Why everyone should oppose water fluoridation.

Summary Statement. Fluoridated water is an uncontrolled drug that works topically to provide, nowadays, marginal dental benefits, but poses significant risks: when used as intended (drinking water) it results in dental and skeletal fluorosis and possibly bone cancer. Its ingestion through the water supply can no longer be considered safe, especially when it is delivered to the communities as a contaminant-laden toxic waste.

Seven good reasons why water fluoridation is outdated and must be stopped.

1. There is no reason to swallow fluoride. Swallowing fluoride provides next to no benefit in terms of preventing tooth decay. Fluoride works primarily through daily contact with teeth already present in the mouth (fluoridated tap water works like fluoridated mouthwashes- by topical exposure to the teeth) [I]. Unlike other halides, like iodine and chlorine, (fluorine) fluoride is not an essential nutrient. Normal development of teeth and bones occurs in the total absence of fluoride[2].

2. Fluoride is a drug. Fluoridated water is the only consumer drug that is unregulated. All other fluoridated products for human consumption (tablets, lozenges, toothpaste's, mouth rinses, floss) are regulated. No safety studies are required before a municipality decides to mass medicate its residents. There are no Federal or Provincial laws making fluoridation mandatory. The dosage of fluoride ingestion cannot be adjusted to suit individual needs and to avoid overdosing some individuals who cannot tolerate 'optimal' levels in the water. For example, diabetics who drink excess amounts of water will ingest excessive amounts of fluoride. Patients with impaired kidney function will retain more fluoride consuming normal amounts of water[3]. Unlike the administration of vaccinations, individuals are being ‘forced’ to ingest this drug without providing informed consent because of its widespread use in improperly labelled foods and beverages.

3. Since the introduction of fluoride in toothpaste in the early 1960's, the total ingestion of fluoride from water and toothpaste has resulted in an increase in the incidence of dental fluorosis[4].

Dental fluorosis is not simply a cosmetic side effect. Fluorotic teeth have to be repaired prior to filling placement and orthodontics. The incidence of moderate to severe dental fluorosis, which results in surface enamel that requires costly restorative therapy, has increased. Dental fluorosis leads to premature dentine hypermineralisation and discoloration associated with ageing teeth[5]. This has contributed to the birth of a multi-billion dollar industry of tooth bleaching and cosmetic dentistry. More money is being spent now on the treatment of dental fluorosis than what would be spent on dental decay if water fluoridation were halted[6].

4. Long-term fluoride accumulation on the skeleton results in skeletal fluorosis. This has been well documented in other parts of the world where endemic fluorosis occurs[7]. Scientists who claim fluoride is perfectly safe in the water supply at levels used to prevent tooth decay are lying since there hasn't been a single study to examine the effects of a lifetime accumulation of fluoride on bone fracture rates or the biomechanical properties of the human skeletal system.

5. With the secular decline in dental decay (there are many reasons for the overall decline of tooth decay in both fluoridated and non-fluoridated regions) the benefits of water fluoridation are no longer as dramatic as was observed in the 1940's and 1950's. Banting and Lewis pointed out in their review in 1994 that there is a lack of modern fluoridation studies.[S] Documentation of comparisons of cities in the last 3 decades (Culembourg-Tiel[9], Thunder Bay-Toronto[10], Stranraer-Annan[11], 1'ruro-Kentville[12]), as well as whole regions (British Columbia Vs other provinces)[13] - these are all published comparisons- demonstrate clearly that caries is at very low in both non-fluoridated and fluoridated regions (the differences in caries rates are so low they are not statistically significant). In fact, some of these comparisons suggest that fluoridated areas have even higher decayed-missing-filled-teeth (DMFT) scores since dental fluorosis is often treated with restorations. Documentation of the effects of reducing water

Fluoridation (e.g. Hong Kong[14], Tiel[15], Wick[16]), is further 'evidence' (the same level of evidence used to justify fluoridation in the 40's and 50's) that the decay rates will not rise significantly when water is defluoridated. Any minor increase in tooth decay (on average) will be the result of an increase in select groups of individuals in our society (e.g. poor people, the institutionalised elderly). These groups can be protected against an increase in dental decay using alternative cost-effective preventive measures.

6. Continuation of water fluoridation without clear evidence of current benefit contravenes United Nations policy to which the US and Canada are signatory nations. We collectively have accepted "Document 1 1b, World Charter of Nature, 1982", in which 'the Precautionary Principle' as developed by the United Nations, is part of this document. It reads:

"Activities which are likely to pose a significant risk to nature shall be preceded by an exhaustive examination; their proponents sha11 demonstrate that expected benefits outweigh potential damage to nature, and where potential adverse effects are not fully understood, the activities should not proceed."

Thus, the onus is now on public health to provide better evidence of efficacy of water fluoridation, especially with respect to the current situation where we have observed a general secular decline of dental decay in North America.

7. The use of 'toxic waste' for the source of fluoride in most communities is an abhorrent practice and should be halted immediately. The most common 'toxic waste' form of fluoride is hydrofluosilicic acid, which is recovered from the smoke stack scrubbers of phosphate fertiliser plants in Florida[17]. It is contaminated with lead, arsenic, and radioactive radium as well as other harmful trace metals, which are diluted along with the fluoride when concentrated hydrofluosilicic acid is added to the water supply. Radioactive radium has been shown to accumulate in the skeletal system and increase bone cancer in Canadian children[18]. This adulterated water is used in the homes to make infant formula, reconstitute juices and cook foods. It is used in the manufacturing of most beverages and foods in the major fluoridated urban areas. Due to restricted inter-provincial trade practices, Torontonians have to purchase goods made in Ontario rather than fluoride-free products from Montreal or Vancouver. The systematic adulteration of our water supply with toxic waste with the false claim that it still provides a significant benefit to the general population in terms of dental decay prevention is an unconscionable practice. Local government officials who mistakenly believe that Provincial guidelines must be enforced should be made to understand that they will be held legally accountable for damage done to our children (dental fluorosis, bone cancer), our sick (fluoride intoxication in diabetes and kidney impairment) and our elderly (skeletal fluorosis) -legal action may be the only way to make these of Ticials realise that the practice of fluoridating water is harmful and no longer justifiable as a public health measure.

Hardy Limeback, B.Sc., Ph.D., D.D.S.

Head, Preventive Dentistry

Faculty of Dentistry, University of Toronto