Home Dentistry Articles Water Fluoridation controversy
Water Fluoridation controversy
Water Flouridation controversy refers to the
debate surrounding the health benefits of governments fluoridating
The Fluoridation Debate
In studies conducted by Masters and Coplan,
higher blood-lead levels are found in children who live in silicofluoridated
communities than in sodium or non-fluoridated communities. Silicofluorides,
used by over 91% of U.S. fluoridating communities, were never
safety tested in humans or animals, either alone or together
with other drinking water chemicals.
Other scientific studies suggest that the use
of fluorides, (H2SiF6 and Na2SiF6), even at levels injected
into water supplies to reduce tooth decay, 1 ppm in water, has
been implicated as a possible contributing factor in cases of
fetal damage, dental fluorosis, skeletal fluorosis, hypothyroidism,
weakened bones and Alzheimer's Disease and more.
At least four separate large-scale studies
totalling nearly half a million persons showed no net reduction
in caries by fluoridation; other studies have shown the decline
in caries has been occurring at statistically the same rate
in fluoridated and unfluoridated areas.This is in contradiction
to the great majority of studies and reviews on this subject.
A few examples:
A large majority of epidemiological studies
of fluoridation have found no adverse health effects. Critics
point out these studies are often funded by institutions with
an interest in continuing fluoridation and, they say, that researchers
such as Phyllis Mullenix have been fired for coming up with
"fluoride is harmful" results. However Dr. Charles
Vorhees, editor-in-chief of the journal Neurotoxicology and
Teratology, said of Mullenix, "Nobody else could ever produce
(results) consistent with Phyllis'" even though non-US
researchers have done so, including finding the effect in humans.
Critics also contend that others, such as William Marcus (reinstated
with back pay and interest in 1992 by a court order, the judge
noting "the reasons given for Dr. Marcus' firing were a
pretext.his employment was terminated because he publicly questioned
and opposed EPA's fluoride policy.") and John Colquhoun,
have been fired for poking holes in attempts to show fluoride
is safe. They go on to say that this discourages objectivity
and that studies have been repeatedly shown to have flawed techniques
or to have misrepresented or massaged their data.
Critics of fluoridation charge that fluoride
is deliberately associated with good health to protect many
major industries, especially uranium, aluminium, and steel smelting,
from the massive lawsuits that began to be filed in the 1930s
for fluoride related damage to livestock, farms, and community
health. One noted critic, Dr. Robert Carton of the US EPA said
"Fluoridation is the greatest case of scientific fraud
of this century, if not of all time." (Marketplace CBC
1992 Nov 24).
It is, however, true that the volte-faces on
fluoridation by the ADA, AMA, and PHS occurred coincidentally
with the heading of the FSA by Oscar Ewing, a highly-paid lawyer
for Alcoa. Alcoa had been connected to fluoride study since
the discovery of fluorosis in the town of Bauxite, Arkansas
as part of the "brown stain" mystery.
Current source and production of fluoridation
The phosphate fertilizer industry requires
phosphoric acid to produce a variety of phosphate salts for
agricultural use. In the manufacture of phosphoric acid, the
reaction of sulfuric acid on phosphate rock yields silicofluoride
gas. The process called "scrubbing" dissolves this
corrosive, toxic gas in water to comply with air quality standards.
The resultant liquid is hydrofluorosilicic acid (HFSA).
The precipitate from the reaction of sulfuric
acid with phosphate-bearing rock is called phosphogypsum. This
powder is stacked in mounds which are used to contain HFSA.
The industrial uses of HFSA include feedstock for synthesis
of sodium silicofluoride, aluminum fluoride, and polysilicones.
As the forementioned uses of HFSA do not provide a market for
all that is produced, the remainder sits in holding ponds on
phosphogypsum mounds or is sold to municipalities for use in
drinking water supplies.
Fluoridation issues spawned many court cases.
Anti-fluoride activists have sued cities for infringing upon
their rights, and on the claim that fluoridation is a form of
involuntary medication. Individuals have sued cities for a number
of illnesses that they blamed on fluoridation of the city's
water supply. In general courts have found in favour of cities
in such cases and have not found a connection between health
problems and fluoride (this in part because even if a statistical
connection to illness is proven, it doesn't prove the individual
is sick of this illness because of the connection. Courts have
an extremely high standard of proof when the illness may have
The FDA has never approved water fluoridation,
fluoride toothpaste for tooth decay, or fluoride supplements;
fluorides were in fact grandfathered into acceptance because
they were accepted before the 1938 law for mandatory testing
of medications. The only previous utilisation that caused the
grandfathering of fluorides is as the active ingredient of rat
poison. The FDA has come under heavy criticism in the US for
not questionning the sale of nontested fluoride despite opposition
in an ADA brochure in 1951:
From a 1951 American Dental Association brochure:
"There is no proof that commercial preparations such as
tablets, dentifrices, mouthwashes or chewing gum containing
fluorides are effective in preventing dental decay. Unfortunately
such preparations are being offered to the public without adequate
scientific evidence of their value."
In 1973 Jason Burton, a boy in Melbourne, Australia,
died after swallowing six fluoride tablets; four were recovered
after a stomach pumping while the other two had already been
absorbed into the body. The hospital staff had assumed it would
take well over 100 tablets to be fatal, making the Burton case
an object lesson in high concentration fluoride intake.
Currently one court case is ongoing in New
Jersey (USA). State Assemblyman John V. Kelly has requested
the ban of children's fluoride supplements; supplements that
duplicate the "ideal" fluoride levels set for water
Cities and countries' choices on fluoridation
A 1998 ADA study asked the question Do you
believe community water should be fluoridated?. 70% said yes,
and 18% said no, with the rest undecided. Health organizations
and dentists that recommend water fluoridation point to the
great majority of studies which show statistically significant
decreases in cavities where water fluoridation is done. A handful
of other studies show no reduction or even increases in cavities.
The idea to fluoridate public water supplies
goes back to study of "Colorado brown stain", a condition
of the first settlers wherein their teeth were severely stained,
sometimes chocolate-colored. This was eventually identified
as severe fluorosis. Unusual resistance to dental decay was
also noted. This was attributed to the fluorine content of the
water; the water also had high calcium and magnesium content
which was apparently overlooked.
Fluoridation was first introduced in the late
1940s. Debates began in many communities; ultimately, most decided
to accept fluoridation. The first city to fluoridate its water
was Grand Rapids, Michigan in 1945, as part of a ten year evaluation
of fluoridation. The experiment was effectively terminated early,
in 1951, with the imposition of fluoridation in the control
group, Muskegon, Michigan.
Unlike North America, less than 2% of Europe's
population has fluoridated water. Sweden banned fluoridation
in 1971 by mandate of their Supreme Court; the Netherlands banned
it constitutionally in 1976. West Germany rejected it in 1971;
Norway, 1975; Denmark, 1977; France, 1980. In other places in
the world, Chile rejected fluoridation in 1977; India and Egypt
also have. Australia has fluoridation in all but one state (Queensland).
Finland maintains an "experimental program" covering
only 1½% of its people.
In Switzerland, only Basel's water was fluoridated,
and that was stopped in April 2003 on the advice of their Health
and Social Commission Diesendorf "Mystery of Declining
Tooth Decay" Nature 1986 points out "in western Europe
where there is little fluoridation...large reductions in caries
had been occurring in unfluoridated areas". (emphasis added).
However, the dental public health systems in most European countries
are significantly different from North America. Many countries
have school-based programs offering free dental care to children,
some offer free and low fee care to all citizens.
In the United States, 45 cities abandoned the
practice between 1990 and 1996. Gov. Pataki of New York signed
on July 2, 1996 a law transferring the decision to fluoridate
water from bureaucrats to elected officials.)
In Canada, Calgary began fluoridating in 1991
after the fifth plebiscite on the prospect finally approved
it in 1989--although a 1984 study showed that fluoridated Edmonton
had a statistically identical rate of tooth decay <note the
1984 result was from a provincial survey which did not report
results by city - it only compared rural to urban>. Whitehorse,
watching Calgary review the decision in 1998, ended its 30 years
Health Canada's current stance is that fluorides
are beneficial to teeth, but that other physiological benefits
are unproven . The National Academy of Sciences generally agrees
with Health Canada's opinion; from a November 1998 letter: "First,
let us reassure you with regard to one concern. Nowhere in the
report is it stated that fluoride is an essential nutrient.
If any speaker or panel member at the September 23rd workshop
referred to fluoride as such, they misspoke. As was stated in
Recommended Dietary Allowances 10th Edition, which we published
in 1989: "These contradictory results do not justify a
classification of fluoride as an essential element, according
to accepted standards. Nonetheless, because of its valuable
effects on dental health, fluoride is a beneficial element for
Secondary effects of fluoridation
In 1970, Grand Rapids, Michigan and Newburgh,
New York had twice the United States average of dentists per
capita (Anne-Lise Gotzsche The Fluoride Question, Panacea or
Poison? p8). The ADA found in 1972 that dentists make 17% more
profit in fluoridated areas as opposed to non-fluoridated areas
(Douglas et al. "Impact of water fluoridation on dental
practices and dental manpower" Journal of the American
Dental Association 84:355-67, 1972). This could simply be a
correlation between cities with fluoridated water having larger
populations to serve, on the assumption that larger cities or
water supplies are more likely to fluoridate their water; a
correlation could also be caused by citizens in those areas
being more concerned with their dental health.
Scientific issues rarely raised
Water fluoridation may be done with non-pharmaceutical
grade material; it may contain substances that would never be
added in toothpaste such as lead, arsenic or other industrial
by-products (in some cases, radionucleides). The quantities
of such substances is however low and within the safety standards
set for each of these substance individually (even if detectable
effects occur at those levels).
One should remember that arsenic and lead may
be more toxic by themselves than the sodium fluoride at the
dosages found in typical fluoridation, and the combination is
known to be more toxic than the parts. Fluoridation is therefore
potentially toxic even if fluorides were at a safe dose. This
argument alone would ban fluoridation as it is done today, but
unfortunately it is little-studied in combination with fluoridation.
Many scientific facts could be tested by studying
pure pharmaceutical-grade water fluoridation on humans without
association to other substances - whether the associated substances
are beneficial, toxic, neutral, or untested. A better scientific
assessment of fluorosis/benefit/fluorosis dosage is the likely
Most of the studies and regular media fail
to ask those questions because it doesn't fit the "prove
fluoridation is toxic/useless" or "prove fluoridation
works" political agendas which are the end result of typical
politics. The "find the safest fluoridation kind"
scientific goal is usually ignored by both sides of the controversy
for reasons completely out of the scope of the scientific method.
All other medications had to answer those two
questions before scientific acceptance. The scientific standards
used to approve of water fluoridation should be no different.
The current FDA position of tolerating the ingestion of an untested,
non FDA approved (*) medication as de facto compulsory and costly
to avoid is without parallel in the FDA's history.
As fluorides are necessary ingredients in some
medications (in order to cross the blood-brain barrier), one
cannot set aside the idea that fluoridation might amplify the
effect/interact with a few medications without doing some research.
Another baffling question: since the Varner
et al. study and its peer review and replications found a surprising
80% early death rate for rats in a sodium fluoride and aluminium
study (in the lowest dosage group and NOT in the high dosage
group - as opposed to expectation), using the same fluoride
and aluminium ppm range as used by aluminium-industry based
fluoridation providers, why didn't the scientists plainly see
that humans don't have a 80% death rate from same and declare
the rats to be a bad model of fluoride+aluminium effects on
humans? Why didn't they mention the nonlinear and not clearly
dose dependant nature of fluoride+aluminium poisoning in rats
isn't proven to be absent in humans? This study has two consequences:
All studies on rats may be badly misleading
as rats are not a good animal model for fluoride+aluminium
studies. Without a good animal model (one that is not known
to react very differently than humans) no animal study may
scientifically claim fluorides are safe or unsafe for humans.
In similar cases at least one monkey study is done but it
is not the case with fluorides.
The overwhelming number of studies on
rats or humans make no attempt to detect the nonlinear effect
of the toxicity of sodium fluoride with aluminium; they
assume sodium fluoride toxicity at fluoridation levels will
simply add with aluminium toxicity at fluoridation levels
without synergy, or only in a one-sided fashion (i.e. the
belief that adding more toxin can't reduce death rate).
This assumption is replicatedly demonstrated to be false
for rats, and cannot be scientifically claimed to be present
(perhaps in a different form and dosage) or absent in humans
before more research is done.
Conclusion on controversy
Most fluoridation studies examine teeth but
not the body. Most show that water fluoridation reduces cavities
with no significant risk of other effects, when done at prescribed
levels because other health effects are seldom part of the study.
Since ingested fluoride delays eruption of teeth, those studies
may be totally invalid. Some show a statistically significant
increase in fluorosis when fluoridation is done (even while
cavities are decreased). Still others show fluoridation providing
no benefits at all.
Some of the early fluoridation studies which
show large improvements in dental health are scientifically
invalid. Cavity decline could be attributed to vitamin D and
other nutrient fortified foods, better health awareness, better
diets and/or better dental care. Non-fluoridated countries also
experience a decrease in cavities during the same period.
In any case the results aren't replicable by
trying the same thing today, so many early studies cannot be
trusted as much as previously claimed. Considering how many
fluoride studies have been discredited for being contested by
peers, a recursive medical literature search about each and
every study's contestation is basic prudence regardless of the
side you take.
In any event, the controversy over fluoridation's
effects (positive, useless, or negative) on the public health
is unlikely to end soon.