Fluoride Resource studies


Ten Key Papers that Challenge the Pro-fluoridtion Mantra

Introduction 

Promoters of fluoridation repeat ad nauseam the mantra that fluoridation is “safe”, “effective” and “cost effective” (how many times have unsuspecting legislators been told that for every $1 spent we save $38?). Instead of backing up these claims with any solid scientific evidence, they use a long list of impressive but fairly meaningless (i.e. “science-free”) endorsements. This is not surprising because the science is not there to support the mantra. What is surprising is that public health officials and professional bodies repeat these claims with no sense of embarrassment. I believe that historians will be astounded that so many “respectable” professional associations and health agencies (in the handful of countries that fluoridate) have endorsed a practice, which has such little scientific and no ethical justification. In Orwell’s Animal Farm the pigs rule, in the fluoridated world the sheep rule.

Below is a list of 10 studies (actually nine studies and one review) that invalidate this mantra.  Fluoridation is neither effective, nor safe, nor cost-effective. In addition I give a few words about the first four studies that challenge the mantra of fluoridation’s “effectiveness” and  “cost-effectiveness.”

In part 2 of this article, I will say a few words on the papers that pertain to safety.

Part 1. A Listing of the 10 studies

1. Brunelle and Carlos. 1990. Recent Trends in DentalCaries in U.S. Children and the Effect of Water Fluoridation. Journal of Dental Research,69(Special Issue):723-727.

2. Featherstone JD. 2000.The Science and Practice of Caries Prevention. Journal of the American Dental Association (JADA), Jul; 131(7):887-99.

3. Warren JJ, et al. 2009. Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes–a longitudinal study. Journal of Public Health Dentistry, 69(2):111-15. Spring.

4. Ko L, Thiessen KM. 2014. A critique of recent economic evaluations of community water fluoridation. International Journal of Occupational and Environmental Health.

5. Luke J. 2001. Fluoride deposition in the aged human pineal gland. Caries Research 35(2):125-128. See also Luke’s PhD thesis click here.

6. Xiang Q, et al. 2003a. Effect of fluoride in drinking water on children’s intelligence. Fluoride 36(2):84-94, and Xiang Q, et al. 2003b. Blood lead of children in Wamiao-Xinhuai intelligence study [letter]. Fluoride 36(3):198-199.

7. National Resource Council of the National Academies. 2006. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.

8. Bassin EB, et al. 2006. Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes and Control, May;17(4):421-8.

9. Choi AL, Grandjean P, et al. 2012. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives, 120(10):1362–1368.

10. Choi AL, et al. 2015. Association of lifetime exposure to fluoride and cognitive functions in Chinese children: A pilot studyNeurotoxicology and Teratology, 47:96–101.

A few words about papers 1-4.

STUDIES ON EFFECTIVENESS OF FLUORIDATION

1. Brunelle and Carlos. 1990.Recent Trends in DentalCaries in U.S. Children and the Effect of Water Fluoridation. Journal of Dental Research,69 (Special Issue):723-727.

This was the largest survey of dental decay in children in the US (the authors studied 39,000 children in 84 communities). The study was organized by the pro-fluoridation National Institute for Dental Research (NIDR). These NIDR authors found an average difference of only 0.6 of one tooth surface between children (aged 5-17) who lived all their lives in a fluoridated community compared to a non-fluoridated community (see Table 6). This result was NOT shown to be statistically significant. The pro-fluoridation bias of the authors becomes apparent in the way they present these unimpressive results in their abstract. They do not report the difference in tooth decay as an absolute value (i.e. 0.6 of one tooth surface) but as a relative % difference. This value of 18% looks more impressive than an absolute saving of 0.6 of about 100 tooth surfaces in a child’s mouth (there are 128 when all the teeth have erupted). Nor did the authors admit that they had not shown that this result was statistically significant: it wasn’t! Here is an excerpt from their abstract, which says more about the politics of this issue than the science.

“Children who had always been exposed to community water fluoridation had mean DMFS (decayed missing and filled surfaces, PC) about 18% lower than those who had never lived in a fluoridated communities. When some of the “background” effect of topical fluoride was controlled, this difference increased to 25%. The results suggest that water fluoridation has played a dominant role in the decline in caries and must continue to be a major prevention methodology.” (my emphasis, PC)

Really?

2. Featherstone JD. 2000.The Science and Practice of Caries Prevention. Journal of the American Dental Association (JADA), Jul; 131(7):887-99.

In this article, which was a cover story in JADA edition of July 2000, Featherstone reached the same conclusions that many prominent dental researchers had reached over the previous 20 years: Namely, that the predominant mechanism of fluoride’s beneficial action is topical not systemic. The CDC acknowledged the same thing in 1999. In other words you don’t have to swallow fluoride to protect your teeth and therefore there is no need to force it on people who don’t want it via their drinking water. This is probably one of the reasons why, according to the World Health Organizations data online, that tooth decay rates in 12-year-olds have been declining at about the same rates in non-fluoridated as in fluoridated countries since the 1960s (http://fluoridealert.org/issues/caries/who-data/ ). Here are Featherstone’s conclusions:

CONCLUSIONS:

Fluoride, the key agent in battling caries, works primarily via topical mechanisms: inhibition of demineralization, enhancement of remineralization and inhibition of bacterial enzymes.

CLINICAL IMPLICATIONS:

Fluoride in drinking water and in fluoride-containing products reduces caries via these topical mechanisms.

3. Warren JJ, Levy SM, Broffitt B. et al. 2009. Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes–a longitudinal study. Journal of Public Health Dentistry, 69(2):111-15. Spring.

If the Brunelle and Carlos (1990) paper was the largest US government funded study, the Warren et al (2009) paper was the most precise. This investigation was conducted as part of the “Iowa study,” which has been examining tooth decay in a cohort of children since birth. Warren et al. examined tooth decay as a function of daily ingestion of fluoride in mg/day (i.e. they examined individual exposure rather than the traditional way of comparing dental decay rates between communities with different concentrations of fluoride in water). The authors could not determine a clear relationship between caries experience and daily dose in mg/day. The authors’ state:

These findings suggest that achieving a caries-free status may have relatively little to do with fluoride intake, while fluorosis is clearly more dependent on fluoride intake.

CONCLUSIONS: Given the overlap among caries/fluorosis groups in mean fluoride intake and extreme variability in individual fluoride intakes, firmly recommending an “optimal” fluoride intake is problematic.

Please note that all three of these studies were carried out by pro-fluoridation dental researchers. Many dentists are oblivious of the fact that research carried out by their own pro-fluoridation colleagues has undermined the effectiveness that they claim. In addition it should be noted that in the 70 years since fluoridation was launched in 1945 there has never been a Randomized Control Trial (RCT) to establish in a scientific fashion that swallowing fluoride lowers tooth decay. This is the gold standard used by the FDA to establish the efficacy of any drug. Considering such a flimsy scientific basis for the effectiveness of this practice it is the height of arrogance to force a known toxic substance on people who don’t want it.

STUDIES ON THE COST-EFFECTIVENESS OF FLUORIDATION

4. Ko L, Thiessen KM. 2014. A critique of recent economic evaluations of community water fluoridation. International Journal of Occupational and Environmental Health.

This paper demolished the claim by Susan Griffin (an economist at the CDC) that for every dollar spent on fluoridation $38 was saved on dental costs. This statement has been used countless times by state dental directors, public health officials and other promoters of fluoridation.  We have provided more details on this in a previous bulletin.

In part 2, I will say a few words about papers 5-10 that challenge the mantra of fluoridation’s “safety.”

Paul Connet, PhD
Director
Fluoride Action Network
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s