As a child, there was
nothing I liked about going to the dental dispensary, with the possible
exception of the large tropical fish aquarium in the waiting room. This
was a distraction to what was coming: three hours in a vast hall
containing a double line of black dental chairs and a matching double
line of white-clad dental students. And that, as a six-year-old, is
where I first met fluoride on a regular basis. After a free cleaning and
checkup (the reason my cost-conscious parents had me go there, and the
reason it literally took three hours to complete), fluoride was applied
to my teeth with a swab. I remember both the smell (acrid) and the taste
(astringent). I actually looked forward to the fluoride treatment,
simply because it was the last thing they did to me before I was allowed
to leave. Did it work? Probably not. In addition to my regular topical
fluoride treatments, I lived in a city with fluoridated water and was
raised on fluoridated toothpaste. And I had a mouthful of amalgam by
high-school graduation.
Controversy? What Controversy?
In the late 1970s, as a young parent, I became aware of the National Fluoridation News,
published in the still largely unknown town of Gravette, Arkansas (pop
2,200). For a very small donation, I received a boxful of back issues by
return mail. In addition to this generosity, what surprised me about
the NFNews was the high caliber of its content. Most of the
non-editorial articles were well referenced and the work of well
qualified scientists. This was something of a poser, for as a college
biology major, I had been thoroughly schooled in the two Noble Truths of
Fluoridation: 1) that fluoride in drinking water would reduce tooth
decay by 60-65% and 2) that anyone who disagreed with this view was a
fool. Yes, I had seen the movie Dr. Strangelove, and yes, I knew how to read an ADA endorsement on a toothpaste label.
Not long after this, my penchant for reading toothpaste labels paid off. There it was, printed right on the back of the tube:
"Children should only use a 'pea-sized' portion of fluoride toothpaste when they brush."
I had two toddlers, and this caught my
interest. Looking into it, I learned that small children swallow a
considerable quantity of toothpaste when they brush, perhaps most of it.
Anyone who has watched television at all
could not have failed to see toothpaste ads. They always showed the
brush loaded, with decorative overhang tips flared out on each end. When
"AIM" brand toothpaste first came out, I distinctly remember toothpaste
being displayed in two or even three layers on the brush. The number of
children that used the product so generously, and swallowed half of it,
will likely remain unknown. As for me, I immediately switched my family
to toothpaste with no fluoride in it. As for toothpaste labels, they
rather quickly were re-written. They now read:
"If you accidentally swallow more
than used for brushing, seek professional help or contact a poison
control center immediately."
But all children swallow more than is used for brushing. The only question is, how much? The US Centers for Disease Control states:
"Fluoride toothpaste contributes to
the risk for enamel fluorosis because the swallowing reflex of children
aged less than 6 years is not always well controlled, particularly among
children aged less than 3 years. Children are also known to swallow
toothpaste deliberately when they like its taste. A child-sized
toothbrush covered with a full strip of toothpaste holds approximately
0.75-1.0 g of toothpaste, and each gram of fluoride toothpaste, as
formulated in the United States, contains approximately 1.0 mg of
fluoride. Children aged less than 6 years swallow a mean of 0.3 g
of toothpaste per brushing and can inadvertently swallow as much as 0.8
g." [1, emphasis added]
For children age 6 and under, that is an average
swallow of a third of the toothpaste they use, and a possibility of
inadvertently swallowing 80% or more. There is about a milligram of
fluoride in a single "serving" of toothpaste. I am calling it a
"serving" because fluoride in toothpaste is regulated as if it were a
food, not a drug. How is this true? Adding even less than one milligram
of fluoride to a single serving of children's vitamins instantly makes
them a prescription drug. It is truly odd that fluoride toothpaste
remains an over-the-counter product.
Into the Schools
When my children were in grade school,
the local dental college (the people who brought us the dispensary I
went to as a young boy) interested our school district in a research
project. Our town's public water was under local control and
unfluoridated, unlike the city nearby. So the idea was to administer
fluoride rinses to schoolchildren, during the school day, and then count
caries. We were asked to sign a permission letter, which emphasized
likely benefits and glossed over any hazards. Remembering what
youngsters did with sweet toothpaste, I made a guess that they'd swallow
a saccharin-laced rinse about as well. We chose to not sign. But I did
check the box to receive results of the study. It ultimately came in the
form of a letter, saying that the results were disappointingly
inconclusive: no evidence that fluoride rinses helped our
unfluoridated-water-drinking community. I am unaware that the study was
published.
That is not especially surprising.
Shutting out access to balanced scientific discussion of fluoridation is
alive and well. . . and taxpayer supported. Negative fluoride studies
and reviews are hardly abundant on PubMed/Medline. One does not need to
be a conspiracy theorist to observe that the US National Library of
Medicine refuses to index the journal Fluoride. [2] Censorship is conspicuously aberrant behavior for any public library.
No Discussion
About 15 years ago, our town's public
water supply was annexed by the nearby metropolis. Aside from a rate
increase, the only other, barely detectable change to our bill was a
one-time typed legend at the bottom of it that fluoride has now been
added to the water. There had been no vote, and there had not even been
any discussion. Communities coast-to-coast know that this is not at all
uncommon. Four glasses of fluoridated tap water contain about as much
fluoride as a prescription dose does. Not only is fluoridated water
nonprescription, it is even more certain to be swallowed than
toothpaste. Being over 6 years of age means better control over
swallowing reflexes, thus limiting ingestion of fluoride from
toothpaste. There is no such accommodation for drinking water.
Evidence-based medicine requires
evidence before medicating. Fluoridation of water is not evidence-based.
It has not been tested in well-controlled studies. Fluoridation of
public water is a default medication, since you have to deliberately
avoid it if you do not want to take it. A person's daily intake of
fluoride simply from drinking an average quantity of fluoridated tap
water, fluoridated bottled water, and beverages produced or prepared
with fluoridated water can easily exceed the threshold for what your
druggist would rightly demand a prescription for. Fluoride in toothpaste
and mouth rinses also is medication. It may be intended as topical, but
the reality is different. No matter how it may be applied in their
mouths, young children are going to swallow it. Indeed, most of the
public and the dental profession already have.
References:
1. Fluoride Recommendations Work Group.
Recommendations for using fluoride to prevent and control dental caries
in the United States. CDC Recommendations and Reports
2001;50(RR14):1-42. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm
2. http://www.orthomolecular.org/resources/omns/v06n05.shtml
If you want access to what the US taxpayer-funded National Library of
Medicine refuses to index, you may read over 40 years' of articles from
the journal Fluoride, free of charge, at http://www.fluorideresearch.org/ Scroll down to "Archives and Indexes,1968-2011."
Comment by Albert W. Burgstahler, PhD: Support for these views and conclusions is found in a recent review in Critical Public Health
(2011:1-19) titled "Slaying sacred cows: is it time to pull the plug on
water fluoridation?" by Stephen Peckham of the Department of Health
Services Research and Policy, London School of Hygiene and Tropical
Medicine. In his article, Peckham concludes that evidence for the
effectiveness and safety of water fluoridation is seriously defective
and not in agreement with findings of a growing body of current and
previously overlooked research. For an abstract of this report, scroll
down at: http://www.fluorideresearch.org/444/files/FJ2011_v44_n4_p260-261_sfs.pdf
This revised article
originally appeared in Fluoride 2011, 44(4)188-190. It is reprinted with
kind permission of the International Society for Fluoride Research Inc.
www.fluorideresearch.org or www.fluorideresearch.com. Editorial Office: 727 Brighton Road, Ocean View, Dunedin 9035, New Zealand.
Andrew W. Saul, Ph.D. (USA), Editor of the Journal of Orthomolecular Medicine and contact person. Email: omns@orthomolecular.org
Readers may write in with their comments and questions for
consideration for publication and as topic suggestions. However, OMNS is
unable to respond to individual emails.
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