Decayed, Missing and Filled Teeth
In 1987, Dr. Allan Gray,
then
Director, Division of Dental Health Services
for the province of British
Columbia, Canada, published an article in the
Journal of the Canadian Dental
Association (vol 10, 763-764) pointing out
that it was "time for a new
baseline." He pointed to the finding that tooth
decay, as measured by DMFT
(Decayed,
Missing and Filled Teeth) rates were
falling "drastically" in
non-fluoridated
areas as well as fluoridated.
Six years later, in 1993, Dr.
D. Christopher Clark, Associate Professor,
Faculty of Dentistry,
University
of British Columbia, wrote in the same
journal (vol 59, 3, 272-279)
that "[T]he traditional thinking about the way
fluorides prevent dental
caries
has changed. Recent studies have
demonstrated that the role of
fluorides in the prevention of dental caries
is predominantly through
remineralization,
which is primarily a
posteruptive phenomenon. The
primary effect from fluorides is
post-eruptive, not
pre-eruptive,
and more therapeutic than preventive."
These "recent studies" are
represented
by those of Doctors O. Fejerskov and
F. Manji of the Royal Dental
College, Aarhus, Denmark and Dr. A. Thylstrup,
Royal Dental College,
Copenhagen,
Denmark and others such as Dr. J.M. Ten
Cate of the Academic Center
for Dentistry, Amsterdam, the Netherlands.
These European dental
scientists
contributed their views to an
international symposium on
fluorides
that was held March 21-24, 1989 in
Pine Mountain, Georgia, U.S.A.
The proceedings of this Conference were
published as a "Special Issue"
in the February 1990 edition (Vol 69) of the
Journal of Dental Research.
Special Issue of Journal of Dental Research
In the same Special Issue,
Doctors
H. Kalsbeek and G.H.W. Verrips of the
Netherlands Institute for
Preventive
Health Care reported on their studies
of dental caries prevalence
and the use of fluorides in different European
countries. They stated (on
page
731) that "no significant association was
found between the availability
of fluoridated water and fluoride
dentifriceand the DMFT in 12
year-old children." They found, also, that
"[I]n most European countries,
the 12 year-old DMFT index is now
(1985-1988) relatively low as
compared with figures from 1970-1974."
Their findings agree with
those
found in the smaller population studied by
Dr. Gray in 1987. Does this
indicate a shift away from fluoridation on the
basis of new scientific
findings?
Is science the nemesis of fluoridation?
Herschel S. Horowitz, of the
National Institute of Dental Research,
National Institutes of Health,
Bethesda, Maryland U.S.A., could
appropriately be called a
"crusader"
for the cause of fluoridation. He
summarized (p760-764) his
concern
regarding the many factors that could
influence public acceptance
of the procedure. Horowitz classifies the
factors as "socio-political."
These factors are:
1. The change in allocating
Federal (U.S.) funds to States that prevents
the "earmarking" of money for
fluoridation as opposed to "block funding" in
which fluoridation must
compete
with other public health priorities;
2. The perception by the
public
of dental fluorosis as a "problem" when
they become increasingly aware
of the high incidence being reported;
3. The publicity being given
to the results of studies such as the
1986-1987 oral health survey
of U.S. schoolchildren which showed a
continuing decline in caries
prevalence in both fluoridated and
non-fluoridated groups, which
called forth a declaration, by those
reporting the data, that
"caries
is no longer a public health problem";
4. The public's perception
that
fluoridation is environmental pollution;
and
5. The increase in public
anxiety
with regard to the many possible adverse
health effects.
Dr. Horowitz expresses his
exasperation
with the democratic process. "In
some localities," he writes,
"politicians are empowered to make such
decisions (i.e., to
fluoridate)
but, frequently, in order to protect their
perceived reelection
potential,
they decide that a public vote should be
held on community water
fluoridation,
which, in effect, transfers the
responsibility to an
uninformed
or misinformed public."
His opinion of those
professionals
who do not possess his zeal for
fluoridation is not much
higher
than his perception of the public. "The
public and health care
practitioners,"
he writes, "are ill-informed or
misinformed about the value
and appropriate uses of fluoride, and about the
relative benefits produced by
fluoride compared with other methods
promulgated for the prevention
of caries."
Dr. Horowitz's first point
appears
to be an admission that the fluoridaters
have had, in the past, a
potent
way to bribe financially strapped
communities to add fluoride
to their water supplies. This "incentive" has
worked well in the past to tie
fluoridation in with Federal grants for
upgrading community water
systems.
It is noteworthy that he is not
mentioning any curtailment of
Federal funds that are used to promote
fluoridation both in the U.S.
and abroad.
Fluorosis
His second point concerns
dental
fluorosis. This has long been painted as a
"mild cosmetic" change in the
teeth of children and adults who were exposed
to fluoride during dental
development.
There is sufficient understanding of
the process underlying dental
fluorosis and the implication of deposition
of fluoride in the skeleton
and soft tissues in papers that accompany
Horowitz's in the Special
Issue.
Fejerskov states (p693) that
"[the clinical features reflect that fluoride
given in low concentrations
over the long period of tooth development
results in various degrees of
enamel porosity (or hypomineralization)." He
continues, "[I]n its mildest
forms, the porosity is to be found in the
outermost enamel only, but the
entire tooth surface is involved. With
increasing severity, both the
depth of enamel involvement and degree of
porosity increase. Assuming
a relatively constant exposure level (most
commonly water-borne
fluoride),
all surfaces of a given tooth will be
equally affected.
"In more severe forms of
dental
fluorosis" Fejerskov continues (p694), "the
tooth erupts into the oral
cavity
entirely chalky white. The degree of
porosity (hypomineralization)
of such teeth result in diminished physical
strength of the enamel, and
parts of the superficial enamel may break
away."
Dr. G. M. Whitford, of the
School
of Dentistry, Medical College of Georgia,
U.S.A., well-known for his
work
on the metabolism and toxicity of fluoride
and support of water
fluoridation,
has this to say about prevalence (p546).
"There is a growing body of
evidence which indicates that the prevalence
and, in some cases, the
severity
of dental fluorosis is increasing in both
fluoridated and
non-fluoridated
regions in the U.S."
Later, he continues, "This
trend
is undesirable for several reasons: (1) it
increases the risk of
esthetically
objectionable enamel defects; (2) in
more severe cases, it
increases
the risks of harmful effects to dental
function; (3) it places dental
professionals at an increased risk of
litigation; and (4) it
jeopardizes
the perception of safety and, therefore,
the public acceptance of the
use of fluorides."
In countries such as China and
India, that have large populations living in
endemic fluorosis areas, the
various degrees of dental fluorosis are seen
as a continuum with
accompanying
bone deposition which leads, in many
cases, to crippling skeletal
fluorosis, paralysis and soft tissue disease.
If dental fluorosis were to
be "officially" recognized as an "adverse
effect" by senior Government,
it would be "game over" for fluoridation as a
"safety factor" would be
required
that would lower the Environmental
Protection Agency's (EPA)
Maximum
Contaminant Level (MCL) for drinking
water to 0.2 mg/L fluoride
(from
its present 4.0 mg F/L). This would be
very much lower than the
"optimal"
concentration of 0.7-1.2 mg/L fluoride
recommended for water
fluoridation.
This lower figure would be based on the
2.0 mgF/L concentration
established
(by EPA) as the level to produce dental
fluorosis and a safety factor
of 10. In actuality, dental fluorosis is
related to total ingestion of
fluoride of 0.75-1.0 mg fluoride per day
(Whitford in The Metabolism
and Toxicity of Fluoride, Karger, 1989).
It is of interest that a
recent
Canadian review, Inorganic Fluorides,
carried out by the Ministries
of Environment and Health under the Canadian
Environmental Protection Act
and published in 1993, declined to assess
either dental fluorosis or the
beneficial effects of fluoride in the
prevention of dental caries,
the subject of Dr. Horowitz's third concern.
Dental fluorosis, to sum up,
is a noticeable and undesirable cosmetic
change due only to the
influence
of fluoride on developing teeth. Because
it is associated with damage
to the teeth and deposition of fluoride in the
skeleton and soft tissues, it
is an adverse effect with psychological as
well as physical implications.
The injury to the enamel,
described
by Fejerskov, must predispose toward
caries, not act as a
preventive.
Dr. Horowitz and his
pro-fluoridationist
colleagues have good cause to be
concerned about recent studies
of effectiveness.
Cost Effectiveness
By the very nature of
statistical
science, selective, small scale studies
can show reductions in caries
as measured by the DMFT or DMFS (tooth
surfaces) of 40% or better,
the figure used to calculate
"cost-effectiveness." For
example,
a British Columbia study compared the
DMFS of 109 children in
fluoridated
Kelowna and 93 children in
non-fluoridated Vernon. The
DMFS of these 10 year-olds was 1.65 and 2.5
respectively. The "benefit"
for the fluoridated group was 34%. But, the
difference was 0.85 of a tooth
surface! This is not clinically significant
and is within "examiner error"
that has been shown to be, typically,
between 15-20%. Dorothea F.
Radusch wrote in the Journal of the American
Dental Association (28,
1959-62)
as long ago as December 1941 that this may
be as high as 74% for carious
tooth surfaces.
When studies based on large
populations are reported honestly, "the truth
will out." Such is the case
with the 1986-87 oral health survey of U.S.
schoolchildren (39,207
children
ages 5-17 years). This, as Horowitz pointed
out, showed a continuing
decline
in caries prevalence in both fluoridated
and non-fluoridated groups.
Analysis of the data (obtained through the
Freedom of Information Act)
by Dr. John Yiamouyiannis, a well-known
biochemist from Delaware,
showed
no significant differences in decay rates
of permanent teeth or the
percentages
of decay-free children in
fluoridated, partially
fluoridated
or non-fluoridated areas. This study was
published in Fluoride, the
journal
of the International Society for
Fluoride Research (vol 23, 2)
in April 1990.
Analysis of the same data by
Doctors J. A. Brunelle and J. P. Carlos of the
National Institute of Dental
Research (NIDR) and published by the U. S.
Public Health Service in
Health
Benefits and Risks February 1991, the
promoter's "Bible," showed a
"benefit" of 17.7% which is within both
mathematical error exhibited
in their paper (Yiamouyiannis) and within
"examiner error" and is,
therefore,
not significant.
Prof. Y. Imai of Japan studied
22,000 schoolchildren in 1972 in naturally
occurring fluoride areas (nat)
and found increased caries with increased
levels of fluoride. A study
of 23,000 elementary schoolchildren in Tucson,
Arizona, by Dr. Cornelius
Steelink
in 1992, showed increased caries with
increased levels of fluoride
(nat) in drinking water as did Prof. S.P.S.
Teotia of India who reported
on a study (nat) of 400,000 children from 1973
to 1993.
Dr. John Colquhoun found in
a study of 26,405 12-13 year old schoolchildren
in New Zealand, in 1989, that
those living in artificially fluoridated
areas had slightly more caries
than those living in non-fluoridated areas.
Furthermore, both Colquhoun
and Steelink showed in their studies that there
was a definite positive
correlation
between low family income and the
prevalence of caries. This was
independent of the level of fluoride in
drinking water and whether it
was artificially added or occurred naturally.
Why is the public not
better
informed about this? Why do Dr. Horowitz and
his colleagues, especially in
the U.S., Canada, the U.K., Ireland,
Australia and New Zealand, the
major fluoridating countries, continue not
only to hang on to this
scientifically
bankrupt procedure but also to
promote it actively.
It is of interest to note that
dental researchers in largely unfluoridated
Europe no longer consider that
the systemic use of fluoride has a place in
the primary prevention of
tooth
decay. Some of these, consider that topical
application, under specific
conditions, may prevent caries formation by
"remineralization" of
incipient
lesions.
Fluoridation does not prevent
tooth decay but it contributes to dental
fluorosis and other adverse
health effects that will be discussed later.
Can it be perceived as
environmental
pollution?
Environmental Pollution
Fluorine is the 13th most
abundant
element on earth. It is so volatile that
it is found in nature as
fluoride
in combination with other elements, such
as calcium, magnesium,
phosphates
etc.
Fluoride is not an "essential
element" so far as human nutrition is
concerned. It is not
recognized
as such by the U.S. Food and Drug
Administration (FDA) and has
never been demonstrated as "essential" by
animal experimentation.
However,
fluoride is essential for modern industry,
the fluoride wastes of which
are responsible for pollution of the air, land
and water.
The fluoride placed into the
majority of drinking water supplies for the
purpose of increasing natural
levels, if any, to the "optimal
concentration" required by
fluoridation
is in the form of hydrofluosilicic
acid or sodium silicofluoride.
These are waste products of the phosphorous
and phosphate fertilizer
industries.
These products are obtained from
scrubbing factory stacks to
remove wastes such as sulphur hexafluoride that
would, otherwise, cause
atmospheric
pollution.
These products are introduced
into public drinking water systems with
little regard to other
contaminants
that may be present such as lead,
mercury, arsenic and
radionucleides.
In the US, a Water Chemicals Codex
addresses the Recommended
Maximum
Impurity Content (RMIC) for lead and
arsenic but not radionucleide
levels.
George Glasser, reviewing the
subject for the Sarasota Eco Report (Vol 4,
No 12,) of December, 1994,
states:
"[A]nother coproduct from phosphate
fertilizer manufacture is
yellow-cake
uranium. The radioactive coproduct is
used in the manufacture of
nuclear
weapons and the nuclear power industry.
The wastes from the
manufacture
of phosphate fertilizers are also
contaminated with radium and
are among the most concentrated radioactive
wastes produced from natural
materials. These radioactive wastes are
referred to as naturally
occurring
radioactive materials (NORM) and the EPA
has no regulations for NORM
waste disposal."
Neither the publication
Toxicological
Profile for Fluorides, Hydrogen
Fluoride and Fluorine (F),
prepared
for the U.S. Department of Health in
December 1991 nor the Canadian
Government's 1993 review, Inorganic
Fluorides, provide estimates
of the amount of fluoride entering the
environment via the
fluoridation
of water supplies. The Canadian report
does contain sufficient
"clues"
to enable an estimate.
The example of Tacoma
(population
250,400 (1990 census) in Washington
State, gives an idea of the
amounts. Fluoride plants' monthly reports were
collected from the Tacoma City
Water Department. The data are recorded in
US gallons, pounds and
"short,"
or US tons.
The daily amounts, on average,
are: 57,000,000 gallons of water processed
through the system; 2,300
pounds
(1.15 tons) of hydrofluosilicic acid and
4,100 pounds (2.05 tons) of
sodium hydroxide are added. The
hydrofluosilicic acid is
"commercial
strength," 24.20%. The daily amount of
fluoride ion added to the
water,
and therefore, into the environment, is
estimated to be 424.62 pounds
(0.2 tons). Annual discharge of
hydrofluosilicic acid into the
Tacoma water system, on average, is 419
tons. The annual amount of
fluoride
ion is 73 tons.
It can be calculated that on
the basis of an intake of one pint of water
per day for children aged 0-11
years, the "target group" of fluoridation,
as estimated by Dr. F.J.
McClure
in 1943 and Dr. J.S. Walker, in 1963,
children consume about 0.06%
of the water supply. Therefore, 99.04% is used
exclusively to carry fluoride
elsewhere, largely through the sewer system
where it is a source of
pollution
to the environment.
One can truthfully state that
"for every $1000 spent for fluoridation
chemicals, less than fifty
cents
goes to children."
Fluoride Discharged into Environment
On the basis of the Tacoma
data,
it can be calculated that for every one
million persons living in a
fluoridated area, 292 tons of fluoride ions are
discharged into their water
supplies each year. For the population of 134
million Americans the A.D.A.
states, who are on fluoridated water supplies,
this is an estimated 39,000
tons of fluoride annually.
The Canadian study, mentioned
previously, permits a calculation of 2000
tonnes (1 tonne = 2240 lbs.)
of fluoride annually discharged into the
environment from fluoridated
water supplies. This amount places this source
of fluoride discharged in
water
second only to phosphate fertilizer
manufacturing, but ahead of
chemical production, coal-fired power, primary
aluminum production, and
others
that are identified.
Fluoride, in community water
systems, enters the environment in various
ways. Surface runoff from fire
fighting, washing cars, watering gardens may
enter streams directly or
through
storm sewers at the "optimal
concentration" of one part per
million (ppm) or 1 milligram per liter
(mg/L). Most enters during
waste
water treatment.
T.T. Masuda reported in 1964,
after studying a large number of US cities,
that concentrations of
fluoride
in sewage effluent in fluoridated cities
even after secondary treatment
was 1.16-1.25 mg/L. This compares to 0.38
mg/L fluoride in unfluoridated
sewage effluent.
Studies by L.L. Bahls,
reported
in 1973, and L. Singer and W.D. Armstong,
in 1977, demonstrated that the
elevation of fluoride levels in sewage
effluent could persist for a
considerable distance, up to 16 km. in one
instance.
The promoters of fluoridation
argue that dilution reduces concentration
over distance. But, the amount
of fluoride is deposited in sediment, either
locally or, in the case of
rivers,
in the estuary. Fluoride in sediment may
persist for 1-2 million years.
It may recontaminate water if dredging takes
place. It also has a direct
toxic effect on sediment-dwelling organisms.
Those responsible for the 1993
Canadian Government Review, Inorganic
Fluorides, concluded that
inorganic
fluorides are entering the Canadian
environment at concentrations
that may cause long-term harmful effects to
biota in aquatic and
terrestial
ecosystems.
With regard to the effects on
aquatic organisms, the authors extrapolate
laboratory findings to the
field,
to yield estimated adverse effects
thresholds (lethal, growth
impairment
and decreased egg production) of 0.28
mg/L fluoride for fresh water
species and 0.5 mg/L for marine species.
These are exceeded by surface
runoff and sewage effluent from fluoridated
water systems.
The author of this article and
Anne Anderson published a review in Fluoride
(Vol 7 No 4, 1994) showing how
effluent from fluoridated water systems in
British Columbia and
Washington
State could be contributing to the loss of
salmon species in the Fraser
and Columbia-Snake river systems. This could
be attributed not only to
direct
toxic effects on all stages of fish
development and their feed;
but also, to the inhibition of migration. This
latter was shown by Drs. D.
Daemker and D.B. Dey in their study of the John
Day Dam on the Columbia river
published in 1989.
Fluoride is toxic in low
concentrations
to all living things. The authors
of the Canadian review, in a
section entitled "Ecotoxicity," present a
review of the effect of
inorganic
fluoride, airborne in particular, on
plants and animals, especially
herbivores.
Fluoride More Toxic than Lead
Fluoride is known to be
more
toxic than lead and only slightly less toxic
than arsenic. Recently, in
1994,
N.P. Gritsan, G.W. Miller and G.G.
Shmalkov reported their study
on the effect of various pollutants on
abnormal plant development in
Southeast Ukraine. They found that among 17
elements, including fluoride,
cadmium, lead and aluminum, fluoride was the
most toxic.
Since humans share the same
enzyme systems and DNA mechanisms as other
biota and fluoride is a proven
enzyme and DNA repair inhibiting agent, why
would anyone think that humans
are immune from its toxic effects?
Dr. Horowitz appears to be
more
concerned about the "increase in public
anxiety" that may lead to lack
of public acceptance of fluoridation, than
about the possible adverse
effects
of fluoride on humans.
In September 1994, the 20th
Conference of the International Society for
Fluoride Research was held in
Beijing, China. This Conference was jointly
sponsored by the Ministry of
Health, People's Republic of China, the World
Health Organization and The
National Natural Science Foundation of China.
In attendance were 200
researchers
from the host country and about 150 from
other countries.
The major area of concern was
the prevalence of fluorosis in China. The
"endemic fluorosis" areas of
China contain a population of 100 million. Of
these, 43 million people have
dental fluorosis of all degrees of severity;
2.4 million have skeletal
fluorosis,
a severe crippling disease with bone
deformities.
The Chinese presented papers
using observations from studies of both
experimental animals and
humans
showing the relationship between poor diet,
especially calcium deficiency,
repeated childbirth and duration of
exposure, to the severity of
the effects of chronic fluoride poisoning.
The Chinese reported not only
adverse effects on teeth and bones but also
those involving soft tissues.
Some of these occur at surprisingly low
levels of total fluoride
ingestion,
some of which were within the range of
total intake reported for
fluoridated
areas of the U.S. and Canada.
They presented evidence of
increased
fractures, poor fracture healing and
bone outgrowths (exostoses)
as some of the skeletal effects.
With regard to soft tissue
involvement,
studies were presented that dealt
with neurological lesions.
They
ascribed paralysis to direct action of
fluoride on the central
nervous
system in addition to the effect of
pressure on motor nerves by
encroachment of fluorotic bone. Studies also
showed that thyroid
dysfunction,
heart disease and abnormal
electrocardiograms and
cerebrovascular
disease were more prevalent in the
endemic fluorosis areas.
An association was shown
between
chronic fluoride intoxication and lowered
intelligence as measured by
IQ tests; chromosomal abnormalities; decreased
immunity; increased senile
cataracts;
and cancer.
The Chinese scientists also
reported higher infant death rates due to
congenital abnormalities and
higher death rates generally in endemic
fluorosis areas. They also
reported
variable synergistic effects between
fluoride and aluminum,
fluoride
and arsenic, fluoride and selenium.
The foregoing would almost
appear
to be the table of contents of Dr. John
Yiamouyiannis' book, Fluoride,
the Aging Factor (Health Action Press,
Delaware, Ohio), and the older
publication, Fluoridation, the Great
Dilemma, by Drs. George L.
Waldbott,
Albert W. Burgstahler and H. Lewis
McKinney (Coronado Press,
1978).
Dr. Horowitz and his
colleagues
can be expected to attempt to refute this
evidence of the potential harm
from fluoridation by arguing that the
endemic fluorosis areas in
China
are largely rural and that the people are
impoverished, with poor
nutrition,
especially calcium deficiency. They
would also point to the higher
levels of fluoride in water, 2.5-5 mg/L, and
to additional sources of
fluoride
such as coal burning for cooking and for
drying corn, wheat and millet.
They would deny that these adverse effects
occur in the US where
fluoridation
has been practiced since 1945.
To do this successfully, they
would have to refute the many studies
published in peer-reviewed
journals,
that show that in the US there is a
significant relationship
between
residence in fluoridated areas and most of
the problems described by the
Chinese.
These studies show increases
in chromosomal abnormalities such as Down's
Syndrome (mongolism) as
demonstrated
by Dr. Ional Rapaport in 1954 and
1957. They show, also,
increased
overall cancer deaths, (Drs. Dean Burk and
John Yiamouyiannis, 1977); and
deaths from osteosarcoma, a rare bone
cancer, in young men reported
by Dr. R. N. Hoover and others in 1991 and
Dr. P.D Cohn in 1992.
The studies on osteosarcoma
were inspired by the finding of the US National
Toxicology Program in 1989
that
there was a dose-related relationship
between fluoride and
osteosarcoma
in male rats. The study found, also, a
relationship between fluoride
and an extremely rare form of liver cancer in
the experimental animals as
well as cancers of other areas such as the
mouth. When the findings were
"peer reviewed," the conclusions were termed
"equivocal," a term that gave
rise to the controversy that continues to
this day.
Fluoridation and Hip Fractures
They would also have to
refute
the studies that show a higher incidence of
hip fracture in residents of
fluoridated areas. This includes U.S. studies
published in the Journal of
the American Medical Association (JAMA) by Dr.
S.J. Jacobsen in 1990 and
Christa
Danielson and others in 1992.
Studies from abroad have shown
the same relationship between fluoridation
and hip fractures: Dr. C.
Cooper
(UK) in JAMA, July 24, 1991 and Dr. J.
Colquhoun, New Zealand Medical
Journal, August 1991. There are also studies
showing the effect of low
concentrations
of fluoride on the immune system
such as that in Complementary
Medicine, 1992, by Dr. Shiela L. M. Gibson of
the Glasgow Homeopathic
Hospital.
There are studies from India where
endemic fluorosis is a major
public health problem. Publications from this
country cover many aspects for
which their extensive literature must be
consulted. One important area
of research in India deals with one of the
most frequently encountered
symptoms that occurs long before skeletal
fluorosis becomes clinically
obvious p; gastrointestinal discomfort.
Outstanding work on this has
been carried out by Dr. A.K. Susheela and her
co-workers at the All India
Institute of Medical Sciences, Delhi. One of
her papers, published in
Fluoride
(Vol 25, No 1) 1992 shows, by means of
photographs taken through an
endoscope, the unhealthy appearance of stomach
mucosa when it is exposed to
very low concentrations of fluoride.
These texts should be
consulted
for further examples of scientific studies
that counter the false notion
that fluoride, even at optimal concentration,
is without harm. Those
individuals
and institutions that promote
fluoridation have by their
actions,
created endemic fluorosis in the US,
Canada and other countries
that
have adopted the practice.
Like China, before
defluoridation,
43% (or more in some studies) of
children in these fluoridated
areas exhibit dental fluorosis. Is it
possible that 2.4% of the
public
have largely unrecognized skeletal
fluorosis? How many deaths
from
congenital abnormalities could be laid at
the doorstep of fluoridation?
How many tons of antacids are
consumed by North Americans for "functional
dyspepsia" (that is, stomach
ulcer pain without demonstrable ulcers) caused
by drinking fluoridated water
and beverages?
People living in endemic
fluorosis
areas, such as China and India,
frequently exhibit as "early"
signs of the development of later skeletal
deformity, back stiffness
along
with joint and tendon pain. How many
persons residing in
fluoridated
areas have these symptoms caused by
fluoride? How many are
misdiagnosed
as "repetitive stress syndrome,"
"tendonitis" or "arthritis"
of unknown type or cause?
Physicians Have Low Index of Suspicion
That we do not have a full
picture
is due to two major factors.
The first, is that physicians
(and other health professionals) have a low
index of suspicion that
fluoridation
could be associated with disease. They
have been assured by the
promoters
that fluoride is safe and they cannot
find fluoride listed in the
commonly used texts in the differential
diagnosis of various related
diseases; for example, articles dealing with
"functional dyspepsia,"
thyroid
dysfunction, arthritis etc. do not present
fluorosis as a possibility.
Second, the reason that we,
in the U.S. and Canada do not see as many of
the deformed and damaged teeth
and severe bone deformities as in countries
such as China and India may
be owing to our good fortune in having adequate
dietary calcium, magnesium and
vitamin C, the deficiencies of which have
been demonstrated to increase
severity of fluorosis.
Dr. Albert Schatz reported on
the increased infant death rates due to
congenital malformations in
Chile that were associated with water
fluoridation. In his paper,
published in the Journal of Arts, Science and
Humanities in January 1976,
he made the following statement:
"The large scale, overall
statistical
studies which compare total
populations in fluoridated and
control cities in the United States actually
conceal the very information
that is purportedly being sought. This occurs
because the relatively
well-nourished
majority numerically overwhelms those
groups in the undernourished
minority which are the most susceptible to
fluoride toxicity."
When are in-depth studies
going
to be carried out on the adverse effects of
fluoridation in the population
of our own "third world," the impoverished
living in the slums of
fluoridated
cities in the US? When is Canada going
to do likewise?
The Canadian Government review
of inorganic fluorides, after condemning
fluoride as a threat to both
aquatic and terrestial plant and animal life
and possibly affecting global
warming, nevertheless adopt the view of the
promoters that "inorganic
fluorides
(i.e., fluoride ions) are not entering
the environment in quantities
or conditions that may constitute a danger to
human life or health." The
reader
may recall that those responsible for
this study deliberately
avoided
discussion of dental fluorosis in humans
(although they did present it
as a problem in their discussion of
herbivores).
The authors of the Canadian
review state that, in spite of their
conclusions, they cannot
lightly
dismiss the implications of the
dose-response trend in the
occurrence
of osteosarcoma in rat experiments.
They also express reservations
regarding the potential of adverse effects
upon human reproduction,
development,
the central nervous and immune
systems; but only at levels
required to produce skeletal effects.
Poor Nutrition Increases Risk of Fluoride Toxicity
In both countries, there is
cause
for concern about the relationship
between poverty and poor
nutrition
and what we know about its increasing
the severity of fluoride
intoxication.
In the US, a Report issued
January
30, 1995 by the privately funded
National Center for Children
in Poverty stated that "more than a quarter of
American children under age
6 were living in poverty in 1992." This is 6
million children. How many of
these live in fluoridated cities?
In Canada, the Canadian
Institute
for Child Health, a nonprofit
organization funded in part
by Health Canada, reported, in 1994, that 21%
of Canada s children, 1.2
million,
live in poverty.
It is ironic that the poor are
the group that are frequently pointed to as
being best served by
fluoridation.
This is very wrong on several counts.
First, these are the most
vulnerable
to severe adverse health effects of
all types. Second, if we were
to accept the most recent rationalization for
fluoridation, to establish the
means for "remineralization," the poor are
the least likely to meet the
preconditions laid down by such advocates as
Drs. G. Rolla, D. Gaare and
Bogaard of the Dental Faculty of Oslo, Norway.
These researchers write in
their
abstract on page 158 of the Proceedings of
the Beijing Conference: "It
can be concluded that fluoride is most
effective in subjects with
reasonably
good, but not necessarily perfect,
oral hygiene."
Without the means to pay for
dental care, it is hardly likely that the
children of the poor,
especially
the "working poor,'' would employ oral
hygiene to the standard
described
by Dr. Rolla et al.
Nation's Health, the official
newspaper of the American Public Health
Association, one of the
organizations
that continue to endorse
fluoridation, contains a
relevant
item in its issue for January 1995. The
newspaper reports the findings
of a study conducted at Harold Washington
Elementary School in Chicago.
This study involved 128 first, second, third
and fourth grade graders that
were given oral examinations in November 1993
and June 1994.
"During the initial exam," the
article relates, "dentists found 135
cavities. Parents were
notified
and given names of public aid dentists.
However, when dentists
conducted
the second exam seven months later, they
found 127 cavities,
representing
both untreated cavities found in the first
exam and new cavities.
Altogether
23 students experienced an increase in
cavities, while 32 experienced
a decrease, meaning they received dental
treatment. The remaining
students
experienced no change."
The author of the study, Susan
Diamond MS, RD, concluded that many students
at this inner city elementary
school have never visited a dentist's office.
She observed that only the
occurrence
of pain alerts many students' parents
to bring them to the dentist.
She attributes the low priority of dental
care to lack of dental
instruction
at school and in the home. "Many
students," she is quoted as
saying, "do not own tooth brushes, and others
must share them with family
members." We must add that Chicago, according
to the U.S.P.H.S. Fluoridation
Census, 1985 has been fluoridated to 1 ppm
since November 1968.
In order that the foregoing
is not interpreted as an endorsement of the
topical use of fluoride, the
reader is invited to look up the paper of
Kalsbeek and Verrips presented
in Georgia in 1989 where they found no
significant relation between
the decline in caries and the availability of
fluoridated water or fluoride
dentifrices. Other investigators have
reported similar findings: Dr.
M. Diesendorf, who presented a study in
Nature (July 1986) involving
eight developed countries over a period of 30
years; and, Dr. John Colquhoun
who reported in New Zealand Environment in
1991 that study of dental
caries
over time in New Zealand showed that a
sharp decline was in evidence
before fluoridation and before the
availability of fluoridated
tooth paste.
Toxic Dose is Probably 5 mg
Furthermore, some methods
of
applying topical fluorides to the teeth of
children may be
life-endangering.
Dr. G. M. Whitford's paper presented to
the Georgia symposium and
included
in the "Special Issue" of the Journal of
Dental Research, concluded
that
the "probable toxic dose" (PTD) is
approximately 5 milligrams
(mg)
of fluoride for each kilogram (kg) of body
weight (1 kg =2.2 lbs).
For a 2 year-old child
(average
weight 11.3 kg) the PTD is 57 mg. This
quantity, according to
Whitford,
is contained in 57 grams (2 ounces) of a
1000 ppm fluoride tooth paste,
38 grams of 1500 ppm tooth paste, 248
milliliters (mL) (8 ounces)
of a 0.5% sodium fluoride mouth rinse and only
4.6 mL (less than 1 teaspoon)
of 1.23% Acidulated Phosphate Fluoride (APF)
gel.
A young child is expected to
hold this highly toxic (12,300 ppm) material,
poured into 2 trays of 2.5 mL
each, for 5 minutes. How many parents are
told by the dentist that if
the child were to swallow the APF gel, he could
die?
Whitford's Probable Toxic Dose
may be lowered in the future. A mass
poisoning with fluoride from
a faulty water system in Hooper Bay, Alaska in
1993 indicated that the PTD
may be as low as 0.3 mg of fluoride per kg body
weight. The implication of
this
finding should be clear.
If these facts concerning the
possible adverse health effects of fluoride
were to become known to the
general public, it should increase the "public
anxiety" that worries Dr.
Horowitz
and his fellow promoters. So far, little
interest has been shown by the
press. To the contrary, the media dutifully
repeats verbatim the press
releases
put out by the endorsing agencies such
as the American and Canadian
Dental Associations (CDA and ADA).
A good example is the
treatment
accorded the 50th Anniversary of
fluoridation. The press
release
from the ADA with its dateline "Chicago,
January 24,1995" bears the
caption:
50 Years of Fighting Tooth Decay with
Fluoride: 1945-1995. "On
January
25, 1945," the text begins, "Grand Rapids
Michigan embarked on a
trend-setting
study and became the first community
to adjust the amount of
fluoride
in its water to an optimum level."
The press release makes the
statement that "more than 134 million Americans
across the country are served
by water supplies where the fluoride
concentration has been
adjusted
to the optimal level for dental health. In
Grand Rapids in 1945 before
fluoridation, better than 99% of the children
examined experienced dental
decay. After the famed 'Grand Rapids Study',
dental decay plummeted 65%."
Let us take a closer look at
this landmark event. Prior to 1945, a search
took place for the cause of
dental staining in states such as Colorado and
Texas. During the course of
study, observations were made that this
disfigurement appeared to
confer
some type of increased resistance to
dental caries. The causative
agent for the tooth discoloration ("mottling")
was discovered to be fluoride
naturally occurring in drinking water.
A number of studies of this
reported phenomenon were undertaken. The most
important of these was the
study
of 21 U.S. cities by Dr. H. Trendley Dean
of the U.S. Public Health
Service.
These studies would not be given much
credence today; they would not
pass through the gates of peer review to
enter the scientific
literature.
Dean's work, in particular, that is still
pointed to as the "classic"
basis for the fluoridation hypothesis, did not
meet even Dean's own criteria
for constancy of water supply. Mathematical
errors abound. "Variation" and
"examiner error," the latter well-known to
Dean, negated the results.
Dr. F.B. Exner, of Seattle,
a Radiologist who became an international
authority on fluoride and
strong
opponent of fluoridation, prepared a
report for the City of New
York
in 1955 entitled Fluoridation of Public
Water Supplies. This was an
analysis of the published studies of Dr. F.J.
McClure and Dr. H. Trendley
Dean, both of whom were "pioneers" in the early
days of research on the dental
effects of fluoride. Exner described their
reports as being unscientific
and inaccurate. Exner even suspected fraud.
It was, perhaps, inevitable
that Dr. Exner was given the opportunity to aid
Mr. Kirkpatrick Dilling in his
questioning of Dr. Dean, under oath as a
witness in a suit to enjoin
fluoridation of Chicago's water supply
(Schuringa et al. vs City of
Chicago) in 1960.
Dr. Dean was forced to admit
that the studies of Galesburg, Quincy,
Monmouth and Macomb and the
studies of 21 cities with 7,257 children did
not meet his own criteria and
were, therefore, worthless. Of course, this
revelation took place 15 years
after the trials began; but it is difficult
to believe that there were not
those in high positions in the U.S.P.H.S.,
including Dean himself, who
recognized the defects in these studies.
Dr. Philip R.N. Sutton, of the
Dental School of the University of
Melbourne, in his monograph
Fluoridation, Errors and Omissions in
Experimental Trials (Melbourne
University Press 1959, 1960), pointed out
that the trials which took
place
not only in Grand Rapids but also in
Newburgh and Evanston in the
U.S. and in Brantford, Canada, constitute the
main experimental evidence
that
has led to fluoridation as a public health
measure.
The hypothesis that was to be
tested was that "a concentration of about 1
part per million of fluoride
in the drinking water, mechanically added,
inhibits the development of
dental caries in the user."
Criteria for a Proper Trial
To carry out such a study
properly,
certain conditions must be met. First,
the investigator must select
the participating communities with a view to
ensuring that when two groups,
fluoridated and non-fluoridated are to be
compared, the water supply to
both the trial population and the control
population must be similar in
all respects except for the mechanically
added fluoride. If it is
desirable
to compare the results of mechanically
fluoridated water at 1 ppm
with
the results from a naturally fluoridated
water supply it is important
that the latter also be at a concentration of
1 ppm and that the analysis
of both water supplies are similar with regard
to other components such as
calcium, magnesium etc.
Second, the populations under
study must be similar in all important
respects: age, socioeconomic
status and, if it is significant, racial
composition. It should go
without
stating that residence in either the test
area or the control area must
be constant.
Third, such a trial, if it is
to mean anything, must be of sufficient
duration to measure the dental
status of permanent teeth after exposure for
at least a "10 year lifetime.''
Fourth, the common-sense
"rules"
of research must be followed. Attention
must be paid to the size of
the sample population. There must be uniformity
in what is measured; for
example,
DMFT. Examinations of both the test
population and the control
population
must be undertaken before the trial
begins and at predetermined
intervals. Mathematics must be accurate and the
results corrected for
"variation"
and "examiner error."
Finally, as in any study of
the possible effect of any treatment,
statistical methods must be
used to evaluate whether the results obtained
are due to "chance" or to the
treatment, in this case fluoride at 1 ppm in
drinking water.
Dr. Sutton's study of the
fluoridation
trials is meticulously documented
with reference to the written
reports prepared by the investigators and an
examination of data that was
made available. On publication, the Australian
Dental Association sent copies
to each of the principal investigators for
review. The second edition
(1960)
contains a section in which these reviews
are reprinted and the
objections
are answered by Sutton.
In general, not one of the
experimental
trials met the criteria presented
previously. Each had one or
more errors or omissions that invalidate any
results that are purported as
being supportive of the hypothesis. The
following deals superficially
with the defects. Sutton's work must be
consulted for details.
Grand Rapids Study
Grand Rapids had Muskegon
for
its control. There were large differences in
sample size so that
variability
was high. In the test city, for example,
samples varied from 1,806
children
to 3; in the control, in 12 categories
less than 20 children were
examined.
One "group" in the control city
consisted of one child. This
grossly affects the reliability of a mean
rate.
Different methods of sampling
were used and changes in examiners took place
with no assessment of examiner
variability. The first examination of caries
in Muskegon did not take place
until after Grand Rapids was fluoridated.
This was a poor beginning.
Finally, the coup de grace,
the control city Muskegon, was fluoridated in
July 1951, six and one-half
years after the commencement of fluoridation in
Grand Rapids. This rendered
Muskegon useless as a control and occurred at a
time when few of the permanent
teeth had erupted in the fluoridated test
city.
The promoters of fluoridation
have stated repeatedly that "at Muskegon
Michigan, the control city
where
fluoride-free water is used, the incidence
of dental caries is
unchanged."
Sutton points out that some of those
presenting this statement in
1954 and 1955 seemed unaware that the
experiment had ended in 1951
with the fluoridation of the control.
But, was this statement true?
The authors of the study (Arnold et al.),
mentioned, according to
Sutton,
that "a similar comparison (to Grand
Rapids) of results at Muskegon
shows the percentage reduction to range from
1.5% in 6 year olds to a high
of 15.5% in 11 year olds in the permanent
teeth. The percentage
reductions
used were obtained by expressing the
difference between the most
recent and the original DMF rate as a
percentage. Variations in DMF
rates obtained in intervening years are
ignored. If the results for
Muskegon had been computed in 1946 instead of
1951, the reduction would have
been 40.7% instead of 1.5% in the six
year-old group, and 32.7%
instead
of 15.5% in the 11 year-old children.
The Grand Rapids trial did
nothing
to support the case for the fluoridation
hypothesis. The children of
both artificially fluoridated Grand Rapids and
the fluoride-free control,
Muskegon,
experienced a decline in dental caries
during the period of the trial
from January 1945 to July 1951.
This should come as no
surprise
today in the light of the studies of
Kalsbeek and Verrips,
Diesendorf,
Gray and Yiamouyiannis mentioned
previously in this review.
Several questions arise. Was
Muskegon's water fluoridated to terminate the
experiment because it was
discovered
that DMF rates were declining in both
cities? Why did "reputable"
members of the dental profession repeat to
audiences in major dental
meetings
that there had been no change in
Muskegon when they should have
known the facts? Why did some of these
appear to be unaware that the
trial had been terminated?
The "result" stated in the ADA
press release of a reduction in tooth decay
in Grand Rapids as a result
of fluoridation is deceptive advertising. The
authors should be brought to
account by the authorities. The same order of
decline may have been
demonstrated
for Muskegon if a properly constructed
study had been allowed to run
its course!
Other Trials
The Evanston, Illinois
study
with Oak Park, Illinois as control, got off to
a bad start. A United Kingdom
Mission (1953) that studied the Evanston
trial observed that in
Evanston
the economic level was high and dental care
was "outstandingly good." But,
comparison of the caries rates before
fluoridation showed that the
control area, Oak Park, was found to have a
lower caries rate than
Evanston.
Sutton uses 21 pages of his
73-page original report to attempt to come to
an understanding of the many
manipulations of the student groups that took
place, in order to compensate
for the lower caries rates encountered in the
control throughout the test
period.
The United Kingdom Mission was
informed that yearly examinations had been
carried out since the
commencement
of fluoridation on February 11, 1947 and
would be continued until 1962.
At the time of the UK Mission report, no
examination of the control
city
had taken place (since February 26, 1947);
and, in Evanston, only one age
group was examined each year. Sutton points
out that the design of the
trial
provided for only two examinations, 11
years apart, to be made in the
control city.
The second examination,
scheduled
for 1958, was commenced in 1956 when it
was apparent that the water
supply of Oak Park would be fluoridated. This
examination was completed
November
1956 soon after the fluoridation of Oak
Park on 1 August.
The data from this study were
not published for 10 years. Much of the data
had not been released at the
time of Sutton's book in 1959!
The authors reporting on this
study made incompatible statements regarding
sample size and what Sutton
describes as "extraordinary changes of opinion
regarding the significance of
results based on the same data.''
Of some note is the evidence
in the data of the effect of fluoride in
delaying tooth eruption. The
results of examinations carried out in
Evanston 1946-1951 suggest a
progressive decline in the number of erupted
first permanent molar teeth
in six year-old children. The results obtained
in examinations conducted in
1953 and 1955 were omitted from the published
reports.
Brantford, Ontario, Canada was
the site of two independent trials. One was
conducted by the City Health
Department, the other by The National Health
and Welfare Ministry. There
were so many mathematical and other errors in
the City report that its
results,
as Sutton states, must be treated with
caution. The National Study
is reputed to be the most complete of the
10-year North American trials.
Again, a bad start. The trial
began over two and one-half years after the
commencement of fluoridation
of the Brantford water supply. Those
responsible for the study
probably
reasoned that little change was to be
expected in DMF rates until
about six years after the commencement of
fluoridation - the so-called
"structural theory" popular at the time that
has now, as indicated by the
ADA Press Release, been replaced by the
"remineralization"
rationalization.
Sarnia, Ontario was selected
as the "fluoride-free" control and Stratford,
Ontario as the control city
with natural fluoride to 1.3 ppm.
The City of Brantford, over
a period of 15 years, had provided more free
dental services for children
than most Canadian cities. As a result, the
children of Brantford compared
to those in the controls had both a higher
treatment and a better oral
hygiene status. This was recognized by the
authors of the report.
No pre-fluoridation survey was
carried out in this study. The initial
examination in 1948, not
surprisingly,
showed that tooth mortality (teeth
which are missing or which
must
be extracted) was much higher in the
controls.
As in the other studies, there
are marked deficiencies and omissions in the
compilation and reporting of
data. This, along with the absence of caries
rates in Brantford and Sarnia
prior to fluoridation, makes it impossible to
establish that there was a
marked
reduction in the test city due to
fluoridation.
The City of Newburg,, New York
was the test area; Kingston, New York was
the "fluoride-free" control.
These two cities situated on the Hudson River
about 30 miles apart were said
to be comparable in all ways, including
comparable water supplies,
except
that Newburg's would have an addition of
sodium fluoride.
Again, as in other studies,
the control city had no examinations until
after fluoridation started in
the test city on May 2, 1945.
However, the major problem was
that the water supplies were not comparable.
The source of Newburg's water
was surface water; Kingston's was obtained
from mountain spring
impounded.
Analysis carried out by the US Geological
Survey showed them to be of
vastly different composition. The water in
Newburgh (N) had much higher
values than Kingston (K) in the following:
calcium (N 35.0 ppm, K 6.6
ppm),
magnesium (N 3.6 ppm, K 0.9 ppm) and
hardness (N 102 ppm, K 20.0
ppm). Eight other characteristics of Newburgh
water were at least 4 times
higher than those of Kingston.
A 1949 statement from the
American
Waterworks
Association (quoted by
Sutton) is to the effect that
the experimental verification of the
fluoride-dental caries
hypothesis
"obviously necessitates the use of a
nearby 'control' city with a
water supply comparable in all respects to
that to which fluoride is
being
added."
In spite of this the study
proceeded
with, as Sutton describes it, a wide
variation in the methods used
in data collection and result presentation.
There were changes in
examiners
and statisticians. The study was also
confounded by uncertainty with
regard to shifts in the population of both
the test and control areas.
The final report of the study
(1956) found a decrease in the "percent
difference" between the DMF
rate per 100 erupted teeth of children aged six
to nine years in Newburgh and
Kingston compared to the previous (1955)
report. A trial period of 10
to 12 years was originally mentioned in the
first report of the study.
Sutton
states that "in view of the decrease in
the 'percent difference'...it
is unfortunate that the trial was stopped as
soon as the minimum period
proposed
by the authors had elapsed."
In May 1989, Dr. J. V. Kumar
and others of the New York State Department of
Health, published a study of
the current situation in Newburgh and Kingston
in the American Journal of
Public
Health (Vol 79, 50). Their analysis of
dental caries data revealed
that caries prevalence declined in both
Newburgh and Kingston. The
difference
in terms of DMFT for 7-14 year old
children was shown graphically
to be less than one tooth; i.e., Newburgh
1.5, Kingston 2.0. This is
probably
within examiner error and not
significant. They pointed out
the confounding effect of other sources of
fluoride such as fluoride
drops,
tablets and dentifrices that have
contributed to dental
fluorosis
in the children of both cities.
It is not difficult to imagine
the reception that Sutton's monograph
encountered in some circles.
He records in an editorial in the January 1990
issue of Fluoride that the
distributors
of the book were approached by the
Nutrition Foundation and
others
to suppress the monograph in the U.S.A. In
addition, the printer's type
of edition was destroyed without authority. He
notes, also, that his book was
omitted from the Index to Dental Literature
published by the ADA.
Dr. Sutton adds, almost as a
footnote, that in 1984 emphasis was shifted by
the World Health Organization,
a major promoter, from the Newburgh etc.
trials to the further 128
studies
listed in a book written by Murray and
Rugg-Gunn in 1982. Sutton
investigated
the scientific status of their
references in 1988. His
conclusion:
"Murray and Rugg-Gunn, in what appears
to have been a comprehensive
worldwide search, were unable to locate even
one study which demonstrated
that fluoridation reduced dental caries."
Why, after the expenditure of
what must have been millions of dollars and
uncountable man-years has it
been impossible to demonstrate proof of the
fluoridation-caries hypothesis?
Fluoridation Does Not Prevent Caries!
The answer is simple:
fluoridation
does not prevent dental caries!
Dr. Rudolph Ziegelbecker,
Director
of the Institute for Environmental
Research, Graz, Austria, ran
through his computer the results of all
published studies of the
relationship
between fluoride in water and dental
caries. These studies included
Trendley Deans' 21 cities and 23 others. He
reported in Fluoride in 1981
that he found no relationship.
Ziegelbecker followed up this
study on what he felt were selected data,
with data from the World
Health
Organization's (WHO) Oral Health Data Bank
and Oral Health Pathfinder
Study.
Using these data, collected in 1987, he
again contradicted the reports
that there was an inverse relationship
between dental caries
incidence
and water fluoride levels. His findings,
reported in Fluoride (Vol 26,
No4) October 1993 pointed out that in most
countries the relationship
tends
to be direct rather than inverse; that is,
dental caries increases as
water
fluoride increases.
This finding conflicts with
the belief of the promoters of fluoridation;
but it is in accord with other
studies, some of which were mentioned
previously. Noteworthy in this
respect are those of Imai (Japan), Colquhoun
(New Zealand), S.P.S. and M.
Teotia (India) and Steelink (USA).
Ziegelbecker adds the studies
of S.K. Ray et al. in India (1981) and O.
Chibole in Kenya (1988).
Let us return again to the
A.D.A.
press release. The manipulated numerical
values (one hesitates to call
them statistics) that are used in the press
release are reminiscent of
those
seen in such advertisements as: "Three out
of four Doctors prefer Camel
cigarettes," or, more recently "choose Tylenol
over Aspirin."
"Half of the children entering
first grade today have never had a single
cavity." This may be true; but
as may be seen from studies of caries over
time, this has nothing to do
with either fluoridation or fluoride
dentifrice.
"In Grand Rapids, in
1945better
than 99% of the children examined
experienced dental decay."
This
presented to us without any details
regarding the age of the
children,
the size of the sample or whether this
is a mean or average. As
Sutton
pointed out, there was enormous variation
in the size of samples so that
variation as well as examiner error made
exact determinations
impossible.
If we accept that only one
child
in one hundred was caries-free, the next
statement is deliberately
ambiguous.
"After the famed 'Grand Rapids Study,'
dental decay plummeted 65%."
We have to ask: "where did this take place and
when did this take place?"
The figure probably comes from
the 1956 final report on the Grand Rapids
Study by Drs. F.A. Arnold,
H.T.
Dean et al. in Public Health Reports in
which they stated: "In
children
born since fluoridation was put into
effect, the caries rate for
the permanent teeth was reduced on the average
by about 60%."
This claim has been used since
by the ADA, the WHO and other promoters; but
such reduction, as we have
seen,
could be equally true of the children in
Muskegon, the control that was
fluoridated before any proper comparisons
could be made.
The studies made subsequent
to 1956, demonstrate that there has been a
general decline in dental
caries
in the developed world and that the number
of decayed, missing and filled
teeth in children who had been fluoridated
all their lives are no fewer
than those children reared in non-fluoridated
areas.
Several paragraphs of the
press
release tell us in gushing terms how
"incredible" the "benefits"
are. The emotive statements tone down the
reductions to "20 to 40%" and
inform us about "remineralization" p; not
telling us, of course, that
the original concept of "restructuring,'' the
rationalization for systemic
fluorides, has been abandoned.
There is an appeal to adults
that fluoride helps decrease root decay for
which properly structured
studies
are lacking. The press release lists a
number of organizations that,
it is implied, assure us that fluoridation
can benefit all "in a safe and
extremely cost-effective manner."
When we know that fluoride
does
not prevent dental caries,
cost-effectiveness is nill.
To the contrary, fluoridation is costing us
dearly, more than we can
calculate
at the present time, to treat its dental
and other adverse effects.
The figure given for cost
effectiveness
is calculated from the per capita
expenditure for fluoridation
chemicals, the average cost of a filling and a
reduction in caries of 40%.
Most of which collapses like a deck of cards
when it is recognized that the
reduction of caries is a "statistical
illusion.''
Not illusory, however, is the
large amounts of taxpayers' money that is
being spent to supply the
chemicals
for this purpose. If the hypothesis
were proven to be genuine, the
facts remain: for every $1,000 spent on
chemicals, less than fifty
cents
goes to children and adverse effects on
humans and other creatures in
the ecosystem would greatly overbalance the
"benefits.''
The press release ends with
the "national health objective" for the year
2000 to increase to at least
75% of the portion of US population served by
community water systems
providing
optimal levels of fluoride.
In view of all the evidence
currently available, such contemplated action
is a disgrace!
Dr. Herschel Horowitz, in a
paper published in the Journal of Public Health
Dentistry (Vol 52, 4) in 1992,
stated: "When Grand Rapids, Michigan, began
to fluoridate its water supply
in 1945, relatively few other sources of
fluoride existed in the United
States. At that time only about 1.7% of the
US population lived in
communities
in which the natural amounts of fluoride
in drinking water were at
optimal
or greater than optimal concentrations
and few food products had
appreciable
concentrations of fluoride, e.g. tea
and seafood."
He pointed out that by 1955,
more than 15% of the U.S. population had
access to drinking water with
optimal or greater concentrations of
fluoride; by 1965, 30%; by
1975,
49%. He estimated that at the time of his
writing (1991), more than 130
million persons or 53% of the U.S. population
lived in areas with "optimal"
or greater concentrations of fluoride in
their drinking water.
He recognized that this has
caused total fluoride consumption to rise in
both fluoridated and
non-fluoridated
areas because of the incorporation of
fluoride in beverages and
foods
prepared in fluoridated areas.
In an editorial in Fluoride
(Vol 24 No 1) 1991, Roy R. Kintner reviewed
studies to that date of total
fluoride intake. A total intake baseline
prior to fluoridation projects
in the U.S. was estimated at 0.45-0.55 mg
fluoride per day for an adult.
These were based on studies predating 1950.
Subsequent studies show
increases
in both fluoridated and non-fluoridated
areas. The rise in low
fluoride
cities "came about due to contamination of
food and beverages through the
importation of commercial products produced
and/or prepared in neighboring
communities when they adopted fluoridation."
Mean Adult Intake, 2.7mg Fluoride
Kintner reported that the
mean
adult male intake, in a fluoridated
community in 1991, was 2.7 mg
fluoride per day. The estimated daily
fluoride exposure for young
adults (11-19 years), adults (20-64 years) and
male adults (20-64 years) in
the upper 1st percentile were, in mean values,
respectively: greater than 4.3
mg fluoride per day (mg F/day); greater than
5.6 mg F/day; and, greater
than
6.0 mg F/day.
Estimates presented in the
USPHS
publication Review of Fluoride Benefits
and Risks 1991 (tables 10 and
11) show that 2 year-old (20kg) children may
ingest 2.3 mg F/day in low
fluoride
areas (less than 0.3 ppm) and 3.6 mg
F/day in optimal (0.7-1.2 ppm)
fluoridated areas. These estimates include
fluoride obtained from the use
of fluoride dentifrice twice a day and
fluoride supplements (0.5
mg/day)
in low fluoride areas.
It can be calculated from
these
tables that a 50 kg adult has a total
intake of 2.2 mg fluoride per
day in low fluoride areas and greater than
6.0 mg fluoride per day in
optimal
fluoridated areas.
The intake of a 200 pound (91
kg) male athlete or heavy industrial worker
replenishing himself with food
and water in a fluoridated area is,
conceivably, in excess of 12
mg fluoride per day!
Kinder points out that these
total intakes of fluoride places a significant
portion of the U.S. population
at or above the 4-5 mg fluoride per day
level. Dr. F.J. McClure in a
1945 paper published in the Journal of
Industrial Hygiene and
Toxicology
recommended that this not be exceeded.
It should come as no surprise
that children consuming these amounts of
fluoride during their
tooth-forming
years in both low fluoride and
fluoridated areas develop
dental
fluorosis. In British Columbia, for
example, 65% of the children
in the sample from fluoridated Kelowna had
mild or moderate dental
fluorosis
of one or more tooth surfaces; in
non-fluoridated Vernon, 55%
were similarly afflicted.
Adults do not have a "marker"
of intoxication such as dental fluorosis to
signal a high level of
fluoride
intake.
It may be the case that the
original dental and public health promoters did
not anticipate that their
actions
would raise total fluoride levels to
their present high values. In
their haste to initiate the artificial
addition of fluoride to
drinking
water, they failed to carry out the
projections required to
predict
the consequences. Lack of adequate
information at the time may
excuse mistakes of the past; but failure to
learn from these mistakes and
take appropriate action could be interpreted
as negligence.
Dr. Horowitz and his fellow
fluoridation promoters consider the increased
numbers of fluoridated
communities
as "progress" along the path to a
society that will, ultimately,
be freed from tooth decay.
Those who are familiar with
the historical development of the concept of
fluoridation and the evidence
of its lack of effectiveness and of its
adverse effects on teeth, the
skeletal system and soft tissues, must
disagree.
Endemic Fluorosis
All of the evidence points
to
fluoridation as the deliberate creation in
the United States and
elsewhere
of an extensive area of endemic fluorosis.
Endemic fluorosis, not dental
caries, is a major public health problem in
1995. This could be as serious
as it is in China, India and elsewhere. The
population at risk is more
than
130 million in the United States alone.
The year 1995 does mark a 50th
anniversary. To anyone who knows the facts,
this is not a celebration of
the conquest of tooth decay by some "magic
bullet." It is an event
marking
the beginning of a period of fraud,
deception and betrayal.
There are those in the dental
profession who call for "a new baseline" or a
"change in traditional
thinking"
and a general acceptance in Continental
Europe that the systemic use
of fluoride to prevent dental caries is passé.
There has been an obvious
switch
on the part of the ADA elite from the
"structural" to the
"remineralization"
rationalization. However, in the US,
Canada, Ireland and the United
Kingdom, orthodoxy regarding fluoridation is
entrenched.
Fluoridation, especially in
the United States, has been established as a
"National Goal" or "Mission.''
Billions of taxpayers' dollars have been
spent over the past 50 years
to fulfill this mission. As is typical of so
many government sponsored
endeavors,
this mission will continue even though
there is ample evidence that
the fluoride-caries hypothesis is invalid and
that fluoridation has created
a major public health problem, endemic
fluorosis. And, in spite of
the fact that fluoridation poses a definite
threat to the environment.
Only the withdrawal of public
support can end such an institutionalized
government program as
fluoridation,
supported as it is by professional
elites. Dr. Horowitz is
correct.
The public will call for a halt to
fluoridation when they learn
that the program is a misuse of increasingly
scarce resources. The program
is a failure and costing us dearly in terms
of treatment for adverse
effects
and losses in the ecosystem due to
fluoride pollution.
How can the public continue
support once they learn that dental fluorosis
is not merely cosmetic but a
sign that we have poisoned our children? How
can they continue support when
they learn that the adverse effects of
fluoride are well-founded,
especially
when total fluoride intake is
considered?
There is a disturbing tendency
on the part of many in the research
community to search only for
"positive" results. These, especially when
they deal with human health,
are more likely than "negative" findings to
lead to the staking out of a
special territory. Cynthia Crossen, in her
book Tainted Truth, the
Manipulation
of Fact in America (Simon and
Schuster, 1994) presents many
examples of cases in which this has occurred;
for example, the "Oat Bran
Miracle"
that wasn't.
Once an idea such as "1 ppm
fluoride, artificially added to drinking water,
prevents dental caries"
becomes
desired territory, only those studies
supporting or enhancing it are
the coin of the realm. Research that
produces results that are
contrary
is dross. If the research does not
support the hypothesis, the
latter remains sound but the research "doesn't
work.''
The early research of Dean and
others are examples of manipulating the
results, either intentionally
or through ignorance of scientific method to
obtain positive support for
the hypothesis underlying fluoridation.
The "trials" in Rapid City,
Evanston, etc. were a graphic example of
research that "didn't work."
Again, either through ineptitude or calumny.
Some defenders have intimated
that these were not scientific studies to
compare the results of a
fluoridated
population with controls, but were
demonstrations that fluoride
could indeed be added to the water supply
without any immediate
mechanical
problems or apparent adverse effects.
Like any commercial product,
fluoridation has been promoted over the past
fifty years to the point that
to millions it is "truth."
Built upon the early
trumpeting
of the power of fluoride to banish tooth
decay, a number of
applications
have arisen over the past half century:
dentifrices for use in the
home
and in the dental office; oral fluoride
tablets, drops and mouth
rinses.
The companies
manufacturing/marketing
these products commission their own
research and fund dental
meetings
on the subject. The list of corporate
sponsors of the International
Conference held in Pine Mountain, Georgia
that has been referred to a
number of times in this article, includes many
familiar names:
Chesebrough-Ponds;
Unilever; Johnson and Johnson; Procter
and Gamble; Colgate-Palmolive;
Bristol Myers; and others. One other name
that has an interest and
publishes
a magazine for dentists is the Princeton
Resource Center; this has
nothing
to do with the university of the same
name but is financed by
M&M/Mars.
Standing in the background
letting
others work for them are those
industries that supply the raw
materials used for fluoridation or who
benefit from the image of
fluoride
as benign. Without fluoridation,
millions of tons of
hydrofluosilicic
acid would have to be funneled into
holding ponds and treated at
great expense, rather than have it turn a
profit.
Smelter operators, faced with
legal suits concerning fluoride damage to the
ecosystem, including humans,
can shrug their shoulders and say "it's good
for children's teeth, isn't
it?"
Additional references for studies cited in the text available on request.
Correspondence:
Richard G. Foulkes, MD
P.O. Box 278
Abbotsford, British Columbia
Canada V2S 4N9
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