I. QUESTIONS about FLUORIDE/FLUORIDATION:
Why is fluoride added to my water?
It was mandated by California law AB733 passed in in 1995. For how fluoridation was forced on California & Sacramento see this.
Is fluoridated water necessary for healthy teeth?
NO. Most recent, large-scale studies have found that fluoridated water provides only a minor benefit to teeth, or no demonstrable benefit at all. According to a recent Canadian government review: "The magnitude of fluoridation's effect is not large in absolute terms, is often not statistically significant and may not be of clinical significance."
Moreover, according to the National Academy of Sciences, fluoride is not an essential nutrient. This means that no human disease - including tooth decay - will result from a "deficiency" of fluoride. Thus, unlike real nutrients like calcium and magnesium, the human body does not need fluoride for any physiological process.
My dentist said "that water fluoridation is . . . ." Who do I trust?
While dentists know teeth, they have no training on the effects of "fluoride" on the rest of your body. See our dentist page for more on the dentist issue.
What makes fluoride different from other chemicals added to water?
In contrast to other chemicals added to water, fluoride does not treat the water, or make the water safer to drink. Fluoride is the only chemical added to water for the sole purpose of medication (to prevent tooth decay -- a non-waterborne disease).
Does fluoride need to be swallowed in order to prevent tooth decay?
NO. Most dental researchers now concede that fluoride’s main benefit comes from direct contact with the outside of teeth (a "topical" effect), and not from ingestion (a "systemic" effect). There is no need to swallow fluoride to prevent tooth decay.
Doesn’t everyone fluoridate their water?
NO. While most water supplies in the United States are artificially fluoridated, most water supplies in other western countries are not. In western Europe, most countries have rejected water fluoridation, including: Austria, Belgium, Denmark, Finland, France, Germany, Italy, Luxembourg, Netherlands, Norway, Scotland, Sweden, and Switzerland.
Less than 10 countries in the world fluoridate more than 50% of their water supplies, while almost half of the world’s population drinking fluoridated water reside in North America (Canada & US).
Where does the fluoride added to water come from?
Well it is not the “naturally occuring fluoride” that is alluded to in Sacramento City/County water reports. The main fluoride chemical added to water (hydrofluorosilicic acid) is an industrial by-product from the phosphate fertilizer industry. Unlike the fluoride used in toothpaste, hydrofluorosilicic acid is not pharmaceutical-grade quality. It is an unpurified, industrial-grade, corrosive acid which has been linked, in several recent studies, to increased levels of lead in children’s blood.
Does fluoride occur naturally in water?
Depends on what “flouride” you are refering to. Like arsenic and lead, very small amounts of (calcium fluoride) can be found in most water supplies. However, the level of fluoride that naturally-occurs in water is usually much lower than the level artificially added in water fluoridation programs. This is not the “fluoride” that is used in Sacramento’s program. Please see our Which Fluoride page.
What are potential risks from consuming fluoridated water?
Recent studies in the peer-reviewed medical literature indicate that fluoridated water can have detrimental side effects. Health risks associated with low-to-moderate doses of fluoride include: dental fluorosis; bone fracture; bone cancer; joint pain; skin rash, reduced thyroid activity; and IQ deficits.
Is fluoridated water safe for babies?
NO. According to the American Dental Association (ADA), children under 1 year of age should not receive infant formula made with fluoridated water. Babies exposed to fluoridated water are at high risk of developing dental fluorosis - a tooth defect caused by fluoride-induced cell damage within the teeth. Other harm is also likely. According, for example, to the US National Research Council, “it is apparent that fluorides can interfere with the functions of the brain.” The danger that fluoride poses to the brain is likely greatest during fetal and infant development, as during this time the barrier which protects the child’s brain from environmental toxins is not yet fully formed. Thus, chemicals that find their way into a baby’s bloodstream can penetrate into the brain.
According to the Greater Boston Physicians for Social Responsibility: “fluoride exposure, at levels that are experienced by a significant proportion of the population whose drinking water is fluoridated, may have adverse impacts on the developing brain. Though no final conclusions may be reached from available data, the findings are provocative and of significant public health concern."
Is fluoridated water safe for people with kidney disease?
NO. Recent research has found that fluoridated water can contribute to the development of painful bone disorders in people with advanced kidney disease.
II. QUESTIONS about REDUCING FLUORIDE EXPOSURE:
How do I avoid fluoride from my tap water?
WATER FILTERS: One way to avoid fluoride from the tap is to purchase a water filter. However, most water filters will not effectively remove fluoride. For instance, Brita filters will NOT remove fluoride. The two types of filters which will reliably remove more than 90% of the fluoride are reverse-osmosis filters and activated alumina filters. Thus, if you are looking for a filter to remove fluoride, make sure it uses "reverse-osmosis" or "activated alumina" technology.
SPRING WATER: Another way to avoid fluoride from the tap is to drink spring water. Most spring water has less than 0.1 ppm fluoride, which is 10 times less than added for fluoridation. If you regularly consume a particular brand of spring water, call the telephone number on the label and ask the company how much fluoride is in their water. (This information will be readily available to them.) We recommend water with less than 0.1 ppm fluoride.
If you decide to use spring water as your main source of water, you might consider (for convenience purposes) buying or renting a water cooler/dispenser that holds 5 gallon jugs of water. In addition, you might want to contact a bottled water company in your area and have them deliver water (in 5 gallon jugs) to your door on a recurring basis. This cuts down on the need to continually buy smaller plastic bottles from the store.
WATER DISTILLATION: A third way to avoid fluoride from the tap, is to distill the water. Water distillation will remove most, if not all, of the fluoride. The price for distillation units varies widely depending on the size. While small (counter-top) units cost as little as $200, large units cost as much as $1600+.
What else can I do to minimize fluoride exposure for myself and my family?
1) If you're using a fluoridated toothpaste, consider switching to a non-fluoridated alternative (which you can find at most health food stores). Young children, who don't have well developed swallowing-reflexes, often swallow a lot of toothpaste when brushing, which can cause disfiguring dental fluorosis and contribute greatly to total systemic intake. Also, even when the toothpaste is not swallowed, the fluoride may cross the gum membrane and enter the bloodstream.
2) If your child is using infant formula, it is imperative to avoid making the formula with fluoridated tap water. Infant formula reconstituted with fluoridated water delivers a very high dose of fluoride to a young baby. For instance, infant formula produced with fluoridated water contains 100 to 200 times more fluoride (1,000 ppb) than is found naturally in breast milk (5-10 ppb). In fact, while breast-fed infants receive the LOWEST body burden (mg/kg/day) in the population, they receive the HIGHEST body burden if they receive fluoridated formula.
3) Minimize consumption of processed beverages (e.g. soda and reconstituted juice). Soda and juice made from concentrate are often manufactured with fluoridated tap water, and hence, have fluoride levels similar to fluoridated water.
4) If you regularly drink non-organic wine or grape juice consider buying only organic varieties. Many commercially-grown grapes in the US are sprayed with a fluoride pesticide called Cryolite. The residues of this pesticide can result in high levels of fluoride in wine or grape juice. In the case of wine, if you don't want to spend the extra money buying organic, consider purchasing a European brand instead of a Californian brand, as Europe uses much less cryolite on its vineyards.
5) Be careful of drinking too much green or black tea. Tea almost always has elevated levels of fluoride and can contribute a substantial amount to one's total fluoride intake.
6) Minimize consumption of mechanically-deboned chicken. Mechanically deboned chicken (e.g. "Chicken McNuggets") has been found to contain elevated levels of fluoride due to the incorporation of ground bone particles (which are high in fluoride) into the meat.
7) Check to see if any prescription medicines you are taking contain fluorine. If so, ask your doctor if there are any appropriate alternatives - as some fluorine-containing pharmaceuticals (e.g. Cipro) can metabolize into fluoride ion within the body, thereby increasing the body's exposure to fluoride.
8) If you are going to have surgery, ask your doctors if they can use a non-fluorinated anesthetic. Fluorinated anesthetics such as Enflurane, Isoflurane and Sevoflurane will produce high peak levels of fluoride in blood for up to 24 hours.
9) Avoid the use of teflon-coated pans. Teflon-coated pans may increase the fluoride content of food.
You say that fluoride works topically. Does this mean that you promote the use of fluoridated toothpaste?
While the use of fluoridated toothpaste has certain benefits over water and salt fluoridation (e.g. the individual is given a choice; the fluoride does not contaminate the food supply; and the fluoride is applied to the teeth in a more targeted manner); it also presents a number of risks as well. For example:
Children usually swallow a lot of toothpaste when brushing their teeth, and therefore, if they are using a fluoridated toothpaste they may ingest a lot of fluoride. (For some children, fluoride toothpaste represents the largest daily source of ingested fluoride.) As noted in a recent review:
"Virtually all authors have noted that some children could ingest more fluoride from dentrifice alone than is recommended as a total daily fluoride ingestion" (Levy 1999).
Swallowing toothpaste at a young age is one of the major risk factors for the development of dental fluorosis - a disfiguring condition that can have damaging effects on a child's appearance and self-esteem.
Even if one doesn't actually swallow the fluoride, the fluoride may make it through the gum membrane and enter the bloodstream - thus contributing to a person's systemic exposure to fluoride.
Among hypersensitive individuals, fluoride toothpaste may cause or aggravate dermatitis (skin rash, usually near the mouth) or stomatitis (mouth ulcers, "canker sores"). If you have dermatitis near the mouth, consider trying a non-fluoride toothpaste for 2-3 weeks and see if your condition improves. (If it does, please let us know.)
Recent research from the pharmaceutical company Sepracor indicates that fluoridated toothpaste may cause or contribute to periodontal bone loss. This finding is serious because periodontal bone loss is the #1 cause of tooth loss among US adults. According to the scientists at Sepracor who conducted the study:
"We have found that fluoride, in the concentration range in which it is employed for the prevention of dental caries, stimulates the production of prostaglandins and thereby exacerbates the inflammatory response in gingivitis and periodontitis.... Thus, the inclusion of fluoride in toothpastes and mouthwashes for the purpose of inhibiting the development of caries [cavities] may, at the same time, accelerate the process of chronic, destructive periodontitis."
The concentrations of fluoride used in toothpaste are very high (1,00o-1,500 ppm). Considering the fact that fluoride is a suspected mutagen, and that many mutagens are also carcinogens (i.e. they cause cancer), there is some concern that fluoridated toothpaste may cause or contribute to oral cancer.
There are safer alternatives for protecting teeth than using a highly toxic compound like fluoride. In addition to non-fluoridated toothpastes, one alternative is xylitol, a natural sugar that is now being widely used in oral health programs throughout Scandinavia. Xylitol - which can be applied to the teeth via mints, gum, and toothpaste - has been found to be very effective in preventing tooth decay, and may even help remineralize teeth as well. A healthy diet, however, will always be the most important tool in the fight against tooth decay.
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QUESTIONS about FLUORIDE/PERSONAL HEALTH:
My child has dental fluorosis. What can we do to fix it?
While the damage that dental fluorosis causes to the internal matrix of the teeth is permanent, the visible staining that fluorosis produces can be cosmetically treated by a dentist - at a cost to you.
Treatment options for fluorosis vary and will depend in part on the severity of the fluorosis and what you can afford (some of the treatments are very expensive). For mild forms of fluorosis, the most common form of treatment is "abrasion." For more advanced forms of fluorosis, it may be necessary to use "composite bonding" or "porcelain veneers."
- Abrasion: Abrasion involves finely sanding off the outer layer of the enamel. It is a common approach when the fluorosis is mild. However, if the fluorosis is of a more advanced severity, abrasion is probably not a good idea as it can bring to the surface of the teeth a highly-porous enamel that will be prone to attrition.
- Composite bonding: Composite bonding first involves lightly roughening the area of the damaged enamel. After etching the enamel, a composite resin (with a color matching your teeth) is "glued" on to the exterior of the tooth.
- Porcelain veneers/laminates: Made out of porcelain, veneers form a ceramic shell over the surface of the tooth. Veneers may need to be replaced after several years, however, which can become very expensive.
Ask your dentist to better determine which method of treating fluorosis will be best for you. If your dentist doesn't specialize in cosmetic dentistry, they should be able to refer you to someone who does. That way every dentist can make a profit from it.
If our water does not contain fluoride, should we give our child fluoride supplements?
No. As pointed out by a growing number of dental researchers, fluoride supplements are unnecessary, ineffective, and much more likely to give your child dental fluorosis than to spare them a cavity.
Fluoride Supplements are Unnecessary: A vast body of dental research now indicates that there is no need to swallow fluoride at all - whether at a young or old age. This is because fluoride's purported 'benefit' to teeth comes primarily from topical application, and not from ingestion. Thus, fluoride supplements - which were developed in the 1950s under the incorrect assumption that fluoride needed to be swallowed - unnecessarily expose a child to systemic fluoride.
Fluoride Supplements are Ineffective: According to a recent review in the dental journal Community Dentistry & Oral Epidemiology:
"The basis for the widespread acceptance of fluoride supplements in caries prevention is a large number of mostly small clinical trials in the late 1950's and 1960's. The early studies have been reviewed again recently in a series of publications and they have again been criticised. The criticisms are serious and virtually none of the early fluoride supplement studies would be published today, because of methodological and other shortcomings. They present conclusions that are not supported by their data or consistent with their designs.... the evidence in support of the effectiveness of fluoride supplements is poor. The benefits claimed for fluoride supplements are, in any case, available through regular toothbrushing with fluoride toothpaste and fairly minor and sensible lifestyle changes."
Fluoride Supplements Place a Child at High Risk for Fluorosis: About 30-45% of children receiving fluoride supplements develop dental fluorosis. As noted by Dr. Paul Riordan: "Supplement use by children younger than 5 years entails a risk of fluorosis which, at the community level, becomes a certainty."
Fluoride Supplements Have Never Been Approved by FDA: Despite nearly 50 years of use, the US Food & Drug Administration has never approved fluoride supplements as a safe and effective method for preventing tooth decay. The FDA has only approved topical fluorides - e.g. toothpaste.
If I take a shower with fluoridated water, will the fluoride enter through my skin?
There is anecdotal evidence indicating that some people may experience adverse skin reactions from showering in fluoridated water. However, there is very little information in the published scientific literature to document this concern. There is also very little published research documenting if, and to what extent, fluoridated water may pass through the skin and enter the bloodstream. The tests that would be needed to determine this would be simple to do. However, as with other important issues related to fluoride and health, these tests have yet to be done.
I think I have been impacted by excess fluoride exposure. What should I do? How can I 'detoxify'?
The first and most obvious thing to do is reduce your fluoride exposure. See the discussion above for ways to do this. A sustained reduction in fluoride intake can bring about substantial improvement in symptoms.
Other than reducing your fluoride intake, it will be important to maintain a healthy diet. The importance of a healthy diet has been suggested by the repeated observation that humans/animals with poor nutrition are more severely impacted by fluoride toxicity than those with adequate nutrition.
Other than reducing fluoride intake and maintaining good nutrition (a diet rich in anti-oxidant), there are few well-established ways of de-toxifying from chronic fluoride poisoning. More research is definitely warranted.