Water FluoridationHarmful to Health, Ineffective & Unethical Dr Mark Diesendorf Sustainability Centre Pty Ltd and Institute of Environmental Studies, UNSW Web: www.sustainabilitycentre.com.au
WHAT IS FLUORIDATION? • Most water supplies contain 0.1 to 0.2 ppm of fluoride (F- ) naturally. • Fluoridation increases the natural F- concentration to 1 ppm (i.e. 5 to 10 times natural level). It is not a small “adjustment”. • Purpose is to try to reduce tooth decay. • Some well water and bore water supplies contain 1 ppm or more naturally. • Fluoridation is mass medication.
FLUORIDATION IS MASS MEDICATION • Fluoridation is administered to treat people, not to make water safer to drink. So it is a medication. • Medical dictionaries and practice establish that preventive medicines are medicines. • F- in mg/day doses is not an essential nutrient. • Natural substances may be medicines: e.g. penicillin, digitalis, salicylates, radioisotopes, etc. • Mass medication violates two principles of medical ethics.
VIOLATIONS OF MEDICAL ETHICS • Principle of informed consent to medication • Principle of controlled dose.
DAILY F- DOSE IS NOT CONTROLLED • Even when F- concentration is controlled (e.g. at 1 ppm), daily dose (mg/day) cannot be. • Large variations in tap-water intake. In fluoridated areas, high F- intake groups are: - formula-fed infants get 100x dose of breast-fed infants; - young children who drink mostly soft drinks; - labourers and athletes; - people with diabetes insipidus, kidney disease, etc.; - heavy tea drinkers get double dose.
WHICH COUNTRIES ARE MORE THAN 50% FLUORIDATED? Only: USA Australia New Zealand Ireland Singapore Columbia Malaysia Israel
INDUSTRIAL WASTE AS MEDICATIONPure fluoride is dangerous enough, but … • Most water supplies are fluoridated with waste from phosphate fertiliser industry. • Contains traces of arsenic, lead & other toxics. • Never subjected to chronic safety tests in animals. Manufacture of phosphate fertiliser
DOES FLUORIDATION REDUCE TOOTH DECAY? Only one point of agreement between pro- and anti- cases: Big reductions in tooth decay occurred in most industrialised countries in 1960s and 70s. But they occurred in both unfluoridated and fluoridated countries. What was the cause? Reductions occurred before F- toothpaste was widely used.
TOOTH DECAY IN SYDNEY, 1961-1972, (fluoridated 1968) 1968 Source: Lawson et al. (1978)
‘THE MYSTERY OF DECLINING TOOTH DECAY’ Diesendorf M 1986, Nature 322: 125-129 Abstract: Large temporal reductions in tooth decay, which cannot be attributed to fluoridation, have been observed in both unfluoridated and fluoridated areas of at least 8 developed countries over the past 30 years. It is now time for a scientific re-examination of the alleged enormous benefits of fluoridation.
DOES F- REDUCE TOOTH DECAY? • There are no randomised controlled trials to determine the benefits of fluoridated water. • Reductions claimed for fluoridated water of “up to 50%” (ADA) are flawed by inadequate design (see critiques by Drs Philip Sutton, John Colquhoun, and Mark Diesendorf). • Some large studies find negligible or even no benefits(e.g.Armfield & Spencer 2004)
Jason M. Armfield and A. John Spencer 2004, ‘Consumption of nonpublic water: implications for children’s caries experience’,Community Dentistry & Oral Epidemiology, 32: 283 “The effect of consumption on nonpublic water on permanent caries experience was not significant.” Now the pro-fluoridation authors claim that their result is being “taken out of context”!
WHO ORAL HEALTH IN 12 YEAR-OLDS (DMFT) DMFT Not fluoridated >50% fluoridated 25-50% fluoridated?
AVERAGE TOOTH DECAY IN 10-YEAR-OLDS BY CAPITAL CITY, 1977 & 1987 School Dental Service data (Diesendorf, 1990). All cities except Brisbane fluoridated for at least 10 years by 1987.
HOW DOES FLUORIDE ACT ON THE TEETH? • Early notion that ingested F- was incorporated in tooth structure and strengthened it.WRONG! • Nowadays: mechanism predominantly ‘topical’ (surface); even pro-fluoridation US Centers for Disease Control admit this. • So, people are being misled that they have to ingest fluoridated water.
DENTAL FLUOROSIS • Caused by F- damage to tooth-forming cells. • Original claim that 1 ppm F- would only produce ‘mild’ mottling in 10% of people. • Actually 50% of people mottled; not only ‘mild’. ‘Mild’ dental fluorosis
DENTAL FLUOROSIS‘Moderate’ and ‘Severe’ Categories <-- Photo: Hardy Limeback DDS Pitting Photo: John Colquhoun BDS, PhD -->
SKELETAL FLUOROSIS IN NATURALLY FLUORIDATED REGIONS: e.g. INDIA, CHINA • Occurs at F- concentrations as low as 0.7 ppm. • F- accumulates in bone, adding mass but destroying structure. • X-rays show structural damage to bones, and calcification of joints and ligaments. • Mild skeletal fluorosis has similar symptoms to arthritis. • Prevalence of arthritis increasing in USA and Australia. • Could some ‘arthritis’ actually be early stage of fluorosis? .
HIP FRACTURES IN THE AGED • Disabling; may be fatal. • Cumulative lifetime F- dose exceeds dose where osteoporosis patients developed hip fractures. • Majority of epidemiological studies find more hip fractures in fluoridated areas. • In China, fracture rate doubled @ 1.5 ppm and tripled @ 4.3 ppm.
INTOLERANCE or HYPERSENSITIVITY • Large body of clinical reports, e.g. by Waldbott, Grimbergen, Petraborg, and Feltman & Kosel. • Several blind & double-blind studies. • Symptoms include excessive fatigue & thirst, stomach ache, muscular weakness. • Never followed up by proponents. Dr George Waldbott
BIOLOGICAL EFFECTS • F- is highly active biologically, not inert. • In lab., F- inhibits enzymes; induces genetic changes; & increases uptake of aluminium by brain. • In lab., AlFx complexes disrupt G-proteins. This could change homeostasis, metabolism, growth & differentiation of living organisms.(NEW) • F- concentrates in pineal gland causing earlier onset of puberty in animals.(NEW)
CAN SIMILAR BENEFITS BE OBTAINED WITH LESS RISK BY OTHER METHODS? • It is possible to have low caries without F intake: e.g. Australian Aborigines on original diet; Hopewood orphanage Australia in 1950s; most of EU today. • Public health officials can influence children’s diet,e.g. by public education and controls on foods sold in school shops & canteens. • Daily, supervised F toothbrushing and/or rinsing (at say 2 ppm) programs in elementary schools are low-risk (for children older than 5 years) and assist low-income groups.
POLITICAL & EQUITY ASPECTS • The principal risk factors for dental caries are poverty and poor diet, not the absence of fluoridation. • Governments use fluoridation to justify cuts to dental health programs for school children & aged. • They cynically peddle myth that fluoridation helps the poor. • But the poor have highest prevalence of dental caries, with or without fluoridation (even in Sydney). • The poor ingest a chronic poison that they cannot afford to avoid. • The poor are more susceptible to fluoride-induced diseases. • Governments use fluoridation to distract attention away from real causes of tooth decay that are politically too hard.
CONCLUSION • Fluoridation is mass medication with uncontrolled dose. Unethical. • Negligible benefit from ingesting F- . • At best fluoridated water, acting at tooth surfaces, reduces tooth decay in a fraction of 1% of tooth surfaces. • Ingestion of F- damages teeth via dental fluorosis and damages bones via skeletal fluorosis and hip fractures. • Worrying biological effects and lab & animal experiments. • Chronic toxicity from impurities in silicofluoride wastes from phosphate fertiliser industry. • Given this evidence, Local and State Govts would be socially irresponsible and open to litigation for supporting fluoridation.
FURTHER READING • Web site of of Fluoride Action Network, convened by Dr Paul Connett, Professor of Chemistry, St Lawrence University, USA:www.fluoridealert.org ; • Mark Diesendorf, 2003, ‘A kick in the teeth for scientific debate’, Australasian Science volume 24, no. 8, pp 35-37, September.(A referenced version may be downloaded from www.sustainbilitycentre.com.au/FluoridePublics.html)