Mention "fluoride" to the average person
and chances are the word elicits a knee-jerk positive
reaction.
For decades, fluoride has been associated with shiny, happy,
cavity reduced kids. Fluoride, dispensed in tablets, oozing
out of toothpaste tubes, is almost as American as apple pie.
However, the topic of water fluoridation remains embedded in
controversy as scientists and medical professionals call into
question the safety of adding fluoridation chemicals to the
public drinking water supply.
Dr. Nicholas Dienel is a cardiologist at the Rogue Valley
Medical Center in Medford, Ore.
"I was pro-fluoride in the late 1990s," he said, "until I was
asked how much I knew about the topic. I just believed what I
was told by other people, and I thought, 'that's not good - to
blindly believe what I'm told.' "
Dienel researched the topic and began drawing his own
conclusions.
"I think there are enough warning signs of dangers or
potential danger [of fluoride]," he said.
According to Dienel, 10, 20, 30 years ago, the medical
community clung tightly to standards that were felt to be
"absolutely the right way."
One of his "humbling observations", Dienel said, is that over
last 20 years, he has seen a "180 degree turnabout in what was
thought to be absolutely correct and is now considered wrong."
He believes that is becoming, and will become, the case with
fluoride.
The fluoride debate is gathering
momentum in Oregon.
Hood River officials last month withdrew their attempt to
place a water fluoridation measure on the upcoming November
ballot after a group of citizens legally challenged the move.
The water supply has been fluoridated for years in Florence.
Earlier this summer, those in favor of leaving fluoride and
any other substances added for medicinal effect out of
drinking water asked the Florence City Council to reconsider
water standards.
Jeff Green is a longtime management consultant for dentists
and other health professionals and now serves as the volunteer
national director of Citizens for Safe Drinking Water, an
organization co-founded by Green and a San Diego dentist. The
group actively participates with Oregon and Florence
affiliates in trying to establish water additive safety
standards.
According to Green, the discussion in Florence and elsewhere
has changed from solely focusing on children's teeth to the
basics of water safety for everyone.
"The citizens in Florence have filed their intention to place
an initiative on the ballot so voters can decide on criteria
for water additives intended for treating people, and let the
facts determine the outcome, rather than fighting with their
neighbors over fluoride," said Green.
Proponents of the water quality criteria are circulating
petitions. If they collect enough valid signatures in the
coming weeks, they could force a vote on the measure.
Not long ago, Beaverton became the latest Oregon city to have
its public water supply artificially fluoridated.
Fifty-three percent of Beaverton voters cast their ballots in
favor of fluoridation before the city began injecting sodium
fluoride into the water in May.
Fluoridation supporters say the health risks associated with
drinking fluoridated water are negligible, but those who
support non-fluoridated water contend that most people who
voted for fluoridation don't know the full story. They say
fluoridation's potential risks outweigh its disputed benefits.
Portland's water supply is not currently fluoridated, but
there's no guarantee it will stay that way. Much to the
distress of environmental groups, those campaigning for
fluoridation say they want fluoridated water to flow from
every faucet in every community. Though water fluoridation has
been rejected by Portland voters in the past, Portland dentist
Kurt Ferre said he and others working to spread water
fluoridation are "not giving up."
Fluoride Facts
The issue of artificial fluoridation of the public's drinking
water supply poses many unanswered questions, but the hard
facts stand firm. For instance, fluoride-based drugs such as
Prozac have been approved for ingestion for their stated
purpose, but no fluoride compound has ever been approved by
the Food & Drug Administration for ingestion for the purpose
of reducing tooth decay.
Ferre doesn't think that matters. He pointed out that the FDA
does not have jurisdiction over water additives, and he
compared FDA approval to endorsement by any random, arbitrary
organization.
"Why don't we get it [fluoride] endorsed by major league
baseball?" he said.
But FDA approval is considered the public's assurance that a
drug is both safe and effective.
The FDA defines any fluoride product (including prescription
drops and tablets) swallowed for a reduction in tooth decay as
a drug which it has never reviewed or approved for that
purpose. What the FDA has approved for reducing tooth decay
are fluoride products to be applied strictly topically, such
as toothpaste containing fluoride.
In contrast to chlorine, which is added to treat water, making
it potable, fluoride is added to treat people.
Fluoride is a poison. Merriam-Webster Dictionary defines
sodium fluoride, the chemical added to Beaverton's water, as
"a poisonous crystalline salt that is used in trace amounts in
the fluoridation of water, in metallurgy, as a flux, and as a
pesticide."
Of course, many drugs which are toxic in high concentrations
are considered medicinal in small quantities. The debate
hinges not only on whether this is the case with fluoride, but
more importantly, whether fluoridated water is safe to drink.
The Fluoride Health Debate
Backed by prominent groups such as the American Medical
Association, the U.S. dental establishment, the Centers for
Disease and Prevention and others, those in favor of water
fluoridation say that not only is fluoride harmless at the low
level added to drinking water, but it's beneficial because of
its plaque-fighting properties that promote healthy teeth.
Fluoridating the water allows everyone to receive an equal
health benefit, regardless of income and access to health
care, they say.
Portland-area dentist April Love said children are the most
vulnerable to cavities, and it's unfair that some kids receive
less or no dental care compared to their more affluent peers.
"We're doing this because of health equity, essentially," Love
said. "What we don't understand is why educated, liberal
people don't push for health equity."
Ironically, fluoride may be hurting the very population that
fluoridation proponents strive to help.
Those most vulnerable to the toxic effects of fluoride and its
compounds include people suffering dietary deficiencies of
calcium, magnesium and essential nutrients -- typically, the
poor. Other susceptible populations include the elderly and
people with cardiovascular and kidney problems. This
information was released in a 1993 toxicological profile by
the U.S. Department of Health and Human Services, the Public
Health Service and the Agency for Toxic Substances and Disease
Registry.
"It's contradictory to add something for health that hurts
health in other ways," said Lynne Campbell, executive director
for Oregon Citizens for Safe Drinking Water.
People in favor of leaving fluoride out of drinking water say
the health equity they advocate is access to a dentist, and
that mass medication is inappropriate. They say, furthermore,
that the chemicals used to fluoridate water put children's
health at stake.
"What individual truly supportive of children's health would
raise their hand to add a product that has never been properly
tested, has never been approved for safety and effectiveness
for the purpose for which it is being added and that contains
contaminants such as lead and arsenic at concentrations that
exceed the points of safety already established by the
government?" Green said.
The lead and arsenic Green alluded to are listed by NSF
International, a company involved with the certification of
fluoridation chemicals, as contaminants found in samples of
manufacturers' products.
In an NSF document written in response to the U.S. House
Committee on Science in 2000, NSF provided data showing that
manufacturers' samples had tested positive for lead and
arsenic. Lead was found at levels up to 1.1 micrograms per
liter, below the EPA's Maximum Contaminant Level of 15
micrograms per liter, but higher than the EPA's maximum
contaminant level goal of zero.
The distinction between the MCL and MCLG is important because
the maximum contaminant level is the highest level of a
regulated contaminant allowed in drinking water, whereas the
maximum contaminant level goal is defined as the level of a
contaminant in drinking water at or below which there is no
known or expected health risk -- in other words, the
established scientific point of safety.
"Samples taken by NSF of fluoridation chemicals have
determined that arsenic was present as high as 1.66 parts per
billion (micrograms per liter) after full dilution in water.
This arsenic concentration correlates to the National Research
Council finding that this level would result in more than one
bladder or lung cancer per every 1,000 consumers," Green said,
citing the NRC Arsenic in Drinking Water 2001 Update.
So if lead is considered unsafe at even minuscule levels, and
arsenic is carcinogenic, why aren't the EPA's maximum
contaminant levels and maximum contaminant level goals one and
the same, or at least closer in number?
People on both sides of the fluoride debate seem to agree that
the EPA is trying to abide by what is economically feasible
for source water remediation. Whereas those in favor of
leaving fluoride out of the water believe public health is
potentially being compromised in favor of economics and
politics, those in favor of fluoridation dismiss health
concerns.
"It's almost ridiculous to be talking about the toxicity of
fluoride," Love said.
David Winship, city utilities engineer for the City of
Beaverton, insists that "fluoride is safe, when used safely."
Winship, who manages Beaverton's water division, said drinking
water in Beaverton, Tigard, Forest Grove and several other
neighboring communities is fluoridated at .9 parts per
million, the equivalent of .9 mg. per liter of water.
He acknowledged that there are "impurities" in the sodium
fluoride added to the water, but said the fluoridated drinking
water is below the EPA's maximum contaminant level of 4 ppm
for fluoride, meeting NSF's standards, and is therefore safe.
Dr. Paul Connett, a professor of chemistry at St. Lawrence
University in New York who specializes in environmental
chemistry and toxicology, says not only are maximum
contaminant levels set at unsafe concentrations, but the
designation of 4 ppm as the MCL for fluoride is based on
outdated data.
"There's more politics involved in this than science," Connett
said. "The U.S. public health service is far more interested
in protecting a policy which it launched in 1950 than it is in
protecting the health of children."
Drinking Water Fluoridation
Debate
Gathering
Momentum in Oregon -- Part 2
September 13, 2004
by Antonia Giedwoyn, kgw.com Staff
(continued from Part 1)
Dr. Tom Maier is an assistant professor at the Oregon Health &
Science University Hospital School of Dentistry and believes
the health concerns associated with fluoride have been
exaggerated. He said a person would have to drink
"bathtub-sized amounts of fluoridated water in one sitting" to
experience health problems.
Maier, who specializes in microbiology and immunology, also
said he doesn't know of any legitimate studies showing health
hazards.
Fluoride Studies
Numerous scientific studies have linked fluoride, which
accumulates in the body's bones and tissues, with cancer in
both humans and animals.
In 1999, the department of health in Britain commissioned a
large-scale study to examine the efficacy and safety of
fluoridated drinking water. The study, referred to as the York
Review, was published in October of 2000. Reviewers were
surprised to find no "reliable good-quality evidence in the
fluoridation literature world-wide," and drew no definitive
conclusions as to fluoride's safety or danger.
"An association with water fluoride and other adverse effects
such as cancer, bone fracture and Down's Syndrome was not
found. However, we felt that not enough was known..." reads a
statement from the Centre for Reviews and Dissemination
regarding the York Review's findings.
Maier said the York Review shows the only bad effect of
fluoride to be dental fluorosis, known as teeth mottling. He
considers dental fluorosis solely an aesthetic concern which
Maier attributes to, "probably the result of mis-prescribing
of fluoride supplements and unsupervised teeth brushing by
small children."
Connett, who served as a peer reviewer for the York Review,
said he thinks the review was "weak" and underestimated
fluoride's health hazards.
"My biggest concern is...they didn't look at biochemistry or
animal studies. It's not what I call a good technique for
toxicology - you want to look at all the clues, which means
want to look at biochemistry, tissue culture, animal, human
and clinical trials," Connett said. "It was not an appropriate
study to inform public health policy....I think they didn't do
a good job with brain or endocrine disruption studies."
As an example of what he considers good research, Connett
pointed to a more recent 2003 study from China comparing the
IQ levels of children in communities with differing levels of
naturally-fluoridated water.
The study found that children's IQs were lower in the areas
with the highest level of fluoride and vice versa.
Connett also said the U.S. government has never funded a
comprehensive study of fluoride present in "our bones, blood
or urine." It's never been measured, according to Connett.
"It's incredible," he said.
Fluoride - Not Enough, or Too Much?
Some dentists, like Love, believe the average child needs more
fluoride.
"They're [kids] not getting nearly enough," she said. Love
didn't say how much fluoride the average child in a
fluoridated community is getting.
That's probably because it's impossible to monitor anyone's
fluoride consumption without medical testing.
Fluoridation chemicals are ubiquitous and the general public
already consumes the compounds in juice and processed foods.
People also ingest fluoridation chemicals from pesticide
residue on fresh fruits and vegetables.
Because of this, U.S. children may be getting too much
fluoride from multiple sources. Just one cup of what the
dental community considers to be "optimally" fluoridated water
(at 1 ppm) delivers a full day's prescription dose for
children ages six months to three years. "So toddlers who
drink more than one cup of water a day are exceeding the
prescription dose," Green said.
Love said the prescription dose was lowered in the late 1990s
to account for the other sources of ingested fluoride.
When in doubt, look to mother nature, is Connett's attitude.
Summarizing the findings of Dr. Arvid Carlsson, who won the
Nobel Prize for medicine in 2000, Connett said a nursing
mother's body is protective against fluoride.
"The naturally occurring level of fluoride in mothers' milk
ranges from .005 ppm to .012 ppm," Connett said, emphasizing
that, according to Carlsson, the fact that fluoride in
mother's milk doesn't appear in significant quantities
demonstrates that infants should not be exposed to high doses
of fluoride.
"When you put fluoride into the water, the gamble that you're
taking is that giving a bottle-fed baby up to 200 times more
fluoride than nature intended will not disrupt any of the
delicate machinery of the baby's early development," Connett
said.
Fluoridation Endorsement
The practice of fluoridating drinking water is drawing
significant and increasing criticism from credible
professionals and organizations, including UNICEF, the Sierra
Club, Canada's former leading proponent (Hardy Limeback, D.D.S.),
The National Nutritional Foods Association and NTEU 280, the
union of all scientists and other professionals who work at
EPA headquarters in Washington, D.C.
Yet, an even longer list of organizations endorse water
fluoridation. What is the public to make of that?
Fluoridation proponents say the sheer number of and prominence
attached to the organizations that support water fluoridation
proves that it's safe. "It's a proven health benefit that's
been in the U.S. for 59 years," said Ferre.
Fluoridation opponents believe the support comes from a
mixture of politics, fear of lawsuits and institutional
embarrassment.
"If I was in their shoes, [agencies endorsing fluoridation]
and I said that we now know what we've been calling safe
actually isn't safe, I'd fear litigation," said Campbell.
For Campbell, health concerns are secondary to any discussion
of whether or not to add fluoride to the public water supply.
What concerns her most is the lack of federal safety standards
for water additives, as acknowledged by the EPA.
"No one is in charge, no one is assuring safety...we're all
supposed to be taking someone's word for it," she said.
Oregon Citizens for Safe Drinking Water is working to
establish "reasonable safety standards for water additives."
Many members believe medicine should be an individual choice.
Ferre holds the opposite view. The benefit of fluoride, he
said, "takes precedence over anyone's freedom."
