Table of Contents

Other Websites to Visit:

Why Do We Want Community Water Fluoridation?

Why Do We Want Oregon to Adopt a Policy that Requires Community Water Fluoridation (i.e. a

            State Mandate)?

Is Water Fluoridation Effective?

Does Water Fluoridation Affect the Pits and Fissures of the Tooth, the Area Where Most Cavities Occur?

Are There Additional Benefits to Receiving Fluoride Systemically During Tooth Development?

Is Community Water Fluoridation Safe?

Does Water Fluoridation Cause Cancer?

Where Do the Fluoridation Additives Come From?

Are the Fluoride Additives "Waste" From the Phosphate Fertilizer Industry?

What is the "Zero Waste" Concept?

Do the Fluoride Chemicals Contain Contaminants?

What are the Chemical Properties of Fluoride?

What are the Different Ways of Receiving Fluoride?

What is the Process of Decay?

How does Fluoride Interfere With the Decay Process?

What is Fluorosis?

What is the Most Common Cause of Fluorosis?

Is Fluoridated Water Recommended for Children Under the Age of 6?

Should Infant Formula be mixed with Fluoridated Water?

Do Foods Contain High Levels of Fluoride?

Do Fruit Juices Contain High Levels of Fluoride?

Can Fluoride be Toxic?

Can Fluoridation Harm the Environment?

Is Fluoridation Harmful to Salmon?

 

Other Websites to Visit:

http://www.ada.org/4047.aspx ("Fluoridation Facts" from the American Dental Association)

http://www.ilikemyteeth.org/ (Campaign for Dental Health)

www.dentalwatch.org/fl/fluoride.html (History of common anti-fluoridationist tactics)

www.fluorideworks.org (Fluoride information & research)

http://www.cdc.gov/fluoridation/fact_sheets/index.htm (Centers for Disease Control fact sheets)

http://www.cdc.gov/fluoridation/links.htm (links to sites recommended by the CDC)

Why Do We Want Community Water Fluoridation?

Communities with optimally fluoridated water experience less dental decay than communities that have only trace amounts (if all other factors, such as socio-economic status, are equal).

 

Why Do We Want Oregon to Adopt a Policy That Requires Community Water Fluoridation (i.e. a "State Mandate")

 

For over 60 years, community water fluoridation has been the cornerstone of caries prevention in the United States. As noted in "Oral Health in America: A Report of the Surgeon General (2000)," community water fluoridation continues to be the most cost-effective, practical, and safe means for reducing and controlling the occurrence of tooth decay in a community.  A significant advantage of water fluoridation is that anyone, regardless of socioeconomic level, can enjoy these health benefits during their daily lives - at home, at work, or at school or play - simply by drinking fluoridated water or beverages prepared with fluoridated water.

 

In Oregon, only 27% of the water supplies are optimally fluoridated, compared to the national average of 72.4%. The main reason cited is that fluoridation should be a "local" decision, not a "state" decision.

 

Oral Health America (2003) says, "State fluoridation laws are a good indication of state commitment to the fluoridation of community water supplies. States with strong laws are in a better position to support the maintenance and upkeep of aging water systems and encourage communities to adopt fluoridation as a preventive oral health measure that will benefit all residents, regardless of income or race."

 

What is the benefit of fluoridation being a state decision (i.e. a decision of the "Oregon" community) rather than a "city" or a "water district" decision?

 

When a community decides to fluoridate, there is a typical unfolding of events:

  • Community members become frustrated with the dental disease that people are experiencing - disease that could have been prevented.
  • Parents, who have always assumed their water supply was fluoridated, realize that it is not.
  • A decision is made to implement fluoridation - an established, evidenced-based preventive measure.
  • Since fluoridation requires equipment and monitoring, the City Council is approached.
  • The City Council places "fluoridation" on their agenda and publishes the agenda on their website.
  • Anti-fluoridationists come to town, claiming fluoridation causes everything from Down Syndrome to Cancer. They claim that fluoridation harms children and causes bone problems in adults. They have a "witness" testify that he/she has had an allergic reaction to fluoridated water. They beg Council members not to implement "mass medication."
  • Few people will know that fluoridation is endorsed by the National Down Syndrome Society, the National Cancer Institute & the American Cancer Society, the American Academy of Pediatrics, the American Academy of Family Practice, and the American Osteopathic Association. Few people will know that the American Academy of Allergy, Asthma, and Immunology states that fluoridation has never produced an allergic reaction. Few people will know that 61,000 Oregonians already drink water that contains naturally-occurring fluoride.
  • The antis place an "ALERT" on their website asking members all over the world to choose one of 8 statements, put it into their own words, and send it to the Council members. The Council is deluged with letters and emails opposing fluoridation.
  • The press, intending to be fair, sets up a debate scenario, inadvertently bestowing on the antifluoridationists the same credibility as established research organizations, such as the National Academy of Sciences and the Centers for Disease Control and Prevention.
  • The public begins to think that fluoridation must be a "questionable" practice.
  • The fluoridation effort grinds to a halt. It has proved "too controversial."
  • The anti-fluoridationists leave town. Mission accomplished.
  • (The next time the antis change their tactics ever so slightly, always with the intent to instill doubt. They then say, "When in doubt, leave it out.")
  • Community members remain frustrated with the dental disease that people are experiencing - pain that could have been prevented.

Fluoridation is effective and safe.  Research proves it.  The state of Oregon can establish public health policy based on evidence-based research, not on opinion. There is no reason to avoid this responsibility and cause individual communities to struggle through this process without legal support.

 

Is Water Fluoridation Effective?

Prior to the wide-spread use of water fluoridation, 98 out of 100 Americans experienced some tooth decay by the time they reached adulthood. In the 1940s, with the advent of public water fluoridation, there began a 56% reduction in caries for children 12 -14 years of age (Dunning, 1979). In general, children showed a 20 - 40 % caries reduction over a lifetime (U.S. Health and Human Services, 1994).

American Academy of Family Physicians (2006)

Fluoridation of public water supplies is a safe, economical, and effective measure to prevent dental caries.

 

Centers for Disease Control and Prevention (2001)

Community water fluoridation is an effective, safe, and inexpensive way to prevent tooth decay. This method of fluoride delivery benefits Americans of all ages and socioeconomic status.

Institute of Medicine (1997)

In regions where only 19% of the population is served with fluoridated water [Oregon 20%], the difference in caries scores between fluoridated and nonfluoridated areas was 61%. In regions where 74% of the population is served with fluoridated water, the difference was only 6%. These findings suggested an important role for the halo or diffusion effect [nonfluoridated communities benefit from the products produced in nearby fluoridated communities, effectively reducing the disparity].

 

National Academy of Sciences (2002)

Research provides conclusive evidence that fluoridation of the water supply or supplemental fluoride reduces dental caries, and of all dietary components exhibiting a protective effect against caries, the most effective is fluoride. Fluoridated drinking water increases resistance to dental caries at all ages. The earlier that children are exposed to fluoridated drinking water or dietary fluoride supplements the greater the reduction in dental caries in both the primary and permanent teeth.

 

Does Water Fluoridation Affect the Pits and Fissures of the Tooth, the Area Where Most Cavities Occur?

Eight out of ten cavities occur in the grooves, or pits and fissures, of the chewing surfaces of the teeth. The greatest reduction in pit and fissure cavities occurs when fluoridated water is received continually, both before and after the teeth emerge into the mouth.

A study by Groeneveld, Van Eck, and Dirks found that about 66 % of the greatest reduction in pit and fissure caries came from pre-eruptive fluoride..provided that the fluoride was also consumed post-eruptively for a considerable period of time. (Groeneveld, A., Van Eck, A.A., and Dirks, O.B., Fluoride in caries prevention: is the effect pre- or post-eruptive? J Dent Res 69, Spec Iss: 751-755, February, 1990.)

 

Are There Additional Benefits to Receiving Fluoride Systemically During Tooth Development?

 

The greatest benefit to children occurs when the child receives fluoridated water his/her entire life, from birth and continuing on - about 50 % reduction in decay in the permanent teeth and about 63 % reduction in the primary teeth. Children who were 8 years old when fluoridation was introduced received about a 25 % reduction in decay in the permanent teeth.

 

Study by Thylstrup (1990)

This study reviewed evidence of the effects of the introduction of fluoridated water into a community. There were about 63 % more 8-year-olds with a caries-free primary dentition after seven years of fluoridation compared with baseline. Permanent teeth emerging into a disease-free environment (primary teeth without decay) were less likely to decay. (Thylstrup, A. Clinical evidence of the role of pre-eruptive fluoride in caries prevention. Department of Cariology and Endodontics, Royal Dental College, Copenhagen, Denmark; Journal of Dental Research 69/Spec Iss: 742-750, February, 1990)

 

Study by Singh, Spencer, and Armfield (2003)

This study showed an important pre-eruptive caries-preventive effect. Exposure to fluoridated water topically alone did not suffice in restricting caries to low levels, whereas a pre-eruption exposure alone resulted in lower overall decay rates. The maximum caries-preventive effects of fluoridated water were achieved by high pre- and post-eruption exposure. These results supported water fluoridation as a public health measure in view of the need for continuous exposure for the maximum benefit. (Singh, K. A., BDS, GDPH, PhD; Spencer, J., MDSc, MPH, PhD; Armfield, J. M., BA, J Public Health Dent 2003; 63(1):11-19)

 

Is Water Fluoridation Safe?

The Oregon Sierra Club, in order to block fluoridation, said (2004) that the "fluoride added to virtually every water supply is an industrial waste product" and that "contaminants including arsenic, lead and mercury are unintentionally being added to our water supply."  In 2007, they again claimed, "fluoridation chemicals contain heavy metals, such as arsenic, mercury, and lead."

The antifluoridationist group Oregon Citizens for Safe Drinking Water (2004) claimed the fluoridation chemicals were "dirty fluoride.Very dirty fluoride."

 

These statements are misleading. The government regulates contaminants to protect health. 

Affirmation of Safety from the Centers for Disease Control and Prevention

 

 

Regulation of Fluoride Products

 

There are two governmental agencies that serve this function - the Food and Drug Administration (FDA) for food and drug safety and the Environmental Agency (EPA) for water safety.

 

The FDA oversees the safety of fluoride containing products used to reduce tooth decay that are not added to public drinking water. The standards that limit the amount of contaminants that food and drugs could contain are set by the United States Pharmacopeia (USP) which is a non-governmental, non-profit organization. Its members include representatives of medicine, pharmacy, government, and the pharmaceutical industry. For the actual testing and certification of food and drugs for quality and safety, the USP uses the National Sanitation Foundation (NSF). This non-governmental, non-profit agency has been testing food products since the 1940s.

 

In 1962, the U.S. Congress passed the "Drug Amendments" to the Food, Drug, and Cosmetic Act in which efficacy became a requirement in addition to safety. Because fluoride supplements had been used with obvious effectiveness and safety since the 1940s to reduce the incidence of tooth decay, they were "grandfathered" in, and were not made to go through a formal application process.

 

The quality and safety of fluoride products added to water is not overseen by the FDA but by the Environmental Protection Agency (EPA) established in 1972. The EPA started the Drinking Water Additives Program in 1985 to establish standards for all products added to drinking water. A committee of medical and public health professionals, governmental agencies, and product manufacturers set standards that limit the amount of contaminant that water additives could contain. This is documented in "Standards 60." Compliance with these standards is voluntary but most states, including Oregon and Washington State, require Standard 60 certification guidelines.

 

The agency that tests and certifies the water additive products is the same one that tests and certifies food and drugs - the National Sanitation Foundation (NSF). These standards are very stringent and quality is closely monitored. But because NSF is a non-governmental agency, fluoridation opponents will often say, "There are no federal standards for fluoridation.

 

 

Standards

 

There are two types of standards that apply - one is for the purity of the product and one is for the limitation of contaminants that the product can contain.

 

Purity relates to the percentage of a product that actually is that product. For example, the USP standard for a fluoride compound added to toothpaste is that it is 99.9% pure. In contrast, the water quality or "industrial" grade of a fluoride product added to water is that it can be 98% pure, partly because of the high dilution factor. The 1.9% difference is usually in the form of an inorganic compound such as calcium carbonate (which is the active ingredient in Tums). Since this is not harmful in the small concentrations found in fluoridated water, it is not removed in order to keep the cost down. Purity, then, is different than contaminant levels. The greatest concern is the amount of arsenic that is present in food and minerals such as fluoride because arsenic is so abundant in nature and can be harmful to humans. It is present ubiquitously in earth so plants contain it, animals that feed on plants contain it, water naturally contains it, and any mineral mined from the earth can contain it.

 

The levels of arsenic and lead allowed in food and drugs by the FDA are 2 parts per million (2000 parts per billion) maximum. The standard for allowable arsenic in bottled water under the jurisdiction of the FDA is now 10 parts per billion (lowered recently from 50 ppb). The arsenic standard for drinking water set under the jurisdiction of the EPA is also now 10 parts per billion (lowered recently from 50 ppb). Of that 10 parts per billion, only 10% or 1 part per billion can be related to the addition of a fluoride compound to drinking water. Although this is the standard, the average amount of arsenic in fluoridated water at the tap, as measured by the National Sanitation Foundation, is 0.1 ppb.

_____________________________________________

 

The following are the regulations (allowable levels) and some actual measured levels for one contaminant "Arsenic." Clearly the contaminants in fluoridated water are well within safe limits.

 

ARSENIC:

 

Allowable Arsenic Levels in parts per billion (ppb)

 

Food additives (1)

2000

Meat (1)

500

Pharmaceuticals (2)

10,000

Toothpaste (1)  

3000

Fluoridated water (3)      

1

 

Actual Measured Arsenic Levels in parts per billion (ppb)

 

Vanilla Ice Cream (4)    

16

Rice (4) 

240

Bread (4)  

24

Chicken (4)

22

Cured Pork (4)

13

Pastrami (4)

24

Tuna (4)

1100

Sole (4)  

4000

Pickerel (4)

140

Shrimp (4)

650

Special K (4)

270

Flour (4)

11

Apple Juice (4)

12

Tea (4)

35

Cigarettes (4)

180

Fluoridated water (3)      

0.1

  

1. Federal Drug Administration, 2005

2. U.S. Pharmacopeia and National Formulary, 2002

3. National Sanitation Foundation, 2003

4. National Academy of Sciences, 1999 (http://books.nap.edu/books/0309063337/html/50.html)

 

Does Water Fluoridation Cause Cancer?

 

Since the inception of water fluoridation, there have been unsubstantiated claims that water fluoridation causes a variety of health problems - cancer, Down Syndrome, Alzheimer’s, bone disease, kidney problems, allergic reactions, etc.  To ensure the public that these claims are false, many organization have moved, one by one, to endorse water fluoridation - the National Cancer Institute & the American Cancer Society; Down Syndrome Society; Alzheimer's Association; American Osteopathic Association; National Kidney Foundation; Academy of Allergy, Asthma, and Immunology, and many others.

 

Harvard Study

In 2006, the claim that fluoridation causes cancer resurfaced, citing preliminary reports from a Harvard study. The Harvard study is a 15-year study looking at a possible link between osteosarcoma (a rare type of bone cancer) and water fluoridation. The data was collected from 1989 to 2004. The research director, Dr. Chester Douglas, was accused by those opposed to fluoridation of suppressing a paper written about the studies preliminary results. An ethics violation was filed with both Harvard and the National Institute of Health who is funding the study. Dr. Douglas was cleared by both institutions of any ethics violations.

 

Dr. Elise Bassin's thesis, published in 2000, was based on data collected from the first 3 years of the study (1989-1992). Dr. Bassin reported an age-specific increase in cancer rates in young males but not among young females. The author clarified that there "are several limitations to our study. She stated that "the etiology of osteosarcoma is not known," that "fluoride may not be the causative agent," and that there were as of yet [no bone biopsies to analyze fluoride content.] 

 

NOTE: One of the requirements of sound research is that the results be reproducible.

 

The second set of cases analyzed (1993-2000) do not replicate the overall findings from the Bassin thesis.  This second part of the study also includes extensive analysis of bone specimens, comparing cancerous and non-cancerous lesions for fluoride content. Dr. Douglas reports, "Our findings currently being prepared for publication, do not suggest an overall association between fluoride and osteosarcoma. Our preliminary analysis of the fluoride content of the bone specimens suggests that the fluoride level within the bone is not associated with excess risk of osteosarcoma. We are grateful to Dr. Bassin and her coauthors for mentioning at the end of their paper that we are not finding a positive association from the bone specimens in the second set of cases." Article by Dr. Douglas

 

In 2000, the National Institute of Environmental Health Sciences (NIEHS), one of the sponsors of the Harvard study, widely disseminated in the results of a first study (1990) that indicated a link with osteosarcoma and fluoride in male rats. A second NIEHS study, however, did not replicate the results of their first study. Drinking water with very high fluoride content was not found to be associated with osteosarcoma in either male or female rats.

 

National Cancer Institute

         

American Cancer Society

     

Where Do the Fluoridation Additives Come From?

 

Fluoride additives used in the United States for water fluoridation (sodium fluoride, sodium fluorosilicate, and fluorosilicic acid) are derived from apatite which is a type of limestone deposit used in the production of phosphate fertilizers. Apatite contains 3-7% fluoride and is the main source of fluoride used in water fluoridation. (1)

 

During processing, apatite is ground up and treated with sulfuric acid, producing phosphoric acid (the main ingredient in the production of phosphate fertilizer [also utilized in soda pop]) plus a solid and two gases. The solid, calcium sulfate (also known as gypsum) is the material used to form drywall or sheetrock.  The two gases, hydrogen fluoride and silicon tetrafluoride, are captured in water to form fluorosilicic acid which today is the most commonly used fluoride additive in the United States. (2)

 

The two remaining fluoride additives (sodium fluoride and sodium fluorosilicate) are derived from fluorosilicic acid.  Sodium fluoride is produced when fluorosilicic acid is neutralized with caustic soda. Fluorosilicic acid is neutralized with sodium chloride or sodium carbonate to produce sodium fluorosilicate. (1)

(1) US Dept. of Health and Human Services, Centers for Disease Control, Dental Disease Prevention Activity. Water fluoridation: a manual for engineers and technicians. Atlanta, September 1986.

(2) American Water Works Association. AWWA standard for sodium fluoride (ANSI/AWWA B701-99), March 1, 2000: AWWA standard for sodium fluorosilicate (ANSI/AWWA B702-99), March 1, 2000 and AWWA standard for fluorosilicic acid (ANSI/AWWA B703-00), September 1, 2000.

 

Are the Fluoride Additives "Waste" From the Phosphate Fertilizer Industry?

 

From time to time opponents of fluoridation allege that fluoridation additives are byproducts of the phosphate fertilizer industry in an effort to infer the additives are not safe.  Byproducts are simply materials produced as a result of producing something else - they are no means necessarily bad, harmful, or waste products.  In the chemical industry, a byproduct is anything other than the economically most important product produced. Byproducts may have certain characteristics which make them valuable resource. For example, in addition to orange juice, various byproducts are obtained from oranges during juice production that are used in cleaner, disinfectants, flavoring, and fragrances.

 

Fluoride additives are valuable byproducts produced as a result of producing phosphate fertilizer. To ensure that public's safety, additives used in water fluoridation meet standards of the American Water Works Association (AWWA) and NSF International (NSF)

 

What is the "Zero Waste" Concept?

For a complete explanation of the concept of using byproducts responsibly for environmental sustainability - instead of "throwing away" valuable resources - go to www.zerowaste.org

 

Do the Fluoride Chemicals Contain Contaminants?

The Oregon Sierra Club, in order to block the adoption of fluoridation, said (2004) that the "fluoride added to virtually every water supply is an industrial waste product" and that "contaminants including arsenic, lead and mercury are unintentionally being added to our water supply." The antifluoridationist group Oregon Citizens for Safe Drinking Water (2004) claimed about the fluoridation chemicals, "This is not pure fluoride, this is 'dirty fluoride. Very dirty fluoride.'"

 

These statements were intended to mislead.  The truth is that contaminants are found in everything and the government regulates contaminants to protect health.  (See "Is Water Fluoridation Safe?)  For example, the following are the regulations (allowable levels) and some actual measured levels for one contaminant "Arsenic." Clearly the contaminants in fluoridated water are well within safe limits.

 

ARSENIC:

 

Allowable Arsenic Levels in parts per billion (ppb)

Food additives (1)

2000

Meat (1)

500

Vitamin tablets (2)

10,000

Toothpaste (1)  

3000

Fluoridated water (3)      

1

 

Actual Measured Arsenic Levels in parts per billion (ppb)

Vanilla Ice Cream (4)    

16

Rice (4) 

240

Bread (4)  

24

Chicken (4)

22

Cured Pork (4)
13
Pastrami (4)
24
Tuna (4)
1100

Sole (4)  

4000

Pickerel (4)
140
Shrimp (4)
650
Special K (4)
270
Flour (4)
11
Apple Juice (4)
12
Tea (4)
35
Cigarettes (4)
180

Fluoridated water (3)      

0.1

  

1. Federal Drug Administration, 2005

2. U.S. Pharmacopeia and National Formulary, 2002

3. National Sanitation Foundation, 2003

4. National Academy of Sciences, 1999 http://books.nap.edu/books/0309063337/html/50.html

 

What are the Chemical Properties of Fluoride?

A chemical compound, like Sodium Fluoride (NaF) is simply a combination of Sodium and Fluorine, two common elements. Fluorine belongs to the group known as Halogens, which in the Greek means "salt-formers." (The best-known example of a halogen compound is Sodium Chloride - common table salt.)  Fluorine is never found in a free state in nature, but is always in compound form. When dissolved in water, salt compounds dissociate into ions.  It is the fluoride ions in the drinking water that cause the reduction in tooth decay.  Fluoride ions are free to bind with the enamel to form a more insoluble structure. There is no difference between artificially [chemically] fluoridated water and naturally fluoridated water in that the ions that are released are identical in their chemical structure regardless of the origin of the fluoride ion.

What are the Different Ways of Receiving Fluoride?

Method of

Fluoride Delivery

Fl content

Cost

Pros

Cons

Comments

Water fluoridation

.7 - 1.2 parts per million (ppm)

69 cents/per person/per year

Safe; minute amounts of fluoride

over long

period of time; convenient; citizens of all ages benefit

Small vocal

minority

fear any additives in the drinking

water

Most effective and safest method of fluoride delivery; considered closest to nature's way

Fluoride tablets

 

.5 -1.0 mg

$50.00/year

Safe, but was originally intended to be dissolved in water; systemic and topical benefits

Causes small spike in fluoride levels in the blood which may cause mild fluorosis (white spots on the teeth); problem with compliance

Recommended for children living in areas that are not fluoridated

Fluoride toothpaste

1,000 - 1,500 ppm

Inexpensive

Safe for topical use; provides topical benefits

Parents must monitor small children, as they tend to swallow toothpaste - only a smear (0-2 years) to a pea-size amount (2-6 years) is recommended

 

Over-the- counter fluoride rinse

 

230 ppm

$14.00/year (approx.)

 

Topical benefits; no systemic benefit; problem with compliance

 

Topical Fl

Applied in

Dental office

12,300

ppm

$60.00/year

(approx.)

 

Because of expense, not available to all; insurance pays only for fluoride treatments for children

 

Prescription

Fluoride gel

 

 

$51.00/year

(approx.)

 

Not suitable for children; problem with compliance; unpleasant taste

 

 

What is the Process of Decay?

(Demineralization and Remineralization)

 

Every time you put refined sugar in your mouth, bacteria starts, within 30 seconds, to make acid from that sugar. If the acid concentrates on the tooth long enough, the minerals calcium and phosphorus are dissolved out of the tooth surface (demineralization). In the absence of an acid environment, minerals present in the saliva will redeposit on the tooth surface (remineralization). A hole, or cavity, occurs when more minerals dissolve out of the tooth than go back in. The next time that you drink a sugared, carbonated drink, feel the tooth surface with your tongue. It will feel slightly chalky because it is slightly demineralized. After an hour, it will fell smooth again because it has remineralized. See Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. Scroll down to How Fluoride Prevents and Controls Dental Caries.

How does Fluoride Interfere With the Decay Process?

 

If, during the remineralization process, there is a fluoride ion present, it becomes incorporated into the tooth surface along with the calcium and phosphorus. This process makes an enamel crystal that is less susceptible to being dissolved by acid. The more frequently fluoride ions are present in the mouth, whether from toothpaste, water, food, rinses, or supplements, the greater the protection against decay. This phenomenon is called the topical effect of fluoride and occurs at any age. The more sugar eaten in the many forms of fructose (fruit sugar), lactose (milk sugar), or sucrose (refined sugar) the greater the need for fluoride. The per capita yearly intake of caloric sweeteners, which has always been high has increased from 132 pounds in 1988 to 157 pounds in 1999.

 

If fluoride is consumed before the age of 12 when all the teeth are forming, it enters the blood stream briefly and is incorporated into the entire developing tooth. This process is called the systemic benefit of fluoride and gives lifetime decay resistance.

 

The other major way fluoride reduces decay is when it concentrates in plaque. The presence of fluoride inhibits or prevents the bacteria from making acid from sugar. Fluoride has also been shown to have a mild effect against the bacteria that cause gum disease (Love, 2002)

 

What is Fluorosis?

 

Fluorosis is caused by the ingestion of a level of fluoride that is above the optimum level during the years when the teeth are developing. Fluorosis generally manifests itself as barely discernable white, opaque spots, and is an esthetic concern. Very high levels of fluoride - levels that are sometimes found in naturally fluoridated water - may produce brown or pitted enamel. Since all water contains some levels of fluoride, the EPA sets certain standards for optimum fluoride content. The levels of fluoride may be increased or decreased to meet with the optimum standards for good dental health.

 

Left: Enamel fluorosis of moderate severity is seen across much of this patient's dentition.

Right: Mild-to-moderate enamel fluorosis (whiter areas) is more localized in this patient.

 

What is the Most Common Cause of Fluorosis?

78% of fluorosis can be attributed to children using more than the recommended "pea-size" amount of fluoride toothpaste and/or inapproriate use of fluoride supplements Journal of the American Dental Association.

 

 The estimated proportion of all cases of mild-to-moderate fluorosis

  in fluoridated communities that can be attributed to early use of more

   than the recommended amount of fluoride toothpaste and inapproriate

 use of fluoride supplements.

 

Toothpastes contain high levels of fluoride (1000 - 1500 ppm). Unfortunately children often swallow toothpaste, even though toothpaste is meant specifically for topical application. Parents must be informed that children should use a "pea-size" amount, in case of incidental ingestion.

 

Fluoride tablets are meant to be taken only by children who do not have access to fluoridated water.  Fluoride tablets may be prescribed inappropriately.

 

Fluorosis only occurs when the fluoride levels exceed the optimum level. Public water fluoridation delivers very low levels of fluoride on a regular basis, the method least likely to cause fluorosis.

Is Fluoridated Water Recommended for Children Under the Age of 6?

 

The CDC states that water fluoridation benefits people of all ages, including children.

The National Academy of Sciences states, "The earlier that children are exposed to fluoridated drinking water or dietary fluoride supplements the greater the reduction in dental caries in both the primary and permanent teeth."

 

Should Infant Formula be mixed with Fluoridated Water?

First of all, it is important to recommend breastfeeding as ideal for infants. The CDC is committed to increasing breastfeeding rates throughout the United States and to promoting optimal breastfeeding practices. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. More can be learned about this subject at CDC recommendations for breastfeeding

Fortunately, through concerted efforts by the Oregon Department of Human Services, the rate of breastfeeding in Oregon has reached 89%. (Oregonian, 2006)


If breastfeeding is not possible, several types of formula are available for infant feeding. Parents and caregivers are encouraged to speak with their pediatrician about which type of infant formula is best suited for their child.

Infant formula manufacturers take steps to assure that infant formula contains low fluoride levels—the products themselves are not the issue. Although formula itself has low amounts of fluoride, when infant formula concentrate is mixed with fluoridated water and used as the primary source of nutrition, it may introduce fluoride at levels above the amount recommended to minimize the risk for fluorosis. Infants consume little other than breast milk or formula during the first four to six months of life, and continue to have a high intake of liquids during the entire first year. Therefore, proportional to body weight, fluoride intake from liquids is generally higher for younger or smaller children than for older children, adolescents, or adults. Mixing concentrate with fluoridated tap water on an occasional basis is unlikely to be of much risk. However, when used consistently as the primary source of nutrition over longer periods of the first year, a child may receive enough fluoride to increase his/her chances of developing very mild or mild fluorosis.

Parents should follow the advice of the formula manufacturer and their child’s doctor for the type of water appropriate for the formula they are using.

CDC recommendations for infant formula

It is important to remember:

 

  • The concerns here are entirely about fluorosis. There are no other consequences at risk.
  • There is a 60 year experience with fluoridation. The only undesirable consequence of infants drinking fluoridated water is minimal and mild fluorosis. Scientists consider these conditions to be inconsequential compared to cavities which are an enormous public health problem.
  • A low rate of minimal and mild fluorosis has always been an acceptable consequence of fluoride's cavity prevention effects.

 

Do Foods Contain High Levels of Fluoride?

At a January 13, 2007 presentation hosted by the Citizens for Safe Drinking Water, an anti-fluoridationist

group, there was a display of food products again labeled with the following high fluoride contents:

 

Gerber Berry Juice

3.00 parts per million (ppm)

Gerber White Grape Juice

6.80 ppm

Fruit Loops

2.10 ppm

General Mills Wheaties

10.10 ppm

Kellogg's Shredded Wheat

9.40 ppm

Post Grapenuts Cereal

6.40 ppm

Cabbage

45.00 ppm

Citrus Fruits

95.00 ppm

Lettuce

180.00 ppm

 

 

The following letter was written in response to similar claims made prior to 2004. The letter is written by Dr. Steven Levy, an expert on fluorides, who has many peer-reviewed articles specific to fluoride. Dr. Levy tested many food products for fluoride content and included the results within this letter.

 

 


 

February 13, 2004

 

I write as a concerned citizen and scientist regarding the three pages of materials you recently faxed me about fluoride, fluoridation, and fluoride levels of foods and beverages.  I believe the information was quoted as originally coming from Citizens for Safe Drinking Water and others.

 

As you know, I have spent much of my professional career trying to better understand the fluoride levels of foods and beverages and fluoride intake from other sources.  We have received eight different NIH grants related to this and are working on a grant application to continue this work.  We have followed a group of nearly 1,000 children longitudinally from birth to current ages 9-12 and are studying dental caries, dental fluorosis, and bone development related to fluoride and other factors.  We have tested thousands of foods and beverages for fluoride content over the past 10 years.

 

Because of both my familiarity with published and unpublished findings and our extensive research concerning fluoride levels of foods/beverages, I was very surprised and concerned to see isolated data (probably from a single laboratory in July 1960) reportedly showing three different brand name cereals with fluoride levels of 6.4, 9.4, and 10.1 ppm, respectively.  These are completely out of line with all other published and unpublished findings.  In addition, the 2.1 ppm value for Fruit Loops seemed too high.  The fluoride levels of dry cereals and of milk have consistently been much lower than these stated values, which naturally would contradict the whole presentation saying “a bowl of Wheaties, a glass of milk, and a Coke or orange juice delivers twice the fluoride salesman’s daily goal of fluoridation.”  Obviously, there is no information on these pages to fully understand the origins of the claims (dates, labs, etc.). (Note that whoever prepared these documents also made a major error in using the faulty values.  Even if the fluoride levels were correct, the 232% excess is off by 100%.)

 

Because of our concern for the validity of these data and the statement above, we decided to purchase and test for fluoride content several of the same cereals, milk, and a few extra similar cereals (but different brands).  We purchased them locally and assayed them (in September 2001), using the same methods we’ve used in our other published work.  The results are very consistent with our previous assays of similar products and other published, scientific results, and are very much lower than those high levels stated on the sheet you sent.

 

Specifically, the results were:

 

FOOD LABEL

FOOD ITEM

PRODUCT PPM

[CSDW claims]

41

Wheaties

0.4

10.10

42

2% Milk

0.04

 

43

Grapenuts

0.6

6.40

44

Original Shredded Wheat—Large

0.9

9.40

45

Mini-Wheats—Frosted, Bite-size

0.5

 

46

Original Shredded Wheat—Small

0.6

 

47

HyVee Nutty Nuggets

0.3

 

48

Cheerios

0.9

 

49

Fruit Loops with Lemon Stripes

0.6

2.10

 

Based on these current findings, I feel even stronger that it is very unfortunate and inappropriate for the data on the sheets to be disseminated further or provide the basis for discussion of water fluoridation policy.  One would need to eat a couple of boxes of cereal to get to the fluoride levels mentioned for the “one bowl of Wheaties”, etc.  And I had never before seen any human, cow, or other animal milk fluoride level that wasn’t very low.  Our 0.04 level for the 2% milk is consistent with all previous studies and only about 5-6% of that listed value of 0.72 ppm.

 

In summary on this, I believe strongly that the fluoride values on the sheets you showed me are erroneous and must be discarded/discounted in any discussions about fluorides and fluoridation.

 

Overall, in summary, I strongly endorse continued use and expansion of community water fluoridation.  It is a great public health measure and was reaffirmed in MMWR (August 17, 2001) by the CDC and external experts as the most efficient and cost-effective means of caries prevention.

 

Please contact me if I can provide additional information.

 

Sincerely,

 

 

Steven M. Levy, DDS, MPH

Professor and Principal Investigator, Iowa Fluoride Study

 

 More "fluoride-levels-in-food" results from Dr. Levy

 

Do Fruit Juices Contain High Levels of Fluoride?

 

The level of fluoride present in grape juice reported in the early 90's was the result of carry over of an insecticidal agent used in organic agriculture.  At the time the juice industry was seeking to shift production to organic systems and did not realize that these organic materials would leave residue of consequence.  The use of these organic materials was banned in the mid-90's and now quality specifications for grape juice allows that no more fluoride be present than is in municipal drinking water.

 

In the past, juice made from concentrate was also a problem, as fluoride is not destroyed during the concentration process. Juice companies used to buy concentrate and reconstitute the concentrate with the municipal fluoridated water, resulting in higher than desirable levels of fluoride. This process is no longer used.

Can Fluoride be Toxic?

 

All substances are toxic, if the levels ingested are too high. It is well know that if a person ingests too much of the fat-soluble Vitamins A and D, they can accumulate to toxic levels in the body. Too much Iron can cause toxicity, although small amounts are necessary for health. Common table salt (Sodium Chloride), similar to Sodium Fluoride in structure, can be toxic if too much is ingested. Too much fat, too much sugar, too much caffeine - all these things are detrimental to health. No one advocates that a person takes too much of anything. Yet a minimum amount of certain nutrients, such as fluoride and calcium, are recommended for good health.

 

Fluoride has an affinity for teeth and bones, as does calcium, and therefore has often been suspect in bone defects. In areas where the fluoride levels in the water are naturally very high (8 ppm - 20 ppm for example) and people have ingested these high levels of fluoride for decades, there is indeed evidence of skeletal deformities or bone brittleness. Once again the level of intake makes all the difference. Research is currently being conducted on the beneficial effects of optimum levels of fluoride to increase bone density and strength.

 

People have been ingesting fluoride since the beginning of the human race, as fluoride is the 13th most common compound in the earths crust and is found naturally in all water supplies. Many studies have been conducted to determine the levels which result in health benefits vs. levels that are detrimental. The recommended levels are a result of this exhaustive research.

Can Fluoridation Harm the Environment?

 

Scientific evidence supports the fluoridation of public water supplies as safe for the environment and beneficial to people. Reports at the local, national, and international levels have continued to support this most important public health measure. There appears to be no concern about the environmental aspects of water fluoridation among those experts who have investigated the matter.

Furthermore, since the chemicals used for water fluoridation are co-products of the manufacture of phosphate fertilizers and the raw material used is a natural resource (rocks excavated for their mineral content), water fluoridation could accurately be described as environmentally friendly, as it maximizes the use made of these natural resources and reduces waste. www.Zerowaste.org

 

Is Fluoridation Harmful to Salmon ?

 

The concentration of fluoride in treated water does not reach levels that could harm any plant or animal species. A report of the effects of industrial pollution from an aluminum plant on salmon indicated that the usual fluoride concentration of the river was 0.1 mg/L and when the concentration was raised experimentally to 0.5 mg/L, there was an effect on the salmon. Since rivers and streams are not fluoridated and the increase in the fluoride concentration of a river as a result of runoff from fluoridated water would be insufficient to raise the level to even 0.2 mg/L, fluoridation of water can have no effect on salmon.

 

 

Last updated March 26, 2012
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