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The Case Against Water Fluoridation The Case Against Water Fluoridation Paul Connett, PhD Professor Emeritus of Environmental Chemistry St. Lawrence University,

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Presentation on theme: "The Case Against Water Fluoridation The Case Against Water Fluoridation Paul Connett, PhD Professor Emeritus of Environmental Chemistry St. Lawrence University,"— Presentation transcript:

1 The Case Against Water Fluoridation The Case Against Water Fluoridation Paul Connett, PhD Professor Emeritus of Environmental Chemistry St. Lawrence University, Canton, NY Director, Fluoride Action Network Ministry of Health, NZ, March 22, 2011

2 Outline of talk Outline of talk 1. Fluoridation is a poor medical practice 2. Fluoridation is unethical 3. The evidence of any benefit is very weak 4. There is no adequate margin of safety to protect the brain from harm and other KNOWN health effects 5. Politics versus Science 6. Other health concerns

3 Part 3. The evidence of benefit is very weak

4 Comparing Countries

5 Most countries dont fluoridate their water, but their kids teeth are as good as those that do Most countries dont fluoridate their water, but their kids teeth are as good as those that do

6 SOURCE: World Health Organization. (Data online)

7 Comparing US States

8 50 USA States and DC Percent National Survey of Children's Health. U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau. The National Survey of Children's Health Rockville, Maryland: U.S. Department of Health and Human Services, 2005

9 Comparing US Communities

10 NIDR conducted the largest survey of tooth decay ever conducted in the US (1986-7) The teeth of over 39,000 children in 84 communities were examined. The teeth of over 39,000 children in 84 communities were examined.

11 The largest US survey of tooth decay Average difference (for year olds) in DMFS 3.4 DMFS NF 2.8 DMFS F

12 Brunelle and Carlos, 1990 Average difference (for year olds) in DMFS = 0.6 tooth surfaces (5 surfaces to a tooth) 3.4 DMFS NF 2.8 DMFS F

13 Weaknesses in Brunelle and Carlos study 1) Brunelle and Carlos did not report statistical significance of the 0.6 tooth surface decay difference 1) Brunelle and Carlos did not report statistical significance of the 0.6 tooth surface decay difference 2) Nor did they adjust for possible delayed eruption of teeth in fluoridated areas- 2) Nor did they adjust for possible delayed eruption of teeth in fluoridated areas- William Kiel of Alamo Heights, Texas, made this adjustment… William Kiel of Alamo Heights, Texas, made this adjustment…

14 Original Data – Age BasedShifted Data – Post-Eruption Based* Recent Trends in Dental Caries in U.S. Children and the Effect of Water Fluoridation by J.A. Brunelle and J.P. Carlos Journal of Dental Research February 1990 (Volume 69, Special Issue, Pages ) *Fluoridated data was shifted back by one year; e.g. age 6 Fluoridated aligns with age 5 unfluoridated, etc. Mean DMFS Adjusted for one year Delayed eruption of teeth William Kiel, Alamo Heights.

15 Studies in Australia have found even less saving than O.6 DMFS! Spe ncer et al. (1996) found a saving in two states of ONLY 0.12 – 0.3 permanent tooth surfaces. Spe ncer et al. (1996) found a saving in two states of ONLY 0.12 – 0.3 permanent tooth surfaces. Armfield and Spencer (2004) found no statistically significant difference in tooth decay in the permanent teeth between children in South Australia who had drunk fluoridated water all their lives and those who had drunk bottled or tank water. Armfield and Spencer (2004) found no statistically significant difference in tooth decay in the permanent teeth between children in South Australia who had drunk fluoridated water all their lives and those who had drunk bottled or tank water.

16 The magnitude of [fluoridations] effect is not large in absolute terms, is often not statistically significant, and may not be of clinical significance. SOURCE: David Locker for the Ontario Ministry of Health & Long Term Care, 1999

17 Studies in NZ John Colquhoun (studies: ) John Colquhoun (studies: ) De Liefde, 1998 The difference in tooth decay in permanent teeth was clinically meaninglesss De Liefde, 1998 The difference in tooth decay in permanent teeth was clinically meaninglesss Recent studies reported in MOH (2010), Our Oral Health Recent studies reported in MOH (2010), Our Oral Health Wellington versus Canterbury saving of 1 DMFS (2.4 – 1.4) Lee and Dennison, 2004, MOH p.28. Wellington versus Canterbury saving of 1 DMFS (2.4 – 1.4) Lee and Dennison, 2004, MOH p.28.

18 Studies in NZ (MOH) … studies found that 9-10 year olds continuously exposed to water fluoridation had half the dental caries experience of those who had not in Auckland (Kanagaratnam et al 2009) and Southland (Mackay and Thomson 2005). Another Auckland study of 9-year-olds similarly found lower levels of dental caries in fluoridated areas than non-fluoridated areas (Schluter et al 2008) p.28, MOH, 2010 … studies found that 9-10 year olds continuously exposed to water fluoridation had half the dental caries experience of those who had not in Auckland (Kanagaratnam et al 2009) and Southland (Mackay and Thomson 2005). Another Auckland study of 9-year-olds similarly found lower levels of dental caries in fluoridated areas than non-fluoridated areas (Schluter et al 2008) p.28, MOH, 2010

19 Schluter et al 2008 Prevalence of caries: Prevalence of caries: Deciduous teeth, prevalence: F = 54.9%, NF = 62.0 % (p=0.05) Saving = 7.1% Deciduous teeth, prevalence: F = 54.9%, NF = 62.0 % (p=0.05) Saving = 7.1% Permanent teeth prevalence F = 15.9%, NF = 11.7% (p=0.14) Permanent teeth worse in F-areas but not statistically significant Permanent teeth prevalence F = 15.9%, NF = 11.7% (p=0.14) Permanent teeth worse in F-areas but not statistically significant Nothing here looks like a saving of half of the dental caries in either the deciduous or permanent teeth (nor was a corrcction made for delayed eruption of teeth in F city). Nothing here looks like a saving of half of the dental caries in either the deciduous or permanent teeth (nor was a corrcction made for delayed eruption of teeth in F city).

20 Mackay and Thomson, 2005 Residence in F area up to age 9 Residence in F area up to age 9 Deciduous teeth: dmfs Deciduous teeth: dmfs None 5.11 None 5.11 Intermittent 4.29 Intermittent 4.29 Continuous 3.42 Continuous 3.42 Saving = 5.11 – 3.42 = 1.69 dmfs Saving = 5.11 – 3.42 = 1.69 dmfs % saving = 1.69/5.11 x 100 = 33% % saving = 1.69/5.11 x 100 = 33%

21 Mackay and Thomson, 2005 Residence in F area up to age 9 Residence in F area up to age 9 Permanent teeth: DMFS Permanent teeth: DMFS None 1.22 None 1.22 Intermittent 1.18 Intermittent 1.18 Continuous 0.70 Continuous 0.70 Saving = 1.22 – 0.70 = 0.52 DMFS Saving = 1.22 – 0.70 = 0.52 DMFS % saving = 0.70/1.22 x 100 =43% % saving = 0.70/1.22 x 100 =43%

22 NZ studies In neither of these two NZ studies was there any attempt to control for the possible delayed eruption of teeth in F communities In neither of these two NZ studies was there any attempt to control for the possible delayed eruption of teeth in F communities Even so the best result indicates a saving of ONLY 0.5 of a single permanent tooth surface Even so the best result indicates a saving of ONLY 0.5 of a single permanent tooth surface There are either 4 or 5 surfaces to a tooth. There are either 4 or 5 surfaces to a tooth. There are 128 tooth surfaces when all the teeth (except the wisdom teeth) have erupted. There are 128 tooth surfaces when all the teeth (except the wisdom teeth) have erupted.

23 Percentage savings versus absolute savings Proponents frequently report their findings as percentage savings. This can be very deceptive. Proponents frequently report their findings as percentage savings. This can be very deceptive. We saw in this last study that a saving of one half of a permanent tooth surface (note there are 4 or 5 surfaces to a tooth) equates to a percentage saving of 43%. We saw in this last study that a saving of one half of a permanent tooth surface (note there are 4 or 5 surfaces to a tooth) equates to a percentage saving of 43%. The latter sounds more impressive to the general public. The latter sounds more impressive to the general public.

24 Kanagaratnam et al., 2009 no signicant relationship was found between residential uoridation history and dental caries in the permanent dentition. This may be partly because, at 9 years of age, only some of the permanent teeth are present, and differences in caries prevalence and severity with differing exposures to uoride may become more obvious in older children who have more permanent teeth for a longer time (29)….no signicant relationship was found between residential uoridation history and dental caries in the permanent dentition. This may be partly because, at 9 years of age, only some of the permanent teeth are present, and differences in caries prevalence and severity with differing exposures to uoride may become more obvious in older children who have more permanent teeth for a longer time (29)….

25 Kanagaratnam et al., 2009 …a longer time (29).The signicantly higher proportion of girls (whose teeth erupt at an earlier age) with permanent teeth caries compared with boys exemplies this limitation. …a longer time (29).The signicantly higher proportion of girls (whose teeth erupt at an earlier age) with permanent teeth caries compared with boys exemplies this limitation.

26 Australian studies The most impressive studies demonstrating a small difference in tooth decay between fluoridated and non-fluoridated communities have come from Australia from Adelaide University (Spencer, Armfield etc). They controlled for several confounding factors to reach a small saving The most impressive studies demonstrating a small difference in tooth decay between fluoridated and non-fluoridated communities have come from Australia from Adelaide University (Spencer, Armfield etc). They controlled for several confounding factors to reach a small saving BUT they did not control for delayed eruption of the teeth in F-areas. BUT they did not control for delayed eruption of the teeth in F-areas.

27 Delayed eruption in F areas The DA (dental age) of the AUS and UK populations was found to be different (Fig. 5). The AUS population had a 0.82 year delay in their DA compared to the UK population. This difference was compared and was found to be very statistically signicant (P < 0.001). Peirisi et al. International Journal of Paediatric Dentistry 2009; 19: 367–376 The DA (dental age) of the AUS and UK populations was found to be different (Fig. 5). The AUS population had a 0.82 year delay in their DA compared to the UK population. This difference was compared and was found to be very statistically signicant (P < 0.001). Peirisi et al. International Journal of Paediatric Dentistry 2009; 19: 367–376

28 Original Data – Age BasedShifted Data – Post-Eruption Based* Recent Trends in Dental Caries in U.S. Children and the Effect of Water Fluoridation by J.A. Brunelle and J.P. Carlos Journal of Dental Research February 1990 (Volume 69, Special Issue, Pages ) *Fluoridated data was shifted back by one year; e.g. age 6 Fluoridated aligns with age 5 unfluoridated, etc. Mean DMFS Adjusted for one year Delayed eruption of teeth William Kiel, Alamo Heights.

29 Important recent studies Komarek et al., 2005 (controlled for delayed eruption of teeth in F- communities). Komarek et al., 2005 (controlled for delayed eruption of teeth in F- communities). Found no difference in tooth decay between F and non-F communities. Found no difference in tooth decay between F and non-F communities. Warren et al., 2009 (measured tooth decay as a function of individual exposure to fluoride). Warren et al., 2009 (measured tooth decay as a function of individual exposure to fluoride). Found no relation between tooth decay and amount of fluoride ingested. Found no relation between tooth decay and amount of fluoride ingested.

30 An explanation for weak evidence of benefit in very large studies The major benefits of fluoride are TOPICAL not SYSTEMIC. (CDC, 1999, 2001). In other words fluoride works on the outside surface of the tooth not from inside the body The major benefits of fluoride are TOPICAL not SYSTEMIC. (CDC, 1999, 2001). In other words fluoride works on the outside surface of the tooth not from inside the body Fluoridation should have ended in 1999!

31 Fluorides main benefit is TOPICAL. It works on the outside of the tooth. Its actions primarily are topical for both adults and children." Centers for Disease Control, 1999 "Fluoride's predominant effect is posteruptive and topical." Centers for Disease Control, 2001

32 Schluter et al 2008 The effect of fluoride on dental caries is due primarily to the topical effect of fluoride after the teeth have erupted into the oral cavity. The harmful effects of fluoride are due to it systemic absorption during tooth development resulting in dental fluorosis … The effect of fluoride on dental caries is due primarily to the topical effect of fluoride after the teeth have erupted into the oral cavity. The harmful effects of fluoride are due to it systemic absorption during tooth development resulting in dental fluorosis … The dose-response relationship is linear and for every 0.01 mg/kg bodyweight increase in exposure, there is a corresponding detectable increase in the population (Ellwood and Fejerskov, 2003). The dose-response relationship is linear and for every 0.01 mg/kg bodyweight increase in exposure, there is a corresponding detectable increase in the population (Ellwood and Fejerskov, 2003).

33 Part 4. There is no adequate margin of safety to protect everyone from known harmful effects of fluoride

34 A KEY QUESTION When fluoride is damaging the babys growing tooth cells (causing dental fluorosis) what is it doing to its other developing tissues? When fluoride is damaging the babys growing tooth cells (causing dental fluorosis) what is it doing to its other developing tissues?

35 The babys developing brain The baby should NOT be exposed to fluoride of up to 250 times the level of fluoride that occurs in mothers milk The baby should NOT be exposed to fluoride of up to 250 times the level of fluoride that occurs in mothers milk

36 One wonders what …an increase in the exposure to fluoride, such as occurs in bottle-fed infants …may mean for the development of the brain and the other organs… 1978 Arvid Carlsson Nobel Prize for Medicine, 2000

37 National Research Council (2006): Fluoride & the Brain it is apparent that fluorides have the ability to interfere with the functions of the brain.

38 Fluoride and the Brain Many more studies on the brain have been published since the NRC review The panel reviewed FIVE IQ studies

39 Human studies As of 2011, there are 24 published studies (from China, Iran, India and Mexico) indicating that moderate to high fluoride exposure is associated with lowered IQ in children As of 2011, there are 24 published studies (from China, Iran, India and Mexico) indicating that moderate to high fluoride exposure is associated with lowered IQ in children See FluorideAlert.org/brain See FluorideAlert.org/brain

40 Xiang et al. (2003 a,b) Compared children in two villages ( <0.7 ppm versus ppm F in water) Compared children in two villages ( <0.7 ppm versus ppm F in water) Controlled for lead exposure and iodine intake, and other key variables (NOTE: both lead exposure and low iodine also lower IQ). Controlled for lead exposure and iodine intake, and other key variables (NOTE: both lead exposure and low iodine also lower IQ). Found a drop of 5-10 IQ points across the whole age range Found a drop of 5-10 IQ points across the whole age range The whole IQ curve shifted for both males and females The whole IQ curve shifted for both males and females

41 Xiang et al. (2003 a,b) MALES

42 Xiang et al. (2003 a,b) FEMALES

43 Xiang et al. (2003 a,b) Estimated that IQ in children lowered at Estimated that IQ in children lowered at 1.9 ppm fluoride in water (threshold) 1.9 ppm fluoride in water (threshold)

44 There is no adequate margin of safety There is no adequate margin of safety If fluoride is associated with lowering IQ of children at 1.9 ppm in a small population study we need to apply a safety factor to protect the whole population of children If fluoride is associated with lowering IQ of children at 1.9 ppm in a small population study we need to apply a safety factor to protect the whole population of children Normally we use a safety factor of 10 to do this Normally we use a safety factor of 10 to do this If we assume that the Chinese children were drinking one liter of fluoride per day the dose that lowered IQ was 1.9 mg/day If we assume that the Chinese children were drinking one liter of fluoride per day the dose that lowered IQ was 1.9 mg/day That would mean to protect the intelligence of ALL the children in a large population a safe dose would be 0.19 mg/day (1.9 divided by 10) That would mean to protect the intelligence of ALL the children in a large population a safe dose would be 0.19 mg/day (1.9 divided by 10)

45 Mini sensitivity analysis Mini sensitivity analysis If the Chinese children were drinking 0.5 liter, LOAEL for lowered IQ = 0.95 mg/day. Safe dose to protect whole population = mg/day. If the Chinese children were drinking 0.5 liter, LOAEL for lowered IQ = 0.95 mg/day. Safe dose to protect whole population = mg/day. If the Chinese children were drinking 2 liters, lowered IQ at 3.8 mg/day. Safe dose to protect whole population = 0.38 mg/day (less than two glasses of water) If the Chinese children were drinking 2 liters, lowered IQ at 3.8 mg/day. Safe dose to protect whole population = 0.38 mg/day (less than two glasses of water) If we reduced margin of safety to 5(instead of10) If we reduced margin of safety to 5(instead of10) Safe dose = mg/day (equivalent to ml of water at 1 ppm a day) Safe dose = mg/day (equivalent to ml of water at 1 ppm a day)

46 Xiang et al. (2010) Xiang et al. elaborated on their 2003 study. Xiang et al. elaborated on their 2003 study. Added in more details of methods etc. Added in more details of methods etc. Added in data showing an association between plasma levels of fluoride and lowered IQ. Added in data showing an association between plasma levels of fluoride and lowered IQ. Accepted for publication by Environmental Health Perspectives the journal of the National Institute of Environmental Health Sciences (NIEHS) Accepted for publication by Environmental Health Perspectives the journal of the National Institute of Environmental Health Sciences (NIEHS) NIEHS is an agency of the US Department of Health and Human Services (DHHS). NIEHS is an agency of the US Department of Health and Human Services (DHHS). Pre-publication copy of this article published online Pre-publication copy of this article published online Article withdrawn because Xiang had published some of the data before (conflicts with EHP policy) Article withdrawn because Xiang had published some of the data before (conflicts with EHP policy)

47 Xiang et al. (2010) Please note: Please note: Xiang et al. (2010) paper was NOT withdrawn because the methodology was considered inadequate Xiang et al. (2010) paper was NOT withdrawn because the methodology was considered inadequate The methodology was PEER REVIEWED and the study considered acceptable for publication in the leading US environmental health journal. The methodology was PEER REVIEWED and the study considered acceptable for publication in the leading US environmental health journal.

48 Ding et al (J. Hazardous Materials) Mean value of uoride in drinking water was 1.31 ±1.05mg/L (range 0.24–2.84). Mean value of uoride in drinking water was 1.31 ±1.05mg/L (range 0.24–2.84). Conclusions Conclusions Overall, our study suggested that low levels of uoride exposure in drinking water had negative effects on childrens intelligence... Overall, our study suggested that low levels of uoride exposure in drinking water had negative effects on childrens intelligence... The results also conrmed the dose–response relationships between urine uoride concentrations and IQ scores… The results also conrmed the dose–response relationships between urine uoride concentrations and IQ scores…

49 Ding et al Fig 2. The relationship between IQ differences and urine fluoride concentrations. Multiple linear regression model was carried out to confirm the association with urine fluoride exposure and IQ scores (F=9.85, p < )

50 Ding et al an increase in the urine uoride concentration of 1 mg/L associated with a decrease of 0.59 IQ scores. an increase in the urine uoride concentration of 1 mg/L associated with a decrease of 0.59 IQ scores.

51 Fluoride and the brain There have now been over 100 animal experiments which show that fluoride can damage the brain There have now been over 100 animal experiments which show that fluoride can damage the brain

52 Varner et al. (1998) Gave rats 1 ppm fluoride in their water for one year (one group got AlF 3 the other NaF) Gave rats 1 ppm fluoride in their water for one year (one group got AlF 3 the other NaF) Both groups had kidney damage, brain damage, greater uptake of aluminum into the brain and beta amyloid deposits that some have associated with Alzheimers disease. Both groups had kidney damage, brain damage, greater uptake of aluminum into the brain and beta amyloid deposits that some have associated with Alzheimers disease.

53 Weight of Evidence on brain studies

54 Positive Findings There have now been over 100 animal experiments which show that fluoride can damage the brain There have now been over 100 animal experiments which show that fluoride can damage the brain There have been 24 studies that show a lowering of IQ at levels at - or close to - exposures in fluoridated communities There have been 24 studies that show a lowering of IQ at levels at - or close to - exposures in fluoridated communities There have been three studies that show fetal brain damage in fluorosis areas in China There have been three studies that show fetal brain damage in fluorosis areas in China There have been two studies from China that show behavioral differences associated with fluoride exposure– one for children and one for industrial workers There have been two studies from China that show behavioral differences associated with fluoride exposure– one for children and one for industrial workers

55 Rocha-Amador et al. (2009) Study from Mexico found an association between visual-spatial learning and fluoride exposure (Neurotoxicology ) Study from Mexico found an association between visual-spatial learning and fluoride exposure (Neurotoxicology )

56 Negative Findings ONE small study in NZ did not find a lowering of IQ associated with living in a fluoridated community (Shannon et al., 1986) One small study did not find behavioral differences associated with severity of dental fluorosis (Morgan et al., 1998)

57 Two preposterous notions What parent in their right mind would put their childrens teeth above their brains? What parent in their right mind would put their childrens teeth above their brains? What government would support a program aimed at lowering tooth decay - by at most 0.6 of one tooth surface – if it lowered the IQ of the population by even a small amount? What government would support a program aimed at lowering tooth decay - by at most 0.6 of one tooth surface – if it lowered the IQ of the population by even a small amount?

58 Other health concerns (see chapters in The Case Against Fluoride )

59 Key Health Studies have NOT been done in most fluoridating countries NO INVESTIGATION of a possible relationship between consumption of fluoridated water and lowered IQ in children (except one small study in NZ), lowered IQ in children (except one small study in NZ), Behavioral changes in children (attention deficit etc) Behavioral changes in children (attention deficit etc) arthritic symptoms in adults, arthritic symptoms in adults, hypo-thyroidism (underactive thyroid), hypo-thyroidism (underactive thyroid), Increased bone fractures in children, Increased bone fractures in children, Melatonin levels in children Melatonin levels in children Earlier onset of puberty, Earlier onset of puberty, Alzheimers disease in adults, and Alzheimers disease in adults, and

60 Key Health Studies have NOT been done in most fluoridating countries There has been NO FORMAL INVESTIGATION of the many anecdotal reports and case studies (and one clinical trial) that some individuals are highly sensitive to fluoride (e.g. gastrointestinal, neurological and skin conditions) There has been NO FORMAL INVESTIGATION of the many anecdotal reports and case studies (and one clinical trial) that some individuals are highly sensitive to fluoride (e.g. gastrointestinal, neurological and skin conditions) See Fluoride Fatigue (Spittle, 2008)

61 If you dont look, you dont find! The absence of studies, does not mean the absence of harm The absence of studies, does not mean the absence of harm Dr. Peter Cooney, the Chief Dental Officer of Canada, told an audience in Dryden, Ontario (April 1, 2008), Dr. Peter Cooney, the Chief Dental Officer of Canada, told an audience in Dryden, Ontario (April 1, 2008), I walked down your High Street today, and I didnt see anyone growing horns, and you have been fluoridated for 40 years! I walked down your High Street today, and I didnt see anyone growing horns, and you have been fluoridated for 40 years!

62 WHY? The only rational explanation for so much irrational (or irresponsible) behavior on the part of health agencies that continue to promote water fluoridation is… The only rational explanation for so much irrational (or irresponsible) behavior on the part of health agencies that continue to promote water fluoridation is… It has become more important to protect this practice than it is to protect the health of the people they represent… It has become more important to protect this practice than it is to protect the health of the people they represent… Why should that be? Why should that be?


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