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Water Fluoridation in Portland: Next Steps

I have three children, one born in New York and two born in Portland.  From the time when they were all young, my husband has commented that their teeth growth has been significantly affected by their water source in the formative years.  Our first child drank fluoridated water for the first three years of their lives.  Our second two children never did.

For our youngest, we don't yet know how the earliest years have affected his teeth, as he is only turning 3.  For our middle child, she has already had carries and fillings, while our eldest seems to have the best oral health.  This could also be a result of being the best tooth-brusher among them.

As educated parents (with ample health care coverage), we have swished, taken oral fluoride supplements prescribed by our pediatrician and used fluoride toothpaste.  Even still, one of our children - born and raised in Portland - has suffered cavities.

My best estimation of what is happening in Portland and Oregon is that, indeed, "we are in a dental crisis".  One in three of our children has untreated tooth decay, and one in five has "rampant decay", which is 7 or more cavities.  

The impact on low-income communities and communities of color is disproportionate: African Americans have twice the rate of tooth decay than white counterparts, 72% of Native Americans have untreated cavities, 46% of Oregon's Latino children have untreated tooth decay.  All these issues result in absenteeism and ultimately affects a child's success in school.  This is a preventable childhood disease.  Does the swishing work?  Yes, but it doesn't help the children before kinder age. And also, what about swishing in the summer or what about teachers who might forget the swish or kids that just throw it out?

Sometimes I like to know who else is support a certain cause.  This fluoridation effort, who else supports it, aside from health, dental, or medical organizations?  Some other supporters include: Urban Leauge, Central City Concern, Children First for Oregon, p:ear, Native American Youth Association, Latino Network, African Women's Coaltion, and many more.  (Full List Here in *pdf)

Commissioner Randy Leonard has been a supporter of this effort.  The Portland City Council is holding a public hearing on water fluoridation next Tuesdsay, September 6, at 2pm in the City Hall Council Chambers.  Interested in learning more?  Please attend.

Representatives from the Everyone Deserves Healthy Teeth Coalition has reached out to me and has offered to offer a Q&A situation where we can have readers email questions and concerns, to see if we can find answers.  For example: I, too, was concerned about the Harvard IQ study that is oft referenced, but - after chatting with other researchers and reading more online from a researcher-mom in Eugene - it sounds like the Harvard study is inconclusive.  I have plenty of questions about fluorosis, and - after again talking with others - it sounds like fluorosis can happen at higher levels of fluoridation but not at the level used to prevent tooth decay (0.7mg/L).  Do you have questions?  Send them over to urbanMamas@gmail.com and we will see if we can find answers.

I have suggested that we gather a group of subject-matter experts - a dentist, a medical doctor, a naturopath, maybe even a teacher who has implented the swish program at schools - to field questions from mamas and papas.  Interested in helping to coordinate this effort?  Please email us at urbanMamas@gmail.com and we will put you in touch!  Perhaps a playdate for parents and kids, where we have the opportunity to learn more?

Until then, keep talking, keep reading up on the issue, and keep informed.  It seems highly likely that this effort will pass in Portland, and we - as parents - need to educate ourselves on all the facts as it relates to fluoridating our water.

Comments

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GREAT post Olivia.. I am worried about poor dental hygiene habits as being the main cause of all these cavities, in what ever color population or socio-economic group you look at. Flouride in the water will not take away their cavities, they may just get a few less. How hard is it for people to brush twice a day with fouride toothpaste and see their dentist every six months..aren't all children in Oregon covered with dental care now?

I grew up with flouride in the water, my kids don't... and they have LESS cavities than I did. Griffin at 10 has never had one and Gleneden at six has never had one. But they have good dental care and parents who make sure they brush their teeth MOST night.. some times they fall asleep... I am NOT going to wake them up to brush their teeth, but they sure do in the morning.
Thanks for this thoughtful post.

Just remember every glass of water, every pot of soup or pasta, every shower, bath, swimming pool, garden hose or sprinkler, ANYTHING with water in it will contain a full dose (.7mg ) in EVERY Liter...
How many glasses of water do you drink daily, or do your kids? If you get a full daily dose in one glass of water, what happens when you drink 6 glasses of water, eat soup for dinner with strawberries you watered with your fluoridated hose water...how much are you and your children getting now? Are you still brushing with fluoride toothpaste? Are your kids still receiving fluoride treatments at the dentist or daily pills at school? Do they drink juice boxes from California where they add their fluoridated municipal water to the concentrate? Did you know that new recommendations have caused many states/communities who fluoridate to send out notices to people with infants that they should not mix formula with fluoridated tap water because of how many ounces an infant drinks a day? What about breast milk when you are drinking extra water to keep hydrated and milk supply steady? How much is your newborn or even unborn child receiving?
What about when we wash our dishes, use the toilet, empty the bath, water the garden etc. and that water, all that water, goes back into the river...how do the salmon and other species now process this water that now every drop is fluoridated?
Fluorosis of the teeth is an indicator that all the bones on the inside of the body that you can't see also have fluorosis. A very little known fact...

Is it possible we are dealing with a substance that is in fact helpful with cavities AND also harmful to the body? It could be that way..so do we have great teeth and poisoned bodies and ecosystems? Do we figure out a better way to help our teeth? Have you ever seen a child eating a PPS breakfast of Golden Grahams cereal and chocolate milk? How much sugar is in there that sits on the teeth all day? maybe we could change our kids sugar and cavity producing food intake rather than adding it to the water where it cannot be easily removed?

The fluoride in toothpaste and tablets is medical grade, the fluoride added to water is the byproduct of the scrubbers of smokestacks from phosphate fertilizer plants. (because medical grade is too costly in the amounts needed for water supplies) fact. In our water? Every drop of water? Is this what we really want? Please don't get sucked into the heartwrenching ads with kids who can't sleep because their water isn't fluoridated- that is pure manipulation and fear based tactics- disgusting-
instead..research for yourself- read the studies- read the research- find out why other communities have voted NO or have reversed their policies- read why Portland hasn't fluoridated in the past- Educate- YOUR WATER SUPPLY IS YOUR LIFE..MAKE SURE YOU ARE SURE ABOUT WHAT YOU WANT IN IT.

First of all, my children are biracial/black. They are 8 and 10 and have never had one cavity. Bad or good teeth can be genetic,or their good teeth could be because the only thing we drink at home is water and milk. No juice or soda. In my kids' case,it might be a little of both since they are not the best brushers. Please dont use the typical generalization that kids of color tend to have bad teeth. Ive seen plenty of non colored kids with cavities. Some of it is genetic, some of it is bad oral hygiene and some of of it may be low income. I also hope that portland does not put fluoride in the water. I dont want the city to force me and my family to ingest fluoride. It is no their choice for everyone. Fluoride is not made to ingest,but if its in the water thats exactly what will happen.

My kids were little in the South before fluoride was on my parent radar. It's in the water, the toothpaste and the kids got the big mouth treatments twice a year at the dentist. Both kids have the fluorosis on their teeth. It's sad to young adults with spots on their permanent teeth that cannot be fixed.

I don't care so much about this issue (since my kids aren't little) but I feel it should have been a more democratic process. What's next? mandatory vaccination and circumcision? So scary!

I am also against fluoride in the water and I'm probably the least "crunchy" person I know (LOL), for some of the same reasons Bea mentioned (though many of her points were things I'd never even thought of until now). Our school doesn't do the swish program, but they offer a chewable tablet to the kids. I opted my kids out of the fluoride program because I didn't think they needed it. We use fluoride toothpaste and rinse (the 2 yo uses Tom's Silly Strawberry because the other kinds are "too spicey"), get dental checkups/cleanings every 6 mos, and are pretty good about brushing (not perfect). None of my kids have every had any cavities. If the choice is all (fluoride in drop of water) or nothing, I choose nothing. There are other (better) ways to get your kids fluoride if they need it.

I became involved in this issue in 2005, just before the publication of a Harvard study showing that boys between 5 and 10 years old who drink fluoridated water are 500 times more likely to develop osteosarcoma, a deadly bone cancer, than boys who do not drink fluoridated water. My son was 4 at the time and I found this very alarming. Since then, my research has shown me that, at a minimum, there are serious health concerns about putting a non-FDA approved by product of the phosphate mining industry into our water. Not just our drinking water - ALL of our water! Even if we assume it is good for our teeth, which is questionable at best, what is it doing to the rest of our body and to our environment?

Please feel free to contact me.

Kimberly Kaminski, Mom, and Executive Director
Oregon Citizens for Safe Drinking Water
(503) 421-9197
kim@safewateroregon.org

Also, check out:
CleanWaterPortland.org
FluorideFree PDX.org

Question for the Coalition:

Why do they choose to use the oral health data for the entire state of Oregon in their messaging, when we have data available just for the Portland Metro area?

Since we're just discussing fluoridating Portland, why not use the more accurate local numbers?

Outside of the Portland metro area, untreated decay is 44%. Inside the Portland metro area, untreated decay is 21%.

(Oregon Smile Survey 2007 pg 12 http://public.health.oregon.gov/PreventionWellness/oralhealth/Documents/smile_2007.pdf)

"One in three kids have untreated decay" is the average of the entire state. Portland metro's numbers are far better than that, and less than half that of the rest of state.

By choosing to use statewide average numbers instead of more accurate Portland metro numbers, the Coalition leaves itself susceptible to charges that it is trying to exaggerate the crisis to make its case, or that it is choosing to use less-accurate numbers in order to run a campaign that appeals to our emotions rather than the facts. Why are they making this choice?

Olivia, if a Coalition representative answers the question by saying that part of the Portland metro area is fluoridated, or that Portland metro includes more prosperous areas that skew the numbers, please ask this follow up question:

Portland metro as defined by the Smile Survey includes fluoridated Beaverton, Tualatin and Forest Grove. As of the 2010 Census, the combined populations of those towns is roughly 8% of the Portland metro area. So the metro area's decay rate of 21% includes a roughly 8% fluoridated population.

In contrast, the state of Oregon is 22.6% fluoridated (CDC 2010) and has a decay rate of 36%.

Fluoridation levels in the Portland metro area are much lower than the state average, yet its decay rates are 15% lower than the state average.

The Portland metro area does have a slightly lower rate of child poverty than the state of Oregon as a whole, 17.5% vs 21.7% as of 2010, which most likely does account for some portion of the difference in decay rates between Portland metro and Oregon as a whole.

Is this small difference in poverty rates really enough to justify the Coalition's choice to use state averages instead of the much lower local numbers?

poverty rate references:
http://portlandpulse.org/child_poverty
http://datacenter.kidscount.org/data/bystate/Rankings.aspx?state=OR&ind=2564

Questions for the Coalition:

1. I've read that the Portland Water Bureau will most likely be using fluorosilicic acid as the fluoridation chemical. Is this true?

2. I've read that fluorosilicic acid is a byproduct of industrial fertilizer manufacturing. Is this true?

3. According to the NSF, the body that regulates fluoridation chemicals, 43% of product samples contained arsenic and 2% of product samples contained lead.

The EPA has set Maximum Contaminant Level Goals for arsenic and lead at zero. According to the EPA:

"The MCLG for arsenic is zero. EPA has set this level of protection based on the best available science to prevent potential health problems.”

and

“The MCLG for lead is zero. EPA has set this level based on the best available science which shows there is no safe level of exposure to lead.”

Why would the coalition advocate adding a product that contains arsenic and lead to Portland's drinking water?
Since the EPA has determined that there is no safe exposure level to these contaminants, why add any amount at all? Especially when children in poverty are already the ones most endangered by lead exposure?

EPA sources:
http://water.epa.gov/drink/contaminants/basicinformation/arsenic.cfm
http://water.epa.gov/lawsregs/rulesregs/sdwa/lcr/fs_consumer.cfm

NSF data sheet pg 4:
http://www.nsf.org/business/water_distribution/pdf/NSF_Fact_Sheet.pdf


Dear Mama's,

Adding the most electro negatively charged particle found in industrial waste is an absurd idea and one that is coming to its end. The deceptive practices being used to hire PR firms and the suppression of the science that is abundant is disturbing. Ingested fluorides are harming brains, the thyroid, bones and importantly can effect a fetus and the proper development of the brain of the most vulnerable and most precious.

The science is ample that harm can and does occur far from the oral cavity. The science is also ample that if fluoride were to work, it works topically and not by drinking it and bathing every cell and enzyme and soft tissue in the body. The NRC Fluoride 2006 report is worrisome.

Put anything in the water and how do you control the dose?

This will go down as the worst public health debacle in 65 years. Look at the rampant arthritis, brittling of bones, hypothyroidism and autistic spectrum disorder. I am not so brazen as to suggest there is necessarily a direct link but in all explosive ailments, the science is abundant.

Portland, the money is huge and do not be fooled, this is NOT about your children's teeth and dental care it is all about money, money and industrial waste products.

Do not "medicate" your water supply. Let water be water for the babies, the bird, the bees the frogs, diabetics, children and the all of us. Water should not be trifled with as the consequences, well I have seen the consequences in too many folks. It happened slowly drop by drop by poisonous drop. The "medication" is tasteless and odorless. Your child's smile will be mottled and potentially much worse life long issues to deal with.
Keep water "water" and let everyone choice their own medication for their own bodies. Once it is on the water it is everywhere and very difficult to filter out.
For more info see www.FluorideAlert.org or
FluorideFreeAustin.org or FluorideFreeFairbanks.org or FluorideFreeAsheville.org or FluorideFreeSacramento.org... the movement is afoot.

These communities have seen the real harm to our babies and our populations.

First and foremost, thank you to the author for coming up with a way to have questions be asked. I haven't seen this, and I really appreciate it.

One item I keep seeing flung around is "follow the money". What is the money behind both sides of this debate? I know the CDC, all the local major health insurance company, all the local major social service agencies support flouridation. CDC is a government agency (underfunded) and local social service agencies are also short funded. I cannot find any truth in the platitudes when people through this phrase around. Can the groupd of experts help me understand the moneyed interests in promoting public health? Similarly, the anti-flouridation groups seem to be a bunch of on-line groups. Well, I can post anything I want on line. Who is to say it is truthful? Can the reliability of this web information be substantiated?

I've seen anti-flouridation folks point to studies in China as reasons not to fluoridate. I'm curious if the coalition of experts can determine if all the other environmental factors are controlled to ensure that a comparison between China and Oregon is truly legitimate. I can think of many reasons that data from China is not transferable to this area.

Last, I'm curious if there is a device - similar to a Brita filter - that a person could purchase to filter out fluoride at their tap if they did not want it in their water. It seems like this may be a partial solution for some of the concerns voiced here.

Excellent post! Thank you providing this forum to voice concerns.

For posters like "Mom for health" and others...The continued accusations of ignorance, ill intent, arguments made in bad faith or motivated by profit levelled against those whom support fluoridation greatly undermine civil discourse on this subject. I'm sure it's gratifying to get on your soap box but it does nothing to create understanding.

N PDX mom, did you get a chance to look at the link to the post by the researcher-mom in Eugene? She really looks into the IQ/China thing. Thanks so much for that link, Olivia. It was a pleasure to read.

In response to NPDX Mom, the money comes from several sources. First, the phosphate fertilizer makes money selling the by product of their mining operations to municipalities. Buy more importantly, they make money by not having to dispose of these products in a toxic waste facility (very expensive!) These contaminants are captured in smokestack scrubbers because they are not allowed to be released into the air. Nor can they be dumped in our oceans, rivers or landfills. The company that distributes these products, LCI, Inc, also has a financial interest. In the background, the sugar industry also has an interest in "protecting our teeth" while at the same time not decreasing sugar consumption.

In addition, there are many, many people who get paid to promote fluoridation. While I truly believe that most people who do, do so because they truly care about children and their dental health. However, there is a small contingent of promoters who are fully aware of the harm caused by these chemicals but continue to promote them because they are getting paid to do so, and to say anything bad about these chemicals would put their credibility at risk, as well as raise questions of liability.

And when we talk about the CDC, we are only talking about the oral health division. Again, a group of professionals paid to promote fluoridation.

The reason we look to China, India and Iran for IQ studies is because the studies simply have not been done in this country. Why not? Because studies showing fluoride is harmful are simply not funded.

And no, a brita filter does not remove fluoride compounds. Neither does our sewage system. Therefore the 99% of the water we don't drink goes directly into our ecosystem and watershed. You can only remove fluoride compounds with reverse osmosis (expensive!) or distillation. And that is only the water we drink. A full house filter is prohibitively expensive, esp for low income families. We can't filter the water we showing in, swim in, wash our cloths in, or water our garden with. When we go to a restaurant or to someone's home, we get it in our coffee, ice tea, soup, pasta, everything. If we go to a local pub, we get it in our beer!

Even if this is good for our teeth (questionable, at best) do we really want this in all of our water?

Hello Mamas! Thank you for your questions. The Everyone Deserves Healthy Teeth Coalition includes 75 member organizations from the education, health, and social justice sectors: http://everyonedeserveshealthyteeth.org. We have come together to address the dental health crisis in Oregon through the most cost-effective, equitable, and safe public health strategy: community water fluoridation.

We are delighted to be able to answer questions from parents, and will provide factual answers with references. This forum is not intended to be a debate between opposing sides, but rather a welcoming forum for curious parents to ask questions and to get answers from the pediatricians, dentists, and public health professionals on the Coalition.

We will strive to address a selection of Frequently Asked Questions every day or so.

The list so far includes: Effectiveness of water fluoridation, Safety & purity of fluoride additives, Fluorosis, Dose/ Multiple Exposures, Fluoride in Breast-milk, Salmon/ Wildlife, Dental Health Disparities, Osteosarcoma/Cancer, Conclusions of the National Research Council Report, Other preventive strategies, and Portland data compared to Oregon data. Let me know if I missed a topic.

We'll work with Olivia to figure out the best way to post a response to each of these questions.

Many of these topics are addressed at http://www.EveryoneDeservesHealthyTeeth.org

Also, please see the Questions and Answers on the CDC website: http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm. Thanks for your interest!

Please specifically address the findings of Dr. Kathleen Thiessen, who was one of the 12 scientists who authored the National Academy of Sciences review of EPA fluoride standards.

Dr. Thiessen found a significant danger of fluoride overdose at 0.8ppm in drinking water, especially for infants. This is just 0.1ppm higher than the Coalition advocates.

Dr. Thiessen is a specialist in human health and ecological assessment, and as a scientist who reviewed all available fluoride research for the EPA, is one of the foremost experts on the topic in the nation. She understands the effects of fluoride better than any pediatrician or dentist ever could.

Why does the Coalition think that this rate of overdose in infants is acceptable? Especially considering that the infants most at risk would be from low-income families less able to afford filtered water?

Dr. Thiessen's presentation to the LA Water District:
http://www.sw4sc.org/met_kmt_talks.html

Transcript of her presentation:
http://iaomt.org/articles/files/files282/Theissen_MET_presentation[1].pdf

Her qualifications:
http://www.senes.com/bio_Kathy.html

Q. Isn’t it enough to brush, floss, and visit the dentist?

A. An ounce of prevention is worth a pound of cure.
Fluoridation reduces tooth decay for everybody by at least 25%, adults and children alike, over and above the benefits of brushing with fluoride toothpaste and regular dental visits. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm
http://www.thecommunityguide.org/oral/fluoridation.html

The CDC recommendation is: Daily and frequent exposure to small amounts of fluoride best reduces tooth decay for all age groups. Drink water with optimal levels of fluoride and brush at least twice a day with fluoride toothpaste—preferably after each meal. For children 2 and younger, use fluoride toothpaste if recommended by your dentist. http://www.cdc.gov/fluoridation/fact_sheets/fl_caries.htm

In Oregon, 58% of children with private health insurance received dental care in 2009, while only 38.8% of children on Medicaid received dental care. http://www.pewstates.org/uploadedFiles/PCS_Assets/2011/048_11_DENT_50_State_Factsheets_Oregon_052311_web.pdf

The lifetime per-person cost of Portland proposed water fluoridation program would be about $50. That’s a bargain compared to the lifetime cost of treating single cavity: $2000. http://www.admin.state.nh.us/wellness/PDF/Resources/Dental%20True_Cost_of_a_Cavity.pdf

Fluoridation reduces Medicaid expenditures, which is a savings for taxpayers. A Texas study found that water fluoridation reduced Medicaid expenditures by $24 per child/year. A New York study found that Medicaid recipients in less fluoridated communities required 33% more treatments for tooth decay than those in fluoridated counties. http://www.ilikemyteeth.org/wp-content/uploads/2010/11/Savings-from-Fluoridation.pdf

I am still learning about much of this, like many of you...and I don't know the ins and outs of flouride, but I do know the ins and outs of research. I think it's misleading to say that "studies that show flouride is harmful are simply not funded." That's not how research is done. The research is funded first, and the results show what they show.

If an idea is already accepted in the scientific community, say, that flouride is ok, then perhaps studies to re-test that idea might not garner a lot of funding. And, studies that show different results might be more prone to criticism of methods, and harder to publish. This is true in science all around, though, and generally the system seems to lead us toward the right answers.

Also, generally studies conducted in Asia do not meet the level of standard that they do in the U.S., and don't carry the same weight as studies here.

PEOPLE LISTEN!! There are two kinds of Flouride,the medical grade and the kind that is a industrial waste by-product literally scraped from the smokestacks of fertilizer and heavy metal factories.
Guess which kind they put in municipal water supplies...
Medical grade? no, too expensive...

They actually use the stuff they remove from the factories, and would put that in our drinking water!!!

Its no doubt that Flouride can help teeth, but what does it do to the rest of your systems?

If radiator fluid was good for your teeth, would you put that in your water? No, because it would poison the rest of your body.

why not address the fact that low income kids eat sugary garbage that rots their teeth? Why try to mask a poisinous diet with a toxic chemical?


Hello Mamas, As a mama myself with spotty childcare the last several days, I haven't been able to be as responsive as I'd wanted. BUT I'm planning to work on responses to the FAQs tonight if my toddler gets to bed at a decent hour :)

In the meantime, here is some very technical information about the purity standards for fluoride additives, as well as relevant links.


Fluoride is a mineral that is present in nearly all water sources, including Bull Run. Water fluoridation is the practice of adjusting fluoride levels up or down to the optimal level shown to prevent tooth decay: 0.7 parts per million (ppm). Optimal water fluoridation reduces tooth decay by at least 25 percent in both adults and children. Over 200 million Americans are on public water systems with optimal fluoride levels; this is over 70 percent of all public water systems. The health effects of water fluoridation have been rigorously studied and the only health outcome is a good one: reduced tooth decay.

Because natural levels can vary widely, the Environmental Protection Agency (EPA) sets a maximum level for fluoride at 4 ppm. This level was designed to prevent fluorosis, which is considered a "cosmetic condition" by the EPA. In the US, fluorosis mostly occurs as light white spots on the teeth. Fluorosis is not a medical condition. The EPA's maximum level is five times higher than the optimal level, and it is rare for a community water system to have fluoride levels higher than the optimal level.

Fluoride additives are regulated by the Environmental Protection Agency (EPA). Since 1970, the EPA has had a memorandum of understanding with the Food and Drug Association (FDA) giving the EPA authority over fluoride additives in public water supplies and the FDA authority over fluoride additives in bottled water.

The fluoride additives used for community water fluoridation must meet high standards for quality and purity. They must be certified as meeting the American National Standards Institute and National Sanitation Foundation Standard 60, which is stricter than pharmaceutical grade. Independent verification organizations test and certify fluoride additives, any products that form when they are added to water, and even the containers they are shipped in. All fluoride additives dissociate to sodium, fluoride, and silicate ions in water. Fluoride ions are chemically identical to each other, regardless of the source.

The ANSI/NSF Standard 60 sets a "Single Product Allowable Concentration" (SPAC) which is ten percent of the Maximum Contaminant Level (MCL) allowed by the EPA. The SPAC is set so low to provide protection for the consumer in the unlikely event of multiple sources of exposure. Fluoride additives are tested for arsenic, copper, lead, radionucleotides, and silicates. For every single fluoride additive, these potential contaminants have been completely absent or barely measurable.... just a tiny percentage of the SPAC. All of these certified products are listed on the NSF website.

A comprehensive, peer-reviewed assessment of the ANSI/NSF Standard 60 was published in 2004. It concluded that the process successfully prevented any problems with trace contaminants in U.S. water treatment additives.

Summary: Fluoridation additives are highly regulated and must meet strict standards for safety and purity.

Resources:

American Water Works Association (AWWA) position: http://www.drinktap.org/consumerdnn/Default.aspx?tabid=184

Centers for Disease Control and Prevention. Achievements in public health, 1900–1999: fluoridation of drinking water to prevent dental caries.MMWR 1999;48(41):933–940.


Brown, Cornwell, MacPhee. Trace contaminants in water treatment chemicals. Journal American Water Works Association 2004;96:12:111–125.

Centers for Disease Control and Prevention. Water Fluoridation Additives. http://www.cdc.gov/fluoridation/fact_sheets/engineering/wfadditives.htm

NSF Fact Sheet on Fluoridation Chemicals: http://www.nsf.org/business/water_distribution/pdf/NSF_Fact_Sheet.pdf

Typo: the Memorandum of Understanding between FDA and EPA is dated 1979, not 1970.

This is an important point, as people often wonder why fluoride additives to public drinking water aren't "FDA-approved."

Related to this question... sodium fluorides are put in drinking water (and toothpaste). Unlike calcium fluoride, sodium fluorides readily dissolve in water.

Thank you, Kylie!

Thanks, Kylie.

Fluoridation has been around for over 60 years and prevalent for longer. The issue of fluorosis has been studied and reviewed, largely to the ongoing engagement of researchers and scientists to ensure that it is safe in an environment where fear is prevalent. The level, 0.7 parts per million is considered very safe, with limited risk for even mile fluorosis. If folks are getting impacted from fluorosis, than it could be overexposure, but not from water - likely from more concentrated forms.

Additionally, any amount that is not consumed has little impact on the environment. The Columbia river, for examples, has a higher concentration of fluoride than 0.7 as it is. When city water runs into it, it will still serve to dilute the overall fluoride concentration, if anything, still it is such a relatively small amount when compared to what is already in the water.

Everything we eat is a chemical of some sort - what is most important is that we get the right amount of the ones that help us. Fluoride is one of those things that helps

Thanks to Olivia for the post, and the opportunity for critical analysis on the issue of fluoride. I'm another parent and activist on the issue working with Kylie and the Everyone Deserves Healthy Teeth Coalition helping to answer questions coming into the UrbanMamas.

A common question we've received is to respond to the Harvard Study about fluoride and IQ in children. This refers to Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis by Choi AL, Sun G, Zhang Y, Grandjean P, and published in Environmental Health Perspectives in July 2012.

The study authors do not raise concerns about US water fluoridation that is optimally set at 0.7 parts per million. This paper reviewed studies in China and Iran where fluoride levels are naturally and unusually high, up to 11.5 ppm, which is more than 16 times higher than the optimal level used to prevent cavities: 0.7 ppm. The authors said they could not do such a study in the US because the levels of fluoride are so low here, and could not identify a high fluoride group.

The study authors noted that any difference between groups was small and may be within the measurement error of IQ testing. They said “each of the articles reviewed had deficiencies, in some cases rather serious, which limit the conclusions that can be drawn.” For example, many of the studies did not account for other factors that could affect IQ (parental education, income, nutrition, other exposures).They also noted “the actual exposures of the individual children are not known.”

This paper did not draw any firm conclusions about even high fluoride levels and IQ, and it did not look at actual brain development or neurotoxicity.

Interestingly, the control groups - the groups with slightly higher IQs - had low fluoride levels similar to what we use in the US to prevent tooth decay.

In fact, between the 1940s and 1990s, the average IQ scores of Americans improved 15 points. This gain - about 3 IQ points per decade - came during the same period when fluoride steadily expanded to serve over 200 million Americans. Ulric Neisser, “Rising Scores on Intelligence Tests,” American Scientist , September-October 1997.)

Unfortunately it is difficult to find the original study on the internet, and examine the research yourself due to the proliferation of anti-fluoride press releases and unsubstantiated conclusions that misrepresent the study’s true findings. Please do share any page of any peer-reviewed study that proves a link between the US level of fluoride and any harmful conditions.

Here is a link to Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis by Choi AL, Sun G, Zhang Y, Grandjean P, and published in Environmental Health Perspectives in July 2012 that you can read for yourself:

http://ehp03.niehs.nih.gov/article/fetchArticle.action;jsessionid=5C98A897B69464FD44D98698EE9FC4A1?articleURI=info%3Adoi%2F10.1289%2Fehp.1104912#abstract0

Just because it's posted on the internet or a blog post doesn't make it fact. It's important to gather your information from a source you trust. I trust the American Adademy of Pedicatrics and the American Medical Association. Both groups thousands professionals across the US. Both groups have taken time to review the research. Both groups support community water fluoridation. I think I'll trust their judgement over that of those posting online who have unknown motive, unknown education, and live in an unknown location.

Here is what the Sierra Club has stated:

http://www.sierraclub.org/policy/conservation/water_fluoridation.aspx

Sierra Club Conservation Policies
Policy on Fluoride in Drinking Water

The Sierra Club recommends lowering the maximum contaminant level of fluoride in drinking water from the present 4mg/L to a level shown not to harm aquatic ecosystems or human health. [National Research Council, Fluoride in Drinking Water: a Scientific Review of EPA's Standards, March 2006]

The Sierra Club understands the historic reason that fluoridation of public water supplies has been promoted and that it may have been historically justifiable (162 million people get fluoride added to their municipal water supply at the recommended level of 0.7-1.2 mg/L). There are now, however, valid concerns regarding the potential adverse impact of fluoridation on the environment, wildlife, and human health.

Therefore, the Sierra Club believes that communities should have the option to reject mandatory fluoridation of their water supplies.

To protect sensitive populations, and because safer strategies and methods for preventing tooth decay are now available, we recommend that these safer alternatives be made available and promoted. If fluoride is added to municipal water supplies, sodium fluoride rather than flourosilicate compounds should be used because the latter has a greater risk of being contaminated with such heavy metals as lead and arsenic.

Before a water supply is fluoridated, there should be a local assessment of the impact on affected aquatic ecosystems. This assessment should examine background fluoride levels and estimate what the levels will be after fluoridation. It should also assess the effect of this increased fluoride on downstream aquatic ecosystems.

Board of Directors, June 19, 2008

--

...Who's assessing and generating an Environmental Impact Statement?
...Who chooses sodium fluoride verses flourosilicate compounds?
...What is the independent verification process for testing heavy metals contamination?

City Council meeting is at 2pm on this Thurs September 6th...if Fluoride in our water supply concerns you, please come to this meeting!!!
The city council will vote on this issue on Sept 12th. They are already projected to approve putting fluoride in the water, and then we will have to gather 20,000 signatures in 30 days to get it on the ballot.
Let's go to that meeting and let them know our concerns, and why we want them to vote NO to compulsory fluoride consumption. See you there!!!

What I still can't figure out from all the pro fluoride people: Why do you feel a municipality has the right to add something to the water that clearly many folks do not want or at least question...why are you AGAINST giving people the option to fluoridate? Why should it be in our water, ALL the water that comes out of the tap?
If you want fluoride why not...
1.take the medical grade pills
2. get treatments at the dentist
3. buy fluoridated water for your family
4. support spending that money to improve nutrition/dental access where needed
Why is it okay to force it on everyone, do we not all have the same rights? Because you think fluoride is good, that makes your opinion more valid than those who think it is poisonous?
re
Show me one other drug (on your toothpaste tube & pill bottle it is in fact listed as a drug) that has a "one dose fits all" measurement...pretty sure there isn't one..how are you going to regulate and track babies, athletes, dialysis patients etc...You can't...Someone please explain how this is okay?

and PLEASE, can someone explain why your opinion is more important? Why do WE have to be forced to have fluoride in our water because YOU think it is good for us???? As I said above, take if you want it, let those of us who don't want it opt out.
that is simple human respect in my book : )

Bastia, I want to respond to your assessment of how studies are funded...
The original author used the unfortunate expression "studies that show flouride is harmful are simply not funded." You're right that studies are generally set up objectively, to prove or disprove a hypothesis, not to set out to show that conventional wisdom is wrong. A study's _hypothesis_ could be to question whether Fluoride is harmful, but studies are expensive, and it is rare for the entities with enough funding to run a study questioning the conventional wisdom, would also be interested in questioning the conventional wisdom, because generally the status quo has helped them to become wealthy in the first place.

About the only reason I can think of that the promoters of a substance would have to test it for possible safety concerns, would be to have it accepted by the FDA as a commercial drug. And there are a lot of stories about corruption in that field, and people doing bad science to 'miss' the unfavorable outcomes that would keep a drug from coming to market.

There are a lot of examples of grand-fathered substances not being studied for their dangerous side-effects (or at least not publicizing them, once they were discovered - think tobacco here). Someone at the council meeting brought up the long journey towards realizing the obvious harmful effects of lead, which is summarized here: http://www.epa.gov/history/topics/perspect/lead.html (starting about halfway through the 'Running on Lead' headline). There are many parallel examples around the lack of effective studies around the impacts of cell phones, deterioration of visual accommodation (the results of which would likely not reflect well on opthamologists or makers of TVs, computer screens, or now, smart-phones), consumption of processed food (big names there), etc, where powerful interests would lose out if the safety of the product is thrown into doubt. There are other categories for which studies are made, but the results are politically downplayed to protect the interests of the status quo, including global warming, exposure to automobile exhaust, or any number of other questionable practices which have become standard elements of modern living. I am particularly suspicious of dentists, who don't seem to study the effect of nutrition on tooth health very much, and have a generally set (and profitable) routine of drill, fill, cap and pull.

My dentist is very 'good', but I still have to ask tons of questions over many visits to translate his worldview into one that actually has relevance to my life, so that I can have something other than a mouthful of mercury or repeated plastic fillings in my teeth. I finally halted over a decade of destructive tooth grinding, which was wearing down my molars quite significantly, even though I'd never had a cavity, by figuring out myself how to re-set my bite to reduce pressure on my rear teeth. I did find out about expensive mouth-guards that help train the jaw to re-align the bite, but my dentist never suggested them because that _wasn't his specialty_. In the stressful, fast-paced world many of us are trying to live in today, you'd think professional dental knowledge about how to relieve the origin of dental damage would be better known, but it isn't. We all love quick fixes, and I think this Fluoridation issue is another case of a quick, feel-good, and profitable (for some) decision being rammed (literally) down our throats without having conducted deep FDA-approved studies of safety on a drug that has been effectively grand-fathered in. Or rather, as pointed out above, it was handed over to the EPA, when it comes to community water fluoridation.

I was wondering if anyone has a link to the CDC data on decay rates for Portland vs Oregon in general? I've been having a hard time finding it. Thank you for posting the link to the Harvard fluoride meta-study. I was very impressed by the testimony of the first nine 'opposed' citizens, as well as the West Slope water commissioner, who I got to see speak at the council hearing - I went mostly concerned about the lack of public process and informed consent, and came away armed with information. It has been interesting to see at the meeting, as well as above, the argument that in the Harvard review, the control groups largely had fluoride exposure at or above what is being proposed for Portland's water supply, so therefore we must be safe at that level. Rather, to me, if measurable differences could be determined between groups that were at 1ppm Fluoride, and groups that were higher, there is a real need for study between groups at less than 0.1ppm and those at 1ppm and higher. As was pointed out quite clearly at the council meeting, standard dosing procedures incorporate a 10:1 margin of safety between effective dose and minimum dangerous dose, and the

I was quite impressed with the democratic spirit I saw at the council meeting, and the compassionate humanity and respect displayed by Amanda Fritz, who particularly continues to impress me. I didn't get a chance to speak, and I'll submit a comment if I can figure out how to, but one suggestion that I still haven't seen, and Mayor Adams almost seemed to be begging for at a couple points, is an alternative distribution method for giving fluoride out to those who can't afford it, want it, and most need it. Clearly, the role of leadership in a city like Portland, is to make partnerships, and who wouldn't want to make a feel-good partnership with the city to distribute free fluoride treatments to poor kids who want to protect their teeth. Maybe a big-box store chain, or pharmacy, the declining Postal Service mail carrier system, or even special racks on Tri-Met buses which already rove all over town, or a combination of all of the above, could be used to distribute fluoride conveniently to whoever would want it, all at very little cost, and without contaminating the city's water supply.

The whole country looks at us as a quirky but innovative city, why don't we look for an 'outside the box' solution? It would surely cost less than providing the network of free reverse-osmosis filters that many concerned and medically-sensitive people are going to demand if this goes through. How many poor people are going to suffer trying to afford personal reverse-osmosis or aluminum-oxide water filters so they can drink un-medicated water, what will they do with all of the RO waste water, and how much will that cost us in the long run?

Thank you Bea!

Wake up! No more toxins in our water! Can we please stop the spraying also?!! It's a terrible feeling to wake up each morning, raising our kids in this hellish slave land knowing they'll be bombarded with more deadly toxins at every turn than I. And all I have to expect is explosive cancer and a painful deterioration of health earlier than my parents.

Did you really just refer to Portland as a "slave land"? Yes, that's what this is; our *elected* officials making public health policy decisions without a weigh in from every layman and woman in the county equals slavery.

@ema - once again, ITA.

Calling PDX slave land because our elected representatives did something we don't like is veering into Teabagger territory. You know, when they insist all our freedoms are lost any time we have to pay taxes (which pay for our free society and general welfare there of, but hey why get technical, right?).

I personally HATE how parking tickets are handled (rude, snotty meter cops looking for any reason to cite you, followed by the guilty until proven innocent process), but I'd hardly say I'm enslaved by it.

Jsantoslyons misinterpreted the Choi Fluoride/IQ Review of Studies

Harvard researchers concluded, after reviewing 27 fluoride/IQ studies, that fluoride’s effect on children’s developing brains should be a “high research priority” especially in the US which has never investigated brain/fluoride effects.

Fluoridation activists, however, misinterpreted this research and mislead legislators in Phoenix, Portland, Wichita and elsewhere by stating the Harvard research isn’t relevant to Americans. Advocates claimed the Harvard study found only a ½ point difference in IQ, and that the fluoride levels were much higher than Americans experience.

That’s wrong. The Harvard team found that fluoride exposure was associated with a statistically significant reduction of 7 IQ points, not the ½ point claimed by advocate, Dr. Myron Allukian. Jsantoslyons, the Pew Children’s Dental Campaign and other fluoridation advocates, including Allukian and Portland Mayor Sam Adams, have stated the Harvard study focused on fluoride levels of 11.5 mg/l. Only one of the studies, however, was at 11.5 mg/l.

The majority of water studies examined by the Harvard team investigated fluoride levels which the US EPA says is safe – less than 4 mg/l.

• One study, sponsored by UNICEF, found reduced IQ at just 0.88 mg/l – a level within the “optimal” fluoride range added to the drinking water of over 200 million Americans.

• Seven found reduced IQs among children drinking water with fluoride levels between 2.1 and 4 mg/l — levels that 1.4 million Americans drink everyday.

• Four found effects at levels between 1.8 and 2.0 mg/l — levels that over 200,000 Americans drink everyday.

EPA’s conventional approach to risk assessment limits chemical exposure to levels ten times less than those known to cause adverse effects. With fluoride and IQ, the levels of fluoride in water and urine are — at most — just two or three times more than the amount experienced by tens of millions of American children

Children with iodine deficiencies are particularly harmed by fluoride. And iodine deficiency has increased significantly and now affects up to 12% of the US population.

The question legislators should be asking themselves is "Do I wait until public health officials catch up with the scientific literature that now shows fluoride can cause serious neurological harm to children, or do I take my leadership role seriously and stop fluoridation immediately,”

Legislators should also question fluoridationists who have fed them misinformation making them look quite foolish.

Do your own research, as I did. Read everything from all sides and decide for yourself. I wanted to find that water fluoridation is "safe and effective", as the tag line I kept hearing claims, but it's just the opposite. I started with the CDC and EPA websites. The 2006 EPA Review of Fluoride in Drinking Water produced by independent scientists, National Research Council and Academy of Scientists will probably be enough for most people to vote against it. In 2000 The EPA Union of Scientists demanded fluoridation be banned, that should tell you something. The more I read, the more sick to my stomach I got. Do you think it's right to put a substance in the water, a known toxin (as defined by the CDC site) that causes an increase in osteosarcoma in young boys? This is known (look up Kingston and Newburgh, NY)(Bassin 2001, Harvard Dental School). They have known this since the 50s, and yet they have continued this practice. Now, after decades of exposure and more studies, they know that it causes a host of other health issues from thyroid, to pineal gland, neurotoxicity, behavioral changes, diminished cognitive function, dental and skeletal fluorosis. Go to www.CleanWaterPortland.org and get involved, sign the petition so the public can vote, and do your research!!

If iodine deficiency is such a terrible problem perhaps they should consider adding iodine to something most people (even the poorest amongst us) consume every day? Maybe something like salt? Of course that'd be tantamount to "involuntary mass medication" so I'm sure nobody would support such an idea and they'd be protesting it on the streets in droves.

I'm going to assume that all those who oppose adding fluoride to the Bull Run water are campaigning with equal vigor to remove the naturally occurring low levels that are present in this otherwise pure source, which they only recognize as pure because of the agencies which have tested and verified it as such, whom they refuse to believe.

http://www.portlandoregon.gov/water/article/327673

http://www.medicalnewstoday.com/releases/257539.php

"The results, published online in the Journal of Dental Research, show that adults who spent more than 75 percent of their lifetime living in fluoridated communities had significantly less tooth decay (up to 30 percent less) when compared to adults who had lived less that 25 percent of their lifetime in such communities.

"At this time, when several Australian cities are considering fluoridation, we should point out that the evidence is stacked in favor of long-term exposure to fluoride in drinking water," said Kaye Roberts-Thomson, a co-author of the study. "It really does have a significant dental health benefit."

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