The Fluoride Debate

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TABLE OF CONTENTS

INTRODUCTION

HISTORY/
ENVIRONMENT

CENSORSHIP

THE FLUORIDE
DEBATE

BENEFITS
Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

ALTERNATIVES
Question 9
Question 10
Question 11
Question 12


SAFETY
Question 13
Question 14

OVERDOSE
Question 15
Question 16
Question 17

DISEASES
Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33

PUBLIC
POLICY

Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

COST
EFFECTIVENESS
Question 41
Question 42
Question 43

CONCLUSION

OVERDOSE

Question 15.
Does the total intake of fluoride from air, water and food pose significant health risks?

ADA's Fluoridation Facts Short Answer
The total intake of fluoride from air, water and food in an optimally fluoridated community in the United States does not pose significant health risks.

ADA's Fluoridation Facts Long Answer

Fluoride from the Air
The atmosphere normally contains negligible concentrations of airborne fluorides. Studies reporting the levels of fluoride in air in the United States suggest that ambient fluoride contributes little to an individual's overall fluoride intake.101, 102

Fluoride from Water
Fresh or ground water in the United States has naturally occurring fluoride levels that can vary widely from less than 0.1 to over 13 parts per million. Few private well water sources exceed 7 ppm.102 Public water systems in the U.S. are monitored by the Environmental Protection Agency (EPA), which requires that public water systems not exceed fluoride levels of 4 ppm.97 The optimal concentration for fluoride in water in the United States has been established in the range of 0.7 to 1.2 ppm. This range will effectively reduce tooth decay while minimizing the occurrence of mild dental fluorosis. The optimal fluoride level is dependent on the annual average of the maximum daily air temperature in the geographic area.27

Additional discussion on this topic may be found in Question 32.

Children living in a community with water fluoridation get a portion of their daily fluoride intake from fluoridated water and a portion from dietary sources which would include food and other beverages. When considering water fluoridation, an individual must consume one liter of water fluoridated at 1 part per million (1 ppm) to receive 1 milligram (1 mg) of fluoride.17, 103 Children under six years of age, on average, consume less than one-half liter of drinking water a day.103 Therefore, children under six years of age would consume, on average, less than 0.5 mg of fluoride a day from drinking optimally fluoridated water (at 1 ppm).

A ten-year comparison study of long-time residents of Bartlett and Cameron, Texas, where the water supplies contained 8.0 and 0.4 parts per million of fluoride respectively, included examinations of organs, bones and tissues. Other than a higher prevalence of dental fluorosis in the Bartlett residents, the study indicated that long term consumption of dietary fluoride (resident average length of fluoride exposure was 36.7 years), even at levels considerably higher than recommended for decay prevention, resulted in no clinically significant physiological or functional effects.95

Fluoride in Food
The fluoride content of fresh solid foods in the United States generally ranges from 0.01 to 1.0 part per million.104 Fish, such as sardines, may contribute to higher dietary fluoride intake if the bones are ingested. Brewed teas may also contain fluoride concentrations of 1 ppm to 6 ppm depending on the amount of dry tea used, the water fluoride concentration and the brewing time.104

The average daily dietary intake of fluoride (expressed on a body weight basis) by children residing in optimally fluoridated (1 ppm) communities is 0.05 mg/kg/day; in communities without optimally fluoridated water, average intakes for children are about 50% lower.74 Dietary fluoride intake by adults in optimally fluoridated (1 ppm) areas averages 1.4 to 3.4 mg/day, and in nonfluoridated areas averages 0.3 to 1.0 mg/day.74

A 1990 review of literature identified no significant increases in concentrations of fluoride in food associated with water fluoridation.105

Questions concerning the possible concentration of fluoride through the biologic food chain have been addressed by the National Academy of Sciences, which concluded:106

Indeed, domestic animals can serve as a protective barrier for humans. Approximately 99% of the fluoride retained in the body is stored in bone, and only slight increases in the concentration of soft tissue fluoride occur even at high levels of dietary fluoride intake. There is, therefore, little danger to humans from the consumption of meat or milk from domestic animals even if the animals have ingested excessive fluoride. A few meat and fish products prepared for human consumption contain portions of comminuted (crushed) bone that may contribute to a higher fluoride content. The proportion of the total diet represented by these products, however, would generally be very small indeed.

The U.S. Food and Drug Administration has established "market baskets" which reflect the actual 14-day consumption of various food items by an average individual in different age groups from six-month-old children to adults. In a nationwide study of market baskets from areas with varying levels of fluoride in water supplies, it was determined that little or no change in food fluoride content has occurred as a result of the fluoridation of U.S. water supplies.107, 108

Repeat of Question 15.
Does the total intake of fluoride from air, water and food pose significant health risks?

Opposition's Response

Yes. See the section on Diseases.

The Journal of the American Dental Association (JADA), in their December 1995 and July 1996 issues (in an effort to slow down the ever-increasing rise in dental fluorosis, the visible display of fluoride poisoning) advise dentists to warn parents of fluoride overdose from fluoride-based pesticide residue and fluoridated water found in fruit juices and drinks made from concentrates. Meanwhile, the ADA claims that children aren't getting enough. Juice concentrates are a real problem. Fluoride is not like chlorine; you can't boil it away. The more you boil fluoride, the more concentrated and poisonous it becomes. (See 15-1: "Fluoride Levels and Fluoride Contamination of Fruit Juices," from The Journal of Clinical Pediatric Dentistry, Vol. 16, #1/1991).

Independent laboratory analyses now show that regularly consumed products found in every neighborhood store, such as Coca-Cola Classic™, Minute Maid™ Orange Juice, and Lucerne™ 2% Milk, contain equal to or more than the amount of fluoride they intend to put in our water; with Froot Loops™, Gerber's™ baby juices, and almost every product with white grape juice , containing two, three, and up to six times the concentration due to fluoride pesticide residue and/or processing with fluoridated water. (See 15-2: "Analytical Testing Report," by Expert Chemical Analysis, Inc., 6/17/98).

In 1995, both the American Dental Association (ADA) and American Academy of Pediatrics (AAP), while segments of these same trade associations simultaneously continued to lobby for fluoridation, created new policy recommendations for fluoride drops and tablets, which are intended to be the substitute for fluoridated water in non-fluoridated communities. The new schedules indicate that mass medication, at the claimed optimal level of fluoridation, grossly exceeds the dosage that a qualified professional could prescribe, even after the professionals individual evaluation of a child for growth and development, weight, total exposure to fluoride from all sources, and individual susceptibility.

According to these new recommendations, infants are to receive no additional fluoride, no matter what the fluoride level in the water; and it is not until a child reaches the age of 6 that the new prescription recommendations ever reach the excessive dosage that is thrust upon a child that consumes fluoridated tap water. (See 15-3: "Policy Statement" from Pediatrics, May 1998, Vol. 95, Number 5).

The Natick Fluoridation Study Committee found that if they fluoridated the water, their children would be consuming about 2 to 3.5 times as much fluoride as was recommended by the American Academy of Pediatrics. (See 15-4: "Recommended Dosage of Fluoride," 9/27/97).

U.S. Public Health Service documents show that even in 1991, non fluoridated communities were already receiving more than the targeted fluoride dosage of 1 mg per day. Fluoridated communities were receiving up to 6 times the optimal goal. (See 15-5: "Review of Fluoride Benefits and Risks," 1991, U.S. Dept. of Health and Human Services).

According to the study published in the July/August Pediatric Dentistry, "... children with educated parents who typically have better oral hygiene practices are at risk for fluorosis ... Fluorosis was found in 69 % of children from high socioeconomic-status families whose parents had college degrees and lived in fluoridated communities." (See 15-6: "Early Fluoride Exposure," from American Academy of Pediatric Dentistry, July 31, 1998).

The famous Washington Post newspaper reported research at the Georgia School of Dentistry at the University of Connecticut showing children should only brush their teeth once a day to avoid fluoride overexposure. Doesn't the ADA say to brush after every meal?

"Not only does the 1 mg/day claimed necessary for teeth not require water fluoridation, but this is why the only oral epidemic is fluorosis in fluoridated areas of the US; and is why the Academy of General Dentistry representing 35,000 dentists has warned parents to limit the amount of juice their children drink — too much fluoride!" (See 15-8).

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