If you’re old enough to read this you have consumed your share of fluoride. It is in everything you eat and drink, too often in the air you breathe. Most of the country’s public water systems are treated with fluoride to help prevent and reduce instances of tooth decay and cavities. They say fluoride is especially good at preventing tooth decay in children younger than age eight.
Although it took them a few decades to get started, they are figuring out what else fluoride does to a human’s body. Too much of it causes dental fluorosis—a streaking and mottling of the teeth—in the same age group it is purported to help the most. Older folk run the risk of being crippled by skeletal fluorosis. Thyroid malfunction, kidney disease, diabetes, cancers and neurological disorders also have been linked to fluoride. They dismiss all of that as incomplete research, voodoo science.
They cannot, however, dispute the fact fluoride compounds are among the most toxic substances known to man. Adolf Hitler used the stuff in his concentration camps. Long before they said it would be good for our teeth, sodium fluoride was sold as a rat poison and a pesticide.
Wait. The practice of fluoridating water began 65 years ago—it started in Virginia cities in the early 1950s. Opponents have been protesting since day one. There is no conclusive research that proves fluoride consumption is safe. The rate of childhood tooth decay is dropping in areas that don’t fluoridate water.
Some believe big business and the Manhattan Project needed a way to dispose of fluoride waste so they bamboozled the government into the tooth fairy bit. Others believe fluoridation is a case worthy of James Bond’s attention, that it has something to do with evil forces spiking the water supply to drug people into some kind of docile stupor.
Pollutant to Additive
All fluorides come from fluorine, the 13th most common element in nature. And fluorine is a troublemaker. It refuses to live alone. It finds ways to marry other elements and compounds to create substances such as sodium fluoride or fluorocarbon or hydro fluoride.
These substances are industrial darlings, used in everything from making fishing line to refining weapons-grade uranium, from anti-depressants such as Prozac to toothpaste.
A survey conducted in 2001 reported 991 facilities released 72 million pounds of hydrogen fluoride into the atmosphere. The biggest culprits were coal-fired electrical plants, aluminum producers and phosphate fertilizer plants. The states that released the most were Pennsylvania, Ohio and North Carolina.
In early January 2010 the Environmental Protection Agency and the U.S. Department of Health and Human Resources, with an endorsement from the Centers for Disease Control announced plans to propose that the amount of fluoride put into the water should not exceed 0.7 milligrams per liter. The current recommendation is a range of 0.7 and 1.2 mpl. The Eastern Virginia water systems that fluoridate follow the 0.9 mpl mandated by the state.
Why the lower concentration? Dental fluorosis now affects 31 percent of the country’s children younger than age eight. Dental flourosis is a sign of ingesting too much fluoride. Reducing the amount added to water could mean safer levels for the kids.
According to CDC statistics, 56 percent of the kids between the ages of 12 and 16 have cavities. Fluoride is in everything kids eat and drink. Critics want to know why that number is so high. How can fluoride reduce cavities by as much as 30 percent in people younger than age eight yet block cavities in less than half of the young teen population?
Although the EPA is steward of the country’s water supply, it has no regulatory power. The best it can do is make recommendations and issue warnings. This is from the agency’s 1997 fact sheet: “There are no federal safety standards that are applicable to additives, including those for use in fluoridating drinking water.” Despite that, the process of putting together a recommendation is convoluted at best.
What happened in January 2010 was the first step of a proposal, according to Joyce Donohue of the EPA’s Office of Water. “Now it has to be put out for a period of public comment. The comments are collected and the pros and cons are reviewed.”
The EPA, which does not conduct its own research, also gathers published reports and data to aid the review process. It was from this material the EPA developed the estimate that the average fluoride concentration for the country’s 57,500 water supply systems is 0.87 mpl. Recommending that be reduced to the proposed 0.7 mpl is much more complicated than it seems.
In areas such as Suffolk, Isle of Wight and Smithfield the water contains high concentrations of naturally occurring fluoride. For those areas it’s a matter of removing rather than adding.
We have to consider the treatment technology needed to remove the fluoride,” Donohue said. “It becomes a situation of benefits versus cost.”
Smithfield recently spent $5 million on a filtering system that removes fluoride. In this era of ruptured municipal budgets and a roller-coaster national economy any expense may be too much. Donohue said the EPA is keenly aware of that. “Nobody benefits if the systems are asked to do something they cannot afford,” she said.
The amount of fluoride under discussion is mind-bogglingly minute. A liter of water weighs 33.8140226 ounces. To that the EPA wants to propose adding 0.7 milligrams, or .000024691773365 ounces.
This is where it gets touchy. Fluoride isn’t something the body takes out with the rest of the trash. As much as half of it finds refuge in the bones. Since fluoride essentially is in everything we eat and drink, we are taking in and retaining much more than is in a glass of water. The EPA concluded people younger than age seven take in 1.21 milligrams per day. The acceptable level is .72 milligrams per day. Dropping the water concentration amount will lower that second figure, Donohue said.
Or so the EPA will explain in its recommendation. Once finished and approved the recommendation is sent to state agencies such as the Virginia State Board of Health. The state agencies hammer the recommendations into regulations and guidelines that are sent to the licensed water suppliers.
When the regulations reach the local level, consumers can make some decisions of their own. They can call for a referendum that lets residents vote for whether or not they want fluoridation.
That brought about a curious situation in the western part of Virginia. The Virginia-Carolina Regional Water Authority is developing a water supply that will serve Independence, Va., and Sparta, N.C. Sparta residents convinced their town council and the Alleghany County Commissioners to vote against fluoridation. Independence and Grayson County did not vote on the issue.
That created the obvious dilemma of delivering fluoridated water one way and non-fluoridated water the other.
Why go through all of this?
All of the work we have done definitely shows the benefits of fluoridation,” Donohue said. “Fluoride helps prevent cavities. That’s a fact.”
A fact that has been finessed and modified over the years. The current belief is fluoride coats the tooth enamel and that helps prevent cavities. To build that layer, which is 10,000 times thinner than a human hair, fluoride must be applied topically—painted onto teeth like a varnish. Swallowing fluoridated water does little more than quenching a thirst.
Take Your Medicine
Putting fluoride in the water supply, they say, is the cheapest and most convenient way to make sure everybody gets a dose—dose is the amount of water a person drinks; concentration is the amount of fluoride in the water. The toothless old man with a wrecked memory gets the same concentration as the college football player, and the football player gets the same concentration as the year-old baby.
And that ships fluoridation into a legal gray area.
When fluoride is used as an additive for health reasons, it becomes a medicine. As a medicine it requires an informed consent from the individual receiving it. The individual needs to be told what the treatment is for and how it will be conducted. Risks and benefits must be explained. The patient should be told if there are alternative treatments.
None of that is done before water is fluoridated.
The Food and Drug Administration is shepherd of the country’s medicines. It has never conducted research or issued a statement on water fluoridation. No matter. In 1979 the Toxic Substances Control Act gave the EPA the water sentry duty. Sort of. The EPA and its Office of Water does not regulate adding fluoride to water. It is, however, beat cop for contaminants and pollution.
On the one hand the EPA is figuring out how much fluoride is needed to protect your healthy smile. It is ready to lower the boom with the other hand when the fluoride concentration passes a safety margin and becomes a contaminant.
Let’s not forget the Safe Drinking Water Act. Passed in 1974, it deputizes the EPA to test for and regulate fluoride and 90 other toxic chemical substances. More than 60,000 chemicals are used every day in the United States, the New York Times reported on Dec. 17, 2009.
Some 200 million pounds of fluoride substances are added to the country’s water supply each year. In the early years sodium fluoride was used because it was a plentiful salt that was easily transported. It had to be handled as a hazardous material, something accomplished easily by a qualified staff.
For the last four decades fluorosilicic acid has been the favorite ingredient. Most of it comes from Florida where it is collected by scrubbing the fertilizer phosphate plants’ smokestacks. It is neither cleansed nor refined before being shipped to water suppliers.
The federal government has no research or risk assessment of fluorosilicic acid.
A Question of Ethics
The medical law issue at work here is, how can water be fluoridated without individual consent? Has anybody ever asked you if you want fluoride in your water? Who among you sees the inherent danger?
On Nov. 11, 1979, 65-year-old Lawrence Blake was receiving renal dialysis at the Bio-medical Applications, Inc., Center of Annapolis. In a ghoulish coincidence, an accident at the city’s water treatment facility released 1,000 gallons of fluoride into the water. Blake died of a heart attack triggered by a toxic reaction. Or, as doctors would say later, he died of “fluoride poisoning.”
Three patients were receiving dialysis treatment at the University Of Chicago Hospitals on July 16, 1993, when the equipment’s filtering devices malfunctioned. Enough fluoride made it through the filters to cause the death of all three patients.
The National Kidney Foundation has since withdrawn support of using fluoride as a water additive. Its position since 1981 said there was insufficient evidence to recommend people with kidney diseases drink fluoride-free water. Since 2007 it has been recommending kidney disease patients educate themselves about the risks of consuming fluoride.
And then there is the conclusion reached by EBSCO, a service company that provides library databases and periodical subscriptions. Its stance on fluoridation, for example, can be found at the University of Virginia Health Library. The debate is between conventional and alternative medicine groups, EBSCO concluded.
The position statement is this: “While water fluoridation in U.S. cities is a continuing source of impassioned controversy by both opponents and proponents, this emotional energy would probably be better spent elsewhere, as the practice is most likely both safe and unnecessary.”
We have spent 65 years barking up the wrong tree? Messing around with fluoride has been a fool’s errand? It cannot be that simple. Can it?
Originally published in the Health Journal’s print edition March 2010.