National Pure Water Association Ltd is strongly opposed to fluoridation for a number of reasons which are outlined below. We uphold a different, but scientifically based, viewpoint from that expressed by South Central SHA, Southampton PCT and the endorsing organisations listed on page 23 of South Central SHA’s Consultation Document, Public consultation on the proposal for water fluoridation in Southampton and parts of south west Hampshire.1
As the Executive Committee of the National Pure Water Association we represent our members and also the tens of thousands of people who have signed the National Register of Objectors to Water Fluoridation. We consider fluoridation to be an outdated concept. It has serious risks that far outweigh any minor benefits; it violates sound medical ethics and it denies freedom of choice.
1. In 2006, a 500-page review of fluoride’s toxicology was published in America by the National Research Council of the National Academies.2 This NRC Report concluded that the US Environmental Protection Agency’s (EPA’s) safe drinking water standard for fluoride (i.e. maximum contaminant level goal or MCLG) of 4 parts per million (ppm) is unsafe and should be lowered. A distinguished panel of scientists worked for three years to produce the Report, which had nothing to say about the safety or effectiveness of artificial fluoridation per se. However, many of the Report’s findings are relevant to the fluoridation issue.
Despite over 60 years of fluoridation, the NRC Report listed many basic research questions that have not been addressed. Unlike the York Review3, which was restricted by its Terms of Reference to look only at human studies and only at a fluoride level in water of 1 ppm, the NRC team was able to review a large body of literature in which fluoride has a statistically significant association with a wide range of adverse effects. These included dental fluorosis, an increased risk of bone fractures, decreased thyroid function, lowered IQ, conditions akin to arthritis, and cancer.
The average daily intakes* of fluoride associated with many of these adverse effects are reached by some people consuming water at the concentration levels now used for fluoridation, especially small children, above average water drinkers, diabetics, people with poor kidney function and other vulnerable sub-groups. For example, the average fluoride daily intake associated with impaired thyroid function in people with iodine deficiency (about 12% of the US population) is reached by small children with average consumption of fluoridated water at 1 ppm and by people of any age or weight with moderate to high fluoridated water consumption. Of special note among the animal studies is one in which rats fed water containing 1 ppm fluoride had an increased uptake of aluminium into the brain, with formation of beta-amyloid plaques, which is a classic marker of Alzheimer’s disease pathology in humans. Considering the substantial variation in individual water intake, exposure to fluoride from many other sources, fluoride’s accumulation in the bone and other calcifying tissues and the wide range of human sensitivity to any toxic substance, fluoridation provides NO margin of safety for many adverse effects, especially lowered thyroid function.
* Note: “Daily intake” takes into account the exposed individual’s body weight and is measured in milligrams of fluoride per kilogram body weight.
2. Studies supporting fluoridation are flawed. In 2000, the UK-government-sponsored ‘York Review’, the first systematic scientific review of fluoridation, found that NONE of the studies purporting to demonstrate the effectiveness of fluoridation to reduce tooth decay were of level A status, i.e. “highest quality of evidence, minimal risk of bias”. Many of the studies failed to consider confounding factors and had not been subject to statistical moderation.3
3. Fluoridation increases the prevalence and severity of dental fluorosis in a population. Dental fluorosis is an abnormal discolouration and mottling of the tooth enamel. Although there are other reasons for discolouration of teeth, this specific irreversible and sometimes disfiguring condition is (by definition) caused only by fluoride.
The York Review estimated dental fluorosis in artificially fluoridated populations at 48% and dental fluorosis of aesthetic concern at 12.5%. York found that dental fluorosis also occurs in non-fluoridated areas.3
The US Centers for Disease Control and Prevention (CDC) in 2005 stated that 41% of American adolescents aged 12–15 and 36% aged 16–19 have dental fluorosis.4 After fluoridation, Hong Kong twice reduced its recommended fluoride level (first to 0.8 ppm and later to 0.5 ppm), because of unacceptable levels of dental fluorosis at higher levels. More recently, Eire and Canada have reduced their fluoridation recommendation to a target of 0.7 ppm for the same reason.
Dental fluorosis has adverse psychological and social consequences and is an entirely predictable consequence of fluoridation. Dental fluorosis of aesthetic concern can be remedied only by veneers. The procedure is quite complex, involving further grinding down of the affected teeth to provide a suitably adhesive surface. As a child grows, a gap becomes evident between the gum and the veneer so children are often recommended to wait for treatment until they have stopped growing. Veneers rarely last more than ten years so have to be replaced. Remedial work for dental fluorosis is expensive and, particularly for adults, is rarely funded by the NHS. The poor, who cannot afford such treatment, face discrimination in social and work situations.5
Children are now being overdosed with fluoride, even in non-fluoridated areas, from fluoridated water, swallowed toothpaste, foods and beverages processed with fluoridated water, and other sources. Of these sources, fluoridated water is the easiest to eliminate.
4. The American Dental Association changed its policy, in November 2006, recommending that only the following types of water be used for preparing infant formula during the first 12 months of life: “purified, distilled, deionized, demineralized, or produced through reverse osmosis.” It warned its members that they should not recommend fluoridated tap water for mixing infant formula. This new policy was implemented to prevent the ingestion of too much fluoride by babies and to lower the risk of dental fluorosis.6
The burden of following the ADA’s recommendation, especially for low income families, is reason alone for fluoridation to be halted immediately. Infant formula made with fluoridated water contains 250 times more fluoride than the average 0.004 ppm concentration found in human breast milk in non-fluoridated areas (Table 2-6, NRC, 2006). This realisation, coupled with the knowledge that twenty-three studies from China, Mexico and Iran indicate that fluoride can lower IQ in children, has led Professor Vyvyan Howard, an expert on the way toxins affect foetuses and infants, to call for fluoridation to be brought to an end.7
5. The (US) Center for Disease Control (CDC) conceded, in 1999 and 20018, that the predominant benefit of fluoride in reducing tooth decay is mainly topical and not systemic. To the extent that fluoride works to reduce tooth decay, it works mainly from the outside of the tooth, not from inside the body. It makes no sense to drink it and expose the rest of the body to the long term potential risks of fluoride ingestion when topical applications such as fluoride toothpaste are readily available.
The widespread use of fluoride toothpaste and fluoride’s topical mechanism probably explain the fact that, since the 1980s, there have been many research reports indicating little difference in tooth decay between fluoridated and non-fluoridated communities.9-21
6. Deprivation is the clearest factor associated with tooth decay, not lack of ingested fluoride. This has been shown graphically for 50 USA states by Dr Bill Osmunson, DDS, MPH.22 According to the World Health Organisation, dental health in 12-year olds in non-fluoridated industrialised countries is as good, if not better, than those in fluoridated countries.23
7. Chemicals that are used in fluoridation have not been tested for safety. Most fluoridation schemes now use fluorosilicic acid (H2SiF6), or its sodium salt. H2SiF6 is a by-product of the production of phosphate fertilizer. Fluoridation uses industrial grade H2SiF6 which is contaminated with trace amounts of heavy metals such as lead, arsenic and radium, some of which are harmful to humans at the levels that are being added to fluoridate the drinking water. Federal agencies in the US, in response to questions from a Congressional subcommittee in 1999-2000, admitted that the industrial grade fluorosilicate waste products used to fluoridate over 90% of America’s drinking water supplies have never been subjected to toxicological testing nor received FDA approval for human ingestion.24 NPWA’s enquiries lead us to believe that no testing has taken place in the UK.25
8. In May 2006 Cancer Causes and Control published a peer-reviewed, case-controlled study from Harvard University which found a 5-7 fold increase in osteosarcoma (a frequently fatal bone cancer) in young men associated with exposure to fluoridated water during their 6th, 7th and 8th years.26 While this study does not prove a relationship between fluoridation and osteosarcoma beyond any doubt, the weight of evidence and the importance of the risk call for serious consideration. The NRC Report points out (page 322) that “Osteosarcoma presents the greatest a priori plausibility as a potential cancer target site because of fluoride’s deposition in bone, the NTP animal study findings of borderline increased osteosarcomas in male rats and the known mitogenic effect of fluoride on bone cells in culture.” The subsequent pages of the NRC Report evaluate a number of relevant studies and record the fact that a relatively large hospital-based case control study by Bassin’s supervisor, Professor C W Douglass was expected to be reported in the Summer of 2006. The NRC Panel say (page 330) “The Douglass study may have limited statistical power to detect a small increase in osteosarcoma risk due to fluoride exposure, but the committee expects the forthcoming report is likely to be a useful addition to the weight of evidence regarding the presence or degree of carcinogenic hazard that fluoride ingestion might pose to osteosarcoma risk, particularly if it addresses some of the limitations of hospital-based studies that are mentioned above in the description and technique of the Bassin thesis.” Douglass’s study has not yet (December 2008) been published.
9. It is said that Birmingham has been fluoridated for over 40 years without any harmful effects having been observed. However, no testing of blood or urine for fluoride is carried out so any incidences of fluorosis are more likely to be missed than discovered. People born in Birmingham have drunk fluoridated water for a maximum of 44 years. As fluoride is a cumulative poison and people often live to 80 or 90 years, the experiment is still ongoing.
10. Throughout the period of the Public Consultation in Hampshire, South Central SHA and Southampton City PCT have continuously promoted fluoridation, presenting it as preventative of tooth decay. “Any substance or combination of substances presented as having properties for treating or preventing disease in human beings” is, under the European Union Directive 2004/27/EC on medicinal products for human use, a Medicinal Product. Many chemicals are used in water treatment but fluoride is the only one put into water not for the purpose of purification of the water but for the purpose of bringing about physiological change in humans. Medication of people ‘with capacity’ should only be on an individual basis and with fully informed consent. Mass-medication is completely unacceptable.
11. Fluoridation gives no control of dose because different people drink different amounts and obtain fluoride from sources other than water. It takes no account of susceptible subsets of the population such as bottle-fed babies, children with dental fluorosis, kidney patients, diabetics, athletes etc.
12. Given the non-existence of good quality research proving that fluoridation is effective and safe, and concerns expressed in the NRC Report regarding the potential harmful effects of fluoride, South Central SHA is acting irresponsibly in proposing to medicate a population of 195,000 people with a cumulative poison.
13. Professor Trevor Sheldon, Chair of the Advisory Committee to the York Review, has said in a letter dated 3 January 2001, “Until high quality studies are undertaken providing more definite evidence, there will continue to be legitimate scientific controversy over the likely effects and costs of water fluoridation.”27 A significant body of scientists and professionals agrees with NPWA’s view on this issue. As of 13 December 2008, two thousand scientists and professionals had signed the Professionals’ Statement opposing fluoridation.24 Some of the signatories are very eminent in their field. They include:-
• 295 PhDs – includes DSc (Doctor of Science) & EdD (Doctor of Education)
• 247 DCs (Doctor of Chiropractic)
• 244 Nurses (RN, BSN, ARNP, APRN, LNC)
• 244 MDs (includes MBBS)
• 238 Dentists (DDS, DMD, BDS)
• 101 NDs (Doctor of Naturopathic Medicine)
• 54 Lawyers (JD, LLB, Avvocato)
For the above reasons, the National Pure Water Association opposes fluoridation and recommends that the Precautionary Principle should be adopted and SCSHA’s proposal to fluoridate 195,000 people in Southampton and Hampshire should be halted forthwith.
Elizabeth A McDonagh BSc(Hons), Cert. Ed.
Chairman, National Pure Water Association Ltd
With acknowledgements to Professors Paul Connett, Hardy Limeback and Vyvyan Howard.
References to NPWA’s Response to the SCSHA’s Public Consultation into Water Fluoridation
- South Central Strategic Health Authority. Public consultation on the proposal for water fluoridation in Southampton and parts of south west Hampshire, 2008.
- (US) National Research Council. Fluoride in Drinking Water A scientific review of EPA’s standards, National Academies Press, 2006.
- The NHS Centre for reviews and Dissemination at the University of York. A Systematic Review of Public Water Fluoridation, 2000 – http://ww.york.ac.uk/inst/crd/fluorid.htm
- Beltran E and Barker L. Prevalence of Enamel Fluorosis Among 12-19 Year-Olds, U.S., 1999-2004 Centers for Disease Control and Prevention, Atlanta GA, USA – http://video.google.com/videoplay?docid=4072416559052593081
- Glasser G and Jones J. Smile, Please – but don’t say ‘Cheese’ The Psychological Impact of Dental Fluorosis, published by NPWA and SPWA, July 2006) – http://www.npwa.org.uk/http://www.npwa.org.uk/wp-content/uploads/2008/06/smile_please_aug08.pdf
- American Dental Association. Interim guidance on infant formula and fluoride, posted 9 November 2006 – http://www.ada.org/prof/resources/positions/statements/fluoride_infants.asp
- Professor Vyvyan Howard MB, ChB, PhD, FRCPath. Lecture, Fluoride and the Developing Nervous System, Steelworkers’ Union Hall, Toronto Aug 11th 2008 – http://video.google.com/videoplay?docid=4072416559052593081
- Fluoride recommendations work group. Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. Morbidity and Mortality Weekly Report, US Center for Disease Control , 17 August 2001 – http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm
- Leverett DH. Fluorides and the changing prevalence of dental caries, Science, 217(4554):26-30, 1982.
- Colquhoun J. New evidence on fluoridation. Social Science & Medicine, 19:1239-46, 1984.
- Colquhoun J. Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology 13:37-41, 1985.
- Colquhoun J. (1987). Education and Fluoridation in New Zealand: an historical study. PhD thesis, University of Auckland, NZ.
- Colquhoun J. Child dental health differences in New Zealand. Community Health Studies, 11:87-104, 1987.
- Diesendorf M. The Mystery of Declining Tooth Decay. Nature. 322: 125-129, 1986 – http://www.fluoridealert.org/diesendorf.htm
- Gray AS. (1987). Fluoridation: Time For A New Base Line? Journal of the Canadian Dental Association. 53(10): 763-5.
- Brunelle JA, Carlos JP. Recent trends in dental caries in U.S. children and the effect of water fluoridation. J. Dent. Res 69, (Special edition), 723-727, 1990 – http://www.fluoridealert.org/brunelle-carlos.htm
- Spencer AJ, et al. Water Fluoridation in Australia. Community Dental Health, 13(Suppl 2): 27-37, 1996.
- De Liefde B. The Decline of Caries in New Zealand Over the past 40 Years. New Zealand Dental Journal, 94: 109-113, 1998.
- Locker D. Benefits and Risks of Water Fluoridation. An Update of the 1996 Federal-Provincial Sub-committee Report. Prepared for Ontario Ministry of Health and Long Term Care, 1999.
- Armfield JM, Spencer AJ. Consumption of non-public water: implications for children’s caries experience. Community Dent Oral Epidemiol 32:283-296, 2004.
- Pizzo G, et al. Community water fluoridation and caries prevention: a critical review. Clinical Oral Investigations, 11(3):189-93, 2007.
- Osmunson B. Water fluoridation intervention: dentistry’s crown jewel or dark hour? Guest Editorial, Fluoride, 2007; 40 (4): 214-221.
- Neurath C. Tooth decay trends for 12-year-olds in nonfluoridated and fluoridated countries. Fluoride, 2005: 38 (4) 324-325.
- Fluoride Action Network, The Professional’s Statement Calling for an end to Water Fluoridation – http://www.fluoridealert.org
- Correspondence between NPWA and Mr Peter Jackson of WRc plc., January 2002. NPWA Watershed, Vol 8, No 1, Spring 2002, page 2 – http://www.npwa.org.uk/http://www.npwa.org.uk/wp-content/uploads/2008/06/ws_v8_n1_sp02.pdf
- Bassin, Elise B, Wypij, David, Davis, Roger B, Mittleman, Murray A. (2006) Age-specific fluoride exposure in drinking water and osteosarcoma (United States), Cancer Causes and Control, 17:421-428.
- Sheldon TA, Chairman, Advisory Panel, York Review, Open Letter, 3 January 2001 – http://www.npwa.org.uk/http://www.npwa.org.uk/wp-content/uploads/2008/06/sheldon_letter.pdf
Other responses to South Central SHA’s Fluoridation Consultation
Council Health Scrutiny Committee Reports
Hampshire County Council’s Health Overview and Scrutiny Committee Click on ‘Key Documents’