There are some real screwball cranks out there. Some are convinced that the US never landed on the Moon. Others consider it an article of faith that immunization causes autism. And so on, you get the picture. And then there are those folks who just can’t be convinced that water fluoridation is a complete waste of public money and possibly dangerous to the environment. And those are the screwballs I want to address in this blog post.
(Did I just give you whiplash?)
I am not a scientist, and I don’t even play one on TV. My only claim to any kind of authority on this subject is the studying that I engaged in back 10 years ago when I helped lead the fight against water fluoridation in the City of Olympia. A fight that we won, by the way. So don’t give what I have to say any more credence than it merits – although I would say that my knowledge of the subject is rather more advanced than most other citizens.
First of all, I will say that I have no problem with dental fluoride treatments, nor with using fluoridated toothpaste, and I would tell anyone who asked me to go right ahead. I myself use fluoride toothpaste. But I do so knowing that the family of substances used for toothpaste fluoridation is potentially dangerous, depending upon the exact chemical being used. There are many forms of fluoride, and I’ll just look at two of them which are commonly used in toothpaste.
I have two tubes of toothpaste in front of me as I write this. One is Pepsodent®, and according to the label on the tube the fluoridation agent is Sodium fluoride (NaF). The other is Listerine® Gel (my favorite), and the label says its fluoridation agent is Sodium monofluorophosphate (Na2PFO3). I extracted the following text from the corresponding articles in Wikipedia.
The lethal dose for a 70 kg (154 lb) human is estimated at 5–10 g. Sodium fluoride is classed as toxic by both inhalation (of dusts or aerosols) and ingestion. In high enough doses, it has been shown to affect the heart and circulatory system. For occupational exposures, the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health have established occupational exposure limits at 2.5 mg/m3 over an eight-hour time-weighted average.
The usual content of monofluorophosphate (MFP) in toothpaste is 0.76%. Currently accepted research indicates that by using such toothpaste, cavities may be reduced 17–38%. The compound is not very toxic but has been shown to have limited evidence of musculoskeletal and respiratory toxicities. The LD50 in rats is 0.9 g/kg.
Both of these tubes of toothpaste contain warnings about their use for children under 6. The Listerine toothpaste merely advises to minimize the amount a child might swallow. But the Pepsodent tube’s warning is much more dire: “WARNING: KEEP OUT OF REACH OF CHILDREN UNDER 6 YEARS OF AGE.” It advises getting medical help or immediate contact with a poison control center right away, “if more than used for brushing is swallowed.” This is by no means some over-reaction. I am anecdotally aware of some fortunately rare cases where dentists giving fluoride treatments to young children have made mistakes and caused deaths as a direct result of fluoride overdose (for example, this one). This stuff is NOT innocuous and must be treated with care and wisdom.
Water fluoridation, however, is another matter entirely. I am completely opposed to it, and will explain why below. But first, I have a good deal of doubt that the studies frequently cited showing that fluoridation “works” to reduce cavities are valid. I guess I would have to read the studies to find how they controlled for certain situations that I believe would tend to invalidate their results. I am not a robot who automatically rejects any evidence that my position might be wrong, and I also do not automatically accept any evidence that happens to agree with my position, either.
But when it comes to a controlled study of fluoridation, I am afraid that the variables are likely to be very much uncontrollable. How much water out of the tap is being drunk, compared to how much is being drunk in the form of soft-drinks, for example? How long do water-drinkers hold water in their mouths, verses bottled-water drinkers, versus soft-drink consumers? Which bottled waters were collected from municipal sources with fluoridation, versus those collected from non-fluoridated sources? Which non-fluoridated municipal sources actually have a high degree of naturally-occurring fluoride? And which fluoridated ones have a high degree of natural fluoride? Do children live in a non-fluoridated community, but attend school in a fluoridated? Do they drink most of their water in one, or the other? How many brush their teeth regularly? How many go to bed each night without brushing, with food residue on their teeth to develop acids which cause cavities? And how many parents lie (or tell counter-factual statements) to researchers because they are ashamed they: (a) let their kids drink too many soft-drinks; (b) do not enforce teeth-brushing or flossing; or (c) do not consistently have their kids take the fluoride tablets they might be prescribed for the purpose of the study?
Here are my problems, in no particular order, with water fluoridation:
Problem #1: Very little of the fluoride compounds used for fluoridation actually makes it into the mouths of those for whom it is intended. People simply do not drink that much water, and vastly more public water goes for flushing toilets, watering lawns, washing dishes and clothes, and just plain wasting down the drain. In short, the vast majority of the fluoride ends up being more or less directly dumped into the biosphere. Even if the compounds used were not, just by the way, toxic in and of themselves, it is a fiendishly inefficient method of delivery.
Problem #2: The last time I visited the dentist and got a fluoride treatment, the dental assistant swabbed the stuff over the surface of my teeth and told me to not clean it off for at least an hour or two, so that it could do its job. I was also told not to swallow it, of course, because it is of course toxic. But toxicity aside (see above), consider how much less fluoride passes my lips when I take a drink of fluoridated water, and how long it sticks to my teeth. Here’s what is happening: the glass of water passes my lips, some of it passes extremely briefly over my teeth, and all it goes into my stomach. That brief passage over my teeth is so brief that there is no way that it is going to do anything useful! Once the fluoride hits my stomach it is of no use whatsoever as a fluoride treatment, except possibly as a result of some (very tiny) amount of the fluoride ending up as part of my saliva. Have the scientists ever tested the saliva of persons whose water was fluoridated, in order to see if there’s enough to make any difference? I don’t know, but I doubt it. Again, this brief passage past my teeth is a fiendishly inefficient method of delivery.
Problem #3: This is related to what you mentioned as your objection to water fluoridation, and that is the unwilling mass medication of everyone who must drink publicly fluoridated water. And there are people who are sensitive to fluoride compounds, and cannot drink it nor bathe in it. If such a person lives in a community that fluoridates, then they must be careful to drink only bottled water (from non-fluoridated supplies), and should not bathe or shower using public water.
Problem #4: Besides the medically unethical mass dosing of the population, there is the environment to consider. The most common form of fluoridation agent is Hexafluorosilicic acid. This substance is a byproduct of the manufacture of phosphoric acid (among other processes), and besides its use as a fluoridation agent, an important use of it is in the manufacture of aluminum metal from its ores. If you read up on this chemical, you will find that it is quite useful in industry, but its usefulness is largely a product of its high reactivity – in some applications its reactivity is higher than Hydrofluoric acid (HF), one of the most reactive acids known (the only acid that can etch glass). In fact, Hexafluorosilicic acid emits HF.
From Wikipedia on the safety of this material:
Hexafluorosilicic acid releases hydrogen fluoride when evaporated, so it has similar risks. It is corrosive and may cause fluoride poisoning; inhalation of the vapors may cause lung edema. Like hydrogen fluoride, it attacks glass and stoneware. The LD50 value of hexafluorosilicic acid is 70 mg/kg.
If I were to dump a hundred gallons of this material into a river, the EPA would come looking for me with blood in its eye, and they would probably be beaten to the punch by every tree-hugger in the area. Yet we permit and even require our municipal corporations to add it to our drinking water, whereupon almost all of it ends up in the rivers and nearby bays, where the fish swim and the shellfish filter. Isn’t that nice that we can thereby eat our fluoride as well? Yumm!
Problems with Studies Validating the Efficacy of Fluoridation
I will admit that I have not looked for any studies which were intended to examine whether water fluoridation was effective or not. Years ago, however, I did run across a study which simply collected children’s cavity data on a statewide, county-by-county basis in the State of Washington. We used the results in our fight to prevent fluoridation in Olympia, because it told a very interesting tale indeed.
This study was done by the University of Washington (UW), and I am sorry I cannot cite it, as I lost most of my materials some time ago. But what I do recall is that the UW collected rates of cavity formation in children for every county in the state (as reported by dentists). Some counties had bad cavity rates, and some had good cavity rates, and some were right in the middle. The astonishing thing was that there was no correlation at all between fluoridation in those counties that had it, with improved cavity rates in children in those counties. Some fluoridated counties had good rates, some had bad rates; some non-fluoridated counties had good rates, and some had bad rates. With all kinds of outcomes in between. Our opponents in the Olympia fluoridation battle tried to discount our claim that the study didn’t validate fluoridation, with the somewhat weak argument that the UW study was not intended to show the efficacy of fluoridation.
Well, I do believe that if the UW had tried to control the data in order to show the efficacy of fluoridation or the lack of it, they would have found that it was simply wonderful. And the reason I believe they would have found this, is because water fluoridation it is one of those sacred cows that the dental profession absolutely does not tolerate heresy about. I will not attempt to claim that this is some kind of conspiracy, or maybe I will, but if you do follow the money you will find that water fluoridation is quite simply the niftiest way to dispose of hexafluorosilicic acid, an industrial byproduct, that has ever been invented. Not only does it not cost industry any money to dispose of it, it actually brings in money. A win-win situation all around. Except for the environment, and for those of us who would rather not ingest toxins we could otherwise avoid.
And if you doubt that such a conspiracy to keep the hexafluorosilicic acid flowing could really be kept quiet, consider what happens to any dentist or other dental researcher who begins to question the status quo! Those who do so are instantly branded as deluded, or as “conspiracy theorists”, and thus not to be taken seriously. Their license to practice dentistry may also be at risk. Remember the fate of Ignaz Semmelweis, who claimed that it was the unclean hands of his fellow physicians that caused the deaths of many women from puerperal fever in childbed, the doctors having gone from handling dead bodies to delivering babies. He was the nail that needed pounding down, and he got it, too. But he was right.
There are just too many doubts, in my mind, and too many unbelievable things involved here. Does it do my teeth any good to fluoridate the water if I don’t drink the water? Do the salmon really appreciate the fluoride all that much?
In closing, I have to say that just because dental fluoridation and toothpaste fluoridation is a good thing when it comes to caries prevention, it does not mean that bathing in and drinking fluoridated water (in which the fluoride is in fact highly dilute!) is going to be at all effective.