Is there a natural way to fight dental decay?

A fluoride-free approach to protecting babies, toddlers and preschoolers

Dr. Hardy Limeback BSc PhD (Biochem) DDS Prof. Emeritus

Former Head of Preventive Dentistry University of Toronto

The Toronto Total Health Show�April 2013�

Copyright�

In accordance with Canadian and American copyright laws, a small percentage of the material in these lectures is provided without permission from the author, only for purposes of criticism, comment, news reporting, teaching, scholarship and research under the "fair use" provisions of federal copyright laws. �

Hardy Limeback�

Disclosures�

I have no financial interests in any product or company mentioned in this lecture.�

I have edited a textbook entitled “Comprehensive Preventive Dentistry”�

–some material in this lecture is based on material in the book (but not the same)�

Published July 2012�

Topics�Why baby teeth get dental decay �

natural strategies to reduce dental decay �

�- reduce carbohydrate frequency �

�- xylitol: the ‘birch sugar’ that fights cavities�

�- probiotics: can they really reduce tooth decay?�

�- remineralization therapies�

�-Sunshine, Vitamin D supplementation, and tooth decay�

How fluoride works to reduce dental decay�

Why fluoridation harms more people than it helps�

This kind of decay, �is rare today.�

�

I�SOUND TOOTH�

M� L�E�

S� S�

If each tooth is protected,it remains unaffected.

Saliva � flow, buffering, pH, anti-bacterial proteins, IgA�Mineralization salivary Ca++, PO4

--- , alkali�Ideal Diet � calcium, protein, less frequent refined carbohydrates�Less Biofolm � good bacterial flora, low S. mutans & lactobacillus�Enamel Resistance morphology, crowding, enamel defects, �Superior Dentistry � healthy restorations, orthodontics�

Protective Factors� �Dental Decay�

If one factor�s diminished,�the tooth is finished.�

Here are the bacteria that cause decay:�-Streptococcus mutans �

�-this one starts it all by making acid��-babies don�t have it until colonized by �� �others when baby teeth first appear��-S. oralis, S. mitis, S. salivarius can make acid too�

-Actinomyces (root caries mostly)�-Lactobacilli (these thrive in acid and make more)�-Veillonella, Bifidobacterium, Propionibacterium �

�may also play a role �

1. Aas JA. et al. (2008) J Clin Micro 46, 1407-117.�2. Filoche et al. (2010) J Dent Res 89, 8-18.�

2-Tone staining for Dental plaque.�

S. Mutans colonies Plaque biofilm�

Sugar makes�S. Mutans stick �better to teeth�

REPEATED CYCLE�(frequency)�

introduce �antimicrobials�

neutralize�plaque acids� apply�

remineralizing�minerals�

modify the diet�introduce�probiotics�

stimulate�saliva�

improve hygiene�

acid�

Enamel�

+�

Sugar�

Plaque Bacteria�

+�Caries�

Strategies to reduce caries�

7 -

6.5

6 -

5.5

5 -

4.5

0 10 20 30 40 50 60 Time (minutes)

Plaque pH Critical pH�

AUC�

caries resistant�

inactive�

active�

Classic Stephan Curve�

Stephan RM, Miller BF. (1943): A Quantitative Method for Evaluating Physical and Chemical Agents which Modify Production of Acid in Bacterial Plaques on Human Teeth, J Dent Res 22:45-51.).

Sucrose�

The area under the curve (AUC) �determines the �

extent of enamel loss�

Remineralization�

DEmineralization�

3 cariogenic snacks + 3 �cariogenic meals = 6 acid �challenges with poor recovery������4 �meals� of moderate cariogenicity spread evenly �throughout the day�����Caries resistance diet�-3 meals of low cariogenicity�

breakfast � lunch dinner� snack snack � snack�

pH 5.5 (critical pH)�

breakfast � lunch dinner�� snack�

breakfast � lunch dinner���

Routine daily snacking on carbs will result in a net demineralization each day. �

http://www.brianpalmerdds.com/pdf/caries.pdf�Indulgy.com�

Traditional diets�and prolonged breast �feeding do not cause �

dental decay �

www.sippigrip.com�

Sports Drink Retail Sales (Million $)�

www.kellogg.northwestern.edu�

Many of today’s drinks from �toddler age and up contain sugar�

Even milk can cause baby’s teeth to decay. �Do not put the baby to sleep with a bottle (unless it’s water) �

Bottled milk vs Breast milk�

Early Childhood Caries�

Frequent snacking on fruit can �cause early childhood decay �

Bolivia�

Bolivia Mission-July �09 �

Bolivia Mission July�09�

Disaccharides� sucrose �maltose �lactose�

Monosaccharides� glucose �fructose �galactose�

Polysaccharides� starch �converts to maltose by salivary amylase�

Sugar alcohols� sorbitol �mannitol �xylitol�

Decreasing Decay potential�

Destructive�

Protective�

The carbohydrates and dental decay potential�

Dissacharides Sucrose -sugar cane -sugar beets

Maltose -sweet potato -cereal

Lactose -milk

Monosaccharides Glucose -honey and fruits

Fructose -fruits and fruit juice -honey

Galactose -cereal -vegetables -honey

Polysaccharides

Starch -complex carbohydrate (amylose + amylopectin)

Converts to maltose by salivary amylase

-potato -corn -rice -wheat -nuts and legumes

Sugar alcohols Sorbitol -fruits

Mannitol -seaweed -mushrooms

Xylitol -birch -corn -fruit

Organic carbs can’t protect you from tooth decay�

Organic carbs *DO* have some dental �disease fighting properties�

�BUT….no clinical trials yet to show that these �

healthy sugars benefit the oral cavity��

Varoni EM, Lodi G, Sardella A, Carrassi A, Iriti M. Plant polyphenols and oral health: old phytochemicals for new fields. �Curr Med Chem. 2012;19(11):1706-20.�

Sugar� Beneficial factors�

Raw Cane Sugar � high in calcium, antioxidants�chewing stalk removes dental plaque�

Agave Syrup �� high fructose inulin (not as potent as refined sucrose)�

Maple sugar � mostly sucrose but some calcium & antioxidants�

Honey ��fructose (38%), glucose (31%)�-anti-oxidants and anti-inflammatory polyphenols �

Soda pop (ab)use�

Teenagers consume 34 teaspoons of refined sugars a day…44% from soda pop!!!�

Researchers at Harvard University say sugary drinks are contributing to an estimated 180,000 deaths around the

globe annually��

http://www.ctvnews.ca/health/sugary-drinks-linked-to-staggering-180-000-deaths-each-year�

Snacking �on�

fruit�Can still cause �dental decay�

Even organic snacks �can cause dental decay.�

Switch them to mealtime.�

Sorbitol

Mannitol

Maltitol

Lactitol

Erythritol

Isomalt

Xylitol

Sweets�with �sugar �

alcohols �don’t cause �dental decay�

Sweetener� properties�Relative sweetness� (sucrose = 1)�

Saccharin �(Sweet ‘N Low,� Sweet Twin)�

-Artificially produced from phthalate anhydride�-OK in the US banned in Canada�

300-500�

Aspartame (Nutrasweet,� Equal) �

-Asp-Phe dipeptide may cause phenylketonuria�-can’t cook with it�

180�

Acesulfame K �(Sunett, �Sweet One)�

-bitter: usually blended with other sweeteners for a better taste�

200�

Sucralose �(Splenda)�

-chlorinated sucrose�-does not affect insulin� 600 �

Sugar substitutes�

Up to 1 gm bulk glucose�added (which is allowed) �-rounded DOWN to zero�

�Contains equivalent �of � sugar cube�

(enough to cause cavities �if ingested frequently)�

Non-cariogenic Sweetener (Natural)�

- Not fermentable, �- 300 X sweeter than sucrose�- 2008/9 Coca Cola got FDA approval for �Truvia� �and PepsiCo got approval for �PureVia� �

Stevioside = steviol + 3 glucose�Rabaudioside A = steviol + 4 glucose

Stevia plant�

Limeback, H. (1995). The Canadian Dental Association guidelines on chewing gum recognition.

J Can Dent Assoc; 61(4): 331-2, 335-7. �

Recognition of sugarless �chewing gum with xylitol �

Product�Cosmetic, Food, Drug or Natural Health Product?�

Fluoridated �toothpaste�

Drug, because it contains fluoride and makes a

therapeutic claim�

Toothpaste �Natural ingredient�

Natural health product�

Chewing gum�No claim�

Food, because it is meant for oral consumption.�

Chewing gum �Anti-caries claim�

Drug�

Tooth whitening gum�Cosmetic + food, because

consumption is secondary to its cosmetic cleansing property.�

European Xylitol Treats�

To get the �tooth friendly� seal in Europe;�

• must contain 50% xylitol

• no fermentable carbohydrates except sugar alcohols

• must pass the plaque pH test

100% Xylitol Gum�

Before� After�

Pictures courtesy of Dr. L.R. Misner, DDS and Dr. Larry W. Bybee, DDS

Use this gum as a frequent snack, �and notice how little there is of plaque.�

Moms who chew xylitol gum for just half a year have children with fewer cavities.��

Söderling E, Isokangas P, Pienihäkkinen K, Tenovuo J, Alanen P. �Influence of maternal xylitol consumption on mother-child transmission of �mutans streptococci: 6-year follow-up. Caries Res. 2001 May-Jun;35(3):173-7.�

Soothers and spoons can get contaminated �with S. mutans.; �

To reduce the risk of dental decay in toddlers��•  Keep your own mouth healthy (good oral hygiene)�•  Take care of any cavities (see a dentist)�•  Avoid frequent snacking on sweet foods�•  Try to avoid sharing utensils, licking soothers�•  Regularly chew gum sweetened with 100% xylitol�•  Moms/dads who don’t chew gum can use xylitol mints�

100% Xylitol gums are sold primarily in health food stores�

12 pieces: $2.69 10 pieces: $2.49 12 pieces: $3.39

Also order online -see www.xlear.com�

Xylitol mints and gums now sold in mainstream pharmacies�

Direct marketing to dental offices through sales representatives…dentists then provide a �pseudo� Rx for over-the-counter products

CAUTION!!!�

• 0.1 g/kg = one piece of 100% xylitol chewing gum ingested by a hypoglycemia

Don�t let me find it....I�ll eat it!��Our dog (died of natural�causes)�1998-2011�

Piscitelli C, Dunayer E, Aumann M. Xylitol toxicity in dogs. Compend Contin Educ Vet. 2010;32(2):E1-4�

Keep xylitol away from dogs- they get huge

insulin spikes.

• 0.5 g/kg = one pack of 100% xylitol chewing gum ingested by a liver failure

Why xylitol isn’t popular with public health�

...�approximately 3000 pieces of chewing gum would be needed to avoid one

cavitated lesion, and the direct cost only for the gums would therefore exceed 300 USD.�

Maybe because public health won�t give up fluoridation.

Twetman S. Current controversies--is there merit? Adv Dent Res. 2009;21(1):48-52.�

Escolar (Hawaiian walu)��Fat free� Chips with �Olean (Olestra)�castor oil �

Loose stool, if eaten in significant quantities�

xylitol-sweetened treats�jojoba oil�

What do these foods have in common?�

Azarpazhooh A, Limeback H, Lawrence HP, Shah PS. Xylitol for preventing acute otitis media in children up to 12 years of age. Cochrane Database Syst Rev. 2011 Nov 9;(11):CD007095. �

But wait... xylitol can reduce acute otitis media (inner ear infections) by 30%

46�

Spry Pacifier�For reducing risk of

early childhood caries �

Adjustable Window�(can control DOSE of

xylitol delivered)

Only sold in health food stores and pharmacies

Using pacifiers to �deliver xylitol to babies�

Other benefits of xylitol�•  Dietary xylitol improves the bioavailability of

calcium salts (good for bones and teeth)�•  Hygroscopic and hydrophilic (good for the skin)�•  Good for wound healing, preservation of blood

and transplant organs�•  Helps in agriculture ��  pigs have better memory�

�  broiler chicks grow better�

�  less ketosis in cows, improves milk output�

Probiotics�Two oral bacteria that do not ferment sugar�

�Lactobacillus rhamnosus GG��Bifidobacterium lactis BB-12�

�Studies on children in Scandinavia��Nase et al (2001) Caries Research�

Milk containing L. rhamnosus GG �reduced caries risk in preschoolers��Taipale et al (2012) caries Research�

B. lactis BB-12 did not affect S. mutans�

Probiotics�

Burton et al (2013) J Med Micro (ahead of print)�

3-mo. RCT (randomized clinical trial) �on 100 caries-active children�-double blinded �-treatment with the probiotic � Streptococcus salivarius strain M18�-reduced plaque significantly (P < 0.05) �

Each piece contains a minimum of 500 million�colony forming units of

BLIS K12 S. Salvaria*�

*BLIS stands for Bacteriocin-Like-Inhibitory-Substance

James SM, Tagg JR. The prevention of �dental caries by BLIS-mediated inhibition�of mutans streptococci. N Z Dent J. 1991 �

L. Reuteri �Strains: �

ATCC55730 �PTA 5289�

-may reduce S. mutans�-but the product is meant

to improve gum health�

Probiotics�

Marketing to the �dental profession�

�-need long term �clinical trials� with caries �

as the outcome�

The new generation probiotics,�will contain GMOs.�

�Our replacement therapy �technology is based on the creation �of a genetically altered strain of �S. mutans (SMaRT), which does �not produce lactic acid.���Source: Oragenics website�

• No acid produced, �• Genetically stabile, �

• continued growth of the GM-S. mutans�• aggressive displacement of native-S. mutans, �

• no adverse effects in rodents, �• colonization after 5 min. (Phase 1 trials)�

��

Natural Remedies �and Herbs�

Natural Remedies�Thai teas�Thai licorice root�

�- Albizia myriophylla Benth. (Leguminosae)��- the most activity against S. mutans�

Joycharat et al. Anti-Streptococcus mutans efficacy of Thai herbal formula used as a remedy for dental caries. Pharm Biol. 2012 Aug;50(8):941-7. �

Thai ginger��-Alpinia galanga (L.) Willd (Zingiberaceae), �

White mangrove��Avicennia marina (Forssk.) Vierh. (Acanthaceae),�

Tulsi, holy basil��Ocimum sanctum L. (Lamiaceae)�

Extracts of honeycomb….��-inhibit the enzymes that � S. mutans need to make the � sticky glycan coating allowing � them to stick to tooth surfaces�

1.  Xiao J, Zuo Y, Liu Y, Li J, Hao Y, Zhou X. Effects of Nidus Vespae extract and chemical fractions �on �glucosyltransferases, adherence and biofilm formation of Streptococcus mutans. Arch Oral Biol. 2007 Sep;52(9):869-75.�

-contain quercetin and kaempferol that are� antibacterial to caries-causing bacteria. �

2. Guan X, Zhou Y, Liang X, Xiao J, He L, Li J. Effects of compounds found in Nidus Vespae on the growth and cariogenic� virulence factors of Streptococcus mutans. Microbiol Res. 2012 Jan 20;167(2):61-8)�

Nidus Vespae �

Vitis coignetiae (VC)�(Crimson Glory Vine) �

-phenolic extract of VC inhibits �

S. mutans biofilm formation�

Yano A, Kikuchi S, Takahashi T, Kohama K, Yoshida Y. �Inhibitory effects of the phenolic fraction from the pomace of Vitis coignetiae on biofilm formation by Streptococcus mutans. Arch Oral Biol. 2012 Jun;57(6):711-9. �

MISWAK (Sewak)�(the toothbrush tree)�'Salvadore Persica'�

Contains�-Tri-methyl amine�-salvadorine�-silica�-sulphur�-Vitamin C�-Tannins, saponins, flavonoids & sterols ��(Miswak-containing toothpaste has been shown to inhibit

oral streptococci and reduce calculus)�

Miswak/Sewak�

Toothpastes with Miswak extract�

Almas K, Al-Zeid Z. The immediate antimicrobial effect of a toothbrush and�miswak on cariogenic bacteria: a clinical study. J Contemp Dent Pract. 2004 Feb 15;5(1):105-14.�

T40–C3 Melaleuca Oil®�Zinc citrate�Myrrh*�Xylitol�Papain�

Tooth Polish�

Melaleuca.com�

*myrrh is resin from the�shrub family Burseraceae�

Fluoride-free with �baking soda and xylitol�

Melaleuca.com�

Properties� Herbal ingredients�

Anti-inflammatory�Aloe vera, bee propolis, ginger, golden seal, juniper, licorice, myrrh, teaberry�

Anti-bacterial�Baking soda, cinnamon, clove, garlic, fennel, green tea, juniper, sanguinarine, �

Boosts immune system� Aloe vera, Echinacea, �

analgesic� Clove, rosemary, aloe vera�

Lee et al, 2004�J Am Dent Assoc, Vol 135, No 8, 1133-1141.�

In vitro inhibition of S. mutans:��Extracts of �• apple (but apples also contain fructose), �• red grape seeds, �• red wine (proanthocyanidins), �• nutmeg (macelignan), �• ajowan caraway (nafthalen-derivative), �• coffee (trigonelline, nicotinic and chlorogenic � �

�acids, melanoidins), �• barley coffee (melanoidins), �• chicory and mushroom (quinic acid)�

Gazzani G, Daglia M, Papetti A. �Food components with anticaries activity. �

Curr Opin Biotechnol. 2012 Apr;23(2):153-9.�

In vivo anticaries activity has been shown by:��• cranberry (procyanidins), �• glycyrrhiza root (glycyrrhizol-A), �• myrtus ethanolic extract, �• garlic aqueous extract, �• cocoa extracts (procyanidins), and �• propolis (apigenin, tt-farnesol).�

Gazzani G, Daglia M, Papetti A. �Food components with anticaries activity. �

Curr Opin Biotechnol. 2012 Apr;23(2):153-9.�

Matsumoto M, Tsuji M, Okuda J, Sasaki H, Nakano K, Osawa K, Shimura S, OoshimaT. �Inhibitory effects of cacao bean husk extract on plaque formation in vitro andin vivo. Eur J Oral Sci. 2004 �

Cacao bean husk extract (CBH) ��-antibacterial (unsaturated fatty acids)��-antiglucosyltransferase activities (epicatechin � �� �polymers)��-reduced cavities in rats��-reduced S. mutans in young adults with poor oral �� �hygiene��-now being tested in toothpaste �� �and mouth washes�

news.softpedia.com�

No trials yet on chocolate bars �

40g water-based, sugar-free topical cream with a special blend of polishing, cleaning and dentinal tubule sealing agents. �

�

Five flavors - melon, mint, strawberry, tutti frutti and vanilla��

Cost ranges between $15 and $30 PER TUBE�

GC-America�s MI Paste�

Remineralization Strategies�

Casein-PhosphoPeptide-Amorphous Calcium Phosphate (CPP-ACP), or RecaldentTM�

Currently the only chewing gum recognized by the CDA contains

Recaldent�

MI-Paste�Professional polishing & “remineralization”. �No need to rinse.���Digestible if swallowed �(even by people with lactose intolerance)��Should not be consumed by people with �milk protein allergies.��Limited online sources since the Japanese tsunami, or because the FDA warning ��

MI Paste contents�CPP-ACP and�Other ingredients: �

Sweeteners (D-sorbitol, Xylitol, Sodium saccharin) �

Humectants and lubricants (Glycerol, Carboxy-Methyl � � � � � �Cellulose, Propylene Glycol, Guar Gum)

Abrasives and whiteners (Silicon dioxide, Zinc oxide, � � � � � � Titanium dioxide, Magnesium oxide)�

Preservatives � � �(Ethyl p-hydroxybenzoate, Propyl �� � � � � �p-hydroxybenzoate, Butyl p-hydrobenzoate) �

Phosphoric acid�Flavouring�

MI paste is NOT MEANT TO BE AN ORGANIC TOOTHPASTE�

MI Paste MAY protect baby teeth from dental decay�

Fluoride IS NOT not recommended in infants and toddlers...but MI

paste can be used instead �

MI Paste is well tolerated by children and tastes delicious.�

They added fluoride� to 900 ppm�(a little less �

than regular toothpaste)�

Treat like any other�fluoridated toothpaste�

…..with CAUTION�

�Advertised MI Paste Plus Technique

0.3 mg fluoride is swallowed each time

-UVB rays reduce the risk of dental caries ��(likely through production of vitamin D, followed �by induction of anti-microbial cathelicidin and �defensins). �

�-�Serum 25-hydroxyvitamin D concentrations at or above 30–40 ng/ml should significantly reduce the formation of dental caries.��

Grant WB. A review of the role of solar ultraviolet-B irradiance and vitamin D�

in reducing risk of dental caries. Dermatoendocrinol. 2011 Jul;3(3):193-8. �

Vitamin D and dental decay�

In 1939, Texans had 58% less tooth decay �than Canadians and 50% more sunshine.�

East BR. Mean Annual Hours of Sunshine and the Incidence of Dental Caries. �Am J Public Health Nations Health. 1939 Jul;29(7):777-80.�

<2000 �2200-2600 �2600-3000�>3000�

Sunshine (hrs annually/year)� Cavities per100 boys�

<2000 �2200-2600 �2600-3000�>3000�

�This systematic review of CCTs suggests that supplemental vitamin D was associated with a 47% reduced risk of caries.��

Nutrition Reviews, 2012�

Fluoride’s benefits �and risks �

Fluoridation, toothpaste, mouthwashes, professional fluorides�

But….there has never been a double blinded, �randomized clinical trial (RCT) to prove �fluoridation reduces dental decay, adjusting �for confounding factors we know affect �dental health�

�-diet and frequent sugar intake��-sweeteners, xylitol and chewing gum��-vitamin D levels in the blood��-delayed tooth eruption�

Fluoridation: they say it is �safe and effective��

How fluoride prevents �tooth decay�

Fluorapatite builds up in areas of�demineralization-remineralization�

How fluoride works (it’s topical !!)�

Ca10(PO4)6(OH)2 (hydroxyapatite) + 2F- �� ��

Ca10(PO4)6(F)2 (fluorapatite) + 2(OH-)�

Sound enamel�

Subsurface mineral loss�

Continued �subsurface �mineral loss�

Cavitation �(permanent � damage) � subsurface mineral �

loss can result in �stain accumulation �

in the voids�

Bacterial acids�

CO3�Mg++�

Reversal of incipient�caries with topical fluoride�

Fluoride in water (1 ppm) ��-does NOT inhibit bacteria��-does NOT accumulate significantly in enamel �before tooth eruption��-increases salivary fluoride but those levels are �STILL 50-100 times lower than food and water��- has NOT been shown with robust studies to �be particularly beneficial �

A lifetime of� fluoridation�

might save one �tooth from decay�

Fluoridated toothpastes and mouthwashes have been shown in clinical trials to reduce dental decay �

�-but, the benefit is not large��-the effects are not antibacterial��-fluoride from toothpaste barely penetrates plaque��-the main effect is a promotion of �

�� � � REMINERALIZATION�

Here�s how fluoride really works:��Ca10(PO4)6(OH)2 + 4H+ = Ca++ + PO4

--- + 2H2O��the more acid made by plaque, ��the more HA crystals dissolve � ��

�

Ca10(PO4)6(OH)2 + 2F- = Ca10(PO4)6(F)2 + 2(OH-)�-fluoride releases hydroxyls from apatite, ��which then neutralize some acid and encourages ��crystal growth�

But at what risk??�

Probably toxic dose of fluoride = 5 mg/kg�"The PTD triggers immediate therapeutic intervention and hospitalization because of the likelihood of serious toxic consequences.� �Whitford GM. (1987) Journal of Dental Research 66: 1056-60.�

= 3 tablespoons of fluoridated kids toothpaste�= half of a professional fluoride gel�

For a 10 kg toddler�

= �

www.clivir.com�

Why fluoride can �harm children�

> 2500 ppm� 0.005 to 0.02 ppm�

0.015 to �0.03 ppm�

Committee on Fluoride in Drinking Water, US National Research Council �

Published�Mar.06�

�Fluoride appears to have the potential to initiate or promote cancers, particularly of

the bone, but the evidence to date is tentative and mixed.� p.286�

Barbier O, Arreola-Mendoza L, Del Razo LM. Molecular mechanisms of fluoride�toxicity. Chem Biol Interact. 2010 Nov 5;188(2):319-33.�

Fluoride effects on human cells�

KAl(SO4)2·12H2O + H2SiF6��

(Alum) (FSA)�

Alum (deflocculates water) + �fluosilicic acid (fluoridates water) can result in ��Aluminum Fluoride (AlF4)��� �� � �

��-the aluminum fluoride/G-Protein complex�has many hormonal reactions and interferes with many enzymes�-activation of heterotrimeric GTP-binding proteins by fluoride �requires only trace amounts of Al3+�

Normal G-protein �complex�

G-protein �Complex with �

aluminum fluoride�

Looks �like �

Of more than 60 metal ion species, Al 3+ binds F- �

most strongly �

Li L. The biochemistry and physiology of metallic fluoride: action, mechanism,�and implications. Crit Rev Oral Biol Med. 2003;14(2):100-14. �

Drink the water �

From �Second Thoughts About Fluoride� by Dan Fagan, �Scientific American, 2008, 74-81.�

…may induce malignant tumours!�

�Our exploratory analysis found an association�between fluoride exposure in drinking water during�childhood and the incidence of osteosarcoma among

males but not consistently among females��

546% increased risk to bone cancer !!!!�

Using H2SiF6 instead of sodium fluoride�as a fluoridation chemical DOUBLES the risk �for increased blood Pb levels�

�In conclusion, this study showed that co-exposure to fluoride

increases lead concentrations in the blood and in calcified tissues in animals exposed to lead from the beginning of gestation. These findings suggest that a biological effect not recognized so far may

underlie the epidemiological association between increased

BPb levels in children and water fluoridation.��

Choi et al (Harvard meta analysis)�Environ Health Perspect. 2012 October; 120(10): 1362–1368�

Slide courtesy of�Prof. Vyvyan Howard�

Fluoride accumulates in human �pineal gland. Average of 9,000 ppm �in calcium hydroxyapatite crystals (highest 21,000 ppm) (Luke, 2001).��In animals (Mongolian gerbils) �fluoride LOWERS melatonin �(the sleep hormone) production �and shortens time to puberty.��Skeletal development is also affected�

��

����������� �������� � ��� ������������������ �������������� ��������������������� !"�#$��!�%�

More Brain Effects�

Thyroid effects (from the NAS report)�

South�Africa�

IMC Agrico - New Wales Plant�Polk County, Florida �

�The solution to �pollution is dilution��

Chart 1: Lifetime Risks of Dying of Cancer from Arsenic in Tap Water�Based upon the National Academy of Sciences' 1999 Risk Estimates*�

Arsenic Level in Tap Water (in parts per billion, or ppb)

Approximate Total Cancer Risk (assuming 2 liters consumed/day)

0.5 1 in 10,000

(highest cancer risk EPA usually allows in tap water)

1 1 in 5,000

3 1 in 1,667

4 1 in 1,250

5 1 in 1,000

10 1 in 500

20 1 in 250

25 1 in 200

50 1 in 100

*See http://www.nrdc.org/water/drinking/arsenic/chap3.asp

Upper�limit�

Arsenic contaminates fluoridation chemicals�

Fluoridation�contributes�5-17% of �

this arsenic�

-people drinking water with 0.1 to 0.5 ppb arsenic had a 50% greater risk of developing bladder cancer than people drinking water

with less than 0.1 ppb. �

Is Arsenic in fluoridation chemicals a problem?�

(Kurttio, et al. 1999) �

A fluoridation chemical spill in Utah�

What message do these workers�send to the public �dressed like this to clean up fluoridation spills ????�Exposed�

Not Exposed�

Facial and�Forearm burns�

Erosion of equipment�

�Everything dies� in contact with full strength fluoride �

A leaky�pump�

Fluoridation workers at risk�

Severely eroded teeth�

Can I Prepare Baby Formula �Using Fluoridated Water?�

Health Canada says �yes� *�

Huh??? �What, no warnings about dental fluorosis ???�

What about arsenic and lead ???�

* http://www.hc-sc.gc.ca/ewh-semt/water-eau/drink-potab/health-sante/faq_fluoride-fluorure-eng.php�

the total daily fluoride intake from all sources should not exceed 0.05-0.07 mg/kg/day�� (in order to minimize the risk� of dental fluorosis)�

Position of the Canadian Dental Association�

0.5 ppm�

+�

0.7 – 1.0 ppm �

= �

Clifford H, Olszowy H, Young M, Hegarty J, Cross M. Fluoride content of�powdered infant formula meets Australian Food Safety Standards. �Aust N Z J Public Health. 2009 Dec;33(6):573-6. �

= 0.174 mg/kg/day �

3500% higher�

Only 1 in 4 babies are fed breast milk exclusively �for 6 mo (as recommended by Health Canada)�

http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/commun/prenatal/trends-tendances-eng.php�

Dental Fluorosis in the US�

NHANES study�

Microabrasion�Bleaching�

Composites�Veneers�

Not �noticeable�

�Prevalence of enamel fluorosis has increased in cohorts �born since 1980.� CDC MMWR Aug.26, 2005�

Fluorosis in Peel�One in every 10 children has ‘objectionable’ fluorosis*��>40% have �some signs�of fluorosis�

*Ito, D. (2007) MSc Thesis�

Canadian Dental Association�

Smear Pea Size

= 0.32 mg F� = 320 ml�

fluoridated�tap water�(1.0 ppm)�

US Toothpaste Warning: �If more than is used for brushing is accidentally swallowed get medical help or contact a poison control center right away.��

It�s the combination� (swallowing tap water, fluoridated food and a little fluoridated toothpaste) that causes fluorosis.��Water is by far the largest contributor.�

What�s going on????�

The manufacturers never show �a pea size in their ads�

Kids at age 3 �swallow 60%�

of the toothpaste �on their brush�

- they could ingest�4.5 mg fluoride�

if they brush 3x/day�

example�

Finally getting the message!�

Fluoride free!!�

Tom�s of Maine �Toothpaste for kids� -no fluoride� -natural ingredients� -still has SLS�

A great Canadian organic toothpaste�

Ingredient� function�

Calcium carbonate� Abrasive, provides calcium, neutralizes�

Sorbitol� Natural sugar substitute sweetener�

Glycerin� Emollient, solvent (nice feeling in the mouth)�

Sodium bicarbinate� Base to neutralize acid�

Silica� Fine sand particles, abrasive�

Xylitol � Anti-cavity sugar substitute (sweetener)�

Green Beaver Toothpaste�

Mentha piperita (peppermint ) oil� Flavouring, stimulates saliva�

Citrus medica limonum (lemon) oil� Flavouring, stimulates saliva�

Calcium ascorbate� Provides calcium and Vitamin C�

Melaleuca alternifolia (tea tree) leaf oil� Anti-bacterial, boosts immunity�

Menthol� Anti-bacterial, reduces mouth odour�

Sclerotium and xanthum gums�

Polysaccharide polymers, thickening agents from fermented mushroom�

Coco glucoside� Non SLS foaming agent from coconut�

Green Beaver Toothpaste�