Federal Fluoride Follies

The Irrational Science of Swallowing Fluoride
in Water and Supplements


John D. MacArthur

Environmental Protection Agency

1983 EPA letter In 1983, the EPA admitted that its primary water fluoridation chemical is a water pollutant (right): "In regard to the use of fluosilicic acid as a source of fluoride for fluoridation, this Agency regards such use as an ideal environmental solution to a long-standing problem. By recovering by-product fluosilicic acid from fertilizer manufacturing, water and air pollution are minimized, and water utilities have a low-cost source of fluoride available to them."

The EPA regulates fluoride as a "contaminant" in drinking water. The EPA's previous Maximum Contaminant Level for fluoride was 1.4–2.4 ppm, but in 1985 it was raised to 4.0 ppm (4 mg/liter) – for unscientific reasons. Documents show that EPA management allowed political pressures to trump the clear consensus among its scientists that 4.0 ppm was not safe. [EPA 1985]

The EPA's comprehensive 2013 report, "America's Children and the Environment," completely ignores fluoride, even though it has a chapter on Drinking Water Contaminants.

Environmental Health Perspectives, a US government-sponsored journal, provides authors with more than 1,000 suggestions for key words, including more than 125 for "environmental agents." Fluoride or fluorosis are not among those key words.

The EPA's Neurotoxicology Division has determined that fluoride is a "developmental neurotoxicant" – one of about 100 chemicals with "substantial evidence" (highest category) for toxicity to the developing mammalian nervous system (below).

Developmental Neurotoxicants  EPA.jpg

Food and Drug Administration

The FDA regulates fluoride as a "drug" in supplements and in toothpaste. Despite this, "FDA has approved no fluoride-containing supplements as prescription or over-the-counter drugs."

Because sodium fluoride was "grandfathered" in as a drug in 1938, drug manufacturers have not been required to file a New Drug Application. "The premise was that all pre-1938 drugs were considered safe," said the FDA, but admitted: "We don't have information on the medical uses of fluoride before 1938." [FDA 2004]

Fluoride supplements are intended for children in nonfluoridated areas. Six-month-old infants (sometimes younger) are often prescribed 0.25 mg of fluoride in the form of Sodium Fluoride Drops, an unapproved drug. This dosage is 15 times higher than the fluoride consumed by six-month-old (8 kg) breastfed infants, who average about 0.002 mg of fluoride per kilogram of weight. (See Infancy and Fluoride Do Not Mix.)

Fluoride Irrationality: Pharmacist or Faucet?

When deciding whether an infant should swallow a maximum daily dose of 0.25 mg of fluoride in a supplement, the ADA says:

Healthcare providers should consider "the individual patient's needs and preferences" before making a "judicious prescription" of dietary fluoride supplements. [ADA 2010]

In February 2014, the ADA again stressed the importance of "developing a personalized prevention plan":

"It also is critical that the dentist assess a child's total fluoride exposure from all sources (beverages, food, toothpaste, supplements, topical applications and so forth)." [ADA 2014]

In fluoridated areas, however, these important considerations are ignored before deciding whether a child should swallow that same 0.25 mg of fluoride when it's in drinking water. (They are usually ignored in nonfluoridated areas too.) No longer treated as an individual patient, that child is now considered as part of a vast herd, even though it's the exact same 0.25 mg dose of fluoride being consumed. The only difference is the concentration of fluoride and amount of water.

Fluoride Irrationality: Supplements, Water, Toothpaste

Fluoride toothpaste has a FDA-mandated warning:
"If you accidentally swallow more than used for brushing,
seek professional assistance or contact a Poison Control Center immediately

Fluoride Concentration: Water, Toothpaste

Same fluoride dose in water and toothpaste.

Fluoride Treatments at the Dentist
The American Academy of Pediatric Dentistry recommends that fluoride varnish should be applied to the teeth of all infants and children every 3 months, starting when the first tooth erupts. After fluoride varnish (22,600 ppm fluoride) was applied to the teeth of toddlers, their mean estimated plasma fluoride concentration increased from 13 to 21 micrograms/L during the 5 hours after treatment – with a peak concentration of 57 micrograms/L. [Milgrom et al. 2014]

After prophylactic treatment with fluoride gel (12,300 ppm fluoride), from 2 to 31 mg of fluoride may be swallowed by children. [Lecompte 1987; Spak et al. 1989] 30 mg is more than 16 times the Tolerable Upper Intake Level (UL) of fluoride consumption for a 40 lb. (18 kg) child.

Ineffectiveness and Risk of Fluoride Supplements
"No conclusion could be reached about the effectiveness of fluoride supplements in preventing tooth decay in young children (less than 6 years of age) with deciduous teeth.... The current recommendations for use of fluoride supplements during the first six years of life should be re-examined." [Cochrane 2011] Also, no evidence of safety was found.

"The risks of using supplements in infants and young children outweigh the benefits." [Burt 1999] "This review confirmed that in non-fluoridated communities the use of fluoride supplements during the first 6 years of life is associated with a significant increase in the risk of developing dental fluorosis." [Ismail and Bandekar 1999]

Ineffectiveness of Fluoridated Water: Claim Allowed by FDA
After reviewing the best available evidence for the effectiveness of water fluoridation, the FDA would only allow a very weak claim: "Drinking fluoridated water may reduce the risk of [dental caries or tooth decay]." [FDA 2006]

"May" reduce the "risk"...
The same could be probably said for many substances, including clean water.

Centers for Disease Control and Prevention

The Oral Health Division of the CDC said that fluoride's "actions primarily are topical." [CDC 1999] Saliva and teeth are briefly exposed to fluoridated water while it's in the mouth. Swallowing fluoride ultimately also involves a topical action, because fluoride enters the bloodstream and into bodily tissues, including salivary glands that secrete a tiny amount of fluoride to act topically on teeth.

"Saliva is a major carrier of topical fluoride. The concentration of fluoride in ductal saliva, as it is secreted from salivary glands, is low – approximately 0.016 parts per million (ppm) in areas where drinking water is fluoridated and 0.006 ppm in nonfluoridated areas. This concentration of fluoride is not likely to affect cariogenic activity. However, drinking fluoridated water, brushing with fluoride toothpaste, or using other fluoride dental products can raise the concentration of fluoride in saliva present in the mouth 100- to 1,000-fold. The concentration returns to previous levels within 1 to 2 hours but, during this time, saliva serves as an important source of fluoride for concentration in plaque and for tooth remineralization." [CDC 2001]

Okay then, what contribution does "drinking fluoridated water" make to "raise the concentration of fluoride in saliva present in the mouth" compared to "brushing with fluoride toothpaste, or using other fluoride dental products"?

Reality Check: essentially zero.

Fluoride Concentration: Water, Toothpaste

The CDC dentists' statement is like saying: Each time you brush your teeth with fluoride toothpaste and rinse with fluoride mouthwash, you'll earn $1,230 dollars. Each time you drink a glass of fluoridated water, you'll earn 70 cents plus a bonus of 1.6 cents every hour!

Fluoride toothpaste (1,000 ppm fluoride) is 62,500 times more concentrated than ductal saliva. Fluoride mouthwash (230 ppm fluoride) is 14,375 times more concentrated than ductal saliva.

Ductal saliva with 0.016 ppm fluoride translates into about 1 microgram of fluoride per hour (based on 1.5 liters of ductal saliva produced per day). That, in a nut shell, is the rationale for the government's dire need for us to swallow fluoride.

It seems that the mere 0.4 microgram of fluoride per hour produced in the ductal saliva of people not drinking fluoridated water is ineffective. That extra 0.6 microgram per hour from fluoridated water is what makes all the difference: inhibiting bacteria and remineralizing over a 100 tooth surfaces. Seriously?

Fluoridated Water is Crappy Mouthwash
Compared to fluoride toothpaste or fluoride mouthwash, where fluoride is brushed on teeth or vigorously swished in the mouth for 1 to 2 minutes (2 or 3 times a day) – and then spit out – fluoridated water merely passes near teeth for a few seconds as it's swallowed several times a day.

Fluoridated water's insignificant effect on oral health was confirmed by the U.S. National Institutes of Health's biggest and still the best epidemiological study that found less than 1% difference in the number of healthy tooth surfaces (not decayed, missing, or filled) in 38,000 children aged 5-17 years living in fluoridated vs. nonfluoridated communities. [Brunelle and Carlos 1990]

Why You Should Not Believe the Fluoridation Sales Pitch

Public Health Service

The original rationale for artificial water fluoridation was based on a survey in the 1930s of 21 cities in four states by H. Trendley Dean, a PHS dentist. Based on his "hunch" that fluoride prevented dental caries, Dean presented data suggesting that fluoride naturally in local water supplies apparently correlated with fewer cavities in children.

Dean's findings were much criticized for their scientific method but became the foundation for justifying the implementation of artificial water fluoridation in 1945. Dean later admitted under oath that his studies in those 21 cities did not even meet his own criteria. [Bryson C. The Fluoride Deception. Seven Stories Press;2004:43. Chapter 3:Notes;74,75.]

In 1981, the Austrian statistician Rudolph Ziegelbecker analyzed all of Dean's studies (Dean had omitted data from 26 states) plus all other published studies involving rates of dental caries in areas where the drinking water contained natural fluoride. The research involved more than 48,000 examined children in North America and Europe. The data showed that fluoride in water was not associated with less cavities:

"The prevalence of dental caries in children aged 12 to 14 from 136 communities with drinking water containing 0.15–5.8 ppm fluoride shows no relationship with the concentration of fluoride naturally in drinking water."

Today there is no evidence of any better oral health in the eight million Americans the CDC said are served by community water systems that have "sufficient naturally occurring fluoride concentrations." [CDC 2008]

On the other hand, Dean was correct about increased dental fluorosis, as Ziegelbecker's analysis confirmed:

"It is evident that the incidence of 'mottled enamel' is positively correlated with the concentration of natural fluoride in drinking water."

From 1986 to 2004, the prevalence of mild dental fluorosis in US adolescents (aged 12–15) more than doubled, from 4.1% to 8.6%. Moderate and severe dental fluorosis nearly tripled. [CDC 2010]

"Dental fluorosis, no matter how slight, is an irreversible pathological condition recognized by authorities around the world as the first readily detectable clinical symptom of previous chronic fluoride poisoning. To suggest we should ignore such a sign is as irrational as saying that the blue-black line which appears on the gums due to chronic lead poisoning is of no significance because it doesn't cause any pain or discomfort." – New Scientist (1983)

More Fluoride is Absorbed from Artificially Fluoridated Water
The degree of absorption of any fluoride compound after ingestion is correlated with its solubility. The readily water-soluble industrial fluorides (sodium fluoride, sodium silicofluoride, fluorosilicic acid) used to artificially fluoridate drinking water are rapidly and almost completely absorbed, in contrast to low-soluble natural compounds such as calcium fluoride. The fluoride that is absorbed into the bloodstream arises chiefly from public water supplies. [European Food Safety Authority 2013, Sauerheber 2013]

"The solubility of fluoride correlates
generally with the degree of toxicity
." – Merck Manual

Ultimately, the fluoride ion is the culprit, according to the Public Health Service Agency for Toxic Substances and Disease Registry:

"The fluoride ion is the toxicologically active agent. ... Existing data indicate that subsets of the population may be unusually susceptible to the toxic effects of fluoride and its compounds." [PHS 2003]

Research Reports by John D. MacArthur

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