1. The Case Against Water Fluoridation The Case Against Water Fluoridation Paul Connett, PhD Director, Fluoride Action Network FluorideALERT.org Hartford, CT, June 26, 2013

2. Introduction I have spent 17 years researching the fluoridation issue, first as a professor of chemistry specializing in environmental chemistry and toxicology, and now as director of the Fluoride Action Network. I have spent 17 years researching the fluoridation issue, first as a professor of chemistry specializing in environmental chemistry and toxicology, and now as director of the Fluoride Action Network.

3. Outline of my presentation Outline of my presentation 1. Why fluoridation should not have started. 2. Key moments since 1990 that should have ended fluoridation. 3. The very poor science underpinning the case for fluoridation. 4. Better alternatives to fight tooth decay

4. Part 1. Why Fluoridation should never have started

5. 1. We should never use the public water supply to deliver medicine. WHY? 1. We should never use the public water supply to deliver medicine. WHY? 2. You can’t control who gets the medicine. 2. You can’t control who gets the medicine. 3. You can’t control the DOSE people get. 3. You can’t control the DOSE people get. 4. It violates the individual’s right to informed consent to medicine.

6. 5) Fluoride is NOT a nutrient. There is not a single process inside the body that needs fluoride to function properly, however There is not a single process inside the body that needs fluoride to function properly, however 6) Fluoride is a known toxic substance that interferes with many fundamental biochemical functions In other words: it doesn’t do any good to swallow fluoride and it has the potential to cause harm

7. 7) 1 ppm fluoride (1 mg/liter) is NOT small. It is 250 times the level in mothers milk in a non-fluoridated community (0.004 ppm, NRC, 2006, p. 40) 8) A bottle-fed baby in a fluoridated community is getting 250 times the fluoride dose that nature intended. Who knows more about what the baby needs – nature or a bunch of dentists from Chicago (ADA)?

8. 9) The fluoridating chemicals used are not the pharmaceutical grade chemicals used in dental products, but are arsenic- contaminated industrial waste products obtained from the fertilizer industry. 10) The dental lobby has controlled this debate for far too long. There are more tissues in the body than teeth. It is time to get dentistry out of the public water supply and back into the dental office.

9. The vast majority of countries do NOT fluoridate their water

10. 97% of Western European population now drinks Non-Fluoridated Water Austria Belgium Denmark Finland France Germany Greece Iceland Italy Luxembourg Netherlands Northern Ireland Norway Scotland Sweden Switzerland

11. Austria* Belgium Denmark Finland France* Germany* Greece Iceland Italy Luxembourg Netherlands Northern Ireland Norway Scotland Sweden Switzerland* *Some fluoridate their salt 97% of Western European population now drinks Non-Fluoridated Water

12. According to WHO data tooth decay in 12-year-olds is coming down as fast in F as NF countries

13. SOURCE: World Health Organization. (Data online)

14. Supporting documents: Neurath, 2005* Cheng, 2007*

15. Part 2 Some of the events since 1990 which should have forced an end to water fluoridation Some of the events since 1990 which should have forced an end to water fluoridation (An ugly fact can destroy a beautiful theory)

16. Ugly Fact # 1 A series of studies since 1980 indicate that the notion that swallowing fluoride reduces tooth decay is very weak A series of studies since 1980 indicate that the notion that swallowing fluoride reduces tooth decay is very weak

17. Between 1980 and 1990 A number of articles began to appear in major journals indicating that there was very little difference in tooth decay between fluoridated and non-fluoridated communities A number of articles began to appear in major journals indicating that there was very little difference in tooth decay between fluoridated and non-fluoridated communities

18. Leverett in Science, 1982 Diesendorf in Nature, 1986* Gray, 1987 Colquhoun* This prompted the NIDR to conduct the largest survey of tooth decay ever carried out in the US.

19. NIDR survey The teeth of over 39,000 children in 84 communities were examined. The teeth of over 39,000 children in 84 communities were examined.

20. Yiamouyiannis Using the FOIA Dr. John Yiamouyiannis obtained the DMFT (= decayed, missing and filled permanent TEETH), data for children aged 5-17 Using the FOIA Dr. John Yiamouyiannis obtained the DMFT (= decayed, missing and filled permanent TEETH), data for children aged 5-17 His plot of the data showed no statistical difference between children from N-F and F communities His plot of the data showed no statistical difference between children from N-F and F communities

21. NIDR - Yiamouyiannis, 1990

22. NIDR - Brunelle and Carlos (1990) Brunelle and Carlos increased sensitivity by factor of five (approximately) by comparing DMFS (= decayed, missing and filled permanent SURFACES - 5 surfaces to most teeth, 4 in the cutting teeth) Brunelle and Carlos increased sensitivity by factor of five (approximately) by comparing DMFS (= decayed, missing and filled permanent SURFACES - 5 surfaces to most teeth, 4 in the cutting teeth)

23. They measured tooth decay as Decayed Missing and Filled Tooth Surfaces (DMFS). There are 4 or 5 surfaces per tooth.

24. Decayed Missing and Filled surfaces (DMFS) There are 4 surfaces to the top six and bottom six cutting teeth and 5 surfaces on all the other teeth. 128 tooth surfaces in all.

25. Brunelle and Carlos (1990) measured tooth decay as Decayed Missing and Filled Tooth Surfaces (DMFS) See Table 6 in their paper. 2.8 DMFS F

26. The largest US survey of tooth decay 3.4 DMFS NF 2.8 DMFS F

27. Brunelle and Carlos, 1990 Average difference (for 5 - 17 year olds) in DMFS = 0.6 tooth surfaces (5 surfaces to a tooth) 3.4 DMFS NF 2.8 DMFS F

28. Not only was this saving very small (0.6 of one tooth surface) but it was not even shown to be statistically significant!

29. Supporting documents: Yiamouyiannis, 1990* Brunelle and Carlos, 1990* (see Table 6)

30. Warren et al. (2009) (the “Iowa” study)

31. 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. They found no relation between tooth decay and amount of fluoride ingested. They found no relation between tooth decay and amount of fluoride ingested.

32. “These findings suggest that achieving a caries-free status may have relatively little to do with fluoride intake…” may have relatively little to do with fluoride intake…” Supporting document Warren et al., 2009* Supporting document Warren et al., 2009*

33. Ugly Fact # 2 CDC (1999) Fluoride’s predominant benefit is TOPICAL not systemic

34. CDC, MMWR, 48(41); 933-940, Oct 22, 1999* “Fluoride’s caries-preventive properties initially were attributed to changes in enamel during tooth development... However, laboratory and epidemiologic research suggest that fluoride prevents dental caries predominantly after eruption of the tooth into the mouth, and its actions primarily are topical…” “Fluoride’s caries-preventive properties initially were attributed to changes in enamel during tooth development... However, laboratory and epidemiologic research suggest that fluoride prevents dental caries predominantly after eruption of the tooth into the mouth, and its actions primarily are topical…”

35. If fluoride works on the outside of the tooth not from inside the body Why swallow fluoride and expose every tissue of the body to a toxic substance, when you can brush it on your teeth and spit it out? And why put it in the drinking water and force it on people who don’t want it?

36. Ugly Fact # 3 The U.S. National Research Council published the results of its 3-year review of fluoride’s toxicity The U.S. National Research Council published the results of its 3-year review of fluoride’s toxicity (NRC, 2006)

37. National Research Council (2006)

38. NRC found that fluoride could cause many harmful effects in the body in countries with high natural levels of fluoride in their water.

39. Independent scientists have argued that there is NO ADEQUATE MARGIN OF SAFETY to protect everyone drinking fluoridated water from some of these harmful effects.

40. An exposure analysis in Chapter 2 of the NRC report shows that subsets of population drinking F -water (including bottle-fed infants) are exceeding EPA’s safe reference dose (0.06 mg/kg/day) See supporting document*

41. John Doull (chairman, NRC, 2006 Review) “What the committee found is that we’ve gone with the status quo regarding fluoride for many years—for too long really—and now we need to take a fresh look... In the scientific community people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the top 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on.” “What the committee found is that we’ve gone with the status quo regarding fluoride for many years—for too long really—and now we need to take a fresh look... In the scientific community people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the top 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on.” Scientific American, Jan 2008. Scientific American, Jan 2008.

42. Ugly Fact # 4 Fluoridation may actually be killing a few young boys each year Bassin et al., 2006

43. Osteosarcoma Bassin found that young boys exposed to fluoridated water in their 6th,7th or 8th years, had a 5-7 fold increase in developing osteosarcoma by the age of 20, compared to non-exposed boys. Bassin found that young boys exposed to fluoridated water in their 6th,7th or 8th years, had a 5-7 fold increase in developing osteosarcoma by the age of 20, compared to non-exposed boys. Her 2006 study has never been refuted. Her 2006 study has never been refuted. The study promised by Douglass (Kim et al., 2011) failed to do so. The study promised by Douglass (Kim et al., 2011) failed to do so.

44. Supporting documents: Bassin et al., 2006* Kim et al., 2011*

45. Ugly Fact # 5 CDC (2010) CDC (2010) Confirms that American kids are being hugely over- exposed to fluoride

46. Dental Fluorosis Early promoters thought that at 1 ppm F they could reduce tooth decay and limit dental fluorosis to 10% of children in its very mild form. Early promoters thought that at 1 ppm F they could reduce tooth decay and limit dental fluorosis to 10% of children in its very mild form.

47. Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004 November 2010: CDC update on fluorosis by Beltrán-Aguilar et al. November 2010: CDC update on fluorosis by Beltrán-Aguilar et al. See supporting document* See supporting document*

48. CDC, 2010

49. 41%

50. Very Mild Dental Fluorosis Impacts up to 25% of tooth surface

51. CDC, 2010 41%

52. Mild Dental Fluorosis Impacts up to 50% of tooth surface

53. CDC, 2010 41%

54. Moderate- Severe Dental Fluorosis Impacts 100% of tooth surface

55. See also CDC (2005) An earlier report from the CDC had found that Black and Hispanic Americans had higher rates of dental fluorosis (especially the more serious categories) than White Americans. See supporting document CDC, 2005, Table 23.* An earlier report from the CDC had found that Black and Hispanic Americans had higher rates of dental fluorosis (especially the more serious categories) than White Americans. See supporting document CDC, 2005, Table 23.*

56. A KEY QUESTION When fluoride is damaging the baby’s growing tooth cells (causing dental fluorosis) what is it doing to its other developing tissues? When fluoride is damaging the baby’s growing tooth cells (causing dental fluorosis) what is it doing to its other developing tissues?

57. Ugly Fact # 6 There is extensive evidence that fluoride damages the brains of animals and humans

58. Over 40 animal studies show that prolonged exposure to fluoride can damage the brain. Over 40 animal studies show that prolonged exposure to fluoride can damage the brain. 19 animal studies report that mice or rats ingesting fluoride have an impaired capacity to learn and remember. 12 studies (7 human, 5 animal) link fluoride with neurobehavioral deficits 3 human studies link fluoride exposure with impaired fetal brain development 37 out of 43 published studies show that fluoride lowers IQ

59. To access any of these brain studies To access any of these brain studies 1) Go to FluorideALERT.org 2) Click on RESEARCHERS 3) Click on Health Data Base 4) Click on Brain Effects Or go direct to FluorideALERT.org/issues/health /brain

60. Varner et al. (1998) Gave rodents 1 ppm fluoride in their water for one year. The exposed rodents had Gave rodents 1 ppm fluoride in their water for one year. The exposed rodents had kidney damage, kidney damage, brain damage, brain damage, A greater uptake of aluminum into the brain and A greater uptake of aluminum into the brain and beta amyloid deposits which are characteristic of Alzheimer’s disease. beta amyloid deposits which are characteristic of Alzheimer’s disease.

61. Xiang et al. (2003 a,b)  Compared children in two villages ( <0.7 ppm versus 2.5 - 4.5 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).  Found a drop of 5-10 IQ points across the whole age range  The whole IQ curve shifted for both males and females

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

63.  Xiang estimated that the threshold for lowering IQ was at 1.9 ppm fluoride in the water  This offers no adequate margin of safety to protect all American children from 1) the large range of doses and 2) large range of sensitivity expected in a large population

64. No protection for range of exposure A child drinking TWO liters of water at 1 ppm would get a higher DOSE (2 mg/day) than A child drinking TWO liters of water at 1 ppm would get a higher DOSE (2 mg/day) than one of the Chinese children drinking ONE liter of water at 1.9 ppm (1.9 mg/day) one of the Chinese children drinking ONE liter of water at 1.9 ppm (1.9 mg/day)

65. To protect for the full range of sensitivity in a large population To protect the most sensitive person in a large population To protect the most sensitive person in a large population We normally divide the DOSE that causes harm by TEN (intra-species variation). We normally divide the DOSE that causes harm by TEN (intra-species variation). What dose were the Chinese children getting at 1.9 ppm? Estimating a RANGE of dose: What dose were the Chinese children getting at 1.9 ppm? Estimating a RANGE of dose: If they drank 0.5 liters/day = 1 mg/day If they drank 0.5 liters/day = 1 mg/day If they drank 1.0 liter/day = 1.9 mg/day If they drank 1.0 liter/day = 1.9 mg/day If they drank 2.0 liters/day = 3.8 mg/day If they drank 2.0 liters/day = 3.8 mg/day

66. To protect for the full range of sensitivity in a large population Chinese children Chinese children Range of dose = 1- 4 mg/day Range of dose = 1- 4 mg/day To protect all of American children divide by 10 To protect all of American children divide by 10 Safe dose would range from Safe dose would range from 0.1 to 0.4 mg/day. Even if we use the higher number this dose would be exceeded by children drinking 0.4 liter (400 ml) of water at 1 ppm 0.1 to 0.4 mg/day. Even if we use the higher number this dose would be exceeded by children drinking 0.4 liter (400 ml) of water at 1 ppm

67. Supporting documents: Xiang et al., 2003a* Xiang et al., 2003b*

68. 11 of the 37 IQ studies found an association between lowered IQ and fluoride levels in the urine

69. Ding et al. 2011* (J. Hazardous Materials) “Mean value of fluoride in drinking water was 1.31 ±1.05mg/L (range 0.24–2.84).” “Mean value of fluoride in drinking water was 1.31 ±1.05mg/L (range 0.24–2.84).” “ Conclusions “ Conclusions Overall, our study suggested that low levels of fluoride exposure in drinking water had negative effects on children’s intelligence... Overall, our study suggested that low levels of fluoride exposure in drinking water had negative effects on children’s intelligence... The results also confirmed the dose–response relationships between urine fluoride concentrations and IQ scores…” The results also confirmed the dose–response relationships between urine fluoride concentrations and IQ scores…”

70. Xiang finds an association between lowered IQ and PLASMA fluoride levels Xiang et al., 2011*

71. Xiang et al. 2010 Xiang et al., 2012

72. Ding et al. 2011 Xiang (2012). Children’s IQ versus Levels of fluoride in the serum (children from both villages combined, personal communication with Paul Connett). The higher the levels of fluoride in the plasma the lower the levels of IQ.

73. Ugly Fact # 7 Choi et al. (2012)* The Harvard review of IQ studies

74. Harvard meta-analysis of 27 studies Choi et al (the team included Philippe Grandjean) did a meta-analysis of 27 studies comparing IQ in “high” versus “low” fluoride villages. Choi et al (the team included Philippe Grandjean) did a meta-analysis of 27 studies comparing IQ in “high” versus “low” fluoride villages. The study was published in Environmental Health Perspectives (published by NIEHS) The study was published in Environmental Health Perspectives (published by NIEHS) They acknowledge that there were weaknesses in many of the studies, however… They acknowledge that there were weaknesses in many of the studies, however…

75. the results were remarkably consistent the results were remarkably consistent In 26 of the 27 studies there was lower average IQ in the “high” versus low-fluoride villages. In 26 of the 27 studies there was lower average IQ in the “high” versus low-fluoride villages. Average IQ lowering was about 7 IQ points. Average IQ lowering was about 7 IQ points.

76. Choi et al. 2012 The Harvard scientists concluded that further investigation of fluoride’s lowering of IQ should be a “high research priority” The Harvard scientists concluded that further investigation of fluoride’s lowering of IQ should be a “high research priority”

77. Promoters claim that the fluoride levels in the “High Fluoride” villages were so high that they are not relevant to fluoridation programs? THIS IS NOT TRUE. In 8 of the studies the “high fluoride village” had concentrations less than 3 ppm THIS IS NOT TRUE. In 8 of the studies the “high fluoride village” had concentrations less than 3 ppm In one “high fluoride village” the concentration was only 0.88 ppm In one “high fluoride village” the concentration was only 0.88 ppm And one study (Xiang et al., 2003 a and b) found a threshold at 1.9 ppm. And one study (Xiang et al., 2003 a and b) found a threshold at 1.9 ppm. These studies offer no adequate margin of safety to protect all children drinking uncontrolled amounts of fluoridated water These studies offer no adequate margin of safety to protect all children drinking uncontrolled amounts of fluoridated water

78. Dr. Philippe Grandjean “Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain. The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.” (Harvard Press Release) “Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain. The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.” (Harvard Press Release)

79. IQ and population 100 Number of Kids With a Specific IQ IQ

80. IQ and population Very Bright Mentally handicapped 100 Number of Kids With a Specific IQ IQ

81. IQ and population 95 100 Number of Kids With a Specific IQ IQ

82. IQ and population Very Bright Mentally handicapped 95 100 Number of Kids With a Specific IQ IQ

83. Other health concerns 1) First symptoms of fluoride’s poisoning of the bone are identical to arthritis. No investigation in any fluoridated country. 2) Li et al (2001).* Doubling of hip fracture at 1.5 ppm? 3) Fluoride used to lower thyroid function in hyperthyroid patients Galletti and Joyet (1958)* 4) Bachinskii et al (1985) Thyroid function lowered at 2.3 ppm. 5) Fluoride accumulates in human pineal gland. Lowers melatonin levels in animals and shortens time to puberty (Luke 1997, 2001*). No attempt to reproduce these findings in any fluoridated country.

84. Supporting documents: Li et al, 2001* Luke, 2001* Galletti and Joyet, 1958*

85. Summary 1) Most countries don’t fluoridate their water but there is no difference in tooth decay in 12-year- olds between those that do and those that don’t (WHO figures) 1) Most countries don’t fluoridate their water but there is no difference in tooth decay in 12-year- olds between those that do and those that don’t (WHO figures) 2) Fluoridation is a clumsy form of medicine (you can’t control the dose or who gets it). 2) Fluoridation is a clumsy form of medicine (you can’t control the dose or who gets it). 3) It violates the individual’s right to informed consent to medicine 3) It violates the individual’s right to informed consent to medicine

86. Summary 4) The evidence that swallowing fluoride actually reduces tooth decay is very weak. Warren et al (2009) could find no relationship between the amount of fluoride swallowed by children and tooth decay. 4) The evidence that swallowing fluoride actually reduces tooth decay is very weak. Warren et al (2009) could find no relationship between the amount of fluoride swallowed by children and tooth decay. 5) Even major promoters of fluoridation (e.g. CDC) admit that fluoride’s predominant action is TOPICAL not SYSTEMIC, i.e. it works on the outside of the tooth not from inside the body 5) Even major promoters of fluoridation (e.g. CDC) admit that fluoride’s predominant action is TOPICAL not SYSTEMIC, i.e. it works on the outside of the tooth not from inside the body

87. Summary 6) For those who want fluoride fluoridated toothpaste is readily available. There is no need to swallow it and there is no need to force it on people that don’t want it. 6) For those who want fluoride fluoridated toothpaste is readily available. There is no need to swallow it and there is no need to force it on people that don’t want it. 7) American kids are being over-exposed to fluoride. 41% of American children aged 12-15 have some form of dental fluorosis (CDC, 2010). 7) American kids are being over-exposed to fluoride. 41% of American children aged 12-15 have some form of dental fluorosis (CDC, 2010). 8) It is reckless to assume – without very careful study – that while fluoride is damaging the growing tooth cells it is not harming other tissues in the child’s developing body. 8) It is reckless to assume – without very careful study – that while fluoride is damaging the growing tooth cells it is not harming other tissues in the child’s developing body.

88. Summary 9) Nature has given us a very good idea about how much fluoride the baby should get. The level of fluoride in mothers milk is EXTREMELY LOW : 0.004 ppm (NRC, 2006, p.40) 9) Nature has given us a very good idea about how much fluoride the baby should get. The level of fluoride in mothers milk is EXTREMELY LOW : 0.004 ppm (NRC, 2006, p.40) 10) It is reckless to give a bottle-fed baby about 200 times the level of fluoride that nature intended. 10) It is reckless to give a bottle-fed baby about 200 times the level of fluoride that nature intended. 11) The evidence that fluoride can damage the developing brain is extensive 11) The evidence that fluoride can damage the developing brain is extensive

89. Summary 9) Nature has given us a very good idea about how much fluoride the baby should get. The level of fluoride in mothers milk is EXTREMELY LOW : 0.004 ppm (NRC, 2006, p.40) 9) Nature has given us a very good idea about how much fluoride the baby should get. The level of fluoride in mothers milk is EXTREMELY LOW : 0.004 ppm (NRC, 2006, p.40) 10) It is reckless to give a bottle-fed baby about 200 times the level of fluoride that nature intended. 10) It is reckless to give a bottle-fed baby about 200 times the level of fluoride that nature intended. 11) The evidence that fluoride can damage the developing brain is extensive. 11) The evidence that fluoride can damage the developing brain is extensive.

90. Summary 12) Studies from China indicate that lower IQs are associated with a) levels of fluoride in water b) level of fluoride in their urine and c) levels of fluoride in their plasma 12) Studies from China indicate that lower IQs are associated with a) levels of fluoride in water b) level of fluoride in their urine and c) levels of fluoride in their plasma 13) One estimate of the threshold for this effcct (1.9 ppm) offers no adequate margin of safety to protect all our children from either the range of doses or the range of sensitivity expected in a large population. 13) One estimate of the threshold for this effcct (1.9 ppm) offers no adequate margin of safety to protect all our children from either the range of doses or the range of sensitivity expected in a large population. 14) A small shift in IQ can have devastating consequences at the population level. 14) A small shift in IQ can have devastating consequences at the population level.

91. Summary 15) There is no question that given a sufficient dose fluoride can harm many human tissues (brain, bone, teeth, thyroid, kidney etc.) (NRC, 2006). 15) There is no question that given a sufficient dose fluoride can harm many human tissues (brain, bone, teeth, thyroid, kidney etc.) (NRC, 2006). 16) There is no adequate margin of safety to protect all our citizens drinking uncontrolled amounts of fluoridated water and getting fluoride from many other sources. 16) There is no adequate margin of safety to protect all our citizens drinking uncontrolled amounts of fluoridated water and getting fluoride from many other sources. 17) It is reckless to expose our population in this way, when alternatives are readily available. 17) It is reckless to expose our population in this way, when alternatives are readily available.

92. Summary 18) It is arrogant in the extreme for the dental lobby (with little training in toxicology) to be forcing this practice on individuals who do not want it (especially those of low-income who cannot afford alternative water supplies). 18) It is arrogant in the extreme for the dental lobby (with little training in toxicology) to be forcing this practice on individuals who do not want it (especially those of low-income who cannot afford alternative water supplies). 19) It is utterly irresponsible that this practice has gone on for over 65 years a) without approval of the FDA, b) without a single randomized clinical trial to demonstrate effectiveness and c) with so many crucial health questions unanswered. 19) It is utterly irresponsible that this practice has gone on for over 65 years a) without approval of the FDA, b) without a single randomized clinical trial to demonstrate effectiveness and c) with so many crucial health questions unanswered.

93. Summary 20) It is bad enough when this decision is made via local referendum but it is even worse when Connecticut forces this practice on the whole state. 20) It is bad enough when this decision is made via local referendum but it is even worse when Connecticut forces this practice on the whole state. I applaud Senator Markley for taking this initiative and hope he will succeed in lifting this state mandate and go on to make CT the first state to outlaw this practice completely. I applaud Senator Markley for taking this initiative and hope he will succeed in lifting this state mandate and go on to make CT the first state to outlaw this practice completely.

94. 1. Nov 2012, Queensland lifted mandatory requirement 2. April 2013, Israel MOH announces lifting of mandatory requirement in one year

95. Part 3 Science supporting fluoridation has been pitiful

96. Basic science has not been done. There have been Basic science has not been done. There have been 1) No randomized clinical trials to demonstrate either effectiveness or safety 1) No randomized clinical trials to demonstrate either effectiveness or safety 2) No systematic monitoring of fluoride in urine, blood or bones 2) No systematic monitoring of fluoride in urine, blood or bones 3) No investigation of a possible relationship between fluoridation and 1) Arthritis; 2) Hypo- thyroidism; 3) Alzheimer’s disease; 4) lowered IQ; 5) behavioral problems in children; 5) earlier onset of puberty and 6) bone fractures in children 3) No investigation of a possible relationship between fluoridation and 1) Arthritis; 2) Hypo- thyroidism; 3) Alzheimer’s disease; 4) lowered IQ; 5) behavioral problems in children; 5) earlier onset of puberty and 6) bone fractures in children The science supporting fluoridation has been pitiful

97. 5) No attempt to reproduce studies of harm found in countries with high natural levels of fluoride 5) No attempt to reproduce studies of harm found in countries with high natural levels of fluoride 6) No attempt to use the severity of dental fluorosis as a biomarker of exposure to fluoride in children to investigate many childhood problems. 6) No attempt to use the severity of dental fluorosis as a biomarker of exposure to fluoride in children to investigate many childhood problems. 7) If you don’t look you don’t find! 7) If you don’t look you don’t find! 8) But the absence of studies is not the same as absence of harm! 8) But the absence of studies is not the same as absence of harm!

98. Dr. Peter Cooney 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 didn’t see anyone growing horns, and you have been fluoridated for 40 years!” “I walked down your High Street today, and I didn’t see anyone growing horns, and you have been fluoridated for 40 years!”

99. Supporting documents: Professor Trevor Sheldon’s letter to the House of Lords on York Review* Also John Doull*

100. Fluoridation is a “belief” system Fluoridation has never been a “science-based” practice (certainly not good science). Fluoridation has never been a “science-based” practice (certainly not good science). The tactics of promoters reveal this: a) they use “endorsements” (i.e. authority) in place of primary science The tactics of promoters reveal this: a) they use “endorsements” (i.e. authority) in place of primary science and b) they attack the credibility of opponents with many personal attacks. and b) they attack the credibility of opponents with many personal attacks. Such tactics would not be necessary if the primary science was on their side. Such tactics would not be necessary if the primary science was on their side.

101. Endorsements 1) The first critical endorsement came in 1950 from the US Public Health Service. This was made before any trial had been completed and before any significant health studies had been published. 1) The first critical endorsement came in 1950 from the US Public Health Service. This was made before any trial had been completed and before any significant health studies had been published. 2) Other endorsements quickly followed, ADA, APHA, etc. 2) Other endorsements quickly followed, ADA, APHA, etc. 3) These endorsements are very effective with the general public and busy legislators, but are less impressive to independent researchers. 3) These endorsements are very effective with the general public and busy legislators, but are less impressive to independent researchers.

102. Some examples of unprofessional tactics, poor science and biased reviews 1) ADA White paper (1979) 1) ADA White paper (1979) 2) CDC (1999) 2) CDC (1999) 3) Queensland Health (2007) promotion 3) Queensland Health (2007) promotion 4) WHO (2004) used biased panel 4) WHO (2004) used biased panel 5) Health Canada (2007) expert panel biased 5) Health Canada (2007) expert panel biased 6) NHMRC (Australia) 2007 review very poor 6) NHMRC (Australia) 2007 review very poor

103. ADA White Paper (1979) “Individual dentists must be convinced that they need not be familiar with scientific reports and field investigations on fluoridation to be effective participants and that non- participation is overt neglect of professional responsibility.”

104. CDC (1999)* In October 1999, the CDC claimed that fluoridation was “one of the great public health achievements of the 20 th century.” But this statement (and all statements on fluoridation from the CDC) comes from the Oral Health Division – consisting of about 30 – largely dentally trained personnel – whose mission is to promote fluoridation.

105. CDC (1999)* This claim was based on a report written by two people. One a dentist who had not published anything on fluoridation before and the other an economist. This report was not externally peer-reviewed. It was six years out of date on the health studies cited for safety (see marked passage*). The evidence cited to demonstrate effectiveness was trivial and embarrassing (see Figure 1).

106. CDC MMWR, October 22, 1999

107. SOURCE: World Health Organization. (Data online)

108. Queensland Health’s promotion of “mandatory” statewide fluoridation) (2007)

109. Queenslanders were told Fluoridated Townsville has 65% less tooth decay than Non-Fluoridated Brisbane

110. Qld Health “results - 65 % less tooth decay” “ In Townsville, water supplies have been fluoridated since 1964, resulting in 65% less tooth decay in children than those in Brisbane” “ fluoride, which is proven to be safe and effective ” Qld Health newspaper ads Dec 2007

111. How did they get the 65% less decay ?

112. 0.26 – 0.09 = 0.17 DMFS 0.17/0.26 x 100 = 65% fewer tooth surfaces decayed An absolute saving of 0.17 of one tooth surface in 7 year olds!

113. This was an atrocious example of “cherry picking” the data

115. “ Teeth exposed to fluoridated water” Qld Health 2007

116. “ Teeth exposed to fluoridated water” Qld Health 2007 “ Teeth without exposure to fluoridated water” Qld Health 2007

117. Does this look like a difference in 0.17 of one tooth surface? “ Teeth exposed to fluoridated water” Qld Health 2007 “ Teeth without exposure to fluoridated water” Qld Health 2007

118. Does this look like a difference in 0.17 of one tooth surface? Or is this fraudulent promotion? “ Teeth exposed to fluoridated water” Qld Health 2007 “ Teeth without exposure to fluoridated water” Qld Health 2007

119. WHO (2004) Fluoride M A Lennon, H Whelton, D O'Mullane, J Ekstrand. http://www.who.int/water_sanitation_health/dwq/nutfluori de.pdf http://www.who.int/water_sanitation_health/dwq/nutfluori de.pdf MA Lennon, is chairman of the British Fluoridation Society H. Whelton and D. O’Mullane are both dental researchers from the University of Cork and are both pro- fluoridation (Ireland has mandatory fluoridation)

120. Health Canada’s expert panel (2007) In 2007 Health Canada selected a panel of six experts to review the literature of fluoridation’s safety and effectiveness Of the 6 panelists chosen FOUR were dentists well-known for their promotion of fluoridation. The review was a self-fulfilling prophecy.

121. The NHMRC (Australia) 2007 review The panel dismissed the relevance of the massive NRC (2006) review (500 pages, 1100 references) in one sentence. The panel dismissed the relevance of the massive NRC (2006) review (500 pages, 1100 references) in one sentence. “The NAS report refers to the adverse health effects from fluoride at 2-4 mg/L, the reader is alerted to the fact that fluoridation of Australia’s drinking water occurs in the range of 0.6 to 1.1 mg/L.” (p.16) “The NAS report refers to the adverse health effects from fluoride at 2-4 mg/L, the reader is alerted to the fact that fluoridation of Australia’s drinking water occurs in the range of 0.6 to 1.1 mg/L.” (p.16)

122. Part 4 Better Alternatives

123. Better Alternatives If you want fluoride use fluoridated toothpaste (96% toothpaste sold in US is fluoridated) Better still use XYLITOL toothpaste. Xylitol toothpaste has been used for over 30 years in Finland Give Xylitol mints (not chewing gum) to kids in school (e.g. Wichita, Kansas). Give free toothbrushes and free toothpaste to low-income families (e.g. Scotland)

124. Better Alternatives Most of tooth decay is concentrated in low- income families Most of tooth decay is concentrated in low- income families Most distressing tooth decay is baby bottle tooth decay Most distressing tooth decay is baby bottle tooth decay Low-income families need better diet and better dental education Low-income families need better diet and better dental education LESS SUGAR! MORE BRUSHING! LESS SUGAR! MORE BRUSHING! Less sugar means less tooth decay and less OBESITY…less diabetes, fewer heart attacks (education = a good investment!) Less sugar means less tooth decay and less OBESITY…less diabetes, fewer heart attacks (education = a good investment!)

125. Modern studies show that tooth decay does NOT go up when fluoridation stopped

126. Recent studies indicate that Dental Caries has not gone up after Fluoridation Stopped 1. Former East Germany Kunzel, W. & Fischer, T. (1997). Rise and fall of caries prevalence in German towns with different F concentrations in drinking water. Caries Res 31(3): 166-73 Caries Res 31(3): 166-73 2. Cuba Kunzel, W. & Fischer, T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Res 34(1): 20-5. 3. Canada Maupome, G. et. al (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dent Oral Epidemiol 29(1): 37- 47. 4. Finland Seppa, L. et. al (2000). Caries trends 1992-98 in two low-fluoride Finnish towns formerly with and without fluoride. Caries Res 34(6): 462-8.

127. EXTRA SLIDES

128. More on IQ studies RESOURCES

129. If you have several weeks to spend

130. National Research Council (2006)

131. If you have several days to spend

132. Book published by Chelsea Green October, 2010 Can be ordered on Amazon.com Contains 80 pages of references to the Scientific literature

133. If you have only half an hour to spend

134. Please watch the 29 minute DVD “Professional Perspectives on Fluoridation” Can be viewed ONLINE at www.FluorideALERT.org

135. If you have only 20 minutes to spend

136. Please watch the 20 minute DVD “TEN FACTS on FLUORIDE” PLUS BOOKLET at www.FluorideALERT.org

137. Fluoridation violates the Precautionary Principle If PP doesn’t apply to fluoridation then you might as well get rid of it! If PP doesn’t apply to fluoridation then you might as well get rid of it! See Chapter 21 in The Case Against Fluoride See Chapter 21 in The Case Against Fluoride

138. Precautionary Principle: Criteria for application. 1. Is there published evidence of harm? YES – 36 IQ studies YES – 36 IQ studies 2. Is this effect serious? YES YES 3. Is the benefit being pursued very significant? NO. A fraction of one permanent tooth surface saved ? NO. A fraction of one permanent tooth surface saved ? 4. Are there alternative cost-effective solutions available? YES. Fluoridated toothpaste. Xylitol YES. Fluoridated toothpaste. Xylitol