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Flouride and Portland kids: news and analysis

Portland water has never been fluoridated, so most of the public concern about fluoride ingestion for kids in our city is imported from other hometowns (though we've had some past discussions about fluoride, here, here and here). I've done a little research on the topic in the past few years, helped by my dentist (an urbanMama reader who encourages even the most militant green among us to use fluoridated toothpaste because it's helpful when applied topically) and a great book, The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Kept It There. (phew.) So when I heard the news on NPR last week that the U.S. Department of Health and Human Services and the Environmental Protection Agency were working together to lower the maximum recommended level of fluoride in water -- to 0.7 mg per liter from its current maximum, 1.2 mg/L -- my first thought was that it wouldn't affect us, much.

Then I started reading through the articles in greater detail, compared with the information in the book I have now on my lap, and found some interesting leaps to conclusion and some great shifts from unexpected sources. For instance, the Centers for Disease Control and Prevention has long been the leading proponent of municipal water fluoridation, arguing that the benefit of preventing tooth decay overrode the risk of toxic effects -- and according to all government sources to date, the biggest risk is fluoridosis, or discoloration, streaks and spots on your tooth enamel. The NPR story begins: "Fluoride is a finicky friend to teeth. Too little of it, and you get cavities. Too much, and it starts to eat away and discolor the enamel of your pearly whites, " and quotes a dentist with the American Association of Pediatric Dentistry as saying, "There's a cosmetic risk, not a health risk."

There are a number of problems with these statements.

To begin with, according to studies cited by Case Against Fluoride, the evidence of reduction in tooth decay is very, very light. Countries in which fluoridation has stopped haven't seen a rise in tooth decay; all the studies which connect a decrease in tooth decay to fluoridation are of moderate or poor quality, and 20% decrease in tooth decay (without, it should be noted, any sort of regression analysis to eliminate other potential causes of decreased tooth decay) is the best noted in more recent studies. What's more, pervasive health effects have been linked to excess fluoride consumption in a number of small studies -- but have been dismissed by those encouraging fluoridation. Health effects linked to excessive fluoride ingestion include bone problems, including hip fractures and bone cancer; lowered IQ; and thyroid problems. These are worse in those with poor nutrition (the same people who are likely drinking the most tap water).

The assertion that fluoride in and of itself is necessary to prevent cavities is another fallacy; eliminating sugar and highly-processed grains would also prevent cavities. (The book points to U.S. sugar company's interests in fluoridating the water as a substitute for telling Americans that cavity reduction could be achieved through eating less sugar.)

In addition, there is no evidence that the fluoride already present in toothpaste and mouth rinses isn't enough. Paradoxically, very young children were until 2008 given oral fluoride tablets because it was thought that swallowing toothpaste, and ingesting that fluoride, would be harmful (now nearly every toothpaste on the market, including the "natural" sorts like Tom's of Maine, contains fluoride, except those marketed for toddlers). Want more? Fluoride sources include foods and beveraged processed with fluoridated water (which could be many of the foods and beverages available in our grocery stores and restaurants here), mechanically deboned meat (think nuggets), tea (because water in India and China is naturally high in fluoride), wine and pesticide residues on food.

Speaking of pesticide residues on food. This afternoon comes news that the EPA is proposing phasing out a pesticide often used on cocoa beans and dried fruit that degrades to fluoride (and is often blamed for Florida's very high rate of dental fluoridosis). The agency also indicates the high fluoride levels could contribute to excess exposure and posed "an excess risk of tooth and bone damage." In my opinion, this is a major reversal of position that could eventually lead to the removal of fluoride from water nationwide.

And how does this affect us? Well, it's a lot of data points but it points to some interesting new reasons to eat organic foods (there are lots more pesticides out there, after all, and this phaseout will be slow); to eat extremely local (so you can avoid food processed with fluoridated water); to eat whole foods and humanely raised and hand-butchered meat; and to avoid bottled water (because much of it comes from municipal sources which may have been fluoridated). In addition, my decision for my family's dental health is to avoid all ingested sources of fluoride (when possible, I'll keep drinking tea); to continue to work to reduce sugar; and yes, to accept the presence of a natural fluoride toothpaste in our medicine cabinet.


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Fluoride was not on my "radar" when my kids were little in the late 90's. We lived in the South where the water was fluoridated, they used a fluoridated toothpaste and got fluoride treatments twice a year at the dentist. Their teeth, although very sound, are discolored. I hate it for them. The kids are teens here in Portland and they get fluoride now only their toothpaste, but the damage is done. No matter how much you know as a parent, something will always escape your radar. I'm glad the word is getting out.

I am not a big proponent of fluoride, but I am concerned with some of the quasi-scientific assumptions in this piece. For example, I'm hoping this statement can be clarified: "These are worse in those with poor nutrition (the same people who are likely drinking the most tap water)."

What's the connection between people with poor nutrition and people who drink tap water????

The Agency for Toxic Substances and Disease Registry (ATSDR) identifies populations that are "unusually susceptible" to the toxic effects of fluoride. The populations include the elderly, people with "deficiencies" in calcium, magnesium and/or vitamin c...

"Poor Nutrition increases the incidence and severity of dental fluorosis and skeletal fluorosis."

page 112, http://www.fluoridealert.org/ATSDR-Fluoride.pdf

The link about fluoride and poor nutrition seems to be that a poor diet offers too little calcium. Fluoride has a great affinity for calcium so it will "take it" (bind in them) from bones. Research comes down in favor to fluoride increasing osteoporosis (bone weakended). It makes teeth and bone more brittle.

kiki, re: your characterization of my "quasi-scientific" comments, I am not attempting to make any scientific claims myself, only to summarize those made in the book and elsewhere in recent news, all which have their own extensive scientific footnotes. the bit about poor nutrition and drinking tap water stems from an old defense of fluoridation: those who want to opt out of it can simply buy bottled water. of course, those who can't afford bottled water -- and therefore are more likely to be drinking tap water -- are the same population that tends to have poorer nutrition (because they can't afford fresh vegetables and high-quality meats, and they aren't as available in poor neighborhoods). all the scientists agree that the effects of toxins like fluoride (and lead, mercury, etc.) are worse on individuals who are getting a low-quality diet. because of this, any contamination of municipal drinking water, whether intentional or accidental, will affect low-income populations worse.

there are more footnotes here: http://lindamelosnd.com/articles/fluoridation

Great info, thanks for the post!

The affinity that fluoride has to calcium, also means that it concentrates in multiple "calcium rich" tissues in the body. Some of the highest concentrations are in the pineal gland and the aorta. Researching fluoride's potential toxic manifestations is woefully inadequate in the most fluoride exposed country in the world.

If you are discouraged to look, you won't find.

Fluoride is neither safe nor effective. We are only now beginning to understand the many adverse affects of fluoride ingestion, especially on our most vulnerable populations - our elderly and our children. A recent Harvard study showed a 500% increase in the risk of deadly osteosarcoma in five to ten year old boys who drank fluoridated water compared to those who did not. We know that fluoride concentrates in the bones, making them brittle and more susceptible to fracture. We also know that fluoridated water should not be used to reconstitute baby formula. The National Kidney Foundations recently withdrew its endorsement of water fluoridation because of adverse effects on those with impaired kidney function. Contrary to what proponents say about dental fluorosis - that it is "only cosmetic" - is wrong. Fluorosis is defined by PubMed as "chronic fluoride poisoning." If it is visibly harming our children's teeth, what is it doing to the rest of their bodies? And ours?! Even proponents of fluoridation do not dispute that fluoride compounds used for water fluoridation are by-products of the phosphate fertilizer industry and are contaminated with lead, arsenic and other toxins. For more info, please feel free to contact me:
Kimberly Kaminski, JD, Executive Director
Oregon Citizens for Safe Drinking Water
(503) 421-9197

Have any of you ever been to a country where they don't fluoridate their water? I worked in Russia for a few years; the percentage of people who have multiple gold teeth is huge. These are people who are well fed, not the poor. I think the significant, known problems due to poor dental health is worse than the possible risk of fluoridating drinking water. We have much worse things to worry about, and if it's a problem for the people with poor nutrition, well then that is a problem that is addressed by improving their nutrition, not depriving them of something that helps them keep their teeth. I also strongly disagree that it's only sugar and processed foods that hurt your teeth. Again, the Russians I worked with ate very little processed foods or sugar, and bad teeth have been around since before we fluoridated them.

All I know is I gave my first child fluoride as scheduled by the doc and I completely slacked on the second. The second child is the only one who has had cavities. I feel pretty bad about it, and assume not giving the fluoride as a baby contributed to it. But I also hate giving it. So, what's a mama to do, eh? I'm glad we're at a point where we have a little fluoride in the toothpaste and I'm very glad it's not in the water. I occasionally give the pills to ease the guilt.

Colleen, you didn't say if they (the Russians) brushed their teeth, used a topical fluoride product or even went to a dentist. Lets start with the sensible stuff first.

Adding a contaminated industrial waste product would hardly constitute sensible.

I would encourage mothers like Kim above looking for a safe, effective alternative to fluoride to consider reading this article: Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. http://www.ncbi.nlm.nih.gov/pubmed/10765964

Xylitol is effective as a non-cariogenic sugar substitute. Habitual xylitol consumption appears to select for mutans streptococci (MS) with impaired adhesion properties, i.e., they shed easily to saliva from plaque....In conclusion, therefore, habitual xylitol consumption by mothers was associated with a statistically significant reduction of the probability of mother-child transmission of MS assessed at two years of age. The effect was superior to that obtained with either chlorhexidine or fluoride varnish treatments performed as single applications at six-month intervals.

Additionally, toothpaste with fluoride meant for children needs to be broccoli and cabbage flavored, not bubblegum.

Fluoride in drinking water is brutal the the health of children. It can lower their IQs and trigger personality disorders and learning disorders. Everyone needs to have a filtration system in their home that removes fluoride.

Exactly my point! You take an "old defense of flouridation" and use it to persuade readers that poor people are more at risk of excess fluoride because "they are likely drinking the most tap water." Not accurate or scientific at all.
I'm all in favor of proving what's healthy and not healthy for our children, but let's be painstakingly clear and accurate about it, or it becomes more mis-information.

Thank you for your thoughtful and sane perspective. I am so grateful for those who continue to share information so that when necessary we can change our minds from what we were raised to believe. It could be emphasized that the CDC has admitted, (quietly) for years that fluorides primary benefit is topical, NOT from ingestion. And of course, ingesting fluoride compounds is where we run into the myriad dangers from overdosing. I would add that lower income people also are more likely to bottle feed and for longer according to stats from WHO and LLL etc. so their babies are deprived of the protection that breast milk affords. Mothers' milk filters fluoride OUT to protect our little ones down to the levels found in saliva. (I believe the actual concentration is .02 ppm which is orders of magnitude lower than the 1 ppm previously allowed by law.)
And for those who are depending on anecdotal evidence to support your belief in fluoride as a necessary aspect of oral health, please put your private anecdotes on hold and consider the absolutely incontrovertible results from responsible research done worldwide. Fluoride is a poison on a par with lead and arsenic. We should not be adding any fluoride compounds to the water and the poor aquatic lifeforms struggling with so many burdens from our "civilized" decisions. But hooray that at least now we'll be adding less.

Thanks for this great article. My family stopped using fluoride about a year ago after a friend presented us with evidence similar to what you've outlined here. Kiss My Face makes some excellent non-fluoride toothpastes that use other natural, safe ingredients to inhibit tooth decay.

If America used the Precautionary Principle, like the EU does, to determine if products are safe before they are allowed to be released, we wouldn't even be having this debate. According to the Fluoride Action Network, "97% of western Europe has chosen fluoride-free water . This includes: Austria, Belgium, Denmark, Finland, France, Germany, Iceland, Italy, Luxembourg, Netherlands, Northern Ireland, Norway, Scotland, Sweden, and Switzerland." http://www.fluoridealert.org/fluoride-facts.htm

"The precautionary principle states that if an action or policy has a suspected risk of causing harm to the public or to the environment, in the absence of scientific consensus that the action or policy is harmful, the burden of proof that it is not harmful falls on those taking the action." (Wikipedia)

I live in Vancouver where the water is flouridated. How do we avoid flouridated water? I buy water from Fred Meyer's self serve machine but I'm fairly sure it says it's from a municipal source on the machine...just carbon/uv filtered. Is there a safe source for those who's tap water isn't safe?

It's much better to rely on evidence from the American Dental Association showing that flouridation is safe and effective than to trust arguments grounded in ignorance at best and paranoia at worst:


We've seen the same phony arguments made against vaccination.


New science reveals fluoride is linked with lower IQ

Twenty-five scientific studies have connected fluoride with lowered human intelligence (1, 2, 3, 4, 5, 6, 7, 8, 9, 10 ,11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25).

Children exposed to more fluoride are 500% more likely to develop lowered IQ (24).

The U.S. National Research Council concluded fluoride has the ability to interfere with functions of the human brain (26).

Fluoride was listed in The Lancet as an emerging neurotoxin. Other neurotoxins are lead, methylmercury, PCB, arsenic, and toluene. Neurotoxins cause developmental disorders such as autism, ADHD, learning disabilities, cerebral palsy, and mental retardation. The authors called for new and strict regulation of fluoride and other neurotoxin pollutants to stop further damage to human brains (27).

Concerns about too much fluoride prompted the U.S. National Research Council (26), the U.S. Department of Health and Human Services (28), and the American Dental Association (29) to call for reduced fluoride in drinking water.

In the face of such damaging evidence against fluoride, why is the government still spending public tax dollars to convince communities to fluoridate their drinking water?

Environmental Working Group, a leader in health advocacy, urges communities not to add fluoride to tap water, and advises parents to avoid fluoridated water for their children, particularly bottle-fed infants (30).

If we value the function of our brains, and our children’s brains,

fluoridation of drinking water must stop!


(1) Chen, et al. Research on the intellectual development of children in high fluoride areas. Fluoride 41(2):120–4. 2008. [Originally published in the Chinese Journal of Control of Endemic Diseases 1991;6 Suppl:99-100.]
(2) Guo, et al. A preliminary investigation of the IQs of 7-13 year old children from an area with coal burning-related fluoride poisoning. Fluoride 41(2):125–8. 2008. [Originally published in the Chinese Journal of Endemiology 1991;10(2):98-100.]
(3) Hong, et al. Research on the effects of fluoride on child intellectual development under different environments. Fluoride 41(2):156–60. 2008. [Originally published in the Chinese Primary Health Care 2001;15(3):56-7.]
(4) Li, et al. The effects of endemic fluoride poisoning on the intellectual development of children in Baotou. Fluoride 41(2):161–4. 2008. [Originally published in the Chinese Journal of Public Health Management 2003;19(4):337-8.]
(5) Liu, et al. Report on the intellectual ability of children living in high-fluoride water areas. Fluoride 41(2)144–147. 2008. [Originally published in the Chinese Journal of Control of Endemic Diseases 2000;15(4):231-2.]
(6) Qin, et al. Using the Raven’s standard progressive matrices to determine the effects of the level of fluoride in drinking water on the intellectual ability of school-age children. Fluoride 41(2):115–9. 2008. [Originally published in the Chinese Journal of the Control of Endemic Diseases 1990;5:203-4.]
(7) Ren, et al. A study of the intellectual ability of 8-14 year-old children in high fluoride, low iodine areas. Fluoride 41(4):319-20. 2008. [Originally published in the Chinese Journal of Control of Endemic Diseases 1989;4(4):251.]
(8) Wang, et al. A study of the IQ levels of four-to-seven-year-old children in high fluoride areas. Fluoride 41(4)340–3. 2008. [Originally published in the Endemic Diseases Bulletin 1996;11(1):60-6.]
(9) Wang, et al. The effects of endemic fluoride poisoning caused by coal burning on the physical development and intelligence of children. Fluoride 41(4):344-8. 2008. [Originally published in the Chinese Journal of Applied Clinical Pediatrics 20(9):897-8.]
(10) Li, et al. Effect of fluoride exposure on intelligence in children. Fluoride 28(4):189-92. 1995.
(11) Lin, et al. The relationship of a low-iodine and high-fluoride environment to subclinical cretinism in Xinjiang. Xinjiang Institute for Endemic Disease Control and Research; Office of Leading Group for Endemic Disease Control of Hetian Prefectural Commitlee of the Communist Party of China; and County Health and Epidemic Prevention Station, Yutian, Xinjiang. 1991.
(12) Lu, et al. Effect of high-fluoride water on intelligence in children. Fluoride 33(2):74-8. 2000.
(13) Rocha-Amador, et al. Decreased intelligence in children and exposure to fluoride and arsenic in drinking water. Cad. Sa·de P·blica, Rio de Janeiro, 23 Sup 4:S579-S587. 2007.
(14) Trivedi, et al. Effect of high fluoride water on intelligence of school children in India. Fluoride 40(3):178–183. 2007.
(15) Wang, et al. Arsenic and fluoride exposure in drinking water: children’s IQ and growth in Shanyin County, Shanxi Province, China. Environmental Health Perspectives115(4):643-647. 2007.
(16) Xiang, et al. Effect of fluoride in drinking water on children's intelligence. Fluoride 36(2): 84-94. 2003a
also see:
Xiang, et al. Blood lead of children in Wamiao-Xinhuai intelligence study. (Letter). Fluoride 36(3):198-9. 2003b.
(17) Zhao, et al. Effect of high-fluoride water supply on children's intelligence. Fluoride 29(4):190-2. 1996.
(18) Seraj, et al. Effect of high fluoride concentration in drinking water on children's intelligence. Journal of Dental Medicine 19(2):80-86. 2007.
(19) An, et al. Effect of high level of fluoride on children’s intelligence. Published in: Zhong Guo Di Fang Bing Fang Zhi Za Zhi 7(2):93–94. 1992. (in Chinese)
(20) Xu, et al. Effect of fluoride on children’s intelligence. Published in: Di Fang Bing Tong Bao 9:83–84. 1994. (in Chinese)
(21) Yao, et al. Comparison of children’s health and intelligence between the fluorosis area with altering water source and those without altering water source. Published in: Yu Fang Yi Xue Wen Xian Xin Xi 3(1):42–43. 1997. (in Chinese)
(22) Zhang, et al. Effect of high level of fluoride and arsenium on children’s intelligence. Published in: Zhong Guo Gong Gong Wei Sheng Xue Bao 17(2):119. 1998. (in Chinese)
(23) Fan, et al. Effect of high fluoride exposure on children intelligence. Published in: Huan Jing Yu Jian Kang Za Zhi 24(10):802–803. 2007. (in Chinese)
(24) Tang, et al. Fluoride and children’s intelligence: a meta-analysis. Biol Trace Elem Res. 2008 Winter, 126(1-3): 115-20.
(25) Xiang, et al. Serum fluoride level and children’s intelligence quotient in two villages in China. Environmental Health Perspectives, Online 17 December, 2010.
(26) US National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. National Academies Press, 2006.
(27) Grandjean P, Landrigan P. Developmental neurotoxicity of industrial chemicals. The Lancet, v 368, November 8, 2006.
(28) Associated Press. AP exclusive: US says too much fluoride in water. January 7, 2010.
(29) American Dental Association. ADA applauds HHS action on recommended fluoride level in drinking water. January 7, 2010
(30) Environmental Working Group. Harvard study: Strong link between fluoridated water and bone cancer in boys. April 5, 2006.

Roger Burt, MS
January 15, 2011

What part of "addition of fluoride to drinking water is considered one of the greatest public health successes of the 20th century" do you think is contradicted by your laundry list? Use some common sense. If, for example, there really were evidence linking fluoridated water with bone cancer in boys, dentists in areas with fluoridated water would be telling their sons to never drink tap water. Would that stay a secret for long?

Hi, I have just started researching fluoridation in my local water district and found that our city once purchased sodium fluoride from China but changed to a company in Japan because the product is finer and easier to disperse from the tanks to the water supply. My question is with the contamination from the Tsunami,Earthquake and Fukashima nuclear incident's how do we know if this product will not be further contaminated? And with the questionable "Official Japanes New's Reporting" of the nuclear aspect and the level of risk ,I think it is something that needs to be looked into. This is going into our water source folks.

I grew up in Florida. My kids are growing up in Portland, OR. We're talking one end of the fluoridated municipal water supply spectrum to the other. I'll also point out that my father, a pediatrician, was a big supporter for fluoridated water. Now, I am mother to equally healthy twins, but my daughter brushes her teeth far more effectively than my son (as evidenced by her patience, careful adherence to technique, and cleaner-appearing teeth). My son tries to skip out on, or at least shorten the duration of, brushing, and often has visible film on his teeth that (no surprise) led him to recently be reprimanded by dentist for having high levels of plaque and tartar build-up. Not so for my daughter. Again, no surprise. We all eat a very healthy diet--virtually no candy or processed sugar, organic and local whenever possible, and very balanced. I breastfed for a year and a half. The kids both use carefully selected fluoride toothpaste (with xylitol, not saccharine; mild abrasives; no unnecessary fillers, colors, flavors). The kicker: they just had their annual dental check-up: my son had no cavities; my daughter had a surprising two. Take it as you will.

omg. To begin with nobody is even being allowed to vote for this fluoridation. Only 5 or 7 people on Portland's City Council are going to make this decision for Portland, Tigard, Tualatin, and Gresham and the people have no vote! Now my other complaint is that they just keep talking about teeth and nothing else. I can't flush any meds down the toilet because it is toxic to the fish but how much fluoride is going to be going down drains and all of the wildlife will be affected, not to even mention that we will ingest more then by eating fish and or all of the fruits and vegetables that we eat and then I will also have my animals ingesting it. If you boil water it will increase the fluoride level. This is not fair, I and all of the public have no chance to even vote, just the City Council and I would bet that Portland is going to get a kickback for excepting this program.

To focus only on the health of teeth and exclude investigation into side effects of fluoride could be compared to an amazing hubcap polish that happens to wear out the motor.
It is interesting that the American Dental Association takes no responsibility for any fluoride that passes the back of the throat.
'Ingest Fluoride'... this from the folks who for many years put mercury, another toxic substance in our mouths.
Do not mistake how long fluoride has been sold to the public as a substitute for good research. A couple questions you might ask are
(1) How much would a company have to pay to dump a truckload of Fluoride in a landfill.
The answer is that the EPA has serious restrictions on where fluoride can be disposed because it is a deadly toxin!
(2) How many sources of Fluoride are you already exposed to, and at what point are you adversely affected.
Answer. There are multiple sources of Fluoride even in non-fluoridated areas. Fertilizer, Toothpaste, canned food that comes from fluoridated areas.
(3) What was the first class action suit following the nuclear bomb.
Answer. It wasn't radiation ...it was the toxic effects of fluoride, an industrial waste product.
The bottom line is, would big business rather pay up to $17,000 per truckload to get rid of their toxic garbage, or with enough PR and hype, convince the public to spend millions and millions to buy the stuff.
Massive fine to dump fluoride in a lake or river. Yet we are paying to add the stuff to our water supply.
By the way... what does a fluoride deficiency look like.
Answer... there is no such malady.

If water fluoridation can be so damaging to a kid's general health, why is still in effect and what is our government doing about this? Do we have to wait 50 years to see the concrete effect of this? Or maybe by then we have other elements or chemicals to blame?

I am a 47 year old native Portlander. As far back as I can remember, I have only used toothpaste containing fluoride. I have not had one single cavity in my entire life! If you brush your darned teeth with a fluoridated toothpaste, why in the heck would you need to DRINK and COOK with fluoridated water?! Buying bottled water the rest of my life is not a viable option and I am totally miserable that I will be to ingest yet another chemical.

Dentist recommendation is always needed before going for a dental treatment. So, it is important to concern with a experienced dentist.

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