Bulletin #742

January 10, 2006

Dear All,

Hearty congratulations to Gerhard Bedding (the FAN Mobilization Team’s representative) for forcing a response (albeit lukewarm) from the NH Department of Health and Human Services on the ADA’s November 9 recommendation that parents not use fluoridated tap water to make up baby formula. Below we have printed Gerhard’s Dec 18 letter (written with the assistance of Shelley Nelkens) and the response of the Department as reported in today’s Manchester Union Leader.

While state health “authorities” dither and squirm their way around this obvious and huge hammer blow (albeit delivered treble pianissimo by the ADA) to their promotion of water fluoridation as being “safe for everyone”, we are more likely to get some action from Wal-Mart, which has more invested in their image than these health bureaucracies. So please keep the online petitions rattling in to http://www.ipetitions.com/petition/walmart/  to persuade this company to take fluoridated “nursery water” off its shelves. Yesterday we added another 87 and our current total stands at 2262.

A few days ago I received an important email from Maureen Jones, one of the FAN Mobilization Team reps in California. She asks if the ADA recommendation is only directed towards protecting the primary teeth from dental fluorosis, because of the stress the ADA puts on infants under one year not being exposed to fluoride. She argues that we should be even more concerned with dental fluorosis in the secondary teeth (the ones you have for the rest of your life). It is well established that discoloration of these teeth give teenagers (especially girls) huge psychological distress. Maureen points out that in the cover story in the March 1999 issue of the Journal of American Dental Association (JADA), the authors say this about the vulnerable period for the development of dental fluorosis on the secondary teeth:

“The primary dentition is believed to be completely formed before the end of the first year of life, while the most critical period for
developing fluorosis on the permanent central incisors (the top two central teeth, PC) has been variously estimated to be between 22 and 25 months of age or between 15 and 24 months for boys and 21 and 30 months for girls although some have suggested that it may be earlier in both sexes.” (Ref #35  Evans RW, Stamm JW. An epidemiologic estimate of the critical period during which human maxillary central incisors are most susceptible to fluorosis.  J Public Health Dent 1991;51:251-9.)

So the bottom line is that as far as causing dental fluorosis on the permanent teeth is concerned even pro-fluoridation dental researchers are indicating that we should be keeping fluoride away from children at least up to the age of three.

For those concerned about tissues other than the teeth, as far as the health effects put on the table by the National Research Council (the paperback copy of their 500 page report “Fluoride in Drinking Water: A Scientific Review of EPA’s Standards”- can be ordered online at http://www.nap.edu/catalog/11571.html) we should be keeping fluoride away from humans of any age.

Paul Connett
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1) Gerhard Bedding’s letter

Gerhard F. Bedding
8 Green Acres Road, Keene, N.H. 03431
 E-mail: gbedding@verizon.net

John A. Stephen                                                                                           
Commissioner, NH Department of Health & Human Services 
129 Pleasant St.
Concord, NH 03301

December 18, 2006

Dear Commissioner Stephen,                                                                           

ADA’s  Fluoride Warning for Infants Not Reaching the Public

As you may know, the American Dental Association’s (ADA) e-gram, sent on November 9th 2006 to its members and supporters, advised using fluoride-free bottled water to reconstitute powdered infant formula to prevent dental fluorosis.

The ADA’s advisory to “simply and effectively reduce fluoride intake during a baby’s first year of life,” (1)  was based on the National Research Council’s (NRC) March 2006 in-depth review  of fluoride in drinking water. (The NRC, an arm of the National Academy of Sciences,  is considered the authority on subjects it studies.) The NRC states that babies under a year risk moderate dental fluorosis (white, yellow or brown stains affecting the tooth surface) from ingesting “optimally fluoridated” water (2).  According to the Centers for Disease Control, dental fluorosis now  impacts 32% of American children, an increase of 9% since the 1980s (3). 

However, the NRC’s analysis reaches well beyond fluoride’s causation of fluorosis.  The March 2006 study reports  “optimally fluoridated” water (0.7 - 1.2 mg/L)  may adversely affect  bones, brains, and thyroid glands.  At greatest risk are diabetics, kidney patients, and large volume water drinkers such as athletes and construction workers. 

Years ago, the Academy of General Dentistry cautioned parents to avoid fluoridated water when preparing infant foods (4).  Since 1999, Dr. Hardy Limeback, Head of Preventive Dentistry, University of Toronto, and Past President of the Canadian Association for Dental Research, has issued similar warnings.  Dr. Arvid Carlsson, 2000 Nobel Laureate for Medicine, also warns against fluoride intake by infants because of fluoride’s effect on babies’ developing brain cells. (5)  Both Limeback and Carlsson point out that breast milk has 150 - 250 times less fluoride than is found in fluoridated water, thus protecting the infant.

Though numerous studies link infant consumption of fluoridated water to dental fluorosis of the permanent teeth (6a-h), the public is still virtually unaware of this information. A handful of local media outlets across the country have publicized ADA’s advisory (7), but many people don’t read newspapers or watch TV news – especially new Moms with little free time.  And too many Americans don’t even see physicians or dentists on a regular basis.  So ADA’s new advisory must be passed onto caregivers and parents in other ways.

We applaud the Minnesota Dental Association (MDA) for sending out a news release alerting the public to the ADA’s fluoride warning (8). To our knowledge, MDA is the only health or dental organization, thus far,  which has taken such action.  Unfortunately, up until November 9, 2006, the only “reminder” issued by most  dental organizations steered parents away from unfluoridated bottled water toward the fluoridated version.(9).

So, on behalf of the Aurum Foundation, NH Pure Water Coalition, and NH Citizens for Health Freedom (whose members include medical doctors, naturopathic doctors, registered nurses, NHDHHS employees, and various other New Hampshire health professionals), as well as on behalf of  those New Hampshire infants whose health is at risk, we offer these suggestions, and hope we can coordinate our efforts  to help parents  “simply and effectively reduce fluoride intake during a baby’s first year of life.”:

a) Make educational materials on this issue available for distribution to the media, health centers, schools, pediatricians, hospitals, obstetrician’s offices, dental clinics, and water departments. 

b) Advise Water Departments to send warnings with each water bill and urge landlords to inform tenants.

c)  Common sense  suggests that baby formula containers display a warning:  “Do not mix with fluoridated water.”  Are you amenable to promoting legislation that requires formula manufacturers to print such a warning?

d) Thought  must be given to providing fluoride-free water, without charge, to economically disadvantaged parents in New Hampshire’s fluoridated cities.  

 e) Since it is total fluoride intake that should be reduced, parents must also be informed of the high fluoride content in some foods, e.g. jarred chicken baby food, grape juice, soy-based formulas, fish, etc. (10).  

Finally, we respectfully request  you consider assigning a staff member to study the NRC March 2006 report on fluoride and its implications for the health of New Hampshire citizens.  
  
We look forward to your reply and to working  together in the future.

Sincerely, 
 
Gerhard Bedding
Executive Director NH Citizens for Health Freedom and NH Pure Water Coalition
President Emeritus Aurum Foundation

Copies to:
– Nicholas Toumpas, NHHHS Deputy    Commissioner 
- Mary Ann Cooney, NHHHS Director of Public    Health 
- Timothy M. Soucy, City of Manchester Public Health Director
- NH Dental Board
- Governor John Lynch
- Attorney General Kelly A. Ayotte
- Senator Judd Gregg
- Senator  John Sununu
- Representative Paul Hodes
- Representative Carol Shea Porter
- New Hampshire State Legislators: 
   Health Committee
- New Hampshire media outlets

References:

 1) ADA e-gram, “Interim Guidance on Reconstituted Infant Formula”, November 9, 2006
http://www.ada.org/prof/resources/pubs/epubs/egram/egram_061109.pdf 

2) National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. National Academies Press, Washington D.C. 

3) Centers for Disease Control, August 25, 2005. http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/s403a1t23.gif 
4) Academy of General Dentistry News Release “Monitor Infant’s Fluoride Intake,”
http://www.agd.org/consumer/topics/baby/fluoride.asp 
http://www.nap.edu/catalog/11571.html?onpi_newsdoc03222006

5) Carlsson A. (1978). Current problems relating to the pharmacology and toxicology of fluorides. Lakartidningen 25: 1388-1392.

6a) Hong L, Levy SM, et al. (2006). Timing of fluoride intake in relation to development of fluorosis on maxillary central incisors. Community Dentistry and Oral Epidemiology 34(4):299-309.
6b) Marshall TA, et al. (2004). Associations between Intakes of Fluoride from Beverages during Infancy and Dental Fluorosis of Primary Teeth. Journal of the American College of Nutrition 23:108-16.
6c) Brothwell D, Limeback H. (2003). Breastfeeding is protective against dental fluorosis in a nonfluoridated rural area of Ontario, Canada. Journal of Human Lactation 19: 386-90.
6d) Pendrys DG. (2000). Risk of enamel fluorosis in nonfluoridated and optimally fluoridated populations: considerations for the dental professional. Journal of the American Dental Association 131(6):746-55.
6e) Bardsen A, Bjorvatn K. (1998). Risk periods in the development of dental fluorosis. Clinical Oral Investigations 2:155-160.
6f) Pendrys DG, Katz RV. (1998). Risk factors for enamel fluorosis in optimally fluoridated children born after the US manufacturers’ decision to reduce the fluoride concentration of infant formula. American Journal of Epidemiology 148:967-74.
6g) Ismail AI, Messer JG. (1996). The risk of fluorosis in students exposed to a higher than optimal concentration of fluoride in well water. Journal of Public Health Dentistry 56:22-7.
6h) Ekstrand J, et al. (1994). Absorption and retention of dietary and supplemental fluoride by infants. Advances in Dental Research 8:175-80.

7a) “New Fluoride Warning for Infants”, Mothering Magazine, November 2006. 
http://www.mothering.com/sections/news_bulletins/november2006.html#fluoride
7b) “Parents Warned Against Fluoride in water” WKRN Nashville, Tennessee, November 25, 2006 
http://www.wkrn.com/nashville/news/parents-warned-against-fluoride-in-water/61618.htm 
7c)  “Fluoride and Babies Don’t Mix, says ADA”, News Channel 5, Nashville, Tennessee, November 24, 2006 http://www.newschannel5.com/Global/story.asp?S=5726800 
7d) “ADA: Avoid using flourinated water with babies.” HOI 19 online ABC, November 16, 2006
 http://www.hoinews.com/news/news_story.aspx?id=21806 
7e) “Water fluoridation: A debate with teeth,” Bangor Daily News By Meg Haskell November 20, 2006 - http://bangordailynews.com/news/t/news.aspx?articleid=143246&zoneid=500 

8) Minnesota Dental Association. November 21, 2006. “Parents Reminded To Monitor Infants’ Fluoride Consumption.” See: http://www.medicalnewstoday.com/medicalnews.php?newsid=57490

9) “Bottled water: Cause for cavity comeback?” http://www.deltadentalca.org/health/bottledwater.html

10) Levy SM, Guha-Chowdhury N. (1999). Total fluoride intake and implications for dietary fluoride supplementation. Journal of Public Health Dentistry 59: 211-23. See: http://www.fluoridealert.org/f-sources.htm

(Letter composed with consultant Shelley Nelkens’ assistance.)
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2) Manchester Union Leader, Jan 12, 2007

New Hampshire
Formula, fluoride mix may discolor infants’ teeth
By MARK HAYWARD
Union Leader Staff
 
Infants fed formula mixed with fluoridated water could ingest more than the recommended amount of the tooth-toughening substance, which could lead to spotted or discolored teeth, a state health official said this week.

Spokesman Gregory P. Moore said the state Department of Health and Human Services is asking two federal agencies — the FDA and the Centers for Disease Control and Prevention — for guidance on the matter. The request follows a statement in November from the American Dental Association, which raised concerns about infants fed formula reconstituted with fluoridated water.

“At this point, from our perspective we think it’s important for the public to realize there is a potential for fluorosis with the continual use of fluoridated tap water in reconstituted baby formula,” Moore said.

Fluorosis occurs when teeth that are under formation become exposed to too much fluoride. The result can range from barely noticeable white spots on the teeth to pitting and staining.

Public water in Manchester and surrounding towns has been fluoridated since late 2000. Other fluoridated public water systems in New Hampshire include Concord, Dover, Hanover, Laconia, Lancaster, Lebanon, Portsmouth and Rochester.

Moore said health officials are receiving mixed signals about fluoride and infants since the ADA released its guideline.

The federal Womens, Infant and Children program, which provides formula and other products to mothers and children, has not changed its recommendation. WIC encourages mothers to mix formula with fluoridated water, Moore said.

The ADA said it acted after the National Research Council raised the possibility of higher-than-optimal levels of fluoride for infants who drink formula.

“While more research is needed before definitive recommendations can be made on fluoride intake by bottle-fed infants, the American Dental Association issues this interim guidance because we know that parents and other caregivers are understandably cautious about what is best for their children,” the ADA writes in its statement.

And last month, the Vermont Health Department recommended that formula be mixed with non-fluoridated or low levels of formula. State health officials stressed that occasional consumption of fluoridated water by infants will not harm developing teeth.

“At this point we are seeking additional guidance on the subject,” Moore said.

The Manchester Health Department will not take a strong position on the matter at this point, said Health Director Tim Soucy. But the department is in touch with state health officials.

“It doesn’t appear to require widespread notification,” he said.

In a Dec. 18 letter to New Hampshire Health and Human Services Commissioner John Stephen, the head of an anti-fluoridation group urged Stephen to spread information about the ADA advisory.

Gerhard Bedding, head of New Hampshire Citizens for Health Freedom and New Hampshire Pure Water Coalition, said only a handful of media across the country have publicized the advisory. Not everyone will see such news articles, especially mothers of newborns with little free time, he said.

Bedding suggested the state health officials make educational material available to pediatricians, dentists and hospitals; encourge water departments to send warnings with bills; require formula manufacturers to put warning labels on their product; consider providing fluoride-free water to poor parents; and assign a professional to review last March’s report by the NRC.

The ADA stresses that it still supports fluoridation of public water.

Breast milk, the preferable source of food and nutrition for infants, avoids any concerns about fluoride, the ADA said.

For others, ready-to-feed formula is preferable during the first 12 months of life because it helps to ensure that infants do not ingest too much fluoride, the ADA said. If liquid concentrate or powdered formula is the primary source if nutrition, it should be mixed with water that contains little or no fluoride, the ADA said. The ADA recommended that parents consult with their pediatrician, family physician or dentist on the most appropriate water to use in their area to reconstitute infant formula.

In response to an e-mail inquiry, ADA spokesman Fred L. Peterson said he knows of no local health officials who have issued guidelines based on the ADA recommendations. Nor has the ADA received a formal response from any medical organization, Peterson said.

 
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