to answer and experts disagree. What we do know is that theCDC reports that 41% of adolescents (12-15 year olds) now have some form of dental fluorosis, a

i i f h l d b h i i f h fl id d i h h h
mailto:[email protected]:[email protected]


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t t i i f th l d b th i ti f t h fl id d i th h th

Water Program, and read newspaper archives relating to the history of fluoridation in our water district. Ibegan my research 100% open-minded. In fact, I was swayed in the direction of favoringfluoridation. After all, I have fluoridated water in my own home and fluoride removal is expensive. Unlikechlorine, it cannot be removed by a simple Brita filter. I've been drinking it, giving it to my 3 year old, andeven prided myself on my eco-conscious avoidance of bottled water. In general, I tend to side with the

government on most public health measures. I vaccinate my children, etc, etc... Still, after reading theopinions of many experts on both sides of this issue, it seems like a strange way to prevent tooth decay inour community, a community in which only 50% of the population is served by municipal water.

As a 29 year old mother of a baby and toddler who grew up in the area, graduated from CHRHS, andmoved back to Camden about 5 years ago, I was a little surprised not to have heard more aboutfluoridation in the past. No water bill or newsletter from the water company ever mentioned anythingabout the water being fluoridated. New Hampshire recently passed legislation requiring that watercustomers be warned that mixing infant formula with tap water could increase the risk of fluorosis, buthere, no such policy is in place. Was I the only one who didnt know that something (a non-nutrient) isbeing added to our water for a purely dental benefit? Yet in my discussions with others my age, I've foundthat many people who are not old enough to have been a part of the initial debate simply do not know thatour water is fluoridated, much less why. Even some health professionals do not realize that we are afluoridated district. Most doctors and nurses I have spoken with havent thought about fluoridation in along time, and dont realize that many respected scientists and dentists, who once promoted the

practice, have changed their minds.

It has been almost fifty years since Camden, Rockland, and Thomaston approved fluoridation by a narrowmargin; having twice previously voted the measure down. Although the debate continues, one thing isvery clear to anyone who reviews the Camden Herald and Courier Gazette for the years of 1968 and 1969:The arguments used to promote it have changed vastly in the 44 years since the practice beganhere. I have included copies of health board statements and advertisements promoting fluoridation thatappeared in the Camden Herald and Courier Gazette in 1968 and 1969. At that time, doctors believed thatfluoride worked like an essential nutrient, that its benefit was primarily systemic, and that it wouldprevent all sorts of things, from tooth decay to bone fractures to arteriosclerosis. Today, even staunchadvocates of fluoridation recognize that most of those things turned out not to be true, and that fluorideworks much differently than we originally believed.

Fifty years ago, not a single fluoride toothpaste was available, and water fluoridation was considered theonly cost effective way of delivering fluoride to those who wanted it. We now have access to fluoride invirtually all toothpastes, and its widespread use as a pesticide (as sulfuryl fluoride and cryolite) leads tohigh levels of the chemical in unexpected places, such as non-organic grape juice. Since fluoride content


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PUBLICHEALTH

Lb f h i d b i d f 46 f h i 50 l i i O

New research indicates that a cavity-fightingtreatment could be risky if overused

By Dan Fagin

Second Thoughts about


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rected by Steven M. Levy of the University of

Iowa College of Dentistry. For the past 16 yearsLevys research team has closely tracked about

700 Iowa children to try to tease out subtle ef-

fects of fluoridation that may have been over-

l k d b i di A h i

is not as strong as it used to be. Instead of just

pushing for more fluoride, we need to find theright balance, Levy says.

The Advent of FluorideF d h d i f

[TRENDS]

FLUORIDATION ACROSS AMERICAWater fluoridation has spread across theU.S. since its introduction in 1945. In 2002,

the latest year for which data are available,

Americans receiving fluoridated water rep-

resented 67 percent of all people supplied

by public water systems and 59 percent of

the total population. Fluoridation is most

prevalent in the District of Columbia (100

percent) and Kentucky (99.6 percent) and

least common in Hawaii (8.6 percent) and

Utah (2.2 percent).

[THE AUTHOR]

59%oftheU.S.populationreceivedfluoridatedwaterin2002

WA

OR

ID

MT

WY

NV

CA

UT

AZ

CO

NM

TXAK

OK

KS

NE

SD

ND

MN

ME

NY

VTNH

MA

NJ

DEMD

CTRI

PA

WI

MI

ILIN

OH

WVVA

KY

TN

IA

MO

AR

LA

MS

FL

AL GA

SC

NC

HI

PERCENTAGE OF STATE POPULATIONS RECEIVING FLUORIDATED WATER, 2002< 25% 25%49% 50%75% >75%

Total U.S. populationSupplied by public water systems*Receiving fluoridated water

FLUORIDATION RISING IN THE U.S.

300

200

100

01945 1965 1985 2002

Year

Number

ofPeople(millions)

*Dat a on p ubl ic w ate r sy ste ms no t ava ila ble bef ore 196 4


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vored by dentists in office treatments, most wa-

ter suppliers eventually switched to the cheaper

option of fluoridating with silicofluorides such

as hexafluorosilicic acid, a by-product of a fer-

tilizer manufacturing process in which phos-

phate ores are treated with sulfuric acid.

By the 1970s and 1980s America was awash

in various forms of fluoride, and fluoridation

had become the cornerstone of preventative

dentistry in most English-speaking countries.

Exactly why and how much caries incidence de-

creased during the same period is a matter offierce debate, but the consensus among dental

researchers is that the decline was steep and that

fluoride deserved much of the credit.

That was the culture in which Levy got his

start in public health dentistry in the mid-1980s.

Colgate-Palmolive funded his early research,

which had the effect of encouraging more fluo-

ride use in dental offices. But as American den-

tists began to see fewer cavities and more fluo-rosis on the teeth of their young patients, Levy

started to wonder whether children were get-

ting too much of a good thing. There was a

transition in my own thinking from more fluo-

ride is definitely our goal to making sure we un-

derstand where the right balance is between

caries and fluorosis.

Fluorides role in causing one disease and de-terring another is rooted in the fluorine ions pow-

erful attraction to calcium-bearing tissues in the

body. In fact, more than 99 percent of ingested

fl id h i i kl d d i

Fluorides role in combating tooth decay is rooted in the ions powerfulattraction to enamel, the hard, white outer layer of the teeth.

[FOCUS ON TEETH]

p With Fluoride

The topical application of fluoride to theteeth has two effects. First, the fluorideions replace some of the hydroxyl groups inthe hydroxylapatite molecules, creatingfluorapatite crystals that are slightly moreresistant to the enamel-dissolving acid ex-creted by the bacteria. Second, the fluoride

FIGHTING CAVITIES

p Without Fluoride

The primary mineral in enamel is hydroxylap-atite, a crystal composed of calcium, phos-phorus, hydrogen and oxygen. When foodremnants become lodged between teeth,bacteria consume the sugar s and excrete lac-tic acid, which can lower the pH of the mouthenough to dissolve the hydroxylapatite. If

Enamel

Gums

Acid excretedby bacteria

Bloodvessels

Fluoride ionsapplied to teethCalcium ions

Phosphate ions

Fluoride ions

Foodremnant

Calcium andphosphate ions

Enhanceddeposition ofcalcium andphosphate


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tals. As a crystal matrix forms, the amelogenins

break down and are removed from the matur-ing enamel. But when some children consume

high doses of fluoride, which is absorbed

through the digestive tract and delivered by the

bl d h d l i h h bi

weight per day. In the early 1990s, when the

children in Levys study were infants, he foundthat more than a third of them were ingesting

enough fluoridemostly via water-based infant

formula, baby foods and juice drinksto put

h hi h i k f d l i ild fl i

[AREA OF CONCERN]

p Normal Bone Formation

Scientists have focused on fluorides effects on bone because so much of the chemical is stored there.Studies have shown that high doses of fluoride can stimulate the proliferation of bone-building osteo-

blast cells, raising fears that the chemical may induce malignant tumors. Fluoride also appears

to alter the crystalline structure of bone, possibly increasing the risk of fractures.

IS FLUORIDE WEAKENING BONE?

Compactbone

Spongybone

PeriosteumMarrow

Existing bone

Bloodvessels

Osteoblasts formingnew bone

Layer of newweak bone

p Effects of Excessive Fluoride

Proliferation ofosteoblasts

Fluorideions


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Levys lab found, for example, that many kinds

of juice drinks and soda pop contain enough

fluoride (generally about 0.6 mg/L) so that

drinking a lit tle more than a liter a day would

put a typical three-year-old at the optimal in-

take level, without counting any other daily

sources.

Dozens of food items tested by Levys team

contained even higher concentrations of fluo-

ride: an average of 0.73 mg/L in cranberry-juice

cocktail, 0.71 mg/L in ice pops, 0.99 mg/L in

beef gravy and 2.10 mg/L in canned crabmeat,for example. In most cases, the fluoride came

from water added during processing, although

higher levels also got into grapes and raisins via

pesticides, into processed chicken products via

ground-up bone, and into tea leaves via absorp-

tion from soil and water.

Levy found that exposure to fluoridated

drinking water was an even more important risk

factor for fluorosis. Iowa children who lived incommunities where the water was fluoridated

were 50 percent more likely to have mild fluoro-

sis on at least two of their eight permanent front

teeth at nine years of age than children living in

nonfluoridated areas of the state (there was a 33

percent prevalence in the former versus 22 per-

cent in the latter). Similar results appeared in

the NRC report, which found that infants andtoddlers in fluoridated communities ingest

about twice as much fluoride as they should.

Furthermore, the committee noted that adults

h d i k b f i

osteoporosisa bone disease that increases the

risk of fractureshave shown that high doses

of fluoride can stimulate the proliferation of

bone-building osteoblast cells, even in elderly

patients. The exact mechanism is still unknown,

but fluoride appears to achieve this by increas-

ing the concentrations of tyrosine-phosphory-

lated proteins, which are involved in biochemi-

cal signaling to osteoblasts. As with tooth

enamel, however, fluoride not only stimulates

bone mineralization, it also appears to alter the

crystalline structure of boneand in this case,the effects are not merely aesthetic. Although

fluoride may increase bone volume, the strength

of the bone apparently declines. Epidemiologi-

cal studies and tests on lab animals suggest that

high fluoride exposure increases the risk of bone

fracture, especial ly in vulnerable populations

such as the elderly and diabetics. Although

those studies are st ill somewhat controversial,

nine of the 12 members of the NRC panel con-cluded that a lifetime of exposure to drinking

water fluoridated at 4 mg/L or higher does

indeed raise the risk of fracture. The committee

noted that lower fluoridation levels may also

increase the risk, but the evidence is murkier.

As the Iowa children in his study enter ado-

lescence, Levy hopes that analyses of the

strength of their spine, hips and overall skeletonwill point to possible connections between fluo-

ride intake and bone health. He presented some

preliminary data in 2007, finding little differ-

i h i l f h b f 11

SIGNS OF

FLUOROSIS

When young children consume

large amounts of fluoride, the

chemical can disrupt the develop-

ment of their permanent teeth.

When the teeth emerge, their

enamel may be discolored (top)

or, in more severe cases, disfig-

ured (bottom ). Researchers have

found that this condition, called


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mal studies, were far above the actual expo-

sures found in fluoridated communities). But

other animal studies as well as most epidemio-

logical studies in human populations have been

ambiguous at best.

The latest dustup over fluoride and osteosar-

coma was instigated by a young researcher

named Elise B. Bassin of the Harvard School of

Dental Medicine. Bassin collected information

about fluoride exposures among 103 osteosar-

coma patients and 215 matched control subjects

and concluded that fluoride is a risk factor forthe cancer among boys (the results were ambig-

uous for girls). Bassins report appeared in 2006

in the journal Cancer Causes and Control; in

the same issue, however, her dissertation advis-

er at Harvard, Chester Douglass, wrote a com-

mentary warning readers to be especially cau-

tious in interpreting her findings because, he

said, better data, sti ll unpublished, contradict

them. Antifluoridationists and some envi-ronmental groups quickly rushed to

Bassins defense, demanding that Har-

vard investigate Douglass, professor

and chair of epidemiology at the den-

tal school, for allegedly misrepresent-

ing Bassins work and for having a con-

flict of interest because he is editor in

chief of a newsletter for dentists funded byColgate. The universitys investigation of Doug-

lass, completed in 2006, concluded that there

was no misconduct or conflict of interest.

Cl h h ibl l i l ff

mechanism: the formation of aluminum fluo-

ride complexessmall inorganic molecules that

mimic the structure of phosphates and thus in-

fluence enzyme activity in the brain. There is

also some evidence that the silicofluorides used

in water fluoridation may enhance the uptake

of lead into the brain.

The endocrine system is yet another area

where some evidence exists that fluoride can

have an impact. The NRC committee conclud-

ed that fluoride can subtly alter endocrine func-

tion, especially in the thyroidthe gland thatproduces hormones regulating growth and me-

tabolism. Although researchers do not know

how fluoride consumption can influence the

thyroid, the effects appear to be strongly influ-

enced by diet and genetics. Says John Doull,

professor emeritus of pharmacology and toxi-

cology at the University of Kansas Medical Cen-

ter, who chaired the NRC committee: The thy-

roid changes do worry me. There are somethings there that need to be explored.

The Controversy ContinuesThe release of the NRC report has not triggered

a public stampede against fluoridation, nor has

it prompted the EPA to quickly lower its fluoride

limit of 4 mg/L (the agency says it is still study-

ing the issue). Water suppliers who add fluoridetypically keep levels between 0.7 to 1.2 mg/L ,

far below the EPA limit. About 200,000 Ameri-

cansand several million people in China,

I di h Middl E Af i d S h

A FLUORIDE DIET

The optimal range for daily intake

of fluoridethe level that maxi-

mizes protection against tooth

decay but minimizes other risks

is generally considered to be 0.05

to 0.07 milligram for each kilo-

gram of body weight. Consumingfoods and beverages with large

amounts of fluoride can put a diet

above this range. Below are typi-

cal trace levels of fluoride, mea-

sured in parts per million (ppm),

found in foods and drinks tested

at the University of Iowa College

of Dentistry.

3.73 ppm Brewed black tea2.34 ppm Raisins u2.02 ppm White wine1.09 ppm Apple-

flavoredjuice drink

0.91 ppm Brewedcoffee

0.71 ppmTap water(U.S.-wideaverage)

0 61 ppm Chicken soup s(beer);CSQUAREDSTUDIOS/GETTYIMAGES(icecream)


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The risks of fluoride were known long before its benefits. Starting in the first decade of the 20th century, adentist named Frederick McKay traveled the American West investigating reports of what was then known

as Colorado Brown Stain. With a collaborator, G. V. Black, dean of the Northwestern University Dental School,

McKay discovered that children born in Colorado Springs, Colo., had stained teeth, but adults who moved

there did not. They hypothesized that young children whose permanent teeth had not yet erupted or developed

enamel faced the highest risk of developing the stain. McKay, who guessed that the stain was caused by some

unknown compound in the local drinking water, also noticed a curious fact: the mottled teeth were surprisingly

resistant to decay.

The cause remained a mystery until 1930, when McKay went to Arkansas to investigate reports of tooth

staining in Bauxite, a company town owned by the Aluminum Company of America (Alcoa). Worried that alu-minum might be blamed, Alcoas chief chemist, H. V. Churchill, tested the local water and discovered some-

thing McKay had never suspected: high levels of naturally occurring fluoride. McKay quickly tested other sus-

pect water supplies and found that wherever fluoride levels were hightypically 2.5 milligrams per liter or

higherColorado Brown Stain was prevalent. A new disease entered the

lexicon: fluorosis.

Spurred by Churchills and McKays discoveries, a researcher named

Henry Trendley Dean, head of the dental hygiene unit at the National

Institute of Health (which later changed its name to the National Insti-

tutes of Health), tried to determine how much fluoride was enough totrigger fluorosis. By the late 1930s he had concluded that levels below

1 mg/L would pose little risk. Dean remembered that McKay had

found that fluorosed teeth were resistant to decay, and so he began

pushing for a citywide test of a revolutionary idea: deliberately add-

ing fluoride to water at levels that would deter cavities without trig-

gering fluorosis. He got his wish in 1945 in Grand Rapids, Mich.,

and Dean went on to become fluoridations leading advocate as the

first director of the newly formed National Institute of Dental Re-

search from 1948 until his retirement in 1953. D.F.

tCOLORADO DENTIST Frederick McKay,

whose investigations led to the discovery

[BACKGROUND]

FLUORIDE HISTORY

MORE TOEXPLORE

Patterns of Fluoride Intake from

Birth to 36 Months. Steven M.Levy, John J. Warren, Charles S.Davis, H. Lester Kirchner, Michael J.

Kanellis and James S. Wefel inJour-nal of Public Health Dentistry, Vol. 61,No. 2, pages 7077; June 2001.

Patterns of Fluoride Intake from

36 to 72 Months of Age. Steven M.Levy, John J. Warren and BarbaraBroffitt inJournal of Public Health

Dentistry, Vol. 63, No. 4, pages 211220; December 2003.

Timing of Fluoride Intake in Rela-

tion to Development of Fluorosis

on Maxillary Central Incisors.

Liang Hong, Steven M. Levy,


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STATEMENT BY DR. HARDY LIMEBACK

by Dr. Hardy Limeback PhD, DDS

Associate Professor and Head, Preventive DentistryUniversity of Toronto

I am the Head of Preventive Dentistry at the University of Toronto in Toronto Canada , a

professor with a PhD in Biochemistry and a practicing dentist who has done years of funded

research in tooth formation, bone and fluoride. I was one of the 12 scientists who served on the

National Academy of Sciences panel that issued the 2006 report, Fluoride in Drinking Water: AScientific Review of the EPAs Standards.

I would like to outline my arguments that fluoridation is an ineffective and harmful public healthpolicy.

1. Fluoridation is no longer effective .

Fluoride in water has the effect of delaying tooth eruption and, therefore, simply delays dentaldecay (Komarek et al, 2005, Biostatistics 6:145-55). The studies that water fluoridation work are

over 25 years old and were carried out before the widespread use offluoridated toothpaste .

There are numerous modern studies to show that there no longer is a difference in dental

decay rates between fluoridated and non-fluoridated areas, the most recent one in Australia

(Armfield & Spencer, 2004 Community Dental Oral Epidemiology. 32:283-96). Recent waterfluoridation cessation studies show that dental fluorosis (a mottling of the enamel caused by

fluoride) declines but there is no corresponding increase in dental decay (e.g. Maupome et al

2001, Community Dental Oral Epidemiology 29: 37-47).

Public health services will claim there is still a dental decay crisis. With the national average in

Europe of only two decayed teeth per child (World Health Organization data) down from more


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assistance to those who cannot afford dental treatment. Even cities where water fluoridation has

been in effect for years are reporting similar dental crises.

Public health officials responsible for community programs are misleading the public by statingthat ingesting fluoride makes the teeth stronger. Fluoride is not an essential nutrient. It does not

make developing teeth better prepared to resist dental decay before they erupt into the oral

environment. The small benefit that fluoridated water might still have on teeth (in the absence of

fluoridated toothpaste use) is the result of topical exposure while the teeth are rebuilding fromacid challenges brought on by daily sugar and starch exposure (Limeback 1999, Community

Dental Oral Epidemiology 27: 62-71), and this has now been recognized by the Centers for

Disease Control.

2. Fluoridation is the main cause of dental fluorosis .

Fluoride doses by the end user cant be controlled when only one concentration of fluoride (1

parts per million) is available in the drinking water. Babies and toddlers get too much fluoride

when tap water is used to make formula (Brothwell & Limeback, 2003 Journal of HumanLactation 19: 386-90). Since the majority of daily fluoride comes from the drinking water in

fluoridated areas, the risk for dental fluorosis greatly increases (National Academy of Sciences:Toxicological Risk of Fluoride in Drinking Water, 2006). The American Dental Association and

the Dental Forum in Ireland has admitted that fluoridated tap water should not be used toreconstitute infant formula.

We have tripled our exposure to fluoride since fluoridation was conceived in the 1940s. This has

lead to every third child with dental fluorosis (CDC, 2005). Fluorosis is not just a cosmeticeffect. The more severe forms are associated with an increase in dental decay (NAS:

Toxicological Risk of Fluoride in Drinking Water, 2006) and the psychological impact on

children is a negative one. Most children with moderate and severe dental fluorosis seek

extensive restorative work costing thousands of dollars. Dental fluorosis can be reduced by


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This could not be ruled out by the CDC in their recent study (Macek et al 2006, Environmental

Health Perspectives 114:130-134).

4. There are serious health risks from water fluoridation .

Cancer: Osteosarcoma (bone cancer) has recently been identified as a risk in young boys in arecently published Harvard study (Bassin, Cancer Causes and Control, 2006). The author of this

study, Dr. Elise Bassin, acknowledges that perhaps it is the use of these untested and

contaminated fluorosilicates mentioned above that caused the over 500% increase risk of bonecancer.

Bone fracture: Drinking on average 1 liter/day of naturally fluoridated water at 4 parts per

million increases your risk for bone pain and bone fractures (National Academy of Sciences:

Toxicological Risk of Fluoride in Drinking Water, 2006). Since fluoride accumulates in bone, thesame risk occurs in people who drink 4 liters/day of artificially fluoridated water at 1 part per

million, or in people with renal disease. Additionally, Brits are known for their tea drinking and

since tea itself contains fluoride, using fluoridated tap water puts many heavy tea drinkersdangerously close to threshold for bone fracture. Fluoridation studies have never properly shown

that fluoride is safe in individuals who cannot control their dose, or in patients who retain toomuch fluoride.

Adverse thyroid function: The recent National Academy of Sciences report (NAS: ToxicologicalRisk of Fluoride in Drinking Water, 2006) outlines in great detail the detrimental effect that

fluoride has on the endocrine system, especially the thyroid. Fluoridation should be halted on the

basis that endocrine function in the U.S. has never been studied in relation to total fluorideintake.

Adverse neurological effects: In addition to the added accumulation of lead (a known

neurotoxin) in children living in fluoridated cities, fluoride itself is a known neurotoxin. We are


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The US Center for Disease Control and American Dental Association have cautioned infants should not be given fluoridated water orfluoridated water be used for making infant formula.7 More than 3 out of 4 infants receive formula. Consider that all are medicatedwith fluoridation, yet the water is not safe for our most vulnerable, our babies. We are now asking moms to haul their infant, its food,toys, clothes, and now water. Parents in third world countries can usually boil their water to make it safe for infants, but manycommunities consciously put chemicals in the public water which cant even be boiled out or traditional filters used to make it safe forinfants.

The biggest problem in the US scientific community is the fear Universities, Medical and Dental Associations and Journals have inpermitting discussion, debate and scientific review of fluoridation. One state medical association requested $50,000 for a short privatepresentation of concerns. Others permit review only by their legal counsel. The BMJ should be commended for their willingness to dowhat few other scientists are willing to do, open scientific discussion.

Bill Osmunson DDS, MPH Aesthetic Dentistry of Bellevue [email protected]

1. The CDC also references Horowitz and Ismail 1996, Johnston 1994, Ripa 1990, Stookey and Beiswanger 1995, however all these

reviewed topical application of fluoride, not the addition of fluoride to water. http://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htm

2.http://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htm

3. National Survey of Children's Health.http://mchb.hrsa.gov/oralhealth/portrait/1cct.htm

http://www.cdc.gov/oralhealth/waterfluoridation/fact_sheets/states_stats2002.htm---(No longer there)

The National Survey of Children's Health 2003. Rockville, Maryland: U.S. Department of Health and Human Services, 2005

U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau

http://www.doh.wa.gov/cfh/Oral_Health/Documents/SmileSurvey2005FullReport.pdf---(No longer there)

http://www.oregon.gov/DHS/ph/oralhealth/docs/databook.pdf#search='Oregon%20Decay%20experience

BRFSS 2002 http://www.dhs.state.or.us/dhs/ph/chs/brfs/02/orahea/dentvisi.shtml---(No longer there)http://apps.nccd.cdc.gov/brfss/display.asp?state=WA&cat=OH&yr=2004&qkey=6610&grp=0&SUBMIT4=Go Sample size OR 3509and WA 12,926 2004 data

National Survey of Children's Health.http://mchb.hrsa.gov/oralhealth/portrait/1cct.htm U.S. Department of Health and HumanServices, http://www.fluoridationcenter.org/papers/2002/cdcmmwr022102.htm---(No longer there)
http://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htmhttp://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htmhttp://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htmhttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://www.oregon.gov/DHS/ph/oralhealth/docs/databook.pdf#search='Oregon%20Decay%20experiencehttp://www.oregon.gov/DHS/ph/oralhealth/docs/databook.pdf#search='Oregon%20Decay%20experiencehttp://apps.nccd.cdc.gov/brfss/display.asp?state=WA&cat=OH&yr=2004&qkey=6610&grp=0&SUBMIT4=Gohttp://apps.nccd.cdc.gov/brfss/display.asp?state=WA&cat=OH&yr=2004&qkey=6610&grp=0&SUBMIT4=Gohttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://quickfacts.census.gov/qfd/states/41000.htmlhttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://apps.nccd.cdc.gov/brfss/display.asp?state=WA&cat=OH&yr=2004&qkey=6610&grp=0&SUBMIT4=Gohttp://www.oregon.gov/DHS/ph/oralhealth/docs/databook.pdf#search='Oregon%20Decay%20experiencehttp://mchb.hrsa.gov/oralhealth/portrait/1cct.htmhttp://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htm


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Vol. 60,No. 3, Summer 2000 131R E V I E W & C O M M E N T A R Y

Fluoride Intake and Prevalence of Dental Fluorosis:Trends in Fluoride Intake with Special Attention to InfantsSamuel J. Fomo n, MD; Jan Ekstrand, DDS, PhD; Ekhard E. Ziegler, MDAbstract

Background: Although the predominant beneficial effect of fluoride occurslocally in the mouth, the adverse effect, dental fluorosis, occurs by the systemicroute. The caries attack rate n industrializedcountries,ncluding the Unitedstatesand Canada, has decreased dramatically over the past 40 years. However, theprevalence of dental fluorosis in the United States has increased during the last30 years both in communities with fluoridated water and in communities withnonfluoridated water. Dental fluorosis is closely associated with fluoride intakeduring the period of tooth development. Methods: We reviewed the majorchanges in infant feeding practices that have occurred since 1930 and thechanges in fluoride ntakes by infants and young children associated with changesin feeding practices. Results and Conclusions: Based on this review, weconclude that fluoride intakes of infants and children have shown a rather steadyincrease since 1930, are likely to continue to increase, and will be associated withfurther increase in the prevalence of enamel fluorosis unless intervention meas-ures are nstituted.Recommendations:We believe the most important measuresthat should be undertaken are ( I ) use, when feasible, of water low in fluoride fordilution of infant formulas; (2) adult supervision of toothbrushing by childrenyounger than 5 years of age; and (3) changes in recommendations for admini-stration of fluoride supplementsso that such supplements are not given to infantsand more stringent criteria are applied for administration to children.Key Words: dental fluorosis, fluoride supplements, fluoridated dentifrices, ormulafluoride.[J Public Health Dent 2000;60(3): 131-91

Current evidence suggests that the fluorosis, occurs by the systemic route.

tirely chalky white teeth (8). In ad-vanced stages, the enamel may be-come soporous that the outer layersbreak down and the exposed poroussubsurface becomes discolored.The caries attack rate in industrial-ized countries, including the UnitedStates and Canada, has decreased dra-matically over the past 40 years (9).Onthe other hand, based on changes inthe earlier community fluorosis indexand in the more recent index of Thyl-strup and Fejerskov (lo), the preva-lence of dental fluorosis in the UnitedStates has increased during the last 30years, both in communities withfluoridated water and in communitieswith nonfluoridated water (1,11-18).Because dental fluorosis is closelyassociated with fluoride intake duringthe period of tooth development (19),we reasoned that a review of trends influoride intake over the past 70 yearswould be useful in predicting futuretrends in dental fluorosis. Thus, thepurpose of this communication is toreview trends since 1930 in fluorideintakes by infants and young children.


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ENVSCI 1173 N f P 6


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Comparison of hydrofluorosilicic acid and pharmaceutical

sodium fluoride as fluoridating agentsA costbenefit

analysis

J. William Hirzy a,*, Robert J. Cartonb, Christina D. Bonannia, Carly M. Montanero a,Michael F. Nagle a

aAmerican University, Department of Chemistry, 4400 Massachusetts Ave., N.W., Washington, DC,. USAb4 Glenwood Terrace, Averill Park, NY, USA

e n vi r on m en t al s c ie nc e & p ol i cy x xx ( 2 01 3 ) x x x x xx

a r t i c l e i n f o

Article history:

Received 30 March 2012

Received in revised form

14 January 2013

Accepted 15 January 2013

Keywords:

Fluoride

Arsenic

Cancer

a

b

s

t

r

a

c

t

Water fluoridation programs in theUnited States and other countries which have them use

either sodium fluoride (NaF), hydrofluorosilicic acid (HFSA) or the sodium salt of that acid

(NaSF), all technical grade chemicals to adjust the fluoride level in drinking water to about

0.71 mg/L. In this paper we estimate the comparative overall cost for U.S. society between

using cheaper industrial grade HFSA as the principal fluoridating agent versus using more

costly pharmaceutical grade (U.S. Pharmacopeia USP) NaF. USP NaF is used in toothpaste.

HFSA, a liquid, contains significant amounts of arsenic (As). HFSA and NaSF have been

shown to leach lead (Pb) from water delivery plumbing, while NaFhas been shown not to doso. The U.S. Environmental Protection Agencys (EPA) health-based drinking water stan-

dards for As and Pb are zero. Our focus was on comparing the social costs associated with

the difference in numbers of cancercases arising from Asduringuse ofHFSA asfluoridating

t b tit ti f USP d N F W l l t d th t f A d li d t

ENVSCI-1173; No. of Pages 6

Available online at www.sciencedirect.com

journal homepage: www.elsevier.com/locate/envsci
http://dx.doi.org/10.1016/j.envsci.2013.01.007http://www.sciencedirect.com/science/journal/14629011http://www.sciencedirect.com/science/journal/14629011http://dx.doi.org/10.1016/j.envsci.2013.01.007


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Review

A recent report rom the National ResearchCouncil (NRC 2006) concluded that adverseeects o high luoride concentrations indrinking water may be o concern and that

o luoride rom drinking water. Such cir-cumstances are diicult to ind in manyindustrialized countries, because uoride con-centrations in community water are usually

Registry 2003). Fluoride exposure to the devel-oping brain, which is much more susceptibleto injury caused by toxicants than is the maturebrain, may possibly lead to permanent damage(Grandjean and Landrigan 2006). In responseto the recommendation o the NRC (2006),the U.S. Department o Health and Human

Services (DHHS) and the U.S. EPA recentlyannounced that DHHS is proposing to changethe recommended level o uoride in drinkingwater to 0.7 mg/L rom the currently recom-mended range o 0.71.2 mg/L, and the U.S.EPA is reviewing the maximum amount ouoride allowed in drinking water, which cur-rently is set at 4.0 mg/L (U.S. EPA 2011).

To summarize the available literature,we perormed a systematic review and meta-

analysis o published studies on increaseduoride exposure in drinking water associatedwith neurodevelopmental delays. We specif-cally targeted studies carried out in ruralChina that have not been widely disseminated,thus complementing the studies that havebeen included in previous reviews and riskassessment reports.

Methods

Search strategy.

We sea rched MEDLINE(National Library o Medicine, Bethesda, MD,USA; http://www.ncbi.nlm.nih.gov/pubmed),Embase (Elsevier B.V., Amsterdam, theNetherlands; http://www.embase.com), Water

Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis

Anna L. Choi,1 Guifan Sun,2Ying Zhang,3and Philippe Grandjean1,4

1Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA; 2School of Public Health, China

Medical University, Shenyang, China; 3School of Stomatology, China Medical University, Shenyang, China; 4Institute of Public Health,University of Southern Denmark, Odense, Denmark

Background: Although uoride may cause neurotoxicity in animal models and acute uoridepoisoning causes neurotoxicity in adults, very little is known o its eects on childrens neuro-development.

oBjective: We perormed a systematic review and meta-analysis o published studies to investigatethe eects o increased uoride exposure and delayed neurobehavioral development.

Methods: We searched the MEDLINE, EMBASE, Water Resources Abstracts, and OXNE

databases through 2011 or eligible studies. We also searched the China National KnowledgeInrastructure (CNKI) database, because many studies on uoride neurotoxicity have been pub-lished in Chinese journals only. In total, we identifed 27 eligible epidemiological studies with highand reerence exposures, end points o IQ scores, or related cognitive unction measures with meansand variances or the two exposure groups. Using random-eects models, we estimated the stan-dardized mean dierence between exposed and reerence groups across all studies. We conductedsensitivity analyses restricted to studies using the same outcome assessment and having drinking-

water uoride as the only exposure. We perormed the Cochran test or heterogeneity between stud-ies, Beggs unnel plot, and Egger test to assess publication bias, and conducted meta-regressions toexplore sources o variation in mean dierences among the studies.

results: Te standardized weighted mean dierence in IQ score between exposed and reerence

populations was 0.45 (95% confdence interval: 0.56, 0.35) using a random-eects model.Tus, children in high-uoride areas had signifcantly lower IQ scores than those who lived in low-uoride areas. Subgroup and sensitivity analyses also indicated inverse associations, although thesubstantial heterogeneity did not appear to decrease.

conclusions: Te results support the possibility o an adverse eect o high uoride exposure onchildrens neurodevelopment. Future research should include detailed individual-level inormationon prenatal exposure, neurobehavioral perormance, and covariates or adjustment.

keywords: luoride, intelligence, neurotoxicity. Environ Health Perspect120:13621368(2012). http://dx.doi.org/10.1289/ehp.1104912[Online 20 July 2012]


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Confirmation of and explanations for elevated blood lead andother disorders in children exposed to water disinfection and

fluoridation chemicals

Myron J. Coplan a,*, Steven C. Patch b, Roger D. Masters c, Marcia S. Bachman a

aIntellequity Technology Services Natick, Massachusetts, United Statesb Environmental Quality Institute, University of North Carolina in Asheville, United States

cDartmouth College Institute for Nuroscience and Society, United States

Received 23 February 2006; accepted 12 February 2007

Available online 1 March 2007

Abstract

Silicofluorides (SiFs), fluosilicic acid (FSA) and sodium fluosilicate (NaFSA), are used to fluoridate over 90% of US fluoridated municipal

water supplies. Living in communities with silicofluoride treated water (SiFW) is associated with two neurotoxic effects: (1) Prevalence of children

with elevated blood lead (PbB > 10 mg/dL) is about double that in non-fluoridated communities (Risk Ratio 2, x2 p < 0.01). SiFW is associated

with serious corrosion of lead-bearing brass plumbing, producing elevated water lead (PbW) at the faucet. New data refute the long-prevailing

belief that PbW contributes little to childrens blood lead (PbB), it is likely to contribute 50% or more. (2) SiFW has been shown to interfere with

cholinergic function. Unlike the fully ionized state of fluoride (F-) in water treated with sodium fluoride (NaFW), the SiF anion, [SiF6]2- in SiFW

releases F- in a complicated dissociation process. Small amounts of incompletely dissociated [SiF6]2- or low molecular weight (LMW) silicic acid

(SA) oligomers may remain in SiFW. A German PhD study found that SiFW is a more powerful inhibitor of acetylcholinesterase (AChE) than

NaFW. It is proposed here that SiFW induces protein mis-folding via a mechanism that would affect polypeptides in general, and explain dentalfluorosis, a tooth enamel defect that is not merely cosmetic but a canary in the mine foretelling other adverse, albeit subtle, health and

behavioral effects. Efforts to refute evidence of such effects are analyzed and rebutted. In 1999 and 2000, senior EPA personnel admitted they knew

of no health effects studies of SiFs. In 2002 SiFs were nominated for NTP animal testing. In 2006 an NRC Fluoride Study Committee

NeuroToxicology 28 (2007) 10321042


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Community Dent Oral Epidemiol 2000; 28: 3829 Copyright C Munksgaard 2000Printed in Denmark . All rights reserved

ISSN 0301-5661

W. Knzel1, T. Fischer1, R. Lorenz2 and

S. Brhmann2Decline of caries prevalence after1Dental School of Erfurt, Department ofPreventive Dentistry, Friedrich-Schiller-University of Jena, 2Public Health Services ofthe cessation ofwater fluoridation Spremberg and Zittau, Germany

in the former East GermanyKnzel W, Fischer T, Lorenz R, Brhmann S: Decline of caries prevalence afterthe cessation of water fluoridation in the former East Germany. Community DentOral Epidemiol 2000; 28: 3829. C Munksgaard, 2000

Abstract In contrast to the anticipated increase in dental caries following thecessation of water fluoridation in the cities Chemnitz (formerly Karl-Marx-Stadt)and Plauen, a significant fall in caries prevalence was observed. This trend corre-sponded to the national caries decline and appeared to be a new population-widephenomenon. Additional surveys (N1017) carried out in the formerly-fluori-dated towns of Spremberg (N9042) and Zittau (N6232) were carried out inorder to support this unexpected epidemiological finding. Pupils from thesetowns, aged 8/9-, 12/13- and 15/16-years, have been examined repeatedly overthe last 20 years using standardised caries-methodological procedures. While thedata provided additional support for the established fact of a caries reduction

brought about by the fluoridation of drinking water (48 % on average), it hasalso provided further support for the contention that caries prevalence may contin-ue to fall after the reduction of fluoride concentration in the water supply fromabout 1 ppm to below 0.2 ppm F. Caries levels for the 12-year-olds of both townssignificantly decreased during the years 199396, following the cessation of water

fluoridation. In Spremberg, DMFT fell from 2.36 to 1.45 (38.5 %) and in Zittau from2.47 to 1.96 (20.6%). These findings have therefore supported the previously ob- Key words: caries prevalence; cessation;

children; East Germany; water fluoridationserved change in the caries trend of Chemnitz and Plauen. The mean of 1.81 DMFTfor the 12-year-olds, computed from data of the four towns, is the lowest ob- Walter Knzel, Dental School of Erfurt and
http://www.ncbi.nlm.nih.gov/pubmed/11014515#http://onlinelibrary.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=0301-5661&date=2000&volume=28&issue=5&spage=382http://www.ncbi.nlm.nih.gov/pubmed/11014515#http://www.ncbi.nlm.nih.gov/pubmed/11014515#http://www.ncbi.nlm.nih.gov/pubmed?term=Br%C3%BChmann%20S%5BAuthor%5D&cauthor=true&cauthor_uid=11014515http://www.ncbi.nlm.nih.gov/pubmed?term=Lorenz%20R%5BAuthor%5D&cauthor=true&cauthor_uid=11014515http://www.ncbi.nlm.nih.gov/pubmed?term=Fischer%20T%5BAuthor%5D&cauthor=true&cauthor_uid=11014515http://www.ncbi.nlm.nih.gov/pubmed?term=K%C3%BCnzel%20W%5BAuthor%5D&cauthor=true&cauthor_uid=11014515http://www.ncbi.nlm.nih.gov/pubmed/11014515#


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7/16/13 4:10 PMCaries prevalence after cessation of wate... [Caries Res. 2000 Jan-Feb] - PubMed - NCBI

Caries Res. 2000 Jan-Feb;34(1):20-5.

Caries prevalence after cessation of water fluoridation in La Salud, Cuba.

Knzel W, Fischer T.

Department of Preventive Dentistry, Dental School of Erfurt, Friedrich Schiller University of Jena, Germany.

Abstract

In the past, caries has usually increased after cessation of water fluoridation. More recently an

opposite trend could be observed: DMFT remaining stable or even decreasing further. The aim of the

present study conducted in La Salud (Province of Habana) in March 1997 was to analyse the current

caries trend under the special climatic and nutritional conditions of the subtropical sugar island Cuba,

following the cessation, in 1990, of water fluoridation (0.8 ppm F). Diagnostic evaluations were carried

out using the same methods as in 1973 and 1982. Boys and girls aged 6-13 years (N = 414), lifelong

residents in La Salud, were examined. Between 1973 and 1982 the mean DMFT had decreased by

71.4%, the mean DMFS by 73. 3% and the percentage of caries-free children had increased from 26.

3 to 61.6%. In 1997, following the cessation of drinking water fluoridation, in contrast to an expected

rise in caries prevalence, DMFT and DMFS values remained at a low level for the 6- to 9-year-olds

and appeared to decrease for the 10/11-year-olds (from 1. 1 to 0.8) and DMFS (from 1.5 to 1.2). In

the 12/13-year-olds, there was a significant decrease (DMFT from 2.1 to 1.1; DMFS from 3.1 to 1. 5),

while the percentage of caries-free children of this age group had increased from 4.8 (1973) and 33.3

(1982) up to 55 2% A possible explanation for this unexpected finding and for the good oral health

Display Settings: Abstract

PubMed
http://www.ncbi.nlm.nih.gov/pubmed/10601780#http://www.ncbi.nlm.nih.gov/pubmed?term=K%C3%BCnzel%20W%5BAuthor%5D&cauthor=true&cauthor_uid=10601780http://www.ncbi.nlm.nih.gov/pubmed?term=Fischer%20T%5BAuthor%5D&cauthor=true&cauthor_uid=10601780http://www.ncbi.nlm.nih.gov/pubmed/10601780#http://www.ncbi.nlm.nih.gov/pubmed/10601780#http://www.karger.com/?DOI=16565http://www.ncbi.nlm.nih.gov/pubmed/10601780#http://www.ncbi.nlm.nih.gov/pubmed/10601780#http://www.ncbi.nlm.nih.gov/pubmed?term=Fischer%20T%5BAuthor%5D&cauthor=true&cauthor_uid=10601780http://www.ncbi.nlm.nih.gov/pubmed?term=K%C3%BCnzel%20W%5BAuthor%5D&cauthor=true&cauthor_uid=10601780http://www.ncbi.nlm.nih.gov/pubmed/10601780#


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7/16/13 4:14 PMThe effects of a break in water fluoridation on t... [J Dent Res. 2000] - PubMed - NCBI

J Dent Res. 2000 Feb;79(2):761-9.

The effects of a break in water fluoridation on the development of dental cariesand fluorosis.

Burt BA, Keels MA, Heller KE.

Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor 48109-2029, [email protected]

Abstract

Durham, NC, fluoridated since 1962, had an 11-month cessation offluoridation between

September, 1990, and August, 1991. The purpose of this study was to assess the effects of this

break on the development of caries and fluorosis in children. Study participants were continuously-

resident children in Kindergarten through Grade 5 in Durham's elementary schools. There were 1696children, 81.4% of those eligible, for whom a questionnaire was completed and clinical data recorded.

Age cohorts were defined by a child's age at the time that fluoridation ceased. Caries was recorded

in children in the Birth Cohort through Cohort 3, and fluorosis for children in Cohorts 1 through 5.

Caries was assessed in the primary first and second molars according to the decayed-filled index;

fluorosis on the labial surfaces of the upper permanent central and lateral incisors was assessed by

the Thylstrup-Fejerskov (TF) index. Mother's education was associated with caries; higher educationof the mother had an odds ratio of 0.53 (95% CI 0.40, 0.76) for caries in the child. No cohort effects

could be discerned for caries. Overall prevalence of fluorosis was 44%. Prevalence in Cohorts 1, 2, 3,


PubMed
http://www.ncbi.nlm.nih.gov/pubmed/10728978#http://www.ncbi.nlm.nih.gov/pubmed?term=Burt%20BA%5BAuthor%5D&cauthor=true&cauthor_uid=10728978http://www.ncbi.nlm.nih.gov/pubmed?term=Keels%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=10728978http://www.ncbi.nlm.nih.gov/pubmed?term=Heller%20KE%5BAuthor%5D&cauthor=true&cauthor_uid=10728978http://www.ncbi.nlm.nih.gov/pubmed/10728978#http://www.ncbi.nlm.nih.gov/pubmed/10728978#http://jdr.sagepub.com/cgi/pmidlookup?view=long&pmid=10728978http://www.ncbi.nlm.nih.gov/pubmed/10728978#http://www.ncbi.nlm.nih.gov/pubmed/10728978#http://www.ncbi.nlm.nih.gov/pubmed?term=Heller%20KE%5BAuthor%5D&cauthor=true&cauthor_uid=10728978http://www.ncbi.nlm.nih.gov/pubmed?term=Keels%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=10728978http://www.ncbi.nlm.nih.gov/pubmed?term=Burt%20BA%5BAuthor%5D&cauthor=true&cauthor_uid=10728978http://www.ncbi.nlm.nih.gov/pubmed/10728978#


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7/16/13 4:24 PMPhysiologic conditions affect toxici... [J Environ Public Health. 2013] - PubMed - NCBI

J Environ Public Health.2013;2013:439490. doi: 10.1155/2013/439490. Epub 2013 Jun 6.

Physiologic conditions affect toxicity of ingested industrial fluoride.

Sauerheber R.

Department of Chemistry, University of California, San Diego, La Jolla, CA 92037, USA ; STAR Tutoring Center, PalomarCommunity College, San Marcos, CA 92069, USA.

Abstract

The effects of calcium ion and broad pH ranges on free fluoride ion aqueous concentrations were

measured directly and computed theoretically. Solubility calculations indicate that blood fluoride

concentrations that occur in lethal poisonings would decrease calcium below prevailing levels. Acute

lethal poisoning and also many of the chronic effects of fluoride involve alterations in the chemical

activity of calcium by the fluoride ion. Natural calcium fluoride with low solubility and toxicity fromingestion is distinct from fully soluble toxic industrial fluorides. The toxicity of fluoride is determined by

environmental conditions and the positive cations present. At a pH typical of gastric juice, fluoride is

largely protonated as hydrofluoric acid HF. Industrial fluoride ingested from treated water enters

saliva at levels too low to affect dental caries. Blood levels during lifelong consumption can harm

heart, bone, brain, and even developing teeth enamel. The widespread policy known as water

fluoridation is discussed in light of these findings.

PMID: 23840230 [PubMed - in process] PMCID: PMC3690253 Free PMC Article


PubMed

G t k M t i
http://www.ncbi.nlm.nih.gov/pubmed/23840230#http://www.ncbi.nlm.nih.gov/pubmed/23840230#http://www.ncbi.nlm.nih.gov/pubmed?term=Sauerheber%20R%5BAuthor%5D&cauthor=true&cauthor_uid=23840230http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690253/http://www.ncbi.nlm.nih.gov/pubmed/23840230#http://www.ncbi.nlm.nih.gov/pubmed/23840230#http://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23840230/http://dx.doi.org/10.1155/2013/439490http://www.ncbi.nlm.nih.gov/pubmed/23840230#http://www.ncbi.nlm.nih.gov/pubmed/23840230#http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3690253/http://www.ncbi.nlm.nih.gov/pubmed?term=Sauerheber%20R%5BAuthor%5D&cauthor=true&cauthor_uid=23840230http://www.ncbi.nlm.nih.gov/pubmed/23840230#


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Televisionadsandbillboards portray phosphatestrip mining as a wholesome industry thatcreates jobs and eeds the world. A closer look

reveals that phosphate mining is extremelyharmul to our wetlands, water quality andquantity, and wildlie habitat. Phosphate miningcompanies own or have mineral rights to over400,000 acres, mostly in the Peace and MyakkaRiver watersheds, with mining projects plannedor over 62,000 acres.

Approximately 340,000 acres have already beenmined in Florida yet ewer than 70,000 acres havebeen reclaimed and released. Moonscapes o un-reclaimed land are let or years in spoil piles anddeep pits, the destruction oten hidden rom viewby tall trees or berms surrounding the mine sites.

Watch this 4-minute flmthat shows

the real ace o phosphate mining:www.youtube.com/watch?v=spzER-HYeKw

Gypstacks: Mountains oWhat can citizens do?

Share this inormation with your riends,neighbors and community leaders.

When new mine permits are being consideredin your community, attend public meetingsand speak out. Write a letter to the editor o

your local paper.

Tell USEPA you support its activities,including aerial surveys or radioactivity anda strong ederal standard or water qualitynutrient control. Email: [email protected]

Learn more at www.thephosphaterisk.com

Watch the movie The Phosphate Dilemma atwww.protectpeaceriver.org

Provide comments to the Army Corps oEngineers as they prepare an Area-wideEnvironmental Impact Statement (AEIS)

which will consider the cumulative impactso mining, as well as more protective alterna-tives. Specic mine projects being consideredare CF Industries South Pasture Extension,Mosaic Fertilizer, LLCs DeSoto Mine, Ona

Mine and Wingate East Mine. For the status othe AEIS and how to participate in the process,go to: www.phosphateaeis.org

State lawsays that the public is entitledto reasonable assurances that our environ-ment, water supplies, and economy will not benegatively aected by phosphate mining. Thecurrent rules do not provide that assurance.

What Floridians Should Know About

Phosphogypsumis the hazardous wastebyproduct created when phosphate ore

is processed into ertilizer. It is stored inmountain-like structures called gypstacks thatcan reach 200 eet or more. These radioac-tive stacks, which re-circulate acidic process

water, will be hereforever. Florida will have to

deal with them long ater the mining compa-nies are gone. There are already 25 gypstacksin Florida. They can sometimes overfowand spill their toxic waste ater strong

storms or prolonged rain events. The Stateo Florida spent over $200 million to cleanup an abandoned gypstack at Piney Point innorth ManateeCounty. Anestimated 30million tons o

waste phospho-gypsum willcontinue to beproduced every

year.

Sierra Club Floridahttp://forida.sierraclub.org

ManaSota-88www.manasota88.org

People or ProtectingPeace River (3PR)www.protectpeaceriver.org

Protect Our Watersheds (POW)www.protectourwatersheds.us

For moreinormation,

contact aconservationorganization

that is workingto protect the

Peace andMyakka RiverWatersheds.

Gypstack, Fort Meade, FL, by Harvey Henkelman.


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Huge Profts or MiningCompaniesNot the Public

A study prepared or the Charlotte Harbor NationalEstuary Program revealed that the Peace River

watershed has an economic value o nearly $7 billionin 2010 dollars. That value depends on clean, plen-tiul water and healthy wildlie habitat. More thanone million people are employed in Floridas shing,

tourism, recreation and agriculture industrieswhile phosphate mining has ewer than 10,000 jobsstatewide with only 3,300 in the Peace River water-shed. The economiccontributions romoutdoor recreation,sheries and agricul-ture are much greaterthan those o phosphatemining. Recent studiesin Hardee, DeSoto andManatee counties showthat short-term mining

jobs will displace long-term agricultural andranch jobs. Displacedarm or ranch workers are not likely to be hired

by mining companies because they dont have theneeded skills or because experienced workers ollowthe jobs as mining moves south.

Mosaic reaps enormous prots while counties wheremining occurs receive minimal nancial benetscompared to the value o the phosphate ore that isextracted. What is the real beneft or our cit izensand our state when over 60% o Mosaics productis shipped to countries outside o the U.S. andCanada and our watersheds are let in ruin?

Mining and RadiationMined lands have elevated levels o radioac-tivity rom radium-226 and other radionuclidesincluding radon. Radon (222) is a radioactivegas whose negative health eects are welldocumented. Even so, mining companies haveopposed USEPA surveys which would help the public understandthe health risks rom this radioactivity. It has been reported

that USEPA estimates that cleanup o ormer mine sitescould cost $11 billion.

Impacts on Communities

Mining is oten incompatible with adjacent land uses. Nearby landowners are not com-pensated or the disruptions to their quality o lie but must put up with land clearing and

years o dust, truck trac, the constant drone o pumps and bright lights as huge draglinesoperate night and day. Decades can go by beore mined land is reclaimed and released.

Reclamation: Not GoodEnough, Delayed or Decades

Reclamation does not mean that land isrestored to its pre-mining condition. Subsuraceground-water systems that are destroyed bymining cannot be reclaimed. Mining companiesreclaim land by lling in mine pits, re-contouringand re-vegetating a sitea process that can take

25 years to complete. Some habitat types such asorested wetlands and scrub are especially di-cult to reclaim and take decades to mature.

Mining compa-nies are routinelyallowed to changeapproved reclama-tion plans by beinggranted a vari-ance. Variances

can be given ordierent reasons.One example isnot having enoughsand or reclama-

tion because so much phosphate ore and clay isremoved by mining. A variance can be grantedthat delays reclamation or 10 years! Anothertype o variance allows deep pit lakes that do notcontain enough oxygen or sh to live in them.

Waste clay or slime ponds, known as clay settlingareas (CSAs), hold water which decreases aquierrecharge and fows to streams. Evenafterrecla-mation, CSAs will permanently coverover 40%o an average mine site and have limited uses.There is also a history o spills rom CSA dambreaks that pollute waterways and kill fsh.

Phosphate Mining =Massive Water Use

Mosaic, a large phosphate mining company,claims to recycle 95% o their water, giving theimpression that their usage is low. But to meettheir operational needs they also withdraw mas-sive amounts o ground water daily to supple-ment their recycled water. Mosaic has

requested a 20-year permit to withdraw upto a yearly average o 69 million gallons ogroundwater per day! This astronomical water

use robs wetlands, streams, and rivers o waterneeded to keep them healthy.

Phosphate minings massive groundwater with-drawals and destructive strip mining practicesare leading causes o fow loss in the Peace River.Documented by the United States GeologicalSurvey, this loss o water fow is linked to the or-

mation o sinkholes as well as the loss o springsand seeps in the upper river including KissengenSpring. Reduction o resh water fows cancause serious downstream impacts to CharlotteHarbor and its estuarychanging the salinityand damaging sh habitat. The counties wheremining occurs are in the Water Use Caution

Area. Florida residents are requently subjectto water use restrictions unlike the phosphatecompanies which may continue withdrawinggroundwater as usual.


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STATEMENTS FROM EUROPEAN HEALTH, WATER, & ENVIRONMENTAUTHORITIES ON WATER FLUORIDATION

Although the U.S. Centers for Disease Control hails water fluoridation as one of the top ten public health

achievements of the twentieth century, most of the western world, including the vast majority of western Eu-

rope, does not fluoridate its water supply.

At present, 97% of the western European population drinks non-fluoridated water. This includes: Austria, Bel-

gium, Denmark, Finland, France, Germany, Greece, Iceland, Italy, Luxembourg, Netherlands, Northern Ireland,

Norway, Portugal, Scotland, Sweden, Switzerland, and approximately 90% of both the United Kingdom and

Spain. Although some of these countries fluoridate their salt, the majority do not. (The only western European

countries that allow salt fluoridation are Austria, France, Germany, Spain, and Switzerland.)

Despite foregoing one of the top ten public health achievements of the twentieth century, tooth decay rates

have declined in Europe as precipitously over the past 50 years as they have in the United States. This raises seri-

ous questions about the CDCs assertion that the decline of tooth decay in the United States since the 1950s is

largely attributable to the advent of water fluoridation.

STATEMENTS FROM EUROPEAN OFFICIALS:

Austria:

Toxic fluorides have never been added to the public water supplies in Austria.

SOURCE: M. Eisenhut, Head of Water Department, Osterreichische Yereinigung fur das

Gas-und Wasserfach Schubertring 14, A-1015 Wien, Austria, February 17, 2000.

Belgium:

This water treatment has never been of use in Belgium and will never be (we hope so) into

the future. The main reason for that is the fundamental position of the drinking water sec-

tor that it is not its task to deliver medicinal treatment to people. This is the sole responsi-

bility of health services.

SOURCE: Chr. Legros, Directeur, Belgaqua, Brussels, Belgium, February 28, 2000.

Denmark:

We are pleased to inform you that according to the Danish Ministry of Environment and

Energy, toxic fluorides have never been added to the public water supplies. Consequently,

no Danish city has ever been fluoridated.

SOURCE: Klaus Werner, Royal Danish Embassy, Washington DC, December 22, 1999.

To read the Danish Ministry of the Environments reasons for banning fluoridation, click here.

Finland:

We do not favor or recommend fluoridation of drinking water. There are better ways of

providing the fluoride our teeth need.

SOURCE: Paavo Poteri, Acting Managing Director, Helsinki Water, Finland, February 7,

2000.

Artificial fluoridation of drinking water s upplies has been practiced in Finland only in one town, Kuopio, situat-

ed in eastern Finland and with a population of about 80,000 people (1.6% of the Finnish population). Fluoridation

started in 1959 and finished in 1992 as a result of the resistance of local population. The most usual grounds for

the resistance presented in this context were an individuals right to drinking water without additional chemicals

used for the medication of limited population groups. A concept of force-feeding was also mentioned.

Drinking water fluoridation is not prohibited in Finland but no municipalities have turned out to be willing to

practice it. Water suppliers, naturally, have always been against dosing of fluoride chemicals into water.

SOURCE: Leena Hiisvirta, M.Sc., Chief Engineer, Ministry of Social Affairs and Health, Finland, January 12, 1996.

France:

Fluoride chemicals are not included in the list [of 'chemicals for drinking water

treatment']. This is due to ethical as well as medical considerations.

SOURCE: Louis Sanchez, Directeur de la Protection de lEnvironment, August 25, 2000.

Germany:

Generally, in Germany fluoridation of drinking water is forbidden. The relevant German

law allows exceptions to the fluoridation ban on application. The argumentation of the Fed-

eral Ministry of Health against a general permissi on of fluoridation of drinking water is the

problematic nature of compuls[ory] medication.

SOURCE: Gerda Hankel-Khan, Embassy of Federal Republic of Germany, September 16, 1999.

Luxembourg:

Fluoride has never been added to the public water supplies in Luxembourg. In our views,

the drinking water isnt the suitable way for medicinal treatment and that people needingan addition of fluoride can decide by their own to use the most appropriate way, like the

intake of fluoride tablets, to cover their [daily] needs.

SOURCE: Jean-Marie RIES, Head, Water Department, Administration De LEnvironment, May 3, 2000.

Netherlands:

From the end of the 1960s until the beginning of the 1970s drinking water in various

places in the Netherlands was fluoridated to prevent caries. However, in its judgement of

22 June 1973 in case No. 10683 (Budding and co. versus the City of Amsterdam) the


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Supreme Court (Hoge Road) rul ed there was no legal basis for fluoridation. After that judgement, amendment to

the Water Supply Act was prepared to provide a legal basis for fluoridation. During the process it became clear

that there was not enough support from Parlement [sic] for this amendment and the proposal was withdrawn.

SOURCE: Wilfred Reinhold, Legal Advisor, Directorate Dri nking Water, Netherlands, January 15, 2000.

Northern Ireland:

The water supply in Northern Ireland has never been artificially fluoridated except in 2

small localities where fluoride was added to the water for about 30 years up to last year.

Fluoridation ceased at these locations for operational reasons. At this time, there are no

plans to commence fluoridation of water supplies in Northern Ireland.

SOURCE: C.J. Grimes, Department for Regional Development, Belfast, November 6 , 2000.

Norway:

In Norway we had a rather intense discussion on this subject some 20 years ago, and the

conclusion was that drinking water should not be fluoridated.

SOURCE: Truls Krogh & Toril Hofshagen, Folkehelsa Statens institutt for folkeheise (Na-

tional Institute of Public Health) Oslo, Norway, March 1, 2000.

Sweden:

Drinking water fluoridation is not allowed in SwedenNew scientific documentation or

changes in dental health situation that could alter the conclusions of the Commission have

not been shown.

SOURCE: Gunnar Guzikowski, Chief Government Inspector, Livsmedels Verket National Food Administra-

tion Drinking Water Division, Sweden, February 28, 2000.

See statement by Dr. Arvid Carlsson, the Nobel Laureate in Medicine, who helped lead the campaign to p revent fluoridation

in Sweden in the late 1970s.

Czech Republic:

Since 1993, drinking water has not been treated with fluoride in public water supplies

throughout the Czech Republic. Although fluoridation of drinking water has not actuallybeen proscribed it is not under consideration because this form of supplementation is con-

sidered:

uneconomical (only 0.54% of water suitable for drinking is used as such; the remainder is employed for hy-

giene etc. Furthermore, an increasing amount of consumers (particularly children) are using bottled water

for drinking (underground water usually with fluor)

unecological (environmental load by a for eign substance)

unethical (forced medication)

toxicologically and physiologically debateable (fluoridation represents an untargeted form of supplementa-

tion which disregards actual individual intake and requirements and may lead to excessive health-threat-

ening intake in certain population groups; [and] complexation of fluor in water into non biological active

forms of fluor.

SOURCE: Dr. B. Havlik, Ministerstvo Zdravotnictvi Ceske Republiky, October 14, 1999.

UPDATES

May 2007: A study of European public opinion on water fluoridation, published in the journal Community Den-

tistry & Oral Epidemiology, reports that the vast majority of people opposed water fluoridation. According to thestudy, Europeans opposed fluoridation for the following reasons:

Many felt dental health was an issue to be dealt with at the level of the individual, rather than a solution to be

imposed en masse. While people a ccepted that some children were not encouraged to brush their teeth, they pro-

posed other solutions to addressing these needs rather than having a solution of unproved safety imposed on

them by public health authorities whom they did not fully trust. They did not see why they should accept poten-

tial side effects in order that a minority may benefit. In particular, water was something that should be kept as

pure as possible, even though it was recognized that it already contains many additives. (See study summary)

November 2004: After months of consulation, Scotland - which is currently unfluoridated rejected plans to add

fluoride to the nations water.

April 9, 2003: The City Parliament of Basel, Switzerland voted 73 to 23 to stop Basels 41 year water fluoridation

program. Basel was the only city in Switzerland to fluoridate its water, and the only city in continental western

Europe, outside of a few areas in Spain.


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SECTION I PRODUCT AND COMPANY IDENTIFICATIONTRADE NAME: Hydroftuosilicic AcidCHEMICAL NAME: Hydrofiuosilicic AcidCAS NUMBER: 16961-83-4CHEMICAL FAMILY: lnorQanic FluoridesFluorosilicic AcidSYNONYMS: Hexafluosilicic AcidHFSFSAPRIMARY USE: Industrial ChemicalMosaic Crop Nutrition, LLCCOMPANY 13830 Circa Crossing DriveINFORMATION: Lithia, Florida 33547www.mosaicco.com866-928-7901 or 306-523-2800, 8 AM to 5 PM Central Time USEMERGENCY CHEMTREC 1-800-424-9300TELEPHONE:

SECTION II HAZARD IDENTIFICATIONEMERGENCY Health Hazards: Corrosive to the skin, eyes and mucousOVERVIEW: membranes through direct contact, inhalation oringestion. May cause severe irritation andburns, which may not be immediately apparent.Handle with extreme care.

Physical Hazards: Not applicablePhysical Form: LiquidAppearance: Water white to amber iquidOdor: Pungent

NFPAHAZARD HMIS HAZARD WHMIS HAZARDCLASS CLASS CLASSHealth: 3 Health: 3 @ymbolFlammability: 0 Flammability: 0Instability: 1 Physical 0 Classification EHazard:Special Corrosive PPE: Section Sub ClassHazard: 8

POTENTIAL HEALTH Eye: Corrosive. Contact may cause severeEFFECTS: irritation, eye burns, and permanent eyedamaQe.Skin: Corrosive. Contact may cause severeirritation, skin burns, and permanent skindamage.Inhalation (Breathing) Corrosive. Harmful if nhaled. May causesevere irritation and burns of he nose, throat,and respiratory tract.

Status: RevisedSection(s) Revised: Section II, V, VII, VIII, IX, XIII, XIV, XV Issue Date: May 27, 2011MSDS #: MOS 20011.09


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