Saturday, July 02, 2016

Debunking the Fluoridationists, By Karen Spencer

To politicians and decision makers,

In response to a pro-fluoridation document being used by area dentists claiming to refute opponent arguments and science, please see counterpoints and End Notes. 

1. "Most developed countries do not fluoridate their water."

According to the Pew Foundation: "Anti-fluoride activists imply that European countries have rejected fluoridation, but this assertion is misleading because these nations use various means to provide fluoride to their citizens. For example, salt fluoridation is widely used in Europe. In fact, at least 70 million
Europeans consume fluoridated salt, and this method of fluoridation reaches most of the population in Germany and Switzerland. These two countries have among the lowest rates of tooth decay in all of Europe. Fluoridated milk programs reach millions of additional Europeans. A number of areas in Italy have water supplies with natural fluoride levels that already reach the
optimal level that prevents decay. This is a major reason why Italy does not have a national program for water fluoridation. Finally, some countries in Europe do elect to adjust fluoride levels in community water systems. Fluoridated water is provided to 12 million Europeans, mostly reaching residents of Great Britain, Ireland, and Spain."

COUNTERPOINT: Only a handful of European countries (with a total population of over 742 million) use fluoridated salt and that salt generally holds a minor market share, being mostly used in institutional settings. Milk fluoridation is used in even fewer countries in east Europe. Only about 10% of the population in Spain and England have fluoridated water. Not unlike the U.S. and due to their two volcanoes, the natural fluoride levels in Italy are quite variable with lows of .02 ppm. Italy, like Iceland which has uniformly high natural fluoride levels, never used any fluoride program, yet both the Italian and Icelandic high dental decay rates dropped even more dramatically than in the U.S. during the 20th century.

The Republic of Ireland (ROI) has mandated fluoridation. Residents of ROI have considerably worse overall health as well as worse dental health than their cousins in Northern Ireland and the EU. Despite its fluoridated status and excellent health care, Americans also ranks near or at the bottom in general health and dental health per the 2013 Institute of Medicine report, “Shorter Lives, Poorer Health.”

• Letters from European countries not fluoridating:

• The Mystery of Declining Tooth Decay. Mark Diesendorf. Nature. 07/1986; 322(6075):125-9.

U.S. Health in International Perspective: Shorter Lives, Poorer Health. Editors National Research Council (US); Institute of Medicine (US); Woolf SH, Aron L, editors. Source Washington (DC): National Academies Press (US); 2013.

2. "Fluoridated countries do not have less tooth decay than non-fluoridated ones."

"The studies often used to support the claims are small scale studies conducted in foreign countries where alternative programs were implemented. However, these studies did not study the cost effectiveness. No other intervention is as cost effective as water fluoridation. The fact that fluoride works to prevent tooth decay has been shown in laboratory and human studies. When one examines the most cost effective and efficient way to deliver fluoride to bring about
population impact, it becomes clear that water fluoridation is the choice.

'Causation of dental decay is multifactorial. Attempting to assess the efficacy of one preventive measure, such as water fluoridation, from a snapshot of data, without controlling for other factors, is misleading and invalid. There are countless peer-reviewed scientific studies which clearly demonstrate the effectiveness of water fluoridation. The following are but a few..."

COUNTERPOINT: Both the prestigious 2000 York and 2015 Cochrane reviews of all fluoridationist studies found them to be poor quality with high risk of bias. Moreover, the reduction in decay reported in these low quality studies sounds more impressive when stated as percentages. In absolute terms, the “lifetime” benefit amounts to a minority of children having one or two fewer cavities during their childhood. And yes, there is a large 1980s U.S. study. When only a small sample of data in support of fluoridation was released subsequent to the completion of that U.S. study, a freedom of information request was used to obtain access to the complete dataset which proved that, although there was a normal variation between communities that allowed for cherry-picking datasets, there was no significant difference between fluoridated and unfluoridated towns (see end notes). 

This analysis supported the finding of the “40 years later” studies of trial and control towns in New York state. Fluoridation does not reduce cavities. Even if fluoridation provided the benefits claimed, a recent re-evaluation of the oft-quoted CDC cost:benefit found it erroneous.

• New Studies Cast Doubt on Fluoridation Benefits. Bette Hileman. Chemical & Engineering News. May 8, 1989.

• European Commission Public Health webpage on SCHER opinion. 2010.

• A critique of recent economic evaluations of community water fluoridation. Lee Ko and Kathleen M. Thiessen. International Journal of Occupational and Environmental Health. 2015, 21:2, 91-120.

3. “Fluoride affects many tissues in the body besides teeth".

"As can be found on page 1 of the report of the 2006 NRC Committee on Fluoride, this Committee was charged with: 'On the basis of its review, the committee was asked to evaluate independently the scientific basis of EPA’s MCLG of 4 mg/L and SMCL of 2 mg/L in drinking water and the adequacy of those guidelines to protect children and others from adverse health

COUNTERPOINT: The argument here is primarily an out of context and misleading copy and paste. Most importantly it ignores the NRC’s confirmation that fluoride is an endocrine disruptor and a substance that poses a particular threat to kidney and bone health. The NRC also found that there was no evidence of any safe level of fluoride in water for susceptible population for whom it was reasonable to anticipate an adverse reaction at lower concentrations. The comments also ignore the considerable science since 2006 that has confirmed this harm noted by the NRC. See statements from three NRC panelists who openly oppose fluoridation plus the unguarded comments of the pro-fluoridation chair: 

Expert in Preventative Dentistry: “The evidence that fluoride is more harmful than beneficial is now overwhelming… fluoride may be destroying our bones, our teeth, and our overall health.” - Dr. Hardy Limeback BSc, PhD, DDS, former President of Canadian Association of Dental Research, former head of Preventative Dentistry at the Univ of Toronto (2007)

Expert in Risk Assessment: "The available data, responsibly interpreted, indicate little or no beneficial effect of water fluoridation on oral health." - Dr. Kathleen Thiessen (2011)

Expert in Neuroscience & Behavioral Psychology: “There’s no doubt that the intake of fluoridated water is going to interrupt basic functions of nerve cells in the brain, and this is certainly not going to be [for] the benefit of anybody...The addition of fluorides to drinking water was, and is, a mistake.”
- Dr. Robert Isaacson (2007)

Fluoridationist Chair: “The thyroid changes do worry me…. People tend to think that it’s settled: But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [water fluoridation] has been going on.” - Dr. John Doull, (in Scientific American, 2008),%20Scientific%20American%20Jan-08.pdf

4. "Fluoridation is not a 'natural' process"

"Hydrofluorosilic acid (HFA), the agent most utilized to transfer more fluoride ions into a water system, is immediately and completely hydrolyzed, dissociated at the pH of drinking water. Once dissociated, it no longer exists in that water. As it no longer exists, it does not reach the tap, and is thus not ingested. As it is not ingested, there is no requirement, or any need whatsoever, for 'tox studies' of HFA..."

COUNTERPOINT: Opponents to fluoridation respectfully suggest the studies and reports by actual toxicologists, chemists and researchers specializing in risk assessments should carry more weight than the opinion statements of dentists which are apparently based on marketing material funded by vested interests. We also suggest that the studies proving that fluoridation increases the lead in water and/or lead absorption of mammals into tissue, as well as the reports on the contamination of fluoridation chemicals with other toxins such as arsenic should also be taken into consideration when comparing the naturally occurring
calcium fluoride with fluoridation chemicals. See scientific citations in End Notes.

5. "40 % of American teenagers show visible signs of fluoride over-exposure"

"This statistic as drawn from a recent CDC report on a study by Beltran-Aguilar, et al. That '41% of all children' is composed of 37.1% with mild to very mild dental fluorosis, both of which are barely detectable, benign conditions requiring no treatment, and which have no effect on cosmetics, form, function, or health of teeth..."

COUNTERPOINT: If it holds steady, the 4% “minority” with moderate to severe dental fluorosis that permanently stains between 50-100% of teeth, often accompanied by flaking enamel and pitting will ultimately represent at least 12 million Americans. Moreover, those with mild dental fluorosis staining their front teeth are likely to seek cosmetic dentistry, this percentage is estimated at 12% of the total population per both York and Cochrane panels, bringing the estimate of those with fluoride damaged teeth to least 38 million Americans.

However, the biggest issue is that dental fluorosis impacts the races disproportionately with 58% of black teenagers being impacted v. 36% of white teenagers. Latinos, Asian Americans, and Indigenous People have similar disparity. This is why Civil Rights leaders have been calling for an end to fluoridation since 2011. See End Notes.

• CDC email per FOIA. “Fluoridation Issues in Georgia” from Nadine Gracia IO/OISH to Howard Koh HHS/ OASH and Dora Hughs HHS/IOS. April 27, 2011.

6. "For infants, fluoridated water provides no benefits, only risk"

"...The U.S. Centers for Disease Control and Prevention states that the primary benefit of fluoride is topical. They do not state that it is the only route of benefit…"

COUNTERPOINT: The only reason the words “predominant” and “almost exclusively” are used in describing the topical versus systemic benefit of fluoride is to protect fluoridation policy and the prestige of those promoting that policy. The only actual science on fluoride providing a dental benefit is from 2013 when it was proved that fluoridated toothpastes (not water) inhibited the enzyme function of cavity causing bacteria. That is not a surprise as fluoride is a known enzyme poison. What is surprising is that, “teeth brushing and mouth
rinsing frequency have been demonstrated to be significantly higher for Irritable Bowel Disease (IBD) patients at disease onset.” See recent study that suggests fluoridation is causal in bowel diseases as well as letter to the American Thyroid Association in End Notes for more on why infants, the unborn, and young children are at particular risk.

• Fluoride: a risk factor for inflammatory bowel disease? Follin-Arbelet B, Moum B. Scand J Gastroenterol. 2016 May 19:1-6.

• Reduced Adhesion of Oral Bacteria on Hydroxyapatite by Fluoride Treatment. Peter Loskill et al. Langmuir. 2013.

• The Association of Early Childhood Caries and Race/Ethnicity among California Preschool Children. Caroline H. Shiboski et al. Journal of Public Health Dentistry. 63(1):38-46, January 2003.

7. "Fluoride supplements have never been approved by the FDA"

"Fluoride supplements are prescribed mainly for children whose primary source of drinking water is not fluoridated... Fluoridated water meets all NSF Standard 60 certification requirements as mandated by the EPA. There are no dosage requirements for fluoride, nor is there any need for such, any more than is there any need of dosage requirements of chlorine in water. The FDA has neither the jurisdiction, nor the need to 'approve' fluoride additives to water..."

COUNTERPOINT: The EPA transferred authority and liability for “water additives” to the private NSF and individual states decades ago in an effort to avoid the politically charged fluoridation minefield. However, in house EPA scientists have been quite vocal about reducing the MCLG (Maximum Contaminant Level Goal) for fluoride to 1 ppm in the 1980s and to 0 ppm in 2005. That science-based opinion of EPA professional staff is supported by the findings of the NRC panel who stated in 2006 that 4 ppm was not protective of health. Moreover, analysis of fluoridation chemical samples proved they are contaminated with a variety of poisons, many of which are not being tested for by the NSF and therefore making the NSF certificates meaningless. See
FDA petition in End Notes and following three EPA items plus a recent expose about Texas:
• 1986 Amicus brief:
• 1999 White paper:
• 2005 Union letter:
• 2016 TCEQ in Texas:

8. "Fluoride is the only medicine added to public water"

"Fluoride is not a 'medicine', and it is not 'forced' upon anyone. Fluoride is a mineral…Antifluoridationists have repeatedly attempted to make the 'forced medication' in U.S. Courts. They have been rejected each and every time…"

COUNTERPOINT: Calcium is a mineral, naturally occurring calcium fluoride is primarily calcium. Fluoridation chemicals added to our water are acids or salts. When fluoride is being used in order to effect the health of people, it is a drug. There are those for whom fluoride is medically contraindicated. Once it is in the water, it is impossible to avoid. Therefore consumers are being drugged without their individual consent. Fluoridation worsens the health of those with renal, endocrine, inflammatory, and autoimmune diseases. Courts have found in favor of those opposing fluoridation on these grounds, but those rulings have been
overturned on appeal based on the legality of “police powers” under the “rational basis” test.

Legal scholars have stated that fluoridation policy would not withstand a strict scrutiny examination. Lawsuits are costly and time consuming. However, there is a Canadian lawsuit pending in Peel, Ontario that should be of particular interest. See End Notes. 

9. "Swallowing fluoride provides little benefit to teeth"

"The U.S. Centers for Disease Control and Prevention states that the primary benefit of fluoride is topical. They do not state that it is the only route of benefit…"

COUNTERPOINT: The only reason the words “predominant” and “almost exclusively” are used in describing the topical versus systemic benefit of fluoride is to protect fluoridation policy and the prestige of those promoting that policy. Moreover, the only justification for adding it to the water was because the 1940s medical hypothesis was that fluoride must be ingested by children in order to work. Also, they believed that it wouldn't be medically contraindicated for anyone or would it cause anything but the most mildest forms of dental fluorosis in fewer than 10% of the population. 

Not only have those assumptions been proved false, but also the clinical
observations of acute inflammatory ailments from fluoridation in susceptible groups that were dismissed in the 1950s have been well documented by science in the past 25 years.

• Fluoride: an adjuvant for mucosal and systemic immunity. Butler JE, Satam M, Ekstrand J. Immunol Lett. 1990 Dec;26(3):217-20. PMID: 1707853.

• Fluoride augments the mitogenic and antigenic response of human blood lymphocytes in vitro. Loftenius A, Andersson B, Butler J, Ekstrand J. Caries Res. 1999;33(2):148-55. PMID: 9892783.

• Fluoride as a factor initiating and potentiating inflammation in THP1 differentiated monocytes/macrophages. I. Gutowskaa et al. Toxicology in Vitro. Volume 29, Issue 7, October 2015, Pages1661–1668.

• Modifying Effect of COMT Gene Polymorphism and a Predictive Role for Proteomics Analysis in Children's Intelligence in Endemic Fluorosis Area in Tianjin, China. Zhang S, et al. Toxicol Sci. 2015 Apr; 144(2):238-45. doi: 10.1093/toxsci/kfu311. Epub 2015 Jan 1. PMID: 25556215.

• Chronic fluoride exposure-induced testicular toxicity is associated with inflammatory response in mice. Ruifen Weia, Guangying Luoa, Zilong Suna, Shaolin Wangc, Jundong Wanga. Chemosphere. Volume 153, June 2016, Pages 419–425.

10. "Disadvantaged communities are the most disadvantaged by fluoride"

"The dental community has never promoted fluoridation as a 'replacement' for proper dental care and treatment…"

COUNTERPOINT: Fluoridation was coincidental with the drop in decay in the U.S., not causal. The improvement in plumbing, diet, oral hygiene, and dental practices as well as the advent of antibiotics are what drove down tooth decay world wide. Dentists deserve credit for some of that. However, when they use scare tactics referencing false teeth as a reason to keep fluoridation in place they ignore both medical history and the fact that root canals and dental implants account for much of the apparent reduction in toothlessness.

Fluoridation lobbyists also ignore the fact that in the first decade of the 21st century, emergency room visits for preventable dental infections rose by 42% in the U.S. Most of the patients were low income and uninsured. They were also predominantly non-white. Further research predictably proved most were also living in fluoridated communities.

Additionally, there is no question that low income populations who can not afford bottled water are most harmed by fluoridation because of malnutrition and non-white populations because of genetics. Higher rates of diabetes and kidney disease in these populations set up a vicious cycle as increased water consumption and reduced fluoride elimination results in higher individual dosages and increased risk of inflammatory symptoms and toxicity.

• Outcomes of Hospitalizations Attributed to Periapical Abscess from 2000 to 2008: A Longitudinal
Trend Analysis. Shah, Andrea C. et al. Journal of Endodontics , Volume 39 , Issue 9 , 1104 - 1110.

- Fluoride is an enzyme poison and an endocrine disruptor
- Fluoride is a potent adjuvant... causing or worsening allergies
- Fluoride is a proliferative agent... causing or worsening inflammation
- Fluoride accumulates in bones and tissue... causing or worsening arthritis and other ailments
- Fluoride impacts thyroid hormones... resulting in both hypo and hyper disorders
- Fluoride interferes with glucose metabolism... a concern for diabetics
- Fluoride causes dental fluorosis... disproportionately by race and socio economic status
- Fluoride is neurotoxic to fetuses, infants and young children... resulting in permanent deficits
- Fluoride is a burden to kidneys... resulting in increased fluoride retention and possible renal damage in those with kidney disease.
- Summary from 2015 letter to the Institute of Medicine signed by safe water   consumer advocate Erin Brockovich; Wm Ingram MD, president of the  American Academy of Environmental Medicine signing on its  behalf; “super lawyer” David P. Matthews of Matthews & Associates, Houston TX and NYC; Dr. Daniel A. Eyink, MD of Newburyport MA; Dr.Jean Nordin-Evans, DDS of Groton Dental Wellness; and Dr. Stephanie  Seneff, PhD at MIT.

End Notes - see scientific and legal citations in
each of these modern aggregate documents

1. 2016 letter to the National Governors Association from Erin Brockovich, Robert W. Bowcock and Michael D. Kohn (lobbying & advocacy)

2. 2016 letter to the American Thyroid Association from Richard Shames, MD, et al. (endocrine disruption & cancer)

3. 2016 petition to the FDA from the Fluoride Action Network and International Academy of Oral Medicine & Toxicology (fluoride supplements & unapproved drugs):

4. 2014 legal analysis by Prof. Rita Barnett-Rose (ethical & legal considerations):

5. 2014 legal memo and scientific affidavit of 2006 NRC panelist, Dr. Kathleen Thiessen, in pending Canadian lawsuit (disproportionate harm & susceptible populations):

6. Fluoride, Chloramine & Lead Resource Sheet (bad for people, pipes, and planet):

Written by Karen Spencer
About KarenCurrently a consultant working with software development teams, Karen Spencer is a former analyst and project leader. She is adept at conducting research and analyzing trends. Her special interests include critical thinking, data-driven decision making, and organizational theory. She and others in her family are among the 15% of Americans with chemical sensitivities triggered by exposure to fluoridated food and drink. 

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