SUMMATION - Dental Fluorosis: (Click for more detail)

Excessive ingestion of fluoride during the early childhood years may damage the tooth-forming cells, leading to a defect in the enamel known as dental fluorosis.

Teeth impacted by fluorosis have visible discoloration, ranging from white spots to brown and black stains.

Teeth with fluorosis also have an increased porosity of the enamel. In the milder forms, the porosity is mostly limited to the sub-surface enamel, whereas in the more advanced forms, the porosity impacts the surface enamel as well, resulting in extensive pitting, chipping, fracturing, and decay of the teeth.

The discoloration induced by fluorosis - particularly in its advanced forms - can cause significant embarrassment and stress to the impacted child, resulting in adverse effects on esteem, emotional health, and career success.

According to the Centers for Disease Control, 32% of American children now have some form of dental fluorosis, with 2 to 4% of children having the moderate to severe stages (CDC 2005).

While proponents of water fluoridation dismiss dental fluorosis as being simply a "cosmetic effect," recent research indicates that the rate of bone fracture among children with fluorosis (even in the mild forms) is higher than the bone fracture rates among children with no fluorosis.

As noted by Dr. Hardy Limeback, Head of Preventive Dentistry at the University of Toronto, "it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion."

PREVALENCE - Dental Fluorosis Rates are Increasing:

"A nine percentage point increase in the prevalence of very mild or greater fluorosis was observed among children and adolescents aged 6-19 years when data from 1999-2002 were compared with those from the NIDR 1986-1987 survey of school children (from 22.8% in 1986-1987 to 32% in 1999-2002)."
SOURCE: Centers for Disease Control and Prevention (CDC, 2005) Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis--United States, 1988-1994 and 1999-2002. Morbidity and Mortality Weekly Report Surveillance Summaries 54:1-43.

"The prevalence of fluorosis in permanent teeth in areas with fluoridated water has increased from about 10-15% in the 1940s to as high as 70% in recent studies..."
SOURCE: 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.

"There is compelling evidence that the prevalence of dental fluorosis has increased in the United States and Canada in recent years."
SOURCE: Warren JJ, Levy SM. (2003). Current and future role of fluoride in nutrition. Dental Clinics of North America 47: 225-43.

"[T]he prevalence of dental fluorosis in the United States has increased during the last 30 years, both in communities with fluoridated water and in communities with nonfluoridated water."
SOURCE: Fomon SJ, Ekstrand J, Ziegler EE. (2000). Fluoride intake and prevalence of dental fluorosis: trends in fluoride intake with special attention to infants. Journal of Public Health Dentistry 60:131-9.

"Current studies support the view that dental fluorosis has increased in both fluoridated and non-fluoridated communities. North American studies suggest rates of 20 to 75% in the former and 12 to 45% in the latter."
SOURCE: Locker, D. (1999). Benefits and Risks of Water Fluoridation. An Update of the 1996 Federal-Provincial Sub-committee Report. Prepared for Ontario Ministry of Health and Long Term Care.

"Systemic F-exposure to children has increased. Mild dental fluorosis is now more common than one would predict on the basis of Dean's findings in the late 1930s and early 1940s: in fluoridated and non-fluoridated communities. Several recent studies report prevalence rates in the 20 and 80 percent range in areas with fluoridated water."
SOURCE: Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis. University of Surrey, Guildford.

"[A] few cases of more severe fluorosis can be found now in some communities. Because the prevalence of fluorosis is now higher than 50 years ago, we can conclude that fluoride availability... has increased in North American children."
SOURCE: Rozier RG. (1999). The prevalence and severity of enamel fluorosis in North American children. Journal of Public Health Dentistry 59:239-46.

"There is a growing body of evidence which indicates that the prevalence and, in some cases, the severity of dental fluorosis is increasing in both fluoridated and non-fluoridated regions in the U.S... This trend is undesirable for several reasons: (1) It increases the risk of esthetically objectionable enamel defects; (2) in more severe cases, it increases the risk of harmful effects to dental function; (3) it places dental professionals at an increased risk of litigation; and (4) it jeopardizes the perception of the safety and, therefore, the public acceptance of the use of fluorides."
SOURCE: Whitford GM. (1990). The physiological and toxicological characteristics of fluoride. Journal of Dental Research 69(Special Issue):539-49.

NOTABLE QUOTES - Dental Fluorosis - Just a "Cosmetic Effect"?

"it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion."
SOURCE: Dr. Hardy Limeback, Head of Preventive Dentistry, University of Toronto. (2000). Why I am now Officially Opposed to Adding Fluoride to Drinking Water.

"Common sense should tell us that if a poison circulating in a child's body can damage the tooth-forming cells, then other harm also is likely."
SOURCE: Colquhoun J. (1997). Why I changed my mind about Fluoridation. Perspectives in Biology and Medicine 41:29-44.

"Like bones, a child's teeth are alive and growing. Flourosis is the result of fluoride rearranging the crystalline structure of a tooth's enamel as it is still growing. It is evidence of fluoride's potency and ability to cause physiologic changes within the body, and raises concerns about similar damage that may be occurring in the bones."
SOURCE: Environmental Working Group, "National Academy Calls for Lowering Fluoride Limits in Tap Water", March 22, 2006.

"It seems prudent at present to assume that the ameloblasts are not the only cells in the body whose function may be disturbed by the physiological concentrations of fluoride which result from drinking water containing 1 ppm"
SOURCE: Groth, E. (1973), Two Issues of Science and Public Policy: Air Pollution Control in the San Francisco Bay Area, and Fluoridation of Community Water Supplies. Ph.D. Dissertation, Department of Biological Sciences, Stanford University, May 1973.

"The safety of the use of fluorides ultimately rests on the assumption that the developing enamel organ is most sensitive to the toxic effects of fluoride. The results from this study suggest that the pinealocytes may be as susceptible to fluoride as the developing enamel organ."
SOURCE: Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis. University of Surrey, Guildford. p. 176.

"A linear correlation between the Dean index of dental fluorosis and the frequency of bone fractures was observed among both children and adults."
SOURCE: Alarcon-Herrera MT, et al. (2001). Well Water Fluoride, Dental fluorosis, Bone Fractures in the Guadiana Valley of Mexico. Fluoride 34(2): 139-149.