Note: The issue of adding fluoride to Abilene’s water supply has been addressed several times over the last 40 years. Most recently, the pros and cons of fluoride were discussed this past spring leading the Abilene City Commission — in a 3-2 vote — to remove fluoride from city water on April 22; and then to reinstate it — in another 3-2 vote on May 13.
This is the final of a two-part article explaining why dentists and dental organizations say fluoride is important for tooth health. This installment examines whether fluoride is safe, whether it puts people at risk for cancer and whether the issue should be placed on the ballot at some point.
Is fluoride safe?
Several studies over the past decades have researched and tested the various effects of fluoride on the body. Some people and organizations, such as the Fluoridealert.org, have proposed fluoride can cause cancer, fluoride toxicity, lower IQ, increased lead exposure and other negative effects.
In the ADA’s most recent Fluoridation Facts sheet published in 2018, the organization sites studies to support that fluoride does not:
– cause cancer or osteosarcoma
– decrease bone health
– decrease human enzyme activity
– negatively affect thyroid glands
– cause early onset puberty
– alter immune function or produce allergic reactions
– negatively affect human reproduction
– increase lead exposure
– lower IQ
– and other aspects of human health
The American Cancer Society covers the issue of cancer, mostly osteosarcoma, and water fluoridation on their website under the section “Water Fluoridation and Cancer Risk.” While they have not published a statement about the issue, the society does state most studies on the issue have not found a strong link between cancer and water fluoridation.
“Some factors are hard to control for in these types of studies (that is, the groups being compared may be different in ways other than just the drinking water), so the conclusions reached by any single study need to be looked at with caution,” reads the society’s website.
Acute fluoride toxicity is possible if someone consumes five liters of fluoridated water at 1 mg/L per every kilogram of body weight, according to the ADA’s fluoridation fact sheet. For example, an adult man weighing 155 pounds would have to drink about 93 gallons of water all at once to develop acute poisoning. Chronic fluoride toxicity would only develop after 10 or more years of consuming levels of fluoridated water much higher than the recommended 0.7 mh/L.
Skeletal fluorosis, a bone disease that weakens bones, is also only caused when consuming excessive amounts of fluoride. The ADA fact sheet reads someone would contract a mild form of skeletal fluorosis, osteosclerosis, after consuming water with fluoride levels of 5 mg/L for 10 years or more. Crippling skeletal fluorosis is “extremely rare” in the U.S., reads the fact sheet.
Dental fluorosis
The CDC and ADA both acknowledge fluoride can cause dental fluorosis in children who consume too much. Dental fluorosis is a cosmetic condition that changes the appearance of the teeth’s enamel, according to the CDC’s website. The change can only occur during the teeth forming years of a child, which is from birth to 8 years old. Adults can never develop dental fluorosis.
The U.S. National Center of Health Statistics released a report in 2010 that detailed dental fluorosis in children and compared the year ranges of 1986 to 1987 and 1999 to 2004. Between 1999 and 2004, 40.7% of children had some case of dental fluorosis.
Dr. Brittan said most cases of dental fluorosis in the U.S. are very mild or mild.
“I myself have not seen a lot of cases of severe fluorosis,” Brittan said. “Moderate I’ve probably seen a few cases. A lot of people have very, very mild fluorosis. They don’t even know it. Their spouse who looks at their teeth doesn’t know it.”
Brittan said children who have a habit of eating toothpaste for years can develop fluorosis because of the higher concentration of fluoride in toothpaste. Swallowing toothpaste just a few times will not cause fluorosis. According to the ADA’s website, fluoride toothpastes available in U.S. stores generally have a fluoride concentration of 1,000 to 1,500 mg/L.
The ADA’s fact sheet also reads the majority of dental fluorosis is caused by ingesting too much fluoride products, the main culprit being toothpaste. Young children inadvertently swallow toothpaste because they do not yet have full control of their bodily functions, Brittan said. The ADA recommends children under the age of three should use no more than an amount of toothpaste the size of a grain of rice. For children between the ages of three and six, they should use no more toothpaste than the size of a pea.
The CDC’s website reads the combination of fluoridated infant formula that requires mixing with water and fluoridated water can increase the chances of a child developing mild dental fluorosis. To avoid the chances, mix formula with bottled water.
“Parents can use low-fluoride bottled water some of the time to mix infant formula to lessen this risk,” reads the CDC’s website. “Look for bottles labeled as deionized, purified, demineralized, or distilled. Additionally, some bottled waters are marketed for infants and for the purpose of mixing with formula.”
Brittan said there are methods she offers to treat dental fluorosis. She offers three methods.
“It (dental fluorosis) is the only drawback to using fluoridated products,” she said.
Fluoridation in Europe
Many people against fluoridation reference the statistic that about 97% of European countries do not fluoridate their water. While this is true, the reasons are not because the general scientific community in Europe is against the practice.
In 2010 The Scientific Committee on Health and Environmental Risks (SCHER) published a document giving opinion statements on and answering common questions about water fluoridation. The document can be found on the European Union’s website at european-union.europa.eu/index_en. The document draws similar conclusions as the CDC and ADA currently give on the chances of skeletal fluorosis, children are at the most risk of developing dental fluorosis and the benefits of fluoride. The document does share some additional information such as, “In children, there is a very narrow margin between the beneficial effects of reducing decay and exceeding the dose which causes dental fluorosis,” their opinion reads.
The most recent online statement from the European Food Safety Authority is from 2013 which sets an adequate fluoride intake amount.
“Fluoride is not an essential nutrient,” reads their statement. “Therefore, no average requirement for the performance of essential physiological functions can be defined. Nevertheless, the panel considered that the setting of an AI (adequate intact) is appropriate because of the beneficial effects of dietary fluoride on prevention of dental caries.”
The authority set their AI to 0.05 milligrams to kilograms of body weight per day for both children and adults including pregnant and lactating women.
The ADA’s fact sheet has adequate intake for several age ranges. For infants between zero and six years old (weighing about seven kilograms), their recommended adequate intake is 0.01 milligrams per day. For infants seven to 12 months old (weighing about nine kilograms), the adequate intake is 0.5 mg/day. The adequate intake gradually rises up to four mg/day for men ages 19 and over and three mg/day for women 19 years and over. The European Food Safety Authority’s formula for adequate intake mostly matches the age range adequate intakes the ADA gives.
As for why most of Europe does not fluoridate their water, the ADA’s fact sheet reads that the water fluoridation in Europe has not been possible due to historical and logistical reasons.
“Many fluoridation systems that used to operate in Eastern and Central Europe did not function properly and when the Iron Curtain (the political barrier started by the Soviet Union after World War II) fell in 1989-90 fluoridation stopped because of obsolete technical equipment and lack of knowledge as to the benefits of fluoridated water,” reads the fact sheet. “Water fluoridation is not practical in some European countries because of complex water systems with numerous water sources.”
According to SCHER’s 2010 opinion, only Ireland and some regions in Spain and the United Kingdom fluoridate their water at levels ranging from 0.2 to 1.2 mg/L.
As an alternative to water, however, many countries have access to dietary fluoride supplements or salt fluoridation available.
In a 2011 study conducted by European doctors titled “Salt fluoridation in Europe and Latin America – with potential worldwide,” most European and Latin American countries have access to fluoridated salt according to 2009 data.
A small portion of populations in Bulgaria and the United Kingdom also have access to fluoridated milk.
Science is evolving
“Healthcare is constantly evolving, and is not always an absolute,” Brittan said. “That’s why treatments that were offered 50 years ago were discontinued at some point because more research was done to say ‘there’s a better alternative.’ It’s the same thing with fluoride. They have been researching this for over 100 years. There are not enough studies that have come out to say that this should not be happening.”
With the internet now making studies more readily available to the public, readers must evaluate a study on its merits and where the study comes from.
“Any kind of court of law requires a certain number of checkmarks next to someone who is an expert to testify about whatever kind of study,” Brittan said. “Has to be peer reviewed, has to have gone through whatever rigorous level of other review, and that kind of thing. That is the sort of thing you need to be looking at.”
The ADA and other organizations continue to research the effects of fluoride to continue 70 years worth of research into the topic.
“In scientific research, there is no such thing as ‘final knowledge,’” reads the ADA’s fact sheet. “New information is continuously emerging and being disseminated.
Government agencies, such as the U.S. National Institutes of Health, National Institute of Dental and Craniofacial Research, and others continue to fund fluoride research.”
The fact sheet reads elsewhere, “Throughout more than 70 years of research and practical experience, the overwhelming weight of credible scientific evidence has consistently indicated that fluoridation of community water supplies is safe,” reads the ADA’s fact sheet.”
Ballot question
One way for a question concerning water fluoridation to be included in an election is for the majority of the Abilene City Commission to approve adding it.
Witt said residents should reach out to commissioners about adding a question. Jeanne Livingston, county clerk, recommended speaking with a lawyer to determine whether the question could be added through another method.
Original article online at: https://www.abilene-rc.com/news/question-is-fluoride-safe/article_b5f47cca-4910-11ef-a93b-7f676674a189.html