Below we have printed our recommended model letter for State Health Departments, requesting that they take urgent action to inform parents in their state of the ADA Nov 9 alert indicating that fluoridated water not be used to make up infant formula. We urge you to send this (or a modified version) as an individual, or as a representative of a group, to your State Commissioner (or Director). Please copy your State Governor and US Reps.

You may wish to exclude the 4th and 3rd paragraphs from the end of this letter (which begin “Also, what does the ADA advisory mean... and  “Parents have also not been informed...”) if you would prefer to stick to the single focus of fluoride in formula made with tap water and not get into fluoride in supplements and certain baby foods.

Paul Connett

Re: Fluoride Warning for Infants is Not Reaching the Public

Dear ......

I am writing to inquire how our State Department of Health is planning to alert parents, caregivers and health professionals about the new American Dental Association (ADA) advisory that fluoridated water should not given to infants? 
  
As you may know, the ADA sent out an alert, on November 9, 2006, to its members and supporters, but not to the public, advising steps be taken to “simply and effectively reduce fluoride intake during a baby's first year of life." One of those steps is the need to advise parents that fluoridated tap water be avoided when making infant formula (1).

The ADA suggests that fluoride-free bottled water be used to reconstitute powdered formula (1) in order to prevent fluoride-discolored or damaged permanent teeth (dental fluorosis), which is a growing U.S. problem. According to the Centers for Disease Control, dental fluorosis now impacts 32% of American children, an increase of 9% since the 1980s (2).
 
The Academy of General Dentistry cautioned parents years ago to avoid fluoridated water when making infant foods (3). And a recent review from the National Research Council (NRC) reports that babies under one year risk moderate dental fluorosis (white, yellow or brown stains affecting 100% of the tooth surface) from what health and dental authorities claim is “optimal” to reduce tooth decay (water fluoride concentrations of 0.7 - 1.2 mg/L). The NRC report is the basis for the ADA’s new advisory (4).

Not only does exposure to fluoridated water during the first year of life put a child at high risk for fluorosis, but according to a recent ruling from the Food and Drug Administration (FDA), it is not effective at preventing cavities (5). But the word isn’t getting out to the public. Why?

Numerous studies have linked a baby’s consumption of fluoridated water to dental fluorosis of the permanent teeth (6a-h). However, no obvious effort has been expended to get this alert to those who need to hear it the most. Dental associations, health officials, and dental researchers churning out these studies at federal tax payers’ expense, will often defend fluoridation without any caveat for infants. In fact, sometimes they try to stop others from getting the information to the public (7).
 
We applaud the Minnesota Dental Association (MDA) for being the only health or dental organization of which we are aware to send out a news release alerting the public to this new ADA fluoride advice even though soft-pedaled (8).  Up until November 9, 2006, the only “reminder” issued by most of organized dentistry was to unduly scare parents AWAY from using fluoride-free bottled water (9).  Now the ADA and MDA tell parents to avoid fluoridated tap water in favor of fluoride-free bottled, or filtered, water to make up baby formula.

While a handful of local media outlets across the country have publicized ADA’s important advisory (10), this is not nearly enough. Moreover, many people don’t read newspapers or watch TV news – especially new Moms with little free time.  Too many Americans don’t even see physicians or dentists on a regular basis because they can’t afford it.  So this new ADA advisory has to be passed onto caregivers and parents in every way possible to minimize the number of infants unnecessarily affected.

Please inform me when educational materials on these issues are available to be distributed to the media, WIC centers, pediatricians, hospitals, obstetrician’s offices, dental clinics, and water departments. Water departments should be required to send warnings with each water bill.

Common sense would also suggest that baby formula containers should be required to have warning labels that say “don’t mix with fluoridated water.” Are you requesting that formula manufacturers do this?
 
Also, what does the ADA advisory mean for fluoride supplements which the ADA still says should be given to infants six months and over? It doesn’t make sense for six month old children to avoid free fluoridated tap water; but then have to be given costly prescription fluoride supplements.

Parents have also not been informed about the high fluoride content of some foods, especially jarred chicken baby food, grape juice, soy-based formulas, and fish (11).  Will you make this information available and publicized so children’s daily fluoride intake can be truly monitored?

Lastly, while the ADA only admits to a relationship between over-exposure to fluoride and dental fluorosis, the NRC report goes much further and reveals scientific research which indicates that optimally fluoridated water (which contains 250 times more fluoride than breast milk) may adversely affect the bones, the brain, and the thyroid gland, especially among high water drinkers, diabetics, and kidney patients.

I look forward to your detailed reply.

Signed,
 


References:
 
1) ADA e-gram, “Interim Guidance on Reconstituted Infant Formula”, November 9, 2006
http://www.ada.org/prof/resources/pubs/epubs/egram/egram_061109.pdf  

2) Centers for Disease Control, August 25, 2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/s403a1t23.gif 

3) Academy of General Dentistry News Release “Monitor Infant's Fluoride Intake,”
http://www.agd.org/consumer/topics/baby/fluoride.asp  
 
4) National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. http://www.nap.edu/catalog/11571.html?onpi_newsdoc03222006

5)  US FDA, Center for Food Safety and Applied Nutrition, Office of Nutritional Products, Labeling, and Dietary Supplements, October 14, 2006, “Health Claim Notification for Fluoridated Water and Reduced Risk of Dental Caries. http://www.cfsan.fda.gov/~dms/flfluoro.html
 
6a) Hong L, Levy SM, et al. (2006). Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry and Oral Epidemiology 34(4):299-309.

6b) Marshall TA, et al. (2004). Associations between Intakes of Fluoride from Beverages during Infancy and Dental Fluorosis of Primary Teeth. Journal of the American College of Nutrition 23:108-16.

6c) Brothwell D, Limeback H. (2003). Breastfeeding is protective against dental fluorosis in a nonfluoridated rural area of Ontario, Canada. Journal of Human Lactation 19: 386-90.

6d) Pendrys DG. (2000). Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association 131(6):746-55.

6e) Bardsen A, Bjorvatn K. (1998). Risk periods in the development of dental fluorosis. Clinical Oral Investigations 2:155-160.

6f) Pendrys DG, Katz RV. (1998). Risk factors for enamel fluorosis in optimally fluoridated children born after the US manufacturers' decision to reduce the fluoride concentration of infant formula. American Journal of Epidemiology 148:967-74.

6g) Ismail AI, Messer JG. (1996). The risk of fluorosis in students exposed to a higher than optimal concentration of fluoride in well water. Journal of Public Health Dentistry 56:22-7.

6h) Ekstrand J, et al. (1994). Absorption and retention of dietary and supplemental fluoride by infants. Advances in Dental Research 8:175-80.
 
7) Diesendorf M, Diesendorf A. (1997). Suppression by medical journals of a warning about overdosing formula-fed infants with fluoride. Accountability in Research 5:225-237. http://www.sustainabilitycentre.com.au/FormulaFedBabies.pdf  

8) Minnesota Dental Association. November 21, 2006. “Parents Reminded To Monitor Infants' Fluoride Consumption.” See: http://www.medicalnewstoday.com/medicalnews.php?newsid=57490
 
9) “Bottled water: Cause for cavity comeback?” http://www.deltadentalca.org/health/bottledwater.html

10a) “New Fluoride Warning for Infants”, Mothering Magazine, November 2006.
http://www.mothering.com/sections/news_bulletins/november2006.html#fluoride 

10b) "Parents Warned Against Fluoride in water" WKRN Nashville, Tennessee, November 25, 2006
http://www.wkrn.com/nashville/news/parents-warned-against-fluoride-in-water/61618.htm 

10c)  “Fluoride and Babies Don’t Mix, says ADA”, News Channel 5, Nashville, Tennessee, November 24, 2006 http://www.newschannel5.com/Global/story.asp?S=5726800  

10d) “ADA: Avoid using flourinated water with babies.” HOI 19 online ABC, November 16, 2006
  http://www.hoinews.com/news/news_story.aspx?id=21806  

10e) “Water fluoridation: A debate with teeth,” Bangor Daily News By Meg Haskell November 20, 2006 - http://bangordailynews.com/news/t/news.aspx?articleid=143246&zoneid=500 

11) Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23. See: http://www.fluoridealert.org/f-sources.htm