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A little history

Water fluoridation began in the United States where today approximately 184 million people are currently served by fluoridated water supplies.

The practice had it origins in observations made by researchers who were investigating the cause of a strange mottling and discoloration of the teeth in children living in parts of Colorado, Texas, and some other areas in the US.

In 1931, fluoride was found to be the cause of this condition and it was renamed “dental fluorosis.”

McKay, a dentist, and other researchers, noted that while the teeth looked horrible, these children had less tooth decay. These early researchers assumed that because fluoride mottled teeth it must also be the reason these teeth didn’t decay. However, they overlooked high amounts of calcium and other tooth-building nutrients in the water. They didn’t know what we know now – fluoride is neither a nutrient nor required for healthy teeth.

H. Trendley Dean of the US Public Health Service (PHS) pursued the matter. He characterized dental fluorosis into 4 levels of severity – very mild, mild, moderate and severe. Then in 1942 he produced his famous 21-City study that purported to show, that as the fluoride in the water increased, tooth decay went down. The decay decreased sharply from 0 to 1 ppm (1 ppm = 1 milligram of fluoride per liter) and then flattened off (see Figure 1). He also noted that at 1 ppm only about 10% of children were impacted with dental fluorosis. Thus was born the notion of the “optimal” level of fluoride being1 ppm.

Trials of artificial fluoridation began in 1945 in Grand Rapids, Michigan, Newburgh, NY, and Brantford, Ontario, using water-soluble sodium fluoride (not the naturally occurring calcium fluoride).

The Great Fluoridation Gamble

In 1950, before any of these trials had been completed, the PHS endorsed fluoridation. By so doing, they were taking a huge gamble on four fronts, 1) that swallowing fluoride actually reduced tooth decay, 2) that it would only lead to about 10% of children developing dental fluorosis in its mildest form, 3) that when a child developed dental fluorosis, no damage was being done to any other growing tissue in its body and 4) that fluoride would have no ill effect on adults.

This clearly was not a scientific decision, because the science wasn’t in, since neither the trials nor any health studies had been completed. What the PHS did know was that dental fluorosis was a systemic effect, meaning that fluoride had to enter the body to cause the damage to the growing tooth cells. Thus the key gamble made by the PHS in 1950 was that fluoride could damage the child’s growing tooth cells, by some undetermined biochemical mechanism, without damaging any other growing tissues or organs in the child’s body.

The great fluoridation gamble has failed

Over the 60 years since fluoridation began, dental fluorosis rates in the US have skyrocketed. A recent report shows that 32% of children in the US now have dental fluorosis, and not all restricted to the very mild level category. 3-4% have dental fluorosis in its moderate and severe levels (CDC, 2005). This is due to more sources of fluoride available today (toothpaste and other dental products; pesticide residues and processed food and beverages made produced in fluoridated areas).

Starting in the 1980’s, studies have shown little, if any, difference in tooth decay between fluoridated and non-fluoridated communities, states or countries. According to a review by Dr. David Locker of the University of Toronto, conducted for the Ontario Government: “The magnitude of [fluoridation’s] effect is not large in absolute terms, is often not statistically significant, and may not be of clinical significance.”

A recent article in the British Medical Journal shows that, according to World Health Organization (WHO) data, tooth decay in 12-year olds has been coming down as fast in non-fluoridated countries as fluoridated ones (Cheng et al., 2007). A similar plot is shown in Figure 2. Furthermore, the early trials have been shown to be riddled with methodological weaknesses (Sutton, 1996), and the findings of Dean’s 21-city study have been seriously questioned (Ziegelbecker, 1981).

Most serious is the growing body of evidence that fluoridation is harmful to health. Fluoride accumulates in the bones and the first symptoms of damage are identical to the symptoms of arthritis: aching joints and bones. Further accumulation makes the bones more brittle and may lead to a possible increase in hip fractures in the elderly. The evidence for this is mixed.

Fluoride was once used by European doctors to lower the thyroid function of patients suffering from hyperthyroidism and the doses used are reached by some individuals in fluoridated communities. In the US, millions of people suffer from hypothyroidism, and even more with subclinical hypothyroidism, for which the symptoms are tiredness not relieved with sleep, lethargy, obesity, and depression.

There are over 50 animal studies that show that fluoride damages the brain and changes behavior. Studies from China indicate that fluoride damages the fetal brain and there are now a total of 23 studies (from China, India, Iran and Mexico) indicating that high fluoride exposure is associated with a lowering of IQ in children.

If you don’t look, you don’t find

For over 60 years, those who have jealousy guarded the practice of fluoridation in the PHS have failed to fund serious health studies. The vast majority of research money goes into endless studies on teeth (see CARTOON), as if it was the only organ in the body. No studies have investigated a possible relationship between fluoridation and the numerous illnesses and impacts discussed above, which affect millions of Americans and at increasing rates, even though fluoride exposure may be one contributory cause.

Even the most basic studies have not been done. For example, no comprehensive survey of fluoride bone levels has been undertaken to see if some people are reaching damaging levels. Nor has there been a monitoring program of fluoride levels in people’s blood and urine. More seriously, studies have not been done on a number of childhood conditions using the severity of dental fluorosis as a biomarker of exposure. All of these failures to do the obvious allow fluoridation promoters to say, “We have been fluoridating the water for over 60 years and we don’t see any health problems”, yet if you don’t look, you don’t find.

Where studies have been done, they have been done largely in countries that do not have a fluoridation program to protect, especially India and China, where there are large areas that have high natural levels of fluoride in the water and are endemic for both dental and skeletal fluorosis. For many years, the US has ignored these studies, claiming that they are not relevant here, because people in these countries drink excessive amounts of water because of the hot climates and have a poor diet, which exacerbates fluoride’s toxicity.

A reason why many Western academics have remained oblivious of these health effects is because Fluoride, the journal of the International Society for Fluoride Research, which has published many important studies, has been excluded from PubMed (the primary medical literature search engine) since the journal began publishing in 1968. Why such a journal, which has peer review, carries no advertising and publishes articles both for and against fluoridation, should be excluded from this important search engine is both puzzling and disturbing. Especially so, when PubMed includes dental trade journals and popular magazines of no academic standing.

Instead of conducting health studies in fluoridated countries, the health issue is usually resolved with review panels made up of government employees and supporters of the fluoridation program. Their conclusions about the safety and effectiveness of fluoridation are predictable. The Irish Fluoridation Forum Report of 2002 is a classic example.

The scientific breakthrough

The scientific breakthrough came in 2003, when at the request of the US EPA, the National Research Council (of the National Academies) reviewed the toxicology of fluoride in water. For the first time in reviews of this kind, the 12-membered panel was truly balanced. Their brief was not to look at the safety of fluoridation per se, but rather to examine the safety of the drinking water standard for fluoride, currently set at 4 ppm. It took the panel three and half years to complete their report and when it was published on March 22, 2006, it was 507 pages long and had over 1000 references.

The panel concluded that the safe drinking water standard for fluoride (4 ppm) was not protective of health and recommended that the US EPA perform a health risk assessment to determine a new MCLG (maximum contaminant level goal). The MCLG is a goal based on the lowest averse effect level, with safety factors applied to protect the most vulnerable individuals in society from known and reasonably anticipated health effects. The MCL is a legally enforceable standard and takes into account the economic costs of removing a pollutant.

Re-enter the politics

Risk assessment specialist Dr. Robert Carton, a former employee of the EPA, has examined the findings of the review panel and argues that the MCLG should be set at zero (Carton, 2006). However, were the EPA to set the MCLG at zero, it would scuttle the fluoridation program overnight. This may explain why after 33 months the EPA has published nothing. This delay appears to be one of many examples of where politics trumps science on this issue.

More politics were revealed by the manner in which the leading proponents of fluoridation treated the NRC report. On the day it was released, the American Dental Association (ADA) declared that the report was irrelevant to fluoridation and six days later, the Centers for Disease Control and Prevention (CDC) declared that it “was consistent” with its promotion of fluoridation at 1 ppm!

In those six days, the CDC did not have time to digest this report, let alone the 1000 references it contained. Nor could it have done the risk assessment recommended by the NRC – a task that has already taken the EPA nearly three years.

All of this may seem very puzzling to someone new to this issue, until they find out just which people at the CDC reached such a rapid conclusion.

The CDC’s Oral Health Division

The CDC has only one division that deals with fluoridation. This is the Oral Health Division (OHD), which is largely staffed by people with dental credentials. They have few staff with expertise in medicine and no toxicologists and risk assessment specialists. In short, they have no one qualified to make the judgment they made. Moreover, there is no one at the CDC – independent of the OHD – overseeing the safety of the fluoridation program.

The OHD has a huge conflict of interest in this matter. They avidly promote fluoridation. They give awards to communities and states based upon their adoption of the practice. They even send out their top personnel to state legislatures to support mandatory statewide fluoridation bills. To all intents and purposes the OHD is an adjunct of the ADA.

Most members of the public and the media know little of this background, so when the CDC makes pronouncements about the “safety and effectiveness” of fluoridation, journalists and officials take it at face value. Not a day goes by without someone in the world citing the CDC’s statement that fluoridation is “One of the top ten public health achievements of the 20th Century” (CDC, 1999). Those that cite this probably have no idea how incredibly poor the analysis was that supported this statement. The report was not externally peer reviewed, was six years out of date on health studies and the graphical evidence it offered to support the effectiveness of fluoridation was laughable and easily refuted by examining the WHO data base, compare FIGURES 2 and 3.

The publication of the NRC (2006) report should have ended fluoridation overnight. Among other things, the review showed how little serious research had been carried out in fluoridated countries. This is what the chairman of the panel, Dr. John Doull, had to say:
“What the committee found is that we’ve gone with the
status quo regarding fluoride for many years-for too long,
and now we need to take a fresh look…In the scientific
community, people tend to think this is settled. I mean,
when the U.S. surgeon general comes out and says this is
one of the 10 greatest achievements of the 20th century,
that’s a hard hurdle to get over. But when we looked at the
studies that have been done, we found that many of these
questions are unsettled and we have much less information
than we should, considering how long this [fluoridation]
has been going on.” (Scientific American, Jan. 2008)

Based upon the levels at which health effects occur, there is simply not an adequate margin to protect every individual in society drinking uncontrolled amounts of fluoridated water, especially vulnerable subsets of the population. The ADA has virtually admitted as much by advising parents not to use fluoridated tap water to make up baby formula (ADA, 2006).

Other reasons for ending fluoridation

There have been other moments that should have ended fluoridation. One of these was the concession by the CDC in 1999, that the promoters had got the mechanism of fluoride’s beneficial action wrong for over 50 years. They now admit that fluoride works topically, not systemically. In other words, it works on the outside of the tooth, not from inside the body. It simply does not make sense to swallow fluoride.

In a videotaped interview in 2005, Dr. Arvid Carlsson, who led the successful fight against fluoridation in Sweden in the 1970s and was awarded the Nobel Prize for Medicine in 2000, stated that:
“In pharmacology, if the effect is local (topical), it’s awkward to use it
in any other way than as a local treatment. I mean this is obvious. You
have the teeth there, they’re available for you, why drink the stuff?”

There are three other important reasons why fluoridation should be ended.

1 • Fluoridation is bad medical practice.

While it is possible to control the concentration (mg per liter) of the fluoride added at the water works, it is impossible to control the dose (mg per day) individuals get, because it is impossible to control how much people drink and how much fluoride they get from other sources.

Fluoridation defies many aspects of medical practice. As Dr. Peter Mansfield, a physician and advisory board member for the important York Review (McDonagh et al., 2000), stated:
“No physician in his right senses would prescribe for a person he has
never met, whose medical history he does not know, a substance which
is intended to create bodily change, with the advice: ‘Take as much as
you like, and you will take it for the rest of your life, because some
children suffer from tooth decay.’ It is a preposterous notion.”

2 • Fluoridation is unethical.

Fluoridation is unethical because it violates the individual’s right to informed consent to medication, one of the key ethical planks of modern medicine. Fluoridation allows decision makers, without medical qualifications, to do to the whole community what an individual doctor cannot do to an individual patient.

3 • Fluoridation disregards an important message from nature.

The average level in mothers’ milk is extremely low 0.004 ppm). This means that a bottle fed baby for which the formula has been made up with fluoridated water is going to get 250 times more fluoride than nature intended. Nature is clearly telling us that the baby does not need fluoride for healthy teeth or any other organ in the body. It might also be telling us that there are strong reasons to keep fluoride away from the baby’s developing tissues, especially the brain. The fact that there are now 23 studies indicating that fluoride may lower IQ, may be a sad confirmation of that possibility.

Summary

Fluoridation is a bad medical practice. It is unethical, ineffective, and poses serious health dangers, especially for vulnerable subsets of the population. Instead of science, in fluoridated countries we get promotion via a long list of dated endorsements, from associations and agencies, most of which are not on top of the current primary literature and who take the word of the ADA and CDC on this issue, at face value.

Unfortunately, because government officials have put so much of their credibility on the line promoting and defending fluoridation, it is difficult for them now to admit that this practice was a huge mistake.

However, we need to restore the public’s trust in the agencies that are supposed to protect our health. Ending fluoridation is a great place to start this restoration.

For those who fear a dental crisis if fluoridation is stopped, it should be noted that at least 5 modern studies have shown that when fluoridation is stopped, tooth decay has not gone up.

In the past, 14 Nobel Prize winners have either opposed fluoridation or have expressed serious reservations about the practice. They have now been joined by over 2000 professionals, who have signed a statement calling for the end of fluoridation worldwide. See: http://www.Fluoridealert.org/professionals.statement.html

President Obama says that he wants sound science underpinning governmental policies. Hopefully, he will encourage Congress to hold hearings in which CDC officials are required to provide the scientific basis for their continued promotion of this outdated practice.

For more information and the full citations go to the Health Data base of the Fluoride Action Network: http://www.fluoridealert.org/health/.

For further information on the fluoridation issue go to: www.FluorideAlert.org

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Dr. Paul Connett is a graduate of Cambridge University and holds a Ph.D. in chemistry from
Dartmouth College. In May 2006, he retired from his full professorship in chemistry at St. Lawrence
University, Canton, NY, where he taught for 23 years. His specialty was environmental chemistry
and toxicology. Over the past 24 years, his research on waste management has taken him to 49 US
states and 50 other countries, where he has given approximately 2000 pro bono public presentations.
Ralph Nader said of Paul Connett, “He is the only person I know who can make waste interesting.” He
has co-authored 6 peer reviewed articles on dioxin and numerous other articles on waste management.
Dr. Connett edits the bulletins for the Fluoride Action Network. To date over 1000 of these bulletins
have been distributed.