In 2010, this research culminated in the publication of a book The Case Against Fluoride (Chelsea Green, 2010), which I co-authored with two other scientists, James Beck, MD, PhD, a physicist from Calgary Alberta, and Spedding Micklem, DPhil (Oxon) a biologist from Edinburgh, Scotland. Even though every argument in this book is meticulously documented with references to the scientific literature (80 pages in all) after two years there has been no scientific rebuttal to this text from promoters of fluoridation.

To summarize the key arguments in our book:

Fluoridation is a bad medical practice (when you use the water supply to deliver medicine you can’t control dose and you can’t control who gets medication),

is unethical (it violates the individual’s right to informed consent to medication),

is unnecessary (Fluoride is not an essential nutrient; there is no known biological process in the body that needs fluoride; on the contrary fluoride harms many biological processes.),

is ineffective (fluoride works topically not systemically; little to no difference in the permanent teeth in 12-year olds between fluoridated countries and non-fluoridated countries (WHO data), (see Chapters 6-8, The Case Against Fluoride)

causes unnecessary harm (42% of American children aged 12-15 have dental fluorosis, CDC, 2010)

and poses serious health dangers, especially for vulnerable subsets of the population (people with poor kidney function, people with borderline iodine deficiency, people with poor nutrition and bottle fed infants (see chapters 11-19, The Case Against Fluoride).

The science promoting fluoridation is very poor (see chapters 5, 8,9, 22- 25, in The Case Against Fluoride).

Here is a link to one chapter in the book (Chapter 25): A Response to Pro-Fluoridation Claims. Here we respond to 40 of the typical and often simplistic arguments used by promoters of fluoridation see: http://www.fluoridealert.org/uploads/proponent_claims.pdf

See also on our web site: 10 Facts on Fluoride, http://www.fluoridealert.org/articles/fluoride-facts/

The 28-minute DVD Professional perspectives on water fluoridation in which 15 scientists explain why fluoridation is an outdated practice. Viewable online at http://www.fluoridealert.org/fan-tv/ Or click on FAN-TV at the top of the home page www.FluorideALERT.org

Sam:  Comment on the response of the American Dental Association, the CDC and the US EPA to the NRC (2006) review of Fluoride’s Toxicity in Water?

Paul Connett: The National Research Council’s review (NRC, 2006)

In 2003, the EPA water division asked the National Research Council of the National Academies (NRC) to review its water standards for fluoride. The current MCL (Maximum Contaminant Level) and MCLG (Maximum Contaminant Level Goal) of 4 ppm is based on assuming that the end point of concern was CRIPPLING skeletal fluorosis. This was outdated then and even more so today. The NRC appointed a panel of 12 experts to review the literature of fluoride’s toxicity. For the first time in US history of this issue the panel chosen was balanced approximately 3 people were known to be for fluoridation, 3 opposed and 6 undeclared. The review was expected to last one year it took three and half years. In March 2006 the panel produced the most comprehensive review of fluoride’s toxicity ever done.

The NRC (2006) report consisted of approximately 500 pages and 1100 references. The panel concluded that the 4 ppm standard was not protective of health and urged the EPA to undertake a new risk assessment to determine a safe MCLG.

On the day the report was released the ADA declared it was irrelevant to water fluoridation and six days later the CDC stated that it was consistent with their promotion of water fluoridation as being safe and effective. I will add some more to this in a minute

But of course the NRC review was very relevant to water fluoridation.

Chapter 2 in their review was an exposure analysis in which they concluded that certain subsets of the population are exceeding the EPA’s safe reference dose (IRIS level of 0.06mg/kg/day to protect against objectionable dental fluorosis) consuming water at 1 ppm, including bottle-fed infants. I would also add that they would also be exceeding the ATSDR’s MRL of 0.05 mg/kg/day to protect against bone fractures (http://www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf, p.255)

Moreover, to say that studies at 4 ppm or more (or even less see below) are not relevant to water fluoridation is to confuse the difference between concentration and dose. Some people drinking a lot of water at 1 ppm and getting fluoride from other sources could actually experience a greater dose than someone consuming a little water at 1 ppm. What is needed here is a computation of the dose (and dosage) that causes harm and seeing how that compares with doses (or dosages) experience by someone living in a fluoridated community. This should be part of a Margin of Safety analysis (see Chapter 20, The Case Against Fluoride).

They reviewed studies that found harmful effects at less than 1 ppm (Lin et al, 1991); increases in hip fracture at 1.5 ppm, although this point was not statistically significant it was part of trend which looks linear); lowered IQ at 1.9 ppm (Xiang et al, 2003) and altered thyroid function at 2.3 ppm (Bachinskii et al, 1985). They also left open the finding of increased osteosarcoma at 1 ppm (Bassin, 2001 (PhD thesis, since published Bassin et al, 2006) and suggested more research on the possibility that some people are very sensitive to fluoride’s toxicity possibly suffering reversible effects at 1 ppm.

Next I will look at the EPA’s lack of/poor response to the NRC report

The EPA’s response to the need to do risk assessment.

After 5 years the EPA had published nothing. On Jan. 7 2011 it announced that their risk assessment was under way but clearly intimidated that they wished to determine a safe MCLG (Maximum Containment Level Goal) without threatening the water fluoridation program. This is unscientific, by law they should be determining what a safe level in the drinking water. Any purported benefits should not interfere with this process. They indicated that the most sensitive end point they would use would be severe dental fluorosis (which already impacts up to 3.6% of US children aged 12-15). Such a position is contradicted by the 36 IQ studies. Not all the children in these studies with lowered IQ had severe dental fluorosis thus unless all these studies are ignored lowered IQ should be the end point on which their risk assessment should be based.

People can check out the NRC report for themselves – it is available free online and can be searched by word. it remains the most important document on fluoride’s toxicity today.

The website is for the NRC 2006 review: http://www.nap.edu/catalog.php?record_id=11571

Dosage takes into account bodyweight and is measured as mg/kg bodyweight/day. This is important when comparing doses between adults and infants and children, because of their much smaller bodyweight – just like aspirin the dose that is safe for an adult is not safe for a child.

Typically to get to safe dosage – one finds the dose that is safe for an adult and then divides by the average bodyweight for an adult. So if we deem that 8 mg/day is safe for an adult – we determine a safe dosage which we can apply across all bodyweights and age ranges) by dividing by 70 kg. This gives us in this case 8/70 kg = 0.114 mg/kg/day.Now if we want to use this to find a safe dose for any bodyweight (corresponding to age range) we multiply the safe dosage by the bodyweight in question. Thus for a 7 kg infant we would simply multiply the safe dosage by 7 kg, in this case 0.114 mg/kg/day x 7 kg = 0.8 mg/day. Thus for this bodyweight the safe dose for a child is TEN times less than for an adult.

Carol:  Should new parents be concerned that fluoride supplements “have not been found by FDA to be safe or effective,” and that fluoride is FDA-described as an “unapproved drug” http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=2e05a9bf-f8e7-41b1-b382-2dc9d8dafee4

Paul Connett: Yes, they should be concerned. Fluoride’s side effects include:

• staining of teeth • unusual increase in saliva • stomach pain • upset stomach • vomiting • diarrhea • rash • weakness • tremor • seizures

The FDA asks that fluoride drug side effects, including dental fluorosis, be reported at http://www.fda.gov/Safety/MedWatch] or [1-800-332-1088]. Reference: http://www.nlm.nih.gov/medlineplus/druginfo/meds/a682727.html

It is incredible to me that after over 60 years of fluoridation that the FDA has never regulated fluoride for ingestion or water fluoridation. It still classifies fluoride as an ‘unapproved drug.’ even though this is the most prescribed drug in American history (albeit by unqualified people) and yet it has never been regulated by the FDA.

The end result is that fluoride has never been subjected to randomized clinical trials (RCT) to establish safety or effectiveness. This is incredible.

Tom Curran:  You and your organization are opposed to fluoridation in spite of the endorsement of dozens of professional medical. dental and government organizations. Your apparent alternative is better oral hygiene and nutrition. Can you show evidence that you and your followers spend any time or money promoting better oral hygiene and nutrition for school children or programs for the financially challenged or the elderly?

Paul Connett:  Tom it is true that dozens of professional organizations endorse fluoridation but endorsements don’t equal science. It is useful PR but to judge an endorsement you have to see on what science it is based, and when it was made and by whom in the body.

In fact the first key endorsement came in 1950 by the US Public Health Service – and that came before any of the fluoride trials had been completed and before any significant health studies had been published. Within the next two years many other endorsements followed (a case of follow my leader or follow my funder perhaps?) but still with no trial completed or significant health study published. Many of these endorsing organizations have never published any review or an updated one. After the NRC (2006) report was published I wrote to each of the fluoridation endorsers listed by the ADA and asked them this key question. Assuming that you have read the NRC review is it the professional judgment of your organization that there is an adequate margin of safety to protect all the people drinking fluoridated water from some if not all of the harmful effects reviewed by the NRC. Out of over 50 organizations I only got about half a dozen replies and not one answered the question. So much for endorsements from professional bodies! Now I have got that off my chest I will take a short pause and get to the other part of your question Tom.

Paul Connett:  As far as alternatives are concerned there are two responses here. First with respect to fluoride. Even leading promoters of fluoride like the CDC Oral Health Division have conceded that the predominant action of fluoride is topical not systemic (CDC, 1999). In other words there is no need to swallow fluoride. If the action is topical then it makes more sense to brush it on your teeth using fluoridated toothpaste and spit it out. This way one minimizes exposure to tissues that a) don’t need fluoride and can be harmed by fluoride. You also avoid forcing fluoride on people who don’t want it – especially by those who may be harmed by it. Thus with this approach you can solve both the medical problem and the ethical problem.

However, you are right. We would prefer to see much more attention to diet: more fruits and vegetables and far less sugar. I would like to see an educational program that aims at cutting back on childhood consumption of sugar both to combat tooth decay and OBESITY. A good investment. We would also like to see more dentists willing to treat children on Medicaid – 80% of dentists won’t and the ADA opposes routine dental procedures from dental therapists, even in areas where dentists are not available like remote parts of Alaska.

Our job is not to provide these services but as a non-profit organization dedicated to educating people about the dangers of fluoride and fluoridation, education is what we do. We do not have the kind of budget that the ADA and the government have to actually provide services. We do however keep in contact with holistic dentists and also citizens like the late June Allen in Wichita, Kansas who had a program of providing children in schools with xylitol mints and chewing gum. Xyilitol has been used for years in Scandinavia and Japan to fight tooth decay and some is more effective and far safer than fluoride.

Meg in Syracuse:  I have spent some time on Dr. Connett’s website and have also read some of the pro-fluoridation information. In science we spend a lot of time talking about best practices, which are learned from conducting lots of studies and looking at meta-analyses of data and studies. When I look at the information Dr. Connett uses it seems like he frequently ignores the full scientific data that goes against his beliefs because he uses single studies that do not necessarily uses rigorous scientific methodology. Why does he do this, and why does he promote such a fear-based perspective without adequate science to back it up?

Paul Connett: Meg instead of perusing our website may I suggest your read our book The Case Against Fluoride. Point me to pages where you think we have been selective in the examination of the literature. I am afraid it is the promoters who are being selective and even denying any harm that is published elsewhere. For example can any promoter point me to one study that reassures them that we can safely ignore the 36 studies that have found an association between fairly modest exposure to fluoride and lowered IQ? See a full discussion of fluoride and the brain at http://www.fluoridealert.org/issues/health/brain/ Meg after reviewing this section could you point to me where we have been selective in this review of the literature on the brain?

Michael:  Good Afternoon! From the articles read on the con’s of fluoridation, is it true that the systemic delivery of fluoride within the bodies system improves calcification of bone, but the internal web structure of that bone is weaker then if treated otherwise? Meaning – is the bone actually weaker with a systemic dose of fluoride. Also please comment on the biological processes that fluoride affects. The counter argument yesterday also expressed us to not look to research studies done in China. Can you comment as to why these studies wouldn’t be relevant in the United States?

Paul Connett:  Yes Michael to save time a quick answer: These Chinese studies are very relevant to the US and the shocker is little effort is being made to reproduce any of the Chinese studies in the US. The absence of studies is not the same as absence of harm.

Ellen:  Would you explain what a Margin of Safety is?

Paul Connett: Margin of safety

This is a critical issue seldom discussed by promoters of fluoridation. Typically the latter dismiss all evidence of harm as being found at high concentrations or high doses. But this betrays a poor understanding of toxicological methods. Normally toxicologists have to extrapolate from harm caused in large doses in animals to determine a safe (and much lower) dose in humans. The goal is to use what studies we have to estimate a safe dose for humans sufficient to protect the whole population (and not just the average person). In the language of the Safe Drinking Water Act the EPA is obliged to determine a safe dose to protect against known and reasonably anticipated health effects, with a sufficient margin of safety to protect the most vulnerable groups in society. This is referred to as a safe reference dose (or dosage). Sometimes the doses they look at in animal studies are at a 1,000 times or more than expected human doses. In the case of fluoride we have the luxury of having data from human studies at fairly low doses, i.e. within an order of magnitude of exposure in fluoridated communities, and these are largely obtained from communities that have moderate to high background levels of fluoride in their water (typically 2 -10 ppm).

The way toxicologist use this data in risk assessment is to determine the dose found to cause harm (usually in a small population study) the LOAEL (lowest observable adverse effect level) or NOAEL (no observable adverse effect level) and then divide by a safety factor. If it is a human study we divide the NOAEL by a safety factor of 10 to account for the full range of sensitivity expected in any large population (difference in genetics, nutrition, health status, age etc). This default value of 10 is sometimes referred to as the INTRAspecies variation factor. If we are not dealing with NOAEL but a LOAEL we divide by a factor of 100. If we are working from an animal study we add another safety factor of 10 and this is called the INTERspecies variation factor.

Let’s do this for one of the IQ studies. Xiang et al. 2003, found a threshold for the lowering of IQ as 1.9 ppm – this would actually be considered the LOAEL – but we will treat is as a NOAEL. The first thing to do is to estimate the dose this represents for these Chinese children. If we assume that they drink one liter per day (but 0.5 or 2 liters of water makes little difference to this argument) the dose would be 1.9 mg/day. If we now apply the default value of 10 to take into account intra species variation we get a safe dose for all children in a large population of 0.19 mg/day. This dose than a child would get drinking one large glass of water (250 ml) a day. In other words there is no margin of safety to protect all of America’s children here. A simpler way of arriving at the same conclusion is that a child in the US drinking two liters of water at 1 ppm would get a higher dose (2 mg/day ) than one of the Chinese children got in the Xiang study drinking the water at the threshold value of 1.9 ppm (1.9 mg/day).