The Fluoride dilemma is not new and continues to extract comments and recommendations from responsible bodies who question the safety and wisdom of public water fluoridation.
The proponents of fluoridation, on the other hand, continue to promote the image of safety and benefits to dental health, and resist efforts to have current fluoridation policy reversed.
These debates are currently topical in the USA, and a review of current policy in Ireland is timely, given the growing concerns expressed by international bodies as they review previously held positions about policy and practice.
The proponents and antagonists of fluoridation policy have been deadlocked in a 60 year old debate, with both sides challenging the credibility of research evidence on which their respective views are based.
Ireland currently adopts a policy of fluoridation, which reflects the USA practice standards recommended by the US Environmental Protection Agency (EPA) in 1986.
(The USA Public Health Service endorsed the fluoridation of public water in 1950, before one single trial had been completed !)
Recognising that fluoride has the potential for toxicity the EPA established a maximum allowable concentration for fluoride in drinking water of 4mg/L, with a lower level of 2mg/L aimed at the prevention of dental fluorosis, a mottling of tooth enamel, widely considered to be a cosmetic consequence without risks to health, while providing for protection against dental caries.
The USA Public Health Service set a range of 0,7mg/L – 1,2mg/L more than 40 years ago for the prevention of dental fluorosis, at which time Ireland introduced fluoridation, and continues to do so, with recommendations to local authorities not to exceed levels of 0,8g/L in fluoridation.
Current levels are reported to be at 0,6mg/L – 0,8mg/L.
A meeting of the Irish Expert Body (IEB) on fluoridation took place on 27 Feb, 2008 at which a review of EPA standards was conducted, with reference to the potential for adverse effects at levels between 2-4mg/L.
No evaluation of risk/benefit was undertaken at this meeting for levels of fluoride concentration between 0,7 – 1,2mg/L.
Gaps in the body of evidence prevented the EPA from making judgements of risk or safety at the lower levels, and the IEB bases its current policy on presumptions of safety at the current level.
The Expert Body, according to its Action Plan 2005, identified “the lowering of the fluoride level in drinking water to a range of 0.6 to 0.8 ppm, with a target of 0.77 ppm” as its first priority. (This represents a policy amendment from the 1966 regulations.)
The Expert Body’s view is that fluoridation is safe and effective, and that current policy benefits overall health.
A legitimate concern expressed by the IEB is the dental decay rates in the Republic which have reportedly improved with fluoridation, compared to those in Northern Ireland, but which are likely to increase, given a background of high sugar intake with sweets and fizzy drinks among Irish teenager, a dietary pattern for which Ireland ranks 3rd worst out of 35 countries, according to a HBSC survey.
The IEB also bases its policy on assessments of international practice, quoting endorsements by the World Health Organisation (WHO), the Centre for Disease Control and Prevention, the United States Public Health Service, and the FDI World Dental Federation.
Several government sponsored reports from USA, UK and Canada have reviewed critically previously held positions, and UNICEF, the health arm of the UN has expressed concerns about the harmful effects of fluoridation.
Dr. Sean O’Hickey (IMN July,14 2008) makes a 10 point defence of the current Irish practice of fluoridation, with references to safety, evidence, contamination, peer review, constitutionality, UK proposals and WHO endorsement.
Robert Pocock (IMN July, 21 2008) in his rebuttal of Dr. O’Hickey’s arguments, raises the important issues of absent fluoride regulation and the clinical consequences of systemic toxicity.
The US Agency for Toxic Substances and Disease Registry lists fluoride as among the top 20 of 275 substances that pose the most significant threat to human health.
Warnings of fluoride toxicity have generally been dismissed by proponents of fluoridation as the rantings of over-zealous members of fringe groups. Nevertheless, increasing numbers of influential academics are adding their names to an impressive listing of those who call for a reversal of fluoride policy.
The sobering discovery by Dr. Elise Bassin (Harvard School of Dental Medicine) in 2001 calls for a review of the prevailing casual approach to fluoride toxicity.
In her Doctoral thesis she demonstrated clearly that young boys who drank fluoridated water were five times more likely to develop osteosarcoma (bone cancer) than those who did not drink fluoridated water.
Unfortunately, the significant and irrefutable data she produced was suppressed by Dr. Chester Douglas, her doctoral advisor, and not made available to the public.
The true data only emerged in April, 2006, at which time her findings were validated in a new study.
Dr. Douglas was ruled to have made an “unintentional” omission, but his strong financial ties to a fluoride toothpaste manufacturer did not go unnoticed !
These events illustrate the degree of powerful political and financial undercurrents that influence scientific enquiry and public health policy, and raises questions about the fluoride industry in the USA and its close relationship with the aluminium industry and toxic waste handling.
In the USA silica-fluoride and sodium fluorosilicate are used in fluoridation, these chemicals being by-products of industrial waste, and may thus contain traces of other contaminants.
The American Medical Association is not prepared to state that no harm will be done to any person by water fluoridation, according to Dr. Flanagan, Assistant Director of Environmental Health, American Medical Association, while the FDA considers fluoride to be an “unapproved drug”.
As such, fluoride used for water fluoridation does not have FDA approval.
The United States Federal government requested an expert opinion concerning risks for neurotoxicity arising from fluoridated water in military supplies. Dr. Mullenix , the neurotoxin expert stated, “hoped for benefit”. fluoride exposures today are out of control…there are no advantages to water fluoridation, The risks today far exceed the benefits…”
Sweden recommended against fluoridation on the grounds of toxicity, as did France, after consultations with the Pasteur Institute.
Since the chemicals utilised for fluoridation are the by-products of aluminium and fertiliser manufacturing, and contain high concentrations of heavy metals such as arsenic, lead and chromium, their carcingenic potential cannot be discounted.
Assurances are required that Irish fluoride sources are not exposed to such hazardous materials.
Several studies show increased fracture rates at fluoride concentrations in drinking water of 4mg/L, and an increase in hip fractures in populations exposed to fluoride concentrations above 1,5mg/L.
Of 19 studies since 1990 exploring the relationship between fluoridated water and hip fractures in the elderly 11 show a positive association.
The sources of fluoride ingestion are ubiquitous and may include many commercial foods, beverages, teas, dental products and pesticide residues on non-organic foods.
Processed Soy products, like milk and ice-cream, readily consumed by young children, contain significant amounts of fluoride.
The lifelong ingestion of these products, in addition to water containing fluoride, may give rise to levels that exceed optimum safety and produce unwanted systemic effects.
Fluoride accumulation may occur in critical organs other than bone (skeletal fluorosis), such as thyroid tissue, the pineal gland and reproductive organs.
A possible link has been demonstrated between fluoride levels and learning disabilities, brain dysfunction and ADD and ADHD.
Fluoride is a haptogen, with similarities to chlorine, bromine and iodine, and when ingested may displace iodine, giving rise to depleted levels in the body with the subsequent development of hypothyroidism.
Cretinism is prevalent in low iodine areas in Xinjiang, China, and Chinese studies reveal lower IQs in children from areas of fluoridation.
It has been estimated that young children, because of their body weight, may accumulate 3-4 times the adult dose when exposed to fluoridated drinking water.
Preparation of formula milks for infants, using fluoridated water, exposes them to additional risks of toxicity, and warnings to this effect have been issued to Hospital Nurseries.
Such alerts should not be necessary if fluoride was non-toxic or absent from drinking water.
The argument of “mass medication” has received a response from Dr. O’Hickey, but the case of “greater common good arising from decreased dental disease” is far from convincing.
The longest survey ever conducted in the USA by the National Institute of Dental Research showed little difference in tooth decay among children in fluoridated and non-fluoridated communities.
A Canadian review by Dr. D. Locker, of the statistical differences in this study concluded, “ the magnitude of fluoridation’s effect is not large in absolute terms, is often not statistically significant and may not be of clinical significance”.
New Zealand studies, where mandatory dental assessments of children aged 12-13 years take place under the National Health Services Plan, show healthier teeth within non-fluoridated communities compared with fluoridated communities.
The mass medication principle is therefore questionable as a philanthropic principle, and also as a moral exercise.
Where is the physician who will impose a life-long prescription of an untested, potentially toxic substance, without proven clinical benefit, on a patient that he/she has never met, interviewed or examined ?
Such an act would be judged to be unscientific, unscrupulous, unethical and thus unacceptable.
This is one of the major reasons that most European countries have rejected the policy of fluoridation, citing the moral issue of “the problematic nature of compulsory medication” (Germany), or “force-feeding (Finland).
The indiscriminate targeting of vulnerable population groups with a potentially toxic chemical is a practice that demands critical review with reference to professional ethics, to the principles of science, and to high standards of safety, never forgetting the dictum that remains our guiding principle, “First do no harm!”.
It is timely to review the evidence presented to the 2002 Irish Fluoridation Forum.
Ireland is now faced with a challenge to distance itself from USA policy and implement an independent national fluoridation policy that takes account of emerging scientific data and the best health interests of its several population groups.
(This article was sent to the IRISH MEDICAL TIMES in July, 2008 and not published.)
Dr. Neville Wilson,
The Leinster Clinic, Maynooth, 28 July, 2008.