FAN Bulletin 1057

March 23, 2009

As a follow up to yesterday’s bulletin warning of a new push to fluoridate Europe, below we examine the very weak evidence that fluoridation actually works. We have divided our arguments into several parts because of the length. Below is Part 1. We are doing this in response to the claim in a European Commission document which states: “no one doubts the beneficial effects of fluoride” (http://fluoridealert.org/eu.docs.html). Well as far as the benefits of ingesting fluoride are concerned ? we certainly do. The piece below explains why.

But first, while we must hope that the European Commission will do an honest job examining the toxicity of fluoride - and some people in Europe feel they might - it remains imperative that the body doing this is stripped of any influence from the dental lobby.  Thus, again we urge you to send in the following message,  preceded with a short note about who you are (experience with this issue and/or your professional qualifications). Here are the details:

Email comments to: Sanco-Sc8-Secretariat@ec.europa.eu

Dear Sirs,

You have asked for comments on your “Working Mandate on fluoridation”

( your personal preamble here ? your experience with this issue and/or your professional qualifications)

I ask that those individuals who have been involved in writing past EU decisions involving fluoride, and are known to be pro-fluoridationists, be removed from all considerations on the “Working Mandate.”  Clearly, the erroneous claim that “no one doubts the beneficial effects of fluoride” suggests that dentists and the dental lobby retain their inside track on this issue. We ask that dentists be removed from this process, a) because they are extremely biased in favor of fluoridation and b) they do not have the qualifications to make judgments on fluoride’s ability to impact other parts of the body.  Instead, on behalf of the public, we request that a balanced panel of toxicologists, neurologists, physiologists, and biologists review the new information and the Working Mandate.

Your name etc

Paul Connett

Why we doubt the benefits of swallowing fluoride.  Part 1
 
Introduction
 
One of the surprises waiting for someone who decides to review the literature on the issue of water fluoridation is the discovery that, despite the impression conveyed by the promoters, the evidence that swallowing fluoride actually reduces tooth decay is very weak. In this bulletin we will begin to review the evidence that the benefits of swallowing have been wildly exaggerated and no grade A study has ever been published to support the claims of “massive” benefit.
 
1. Fluoride is not an essential nutrient
 
Fluoride is not an essential nutrient (NRC 1993 and IOM 1997). No disease has ever been linked to a fluoride deficiency. Humans can have perfectly good teeth without fluoride. This is not surprising when one notes the level of fluoride in mothers’ milk. This is only 0.004 ppm (NRC, 2006, p.36 and Table 2-6, p. 40). If the infant needed fluoride to develop strong health teeth then clearly evolution messed up on this requirement.
 
2. No “Randomized Controlled Trials”  demonstrating effectiveness

In the 60 years (plus) of this practice there has never been a study of the quality required by the FDA and other national regulatory bodies when approving new drugs for efficacy. Such trials require random selection of the individuals tested (exposed and unexposed) and examinations should be “double blind.”  Double blind means that neither the person examining the subject nor the person being tested should know whether the substance given is the drug or a placebo. The modern terminology for this testing is “Randomized Controlled Trial.”
 
The York Review (McDonagh et al., 2000) after an exhaustive review of the literature could identify NO “Randomized Controlled Trials” of either fluoridation’s effectiveness, or safety.
 
3. No controls for delayed eruption of teeth
 
Not one single study purporting to demonstrate fluoridation’s effectiveness has ever controlled for a possible delayed eruption of teeth caused by fluoride, for which there is some evidence (Feltman and Kosel, 1961; Komarek, et al. 2005).
 
4. Primary versus secondary dentition
 
Those promoting fluoridation usually do so using the data on primary dentition (deciduous teeth) rather than secondary dentition (permanent teeth). However, it is the latter which are more important since these are the teeth we hope to have for the rest of our lives.
 
5. Cross-sectional versus Longitudinal studies
 
The York Review (McDonagh et al., 2000) only looked at longitudinal studies (these compare the same community over a period of time). Cross-sectional studies (these compare 2 or more communities at the same point in time) are much larger and more convincing in indicating no or little benefit from ingesting fluoride. Some of these studies are discussed below.
 
6. Baby bottle tooth decay
 
Even promoters of fluoridation have conceded that fluoridation cannot prevent baby bottle tooth decay (BBTD) and this is the cause of the most distressing examples of tooth decay in infants often leading to extractions under anesthesia. BBTD is caused by babies sucking on sugared water, fruit juice (and even coca cola) for hours on end (Kelly et al. ,1987; Barnes et al. ,1992; Weinstein et al. ,1992;  Von Burg et al. ,1995; Febres et al. ,1997; Tang et al. , 1997; Blen et al. ,1999 and Kong,1999).
 
Promoters are being intellectually dishonest when they use pictures of BBTD to promote fluoridation. But this has become a standard ploy of many promoting fluoridation.
 
7. Pit and fissure decay
 
Since 1950, it has been found that fluorides do little to prevent pit and fissure tooth decay, a fact that even the dental community has acknowledged (Seholle 1984; Gray 1987; PHS 1993; and Pinkham 1999).
 
This is significant because pit and fissure tooth decay represents up to 85% of the tooth decay experienced by children today (Seholle 1984 and Gray 1987). Pit and fissure decay is best prevented with sealants.
 
8. Decay rates have been coming down before fluoridation began and after the” benefits” would have been maximized
 
Modern research (e.g. Diesendorf 1986; Colquhoun 1997, and De Liefde, 1998) shows that decay rates were coming down before fluoridation was introduced and have continued to decline even after its benefits would have been maximized (see discussion on Diesendorf’s 1986 paper below).
 
Many other factors influence tooth decay. Some recent studies have found that tooth decay actually increases as the fluoride concentration in the water increases (Olsson, 1979; Retief 1979; Mann 1987, 1990; Steelink, 1992; Teotia, 1994; Grobleri, 2001; Awadia, 2002 and Ekanayake, 2002).
 
9. Little difference between fluoridated and non-fluoridated communities
 
There is very little evidence which demonstrates a significant difference in the permanent teeth when comparing children living in fluoridated and non-fluoridated communities (Leverett, 1982; Diesendorf, 1986; Gray, 1987; Yiamouyiannis, 1990; Brunelle and Carlos, 1990; Spencer et al., 1996; deLiefde, 1997; Locker, 1999; Armfield & Spencer, 2004 and Pizzo et al., 2007).

10. Benefits topical not systemic.

Even ardent supporters and promoters of fluoridation like the Centers for Disease Control and Prevention (CDC), now admit that the benefits of fluoride are largely topical not systemic (CDC, 1999, 2001). In other words fluoride works on the outside of the tooth not from inside the body. The fact that fluoridated toothpaste is universally available today, coupled with an increasing standard of living, are more likely explanations for declines in tooth decay in industrialized societies than the availability of fluoridated drinking water.
 
11. World Health organization (WHO) data
 
According to WHO data there is no significant difference in the rates of decline in decay in the teeth of 12-year olds between fluoridated and non-fluoridated countries, over the period from the 1960s to the present. The same set of data shows no significant difference today. See the figure at http://www.FluorideAlert.org/who-dmft.htm which presents this data graphically.  See also a similar graph presented in the article by Cheng et al, 2007 in the British Medical Journal.
 
12. Comparing WHO data with CDC claims.

It is interesting to compare the figure based on the WHO data and the figure used by the CDC in 1999, which can also be observed at  http://www.FluorideAlert.org/who-dmft.htm . This figure was used by the CDC in 1999 to “demonstrate” the effectiveness of fluoridation. They inferred that tooth decay was coming down over the period 1960 to the 1990’s in the US because the percentage of the American population drinking fluoridated water had gone up over this same period (CDC, 1999).  
 
It is disturbing that the CDC authors appear to have been unaware of the WHO data which clearly refutes the claim for such a simplistic causal relationship.
 
This CDC graph was used in the report which was supposed to substantiate their claim that fluoridation is “One of the top ten public health achievements of the 20th Century” (CDC, 1999).
 
This famous statement is quoted nearly every day somewhere in the world by some unsuspecting editor, journalist or public health official as the final word on fluoridation’s safety and effectiveness. As far as an attempt to demonstrate effectiveness is concerned this graph remains a total embarrassment to any genuine scientist at the CDC ? or it should be.

End of Part 1.

All references can be found at http://www.fluoridealert.org/health/biblio.html