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The Chemical Marketplace Series – Drinking It In: Is Fluoride Good for You?

by Bill Chameides | September 14th, 2010
posted by Erica Rowell (Editor)

Permalink | 8 comments


The difficult case of fluoride. Time magazine lists it in its “Top 10 Common Household Toxins” and yet, starting with Grand Rapids, Michigan, in 1945, many U.S. municipalities have added it to drinking water.

More than 80,000 chemicals are produced and
used in the United States. This is one of their stories.

With nearly 200 million Americans drinking fluoridated tap water these days, is it time to ask ourselves, do we really need the fluoridation?

Fluoridation and the Red Scare

I grew up in the 1950s when municipalities across the nation began fluoridating their drinking water to promote dental health. My parents thought it was a good idea and so, so did I. But I remember hearing friends say their parents were against it, some even claiming that fluoridation was a communist plot to undermine capitalism by poisoning our water supply.

(This communist myth was carried to extremes in Stanley Kubrick’s 1964 classic black comedy Dr. Strangelove or: How I Learned to Stop Worrying and Love the Bomb in which a mad general, Jack D. Ripper, played by Sterling Hayden, cites the fluoridation of water as a primary motive for a nuclear strike against the Soviet Union.)

The Chemical Marketplace
A series that looks at chemicals in everyday consumer products
     Alkylphenols and laundry and such »
     Aluminum and antiperspirants »
     BPAF »
     Dioxin and eggs »
     Flame retardants and pets »
     Fluoride and water
     Formaldehyde and no-iron shirts
     Insect repellents »
     Nanoparticles and food »
     PAH and seal coats: A no-brainer »
     PBDE and fire retardants »
     PFOA and popcorn »
     Piperonyl butoxide, a pesticde »
     Propoxur and bedbugs »
     Rotenone, a pesticide »
     Spray foams, sealants, diisocyanates »
     TDCPP and the air »
     Triclosan and toothpaste »
     Trihalomethanes (THM) and
showering »

While back then such a communist plot seemed pretty scary, now it just seems far-fetched. But today there are people, thoughtful people, who, despite decades of living with fluoridated tap water, oppose it. What’s the fear now and is it grounded in reality? I decided to find out.

We Fluoridate Water in the Name of Healthy Teeth

We add fluoride [pdf], a reduced form of the naturally occurring fluorine, to water (which contains some amount of fluoride naturally) to prevent tooth decay. And while to you or me a cavity may seem little more than a hassle — the sting of Novocain, the rrreenee-reenee of the dentist’s drill, a drooping lip for a few hours — it’s a big deal from a general and public health point of view. Consider the following:

So, if your job is protecting public health, fluoridating drinking water might seem like a very good idea. But it’s only a good idea if it works. Does it?

Fluoridation Testimonials and Then the Fine Print

To find out, I first Googled the Centers for Disease Control (CDC) and the Surgeon General. Results?

But after heaping accolades on fluoridation in one paragraph, the Surgeon General waffles later on: “There are no randomized, double-blind, controlled trials of water fluoridation because its community-wide nature does not permit randomization of people to study and control groups. … Conducting a study in which individuals are randomized to receive or not receive fluoridated water is unnecessary and is not feasible.” Not feasible? Maybe. But unnecessary? I don’t think so.

In 2000 the Centres for Review and Dissemination at the University of York in England similarly equivocated in a review of fluoridation research. While reporting [pdf] “a beneficial effect of water fluoridation,” the researchers also note the dat
a “could be biased” because of the potential for “confounding factors,” and went on to state that: “Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken.”

So, apparently the studies touting the benefits of fluoridation are not all that iron-clad. And then there are the studies that seem to show that fluoridation is plain out ineffective.

Studies Finding Fluoridation Ineffective

Several studies from Europe and elsewhere (see here [pdf], here and here) show that developed countries now have similar levels of cavities whether they fluoridated their water or not — a change from the 1970s and ’80s when countries that did not fluoridate their water had more tooth decay on average than those that did.

Today, according to these studies, the incidence of tooth decay is universally low regardless of fluoridation.

What’s the Harm of Adding Fluoride to Drinking Water?

People along Ethiopia’s Ridge Valley are plagued with fluorosis because the groundwater they drink is heavily laced with geologic fluoride. Pictures taken in May 2010 by my Nicholas School colleague, Avner Vengosh, who studies the sources of groundwater contamination in the region.

The problem is fluorosis, dental and skeletal. Mild forms of dental fluorosis lead to faint discoloring or mottling of the tooth surface, a condition easily covered up by a dentist.

More severe fluorosis is characterized by dark stains and pitted teeth, in which the tooth’s protective enamel is severely compromised. (See more pictures of fluorosis here.)

Skeletal fluorosis can be a lot more serious. In its mild form, skeletal fluorosis brings painful stiff joints; but in severe cases, individuals can experience crippling calcification and/or fusing of the vertebrae.

How Much Fluoride Is Too Much Fluoride

U.S. municipalities add between 0.7 to 1.2 parts per million (ppm) of fluoride to our drinking water. The U.S. Environmental Protection Agency’s standard for safe drinking water is 4 ppm, well above the 1.2 ppm maximum from fluoridation. So all’s well, right? Not quite:

  • In addition to being added to a lot of our drinking water, fluoride is in our foods, our soft drinks, and of course our toothpaste. In fact there’s a lot more fluoride in the average American diet today than in 1962 when the standards were established. Depending on your diet, your drinking water’s 0.7-1.2 ppm dose of fluoride may or may not be safe. For example, a recent study illustrated that babies fed food reconstituted with optimally fluoridated water would exceed the safe fluoride intake for infants.
  • In a 2006 report the U.S. National Academy of Sciences concluded that EPA’s 4 ppm standard for fluoride in water is not sufficiently protective and should be lowered — a recommendation that EPA has yet to respond to (see story) and one indicating that the margin of safety between the supposed beneficial levels of fluoridation and harmful levels leading to fluorosis is much narrower than current regulations imply.
  • And then there’s the kicker — the health risks of fluoridation may include cancer. For example, Elise Bassin of the Harvard School of Dental Medicine and colleagues found [pdf] that the incidence of osteosarcoma (a rare and deadly form of bone cancer) increased by a factor of about five to six for boys who drank moderately fluoridated water as compared to those who drank water with little to no fluoride (more on study). (Without minimizing this result, bear in mind that the chances of an adolescent boy contracting osteosarcoma is only about eight per one million boys per year. So, if correct, this study suggests that the risk increases to about 40 to 48 boys per million per year. Those are still pretty long odds, long enough to suggest that it might make sense to accept the increased but still minuscule cancer risk for the benefit of avoiding tooth decay — that is, if fluoridation really protects you from tooth decay.)

So, What to Conclude About Fluoridating Water?

Fluoridation, controversial in the ‘50s, is still controversial today. Maybe fluoridation fights cavities, maybe not. Maybe it’s safe, maybe not. But there’s one more wrinkle.

When the U.S. policy to fluoridate our drinking water was first developed, scientists and dentists believed that only ingested fluoride benefited teeth. We now know that that’s not true. Topical application (e.g., from brushing teeth with toothpaste) is also effective at reducing cavities, by about 24 percent on average, though it’s not without its own risks. In the decades since 1955 when Crest with stannous fluoride first hit the market, it’s become hard to find a toothpaste without fluoride. Do we need fluoridation if we’ve got fluoride toothpaste?

All this makes me wonder, could fluoridating drinking water now be as anachronistic as fears of a communist plot?

Additional Resources

  • Does your area fluoridate your water? Find out here or through your local water utility.
  • Does your water filter filter out fluoride? See if it’s listed here or check with the company that makes your filter for information on what is
    filtered by your brand’s.
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  1. Doug Cragoe
    Sep 15, 2010

    Yes, infants are exceeding the safe limit of fluoride intake. But after the CDC warning about this in 2006 many state dental agencies affirmed once again that they recommend fluoridated water for the preparation of infant formula. There is a belief, but probably no studies, that says infants 0 to 6 months of age benefit from this large overdose of fluoride. Neither the CDC nor any leading dental researchers will say how much benefit these over dosed infants might get, thus informed parents are left in the dark regarding what to do. Should they take the risk of fluorosis or hope for a possible benefit of reduced tooth decay? The public health establishment is doing next to nothing to inform parents about this risk. According to the CDC the benefit of systemic fluoride is now considered secondary to the topical benefit. Infants have no erupted teeth for a topical benefit. Despite the U.S. National Academy of Sciences 2006 report recommending the EPA lower the MCL and MCLG for fluoride the EPA has chosen to do nothing. EPA scientists say there was scientific fraud committed when the EPA raised the MCL and MCLG for fluoride in the 1980’s. When the EPA said that severe dental fluorosis (stained teeth likely to fracture, wear out, decay and not last a lifetime) is not an adverse health effect it only served political purposes. The 2006 NAS report rightly said that severe dental fluorosis IS an adverse health effect. More children in the U.S. have fluorosis now than any time in history. Despite widespread public opposition, fluoridation is increasing in the U.S., mainly due to state mandatory fluoridation laws.

  2. Mel
    Sep 15, 2010

    From an exposure perspective, I’d be more concerned with kids eating bubblegum flavored toothpaste than fluoride in drinking water.

  3. Mel
    Sep 15, 2010

    I still believe the fears over the dangers of fluoride are exaggerated causing a mistrust of gov’t and misplaced conspiracy theories. Wasting money on filters for removal of fluoride also creates filter waste. I’m not sure I agree with the osteosarcoma findings yet but it is good to keep researching. You’re dollars are better spent on other healthy options like buying and eating healthier food. Yes, fluoride toothpaste may make water fluoridation a thing of the past for some countires but I’m still not buying the hype that the evil gov’t is killing us with fluoride to get ride of toxic waste (yes, opposition says this).

  4. Joy Warren
    Sep 15, 2010

    Fluoridation is supposed to prevent tooth decay in small children so that when they have their first dental examination at age 5, their teeth are less decayed than non-fluoridated children in other areas. However, fluoridation is a smoke-screen and the truth has been carefully buried by fluoridation proponents. In reality, fluoride delays the normal growth of primary teeth. Thus at age five, a fluoridated child’s teeth are younger and have had less time to become decayed and this ‘proves’ that fluoride works – or not. By the time that a neglected child is 6½ years old, the decay starts to catch up with the decay seen in a neglected 5-year-old in a non-fluoridated area. Because of delay in primary tooth growth, secondary tooth growth is also delayed and when they erupt, they often have dental fluorosis (DF) and because of cramped conditions, are often misaligned and misshapen. In Birmingham (West Midlands), a research report showed 34% of 9-year-olds in 5 primary schools as having DF because of swallowing fluoridated toothpaste. (Rock and Sabieha 1997.) The degree and incidence of DF would have been less if the children were not also fluoridated from birth and via the placenta). The research has been carefully buried. Send me your email address for a scanned version. Little research is done on adverse health effects because the UK Department of Health does not want to ask the questions and doesn’t want to discover the uncomfortable truth. For more information, please access and in particular the pages on ‘Dental Fluorosis’ and ‘Babies and Fluoride’. Joy Warren, BSc. (Hons) Environmental Science Coordinator, West Midlands Against Fluoridation

  5. Anita Knight
    Sep 14, 2010

    The US Dept. of Health & Human Services/ATSDR book; Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine (F)1993 and 2003, has a wealth of the health problems. What isn’t generally known is that the term ‘Fluoride’ should be plural as fluorine forms compounds and complexes with most all other elements, varying in toxicity. Calcium-fluoride for instance is mostly insoluble and rarely absorbed by the body. Another important factor is the “Grade”. All prescription drugs are USP pharmaceutical grade, whereas, all fluoridation agents are “Commercial Grade”. See The Merck Index, under “Fluorosilicic Acid”. Another very informative government document is “Health Effects of Ingested Fluoride” National Academy of Sciences/NRC, 1993, report for Congress.

  6. Anita Knight
    Sep 14, 2010

    The American Water Works Association AWWA Standard for Fluorosilicic Acid B703-06, liguid form used in around 90% of drinking water systems, is available from utilities departments. The forward gives source and proces which is from phosphate fertilizer industries. Also, the Florida institute of Phosphate Research, Public & Environmental Health report 2003-2004, available online, 2 pages, 4th paragraph gives environmental damages to cattle and orange groves prompting the use of “Wet Scrubbers” to capture the fluorides into…Fluorosilicic Acid. Second page notes presence of uranium and radium 226-228. The standard above here lists all these on page 13.

  7. nyscof
    Sep 14, 2010

    Fluoridation began in the early 1900’s when vitamins & minerals were discovered to “cure” diseases, e.g. Vit C prevents scurvy. Old-time dentists thought fluoride was their magic bullet, an essential nutrient required for healthy teeth. Modern science proved them wrong. Fluoride is neither a nutrient nor required for decay-free teeth. Consuming a fluoride-free diet will not cause tooth decay. A 1999 dental textbook, “Dentist, Dental Practice, and the Community,” by prominent researchers and dental university professors, Burt and Eklund, reports fluoridation is based more on unproved theories than scientific evidence. They report that there is no evidence that “optimal” intake inhibits cavities. In fact, the authors suggest “optimum intake” of fluoride be dropped from common usage. The politics of organized dentistry with its deep pockets filled with corporate cash keeps fluoridation alive. Fluoridation is their substitute for meeting the dental needs of low-income Americans. 80% of dentists refuse Medicaid patients and 130 million Americans don’t have dental insurance. Fluoridation keeps legislators off their backs when they should be mandating dentists treat everyone since government subsidies support their dental schools and tuition. Organized dentistry protects its lucrative monopoly by lobbying against viable groups from providing dental care, e.g. dental therapists. Meanwhile, two young boys died from the consequences of untreated tooth decay – one after two dozen dentists refused him. 6.2 million children on Medicaid suffer with untreated tooth decay, according to the GAO

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