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~PA Standards March 28, 2006
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Issue #28: Excerpts from NRC Report
Histor NRC Review by Michael Connett
2006
Last week, the National Research Council (NRC) released its long-awaited review of EPA's
safe water standard for fluoride (4 ppm).
Google Search As reported by the media, the NRC concluded that EPA's safety standard for fluoride is not
0 EPA Files safe and "should be lowered." According to the NRC, EPA's "safe" standard (4 ppm) puts a
person at increased risk for both tooth and bone damage ("severe dental fluorosis" and
bone fracture).
rte, While most of the press coverage so far has focused on NRC's concerns with teeth and
J bone, there are many other serious concerns expressed in the NRC report.
VAIN
To give readers an indication of the other concerns expressed by the NRC, we have
reproduced a series of excerpts from the report (see below).
The excerpts detail the various systems in the body (e.g. nervous, endocrine, and immune)
that fluoride may damage, and how these effects may be enhanced or mediated through
fluoride's interactive/synergistic effects with other compounds (e.g. iodine deficiencies and
aluminum overload).
When one couples the multitude of serious health concerns expressed by NRC, with their
uncertainties on what the various safe vs. toxic doses are, it should cause a great deal of
concern.
Here, for example, are what two of the NRC panel members - Dr. Kathleen Thiessen and
Dr. Robert Isaacson - had to say about the relevance of NRC's report to the water
fluoridation program (see: http://Www.portiandtribuiie.com/grghview.cAJ?Jd=34527)
However, some of the research that is validated by the report suggests that
water-fluoridation levels advocated by Hamilton and Ferre may be
unhealthy, two members of the NAS panel said in interviews with the
Portland Tribune.
NAS panel member Kathy Thiessen, a former senior scientist at Oak Ridge
National Laboratory who has studied fluoride for the EPA, said the report
showed "the potential is there" that water fluoridation is unhealthy. As for the
studies finding that higher levels damage children's IQ, she said it's possible
water fluoridation levels may have a similar, albeit reduced effect. She said
in her personal opinion the research suggests "most people should minimize
their fluoride intake" -which includes avoiding fluoridated water.
"I think you can look at most chapters of this report and say, 'Whoa,'" she
said. "We have made major strides from previous (looks) at this topic."
NAS panel member Robert Isaacson, a distinguished professor of
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neurobehavioral science at the State University of New York in Binghamton,
agreed, saying that the possible effects on endocrines and hormones from
water-fluoridation are "something that I wouldn't want to happen to me if I
had any say in the matter."
The report "should be a wake-up call," he added.
For more information, and news articles, on NRC's review, see:
ht, tr)://www,fluoridealert. org/health/eua/nrc/index, html
Excerpts from: "Fluorlde in Drinking Water: A Scientific Review of EPA's
Standards" (National Research Council, 2006)
FLUORIDE'S EFFECTS ON THE BRAIN:
"On the basis of information largely derived from histological, chemical, and
molecular studies, it is apparent that fluorides have the ability to interfere
with the functions of the brain and the body by direct and indirect means."
p187
"A few epidemiologic studies of Chinese populations have reported IQ
deficits in children exposed to fluoride at 2.5 to 4 mg/L in drinking water.
Although the studies lacked sufficient detail for the committee to fully assess
their quality and relevance to U.S. populations, the consistency of the
results appears significant enough to warrant additional research on the
effects of fluoride on intelligence" p6
"histopathological changes similar to those traditionally associated with
Alzheimer's disease in people have been seen in rats chronically exposed to
AIF." p178
"Fluorides also increase the production of free radicals in the brain through
several different biological pathways. These changes have a bearing on the
possibility that fluorides act to increase the risk of developing Alzheimer's
disease." pl86
"More research is needed to clarify fluoride's biochemical effects on the
brain." p186
"The possibility has been raised by the studies conducted in China that
fluoride can lower intellectual abilities. Thus, studies of populations exposed
to different concentrations of fluoride in drinking water should include
measurements of reasoning ability, problem solving, 10, and short- and
long-term memory." p187
"Studies-of-populations-exposed-to-different-conmntratin z-af flu-o Iii
should be undertaken to evaluate neurochemical changes that may be
associated with dementia. Consideration should be given to assessing
effects from chronic exposure, effects that might be delayed or occur late-in-
life, and individual susceptibility." p187
"Additional animal studies designed to evaluate reasoning are needed." p.
187
FLUORIDE'S EFFECTS ON THE ENDOCRINE SYSTEM:
"In summary, evidence of several types indicates that fluoride affects normal
endocrine function or response; the effects of the fluoride-induced changes
vary in degree and kind in different individuals. Fluoride is therefore an
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endocrine disruptor in the broad sense of altering normal endocrine function
or response, although probably not in the sense of mimicking a normal
hormone. The mechanisms of action remain to be worked out and appear to
include both direct and indirect mechanisms, for example, direct stimulation
or inhibition of hormone secretion by interference with second messenger
function, indirect stimulation or inhibition of hormone secretion by effects on
things such as calcium balance, and inhibition of peripheral enzymes that
are necessary for activation of the normal hormone." p223
"Some of these [endocrine] effects are associated with fluoride intake that is
achievable at fluoride concentrations in drinking water of 4 mglL or less,
especially for young children or for individuals with high water intake. Many
of the effects could be considered subclinical effects, meaning that they are
not adverse health effects. However, recent work on borderline hormonal
imbalances and endocrine-disrupting chemicals indicated that adverse
health effects, or increased risks for developing adverse effects, might be
associated with seemingly mild imbalances or perturbations in hormone
concentrations. Further research is needed to explore these possibilities."
p7
"Further effort is necessary to characterize the direct and indirect
mechanisms of fluoride's action on the endocrine system and the factors
that determine the response, if any, in a given individual." p223
"The effects of fluoride on various aspects of endocrine function should be
examined further, particularly with respect to a possible role in the
development of several diseases or mental states in the United States."
p224
FLUORIDE'S EFFECTS ON THE THYROID:
"several lines of information indicate an effect of fluoride exposure on thyroid
function." p197
"it is difficult to predict exactly what effects on thyroid function are likely at
what concentration of fluoride exposure and under what circumstances."
p197
"Fluoride exposure in humans is associated with elevated TSH
concentrations, increased goiter prevalence, and altered T4 and T3
concentrations; similar effects on T4 and T3 are reported in experimental
animals." p218
"In humans, effects on thyroid function were associated with fluoride
exposures of 0.05-0.13 mglkglday when iodine intake was adequate and
0.01-0.03 mg/kg/day when iodine intake was inadequate." p218
"The recent decline in iodine intake in the United States (CDC 2002d;
Larsen et at. 2002) could contrjbWe-to-incr_easad-toxicity_oLtiuoride_for_some - -
individuals." p218
"Intake of nutrients such as calcium and iodine often is not reported in
studies of fluoride effects. The effects of fluoride on thyroid function, for
instance, might depend on whether iodine intake is low, adequate, or high,
or whether dietary selenium is adequate." p222
FLUORIDE'S EFFECTS ON THE PINEAL GLAND:
"The single animal study of pineal function indicates that fluoride exposure
results in altered melatonin production and altered timing of sexual maturity
(Table 8-1). Whether fluoride affects pineal function in humans remains to
be demonstrated. The two studies of menarcheal age in humans show the
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possibility of earlier menarche in some individuals exposed to fluoride, but
no definitive statement can be made. Recent information on the role of the
pineal organ in humans suggests that any agent that affects pineal function
could affect human health in a variety of ways, including effects on sexual
maturation, calcium metabolism, parathyroid function, postmenopausal
osteoporosis, cancer, and psychiatric disease." p221-22
FLUORIDE'S EFFECTS ON INSULIN SECRETION/DIABETES:
"The conclusion from the available studies is that sufficient fluoride exposure
appears to bring about increases in blood glucose or impaired glucose
tolerance in some individuals and to increase the severity of some types of
diabetes. In general, impaired glucose metabolism appears to be associated
with serum or plasma fluoride concentrations of about 0.1 mg/L or greater in
both animals and humans. In addition, diabetic individuals will often have
higher than normal water intake, and consequently, will have higher than
normal fluoride intake for a given concentration of fluoride in drinking water.
An estimated 16-20 million people in the U.S. have diabetes mellitus;
therefore, any role of fluoride exposure in the development of impaired
glucose metabolism or diabetes is potentially significant." p. 217
FLUORIDE'S EFFECTS ON THE IMMUNE SYSTEM:
"Nevertheless, patients who live in either an artificially fluoridated community
or a community where the drinking water naturally contains fluoride at 4
mg/L have all accumulated fluoride in their skeletal systems and potentially
have very high fluoride concentrations in their bones. The bone marrow is
where immune cells develop and that could affect humoral immunity and the
production of antibodies to foreign chemicals." p249
"There is no question that fluoride can affect the cells involved in providing
immune responses. The question is what proportion, if any, of the
population consuming drinking water containing fluoride at 4.0 mg/L on a
regular basis will have their immune systems compromised? Not a single
epidemiologic study has investigated whether fluoride in the drinking water
at 4 mg/L is associated with changes in immune function. Nor has any study
examined whether a person with an immunodeficiency disease can tolerate
fluoride ingestion from drinking water." p250
"bone concentrates fluoride and the blood-borne progenitors could be
exposed to exceptionally high fluoride concentrations. Thus, more research
needs to be carried out before one can state that drinking water containing
fluoride at 4 mg/L has no effect on the immune system." p250
"it is important to consider subpopulations that accumulate large
concentrations of fluoride in their tones (e.g., renal patients). When bone
turnover occurs, the potential exists for immune system cells and stem cells
to be exposed to concentrations of fluoride in the interstitial fluids of bone
that are higher than would be found in serum. From an immunologic
stand point-individuals-who-are-immunoeom prom ised-(e-.g-., AIDS,
transplant, and bone-marrow-replacement patients) could be at greater risk
of the immunologic effects of fluoride." p 258
"Within 250 ?m of a site of resorption, it is possible to encounter progenitor
cells that give rise to bone, blood, and fat. Thus, one must assume that
these cells would be exposed to high concentrations of fluoride. At this time,
it is not possible to predict what effect this exposure would have on the
functioning of skeletal elements, hematopoiesis, and adipose formation."
p115
"It is paramount that careful biochemical studies be conducted to determine
what fluoride concentrations occur in the bone and surrounding interstitial
fluids from exposure to fluoride in drinking water at up to 4 mg/L, because
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bone marrow is the source of the progenitors that produce the immune
system cells." p 259
"In addition, studies could be conducted to determine what percentage of
immunocompromised subjects have adverse reactions when exposed to
fluoride in the range of 1-4 mg/L in drinking water." p259
FLUORIDE'S INTERACTIVE/SYNERGISTIC EFFECTS (w/ IODINE, ALUMINUM, ETC):
"Intake of nutrients such as calcium and iodine often is not reported in
studies of fluoride effects. The effects of fluoride on thyroid function, for
instance, might depend on whether iodine intake is low, adequate, or high,
or whether dietary selenium is adequate." p222
"Better characterization of exposure to fluoride is needed in epidemiology
studies investigating potential effects. Important exposure aspects of such
studies would include the following: collecting data on general dietary status
and dietary factors that could influence exposure or effects, such as
calcium, iodine, and aluminum intakes." p72
"Available information now indicates a role for aluminum in the interaction of
fluoride on the second messenger system; thus, differences in aluminum
exposure might explain some of the differences in response to fluoride
exposures among individuals and populations." p222
"With the increasing prevalence of acid rain, metal ions such as aluminum
become more soluble and enter our day-to-day environment; the opportunity
for bioactive forms of AIF to exist has increased in the past 100 years.
Human exposure to aluminofluorides can occur when a person ingests both
a fluoride source (e.g., fluoride in drinking water) and an aluminum source;
sources of human exposure to aluminum include drinking water, tea, food
residues, infant formula, aluminum-containing antacids or medications,
deodorants, cosmetics, and glassware." p42
"Further research should include characterization of both the exposure
conditions and the physiological conditions (for fluoride and for aluminum or
beryllium) under which aluminofluoride and beryllofluoride complexes can
be expected to occur in humans as well as the biological effects that could
result." p42
"Another possible explanation for increased blood lead concentrations which
has not been examined is the effect of fluoride intake on calcium
metabolism; a review by Goyer (1995) indicates that higher blood and tissue
concentrations of lead occur when the diet is low in calcium. Increased
fluoride exposure appears to increase the dietary requirement for calcium
(see Chapter 8); in addition, the substitution of tap-water based beverages
(e.g., soft drinks or reconstituted juices) for dairy products would result in
both increased fluoride intake and decreased calcium intake." p43
"[G]iven the expected presence of fluoride ion (from any fluoridation source)
and silica (native to the water) in any fluoridated tap water, it would be
useful to examine what happens when that tap water is used to make acidic
beverages or products (commercially or in homes), especially fruit juice from
concentrate, tea, and soft drinks, Although neither Urbansky (2002) nor
Morris (2004) discusses such beverages, both indicate that at pH < 5, SiF6
2- would be present, so it seems reasonable to expect that some SiF6 2-
would be present in acidic beverages but not in the tap water used to
prepare the beverages. Consumption rates of these beverages are high for
many people, and therefore the possibility of biological effects of SiF62-, as
opposed to free fluoride ion, should be examined." p44
FLUORIDE'S EFFECTS ON THE REPRODUCTIVE SYSTEM:
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Excerpts from NRC Report: "Fluoride in Drinking Water: A Scientific Review of EPA's S... Page 6 of 8
"A few human studies suggested that high concentrations of fluoride
exposure might be associated with alterations in reproductive hormones,
effects on fertility, and developmental outcomes, but design limitations make
those studies insufficient for risk evaluation." p6
"the relationship between fertility and fluoride requires additional study."
P161
FLUORIDE & DOWNS SYNDROME:
"The possible association of cytogenetic effects with fluoride exposure
suggests that Down's syndrome is a biologically plausible outcome of
exposure." p170
"A reanalysis of data on Down's syndrome and fluoride by Takahashi (1998)
suggested a possible association in children born to young mothers. A case-
control study of the incidence of Down's syndrome in young women and
fluoride exposure would be useful for addressing that issue. However, it may
be particularly difficult to study the incidence of Down's syndrome today
given increased fetal genetic testing and concerns with confidentiality." 172
FLUORIDE'S EFFECTS ON THE GASTROINTESTINAL SYSTEM:
"The numerous fluoridation studies in the past failed to rigorously test for
changes in GI symptoms and there are no studies on drinking water
containing fluoride at 4 mg/L in which GI symptoms were carefully
documented." p230
"GI effects appear to have been rarely evaluated in the fluoride supplement
studies that followed the early ones in the 1950s and 1960s." p231
"The table suggests that fluoride at 4 mg/L in the drinking water results in
approximately 1 % of the population experiencing GI symptoms." p231
"Whether fluoride activates G proteins in the gut epithelium at very low
doses (e.g., from fluoridated water at 4.0 mg/L) and has significant effects
on the gut cell chemistry must be examined in biochemical studies." p236
"There are a few case reports of GI upset in subjects exposed to drinking
water fluoridated at 1 mg/L. Those effects were observed in only a small
number of cases, which suggest hypersensitivity. However, the available
data are not robust enough to determine whether that is the case." p. 250
"Studies are needed to evaluate gastric responses to fluoride from natural
sources at concentrations up to 4 mg1L and from artificial sources." p. 258
FLUORIDE'S EFFECTS ON THE LIVER:
"It is possible that a lifetime ingestion of 5-10 mg/day from drinking water
containing 4 mg/L might turn out to have long-term effects on the liver, and
this should be investigated in future epidemiologic studies." p248
"The effect of low doses of fluoride on kidney and liver enzyme functions in
humans needs to be carefully documented in communities exposed to
different concentrations of fluoride in drinking water." p258
FLUORIDE'S EFFECTS ON THE KIDNEY:
"Human kidneys... concentrate fluoride as much as 50-fold from plasma to
urine. Portions of the renal system may therefore be at higher risk of fluoride
toxicity than most soft tissues." p236
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"Early water fluoridation studies did not carefully assess changes in renal
function." p236
"future studies should be directed toward determining whether kidney stone
formation is the most sensitive end point on which to base the MCLG." p247
"On the basis of studies carried out on people living in regions where there
is endemic fluorosis, ingestion of fluoride at 12 mg per day would increase
the risk for some people to develop adverse renal effects." p247
"The effect of low doses of fluoride on kidney and liver enzyme functions in
humans needs to be carefully documented in communities exposed to
different concentrations of fluoride in drinking water." p258
FLUORIDE & CANCER:
"Fluoride appears to have the potential to initiate or promote cancers,
particularly of the bone, but the evidence to date is tentative and mixed
(Tables 10-4 and 10-5). As noted above, osteosarcoma is of particular
concern as a potential effect of fluoride because of (1) fluoride deposition in
bone, (2) the mitogenic effect of fluoride on bone cells, (3) animal results
described above, and (4) pre-1993 publication of some positive, as well as
negative, epidemiologic reports on associations of fluoride exposure with
osteosarcoma risk." p. 286
"Because fluoride stimulates osteoblast proliferation, there is a theoretical
risk that it might induce a malignant change in the expanding cell population.
This has raised concerns that fluoride exposure might be an independent
risk factor for new osteosarcomas." p109
"Osteosarcoma presents the greatest a priori plausibility as a potential
cancer target site because of fluoride's deposition in bone, the NTP animal
study findings of borderline increased osteosarcomas in male rats, and the
known mitogenic effect of fluoride on bone cells in culture (see Chapter 5).
Principles of cell biology indicate that stimuli for rapid cell division increase
the risks for some of the dividing cells to become malignant, either by
inducing random transforming events or by unmasking malignant cells that
previously were in nondividing states." p275
"Further research on a possible effect of fluoride on bladder cancer risk
should be conducted." p288
Back to top
http://fluoridealert.org/health/epa/nre/excerpts.html 2/19/2011
Booklist Starred Review for The Case Against Fluoride! : Chelsea Green Page 5 of 9
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Three cheers for The Case.11gairasl Fluoride by Paul Connett, James Beck, and Spedding Micklem.
which just garnered this terrific starred review in Booklist!
*Starred Review* On the eve of the new millennium, the Centers for Disease Control (CDC) listed
water fluoridation as one of the twentieth-century's 10 greatest public-health achievements. Yet
according to the authors of this painstakingly researched expose' of fluoridation's overall
ineffectiveness and toxicity, endorsements such as these from the CDC and other health organizations
are motivated more by face-saving politics than credible research. Fluoridation advocates who have
previously branded detractors as conspiracy theorists and shills for junk science will be hard-pressed
to debunk the hundreds of peer-reviewed studies and sound scientific reasoning presented here. In
demonstrating fluoridation's ineffectiveness, the authors cite exhaustive evidence proving fluoride's
only benefits are topical, as in tooth-brushing, as opposed to swallowing. But the case against
fluoride's alleged safety, even in small doses, is more alarming, with multiple studies showing
fluoride's probable complicity in lowered intelligence scores, thyroid dysfunction, hip fractures, and
the ominously rising incidence of osteosarcoma in boys. The authors academic, hyperbole-free
writing style serves them well in marshaling a series of facts that, all by themselves, expose
fluoridation as a false panacea. It remains to be seen, however, whether the public-health community
will give this landmark work due credit or continue to rubber stamp an outdated policy that, like
bloodletting and trepanation, properly belongs on the scrap heap of sham medical interventions.
Reprinted with permission of Booklist, copyright 2010, American Library Association.
Check out The Case Against Fluoride now!
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UNITED STATES ENVIRONMENTAL PROTECTION AGENCY
NATIONAL RISK MANAGEMENT RESEARCH LABORATORY
CINCINNATI, OH 45268
r'0l MW
November 16, 2000
OFFICE OF
RESEARCH AND DEVELOPMENT
Roger D. Masters
Research Professor of Government
Dartmouth College
Department of Government
6108 Silsby Hall
Hanover, New Hampshire 03755-3547
Dear Professor Masters:
We have received your letter dated September 27, 2000, requesting empirical scientific
data we may have on the health effects of fluosilicic acid or sodium silicofluoride and manganese
neurotoxicity.
To answer your first question on whether we have in our possession empirical scientific
data on the effects of fluosilicic acid or sodium silicofluoride on health and behavior, our answer
is no. Health effects research is primarily conducted by our National Health and Environmental
Effects Research Laboratory (NHEERL). We have contacted our colleagues at NHEERL and
they report that with the exception of some acute toxicity data, they were unable to find any
information on the effects of silicofluorides on health and behavior.
In answer to your question on empirical information we may have on manganese
neurotoxicity, NHEERL scientists forwarded to us several manuscripts with reference sections
that contain information on the neurotoxicity of manganese. These are enclosed for your
information.
I apologize for the delay in responding to your request and hope you find the enclosed
information useful.
Sincerely,
Robert C. Thurnau, Chief
Treatment Technology Evaluation Branch
Water Supply and Water Resources Division
Enclosures
Products - Data Briefs - Number 53 - November 2010 Page] of 8
Centers for Disease Control and Prevention
Your Online Source for Credible Health Information
NCHS Data Brief
Number 53, November 2010
Prevalence and Severity of Dental Fluorosis in the United States,
1999-2004
PDF Version = S/nchs/data /databriefs/db5lpdfl (848 KB)
Eugenio D. Beltran-Aguilar, D.M.D., M.S., Dr.P.H.; Laurie Barker, M.S.P.H.; and Bruce A. Dye,
D.D.S., M.P.H.
Key findings
Data from the National Health and Nutrition Examination Survey, 1999-2004 and
the 1986-1987 National Survey of Oral Health in U.S. School Children
• Less than one-quarter of persons aged 6-49 in the United States had some form of dental
fluorosis.
• The prevalence of dental fluorosis was higher in adolescents than in adults and highest
among those aged 12-15.
• Adolescents aged 12-15 in 1999-2004 had a higher prevalence of dental fluorosis than
adolescents aged 12-15 in 1986-1987.
Dental fluorosis refers to changes in the appearance of tooth enamel that are caused by long-
term ingestion of fluoride during the time teeth are forming 1 #refi . Studies conducted in
the 1930s showed that the severity of tooth decay was lower and dental fluorosis was higher in
areas with more fluoride in the drinking water (2 #ref2 In response to these findings,
community water fluoridation programs were developed to add fluoride to drinking water to
reach an optimal level for preventing tooth decay, while limiting the chance of developing
dental fluorosis ( #ref By the 198os, studies in selected U.S. communities reported an
increase in dental fluorosis ( #ref #ref , paralleling the expansion of water fluoridation
and the increased availability of other sources of ingested fluoride, such as fluoride toothpaste
(if swallowed) and fluoride supplements (6 #ref6 _ . This report describes the prevalence of
dental fluorosis in the United States and changes in the prevalence and severity of dental
fluorosis among adolescents between 1986-1987 and 1999-2004•
Keywords: children, dental public health, National Health and Nutrition Examination
Survey, National Survey of Oral Health in U.S. School Children
Less than one-quarter of persons aged 6-49 had dental fluorosis.
http:/,/www.cdc.gov/nchs/data/databriefs/db53.htni 2/19/2011
Products - Data Briefs - Number 53 - November 2010 Page 2 of 8
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Among persons aged 6-49,16.o% had very mild fluorosis, 4.8% had mild fluorosis, 2.o% had
moderate fluorosis, and less than 1% had severe fluorosis (Figure 1(#fi>;1)
For the remaining three-quarters of persons in this age group, 60.6% were unaffected by dental
fluorosis and 16.5% were classified as having questionable dental fluorosis.
Prevalence of dental fluorosis was higher among younger persons
and ranged from 41% among adolescents aged 12-15 to 9% among
adults aged 40-49•
Adolescents aged 12-15 had the highest prevalence of dental fluorosis (40.6%) (Figure 2
#fi Z2 D. The prevalence is lower among older age groups. The lowest prevalence was among
those aged 40-49 (8.7%). The prevalence of-dental -fluorosis among-child en aged-6-11 (33.4%)
was lower than the prevalence among those aged 12-15 (40.6%).
littp:/,/w\,\,w.cdc.gov/nclis/clata/databriefs/db5'3.htni 2/19/2011
Products - Data Briefs - Number 53 - November 2010 Page 3 ol'8
Figure 2, Grevatence of dental &"osis among persons aped S 49, by ape group: UnRed States, 1999-2001
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Children aged 12-15 in 1999-2004 had higher prevalence of dental
fluorosis compared with the same aged children in 1986-1987.
In 1986-1987, 22.6% of adolescents aged 12-15 had dental fluorosis, whereas in 1999-2001,
40.7% of adolescents aged 12-15 had dental fluorosis (Figure 3 (#fig.-I) The estimates for
severe alone were statistically unreliable.
The prevalence of very mild fluorosis increased from 17.2% to 28.5% and mild fluorosis
increased from 4.1% to 8.6%. The prevalence of moderate and severe fluorosis increased from
1.3% to 3.6%.
http://www.cdc.gov/nchs/data/databriefs/db53.htm 2/19/201 1
Products - Data Briefs - Number 53 - November 2010 Page 4 of 8
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Summary
Twenty-three percent of persons aged 6-49 had dental fluorosis in 1999-2004. Approximately
2% had moderate dental fluorosis and less than 1% had severe dental fluorosis. Dental fluorosis
was most prevalent among children aged 12-15, and less prevalent among older age groups.
The prevalence of dental fluorosis among children aged 6-11 was lower than the prevalence
among adolescents aged 12-15. This may be explained by an incomplete set of permanent teeth
among children aged 6-11; some posterior permanent teeth, including premolars and second
molars, erupt between ages 1o and 12.
The-levels of very mild, mild, and moderate or severe dental fluorosis werehigher among
adolescents aged 12-15 in 1999-2004 than in 1986-1987.
In the analyses of changes in prevalence between both national surveys, moderate and severe
dental fluorosis were aggregated into one category because all estimates of severe fluorosis
were statistically unreliable after stratification (standard error of the percentage was greater
than 30% the value of the percentage).
Definitions
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Products - Data Briefs - Number 53 - November 2010 Page 5 of 8
Dental fluorosis: Defined as a change in the mineralization of the dental hard tissues
(enamel, dentin, and cementum) caused by long-term ingestion (eating and drinking) of
fluoride during the period of tooth development prior to eruption into the mouth (first 8 years
of life for most permanent teeth excluding third molars). Once the tooth erupts, dental
fluorosis refers to a range of visually detectable changes in enamel. Changes range from barely
visible lacy white markings in milder cases to converged opaque areas and pitting of the teeth
in severe forms. After eruption the pitted areas can become stained yellow to dark brown.
Dean's Fluorosis Index: Developed in the 193os by H.T. Dean to assess the prevalence and
severity of dental fluorosis in various communities in the United States 2 #ref2 Major
criteria for each category are listed below:
- Unaffected: The enamel is translucent. The surface of the tooth is smooth, glossy, and
usually has a pale creamy white color.
• Questionable: The enamel shows slight changes ranging from a few white flecks to
occasional white spots. This classification is utilized in those instances in which a
definitive determination of the mildest form of fluorosis is not warranted and a
classification of unaffected is not justified.
• Very mild: Small opaque paper-white areas are scattered over the tooth surface, but (to
not involve as much as 25% of the surface.
• Mild: White opaque areas on the surface are more extensive, but do not involve as much
as 50% of the surface.
• Moderate: White opaque areas affect more than 50% of the enamel surface.
• Severe: All enamel surfaces are affected. The major aspect of this classification is the
presence of discrete or confluent pitting.
Prevalence of dental fluorosis: Defined as the proportion of the population with very mild
or higher levels of dental fluorosis, by convention established by H.T. Dean 2 #refz The
questionable category is excluded.
Data source and methods
Data from the National Health and Nutrition Examination Survey (NHANES) were used for
most of these analyses. N1 ANES is a cross-sectional survey designed to monitor the health and
nutritional status of the civilian noninstitutionalized U.S. population. The oral health exam was
conducted in mobile examination centers by trained dentists. In 1999, NHANES became a
continuous survey with each year of data collection based on a representative sample covering
all ages. The NHANES sample is selected through a complex, multistage-design_thatincludes
se ection of primary sampling units (PSUs) (counties or county equivalents), household
segments within the PSUs, and finally, sample persons from selected households. The sample
design includes oversampling in order to obtain reliable estimates of health and nutritional
measures for population subgroups. In 1999-2004, oversampling included non-Hispanic black
and Mexican-American persons as well as adolescents. Visit NHANES
(/nchs/nhanes/nhanes questionnaires.htm) for additional information.
Data from the 1986-1987 National Survey of Oral Health in U.S. School Children were also
used, which was conducted by the National Institute of Dental Research (NIDR, currently the
National Institute of Dental and Craniofacial Research). The oral health exam was conducted
using portable dental equipment on the school premises by trained dentists. The 1986-1987
NIDR sample was selected through a multistage design that included selection of school
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Products - Data Briefs - Number 53 - November 2010 Page 6 of 8
districts, schools, and classrooms. Because the 1986-1987 NIDR survey was school-based,
children not attending school were not part of the sampling frame. Additional information for
the 1986-1987 NIDR survey is available in the public-use data file documentation and survey
methodology report #ref
Both surveys included intraoral assessment of all permanent teeth conducted by trained and
standardized dental examiners who used the Dean's Fluorosis Index (2 #ref2 . Accordingly,
each tooth was assigned one of six diagnostic codes: unaffected, questionable, very mild, mild,
moderate, and severe. Examiners in both surveys reached acceptable levels of interexaminer
reliability against a standard examiner (8-10 (#erf8) Data from the 1986-1987 NIDR survey
represent the first national data on dental fluorosis, while data from the 1999-2004 NHANES
represent the most recent national data. The age group 12-15 was used to compare changes
between surveys because, on average, all permanent teeth are fully erupted at that age.
Publicly available datasets from both surveys were used to calculate a person-based score for
dental fluorosis following Dean's criteria, that is, using the score corresponding to the two most
affected teeth. For example, in order to have a category of "moderate" fluorosis, the person
should have at least two permanent teeth with the score of moderate. For analyses using age,
data from the 1999-2004 NHANES were grouped into six age groups (6-11,12-15,16-19, 20-29,
30-39, and. 40-49) and comparisons to the 1986-1987 NIDR survey used data from
respondents aged 12-15.
Population estimates and standard errors were calculated in SAS-callable SUDAAN software
(release 9.0; Research Triangle Institute, Research Triangle Park, N.C.). Sample weights
provided by the National Center for Health Statistics and NIDR to account for differing
probabilities of selection, nonresponse, and noncoverage, were used for analysis. The standard
errors of the percentages were estimated using Taylor Series Linearization to take into account
the complex sampling design. Graphs include 95% confidence intervals.
About the authors
Eugenio D. Beltran-Aguilar and Laurie Barker are with the Centers for Disease Control and
Prevention's (CDC) National Center for Chronic Disease Prevention and Health Promotion,
Division of Oral Health. Bruce A. Dye is with CDC's National Center for Health Statistics,
Division of Health and Nutrition Examination Surveys.
References
1. Aoba T, Fejerskov O. Dental fluorosis: Chemistry and biology. Crit Rev Oral Biol Med 13
(2):155-70.2002.
2. Dean HT. The investigation of physiological effects by the epidemiological method.
Report no 19. Washington, DC: American Association for the Advancement of Science.
1942.
3. CDC. Fluoridation of drinking water to prevent dental caries. MMWR 48:933-40.1998.
http:/./www.edc.gov/nchs/data/databriefs/ldb53.1-itm 2/19/2011
Products - Data Briefs - Number 53 - November 2010 Page 7 of 8
4. Leverett D. Prevalence of dental fluorosis in fluoridated and nonfluo6dated communities
-A preliminary investigation. J Public Health Dent 46(4):184-7. 1986.
5. Szpunar SM, Burt BA. Dental caries, fluorosis, and fluoride exposure in Michigan
schoolchildren. J Dent Res 67(5):802-6. 1988.
6. Mascarenhas AK. Risk factors for dental fluorosis: A review of the recent literature.
Pediatr Dent 22(4):269-77.2000.
7. National Institute of Dental Research. Oral health of United States children. The National
Survey of Oral Health in U.S. School Children, 1986-1987. Public-use data file
documentation and survey methodology. Bethesda, MD: National Institutes of Health.
1992.
8. National Institute of Dental Research. Oral health of United States children. The National
Survey of Dental Caries in U.S. School Children, 1986-1987. National and regional
findings. NIH Publ no 89-2247. Bethesda, MD: National Institutes of Health. 1989.
9. Dye BA, Barker LK, Selwitz RH, Lewis BG, Wu T, Fryar CD, et al. Overview and quality
assurance for the National Health and Nutrition Examination Survey (NHANES) oral
health component, 1999-2002. Community Dent Oral Epidemiol 35(2):140-51. 2007.
1o. Dye BA, Nowjack-Raymer R, Barker LK, Nunn JH, Steele JG, Tan S, et al. Overview and
quality assurance for the oral health component of the National Health and Nutrition
Examination Survey (NHANES), 2003-04. J Public Health Dent 68(4):218-26.20o8.
Suggested citation
Beltran-Aguilar ED, Barker L, Dye BA. Prevalence and severity of dental fluorosis in the United
States, 1999-2004. NCHS data brief, no 53. Hyattsville, MD: National Center for Health
Statistics. 2010.
Copyright information
All material appearing in this report is in the public domain and may be reproduced or copied
without permission; citation as to source, however, is appreciated.
National Center for Health Statistics
Edward J. Sondik, Ph.D., Director
Jennifer H. Madans, Ph.D., Associate Director for Science
ivisio-- on ofTIealth and Nutrition Examination Surveys
Clifford L. Johnson, M.S.P.H., Director
Page last updated: November 8, 2oto
Page last reviewed: November 8, 2oio
Content source: CDC/National Center for Health Statistics
Page maintained by: Office of Information Services
http://www.cdc.gov/nchs/data/databriefs/db53.btm 2/19/2011
A Special Interview with Dr. Paul Connett
By Dr. Mercola
DC: Dr. Paul Connett
DM: Dr. Joseph Mercola, DO
INTRODUCTION: Hi this is Dr. Mercola. Today, we're here with Dr. Paul Connett who is
our honored guest and really is one of the true experts in the movement to oppose
fluoridation. He is trained as a chemist and his specialty is environmental chemistry. He
is really known throughout the world as a leader in this movement because of his
knowledge base. He is full time dedicated to this. He is a head of an organization called
the Fluoride Action Network. It really has compiled amazing information.
The purpose of our meeting today in our interview is to really give you some information
that you may have not been aware of before. And then to actually provide some take
home points so that we can start to implement the process to remove fluoride from the
water supply of the United States. The United States is only one of eight countries in the
entire world, the entire developed world that has more than 50% of their water supply
fluoridated. If you can believe that most all of Europe is not fluoridated.
DC: Only just Ireland is fluoridated.
DM: Ireland is the only country in Europe with over 50% of it fluoridated.
DC: Spain has a little bit of fluoridation. England is at 10%. It has been at 10% for years.
Most of mainland Europe is not fluoridated and yet their teeth are just as good, if not
better than ours.
DM: That's the challenge here. We have the United States supposedly one of the wisest
scientific countries in the world but yet, we're still engaging this process which is
questionable at best as I'm sure you'll reach that conclusion. That is really sort of the
central core but we're hoping to get people interested and committed to action efforts in
three areas primarily.
One is Canada because only 40% of Canada is fluoridated. We believe with some
efforts and {inaudible 3:18}, we have a lot of people viewing this who live in Canada that
we can actually get fluoride out of the entire country of Canada. I think that's doable in
the near future.
DC: British Columbia and Quebec are essentially non.-fluoridated now. So it's really
most the fluoridation is concentrated in Alberta and Ontario. If Ontario goes, Canada
goes.
1.
DM: So that's a doable thing. And then the other two communities in the United States
that we want to focus our efforts on because we've already have leadership in this area
and some of the media support which is key to getting it removed from the community is
San Diego, California and Austin, Texas.
There maybe some other communities that we're not aware of and the purpose of this
format and (inaudible 3:59) you'll below the comment here, there is an opportunity for
you to participate and if you're already registered, it's fine, you can just add your
comments. If not, it's just a simple process to add it. Then let us know that you're
interested in starting a movement in your local community and we can work together to
collect that information and start the process rolling. But those are the three areas we're
going to focus on.
If you already know about fluoride, most likely, you're going to learn more because this
is the world expert sitting next to me. I'm just so delighted we have the opportunity to
work with you. We get together regularly with our team once a quarter and one of our
highest priorities is to remove fluoride from the water supply. So we're absolutely
committed. We're working with him, Paul to do this. It's an achievable goal. I really think
we can do it.
DC: It's as easy to stop as turning off a tap. Right now, we have this huge problem in
the Gulf of Mexico trying to tap a leaking oil well. Everybody knows that. It's incredibly
difficult. But fluoridation, if we have the political will, it's as easy to stop tomorrow as is
turning off a tap.
DIVI: The supposition, the theory as to why it was initially introduced seems beneficial. I
mean, it's a public health benefit. You would have to be out of your mind to oppose
reducing dental caries in kids.
DC: That's right.
DM: Harmless (inaudible 5:17). 1 mean, who could be opposed to that? Certainly, we
aren't. But the issue is, let's provide interventions. You're actually going to achieve that
rather than support one that is not achieving that but even worse, causing harm and
damage. So why don't you expand on that concept.
DC:-Well-there-are-many-argument"g- ainsHuoridation-of-cours-f--Number-ne it's very
bad medicine because once you put in the water, you can't control the dose. You can't
control who gets it. There is no oversight. You're allowing a community to do to
everyone what a doctor could do to no one and force them to take medication.
Secondly, it's avoidable. Its unnecessary because they now, even the promoters of
fluoridation concedes that the major benefits are topical; it works from the outside of the
tooth not from inside of the body so why swallow it? Why puff it in the drinking water
when you could brush your teeth with fluoridated toothpaste.
2
It's ineffective. There is practically no difference in tooth decay between fluoridated
countries which is the majority and non-fluoridated countries. No difference between
fluoridated States or Stater which have a high percentage of fluoridation and those
which are low.
DM: Because there is an important tangent. There are a large number of communities
within the United States currently that do not fluoridate their water. Is that correct?
DC: No, the majority fluoridate.
DM: But there is a large number.
DC: There is a large number that don't and you can't tell the difference. If you look at
them, you can't tell the difference between the communities that are fluoridated and
non-fluoridated. As you've said, in addition to all of that, it's probably causing harm. We
know that 32% of American children have been overexposed to fluoride because you
have this telltale sign of dental fluorosis which in its mildest form, little white specs. But
when it gets more serious, it affects more of the surface of the teeth and it becomes
colored; yellow, brown, orange and so on, mottling of the teeth. Thirty two percent of
American children are overexposed to fluoride. What their attitude, the promoters of
fluoridation, "Oh it's just: a cosmetic effect."
DM: A small price to pay for reducing your dental caries.
DC: Exactly. But, as we said, it is not reducing dental decay by very much if any. And at
the same time, this is an indicator for somebody who has studied toxicology,
environmental chemistry as I have done, this is a worrying indicator that the body has
been overexposed to fluoride and it will be a biochemical miracle if fluoride that's
damaging the growing tooth cells is riot damaging something else in the child's body; for
example, the bones. The teeth are the window to the bones. If you've seen the damage
to the teeth, what damage can you not see...
DM: Especially to a growing developmental child.
DC: Absolutely. Now, we have 23 studies, if you believe, from four different countries;
Brazil, Iran, India and China which indicate that moderate exposure to fluoride are
lowering-IQ-in-children.
The lowest level that they estimate that this is happening, 1.9 parts per million fluoride.
If you've got an affect at 1.9 parts per million with a few hundred children in the study
and I visited the villagers in China where that study was done. There is not enough
margin of safety to protect every child that's being exposed to fluoride. You need a
much larger margin of safety. This study here, this is the National Research Council, the
EPA (Environmental Protection Agency) asked the National Research Council to do this
study. It took them over two years to do 507 pages...
3
DM: What's the National Research Council for those who aren't familiar with it?
DC: It's part of the National Academies--
DM: Of Sciences?
DC: Yeah.
DM: That's private or is it a government institution?
DC: It's a private entity but the government uses it a lot when they want a study with an
independent...
DM: It's an independent objective.
DC: Exactly. This was one of the most balanced panels that have ever looked at
fluoride.
DM: So you're convinced that there were really no significant members on the
committee that have serious conflicts of interest as do so many of these other expert
panels.
DC: No. In fact it was the first time they ever had people on there that were publicly anti..
fluoridation and people on there that were pro-fluoridation. Its usually they're all pro-
fluoridation because it's an establishment position. They looked at it for two or three
years and they came back and said that the current safe drinking water standard in the
EPA is too high and it should be lowered. And after four years, the EPA has done
nothing, published nothing.
DM: That's an interesting aspect. I mean, the government asked for a study objectively
done. It was done and performed and showed that policy needed to be changed and
over four years later, nothing as happened. So this is based on the government's own
data.
DC: Look at it. Basically what you've got is you've got the CDC saying one part per
million is good for children to drink to protect their teeth. We have now the National
Research-Council-saying; that the-safety-standard-of 4 parts-per-millirnTis-twhigh-wd
needs to be lowered. Again, what margin of safety would you want to protect the whole
population?
DM: I would like to look at it from a different perspective too because it's important to
understand that adding fluoride to the water supply it is a drug. Absolutely it's a drug.
Try to get fluoride without a prescription, you can't do it. It's a drug. But this is the only
example of a drug that is put into the water supply on a mandatory basis where a
~i
person has no choice about it just being exposed to that. There is no other example of
this. It doesn't exist. I mean it's a major assault on your freedom of choice.
DC: That's right. I mean I'd love to go to the tap and pour out a glass of water and drink
it. You know what he irony here is that the FDA which doesn't regulate fluoride in
drinking water at all, the FDA does regulate toothpaste and on the back of a tube of
toothpaste and your viewers can watch this and look at it and read on the back of a tube
of toothpaste.
DM: Almost any commercial. Obviously there is toothpaste at health food stores that are
non-fluoride.
DC: But the fluoridated toothpaste, if it's fluoridated, on the back, FDA required if your
child swallows more than the recommended amount, contact a poison center. The
amount that they're talking about, the recommended amount which is pea-sized amount
is equivalent to one glass of water. The FDA is not putting a label on the tap saying
don't drink more than one glass of water. If you do, contact a poison center. So you got
this tweedledum and tweedledee...
DM: How much fluoride is there in a typical size of toothpaste? Is there enough to kill
one child?
DC: The child would probably be sick, vomit long before they got through a whole tube
of toothpaste. But there is no question that fluoride, not an excessive amount, can
cause serious harm. There have been examples of children who swallowed the gel that
is used for topical treatment and they died as a consequence. So fluoride is extreme.
DM: It's a poison folks. It can kill you. And they're putting this on your toothpaste. It's
just almost incomprehensible. The thought when you're using toothpaste, that it is a
topical and you've already given this so it may work topically and it may. There is not
really definitive proof that it may but it may. It clearly does not work systemically and
that's what we're warning them. The challenge when you brush your teeth is that it just
isn't in your teeth. There is a tendency to swallow it and that's the problem.
DC: That's the problem. We know that as far as dental fiuorosis is concerned for
example, scientists have shown that there is a greater risk of dental fluorosis if you're
kid brushes his teeth twice a day compared to one that uses it once a day. Going back,
we're-not-talking-about killing-people-outright-with-drinking-water tiWftat e're concerne
is the chronic.
DM: This can kill you. I'm not saying it typically doesn't.
DC: It's poisonous.
DM: It's a poison.
DC: What we're really concerned about, for example, if you take the bones, 50% of the
all the fluoride that you take in each day essentially accumulates in your bones over a
lifetime. It takes about half life turnover of bones, maybe three times in a lifetime. So
you're steadily increasing the fluoride levels in your bones.
What we know from India and China, where they have areas with high natural fluoride
levels, is that the first symptoms of fluoride poisoning the bone is just like arthritis, pains
in the joints and so on. And yet, there has never been a study in the United States to
see if there is an association between people living in fluoridated areas and increasing
arthritis rates.
DM: I've got two points there, I think you mentioned earlier that China and Japan both
are non-fluoridated countries, is that correct?
DC: That's right, yes.
DM: The largest country in the planet, China, and then Japan, a very sophisticated
technological country, both are not fluoridated. The other question I had on this, I point
wanted you to comment on was the distinction between naturally occurring fluoride, the
one that you mentioned in China and India and the type of fluoride that is added to the
traditional fluoride treatments in this country through the toothpaste or the water supply -
the two most common sources. I wonder if you can comment on that.
DC: Ninety percent of the chemicals used in fluoridation in the United States are not
natural. It's a substance called hexafluorosilicic acid or its sodium salt, we'll say silicon
fluorides. These silicon fluorides are captured pollutants from the phosphate fertilizer
industry. When you're making phosphate fertilizers, you take phosphate rock, heat it up
with sulfuric acid to drive off the phosphoric acid, to make the soluble phosphate.
In the process, it generates two very toxic gasses; hydrogen fluoride and silicon
tetrafluoride. For about a hundred years, these decimated the local area, the vegetation,
crippled cattle and so on. Eventually, they were required to capture these toxic gasses.
They used a spray of water. That spray of water produces these silicon fluorides.
That stuff, the scrubbing liquor, cannot be dumped into the sea by international law. It
can't be dumped locally because its too darn concentrated but if someone buys it, its no
longer a hazardous waste, it's a product. There is no other regulations which control
well,-who-buys-it? The-public-water-utilitie&-buy-t-his-stuff-and-put-it-in-eur-drinki -
It's absolutely absurd.
Bill Hersey from the EPA points out, if it goes into the air, it's a pollutant. If it goes into
the local water its pollution. But if the public water utilities buy it, it's no longer a
pollutant. It's bizarre. So not only are we doing something quite unique using the public
water supply to deliver medicine. As you said, it's never been done apart from one short
experiment with iodine. It didn't work; never been done to do that.
6
Secondly, we're using the public water supply to get rid of hazardous waste from the
phosphate industry. It makes a lot of money for them but it costs them a lot of money to
get rid of it as hazardous waste.
DM: One of the things that we see in the news is the use of fluoride supplement to the
water supply, the municipal water supplies from China. I would like you to comment on
this. It's somewhat confusing to me because it seems that there would be a surplus of
this toxic material in the United States alone. Is it just China able to sell it to them less
expensively?
DC: Yeah.
DM: So China is coming to the market now...
DC: Two things are going on. Number one, the number of companies that were making
phosphate down in Florida has reduced. There have been some problems down there
and so on. Also, China has a lot of supply of this stuff and they are able to sell it
cheaply.
DM: Because they are manufacturing and they're producing these materials.
DC: Yeah.
DM: It's a toxic byproduct of their industrial process and they want to sell it too and they
could sell it cheaper.
DC: One of the peculiar things that is happening is that some communities in the United
States including a town in Massachusetts, I forgot the name, have stopped using this
because it was producing a sludge. It was jamming up the delivery system. It was a
white sludge. The Center for Disease Control engineer said, "We don't know what this
sludge is but we know it's safe." If you don't know what it is, how can you say it's safe?
DM: Well, we can't. Actually in our discussion earlier, we are going to seek to obtain a
source of some of this fluoride from China and actually have it analyzed by some
objective independent laboratory to see what's in this that is actually being introduced
into the water supply of so many local American communities.
DC:-I'm-glad you've-used-the-word-n-atur-aFbecause they-do-that-a-iot-TiTe say,
"Fluoride is just natural. It's in the water naturally." The natural levels on the mean, on
average, 10 times less than we add to the water.
DM: The current levels in the water is 1 part per million?
DC: The level that they use for fluoridation ranges from 0.7 to 1.2 depending upon the
weather, the climate. When we talk about natural, I think the key natural thing to look at
is the level in mother's milk; babies' first meal. That level is up to 200 times less than
7
they add to the water. We add about 1 part per million. The level in mother's milk ranges
from 0.04 to 0.004 parts per million. So a bottle-fed baby can get up to 250 times more
fluoride than nature intended for the newborn baby or for a breastfed baby.
DM: There are a lot of reasons why infants shouldn't be receiving infant formula. Breast
milk is obviously the way to go and there are other alternatives to that. But this clearly is
a significant issue. I'm wondering if you know of any known benefit for fluoride. If it's in
breast milk, is it in there because it's required by the infant? Or is it in there because it's
a contaminant in the environment?
DC: It's out there so the fluoride fluorine is about the 13th most abundant element on
the planet, on the Earth's crust.
DM: Because aluminum we know, it was even more abundant. There is no medical or
health (inaudible 20:35). So it's a contaminant. Its a toxic waste. You want to avoid it. Is
that similar to fluoride?
DC: Yes. It's very, very low in mother's milk. There has been no evidence, no scientific
evidence has ever been brought forth to show that fluoride is an essential nutrient -
none. To demonstrate that something is an essential nutrient, you have to starve the
animal of this source. If it's a nutrient, then it develops a disease. There is no disease
that develops with a shortage of fluoride which is as you would have imagined is just as
well if its so low in mother's milk.
As far as tooth decay is concerned, this tooth decay is not caused by lack of fluoride.
Tooth decay is caused by acids in the mouth usually created from sugar being
metabolized by bacteria (Streptococcus mutans). It's the acid that then attacks the
enamel. If it attacks it enough then the bacteria could get into the dentine and you get
tooth decay. So it's not a disease caused by a lack of fluoride. It's a lack of dental care
particularly relevant in poor communities with poor access to dentists.
DM: You know lack of information and discernment to really cut through the media
manipulation and the nonsense because the number one source of calories in the
United States is high fructose corn syrup.
And when you have that sugar as your number one source of calories, you're going to
shift the terrain, the biological levels of different bacteria in your system and you're
going-to-produce-the-bad-bacteria-versus-the-gvod-bacteTia -thybacteria will
produce these acids. Because if you go to primitive cultures where they are avoiding
sugar, you just do not see dental caries. Even in whole countries where they tend to
have very low sugar like Korea. I mean, you try to find a cavity in a native Korean,
they're not just there. It's like 1 % of the population has cavities.
DC: You're absolutely right. We need education not fluoridation. That education would
have a double dividend avoiding the high fructose sugar. We'll not only score a huge
benefit with dental decay but also with obesity.
8
DM: And health.
DC: Yes. We have a huge problem here. When you got teenagers getting Type 2
diabetes, you think of the cost that's going to be. So fluoridation, if we had the political
will, is as easy to stop as turning off a tap and we could have this double dividend if we
use the money that we are squandering on chemicals and equipment to deliver this stuff
and all the tank and trucks which are going around the country and all the money that is
spent on propaganda, on promotion by the government, by the American Dental
Association. If we took that money and put into education to avoid what you talked
about, high fructose syrup and so on...
DM: And just optimizing your diet.
DC: And better dental care. I mean, brush your teeth after meals, all those things, floss
your teeth and so on.
DM: Well that's important but really when you go to these countries that are eating right
to begin with, they don't do those practices. It's really an artifact that needs to be
implemented when you're choosing unhealthy lifestyles.
DC: It's funny, there is an irony here. In the 1930's, Weston Price who was a former
president of the American Dental Association which pushes fluoridation, wrote a book
and established just what you said, that indigenous people around the world from the
Inuits to the aborigines, to the Maoris and so on, had perfect teeth until Western diets;
refined sugars and all those other things.
DM: Its actually from my understanding of his life work, around the turn of the 19th
century, 1900 to 2000 is when he was a practicing dentist. He saw this enormous
increase in dental decay and he made the correlation it was actually due to the
introduction of processed foods.
DC: Yeah, in the 30's.
DM: Then he went around the world to document this because there are many countries
at that time that had not been exposed to that type of food. The book is phenomenal
because it's just massively filled with this pictures that document that.
DC: As far as tooth decay is concerned and health generally, better diet. As far as this
issue is concerned, when you got 23 studies which shows a lowering of IQ and you
got...
DM: A lowering of IQ from being exposed to fluoridated water.
DC: We haven't had yet an IQ study because they're not doing them. The countries
which are fluoridated are not doing any (inaudible 25:21) of practically no health studies.
9
They are far more concerned about protecting this policy for some reason than
protecting health.
But when you've got levels of fluoride, natural levels of fluoride, not so much higher than
the levels at which we are fluoridating, it raises the question, which is more important to
protect; your children's teeth or children's brains? I mean, we got some pretty wonkey
evidence that ingesting fluoride maybe reducing tooth decay. I don't think the evidence
is very strong scientifically but you got two sets of evidence.
One set of evidence says the promoters think that fluoride lowers tooth decay if you
swallow the fluoride. You got this other set of evidence which from China and India and
so on which says, your children swallowing fluoride maybe lowering their intelligence.
Where are you going to hedge your bets here? What's the sensible thing to do?
DM: Well, the sensible thing is implement the precautionary principle and err on the side
of caution.
DC: If ever the precautionary principle should be applied, it must be in the case of
fluoridation. If you believe in the precautionary principle and incidentally, I think of San
Francisco which has actually incorporated the precautionary principle into its charter
what have you and yet, they've been fluoridating for years. There is a contradiction
here.
If you believe in the precautionary principle, then turn off that tap. It's not doing much
good. They concede, the promoters concede that topically, we have topical treatments
available including fluoridated toothpaste and we've got plenty of evidence
accumulating that fluoride at certain levels, definitely causing health effects and the
issue comes down to whether there is an adequate margin of safety. I will put my
scientific training on the line to say there is not an adequate margin of safety to protect
the whole population from known health effects. So, take it from there.
I
DM: Part of the problem is that there is individuals who may drink a few cups of water
but there is another set of individuals who may drink a gallon or two gallons and be
exposed to the amount of fluoride in that water supply at levels five times or greater so
that your margin of safety which you are referring to essentially disappears because
you're getting to toxic levels.
We're-just-talking-about-the-water-supply-which-is-really-wh-at-we-want- s on
because we absolutely are both incredibly convinced that this is a winnable battle. In
fact, there is no doubt in my mind we're going to win it but we can only win it with your
help. We'll tell you some specifics and repeat that again. But that's only one source of
fluoride.
Though most everyone watching this, who are educated, we know better, we're not
going to be drinking the municipal water supply that is fluoridated. We're going to have
reverse osmosis systems. We're going to have other bottled water sources. We're going
10
a
to be able to avoid it. But what we're really doing here is we're protecting the people
who don't have the resources. The low income families who can't afford those strategies;
and really who are suffering most of the impact of this tragic decision that was
implemented 50, 60 years ago.
DC: You know, back in November of 2006, the ADA actually sent around an eGram to
an alert to its membership recommending the parents to not use fluoridated tap water to
make up formula. They actually said that. And a few days later, the CDC followed suit.
Don't use fluoridated water to make up formula.
But what they didn't do, is they didn't inform the people, the public. So there are millions
of parents out there that are using tap water to make up formula oblivious of the fact
that the agencies that promote fluoridation in this country said don't use it for this
purpose.
How can you fluoridate tap water on the other hand and manage to educate all the
people to do this? How can low income families use bottled water for this purpose? So
the whole thing is absolutely bizarre. Just as you said, we need masses of people. Joe,
you can reach them more than I can masses of people to get informed upon this issue.
But also, in addition to that, we need scientists and we need doctors to read the
literature. I mean, they can understand it.
DM: You compiled a list of professionals, healthcare professionals and scientists who
I m one of them, who signed on the statement...
DC: Two thousand eight hundred.
DM: So if you have the credentials and the scientific training, we encourage you and
we'll put a link on this to address that so that you can sign on and we can increase that
to even a higher level.
DC: Also to make things easier after 14 years, I've actually written a book on this called
The Case Against Fluoride. It will be out in September. Two other scientists and myself
wrote this book to give you the whole information. And also journalists, I mean, you're
rare on this one. Would you call yourself a journalist? No, you're a communicator.
DM: I'm a physician journalist.
DC: We have too many journalists in this country that just take one liners out there and
think they've covered the issue. They'll say things like, "The Center for Disease Control
says that fluoridation is one of the top 10 public achievements of the 20th century."
And just take it at face value without realizing the Center for Disease Control only has
one division looking at this called the Oral Health Division. They're nearly all dentally
trained and their mission is to promote fluoridation. There is no other division that the
11
CDC which is looking at the health. This is not happening. So we need journalists to get
below the surface of this thing.
DM: We will do it. There is no question. This is not going to be the last time you see us
together. We're going to come up with a whole process. We're going to break these
issues down to a very specific point, to give you talking points so that you can
communicate intelligently to others and help educate them and increase the awareness
and consciousness.
We don't need to convince every person in this country. It's absolutely not the case. We
have to reach, as Malcolm Gladwell refers to is a tipping point. It may be as little as 5%
of the population. Once they understand that, once they get behind this, the policies will
change. They'll fall like dominoes.
DC: You know another issue which we haven't mentioned is thyroid function. Doctors
used to in the 30s, 40s and 50s in Europe, doctors used to use fluoride to lower thyroid
function off of patients with hyper overactive thyroid glands. So that's a real concern
especially today, we have millions of people with low thyroid function.
DM: Mostly women, for some reason seems to be particularly sensitive to this. I've seen
tens of thousands of patients. You know, it's a really common problem. If you're a
woman watching this and you think you have some low thyroid condition such as low
body temperature, lack of energy, dry skin, tendency towards constipation, not sweating
very well.
If these are symptoms that you have, you want to get a test called a TSH or a thyroid
stimulating hormone. If it's above 1.5 then you probably have something that needs to
be addressed then it becomes really mandatory to avoid fluoride into the (inaudible
32:47) but also other sources of fluoride. I wonder maybe we can touch on that now
because it's not just in your water folks, it's in other areas. Obviously fluoridated
toothpaste but the other areas would be the drugs you take.
You know a lot of the antidepressants and many of the antibiotics especially the
fluoroquinolones are just loaded with fluoride. As we believe some of them are so toxic.
These are really toxic drugs. The other source would be pesticides. So that's the
importance of eating organically. You know why they're in pesticides because they're
toxic. They kill organisms. It's not a mystery. Fluoride is a poison.
DC: One of the reasons why it's in toothpaste is they're acting as a pesticide to kill the
bacteria in the mouth.
DM: I thought the primary reason was to improve the bone density in some way but I
didn't realize that was a mechanism of action.
DC: One is to harden the enamel. That's the theory is the fluoride ion replaces the
hydroxide ion in the enamel. The other thing is that those high levels of 1000 parts per
12
million in toothpaste it will kill some of the bacteria. This argument is about whether
those bacteria now are sort of developed and so now they're immune to it.
Another issue, I don't know if you knew this Joe, there was a study done in England,
shows that fluoride accumulates in the human pineal gland that little gland between
the two hemispheres of the brain that makes melatonin.
What I find fascinating here is the way that protecting this policy is more important
apparently than protecting our health because even though that study was done in
England and was published in 2001, fluoride accumulates in the human pineal gland
and in her animal study she showed that it lowered melatonin in animals so that was
consistent with this. Not one single fluoridating country has attempted to reproduce that
study. Why not? It's not a difficult study to analyze the pineal gland of corpses in the few
fluoridated not doing it. Why not?
I find that shocking, I find personally as a scientist, the way science has been abused in
promoting fluoridation. With science, if you don't have truth, it is not science anymore.
It's something else, when you don't have science in forming public health policy, that's a
huge threat. That's as big a threat to our country I think as it is a threat to our health.
DM: It's a very serious issue. I recently interviewed MD PhD Beatrice Golomb who is
out at the University of California, a really high integrity physician. Really addresses well
in the drug model because you're right, the scientific method works, and no question.
The problem is it has become bastardized in this country because there is massive
conflict of interest which distorts the results. Its just you can't trust them anymore, they
become untrustworthy, unreliable.
She goes into all the different mechanisms or factors and variables how its penetrating
to the whole process from the actual peer-reviewed journals themselves, to accepting
them and reprints, and advisory committee. It's just a massive mess. What I want to say
is that we are firm believers in the scientific method because somebody who counters
what we're saying is saying that we've abandoned this. Nothing can be further from the
truth. It's nonsense. We believe the scientific method works. It just has to be free from
conflict of interest.
DC: We need two taps. We need to turn off the tap on fluoridation and we need to turn
on the tap of scientific integrity. Let's have scientific integrity back in our universities.
Back-into-our-research-and-back-into-informing-our-regulatoyry-a-genL es-That's one of
my missions. I hope that we can see some progress on that too. But we can begin with
stopping fluoridation.
DM: Yes. And the reason again, we're together is because we share a similar mission.
We are both convinced that we, with your help and only with your help are going to be
able to eliminate and I'm talking no fluoride in any municipal water supply in the U.S.
The strategy we're going to take because we need to be strategic about this is to first
13
address Canada because 60% of Canada is not fluoridated, 40% is. If we can get the
rest of Canada to become non-fluoridated, we believe the U.S. will follow.
We're also going to be addressing the two committees; Austin, Texas and San Diego,
California. So if you're in any of those areas, certainly let us know and we'll probably
have a link what would you recommend as a strategy on how they can participate, if
they are in Canada and they want to help or if they're in there in those local
communities of California and Texas.
DC: I think go to our web page to begin with. We keep people posted on that
www.FluorideAlert.org. They can contact you and contact me and we'll give them the
contacts.
DM: If any of these other communities that you think you've got some really strong
credible activist who are scientifically based and grounded and really can provide a
good support then let us know and we can provide resources to help support you in
your effort to eliminate fluoride from your local community because it really needs to be
a community battle. We're not going to pass a Federal Law. There is not going to be a
presidential mandate or even a State-wide elimination. It's really community by
community.
DC: Its politics which is interfering with science in this issue. It's a matter of political will
and you cannot change political will if you don't get the people. We must be going with
the people.
DM: And we folks, we've got the numbers. There are only a small number of people
who are confused about this. The more people that we can educate about the truth, the
more we can convince them, the more we're going to win this. So really it's about
scientific (inaudible 38:57). You could challenge anyone who is opposing you to just do
the research. Go in and evaluate the data. It's there. This was work commissioned by
the United States government objective third party and this conclusion they reached.
We're not making this up. There is hundreds if not thousands of references in this in the
scientific literature.
DC: You know Scientific America actually had an eight-page article on this in January of
2008. People go back to that Scientific American. In that article, they interviewed the
chairman of this report, Dr. John Dewel. He said how shocked they were that when they
went to-the-scientific-literature-how-little-science,-real-science-had-been-done that-th ere
were so many unresolved questions on health. He singled out in the interview, the
thyroid function. It really did concern him, the possibility that fluoride may be interfering
with the thyroid gland.
DM: Folks you got a lot of decision in your plate. Many people are going to think, "What
the heck, am I going to take up another cause for?" Well, you don't have to. If you're not
concerned about losing your front teeth and injuring the thyroid gland or your wife losing
it or your daughters or the intelligence of the whole population because it's being...
14
DC: Or brittle bones and hip fractures when you get old.
DM: Or brittle bones and developing osteoporosis then I would forget about it. But if you
are interested and you really have a passion to help people not only yourself because
you probably can avoid it but it's the people who don't have access to these tools, who
can afford reverse osmosis or whatever. I would strongly encourage you to take a step
because you can make a difference.
You absolutely can. We've seen it with the swine flu. We've seen it now with fructose
and major industry, actually removing some huge products like Gatorade and some
other massive products. So we can make a difference but you have to take action.
DC: You know, it took us seven and a half years for my wife and I and our friends to get
fluoride out of our little village of Canton, New York where I live. But, Joe, when we were
able to stop that, it was so great to actually take a glass and go to the tap and drink and
cook with our own tap water instead of using bottled water. It was great to go downtown
and go to restaurants and drink the water.
DM: I'm not sure which is more dangerous because you know, that doesn't mean the
tap water is safe because they chlorinate it and because any infections from the water
supply. The chlorine itself isn't dangerous but when it interacts with organics it produces
disinfection byproducts like trihalomethanes and (inaudible 41:44) acids. Those are the
dangers. But those are you can still filter those.
Fluoride is just a side point but an important one, is very difficult to filter from the water
supply. You are not going to remove it for the most part from most type of carbon filters.
You have to use a distiller or a reverse osmosis to get it out. Then it makes it easier for
you to drink from the tap with the simpler filter which is easier to access. So I don't want
to give to people just go drink your tap water because there are other issues with it.
DC: But we have pretty good water from where I am so once the fluoride was out there,
that was drinkable.
DM: But it is a major victory. There is no question. I don't want to take away from that.
DC: It's true that there are other chemicals added to the water but this is a huge
distinction-between-add rInk-by
killing bacteria and so on and adding a chemical to the water...
DM: A drug.
DC: A drug to the water to use the water as a vehicle to delivering a drug when as
we've said already, if you do that, then you can't control the dose. Ask any pharmacist
what's the key thing about drugs? Who do you give it to? Do you have a different dose
for babies from you do from older people? You've got physician supervision. All of this
15
goes out of the window when you put a drug in the water. You can't control the dose.
You can't control who gets it. You're going to have it for life. I mean, the whole is
preposterous. It really is.
i
DM: I love that word, preposterous.
i
DC: It is.
DM: It is its preposterous. 1 think this a pretty bit of the initial information. We're
j definitely going to have more. This is going to be an ongoing project and we're not going
f to stop until the fluoride is out of the United States' water supply. I'm absolutely
committed to that. I'm convinced as I said before that we can do it with your help. So we
really need your help. Let's do it.
DC: I think this is a beginning of a beautiful relationship.
DM: Alright, thanks we're excited.
16
1
A summation of:
The Case Against Water Fluoridation: how hazardous waste ended up in the drinking water,
and the bad science and powerful politics that keep it sere. (pp 372)
Authored by Dr. Paul Connett, PhD with James Beck, MD, PhD and H. S. Micklem, DPhil
Released October 2010 by Chelsea Green Press, White River Junction, Vermont
by Chris Copp, Vermont Citizens for Safe Water
The principal author, Paul Connett holds a PhD in chemistry from Dartmouth College. In
May of 2006 he retired from full professorship at St. Lawrence University in Canton, NY
were he specialized in chemistry and toxicology. He is currently the director of the Fluoride
Action Network, an international organization working to educate the public about the toxic
effects of fluoride and the absurdity of water fluoridation. Before Professor Connett began
reading the literature on fluoride, he accepted the prevailing American perception that people
opposed to fluoridation were scientifically ill informed. After fourteen years of reviewing
the primary literature his perception has dramatically changed. He has spoken before many
review boards, including the National Research Council. There are few if any in the world that
are as familiar with the debate over water fluoridation as Dr. Connett
While this book offers a new look at scientific information, it begins with the common
sense arguments that have long been ignored. Most simply, fluoridation violates a person's
right to refuse medication (1). Further, fluoridation and its promoters ignore people's need
for informed consent. Most people are completely unaware that fluoride is toxic or that
there are adverse health effects from ingesting it. While the chemical used to fluoridate,
hydrofluorosilicic acid, is untested and as such remains listed as an "unapproved new drug"
(7) it is distributed to some 180 million Americans daily.
Using the water supply to distribute fluoride is bad medical practice, because it offers no
ability to finely control who gets how much and no method to track effects (8). It does
to a population what a doctor cannot do to a single individual. It is important to have an
understanding of dose vs dosage. Proponents claim the 1 ppm dose used to fluoride is too
small to hurt anyone. This is misleading in that what is of concern is the total dosage, or
amount, one ingests daily divided by their body weight (10). Fluoridation fails to account for
factors as simple as people drinking above average amounts (thus receiving more fluoride) or
someone who is particularly sensitive like elderly kidney patients. The 2006 National Research
Council (NRC) report determined babies drinking formula constituted with fluoridated water
were receiving nearly twice the reference dose (.06 mg/kg/day) applied to adults (10). This
prompted the ADA and CDC to reverse its recommendation that babies consume fluoride, a
retraction neither has put much effort into making public.
2
Few dentists or local promoters of fluoridation are aware that in 1999 the CDC finally
conceded that the primary action of fluoride was topical rather than systemic, a fact that
alone should halt fluoridation (13). Nor are they aware that the chemical used to fluoridate
is actually classified as hazardous waste by the EPA (16). While proponents brush aside this
claim, it is in fact true. The waste can be traced back to water scrubbers on the smoke stacks
of Florida's phosphate fertilizer industry. A process used to keep these toxic chemicals out of
the air, has them ending up in the drinking water, untreated and unfiltered. Shipments come
with hazardous material. handling instructions and studies of acute toxicity, but nowhere
are there studies proving hydrofluorosilicic acid safe (19, 21). While many organizations
aggressively promote fluoridation none accept any responsibility for the safety of the
chemicals used or any liability resulting from injury (23).
Proponents claim that fluoride's ability to reduce decay was so soundly proved years ago that
there is no room for debate. However, a look at fluoridation's beginning reveals a willingness
to proceed without certainty and scientific clarity. Trials ran in several cities in the late
1940's and were cut short before any long term analysis was available. Amazingly, without
solid evidence the Public Health Service (PHS) endorsed fluoridation in 1950. No serious
monitoring of the program has taken place since, even though dental fluorosis, an outward
sign of fluoride overexposure, effects 41% of American children (11). With fluoride finding its
way into more and more products there is virtually no way to know how much a person might
be consuming. Also, no fluoridating country has made attempts to verify the results of studies
showing harm (29).
Evidence that fluoridation is ineffective has been, and continues to mount. Proponents quickly
point to falling decay rates in the United States without acknowledging this trend exists in
every western country fluoridated or not (39). However, strong relationships are known to
exist between decay rates and income levels, access to dental care, and diet (48).
The early studies of fluoride's effect on teeth were crude, and the method used to derive
the 'optimal" dose of 1 ppm was unscientific. New statistical analysis of Dean's famous
21 city study, which was used as a benchmark to begin fluoridation, shows no connection
between fluoride and tooth decay (49). Dr. Hubert Arnold, statistician remarks "the early
fluoridation trials are especially rich with fallacies, improper design, improper use of statistical
methods, omissions of contrary data and just plain muddleheadedness" (51). More modern
studies also cast doubt on the relationship between fluoridation and reduced tooth decay.
John Colquhoun, a New Zealand dental officer and enthusiastic supporter of fluoridation in
the 60's and 70's, reversed his position in 1980 after a tour of the worlds fluoridated and non
fluoridated cities showed no difference in decay rates (55). Another ten studies between 1982
and 2009 also show no statistical correlation between fluoridation and reduced tooth decay
3
(56-63). Two studies show that after the cessation of fluoridation, decay rates did not go up,
but continued to decline.
It is interesting that prior to the Public Health Service endorsement in 1950 fluoride was
widely considered a toxic substance bad for teeth and bones (68). Some of the first scientists
to speak against fluoridation were molecular biologists who used fluoride to sterilize their
cultures. In the 1930's fluoride was known to effect the thyroid and parathyroid glands and
increase bone fragility (72). An editorial in the journal for the American Medical Association
described fluoride's as "central protoplasmic poisons" (73). An editorial in the journal for the
American Dental Association had this to say, "drinking water containing as little as 1.2-3 ppm
fluoride will cause such developmental disturbances in bone as osteosclerosis" (76).
These initial concerns, some voiced by the very same organizations that now promote
fluoridation, were turned aside by a 1950 report by Gerald Cox and Harold Hodge. Cox, an
industrial scientist, promoted fluoridation while on the payroll of the aluminium industry of
which fluoride pollution was a major concern. Industrial interests like the aluminum and
sugar industry have been intimately involved with the funding of both promotion and study
of fluoride. Hodge, at the time of the 1950 report, was chief toxicologist for the Manhattan
Project which, like the aluminum industry, required huge amounts of fluoride (80). Much of
the early certainly of fluoridation's safety was based on his word (85). This industrial back
story is given full attention in Chris Bryson's authoritative work The Fluoride Deception (Seven
Stories Press, 2004). Simply said, these two men were working within huge conflicts of
interest to prove fluoride safe.
After the assurances from Hodge and Cox, and the endorsement from the PHS the
fluoridation program moved quickly from scientific exploration to promotion. Many
organizations were eager to put their stamp of approval on fluoridation without reviewing a
single study. The words of Dr. Frank Bull at a 1951 D.C. Conference, "we have already told
the public it works, we cannot go back on that. The question of toxicity ...lay off it altogether"
(88). In 1952 the case to fluoridate Kingston, NY relied heavily on endorsements rather than
science, while citing "overwhelming evidence" (89). Throughout the 1950's Hodge continued
to make claims of fluoride's effectiveness while also dismissing reports of harm (I02~105 ,
Yet, in 1963 he shockingly admitted "a large scale epidemiological study is lacking" (105).
There are several common sense arguments against fluoridation including. fluoridation
is unethical and poor medical practice, that the chemical used is an untested, untreated
industrial pollutant, or that the evidence supporting a connection between ingested fluoride
and reduced tooth decay is weak. However, the most compelling reason to cease fluoridating
is the risk that it is causing harm (107). Dental fluorosis, the white spotting and in more
4
severe cases pocking of teeth effects 41% of American children with 3-4% of those effected
experiencing moderate to severe conditions (110). While proponents claim fluorosis is simply
a cosmetic effect, it is rather a sign of fluoride overexposure. Also, the psychological effects
of a child dealing with a spotted smile should not be overlooked. Even early promoters saw
fluorosis as something of concern. In 1952 Dean stated, "we don't want any mild fluorosis,
we don't want to go that high" (111). If fluoride can negatively alter teeth, what effect is it
having on the other tissues of the body? With thousands of metabolic processes continually
happening throughout the body, fluoride's ability to act as an enzyme inhibitor, as well as a
disruptor of cellular communication, could effect ever system of the body (119). It has been
observed that many ill effects like headaches, stiffness and arthritis, as well as depression
have disappeared when people suffering these conditions stop drinking fluoridated water
(126).
The most comprehensive review of fluoride's effects on the body was released by the
National Research Council in 2006. It was the first government panel asked to review fluoride
that contained someone opposed to fluoridation (137). While the report did not directly
deal with fluoridation, it did include many kinds of studies and "any science that might shed
light on fluoride's toxic potential" (138). The panel did indicate that several subsets of the
population were at greater risk to fluoride's toxic effects, and that infants were exceeding
the EPA's reference dose for fluoride of .06 mg/kg/day. The ADA dismissed the 507 page
report with 1,100 references the same day it was released citing the 4 ppm limit investigated
was "much higher" than the 1 ppm used for fluoridation (141).
Proponents claim there are no ill effects posed by fluoridation. However, it is simply
unreasonable to think a compound as biologically active as fluoride would only effect the
teeth. Dr. Phyllis Mullenix's study showed fluorides ability to cause both hypo and hyper
activity in the thyroid (149). A report from Spittle in 1994 showed "chronic fluoride exposure
maybe associated with cerebral impairments" (149). Recently, 23 peer reviewed studies
from four non-fluoridating countries, studying levels as low as 0.9 and 1.9 ppm have shown
an association between fluoride and lowered IQ. A 1998 study from Varner, in which rats
were fed sodium fluoride and aluminum fluoride showed morphological changes in the
kidney and brain 151. Also, a study from Dartmouth College researcher Roaer-Masters
has shown fluoride's ability to increase the uptake of lead and aluminum into the brain. He
has speculated that the increasing levels of fluoride consumed by children is causing the
increased prevalence of ADD and ADHD. It also appears fluoride plays a role in the formation
of beta amyloid deposits usually associated with Alzheimer's (151).
The NRC report details fluoride's effects on the endocrine system. They wrote, "in humans,
effects on thyroid function were associated with fluoride levels of .05-.13 mg/kg/day." This
5
amount is achieved by children consuming as little as two glasses of water a day (161). The
report also acknowledged fluoride's effect on the pineal gland, "the single animal study of
pineal function indicates that fluoride exposure results in altered melatonin production and
altered timing of sexual maturity" (166).
The report goes on to detail fluoride's effects on bone. A study in Mexico found as dental
fluorosis increases so too do bone fractures (169). In 1988 the senior science editor for
Chemical and Engineering news said, "because clinical symptoms mimic arthritis, the first
two clinical phases of skeletal fluorosis could be easily misdiagnosed" (170). The panel also
drew the attention to the increased incidents of hip fractures in the US and other fluoridated
countries, namely Ireland. They stated flatly, "the safety standard of 4 ppm did not protect
bones" (179).
Half the fluoride ingested remains in the body concentrating mostly in bone. Because of
fluoride's ability to cause genetic damage and increase rates of cellular division bone cancer
is of particular concern. In 1975 Dr. Dean Burke and Dr. John Ylamouyiannis testified
before congress that cancer rates were higher in 10 fluoridated cities than non (182).
In 2001 researcher Elise Bassin reported a "robust finding" that young boys exposed to
fluoride between their 6th and 8th years had a five to seven fold increased risk of contracting
osteosarcoma, a rare and often fatal bone cancer, by the age of 25 (189). Beyond bone other
soft tissues are at risk. A Chinese study found kidney damage among children drinking water
with as little as 2.6 ppm (196).
Proponents, including the ADA, have dismissed studies showing harm by pointing out that
the concentrations observed were over 1 ppm. However, a typical margin of safety for a
substance intended for ingestion is a factor of ten. That is to say the upper limit of a dose
is set 10 times less than the level at which adverse health effects are seen. With lowered
IQ shown at as little as 1.9 and 0.9 ppm, thyroid impairment at 2.9 ppm, increased hip
fractures at 1.5 ppm and rates tripled at 4.3 ppm it is clear that 1 ppm does not provide
adequate safety margins (201), especially when varied amounts of water consumed, personal
sensitivity, and exposure from other sources are considered (207).
With information of fluoride's negative health effects mounting, at what point should
fluoridation be stopped? This question is considered in terms of the precautionary principle
by Joel Tickner and Melissa Coffin. They write, "if there is uncertainty yet credible scientific
evidence or concern of threats to health precautionary measures should be taken. In other
words, preventative action should be taken on early warnings even though the nature and
magnitude of risk are not fully understood" (212).
6
Fluoride's safety and effectiveness should also be questioned since nowhere in the sixty years
of fluoridation have randomized clinical trials been preformed (217). Because these necessary
studies are lacking the FDA has never approved fluoride or the chemicals used to fluoridate.
Dr. John Doull, chairman of the NRC committee said "we have much less information than we
should, considering how long this has been going on" (219).
This lack of information becomes apparent when promoters use endorsements rather
than science to justify fluoridation (227). Promoters further discredit themselves when
rather than engaging in debate resort to labeling those opposed to fluoridation as "health
terrorists", "poison mongers", and "anti-science messengers" (229). The willingness to avoid
scientific debate is spelled out to dentists by the ADA. They instruct, "individual dentists must
be convinced that they need not be familiar with scientific reports and field investigations
on fluoridation to be effective participants and the non-participation is overt neglect of
professional responsibility" (231). This overall disregard for scientific integrity can be seen
in an Trish review board's report on fluoridation. Of the 296 pages less than two dealt with
primary health studies (240).
So the question is how has fluoridation lasted this long? The author believes that the
organizations promoting fluoridation are trying to save face, prestige and credibility. Dr.
Hirzy, former EPA toxicologist has this to say, "putting this stuff in the water is a hazardous
waste management tool. It has nothing to do with dental health whatsoever. It has to do
with defending the reputations of people who have been promoting fluoridation for years
and years and now find themselves very far out on a limb and have nothing more to say
except safe and effective, safe and effective when in fact it is neither safe nor effective.
They are riding a tiger they can't get off" (261). While this book intentionally gives little time
to possible motivations they are mentioned. As discussed fluoride is required in a host of
industrial processes, including aluminum production, and is a pollutant of major concern.
Has fluoridation been offered as a way to disguise the potential harmful effects of fluoride?
Fluoridation, even tubes of toothpaste, have been used in court to defend industry against
litigation from injured workers or communities adversely effected. Again, this collusion of
industrial scientists and early promoters of fluoridation is meticulously revealed in Bryson's
book. One example of this lack of clarity between indust and science is shown with the
American Council on Health and Science's aggressive promotion of fluoridation while at
the same time receiving funds from Coca-Cola, Kellogg, General Mills, Pepsi Co, and the
Association of American Beverage Manufacturers (263). Also supporting fluoridation, The
American Sugar Research Foundation, whose stated goal is, "to find out how tooth decay
may be controlled effectively without restriction of sugar intake" (264) Fluoridation, and
fluoridated dental products have white-washed the public's perception of fluoride. Few
people are aware that fluoride is a leading environmental pollutant or have any idea that
7
fluoride is extremely toxic to the body. While this information is not required to soundly reject
fluoridation it provides a motive and reasons why proponents are so unwilling to engage in
debate or why fluoridating governments have refused to investigate possible harm.
Silicofluorides & Higher Blood Lead: Statement from Dr. Roger Masters Page 1 of 2
cx I iiyi iti;i i_);UUU LeaU.
,taternent from Dr. Roger Masters
Professor Roger D. Masters
Research Professor of Government & Nelson A. Rockefeller Professor Emeritus
President, Foundation for Neuroscience & Society
310 Gerry Hall - HB 6222
Dartmouth College, Hanover, NH.
Office telephone: 646-
F L U O R I D E Office FAX: (603) (603)646-0508 2153
A C T 1 0 N
NETWORK June 17, 2001
Home
•••....••••.••••••........I....••.•••• Silicofluorides and Higher Blood Lead
About FAN
Latest News At present, U.S. public water systems serving over 140 million people are fluoridated
' with 200,000 tons of commercial grade hydrofluosilicic acid (H2SiF6) and sodium
Water Fluoridation silicofluoride (Na2SiF6), together called "silicofluorides" (or "SiFs"). Data from
Health Effects numerous studies show that, taking economic, social and racial factors into account,
Database where silicofluorides are used, children absorb more lead from the environment, and
Sources of Flu
"""""""of.Flu"ori de ".d.e there are higher rates of diseases and behavioral problems associated with lead Exposure poisoning (including hyperactivity' substance abuse,
and violent crime).
Fluoride Pollution Although some early studies showed differences between sodium fluoride and sodium
Fluorine Pesticides silicofluoride, to this day the substitution of silicofluorides in public water treatment
facilities has never been subjected to appropriate animal or human testing. Recently,
Take Action! the Assistant Administrator of the EPA admitted to Congress that his agency had no
Contact Us data on SiF toxicity and the Chief of the Treatment Technology Evaluation Branch at
the National Risk Management Research Laboratory confirmed that the EPA has "no"
Donate data on the "health and behavioral effects of fluosilicic acid."
FAQs
Search: Despite claims of safety by oral health officials, laboratory research in Germany
revealed that silicofluorides do not dissociate completely and have important biological
Go effects. To follow up on this issue, we have compared children's blood lead levels in
communities using SiF treated water with communities using sodium fluoride or with
non-fluoridated water. In three separate samples, totalling over 400,000 children, SiF
treated municipal water is ALWAYS significantly associated with increased blood lead
levels in children.
This effect was evident in a -i of lead levels in 280,000 children
(see graph for children exposed to SiF from the Greater Boston water system, from
towns that add SiF locally, or from communities using sodium fluoride, and towns
without fluoridation). For the state of New York, data was available on venous blood
lead levels for 151,225 children in communities of 15,000 to 75,000. Controlling for
other factors associated with higher blood lead, silicofluorides were again significantly
associated with higher uptake of lead from the environment. For black children, who
are especially at risk for high blood lead, those in towns using SiF were less likely to
-have low blood lead and more-ikely_to havelea"ver 10pg/dL-To-confirm that these
results are not due to other socio-economic or demographic factors, additional
statistical tests were run.
The third study concerned children's blood lead levels in the National Health and
Nutrition Evaluation Survey (NHANES III), which had reports for 7224 children from 80
counties with populations over 500,000. Since only 4 of these counties had any
communities that used sodium fluoride, analysis of the NHANES III data focused on
the percentage of the entire county population exposed to silicofluoride treated water.
Among the 1543 children of all ages from large urban counties with over 80% of the
population exposed to fluoridation (almost all of whom receive water treated with SiF),
average blood lead was 5.12 pg/dL whereas the average for 1139 children in low
fluoride exposure counties was 3.64 pg/dL Blood lead in the 473 children sampled
from the medium fluoridation counties was 3.23 pg/dL, which was significantly different
http://www.fluorldealei-t.org/sf-masters.htm 2/19/2011
Silicofluorides & Higher Blood Lead: Statement from Dr. Roger Masters Page 2 of 2
from the high fluoridation counties but not from either low fluoridation counties or those
with unknown fluoridation status, where average blood lead levels were 3.16 pg/dL
(S.D. 2.83). Controlling for the Poverty, the effect of SiF use was highly significant (p
< ,0001). When the sample is divided by age and race, these findings provide six
separate samples in which SiF is associated with high blood lead (see Graphs).
In all three populations studied, those children in each racial category and each age
group who were highly likely to be exposed to silicofluorides differ strongly in levels of
blood lead from those not exposed. This conclusion was further checked by analyzing
available data for health and behavioral traits that have been associated with high
blood lead (such as violent crimes, cocaine use and asthma). In each case, those
exposed to silicofluoride treated water were more likely to have behavioral or health
problems that are more likely among those with high lead in their bodies.
The injection of silicofluorides in public water supplies is a practice whose elimination
could possibly contribute to reduced rates of learning disabilities, substance abuse,
violent crime, and asthma (all connected with lead poisoning and other toxins).
Whatever the benefits to teeth (and this is highly controversial), our research shows
that the issues facing the public concern silicofluoride chemistry, toxicology, and the
linkage of neurotoxins with behavior or health. Before SiF chemicals are used, citizens
must know that they are safe for all,
For more information, see: ht //www darlmouth.adu1 n~asters/ahabs.htm. (Note:
from this site, that one can download an English translation of Westendorfs studies of
silicofluorides, which have not hitherto been available in the U.S.)
Fluoride Action Network 1802-338-5577 info fluorideaiert. r
http://www.fluoridealert.org/sf-masters.htni 2/19/2011
This Information
is provided for For 24 Hour
your protection Em~rg~ncy
by: Assistance LCI LTD Cali:
TO rLUCK1011r6CIAL13T3
CfiMTR
JE
904-241-1200
800-424-9300
xr cti oil
,~>t~sbr7bntian s~,
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NFPA Ratings (Scale 0-4)
~,.~:>>=.smu: Health=3; Fire=O; Reactivity=1
MATERIAL SAFETY DATA SHEET
This information is provided for your protection by:
LCI,Ltd.
P. O. Box 49000
Jacksonville Beach, FL 32240-9000
904-241-1200
24 Hour Emergency Assistance:
Chemtrec: 1-800-424-9300
Fluorosilicic Acid
Section I Product Name and Description
Section II Personal Protection Information
Section III Health Information
Section IV Emergency and First Aid Procedures
Section V Ingredients
Section VI Physical Data
Section VII Reactivity
Section VIII Fire and Explosion Hazards
Section IX Storage and Special Precautions
Section X Transportation Requirements
Section XI Emergency Action - Spill or Leak
Section 1
PRODUCT NAME AND DESCRIPTION
i
DOT Chemical Name: Fluorosilicic Acid
Hydrofluosilicie Acid,
Synonyms: Fluosilicic Acid,
Hexafluosilicic Acid
Chemical Family: Inorganic Acid Formula: H2SiFb
CAS Number: 16961-83-4 NIOSH Number: V V 8225000
Note: NIA indicates Not Applicable where shown.
Section 11
PERSONAL. PROTECTION INFORMATION
Respiratory Protection: A NIOSH approved cartridge respirator with full-face
shield. Chemical cartridge should provide protection against acid fumes (Hydrogen
Fluoride). For concentrations greater than 20ppm, a NIOSH approved self-contained
breathing apparatus with full-face shield should be used.
Eye and Face Protection: Use tight-fitting chemical splash goggles and a full-face
shield, 8 inch minimum. Contact lenses should not be worn.
Hand, Arm and Body Protection: Prevent contact with skin by use of acid-proof
clothing, gloves and shoes. Use a NIOSH approved acid proof suit and boots where
Itgafid-or-hightrat' s possible.
Other,Protective Clothing and Equipment: Eye wash and emergency shower
facilities should be available in handling area.
Engineering Controls: General or local exhaust systems sufficient to maintain
vapors below
2.5 mg/m3 (as F).
ti
Section III
HEALTH INFORMATION
OSHA Permissible Exposure Limit (PEL): 2.5mg/m3(as F)
ACGIH Threshold Limit Value (TLV): 2.5mg/m3(as F)
Listing in the following:
Department of Transportation Hazardous Material Regulations (49CFR)
Massachusetts Hazardous Substance List
toxic Substances Control Act Inventory of toxic Substances (TSCA)
OSHA Health Hazard Classification: Corrosive
Primary Route(s) of Entry: Eye and skin contact, inhalation
Symptoms of Exposure:
Acute: Liquid or vapors can cause severe irritation and burns which may not be
apparent for hours. Can cause severe irritation to the lungs, nose and throat if
swallowed, can cause severe damage to throat and stomach.
Chronic: Prolonged exposure could result in bone changes, corrosive effect on
mucous membranes including'ulceration of nose, throat and bronchial tubes, cough,
shock, pulmonary edema, Fluorosis, coma and death.
Aggravated Medical Condition: Any skin condition and/or pre-existing respiratory
disease including asthma and emphysema.
Toxic Data: LD50200 mg/kg (Oral - Guinea Pig)
Section IV
EMERGENCY AND FIRST AID PROCEDURES
Inhalation: Remove exposed person to an uncontaminated area immediately. If
breathing has stopped, start artificial respiration at once. Oxygen should be provided
for an exposed person having difficulty breathing (but only by an authorized person)
until exposed person is able to breathe easily by themselves. Exposed person
should be examined by a physician.
Eye Contact: Flush eyes for at least 95 minutes with large amounts of water.
Eyelids should be held apart during the flushing to insure contact of water with all
irritating odor can be detected, workers are being over-exposed. Eye wash and
safety shower should be available in all acid handling areas.
Section X
TRANSPORTATION REQUIREMENTS
DOT Proper Shipping Name: Fluorosilicic Acid Packing Group: 11
DOT Hazard Class: 8 (Corrosive) Subsidiary Hazard Class: N/A
Identification Number: UN 1778 Placarding Requirement: Corrosive
EPA Hazardous Substance: No Reportable Quantity: N/A
RCRA Status of Unused Material if Discarded: Not Listed
Waste Disposal Method: Disposer must comply with federal, state and local
disposal or discharge laws.
Additional Comments: For International transportation, Fluorosilicic Acid is
regulated by the International Maritime Organization (IMO) and the International Air
Transport Association (IATA) for vessel and air movement as a Class 8. Packaging,
marking, labelling and shipping paper descriptions must precisely reflect the
regulation for export movement.
Section Xi
EMERGENCY ACTION - SPILL OR LEAK
Emergency Action: Keep unnecessary people away. Stay upwind, keep out of low
areas. Isolate hazard area and deny entry. We recommend that the user establish a
spill prevention, control and countermeasure plan. This plan should include
procedures for proper storage as well as containment and clean-up of spills and
leaks. The procedures should conform to safe practices and provide for proper
recovery and disposal in accordance with federal, state and local regulation. Contact
Chemtrec at 1-800-424-9300 for 24-hour emergency assistance.
Small Spills: Any personnel in area should wear a NIOSH approved air supplied
acid suit. Dike area to contain material. Do not allow solution toe enter sewers-ar
surface water. Neutralize the spill with water and lime (hydrated lime). Take up with
sand or non-combustible absorbent material and place in containers for later
disposal. Provide ventilation and be wary of hydrogen generation upon reaction with
some metals. Contact Chemtrec at 1-800-424-9300 for 24-hour emergency
assistance.
Large Spills: Contact Chemtrec at 1-800-424-9300 for 24-hour emergency
assistance. Any personnel in area should wear a NIOSH approved air supplied acid
suit. Dike area ahead of spill to contain material. Do not allow solution to enter
accessible tissue of the eyes and lids. Medical attention should be given as soon as
possible.
Skin Contact: Exposed person should be removed to an uncontaminated area and
subjected immediately to a drenching shower of water for a minimum of 15 to 20
minutes. Remove all contaminated clothing while under shower. Medical attention
should be given as soon as possible for all burns, regardless of how minor they
seem.
Ingestion: If conscious, give the exposed person large quantities of water
immediately to dilute the acid. Do NOT induce vomiting. Milk may be given for its
soothing effect. A physician should be contacted immediately.
Note to Physician: Beware of late onset of pulmonary edema for up to 48 hours.
Treat severe burns similar to Hydrofluoric Acid exposure.
Section V
INGREDIENTS
Composition. Percentage
H2SiF6 25.0+/-2%
H2O - 75.0 2%
Section VI
PHYSICAL DATA
Freezing Point: 4°F(-15.5°C)
Boiling Point: 222°F (105°C)
Specific Gravity(Hz0-1): 1.234 cr 25% Vapor Pressure(mm Hg): 24 @ 77° F
Percent Volatile by Volume. NIA Vapor Density (Air=1): N/A
Solubility in Water: Complete Evaporation Rate: N/A
Physical State: Fuming Liquid Molecular Weight: 144.08 _
Bulls Density: 0.29 s ga @ 25° o pH 1° o Solution): 1.2
Appearance and Odor: Water white to straw yellow,burning liquid,with pungent
odor
Section VII
REACTIVITY
a
Stability: Stable.
Hazardous Polymerization: Will not occur. .
Conditions and Materials to Avoid: Metal, glass, stoneware, alkali and strong
concentrated acids.
Hazardous Decomposition Products: When heated to decomposition (222°F) it
emits highly toxic and corrosive fumes of Hydrogen Fluoride, Silicon Tetra-fluoride
and Hydrogen Gas.
Section V1II
FIRE AND EXPLOSION HAZARDS
Flash Point and Method Used: N/A
Flammable Limits - % Volume in Air: Lower NIA Upper NIA
Extinguishing Media: Use agent which is appropriate for surrounding fire.
Special Fire Fighting Procedures and Precautions: Wear NIOSH approved self-
contained acid suits.
Auto Ignition Temperature: NIA
Unusual Fire and Explosion Hazards: Reacts with many metals to produce
flammable and explosive hydrogen gas. Keep container cool with water, using fog
nozzles, as decomposition will occur above
222°F and produce toxic and corrosive fumes of fluoride.
Section IX
STORAGE AND SPECIAL PRECAUTIONS
Hand ling-and-Storing-P-r-ecautionsrSto- re-in-containerz-in-cool; dr-y; well ventilated -
area away from sources of heat or ignition. Do NOT store in glass or stoneware. Use
non-sparking tools. Keep separate from alkali metals, oxidizing agent, combustible
solids and organic peroxides.
Ventilation: Provide adequate general andlor local exhaust to maintain vapors
below 2.5 mglm3 (as F).
Other Precautions: Do not inhale fumes and prevent skin contact. If pungent,
sewers or surface water. Neutralize the spill with wafter and lime (hydrated lime).
Provide ventilation and be wary of hydrogen generation upon reaction with some
metals. Notify the National Response Center, if required.
DISCLAIMER
The information presented herein is based on data considered to be accurate and that reflects the requirements
of the OSHA Hazard Communication Standards in effect as of the date of preparation of this Material Safety
Data Sheet. However, no warranty or representation, express or implied, is made as to the accuracy or
completeness of the foregoing data and safety information. In addition, no responsibility can be assumed by
vendor for any damage or injury resulting from abnormal use, from any failure to adhere to recommended
practices, or from any hazards inherent in the nature of the product.
i
I '
i
I
f
How Toxic is Fluoride compared to Lead &
Arsenic.
EPA Maximum
Relative Toxicity Contaminant Levels
6 4000
5= Extremely Toxic - 3500
5
4= Ve Toxic 3000
4
2500
3 2000
2 1500
1000
1 500
0 _ 0
Lead Fluoride Arsenic Lead Fluoride Arsenic
Source: Clinical Toxicology of Commercial ppb (Parts per Billion)
Products LD50 data - 1984
v. _ - SENE33 Oak Ridge Inc. and Emr1mnmenti! scioncoar
ENE' Center for Risk Analysis Cusfnno ndVr~~<~,.onsfnHumanHc.~l:
rind ,j
F. Owon Hoffman, Ph.D., Pfasidant
May 2, 2006
Daniel G. Stockin, MPH
Senior Operations Officer
The Lillie Center, Inc.
P.O. Box 1951
Brentwood, TN 37024
Dear Mr. Stockin,
Thank you for your interest in (lie recent National Research Council report on the toxicology of
fluoride; as you know, I had the privilege of serving on the committee that prepared this report.
As a resident of Tennessee for 25 years, 1 appreciate your concern regarding the significance of
the NRC report for water districts in Tennessee that are evaluating the safety and desirability of
starting or continuing water fluoridation.
/ks you are aware, the NRC report did not evaluate the safety or benefits of water fluoridation,
%N,hich were outside the scope of our committee's assignment. However, we also did not say that
ilic practice of fluoridation is safe or that fluoride concentrations in water of 0.7-1.2 mg/L are
safe-we did not evaluate that. We did specifically address the safety of the Maximum
Contaminant Level Goal (MCLG) of 4 ing/L, and we concluded, unanimously, that the MCLG is
not protective of human health. We said that the MCLG should be lowered, but we did not
cicrive or stiogest a new value for the MCLG.
t)ur conclusiuri that the MUG of 4 nng/L is not protective was based largely on health effects
that have long been considered specific to fluoride and significant enough to warrant protection,
namely dental fluorosis and skeletal fluorosis. We parted ways with previous reviews of fluoride
by saying that severe dental fluorosis is an adverse health effect, not merely a cosmetic effect,
that stage II as well as stage III skeletal fluorosis is an adverse health effect, and that a fluoride
concentration of 4 nng/L is likely not protective with respect to an increased risk of bane fracture.
We indicated that at 2 or 4 mg/L, bone fluoride concentrations can reach the ranges historically
associated with-stage R a►uL [IL wtre4uA-able-to-rule out a carcinogenic
effect of fluoride. We reported that fluoride exposure is plausibly associated with a number of
ether health effects, including neurotoxicity, gastrointestinal problems, and endocrine problems,
and that even though these effects are not necessarily specific to fluoride exposure, the
associations cannot be ruled out and need further study.
l'or dental fluorosis, skeletal fluorosis, and risk of bone fracture, the committee considered
studies in which populations were exposed to concentrations of fluoride in drinking water of
111,0uind 4 mg/L; because there were sufficient studies at the exposure level of interest, we did not
lit?(iuuu'~ Uu:U-'.:ItuAl. i❑ii!-:,_.~ :;iW-"O • I'd 1:4'1.10: Seiiesar>-:senescom
examine the whole range of possible fluoride exposures. from those studies we concluded that 4
mg/l, is not protective of those effects; only when the fluoride concentration in water is below 2
mg/L does the prevalence of severe dental fluorosis approach zero. For some of the other health
effects mentioned above, the committee examined studies over a wider range of exposures,
depending on what information was available. Some of those studies do include exposure levels
that would be associated with water fluoride concentrations of around 1 ing/L. The committee
also provided a very thorough analysis of overall fluoride exposures in the U.S., which are
largely driven by drinking water and beverages made with tap water. We identified population
subgroups who are at higher risk than usual of problems due to fluoride exposure, due to factors
such as very high water consumption rates or increased retention of fluoride in the body.
1 personally feel that the NRC report is relevant to many aspects of the water fluoridation debate,
even though the committee did not directly address water fluoridation, in terms of either risks or
benefits. For instance, the report discusses the wide range of drinking water intake among
members of the population, which means that groups with different fluoride concentrations in
their drinking water ma), still have overlapping distributions of individual fluoride exposure. In
other words, the range of individual fluoride exposures at 1 mg/L will overlap the range of
individual exposures at 2 mg/L or even 4 mg/L. Thus, even without consideration of differences
in individual susceptibility to various effects, tite margin of safety between 1 and 4 mg/L is very
low. The report also discusses a number of health effects plausibly associated with fluoride
exposure that should be considered in any future risk assessment for fluoride, besides the effects
that have historically been attributed to fluoride. Several issues pertaining to use of
silicofluorides in municipal water are brought up, although it was outside the committee's scope
to address them in detail. Decent information provided on the relationship between outdoor
temperatures and drinking water consumption suggests that the historical guidelines for setting
water fluoride levels should be revisited. The report attempts to draw together much of what is
known about the effects of fluoride exposure on human health and to identify the sizeable areas
that are still not fully understood, for example, the molecular mechanisms by which fluoride
exerts its effects.
I encourage you to read the report yourself, and to encourage your contacts at the various water
districts to read it. 1 hope that you and your contacts will feel free to call me or send me an e-
niail if I can he cif any further help to you.
Sincerely,
Kathleen M. Thiessen, Ph.D.
Senior Scientist
(865) 483-6111
kmt a sencs.com
I
- rreu. -a r.wr sw•rir• r~n `tg
AFGE N fMGE
i ~
I
I
Coalition of U.S. Environmental Protection Agency Unions
August 5, 2005
RE: Bone Cancer-Fluoridation Cover-Up
Hon. Daniel Inouye, Ranking Member
Committee on Science and Transportation
560 Dirksen Senate Office Building
Washington, D.C. 20510-6125
Dear Senator Inouye:
Our unions represent a substantial portion of the nation-wide workforce at the
U.S. Environmental Protection Agency, and we are writing to ask for a moratorium on
the national program of the U.S. Public Health Service to fluoridate all of America's
public water supplies.
One us us (Dr. Hirzy, of NTEU Chapter 280) testified before the Subcommittee
on Wildlife, Fisheries and Water of the Senate on June 29, 2000 on this subject on behalf
of his headquarters union. At that time the union called for a moratorium based on
science indicating a number of adverse health effects and out-of-control, excessive
exposures to fluoride.
We now join NTEU Chapter 280 in renewing the call for a moratorium, based on
startling and disturbing new information that confirms the worst fears expressed in the
earlier testimony.
Work done at Harvard College's School of Dental Medicine by Dr. Elise Bassin,
which has been hidden since 2001, shows that pre-adolescent boys who drink fluoridated
water are at a seven-fold increased risk of osteosarcoma, an often fatal bone cancer. We
ask that the moratorium take effect immediately and remain in place until a full hearing
by the Congress on the wisdom of continuing the practice is concluded. The last such
hearing was in 1978.
Dr. Bassin's work, done as her doctoral thesis, was completed and accepted by
Harvard in partial fulfillment of the requirements for her Ph.D. in 2001. It is a landmark
investigation of age-specific exposure of young people in a case-control epidemiology
study of the incidence of osteosarcoma. The thesis remained sequestered until 2004,
when her research adviser, Chester Douglass, inexplicably reported to the funding
agency, the National Institute of Environmental Health Sciences, that no connection was
found between fluoride and osteosarcoma. This discrepancy between Chester Douglass'
written report and the actual findings of the funded study is under investigation by several
entities, and we believe should be looked into by the Congress as well. It appears to be
yet another instance of federally funded science gone awry to protect special interests.
Chester Douglass edits Colgate Company's Oral Health Report.
Chapter three of Dr. Bassin's work (enclosed) cites the impressive weight of
convergent evidence for the carcinogenicity of fluoride in young boys (but not girls):
fluoride is a mitogen, increasing the rate of cell division; it has been shown to be
mutagenic, damaging chromosomal structure; it accumulates primarily in bone, site of the
cancer; several previous epidemiology studies have found heretofore unexplained
increases in osteosarcoma in young men (but not young women); a National Toxicology
Program animal study found statistically significant increases in osteosarcomas in male
(but not female) rats. And she discusses why several other epidemiology studies found no
association between fluoridation and osteosarcoma; principally, those studies did not
consider age-specific exposures and development of the cancer.
It is simply unconscionable that her federally funded work was hidden for four
years while millions of young boys continued to be exposed to increased risk of this
disease, whose best outcome involves amputation. Several federal statutes express
Congressional intent regarding timely warning about such risks. These include, for
example, the Toxic Substances Control Act, section 8(e) and the Federal Insecticide,
Fungicide and Rodenticide Act section 6(a)(2). We believe another area for
Congressional investigation is: who knew about the results of Dr. Bassin's work besides
herself and Chester Douglass? and was any federal statute violated by keeping those
results hidden for four years?
j Another reason for a Congressional review of fluoridation is the recent work of
Dr: Richard-Maus-of the~nvir-onmental-Quality-Institute; University of N-on1T-Carolma-
Ashville, which shows that use of chloramine disinfectant and silicofluoride fluoridating
agents with excess ammonia increases lead concentrations in public water supplies. This
may explain at least some of the increased lead levels seen in the District of Columbia's
water supplies and in the blood of children drinking water fluoridated with
silicofluorides. The Centers for Disease Control and Prevention says that ninety four
percent of fluoridated water systems use silicofluorides.
Dr. Hirzy is available to meet with your staff to pursue this matter, and we hope
that you will find it of sufficient concern to initiate a full investigation of fluoridation,
which we believe is long overdue.
I
I
Sincerely,
I
Dwight A. Welch, President J. William Hirzy, Vice-President
NTEU Chapter 280 NTEU Chapter 280
3 EPA Headquarters EPA headquarters
/s/Steve Shapiro, President /s/Paul Sacker, President
AFGE local 3331 AFGE Local 3911
EPA Headquarters Region 2 Office, New York
/s/Larry Penley. President /s/Nancy Barron, President
NTEU Chapter 279 NAGE Local R5-55
EPA Cincinnati Laboratory Region 4 Office, Atlanta
/s/Wendell Smith, President /s/Patrick Chan, President
ESC/IFPTE Local 20 NTEU Chapter 295
Region 9 Office, San Francisco Region 9 Office, San. Francisco
/s/Henry Burrell, President /s/Alan Hollis, President
AFGE Local 3428 AFGE Local 3611
Region 1 Office, Boston Region 3 Office, Philadelphia
/s/Frank Beck, President /s/Mark Coryell, President
' 'GE-hoe
Ada Laboratory Aim Arbor laboratory
cc: Hon, Stephen L. Johnson, Administrator
U.S. Environmental Protection Agency
NEWS RELEASE
Fluoridegate: Fluoride Spots On Teeth the Tip of the Iceberg
Calls for Investigation Accelerate as Documents, Conflict of Interest Questions Emerge
Decades of assurances that consuming fluoride in drinking water is a safe and an effective way to prevent cavities are
being called into question as a jarring Fluoridegate controversy erupts across the nation.
A series of disclosures are surfacing about the actions of water fluoridation promoters that point to a likely tsunami of
Fluoridegate investigations, hearings, and explosive courtroom entanglements.
Tennessee state legislator Frank Niceley states, "There is a real Fluoridegate scandal here. Citizens haven't been told
about harm from fluorides, and this needs to be investigated by the authorities and the media."
Washington D.C. toxic tort attorney Chris Nidel says, "I think when we look back we'll ask why Fluoridegate didn't surface
earlier. There are serious concerns about possible conflict of interest and heavy editing of information being fed to the
public about fluoride risks and impacts."
On January 7, 2011 officials at the U.S. Dept. of Health and Human Services recommended lowering the amount of
fluoride in drinking water.
Health officials stated that their recommendation was simply a fine-tuning of fluoride levels to prevent a largely
unnoticeable teeth staining called "dental fluorosis." But information now being shown to law firms, legislators,
and investigative journalists affirms that the tooth staining is often disfiguring, that fluorides pose multiple other risks, and
that questions about conflict of interest, undue influence and improper actions warrant investigation.
Americans are surprised to learn that the Centers for Disease Control's Oral Health Division is in charge of making
assessments and statements for CDC about outside-the-mouth fluoride safety and research.
The apparent conflict of interest is drawing fire from several angles.
"This is clearly the fox guarding the henhouse," states Daniel G. Stockin about the CDC. Stockin is a career public health
professional and former manager of the EPA Western Regional Lead Training Center. He works at The Lillie Center,
a small firm in Georgia known for its efforts toward ending fluoridation.
"A number of groups, law firms, and journalists now want the names and job descriptions of persons inside CDC, both
now and previously, that have been responsible for CDC's promotion of water fluoridation," Stockin says.
Other key issues are surfacing: Was improper influence by dental groups the reason CDC did not issue a press release
four years ago about risks related to baby formula and fluoride? At the time, CDC quietly admitted on a little-noticed web
page that because of possible dental fluorosis, parents may want to mix infant milk formula with unfluoridated water.
The Gerber baby products company now sells an unfluoridated water so parents of babies can avoid using fluoridated
water for mixing milk formula.
Additional explosive questions offer to ignite investigative hearings. Why did CDC not openly share with the black
community CDC's own data showing black Americans to be disproportionately harmed by the worst forms of dental
fluorosis? Who is to pay for expensive teeth repair for persons unwilling to live with disfiguring dental fluorosis?
In a 2010 letter the President of the 5,000-member Coalition of African American pastors voiced his opposition to
fluoridation, citing concern about higher amounts of fluorosis in black citizens.
The Fluoridegate developments also threaten to embroil private sector organizations.
Stockin says law firms are investigating legal strategies for personal injury, failure to warn, negligent misrepresentation,
consumer fraud, environmental justice harm, and medical malpractice.
"Actions against private sector groups will bring public sector fluoride proponents to the witness stand, for the first
time exposing the relationships and communications between government fluoridation promoters and private sector
groups," Stockin says.
"This will expose the fluoride money trail and tell Americans about kidney risks, thyroid issues, and dental fluorosis," he
adds.
The National Kidney Foundation quietly withdrew its endorsement of fluoridation in 2008 and did not put up a visible link to
its new statement on its website or issue a press release to alert its members.
NKF is a recipient of grant funding from the Centers for Disease Control.
In 2006 a National Academy of Sciences report designated kidney patients, diabetics, infants, and seniors as "susceptible
subpopulations" that are particularly vulnerable to harm from ingested fluorides.
A 1999 statement about fluoride supplements in the journal Community Dentistry and Oral Epidemiology predicted
fluoride trouble ahead:
"It is only a matter of time until a case is brought that gets public attention. The risk is that noticeable fluorosis will be
perceived by the public as a toxic consequence of fluoride ingestion which, arguably, it is and there will be a reaction
against all uses of fluoride..."
Laura Seydel, well known Atlanta environmental activist and daughter of CNN founder Ted Turner says, "As a parent
and citizen, I am outraged of what hasn't been told to Americans about potential harm from fluorides to susceptible
groups."
"I call on our political leaders to hold Fluoridegate hearings to investigate CDC and other groups that have not openly .
shared vital information about fluorides with Americans," Seydel says.
"The world is not flat, and fluoridation is not safe," Stockin concludes.
Reference Links / Sources:
Toxic tort law firm with fluoride questionnaire: http://www.nidellaw.com/Forms/Fluoride/FluorideForm.html
Gerber@ Pure TM water info (unfluoridated water for mixing milk formula):
17ttp:llwww.cerber.com/allstactes/productslbeverages/gerber pure water.aspx
Photos of dental fluorosis: http./Iwww_SotsOnMyTeeth.ccornMedia story about National Kidney Foundation withdrawing support for fluoridation:
htlpllwww.reuters.com/article/pressRelease/idUS1 23736+09-Jun-2008+PRN20080609
NAS: Kidney patients and others as fluoride-susceptible groups - see p. 351
http://www.nap.edu/openbool<.php?record id=11571&page=351
Fluoride health effects database and professionals petition to end fluoridation: http://www.fluoridealert.org,
CDC's now-revised statement on fluoridated water in formula (updated since originally published):
http.L/wLvDL.cdSgoy/fluoijidation/safQt_yiLnfant formula.htm
Disproportionate moderate/severe fluorosis harm to blacks (79% higher than whites, see Table 23):
htti)-//www.cdc.gov/m mwr/preview/mmwrhtm l/ss5403al .htm
Cited quotation re: fluoride supplements: Community Dentistry and Oral Epidemiology 1999; 27:72-83.
National Center for Health Statistics dental fluorosis data brief:
htta://www. cdc.gov/nchs/data/databriefs/db53. htm
NEWS RELEASE CONTACT:
Daniel-G. Stoekin-MPH
The Lillie Center, Inc. P.O. Box 839 Ellijay GA 30540
Ph: 706-669-0786 email: stacking & ahoc .com or dan thelilliecenter.com
web: http;/lwwgtsOnMeeth,com
PRESS RELEASE For Immediate Release
January 21, 2011 Contact:
Willliam Owens
901-679-5286
901-785-5279 (fax)
william.owons bellsoutq,0et
Black Pastors Association Leader Calls for Fluoridegate
Investigations
Cites Disproportionate Fluoride Risks for African Americans, Lack of Info Given to Black Leaders
Memphis, TN: Rev. William Owens, President of the Coalition of African American Pastors, is joining a growing
chonis of leaders calling for federal and state hearings and investigations into new revelations about risks from drinking
fluoridated water.
Owens wants to know why important fluoride information wasn't shared with African American leaders and citizens,
and is especially concerned about fluoride impacts on poor and inner city-families.
"There are so many issues that need to be addressed in Fluoridegate investigations," he states. "This is very disturbing."
"Why wasn't the black community told that blacks are disproportionately impacted by harm from fluorides and
fluoridated water? Nobody told me until I learned about this a year ago. African Americans have more kidney disease
and more diabetes, but nobody elected to tell us that kidney patients and diabetics are more susceptible to harm from
ingested fluorides."
In 2006 the National Research Council published a report that listed diabetics, kidney patients, babies and children,
seniors, and outdoor workers as "susceptible subpopulations" that are especially vulnerable to harm from fluorides.
Owens also wants to know why the Centers for Disease_Oontro]_didn_t_isaue-a-pr_essxeleaae.whem.it-changed-ita-staur,-e
about mixing baby formula with fluoridated water after the NRC report was issued.
Shortly after the NRC report was published the CDC posted deep inside its website a statement about children
potentially developing permanent staining of teeth called "dental fluorosis" if fluoridated water is used to mix baby
formula.
"Do you know how many millions of moms and dads are going to their kitchen sink every day to get water for baby
formula? This affects a lot of people. Why no press release?" he asks.
"What are poor families to do if they can't afford unfluoridated water? How are they to learn the information about
fluorosis? How are they to pay to repair the stains on their teeth?"
"What about the kidney risks and concerns about 10 impacts?" he continues. "Does the Center for Disease ContmUeaUy
think that fluorides miraculously only affect teeth in the mouth and don't impact the rest of the body?"
Owens is an outspoken advocate for assisting children in their education and is concerned about reports of IQ impacts
from children ingesting fluorides.
A recent study published in Environmental Health Perspectives, a publication of the National Institute for
Environmental Health Sciences, documented-diminished IQ in children from fluorides in water.
In 2009 a study in the Journal of Public Health Dentistry noted that black children ingest significantly more fluorides
than white children.
The 2006 NRC report included a statement that, "More research is needed to clarify fluoride's biochemical effects on the
brain."
CDC's Morbidity and Mortality Weekly Report published data in 2005 showing that blacks have significantly more of
the worst forms of dental fluorosis than whites. Owens wants to know why African Americans leaders weren't openly
given this and other important information.
The U.S. Department of Health and Human Services proposed somewhat reducing the level of fluoride in water in a
statement on January 7, 2011.
The HHS actions don't go far enough, according to Rev. Owens, citing the issue that some people drink dramatically
more water than others, have medical susceptibilities to fluorides, and have numerous other uncontrolled sources of
fluoride in their diet.
"We need to investigate this Fluoridegate mess. This is a civil rights and environmental justice issue. We don't need just
a little less fluoride in water. Fluoridation needs to end," he says firmly.
Parents Should be Warned: Fluoridated Water is Not Recommended for Infants
Fluoride Action Network Press Release
A new study confirms Infants fed formula reconstituted with fluoridated water are at greater risk of developing discolored teeth (dental
fluorosis). (1) The American Dental Association (ADA) warned dentists about this in 2006 but has done little or nothing to inform the
nearly 200 million Americans who live in communities with fluoridated drinking water.
The study by Levy et al., a Journal of the American Dental Association cover story (October 2010), confirms Levy's earlier studies,
which show "[F]luoride Intakes during each of the first 4 years were individually significantly related to fluorosis on maxillary central
incisors, with the first year most important," and that "[[Infant formulas reconstituted with higher fluoride water can provide 100 to 200
times more fluoride than breastmilk, or cow's milk." (2, 3)
According to the Centers for Disease Control (CDC), 32% of American children have dental fluorosis, an increase of 23% from the
1980s. (4) Black and Hispanic populations have even higher rates. Dental fluorosis is a visible sign that a child was overexposed to
fluoride. Pictures of fluorosis: I74tp://www ,flttorlefe ilk rk.orr~/heal fith(tepthifl,ur~rosis/n~oderratc~ .5evert~.:I till!
"The message from Dr. Levy's work is loud and clear: Don't give babies fluoridated water," says Paul Connett, PhD, Executive Director,
Fluoride Action Network (FAN). "Unfortunately the ADA has known about these risks for more than four years. Researchers are telling
dentists; but dentists are not telling parents."
This and other little-known adverse fluoride health effects led Connett to co-author, "The Case Against Fluoride: How Hazardous Waste
Ended Up in Our Drinking Water and the Bad Science and Powerful Politics that Keep it There," with James Beck, MD, PhD, professor
emeritus of medical physics, University of Alberta and Spedding Micklem, DPhil, professor emeritus at Edinburgh University.
A recent review in The Lancet (5) describes fluoride as "an emerging neurotoxic substance" that may damage the developing brain.
The National Research Council (NRC) has identified fluoride as an "endocrine disrupter" that may impair thyroid function, A recent
Harvard University study links fluoride to bone cancer (6).
"Approximately half of the newborns and Infants I see in practice are fed formula reconstituted with fluoridated water, which I find
alarming since the blood-brain barrier is not even developed until 6 months of age, placing these young infants at risk for neurotoxic
effects that can be severe and permanent," says Dr. Yolanda Whyte, a pediatrician in Georgia. "Parents should be warned not to give
fluoridated water to babies and children, and they should know that fluoride is also present in juice and other water-reconstituted
beverages. I diagnose dental fluorosis on average 5 times daily, but fluoride doesn't only affect teeth, it can potentially affect the brain
and nervous system, kidneys, bones, and other tissues in young children during their critical stages of organ development. A public
awareness campaign is urgently needed."
FAN will launch a campaign In November to urge water companies and public-health officials to Inform parents that fluoridated water
should not be mixed into infant formula. "If the ADA and CDC won't educate parents, then FAN will," said Connett.
FAN is the leading science and advocacy group focused on health issues surrounding fluoride in water, food, air, pesticides, and
industrial exposures. Dr. Connett was an invited presenter at the initial meeting of the NRC panel and FAN researchers submitted
extensive scientific information throughout the panel's proceedings. Visit: www,fluoridLogiert,prct
References: Fluoride Action Network 1 802-355-0999 Info _f1uq ndealert,or~
(1) Levy SM, et al. 2010. Associations between fluorosis of permanent incisors and fluoride intake from infant formula, other dietary sources and
dentifrice during early childhood. Journal of the American Dental Association 141(10):1190-1201.
h ' 1:ff'ada,ado.orufc~ifccmtentlabstrdct1141/10f 119Q
(2) Hong L, Levy SM, et al. 2006. Timing of fluoride intake In relation to development of fluorosis on maxillary central incisors. Community Dentistry and
Oral Epidemiology 34(4):299-309.
(3) Levy SM and Guha-Chowdhury N. 1999. Total fluoride intake and implications for dietary fluoride supplementatlon. Journal of Public Health Dentistry
59(4):211-23.
(4) CDC. Table 23 from Beltran-Agullar et al. 2005. Surveillance for Dental Carles, Dental Sealants, Tooth Retention, Edentulism, and Enamel Ruorosis
United States, 1988--1994 and 1999-2002. MMWR Surveillance Summaries. 54(03);1-44.
Table 23 at http:llw4vw.cdc cty%Intmwrll~r vIwArImmwihitBIfi es,].-4;0~ IIt21, f
Full article at tigff.lwww,cdc.uovlmrriyr ~rc~vievvimr~w irnllssCi~t03i1,htm
(5) Grandjean P and Landrlgan P. 2006. Developmental neurotoxicity of Industrial chemicals. The Lancet 368(9553):2167-78. December 6.
(6) Bassin BB, Wypij D, Davis RB, Mittleman MA. 2006. Age-specific fluoride exposure in drinking water and osteosarcoma (United states). Cancer Causes and
Control 17(4):421-8. May.
Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries Page 1 of 7
F L U O R I D E HEALTH EFFECTS: Tooth Decay Trends in Fluoridated vs.
A C T I O N
NETWORK UnflUoridated Countries
HEALTH - - - - -
E F F E C T S DIRECTORY: FAN > Health > Teeth > Caries > Tooth Decay Trends in F vs. NF Countries
- -
HEALTH
7
EFFECTS r ■ ®
........H0MEPAGE ■
Accidents Key Findings - Tooth Decay Trends in f=luoridated vs. Unfluoridated Countries
Allergy In the second half of the 20th century, a steep decline in tooth decay occurred among children in
Arthritis_ the United States. Proponents of water fluoridation have long claimed that this reduction in tooth
decay is primarily the result of adding fluoride to water.
Bone Disease
Brain When the Centers for Disease Control (CDC) nominated water fluoridation as one of the top 10
public health achievements of the 20th century, it published a graph (see igureI , which
Cancer showed the reduction of cavities in US children coupled with the increase in water systems that
Dental Fluoros's have been fluoridated since the 1960's. The CDC referred to the graph with the statement:
EPA Standards "as a result [of water fluoridation], dental caries declined precipitously during the
second half of the 20th century."
Gastrointestinal
Infant Exposure However, what the CDC failed to mention is that similar declines in tooth decay have occurred in
virtually every western country, most of which do not fluoridate water (see Figure 2 .
Immune System
Kidney -
Pineal Gland Centers for Disease Control (1999) -
Respiratory Tooth Decay in the U.S. vs Fluoridation Status: (back to top)
"oproductive
FIGURE 1. Percentage of population residing in areas with fluoridated community
I hyroi Gland water systems and mean number of decayed, missing l1because of earieel, or filled
Tooth Decay permanent teeth {DMFT] among children aged 12 yeas - United States, 1967-1992
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Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries Page 2 of 7
Tooth Decay Trends: Fluoridated vs. Unfluoridated Countries UNFLUC-10ATED
Data from the world Heafth [Ngantiatlon - http:'Avr+w.6tiocollab.od.mah.seI -+-Austria
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19ss 19W 1965 1970 1975 1981 19" 11990 1995 2000 2005 New Zealand
Year
United States
Back to top
DMFT (Decayed, Missing & Filled teeth) Status for 12 year olds by Country
World Health Organization Data (2004) -
Country DMFTs Year Status*
Germany 0.7 2005 No water fluoridation, but salt fluoridation is
common
Australia 0.8 1999 More than 50% of water is fluoridated; no salt
-71 fluoridation
Denmark 0.8 2006 No water fluoridation or salt fluoridation
Netherlands 0.8 2002 No water fluoridation or salt fluoridation
Zurich, Switzerland 0.9 2000 1 No water fluoridation, but salt fluoridation is
common
UK (England & 0.9 2000 11 % of water supplies are fluoridated; no salt
wales) fluoridation
Austria 1.0 2002 No water fluoridation, but salt fluoridation is
available to a limited extent.
Sweden 1.0 2005 No water fluoridation or salt fluoridation
Italy 1.1 2004 No water fluoridation or salt fluoridation
Belgium 1.1 2002 No water fluoridation or salt fluoridation
Ireland 1.1 1997 More than 50% of water is fluoridated; no salt
fluoridation
Finland 1.2 2006 No water fluoridation or salt fluoridation
I I us 1.28 1992-1994 More than 50% of water is Fluoridated; no salt
fluoridation
Iceland 1.4 005 No water fluoridation or salt fluoridation
New Zealand 1.7 2005 More than 50% of water is fluoridated; no salt
fluoridation
Norway 1.7 2004 No water fluoridation or salt fluoridation
France 1.9 1998 11No water fluoridation, but salt fluoridation is
common
http://www.fluoridealert.org/health/teeth/caries/who-dmtl.html 2/21/2011
LCI LTD Fax:9042411220 Apr 23 2009 10:32am P002/002
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