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September 2000 Vol. 93 Number 6

Water Fluoridation : Pollutant or Panacea?

Benefits of Fluoride now in question

Increasing international, statistical evidence shows that there is no difference in tooth decay between fluoridated and non-fluoridated communities.

Recent studies of over 400,000 children worldwide seriously questions the efficacy of artificially adding the chemical fluoride to drinking water. 

Dr. J. Yiamouyiannis in 1989 reviewed the tooth decay figures in a survey conducted by the National Institute of Dental Research involving 39,207 children aged 5-17 years old from 84 areas across the United States (U.S.).¹ This study showed no difference in decayed, missing and filled teeth between children living in fluoridated and non- fluoridated areas.

The New Zealand School Dental Service recorded the dental status of 59,331 students aged 12-13 years old in 1987.² They concluded that “child dental decay differences are not closely related to the presence or absence of water fluoridation” but are more related to demographic, and especially socio-economic, factors. There is, in fact, “no significant difference in tooth decay in fluoridated and non-fluoridated areas”.

Kuopio, Finland initially fluoridated in 1959 but after increasing concerns about bone damage, fluoridation was discontinued in 1992. A study to “examine the consequences of the discontinuation on dental health” concluded that, “in spite of discontinued water fluoridation, no indication of an increasing trend of caries (tooth decay) could be found in Kuopio”.³

The most recent World Health Organisation figures for tooth decay in Ireland also mirror this trend. Tooth decay is decreasing almost as quickly in non-fluoridated as their fluoridated neighbours. In Europe, figures for 12-year-olds place Ireland only sixth for tooth quality.⁴ Of the five countries with better teeth, four do not fluoridate and the U.K. has only 10% fluoridation. This is surprising that Ireland with 73% fluoridation coverage does not have the best teeth in Europe. Also surprising is the fact that 98% of Europe says no to water fluoridation!

Tooth preserving acid

The chemical fluoride used to dose our drinking water is called hydrofluosilicic acid. Through the Freedom of Information Act, I found that this compound is a waste product of the phosphate fertiliser industry. Ireland imports this acid from Holland, which ironically, prohibits fluoridation by law. A recent chemical analysis from Albatros Fertilizers Ltd., New Ross, Co. Wexford (the importers) shows this fluoride cocktail contains contaminants such as Arsenic, Lead and Antimony, all of which are heavy metals.⁵ Further evidence indicates that another contaminant phosphorus pentoxide contains Uranium 238. Incredible as it may seem, Ireland pumps this acid, controlled by an EU hazardous substances directive, into our drinking water at the rate of 2000 gallons each day. 

According to the Irish Medicines Board, this fluoride acid is not registered as a medicine, is unlicensed and has never been proved safe or effective for use on humans. The Eastern Regional Health Area spends £350,000 annually purchasing this hydrofluosilicic acid from Albatros Fertilizers Ltd., who import it from Kemira Chemicals, a powerful multinational chemical company with fertiliser and chemical factories in over 20 countries. The cost of safely disposing of this fertiliser waste is unknown. 

Toxicity of Fluoride

In 1943, before fluoridation in U.S., The Journal of the American Medical Association stated that, “fluorides are general protoplasmic poisons” with the capacity to “modify the metabolism of cells” by “inhibiting certain enzyme systems”.⁶

More recently, the U.S. Environmental Protection Agency classified fluoride as more toxic than lead and slightly less toxic than arsenic. The British Medical Association in 1994 highlighted the risks of excess fluoride in the “New Guide to Medicines and Drugs”. They concluded, “In large quantities, fluoride may cause slow poisoning-termed fluorosis. Prolonged intake of water containing more than 2ppm may lead to mottled or brown discolouration of the enamel of developing teeth. Very high levels (over 8ppm) may also lead to bone disorders and degenerative changes on the kidneys, adrenal glands, heart, central nervous system and reproductive organs”.⁷ Considering the water in Ireland is “optimally fluoridated” at 1ppm, this is a very narrow margin of safety. It does not take into consideration persons with large consumption of water e.g. athletes, dialysis patients, infants. 

The same publication states that 0.15 mg fluoride is a safe daily intake for children under 3 months and about 0.5 mg up to 2 years.⁸ Black’s Medical Dictionary advises 2.5 fl. oz. per lb. of body weight of human milk or equivalent. Therefore, a newborn baby will drink 20 fl. oz. (1 pint) milk daily. If the parent is using formula baby feed with fluoridated water, one pint is equivalent to 0.55 litres approximately. And in fluoridated areas, there is 1mg of fluoride in every litre of water drunk. Therefore, a newborn will receive over 0.5mg fluoride in their daily feed. This is over three times the limit set by the BMA. Correspondingly, a three-month-old child weighing around 14lb will drink around 1.75 pints and will therefore receive 0.875 mg of fluoride daily-nearly six times over the limit. 

Thus, prescribing by thirst is very dangerous as everyone receives a different dose. Would a doctor prescribe a drug never having known their patient’s age, weight or medical history? The answer is “NO”! This type of mass medication has lead to professionals and academics alike voicing their concerns.

Professor Hardy Limeback, consultant to the Canadian Dental Association and Professor of dentistry at the University of Toronto stated last year, “Children under three should never use fluoridated toothpaste. Or drink fluoridated water. And baby formula should never be made up using (fluoridated) Toronto tap water”.⁹

1500 scientists, lawyers and other professionals from U.S. Environmental Protection Agency have also called for an end to water fluoridation. In 1997 their union stated, “our members review of the body of evidence over the last eleven years, including animal and human epidemiology studies, indicate a causal link between fluoride/fluoridation and cancer, genetic damage, neurological impairment and bone pathology.”¹⁰

In Ireland, Dr. Patrick Flanagan of Environmental Protection Agency, repeated, “While neither the Agency nor I can remain other than neutral in the debate as to the pros and cons of fluoridation, it is clear to me that there is an existing and growing body of medical and/or scientific opinion supporting the cessation or prohibition of fluoridation”.

Fluoride damage to teeth

All medical and dental authorities acknowledge that fluoride can cause dental damage called dental fluorosis. This is structural damage to teeth. This damage occurs in permanent teeth during the period of tooth development from infancy to early childhood i.e. birth to 6-8 years old. Dental fluorosis exhibits as fine white lines, cloudy areas, chalky pitting or brown staining or mottling in severe cases. Prof. O Mullane (University College Cork) said on the BBC Spotlight programme of March/April 1996, that 50% of the population living in fluoridated areas have this condition. This is not a cosmetic condition, it is structural damage and it has psychological implications for the sufferer. In my experience, the dental fluorosis sufferer will not smile, as they are ashamed of their appearance. These kids are teased and traumatised at school about their “bad teeth”. These teeth are usually brittle and more susceptible to wear. Expensive cosmetic dental treatment is usually the only treatment and is not available under the Medical Card or PRSI schemes.

Because of the epidemic of dental fluorosis in Canada, in March 2000, the Canadian Dental Association now advises no fluoride supplements for children under seven years old.¹¹

Dr. John Colquhoun, Principal Dental Officer, Auckland, New Zealand, said, “Common sense should tell us if a poison circulating in a child’s body can damage tooth-forming cells then other harm is likely”.

Fluoride damage to health

Recent, international, peer-reviewed, scientific studies have shown links between water fluoridation and hip fracture, irritable bowel syndrome, osteosarcoma, decreased fertility and allergic response.

The Act of Law permitting water fluoridation in Ireland, Health (fluoridation of water supplies) Act 1960 section 6, states, “It shall be the duty of the Minister to arrange from time to time for such surveys as appear to him to be desirable to be made as respects the health, or any particular aspects of the health, of persons” living in fluoridated areas.¹²There are no health studies in Ireland in thirty-five years of water fluoridation. Successive health ministers including Minister Martin have failed to monitor public health. They are only interested in teeth.

Water Fluoridation and Cancer
Fluoride has been recognised as mutagenic for many years.^13,14,15 In the U.S., a comparison between the ten largest fluoridated cities and the ten largest non-fluoridated cities showed that, while cancer rates had been similar initially, after 20 years the fluoridated cities had 10 percent more cancer deaths than the non-fluoridated ones.¹⁶ The U.S. National Cancer Institute checked these figures and confirmed their validity in 1976. In Poland, scientists at the Pomeranian Medical Academy reported that as little as 0.6 parts per million produced chromosomal damage to human white blood cells.¹⁷

Following these results, Dr. Dean Burk, the Chief Chemist Emeritus of the U.S. National Cancer Institute, stated: “In point of fact, fluoride causes more human cancer death, and causes it faster, than any other chemical”.¹⁸

Dr. Perry Cohn of the New Jersey Department of Health discovered an epidemiological correlation between osteosarcoma (one of the principal cancers of childhood) and fluoridation.¹⁹ He surveyed its incidence in seven counties of New Jersey relative to water fluoridation. He found that, as demonstrated in Table I, in the fluoridated areas, the incidence of osteosarcoma in boys under the age of 10 was 4.6 times higher than in the unfluoridated areas, 3.5 times higher in the 10 to 19 age group and over twice as high in the 20 to 49 age group.

Table 1
 

Fluoride and osteosarcoma in young males
Seven Counties, New Jersey, 1979-1987
Age		Cases	Population	Rate/100,000
0-9	Fluoridated	2	48,129	4.6
	Unfluoridated	1	102,123	1.0
10-19	Fluoridated	10	62,990	17.6
	Unfluoridated	7	151,384	5.1
20-49	Fluoridated	5	141,429	3.9
	Unfluoridated	5	348,570	1.5
Municipalities, NJ, 1979-1987
Age		Cases	Population	Rate/100,000
0-9	Fluoridated	2	38,654	5.7
	Unfluoridated	1	46,708	2.3
10-19	Fluoridated	10	50,297	20.0
	Unfluoridated	2	67,678	3.2
20-49	Fluoridated	4	115,367	3.8
	Unfluoridated	2	153,713	1.4
Cohn PD. A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males. N J Dept of Health, Trenton, New Jersey. Nov 8, 1992.

   
Water Fluoridation and Hip Fracture

To date (August, 2000), since 1990, there have been 18 studies investigating the relationship between fluoride exposure via the water supply (both natural and artificial) and the incidence of hip fracture in the elderly. The lead authors of these studies are Jacobson (1990); Cooper (1990, revised in a 1991 letter to JAMA); Sowers (1991); Keller (1991, unpublished); May (1991, unpublished); Jacobson (1992); Danielson (1992); Suarez-Almazor (1993); Jacobson (1993); Cauley (1995); Jacqmin-Gadda (1995, letter to JAMA); Karagas (1996); Jacqmin-Gadda (1998); Lehmann (1998); Phipps (1999, unpublished); Li (1999, unpublished); Hellier (2000), and Hegmann ( 2000, abstract).²⁰ Of these 18 studies, 4 are unpublished, 1 is only available as an abstract, 2 appear as letters to the Journal of the American Medical Association. Of the 18, 10 studies show an association between fluoride exposure and increased hip fracture, but 8 do not.

Most recently, Kurttio et al studied over 144,000 elderly Finish people admitted to hospitals with their first hip fracture.²¹ The Finnish found that women aged 50-64 exposed to water fluoride levels greater than 1.5mg/litre had significantly more hip fracture than similar women exposed to fluoride at 0.1mg/litre. Finland ceased water fluoridation in 1992.

In 1992, Danielson et al investigated the correlation in the elderly population of Utah, U.S.²² They concluded, “we found a small but significant increase in the risk of hip fracture in both men and women exposed to artificial fluoridation at 1ppm”.

Water Fluoridation and Gastro-intestinal changes

Prof. A.K. Susheela, a histocytochemist and director of Fluorosis Research and Rural Development Foundation in India has over 70 studies on the adverse health effects of fluoride. In 1998, Prof. Susheela presented her evidence to the U.K. Health Minister in Westminister. In her presentation, she highlighted the gastro-intestinal changes from excess fluoride. This “non-ulcer dyspeptic” complaints include nausea, vomiting, cramps, gas, constipation followed by diarrhoea. She concluded that, “such symptoms were related to fluoride ingested via water, food or even dental products”.

Upper gastro-intestinal endoscopy using fibre-optic endoscope and punch biopsy material examined under an electron microscope revealed, (1) loss of microvilli on the cell surfaces, (2) loss of mucus in the mucosa and (3) “cracked clay” appearance of the cell surfaces at 1ppm fluoride in drinking water.

Water Fluoridation and decreased fertility

In several studies, the toxicity of fluoride includes detrimental effects on human sperm and reduction in testosterone in skeletal fluorosis patients.^23,24 A further review of fluoride toxicity showed decreased fertility in most animal species studied. 

In 1994, S.C. Freni, initiated a study to see whether fluoride could also affect human birth rates.²⁵ His results concluded, “most regions studied showed an association of decreasing Total Fertility Rate (TFR) with increasing fluoride levels in water. There is no evidence that this outcome resulted from selection bias, inaccurate data, or improper analytical methods. However, the study is one that used population means rather than data on individual women. Whether or not the fluoride effect on the fertility rate found at the county level also applies to individual women remains to be investigated”. 

Conclusion

In light of this new scientific evidence and based on the freedom to choose, water fluoridation is now unsafe, ineffective and undemocratic. 

1. Yiamouyiannis J. NIDR study shows no relationship between fluoridation and tooth decay rate, American Laboratory, 1989, May, p.9-10.
2. Colquhoun J, Child dental health dental differences in New Zealand, Community Health Studies, 1987, XI:2, p85-90.
3. Seppa L et al, Caries frequency in permanent teeth before and after discontinuation of water fluoridation in Kuopio, Finland, Community Dental Oral Epidemiology, 1998 August, 26:4, 252-62.
4. Marthaler T.M. The prevalence of dental caries in Europe 1990-1995, Caries Res., 1996; 30: 237-255.
5. Fluoride Free Water. Internet site. http://homepage.eircom.net/~fluoridefree/CampaignUpdate/Analysis.htm
6. "Editorial: Chronic fluorine intoxication”, Journal of the American Medical Association, Vol., 123, p.150(1943). 
7. New Guide to Medicines and Drugs, British Medical Association, 1994, Third edition.
8. Information to be used in conjunction with British Medical Association, “New Guide to Medicines and Drugs”. Third Edition, 1994.
9. Downey, Michael. “A crack appears in the fluoride front”, The Toronto Star, April 25, 1999.
10. O’ Doherty, Gemma. “Fluoride in our water: are you brushing with danger?” The Irish Independent, March 29, 2000.
11. “Considerations re: Fluoride Supplementation”, approved by Resolution 2000.06, Canadian Dental Association Board of Governors, March 2000. 
12. Health (fluoridation of water supplies) Act 1960, section 6.
13. Klein W, et al. DNA repair and environmental substances. Zeitschrift fur Angewandte Bader-und Klimaheilkunde. 1977; 24 (3): 218-223. 
14. Mohamed A, Chandler ME. Cytological effects of sodium fluoride on mice. Fluoride. 1982; 15 (3): 110-18 
15. Jagiello G, Lin J-S. Sodium fluoride as potential mutagen in mammalian eggs. Archive Environmental Health. 1974; 29: 230-5.
16. Yiamouyiannis JA, Burk D. Fluoridation of public water systems and the cancer death rate in humans. Presented at the 67th Annual Meeting of the American Society of Biologists and Chemists and the American Society of Experimental Biologists. June 1976. 
17. Jachimczak D, Skotarczak B. The effect of fluorine and lead ions on the chromosomes of human leucocytes in vitro. Genetica Polonica. 1978; 19 (3): 353-7.
18. Yiamouyannis JA. Fluoride: The Aging Factor. Health Action Press, Delaware, Ohio. 1983. 
19. Cohn PD. A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males. N J Dept of Health, Trenton, New Jersey. Nov 8, 1992. 
20. Hip Fracture Studies: Cauley, J., P. Murphy, et al. (1995). “Effects of fluoridated drinking water on bone mass and fractures: the study of osteoporotic fractures.” J Bone Min Res 10(7): 1076-86. Cooper, C., C. Wickham, et al. (1991). “Water fluoridation and hip fracture.” Journal American Medical Association (JAMA) 266: 513-514 (letter, a reanalysis of data presented in 1990 paper). Cooper, C., C. Wickham, et al. (1990). “Water fluoride concentration and fracture of the proximal femur.” Journal of Epidemiology and Community Health 44: 17-19. Danielson, C., J. L. Lyon, et al. (1992). “Hip fractures and fluoridation in Utah’s elderly population.” JAMA 268(6): 746-748. Hegmann, K.T. et al (2000) the Effects of Fluoridation on Degenerative Joint Disease (DJD) and Hip Fractures.Abstract #71, of the 33rd Annual Meeting of the Society For Epidemiological research, June 15-17, 2000. Published in a Supplement of American Journal of Epidemiology. Hillier, S., C. Copper, et al. (2000). “Fluoride in drinking water and risk of hip fracture in the UK: a case control study.” The Lancet 335: 265-269. Jacobsen, S., J. Goldberg, et al. (1992). “The association between water fluoridation and hip fracture among white women and men aged 65 years and older; a national ecologic study.” Annals of Epidemiology 2: 617-626. Jacobsen, S., J. Goldberg, et al. (1990). “Regional variation in the incidence of hip fracture: US white women aged 65 years and olders.” JAMA 264(4): 500-2. Jacobsen, S.J. et al (1993). Hip Fracture Incidence Before and After the Fluoridation of the Public Water Supply, Rochester, Minnesota. American Journal of Public Health, 83, 743-745. Jacqmin-Gadda, H. (1995). “Fluorine concentration in drinking water and fractures in the elderly.” JAMA 273: 775-776 (letter). Jacqmin-Gadda, H., A. Fourrier, et al. (1998). “Risk factors for fractures in the elderly.” Epidemiology 9(4): 417-423. (An elaboration of the 1995 study referred to in the JAMA letter). Karagas,M.R. et al (1996). “Patterns of Fracture among the United States Elderly: Geographic and Fluoride Effects”. Annals of Epidemiology, 6 (3), 209-216. Keller, C. (1991) Fluorides in drinking water. Unpublished results. Discussed in Gordon, S.L. and Corbin, S.B,(1992) Summary of Workshop on Drinking Water Fluoride Influence on Hip Fracture on Bone Health. Osteoporosis Int. 2, 109-117. Kurttio, P., N. Gustavsson, et al. (1999). “Exposure to natural fluoride in well water and hip fracture: A cohort analysis in Finland.” American Journal of Epidemiology, 150(8): 817-824. Lehmann R. et al (1998). Drinking Water Fluoridation: Bone Mineral Density and Hip Fracture Incidence. Bone, 22, 273-278. Li, Y., C. Liang, et al. (1999). “Effect of Long-Term Exposure to Fluoride in Drinking Water on Risks of Bone Fractures.” Submitted for publication. Contact details: Dr. Yiming Li, Loma Linda School of Dentistry, Loma Linda, California, Phone 1-909-558-8069, Fax 1-909-558-0328 and e-mail, Yli@sd.llu.edu May, D.S. and Wilson, M.G. Hip fractures in relation to water fluoridation: an ecologic analysis. Unpublished data, discussed in Gordon, S.L. and Corbin S.B.,(1992), Summary of Workshop on Drinking Water Fluoride Influence on Hip Fracture on Bone Health. Osteoporosis Int. 2, 109-117. Phipps, K. R. (1999). Community water fluoridation, bone mineral density and fractures. R01DE10814-02. HSR/96101800. USA, Oregon Health Sciences University, 611 SW Campus Dr, Portland, OR 97201, IR: (503) 494-8895,. 199309: National Institute of Dental Research (NIDR) - Grant: Noncompeting Continuation (5). To be published in the British Medical Journal. Sowers, M., M. Clark, et al. (1991). “A prospective study of bone mineral content and fracture in communities with differential fluoride exposure.” American Journal of Epidemiology 133: 649-660. Suarez-Almazor, M., G. Flowerdew, et al. (1993). “The fluoridation of drinking water and hip fracture hospitalization rates in two Canadian connunities.” American Journal of Public Health, 83: 689-693.
21. Kurttio, P., N. Gustavsson, et al. (1999). “Exposure to natural fluoride in well water and hip fracture: A cohort analysis in Finland.” American Journal of Epidemiology, 150(8): 817-824.
22. Danielson, C., J. L. Lyon, et al. “Hip fractures and fluoridation in Utah’s elderly population.” Journal of American Medical Association, 1992. 268(6): 746-748.
23. Susheela AK, Jethanandani P. “Circulating testosterone levels in skeletal fluorosis patients”. J Toxicol Clin Toxicol 1996; 34: 183-9. 
24. Chinoy NJ, Narayana MV. “In vitro fluoride toxicity in human spermatozoa”. Fluoride 1994; 27: 231-232. 
25. Freni SC, “Exposure to high fluoride concentrations in drinking water is associated with decreased birth rates”. Journal of Toxicology and Environmental Health 1994; 42: 109-12.