Drink the Water, Not the Kool-Aid: A Little Fluoride Won’t Hurt Your Kid

Earlier this week, Newsweek published an article about a possible link between fluoride in water supplies and ADHD. It seems to have caused quite a stir. Just three weeks ago, Newsweek published another article (by the same author) about a potential link between water fluoridation and thyroid disease. If you read the comment threads–which I wouldn’t recommend, you’ll see fluoride implicated in arthritis, intellectual disability, kidney disease, hip fractures, and a multitude of other maladies. (You may also notice that the vast majority of the hundreds of comments are written by the same handful of people…or that some of the comments are directly copied and pasted onto over 600 other sites–not very creative.) By the time you get to the end, you’ll probably be thinking that “fluoridation is the most monstrously-conceived and dangerous Communist plot we have ever had to face.” But don’t knock that glass of water out of your kid’s hand just yet.

Just like those who oppose vaccines or promote homeopathy, anti-fluoride activists are a very vocal minority, and they are intent on banning this “toxin” from our water supplies. Leading the way is the Fluoride Action Network. When I visited their website (I cringed a little before I clicked), I noticed a few things right away. There are lots of underlined words in red capital letters: ALERT, POISON, TOXIC, GOVT FAILED TO WARN. There’s a large picture of a stamp reading BANNED.  They use a time-honored tactic—the appeal to a celebrity (because what film star doesn’t have an in-depth understanding of dental pathophysiology?). And, of course, they include several links to make it easy for you to make a one-time or recurring donation.

Opponents of water fluoridation cite numerous studies that show adverse health outcomes supposedly attributable to fluoride. But if you examine the studies closely, to see what they really say (or if they’re even capable of saying anything at all), the claims just don’t hold up. Take the ones I mentioned above, for example:

The ADHD article cites a study recently published in the journal Environmental Health. The Newsweek headline reads: “Water Fluoridation Linked to Higher ADHD Rates.” But linked is a strong word. The authors are somewhat more conservative in their conclusion and mention that there may have been some other confounding factors. I’d take it a step further and say the study is largely worthless and doesn’t really say anything at all about ADHD except that it might be more prevalent in the South. Here’s why:

  • The authors gather data about the prevalence of ADHD and water fluoridation in each state. But when they report it (see the table below), they report it by region. Maybe that was just for convenience, but the skeptic in me wonders if compiling the states into regions made them average out to show a better correlation and support their hypothesis.

Tables

  •  There’s no analysis of the dosage of fluoride per state or region–only whether or not they contained fluoride. The fluoride concentration in one location may be 6 mg/L, but only 0.9 mg/L somewhere else. If fluoride were, in fact, a neurotoxin that could cause ADHD, this would certainly be important information. The concept of a dose-response relationship isn’t a secret, and it should be familiar to the editors of Environmental Health. It would make much more sense to compare the concentration in different locations instead of the percentage of people receiving fluoridated water (you know, unless it doesn’t support your hypothesis).
  • While there was a positive association overall between fluoridated water and ADHD, there were also times where those two things didn’t match up at all–and times when the exact opposite was true. The statistical analysis gets complicated, but to keep it simple, it’s really not a very consistent relationship.
  • There are lots of confounding factors that go unaddressed. Besides fluoride, what other things could affect the prevalence of ADHD in different regions? The authors account for one: that children in poor families are more likely to have ADHD. But there are so many more for which they don’t account: genetics, race, gender, access to healthcare (and thus diagnosis), school systems, premature birth rates…the list goes on. And in the statistical analysis, they are all ignored.
  • A study with this design can never prove that one thing caused another; only that two things are “associated.” For instance, there’s a strong association between organic food consumption and autism. But eating organic foods doesn’t cause autism. The two trends just happened at the same time (or, if anything, autism played a role in increasing organic food consumption). To show “causation,” you’d need to start with two groups of otherwise similar people, give some of them fluoridated water and the rest water with no fluoride (without telling them which group they are in), and then watch them over time to see if one group developed ADHD at a higher rate.

I could keep going, but my point isn’t to rip this article apart; it’s to emphasize that studies like this should never be interpreted as “linking” one thing to another. To be fair, the authors of the study identify some of these limitations, which are also briefly mentioned in the Newsweek article. But there seems to be a lot more attention given to the rather meaningless correlation between ADHD and fluoridated water, while a number of weaknesses go unaddressed. Given the significantly higher prevalence of ADHD in Southern states, the researchers probably could have shown an even stronger correlation between ADHD and consumption of sweet tea.

As far as the thyroid study goes, a group of researchers looked at different areas in England and compared the prevalence of people with hypothyroidism (underactive thyroid) with the fluoride content of their water. Brits who drank fluoridated water were more likely to have hypothyroidism. But it’s pretty much the same story as the one above–those two things could very feasibly be entirely unrelated.

There are so many others. Some involve injecting large doses of fluoride into pregnant rats (whose offspring apparently exhibit “ADHD-like symptoms”–whatever that means for rats). But people aren’t rats, and nobody’s talking about injecting pregnant women with ridiculous doses of fluoride. Another article, often cited as “proof” that fluoride is a neurotoxin, was a review of studies performed in China that looked at children in regions with fluoride concentrations much higher than those recommended in the US, comparing their IQs to those of children in areas with lower fluoride concentrations. Again…only a correlation, higher doses than we recommend, a totally different population, doesn’t address confounding factors, etc. In short, there hasn’t been a methodologically-sound study showing that fluoride concentrations in the recommended range cause any harm at all.


We care about fluoride because it helps to prevent dental cavities in children, which is the #1 chronic disease in childhood, affecting well over half of our nation’s children. It helps to repair and strengthen the enamel of the tooth, preventing bacteria from taking root and causing dental decay. But why add it to water? The same reason that we add vitamin D to milk or folic acid to Cap’n Crunch—it’s the most cost-effective way to distribute a substance known to have positive health effects to the entire population.

But like most things in life, moderation is key. At concentrations up to about 1 mg/L, fluoride helps to prevent tooth decay and the associated complications. At higher concentrations, it can cause fluorosis, which typically involves nothing more than a few small and almost imperceptible white spots on the teeth. Even higher doses can cause more severe fluorosis, which can actually increase the risk for cavities. And in extremely high amounts, it can be quite toxic–but so can anything else, in high enough doses. The new recommendation is for water companies to target a fluoride concentration of 0.7 mg/L–enough to provide the positive benefits while minimizing any potential for harm.

In many ways, the fluoride conspiracy theory is similar to those perpetuated by the anti-vaccine crowd or those who oppose conventional medicine as a whole. And, as you know if you clicked on my Dr. Strangelove link above, it’s not a new concept. But here’s what I don’t understand—there doesn’t appear to be much secondary gain to be had. With the large amounts of money spent on vaccines or pharmaceutical companies, I get why people would be concerned. But fluoride? The best estimate I’ve found is that water fluoridation costs between 25 and 50 cents per person per year. Compared to the cost of dental work, that’s a pretty good deal. And compared to the thousands of dollars it costs to fully immunize a child (which also happens to be cost effective), it’s really not that much money. So if the government–or the dentists–are out to get you, I can’t figure out why. Perhaps we could find clues if we clicked on the donation links on the Fluoride Action Network website.

I’ll be honest–doctors and dentists aren’t perfect. Some aren’t even very good. But we’re not evil, and we’re not oblivious to the need to balance the benefits of our therapies with their potential risks. The thousands of pediatricians and dentists represented by the American Academy of Pediatrics and the American Dental Association aren’t trying to poison your child; we’ve devoted our lives to protecting them.

My advice: drink the water, not the Kool-Aid. At the recommended levels, fluoride isn’t hurting your child; it’s just protecting his teeth. And if you’re looking to point fingers about ADHD, you’d be better off looking at genetics.


 

If you’re interested in reading more about the dental benefits of fluoride, check out the website for the Campaign for Dental Health.

As always, your comments are welcomed (even if you happen to disagree). I'll get back to you as soon as I can. Please try to keep it civil--I reserve the right to delete comments that are offensive or off-topic.

14 thoughts on “Drink the Water, Not the Kool-Aid: A Little Fluoride Won’t Hurt Your Kid

  1. One other point about the ADHD study. It basically discredits itself. While the authors concluded a positive correlation between ADHD and fluoridated areas, they also found a negative and neutral correlation between ADHD and what they termed “naturally” fluoridated areas.

    Erroneous, antifluoridationist proclamations to the contrary notwithstanding, the fluoride added to water during fluoridation is identical to that which exists in water “naturally”. Fluoride is an ion of the element fluorine. As groundeater courses over rocks, it picks up fluoride ions leached from calcium fluoride and fluorosilicates in those rocks. These fluoride ions are to what is commonly referred as being “naturally occurring” fluoride. The most commonly utilized substance in fluoridation is hydrofluorosilic acid (HFA). Once added to drinking water, due to the pH of that water, HFA is immediately and completely hydrolyzed (dissociated). The products of this hydrolysis are fluoride ions, identical to those which exist in water “naturally”, and trace contaminants in barely detectable amounts which fall far short of EPA mandated maximum levels of safety. After this point, HFA no longer exists in that water. It does not reach the tap. It is not ingested.

    Thus, given that the fluoride ions are identical in the “artificially” fluoridated areas to those in the “naturally” fluoridated areas, the fluoride ions are obviously not the cause of the correlation with ADHD. This leaves the fluoridation substances as being the only variable, in regard to fluoridation, between the two regions. Given that the only substances ingested as a result of fluoridation are fluoride ions and trace contaminants far below maximum levels of safety, it is obvious that the fluoridating compounds are not the cause of the correlation, either.

    Thus, it can be concluded that the ADHD study is of absolutely no relevance, whatsoever, to water fluoridation. It has no merit.

    Steven D. Slott, DDS

    • Well said, and thanks so much for your response. It’s always nice to hear from dentists in the areas where our fields overlap. It’s also interesting that the astounding number of weaknesses of this article were not picked up prior to publication by the editors of a journal that specializes in environmental health. The authors of the study were trying to prove their hypothesis, and they failed. So, instead, they reported only the part of the data that supported their cause.

      Another thing I found interesting is that one of the more vocal anti-fluoridation proponents (or, at least a Facebook account set up to look like one–the one that copies and pastes the same comments to every fluoride thread on the internet), recommended on my Facebook page that we switch to having fluoride in toothpaste or topical varnishes. So, obviously not against fluoride altogether–just opposed to trace amounts of it in water. Doesn’t make much sense. Obviously this is one of the most absurd non-issues in medicine/dentistry, and yet I still have frequent discussions with patients and read strongly biased articles about it in national publications.

      Thanks again for reading and your additions to my analysis of this article. Keep fighting tooth decay!
      -Chad

  2. Thank you, Chad. It is extremely valuable when MDs speak up on this issue, especially in the knowledgeable manner in which you have. Connett and his people constantly attempt to make this an issue supported only by dentists, and then do everything they can to discredit dentists and dentistry. They totally disregard the overwhelming support of fluoridation from the worldwide body of respected science and healthcare, as well as the fact that there is not one, single respected organization in the world which opposes it.

    The Thyroid study is just as weak as is the ADHD study, having been performed by Stephen Peckham, the former chair of the British antifluoridationist faction, “Hampshire Against Fluoridation”. Here is an excellent critique of this study:

    https://openparachute.wordpress.com/2015/02/25/paper-claiming-water-fluoridation-linked-to-hypothyroidism-slammed-by-experts/

    Steven D. Slott, DDS

  3. Fluoridation Opposition Scientific, Respectable and Still Growing
    Because of valid evidence revealing fluoridation’s ineffectiveness and harm, 4600 professionals signed a statement calling for an end to fluoridation:
    http://fluoridealert.org/researchers/professionals-statement/text/

    Nobel Prize winner in Medicine, Dr. Arvid Carlsson, says, “Fluoridation is against all principles of modern pharmacology. It’s really obsolete.”

    New Evidence concerning fluoride’s brain effects:

    US Environmental Protection Agency lists fluoride as having “Substantial Evidence of Developmental Neurotoxicity.”

    A paper in The Lancet classified fluoride as one of the few chemicals known to damage the developing brain in humans

    Human research now shows that fluoride can damage the fetal brain, adversely affect newborn babies’ behavior, damage the central nervous system of fluoride-exposed workers, and affect performance on neurological assessment tests.

    Forty one out of 48 studies show fluoride reduces IQ; 17 at levels the US EPA claims are safe.

    In the early 1990s, toxicologist Dr. Phyllis Mullenix published her research which predicted that fluoride could cause “IQ deficits and/or learning disabilities in humans” based on the behavioral effects she observed in fluoride-exposed rats. Officials continue to protect fluoridation and ignore Mullenix’ and any other study indicting fluoride in any way and at any dose.

    It’s not surprising that the first US study of its kind found fluoridation is linked to Attention Deficit Hyperactivity Disorder (ADHD)
    More fluoride/brain information here: http://fluoridealert.org/issues/health/brain/

    • 1. Dr. Carlsson’s statement that water fluoridation is “against all principles of modern pharmacology” was in reference not to its effectiveness, but to the delivery system itself. I agree that supplementing public water systems is not the ideal delivery system, but it appears to be effective based on the best available evidence and has minimal documented risks at the recommended levels.

      2. The EPA’s classification of “substantial risk of developmental neurotoxicity” is not a confirmation that fluoride causes these issues; only that it has been mentioned in 2 or more studies. Here’s the link.

      3. Dr. Mullenix’s studies were the ones I referred to above–with the rats with “ADHD-like symptoms.” As tempting as it is to assume that animal studies are applicable to people, they’re not. She also used doses and delivery routes that are not the same as in community water fluoridation.

      4. As for the other human studies you mention (and as I wrote above), there have not been well-designed studies that showed fluoride to cause significant harm at the recommended doses.

      5. Again, this study did not “link” ADHD to fluoride. The only convincing association their data showed was that ADHD is more common in the Southern US. In fact, as Dr. Slott points out above, they intentionally ignored the fact that higher naturally-occurring fluoride concentrations were associated with LOWER rates of ADHD, although the fluoride ions don’t tend to care much where they came from. The distinction between naturally-occurring and supplemented fluoride seems to be emphasized or ignored based on how it would best support an individual argument.

      • Good points, Chad.

        Just for the sake of disclosure, “nyscof” is the “Media Relations Director” for the “Fluoride Action Network”. She posts these comments, verbatim, all over the internet, not having the science or healthcare education, training, or experience to really understand, or defend, what she posts.

        As I’m sure you know, Paul Connett is behind most of the misleading, and misinformative information, with those such as “nyscof” simply disseminating his talking points.

        Steven D. Slott, DDS

          • As excellent as is your site…….I wouldn’t feel too “honored”. They flood the internet with their junk.

        • In regard to Mullinex, her study was seriously flawed, basically demonstrating her bias more than anything.  In a 1995 letter to “Neurotoxicology and Teratology”, Ross and Daston point out these flaws, with the conclusion that her study could not be used as any indication of neurotoxicity of fluoride.

          “In summary, much of the ambiguity in the interpretation of these results could have been avoided with information from two concurrent or historical control groups: 1) a group to define the behavioral signature  resulting from long term adulteration of the drinking water, and 2) a group to define the behavioral signature of animals with hippocampal damage in this testing system.  Such controls are an essential feature of test validation and experimental design.  Novel behavioral chemicals of unknown toxicity are dosed, and all possible results interpreted as neurotoxicity.  Instead, both positive and negative control materials should be evaluated, and the results linked with well-characterized functional and morphological indices of neurotoxicity. ”

          “We appreciate the opportunity to provide our interpretations of this study.  We do not believe that the study by Mullenex et al. can be interpreted in any way as indicating the potential for NaF to be a neurotoxicant”

          Dr. Joseph F. Ross, D.V.M., Ph.D
          Dr. GeorgeP. Daston, Ph.D.

          Neurotoxicology and Teratology, Vol. 17, No. 6, pp. 685-686, 1995

          Steven D. Slott, DDS

  4. Chad,
    Just a few comments if I am may. I assume most write articles to have a discussion on the subject matter and “do” expect replies to follow.
    I do appreciate your take on the subject and have at least offered some good points.
    I think all these discussions should get past the fact that almost without fail, no one feels a Doctor/Dentist at the patient level would knowingly promote unsafe practices.
    Once past that, can only defend the facts as they are known to all at this point. Should not be as hard as it is to disagree on a “fact” but seems it is so and open to much interpretation which is an absolute shame.

    I can take however take a few exception to a couple of things I hope you will allow me to note.

    The title is catchy I guess, but shows you heavily leaning ( before the reader even gets started) that you have a personal bias along with the facts presented. However your right as the author, but I may also note these are the types of sensational things you might “cringe” at when visiting an opposing site.

    Your insertion of this study :
    A study with this design can never prove that one thing caused another; only that two things are “associated.” For instance, there’s a strong association between organic food consumption and autism. But eating organic foods doesn’t cause autism.
    With follow up comment on this “study” from another site:
    His tongue is obviously planted firmly in his cheek here, but the chart is nonetheless a simple and compelling example of how susceptible we can be to logical fallacies, cognitive biases.
    At first read, it seems this may be a “true” study (hyperlinked in blue). But seems done as joke almost to further validate the claim that the correlation can be “anything.” Adolescence cell phone usage follow this same bell curve? Maybe so.

    Further, most articles I see simply have to defend what water fluoridation “doesn’t” do rather than what it does. You say a low cost and therefore no one should really be concerned. Maybe so, but not sure that would be enough validation to continue.
    “The solution to pollution is dilution” has been said many times, and ultimately true.
    This is a legacy program that would be very hard to stop, for many reasons I would not have to list.
    In addition to all this back/forth , I would like see someone track the entire logistics trail of water addition on at least one specific basis. Where it comes from (exactly) US, China etc., exact company, exact plant, what the exact cost per (bag/barrel?) is, what the upcharge is and what the cost is collectively spent for the entire USA. Seems anyone that really cares, would want to know. We know this is not a natural occurring product actually being “used” (like saccharin to sugar). Wonder how far someone would get in this process?
    Have to also say that Congress has been sitting on this issue for years and just now making a statement on downgrading.
    Just so much trust involved here with equipment delivering the right amount consistently, how much one drinks over another. All very confusing.
    I have to say I too, wish the process was stopped as the perceived value can be obtained “so” many other ways. With that theory in place, why then keep adding it to the water? Like Lead Paint and Asbestos, I am sure someone somewhere had the same thoughts/heated discussions on these issues at one time in history.

    • Thanks for reading and for your comments. I’m not sure if you follow my blog or just stumbled across this post, but using humor to make a point is kind of my style. The title was meant to be catchy, and maybe even a little bit edgy–and it worked. The link to the autism/organic food site isn’t meant to cite a study at all; it’s simply to point out the absurdity of using that kind of data to make claims like those in the original article.

      My point with this article isn’t to prove beyond a doubt that water fluoridation is the best solution to our society’s dental problems. Perhaps there are better ways–topical fluoride administration, for instance. Maybe if someone did a better study to directly compare fluoridated water vs non-fluoridated water vs topical fluoride administration, the results would contradict the current thinking. I’m more than willing to accept new data from well-designed and executed studies. But we do the best we can with the information we have.

      What I was really trying to get across was that the Newsweek article (and the original study) were shoddy, to say the least, and didn’t even come close to proving what the authors said they did. There is no causal relationship between ADHD and water fluoridation, and articles like this do nothing but cause needless panic. I have little control over Congressional decision making or vast public health policy. But I can certainly help people to see through some of the misinformation out there and eliminate some unnecessary concerns.

    • Noan

      The fallacies of the recent hypothyroidism and ADHD studies have already been detailed previously. However, in regard to the other concerns you’ve raised…..

      1. “Further, most articles I see simply have to defend what water fluoridation “doesn’t” do rather than what it does”

      Here are but a few of the countless peer-reviewed scientific studies clearly demonstrating the effectiveness of fluoridation. I will be glad to provide as many as you would reasonably care to read:

      1) http://www.ncbi.nlm.nih.gov/pubmed/22998306

      CONCLUSIONS:

      “Fewer studies have been published recently. More of these have investigated effect at the multi-community, state or even national level. The dmf/DMF index remains the most widely used measure of effect. % CR were lower in recent studies, and the ‘halo’ effect was discussed frequently. Nevertheless, reductions were still substantial. Statistical control for confounding factors is now routine, although the effect on per cent reductions tended to be small. Further thought is needed about the purpose of evaluation and whether measures of effect and study design are appropriate for that purpose.”

      —–Community Dent Oral Epidemiol. 2012 Oct;40 Suppl 2:55-64. doi: 10.1111/j.1600-0528.2012.00721.x.
      Effectiveness of water fluoridation in caries prevention.
      Rugg-Gunn AJ, Do L
      Newcastle University, UK.

      2). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3543717/

      Conclusions:

      “The results of this study support existing work suggesting water fluoridation together with the use of fluoridated dentifrice provides improved caries prevention over the use of fluoridated dentifrice alone. The social gradient between caries and deprivation appears to be lower in the fluoridated population compared to the non-fluoridated population, particularly when considering caries into dentine, demonstrating a reduction in inequalities of oral health for the most deprived individuals in the population.”

      —-The association between social deprivation and the prevalence and severity of dental caries and fluorosis in populations with and without water fluoridation
      Michael G McGrady, Roger P Ellwood, […], and Iain A Pretty

      3). http://www.ncbi.nlm.nih.gov/pubmed/15074871

      CONCLUSIONS:

      “Caries levels are lower among children with fluoridated domestic water supplies. Decay levels are much lower in 2002 than they were in 1984 and in the 1960s. The oral health of the less well off is worse than that of the rest of the population. The prevalence of dental fluorosis is higher amongst children and adolescents with fluoridated water supplies. Comparisons with 1984 data show an increase in the prevalence of fluorosis since that time.”

      —-Community Dent Health. 2004 Mar;21(1):37-44.
      Dental caries and enamel fluorosis among the fluoridated and non-fluoridated populations in the Republic of Ireland in 2002.
      Whelton H, Crowley E, O’Mullane D, Donaldson M, Kelleher V, Cronin M.
      Oral Health Services Research Centre, University Dental School and Hospital, Wilton, Cork, Ireland.

      4). http://www.ncbi.nlm.nih.gov/pubmed/7643331

      CONCLUSIONS:

      “The ingestion of water containing 1 ppm or less fluoride during the time of tooth development may result in dental fluorosis, albeit in its milder forms. However, in these times of numerous products containing fluoride being available, children ingesting water containing 1 ppm fluoride continue to derive caries protection compared to children ingesting water with negligible amounts of fluoride. Thus, the potential for developing a relatively minor unesthetic condition must be weighed against the potential for reducing dental disease.”

      —–J Public Health Dent. 1995 Spring;55(2):79-84.
      Dental fluorosis and caries prevalence in children residing in communities with different levels of fluoride in the water.
      Jackson RD, Kelly SA, Katz BP, Hull JR, Stookey GK.
      Oral Health Research Institute, Indianapolis, IN 46202-2876, USA.

      5). http://www.ncbi.nlm.nih.gov/pubmed/11109211

      RESULTS:

      “The prevalence of dental caries was inversely related and the prevalence of fluorosis was directly related to the concentration of fluoride in the drinking water. The mean DMFS in the communities with 0.8 to 1.4 ppm fluoride was 53.9 percent to 62.4 percent lower than that in communities with negligible amounts of fluoride. Multivariate analysis showed that water fluoride level was the strongest factor influencing DMFS scores. The prevalence of fluorosis ranged from 1.7 percent to 15.4 percent, and the increase in fluorosis with increasing fluoride exposure was limited entirely to the milder forms.”

      —–J Public Health Dent. 2000 Summer;60(3):147-53.
      The prevalence of dental caries and fluorosis in Japanese communities with up to 1.4 ppm of naturally occurring fluoride.
      Tsutsui A, Yagi M, Horowitz AM.
      Department of Preventive Dentistry, Fukuoka Dental College, Fukuoka, Japan.

      2. “You say a low cost and therefore no one should really be concerned. Maybe so, but not sure that would be enough validation to continue.”

      A. At a cost of less than $1 per person, per year for fluoridation, there is no other dental decay preventive measure which even approach the cost-effectiveness of fluoridation.

      B. In the entire 70 year history of fluoridation, there have been no proven adverse effects

      C. Peer-reviewed science has clearly demonstrated a savings of $15-$50 or more, for every $1 spent on fluoridation. I will gladly cite the studies if so desired.

      3. “The solution to pollution is dilution” has been said many times, and ultimately true.
      This is a legacy program that would be very hard to stop, for many reasons I would not have to list.”

      Most, if not all routine water additives are delivered, and stored in their concentrated forms, as are countless substances we use every day. To transport, deliver, and store such substances in their undiluted form would be nonsensical, and probably cost prohibitive. Raw, undiluted fluoridation products are no more “pollution” than are raw, undiluted chlorine, ammonia, and numerous other substances added to drinking water supplies.

      With that said, it makes no difference what are the contents of any of these substances in their raw, undiluted forms, or from where they are sourced. All water from the tap must meet all EPA mandated quality certification requirements under Standard 60 of the National Sanitary Foundation. If it doesn’t it is not allowed. It’s that simple. Fluoridated water at the tap easily meets of of these requirements. A complete list of the contents of fluoridated water at the tap, including precise amounts of any detected contaminants, and the EPA mandated maximum allowable level for each, may be found in the “Fact Sheet on Fluoridation Chemicals” on the website of the National Sanitary Foundation:

      http://www.nsf.org/newsroom/nsf-fact-sheet-on-fluoridation-chemicals

      4. “In addition to all this back/forth , I would like see someone track the entire logistics trail of water addition on at least one specific basis. Where it comes from (exactly) US, China etc., exact company, exact plant, what the exact cost per (bag/barrel?) is, what the upcharge is and what the cost is collectively spent for the entire USA. Seems anyone that really cares, would want to know.”

      All of this is entirely irrelevant, as I have explained above.

      5. “We know this is not a natural occurring product actually being “used” (like saccharin to sugar). Wonder how far someone would get in this process?”

      The substance most widely utilized in the fluoridation process is hydrofluorosilic acid (HFA). HFA is derived from naturally phosphorite rock as a co-product of the process which derives the other co-product, phosphoric acid. The phosphoric acid co-product is utilized in soft drinks we consume and in fertilizers which become incorporated into foods that we eat. The HFA co-product is diluted to a 23% aqueous solution which is used to fluoridate water systems. To irrationally far one co-product of this process is to irrationally fear the other.

      When groundwater flows over rocks, it picks up fluoride ions which have been leached from calcium fluoride and fluorosilicates in those rocks. These fluoride ions are to what is commonly referred as being “naturally occurring fluoride”. When HFA is added to drinking water, due to the pH of that water (~7), the HFA is immediately and completely hydrolyzed (dissociated). The products of this hydrolysis are fluoride ions, identical to those “naturally occurring” fluoride ions, and trace contaminants in barely detectable amounts far below EPA mandated maximum levels of safety. After this point, HFA no longer exists in that water. It does not reach the tap. It is not ingested. It is of no concern.

      A fluoride ion is a fluoride ion, regardless the source compound.

      6. “Have to also say that Congress has been sitting on this issue for years and just now making a statement on downgrading”

      Congress has not “been sitting” on anything, in regard to water fluoridation. The “downgrading” to which you refer, was not a “downgrading” of anything. It was simply an updating of the optimal level of fluoride, by the US Department of Health and Human Services, in response to recent scientific evidence. Exactly as we need and expect our government regulatory and oversight entities to perform.

      The optimal level of fluoride in drinking water is that level at which maximum dental decay prevention will occur, with no adverse effects. This optimal level was originally set by the US Public Health Service in 1962, as a range of 0.7 ppm to 1.2 ppm. It was set as a range in order to allow for different amounts of water consumption between different climates. Recent scientific evidence has demonstrated that, due to air-conditioning and other modern amenities, there no longer exist any significant difference in water consumption due to climate differences. Thus, there is no longer a need for a range. In recognition of this fact and of the greater availability of fluoride now, than when the optimal was originally established, the CDC, in 2011, recommended that the optimal range be consolidated into simply the low end of that range, 0.7 ppm. After several years of careful study and consideration as to whether this consolidation would significantly reduce the dental decay prevention of fluoridation, the US DHHS determined that it would not. Thus, in keeping with the original goal of providing maximum dental decay protection while minimizing any risk of adverse effects, the US DHHS recently announced that the optimal recommendation had been officially consolidated into the low end of the previous optimum range. The current optimal level is 0.7 ppm, the level at which most water systems have been fluoridating for years, anyway.

      7. “Just so much trust involved here with equipment delivering the right amount consistently, how much one drinks over another. All very confusing.”

      Yes, water treatment, as do an infinite amount of other processes on which we routinely depend, requires professionals who know their jobs, and appropriate equipment which is properly maintained and utilized. Fears about the competence of water treatment professionals and/or the equipment they utilize, extends to all of the corrosive, highly toxic substances they add to our drinking water supplies. Concerns in this regard are reasons to appropriately address personnel and equipment issues, not a reason to deprive entire populations the benefits of a very valuable public health initiative.

      8. “I have to say I too, wish the process was stopped as the perceived value can be obtained “so” many other ways. With that theory in place, why then keep adding it to the water?”

      Fluoridated water provides a protection of the dentition from decay, first through systemic incorporation into developing teeth of infants and children 0-8 years. After that, through systemic incorporation of fluoride into saliva, a consistent bathing of the teeth in a low concentration of fluoride all during the day, is provided. This is a very effective means of dental decay prevention which cannot be obtained, in any manner as cost-effectively, by any other means.

      9. ‘Like Lead Paint and Asbestos, I am sure someone somewhere had the same thoughts/heated discussions on these issues at one time in history.”

      Lead paint and asbestos, have no relevance to water fluoridation.

      Steven D. Slott, DDS

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