Whole Living Guide > Feature
Rethinking Water Fluoridation
by Dylana Accolla; Illustration by Vladimir Zimakov

“Tooth-friendly fluoride.” “Fluoride—the beneficial provider of gleaming smiles.” A harmless substance that strengthens teeth and protects them from decay, or a poisonous toxin?

Fluoride is a natural mineral found throughout the earth’s crust and widely distributed in nature. And like mercury and lead, fluoride is a toxin. When ingested, fluoride concentrates in bones and teeth. When applied topically to teeth, fluoride hardens enamel and helps prevent decay caused by plaque bacteria and sugars.

For 50 years fluoride has been a mainstay of dental treatment. It’s found in virtually every tube of toothpaste. Dentists regularly prescribe daily fluoride tablets to children as well as topical treatments that apply fluoride directly to teeth in the form of mouthwash, gels, foams, and varnishes. Fluoride is added to some brands of children’s vitamins. And since 1945 public health officials have promoted medicating entire communities through public drinking water.

More than half of all Americans, approximately 162 million people, drink fluoridated water. That’s nearly 66 percent of all Americans served by public water systems.

But ever since the first fluoridation program was established in Grand Rapids, Michigan, the debate over the efficacy and safety of fluoridation has been raging. People are deeply divided over this issue.

A 1988 report states that of 2,000 referenda held on fluoridation i n us communities since 1950, about 60 percent have been voted down. A 1990 statement put that figure at 75 percent. Last November a fluoridation referendum was held in Texarkana, Arkansas, a small city of 30,000 on the Texas border. The second such referendum in 16 years, it was voted down by a 2-to-1 margin. But on February 12 of this year, the Metropolitan Water District of Southern California, the state’s largest water agency, voted to add fluoride to the water it supplies to 18 million homes and businesses, from the Mexican border to the Central Coast. So there seems to be no clear trend.

On one side of the debate are 92 national and international organizations that promote fluoridation, including the American Dental Association (ada), the American Medical Association, the Medical Associations of Britain and Canada, the Center for Disease and Prevention, and the World Health Organization. On the other side are hundreds of passionate, articulate antifluoridation groups devoted to ending it.

The ada publishes “Fluoridation Facts,” a comprehensive, 56-page booklet that answers 40 questions regarding fluoride benefits, safety, public policy, and cost effectiveness, backed up by 237 scientific references. The ada argues that fluoridation is safe, economical, and equitable: “Simply by drinking optimally fluoridated water, the entire community benefits, regardless of age, socioeconomic status, educational attainment or other social variables.” The ada frankly acknowledges the anti-fluoridation arguments, but dismisses most opposition as junk science: “Some opponents may knowingly or unknowingly use half-truths and innuendoes to support their opinions, either misquoting or applying statements out of context. The sometimes alarming statements used by some antifluoridationists, however, are not substantiated by general accepted scientific knowledge.”

In turn, antifluoridationists highlight the dubious underpinnings of early fluoride research and its connection to industrial polluters, offer conflicting studies of the effects of fluoridation, and suggest potential risks involved with long-term exposure to fluoride, which is more and more present not only in water but in processed foods and drinks. They argue that the public health community and government organizations have not been responsive enough to compelling evidence. Here is their side of the story.

In recent years there has been a deluge of well-respected, peer-reviewed research studies indicating that the universal fluoridation of public drinking water may not be such a good idea.
It seems that justification for fluoridation was based on exaggerated and false reports. For example, although scientists in 1945 believed you had to ingest fluoride for it to be effective, the Centers for Disease Control and Prevention recently acknowledged that only topically applications after a cavity erupts are of any benefit. Scientists also once believed that fluoride was an essential nutrient, but there is no known disease due to fluoride deficiency, and it is present in breast milk in only very minute amounts (0.01 parts per million).

A third early belief was that dental fluorosis, a defect in the tooth enamel (and the first visible sign of chronic fluoride toxicity), would occur in only 10 percent of children drinking water fluoridated at 1 ppm and would occur only in its mildest form. Actually, fluorosis occurrence is considerably higher in fluoridated communities (30 percent) and can be considerably more severe than a couple white flecks on teeth. In addition, scientists thought that 1 ppm in drinking water would provide an ample margin of safety against toxic effects. Recently we have discovered that not only is there no safety margin for fluorosis, but also there may not be one for changes to bone structure, the thyroid and pineal glands, the reproductive system, and more.

Fluoride, the early industrial pollutant
Fluoride also has the dubious honor of being the sixth most emitted toxic industrial by-product. In a bizarre twist of irony, we now pay industry to dump its toxic by-products into our drinking water.

The story of how fluoride went from being an industrial pollutant to a public health asset is told in a 1992 article by investigative reporter Joel Griffiths, “Fluoride: Commie Plot or Capitalist Ploy” (Covert Action Quarterly, No. 42). As early as 1850, fluoride emissions from iron and copper industries were poisoning livestock, crops, and people. By the turn of the century, lawsuits and heavy regulations threatened to put an end to those industries in Germany and England. The invention of the tall smokestack saved those industries by dispersing fluorides and other toxins into the upper air, so less of it would directly effect living creatures below. But when industrial expansion in the 1920s sent fluoride emissions spiraling out of control, not even tall smokestacks could screen the damaging effects. In 1933, the world’s first major air pollution disaster, in the Meuse Valley, Belgium, in which several thousand people became violently ill and died, involved fluoride poisoning.

Some of the biggest polluters were the aluminum industry and the fluorocarbon chemicals industry, which manufactures aerosols and refrigerants. By 1938, on wartime production schedule, the aluminum industry was producing an unprecedented amount of fluoride waste.
Realizing that industrial growth depended on the necessity of releasing millions of tons of waste fluoride into the environment, American and European industrialists and governments initiated studies on the toxicity of fluoride. In 1931, the Public Health Service, under the leadership of Andrew W. Mellon, us Treasury Secretary and a founder and major stockholder of the Aluminum Company of America (alcoa), sent a dentist named Trendley Dean to several remote Western towns where drinking water contained high concentrations of natural fluoride from deep in the earth’s crust. “Dean’s mission,” explains Griffiths, “was to determine how much fluoride people could tolerate without obvious damage to their teeth.” Writes Griffiths, “Dean found that teeth in these high-fluoride towns were often discolored and eroded, but he also reported that they appeared to have fewer cavities than average.

He cautiously recommended further studies to determine whether a lower level of fluoride in drinking water might reduce cavities without simultaneously damaging bones and teeth, where fluoride settles in humans and other animals.”

In response to Dean’s report, Gerald J. Cox, an alcoa industrial lab biochemist, immediately began a study fluoridating lab rats. He found that fluoride reduced their cavities, proclaiming that “the case should be regarded as proved.” (G.J. Cox, “Discussion,” Journal of the American Medical Association, Vol.113, 1938, p. 1753). The next year, Cox announced that “the present trend toward complete removal of fluoride from water and food may need some reversal” (Journal of American Water Works Association. Vol, 31:1926–30, 1939). And in 1939 the first proposal that the us should fluoridate its drinking water was made—“not by a doctor, or dentist,” notes Griffiths, “but by Cox, an industry scientist working for a company threatened by fluoride damage claims.” Subsequently, Cox toured the country campaigning for fluoride.
Cox got help from Edward L. Bernays, a nephew of Sigmund Freud who pioneered the application of Freud’s psychological theories to advertising and government propaganda. “If you can influence the [group’s] leaders, either with or without their conscious cooperation,” wrote Bernays in his 1928 book Propaganda, “you automatically influence the group which they sway.” The main targets of Bernays advertising blitz were doctors and dentists. Under Bernays’ media tactics, a quick shift in peoples’ perception of fluoride began to take place.

In 1945 water fluoridation began abruptly in Grand Rapids, Michigan, with the backing of the federal government. It was planned as a 15-year comparison study to determine whether fluoride could safely reduce cavities in children, explains Griffiths. But within a year, before research had barely begun, the water in six American cities, including Newburgh, New York, was fluoridated.

In 1951, the American Medical Association endorsed the principle of fluoridation of community water supplies. And by the early 1950s, much of America was clamoring for that “beneficial provider of gleaming smiles”—fluoride.

It’s worth noting that by this time, the us Public Health Services had endorsed silicofluoride, a chemical by-product of various industries, to be added to water as a cheaper substitute for naturally occurring sodium fluoride. Research since 1975 has shown that it is much more toxic than sodium fluoride.

Recent Findings
In 1990 the largest dental survey ever conducted in the United States, by Yiamauyannis et. al. (1990), was commissioned by National Institute of Dental Research. Scientists examined over 39,000 school children aged 5 to 17 years. They found that the average difference in the occurrence of tooth decay between children living in fluoridated versus non-fluoridated communities amounted to less than 0.5 percent.
Repeated studies from pro-fluoridation researchers who have since become fluoride critics (including Limeback, 1999; Riodan, 1999; Featherstone, 1999 from the us Centers for Disease Control) have shown that topical fluoride is the only way that fluoride benefits dental health. In other words, drinking water supplemented with fluoride has minimal or no effect on dental health. Five peer-reviewed studies published in the past two years have found that dental decay does not increase when communities stop fluoridating.
Another key piece of the fluoride research comes from our own back yard. In 1998, scientists Kumar and Green compared the teeth of residents of Newburgh who had been drinking fluoridated water for 50 years with those of residents in unfluoridated Kingston. They found no significant difference in the rate of cavities. The only difference the study did find, in fact, was that fluoridated Newburgh showed about twice the incidence of fluorosis. In 1997, K.E. Heller et al. reported that approximately one in three children living in fluoridated water communities have fluorosis on at least two teeth.
Today, fluorosis in children has become such a big deal in dental circles that the ada recommends that no fluoride be given to children under the age of six months, and those under the age of three years should receive no more than 0.25 milligrams per day. When a parent feeds a child infant formula reconstituted with fluoridated water, she or he is already exceeding these fluoride dosage recommendations.

Health Hazards
If the beneficial effects of fluoride in the water are negligible, its negative effects on health have been leaking out slowing since the 1950s.

One of the first negative effects of fluoridation came out back in 1956, again comparing the fluoridated population of Newburgh to that of Kingston. In this study, Schlesinger and his group found that young girls in Newburgh experienced the onset of menstruation a full six months earlier than did girls in non-fluoridated Kingston. (Newburgh-Kingston caries-fluoride study XIII. Pediatric findings after 10 years. Journal of the American Dental Association 52 296-306 (1956).)

More recently, researchers have documented chronic toxic health hazards ranging from dental fluorosis to Alzheimer’s, arthritis, behavioral disorders and hyperactivity, bone pathology, cancer, gene mutation, melatonin disturbance, neurotoxicity, thyroid dysfunction, and reproductive effects.

Fluoride Overdose
Whether your public drinking water is fluoridated or not, you may be overdosing on fluoride. Every bottle of processed beverage you drink, from soda to Snapple, is fluoridated. Any processed food product made with fluoridated water contains fluoride. Toothpaste is fluoridated. Baby food reconstituted with fluoridated water has a hundred times more fluoride in it than breast milk. There is fluoride in air pollution as well as pesticide residues.

According to Michael Connett, a professor at St. Lawrence University, in an article from Rachel’s Weekly (2001), if 1 ppm in drinking water were the only source of fluoride, the average person would ingest 2 mg of fluoride each day. In 1991 the federal Department of Health and Human Services estimated that people are exposed to between 1.58 to 6.6 mg of fluoride a day. At 1.58 mgs per day, fluoride starts to suppress the thyroid gland. But half the fluoride you ingest is not excreted. It builds up in the bones. At 75 mgs per day it increases the rate of hip fractures in osteoporosis patients.

Policy and Choices
Why our governments have been so slow to act on these findings is puzzling. One reason may be that the rhetoric supporting fluoridation is increasingly centered on the idea that fluoridation mostly benefits the poorest in society. But statistics show that dental decay is worst in the United States in poor urban centers that have been fluoridated for decades. (One of the major dental health problems experienced in poor communities is called “early childhood caries,” or “baby bottle tooth decay.” This condition, resulting from excessive consumption of sweetened liquids from a young age, is not prevented by water fluoridation.)

In an April 2000 statement, former pro-fluoridation advocate Dr. Hardy Limeback, head of the Department of Preventive Dentistry at the University of Toronto, noted that “when dental decay rates were high, a certain amount of dental fluorosis was considered an acceptable ‘trade off.’” Not anymore, he says: “The benefits of water fluoridation no longer outweigh the risks.” He points out that “the major reasons for the general decline of tooth decay worldwide, both in non-fluoridated and fluoridated areas, is the widespread use of fluoridated toothpaste, improved diets, and overall improved general and dental health (antibiotics, preservatives, hygiene etc).”

As more and more dentists and health experts in communities around the US and across the world publicly denounced policies of fluoridation, it may be time to leave fluoride on the shelf.