Fluoride Action Network

Another look at Brunelle & Carlos

By Paul Connett, PhD | April 27, 2001

Recently we received a letter commenting on our analysis of the Brunelle & Carlos (1990) paper. Before we print the letter and Michael’s response, a little background. The Brunelle & Carlos paper was published in the Journal of Dental Research, Volume 69, pages 723-727, in 1990. The paper was the official analysis of the data gleaned in the largest survey of dental caries ever undertaken in the US. The survey was conducted by the National Institute of Dental Research. It cost $3.6 million and 39,000+ children were examined in 84 communities. When Dr. Yiamouyiannis looked at the raw data, obtained under the Freedom of Information Act, he found no significant difference in Decayed Missing and Filled Teeth (DMFT) of the permanent teeth of children whether they lived in fluoridated, non-fluoridated or partially fluoridated communities.

However, Brunelle & Carlos looked at a more sensitive measure of tooth decay – they looked at Decayed Missing and Filled SURFACES (DMFS). There are 128 tooth surfaces in a child’s mouth. (16 teeth with 5 surfaces and 12 (6 front top and bottom) with 4 surfaces = 80 + 48 = 128.)

For children (aged 5 – 17 years) who lived all their lives in fluoridated (number of children= 8165) or non-fluoridated communities (number of children = 8233) Brunelle and Carlos found an average difference of 0.6 tooth surfaces, i.e. this is less than 1% of the tooth surfaces. We find this truely amazing. It is for this incredibly meager benefit that our government is prepared to: 1) Impose medication on the whole population whether individuals want it or not. 2) Knowingly increase the chance that about 30% of our children will get unsightly dental mottling and discoloration on at least two teeth (Heller, 1997). 3) Allow the build up of fluoride in our bones – about 50% of all the fluoride we swallow ends up in our bones-thus increasing the risk of hip fracture and arthritis-like symptoms in the elderly, and possibly bone cancer in young males. 4) Allow the accumulation of fluoride in the pineal gland (Luke, 2001). 5) Run the risk of increasing the uptake of aluminum into our brains (Varner, et al 1998). 6) Run the risk of interfering with the normal functioning of the thyroid gland. 7) Run the risk of poisoning many enzymes in our body and interfering with the signaling mechanism of water soluble hormones and 8) make life miserable for those who are super-sensitive to fluoride exposure. That’s a huge amount of risk for a very tiny benefit, especially when you can get the same benefit from toothpaste!

Here now is the letter we received and Michael’s response.

Paul Connett.

From: ******************************
Date: Mon, 9 Apr 2001 13:14:19 -0400
To: “‘mconnett@www.fluoridealert.org'” <mconnett@www.fluoridealert.org>
Subject: The fluoride alert webpage

I have recently become interested in the issue of fluoride addition to water supplies and have run across your webpage in looking into the topic. The webpage you have prepared is quite impressive and well laid out, obviously a great deal of time has been spent of preparing it.

However, the copious amounts of information you have filled it with is not all truthfull!

On this webpage http://www.fluoridealert.org/fluoride-facts.htm you make the statement:

“Fluoridation Provides Very Little, If ANY, Benefit: In the largest dental health survey ever conducted in the United States, the difference in tooth decay (as determined by the National Institute of Dental Research) between children living in fluoridated vs. unfluoridated communities was a mere 0.6 tooth surfaces! 0.6 tooth surfaces is less than 1% of the 128 tooth surfaces in a child’s mouth (1).”

and give the following reference, which, for your benefit I have added the abstract of the article

Recent trends in dental caries in U.S. children and the effect of water fluoridation. Brunelle JA, Carlos JP. Epidemiology Branch, National Institute of Dental Research, National Institutes of Health, Bethesda, Maryland 20892.

The decline in dental caries in U.S. schoolchildren, first observed nationwide in 1979-1980, was confirmed further by a second national epidemiological survey completed in 1987. Mean DMFS scores in persons aged 5-17 years had decreased about 36% during the interval, and, in 1987, approximately 50% of children were caries-free in the permanent dentition. Children who had always been exposed to community water fluoridation had mean DMFS scores about 18% lower than those who had never lived in fluoridated communities. When some of the “background” effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology.

PMID: 2312893 [PubMed – indexed for MEDLINE]

Doesn’t really sound like the same conclusion to me! Infact the article seems to conclude the exact opposite of what you are proposing.

Good work on the lies!

Dr. M.G.

From: Michael Connett <mconnett@www.fluoridealert.org>
Date: Mon, 09 Apr 2001 16:02:50 -0400
To: ******************************
Subject: Re: The fluoride alert webpage

Hi Dr. G.,

The point you raise concerning Brunelle & Carlos’ 1990 study is a very good one, and I’d like to take a second and respond.

First, there is no doubting that Brunelle and Carlos believe that fluoridation is a very effective means of preventing caries, and as you rightly point out, their 1990 paper is by no means a critique of fluoridation.

But their opinions are one thing, and the data they present are another. It is the latter which we are interested in, and we hope that more people will take a look at it, for we feel this study – being conducted by the NIDR, and being the largest dental survey ever done in the US (39,000+ children), is quite important.

Now, according to the data presented by Brunelle and Carlos the difference in DMFS (Decayed, Missing and Filled Surfaces) between children (aged 5-17) with life long exposure to fluoridation versus children (aged 5-17) with no exposure to fluoridation is 0.6 tooth surfaces. (see Table 6, p. 726).

Decayed, Missing, and Filled Surfaces (DMFS)
Area Avg. DMFS Relative Difference Absolute
Fluoridated 2.79 18% 0.6 out of 100+ tooth surfaces Not reported
Unfluoridated 3.39

Now we believe that 0.6 tooth surfaces is a very meager difference considering that in a child’s mouth there are 128 such surfaces. Would you not agree?

It’s important to point out here, that one of the ways this miniscule benefit begins to look substantial, is when it is presented as a percentage of relative difference (which is exactly what Brunelle and Carlos do). For instead of saying that the difference in tooth decay found by the NIDR was 0.6 tooth surfaces, or that the difference amounts to less than 1% of the total number of tooth surfaces, the authors state that children in fluoridated areas had 18% less tooth decay.

18% sounds impressive, 0.6 tooth surfaces does not.

If you’d like to read this paper and take a look at the data for yourself, please let us know, and we will fax it to you.

Perhaps you will agree with us, that it is the authors, Brunelle and Carlos,
who are guilty of misrepresenting the results, not us.


Michael Connett
Fluoride Action Network