Water FluoridationWater FluoridationHarmful to Health, Ineffective & Unethical Harmful to Health, Ineffective & Unethical

Dr Mark DiesendorfDr Mark DiesendorfSustainability Centre Pty LtdSustainability Centre Pty Ltd

and Institute of Environmental Studies, UNSWand Institute of Environmental Studies, UNSWWeb: www.sustainabilitycentre.com.auWeb: www.sustainabilitycentre.com.au

WHAT IS FLUORIDATION?WHAT IS FLUORIDATION?

• Most water supplies contain 0.1 to 0.2 ppm of fluoride (FMost water supplies contain 0.1 to 0.2 ppm of fluoride (F- - ) ) naturally.naturally.

• Fluoridation increases the natural FFluoridation increases the natural F-- concentration to 1 ppm (i.e. concentration to 1 ppm (i.e. 5 to 10 times natural level). It is not a small “adjustment”.5 to 10 times natural level). It is not a small “adjustment”.

• Purpose is to try to reduce tooth decay. Purpose is to try to reduce tooth decay.

• Some well water and bore water supplies contain 1 ppm or more Some well water and bore water supplies contain 1 ppm or more naturally.naturally.

• Fluoridation is mass medication.Fluoridation is mass medication.

FLUORIDATION IS MASS MEDICATIONFLUORIDATION IS MASS MEDICATION

• Fluoridation is administered to treat people, not to make water Fluoridation is administered to treat people, not to make water safer to drink. So it is a medication.safer to drink. So it is a medication.

• Medical dictionaries and practice establish that preventive Medical dictionaries and practice establish that preventive medicines are medicines.medicines are medicines.

• FF-- in mg/day doses is in mg/day doses is notnot an essential nutrient. an essential nutrient.

• Natural substances may be medicines: e.g. penicillin, digitalis, Natural substances may be medicines: e.g. penicillin, digitalis, salicylates, radioisotopes, etc.salicylates, radioisotopes, etc.

• Mass medicaMass medicationtion violates violates twotwo principles of principles of medical ethics.medical ethics.

VIOLATIONS OF MEDICAL ETHICSVIOLATIONS OF MEDICAL ETHICS

• Principle of informed consent to medicationPrinciple of informed consent to medication

• Principle of controlled dose.Principle of controlled dose.

DAILY FDAILY F-- DOSE IS NOT CONTROLLED DOSE IS NOT CONTROLLED

• Even when FEven when F-- concentration is controlled (e.g. at 1 ppm), concentration is controlled (e.g. at 1 ppm), daily dose (mg/day) cannot be.daily dose (mg/day) cannot be.

• Large variations in tap-water intake. In fluoridated areas, Large variations in tap-water intake. In fluoridated areas, high high FF-- intake groups are: intake groups are:

- formula-fed infants get 100x dose of breast-fed infants;- formula-fed infants get 100x dose of breast-fed infants;

- young children who drink mostly soft drinks;- young children who drink mostly soft drinks;

- labourers and athletes;- labourers and athletes;

- people with diabetes insipidus, kidney disease, etc.;- people with diabetes insipidus, kidney disease, etc.;

- heavy tea drinkers get double dose.- heavy tea drinkers get double dose.

WHICH COUNTRIES ARE MORE THAN WHICH COUNTRIES ARE MORE THAN 50% FLUORIDATED?50% FLUORIDATED?

Only:Only: USAUSA

AustraliaAustralia

New ZealandNew Zealand

IrelandIreland

SingaporeSingapore

ColumbiaColumbia

MalaysiaMalaysia

IsraelIsrael

INDUSTRIAL WASTE AS MEDICATIONINDUSTRIAL WASTE AS MEDICATIONPure fluoride is dangerous enough, but …Pure fluoride is dangerous enough, but …

• Most water supplies are Most water supplies are fluoridated with waste from fluoridated with waste from phosphate fertiliser industry.phosphate fertiliser industry.

• Contains traces of arsenic, Contains traces of arsenic, lead & other toxics.lead & other toxics.

• Never subjected to chronic Never subjected to chronic safety tests in animals.safety tests in animals.

Manufacture of phosphate fertiliserManufacture of phosphate fertiliser

DOES FLUORIDATION REDUCE TOOTH DOES FLUORIDATION REDUCE TOOTH DECAY?DECAY?

Big reductions in tooth decay occurred in most Big reductions in tooth decay occurred in most industrialised countries in 1960s and 70s.industrialised countries in 1960s and 70s.

But they occurred in But they occurred in bothboth unfluoridated and fluoridated unfluoridated and fluoridated countries. countries.

What was the cause? Reductions occurred before FWhat was the cause? Reductions occurred before F-- toothpaste was widely used.toothpaste was widely used.

Only one point of agreement between pro- and anti- Only one point of agreement between pro- and anti- cases:cases:

TOOTH DECAY IN SYDNEY, 1961-1972, TOOTH DECAY IN SYDNEY, 1961-1972, (fluoridated 1968)(fluoridated 1968)

0

10

20

30

40

50

60

70

1961 1963 1965 1967 1970 1972

Caries-freeteeth (%)

Source: Lawson et al. (1978)Source: Lawson et al. (1978)19681968

‘‘THE MYSTERY OF DECLINING TOOTH THE MYSTERY OF DECLINING TOOTH DECAY’DECAY’

Abstract: Abstract:

Large temporal reductions in tooth decay, which cannot Large temporal reductions in tooth decay, which cannot be attributed to fluoridation, have been observed in both be attributed to fluoridation, have been observed in both unfluoridated and fluoridated areas of at least 8 unfluoridated and fluoridated areas of at least 8 developed countries over the past 30 years. It is now developed countries over the past 30 years. It is now time for a scientific re-examination of the alleged time for a scientific re-examination of the alleged enormous benefits of fluoridation.enormous benefits of fluoridation.

Diesendorf M 1986, Diesendorf M 1986, NatureNature 322: 125-129 322: 125-129

DOES FDOES F-- REDUCE TOOTH DECAY? REDUCE TOOTH DECAY?

• There are There are no no randomised controlled trials to randomised controlled trials to determine the benefits of fluoridated waterdetermine the benefits of fluoridated water ..

• Reductions claimed for fluoridated water of “up Reductions claimed for fluoridated water of “up to 50%” (ADA) are flawed by inadequate design to 50%” (ADA) are flawed by inadequate design (see critiques by Drs Philip Sutton, John (see critiques by Drs Philip Sutton, John Colquhoun, and Mark Diesendorf).Colquhoun, and Mark Diesendorf).

• Some large studies find negligible or even no Some large studies find negligible or even no benefitsbenefits (e.g.Armfield & Spencer 2004)(e.g.Armfield & Spencer 2004)

Jason M. Armfield and A. John Spencer 2004, Jason M. Armfield and A. John Spencer 2004, ‘Consumption of nonpublic water: implications for ‘Consumption of nonpublic water: implications for

children’s caries experience’,children’s caries experience’, Community Dentistry Community Dentistry & Oral Epidemiology& Oral Epidemiology, 32: 283, 32: 283

““The effect of consumption on nonpublic The effect of consumption on nonpublic water on permanent caries experience water on permanent caries experience was not significant.”was not significant.”

Now the pro-fluoridation authors claim that their Now the pro-fluoridation authors claim that their result is being “taken out of context”! result is being “taken out of context”!

WHO ORAL HEALTH IN 12 YEAR-OLDS WHO ORAL HEALTH IN 12 YEAR-OLDS (DMFT)(DMFT)

0

0.5

1

1.5

2

2.5

3

3.5

Rw

anda

Tanz

ania

Gha

na

Uga

nda

Leso

tho

Libe

ria

Bot

swan

a

Gui

nea-

Bis

sau

Bel

ize

Nig

eria

Ant

igua

Bur

kina

Fas

o

Net

herla

nds

Aus

t ral

ia UK

Den

mar

k

Sw

itzer

land

Indi

a

Sin

gapo

re

Aus

t ria

Sw

eden

Bel

gium

Spa

in

Irela

nd F

Ger

man

y

Irela

nd N

F

US

A

Nor

way

New

Zea

land

Port

ugal

Icel

and

Mal

aysi

a

Isra

el

Fran

ce

Italy

Col

umbi

a

Bra

zil

Can

ada

Not fluoridated

>50% fluoridated

25-50% fluoridated?

DMFTDMFT

AVERAGE TOOTH DECAY IN 10-YEAR-AVERAGE TOOTH DECAY IN 10-YEAR-OLDS BY CAPITAL CITY, 1977 & 1987OLDS BY CAPITAL CITY, 1977 & 1987

00.5

11.5

22.5

33.5

44.5

5

Bris. Hob. Can. Syd. Ade. Per. Melb.

DIM

FT 1977

1987

School Dental Service data (Diesendorf, 1990). School Dental Service data (Diesendorf, 1990). All cities except Brisbane fluoridated for at least 10 years by 1987.All cities except Brisbane fluoridated for at least 10 years by 1987.

HOW DOES FLUORIDE ACT ON THE HOW DOES FLUORIDE ACT ON THE TEETH?TEETH?

• Early notion that ingested Early notion that ingested FF-- was incorporated in tooth structure was incorporated in tooth structure and strengthened it.and strengthened it. WRONG!WRONG!

• Nowadays: mechanism predominantly ‘topical’ (surface); even Nowadays: mechanism predominantly ‘topical’ (surface); even pro-fluoridation US Centers for Disease Control admit this.pro-fluoridation US Centers for Disease Control admit this.

• So, people are being misled that they have to ingest fluoridated So, people are being misled that they have to ingest fluoridated water.water.

DENTAL FLUOROSISDENTAL FLUOROSIS

• Caused by FCaused by F-- damage to tooth- damage to tooth-forming cells.forming cells.

• Original claim that 1 ppm FOriginal claim that 1 ppm F-- would only produce ‘mild’ would only produce ‘mild’ mottling in 10% of people.mottling in 10% of people.

• Actually 50% of people mottled; Actually 50% of people mottled; not only ‘mild’.not only ‘mild’. ‘‘Mild’ dental fluorosisMild’ dental fluorosis

DENTAL FLUOROSISDENTAL FLUOROSIS‘Moderate’ and ‘Severe’ Categories‘Moderate’ and ‘Severe’ Categories

PittingPitting

Photo: John Colquhoun BDS, PhD -->Photo: John Colquhoun BDS, PhD -->

<-- Photo: Hardy <-- Photo: Hardy Limeback DDS Limeback DDS

SKELETAL FLUOROSIS IN NATURALLY SKELETAL FLUOROSIS IN NATURALLY FLUORIDATED REGIONS: e.g. INDIA, CHINAFLUORIDATED REGIONS: e.g. INDIA, CHINA

• Occurs at FOccurs at F-- concentrations as low as 0.7 ppm. concentrations as low as 0.7 ppm.

• FF- - accumulates in bone, adding mass but destroying structure.accumulates in bone, adding mass but destroying structure.

• X-rays show structural damage to bones, and calcification of X-rays show structural damage to bones, and calcification of joints and ligaments.joints and ligaments.

• Mild skeletal fluorosis has similar symptoms to arthritis.Mild skeletal fluorosis has similar symptoms to arthritis.

• Prevalence of arthritis increasing in USA and Australia.Prevalence of arthritis increasing in USA and Australia.

• Could some ‘arthritis’ actually be early stage of fluorosis?Could some ‘arthritis’ actually be early stage of fluorosis?

.

HIP FRACTURES IN THE AGEDHIP FRACTURES IN THE AGED

• Disabling; may be fatal.Disabling; may be fatal.

• Cumulative lifetime FCumulative lifetime F-- dose exceeds dose exceeds dose where osteoporosis patients dose where osteoporosis patients developed hip fractures.developed hip fractures.

• Majority of epidemiological studies find Majority of epidemiological studies find more hip fractures in fluoridated areas.more hip fractures in fluoridated areas.

• In China, fracture rate doubled @ 1.5 In China, fracture rate doubled @ 1.5 ppm and tripled @ 4.3 ppm.ppm and tripled @ 4.3 ppm.

INTOLERANCE or HYPERSENSITIVITYINTOLERANCE or HYPERSENSITIVITY

• Large body of clinical reports, e.g. by Large body of clinical reports, e.g. by Waldbott, Grimbergen, Petraborg, and Waldbott, Grimbergen, Petraborg, and Feltman & Kosel.Feltman & Kosel.

• Several blind & double-blind studies.Several blind & double-blind studies.

• Symptoms include excessive fatigue & thirst, Symptoms include excessive fatigue & thirst, stomach ache, muscular weakness.stomach ache, muscular weakness.

• Never followed up by proponents.Never followed up by proponents.

Dr George WaldbottDr George Waldbott

BIOLOGICAL EFFECTSBIOLOGICAL EFFECTS

• FF-- is highly active biologically, not inert. is highly active biologically, not inert.

• In lab., FIn lab., F-- inhibits enzymes; induces genetic inhibits enzymes; induces genetic changes; & increases uptake of aluminium changes; & increases uptake of aluminium by brain.by brain.

• In lab., AlFIn lab., AlFxx complexes disrupt G-proteins. complexes disrupt G-proteins.

This could change homeostasis, This could change homeostasis, metabolism, growth & differentiation of metabolism, growth & differentiation of living organisms.living organisms. (NEW)(NEW)

• FF-- concentrates in pineal gland causing concentrates in pineal gland causing earlier onset of puberty in animals.earlier onset of puberty in animals. (NEW)(NEW)

SUMMARY: RISKS OF FLUORIDATIONSUMMARY: RISKS OF FLUORIDATION

Well established Well established in humans

• Dental fluorosisDental fluorosis

• Skeletal fluorosisSkeletal fluorosis

ProbableProbablein humansin humans

• Hypersensitivity/intolerance reactionsHypersensitivity/intolerance reactions

• Hip & other bone fracturesHip & other bone fractures

• ‘ ‘Arthritis’ = early stage of skeletal fluorosisArthritis’ = early stage of skeletal fluorosis

• Interference with thyroid functionInterference with thyroid function

Possible, based on Possible, based on lab. & animal lab. & animal expts, but so far expts, but so far not proven not proven in humans

• Genetic damage in lab experimentsGenetic damage in lab experiments

• Brain damage in animalsBrain damage in animals

• Many diseases involving biological signallingMany diseases involving biological signalling

• Chronic poisoning from traces of toxicsChronic poisoning from traces of toxics

CAN SIMILAR BENEFITS BE OBTAINED WITH CAN SIMILAR BENEFITS BE OBTAINED WITH LESS RISK BY OTHER METHODS?LESS RISK BY OTHER METHODS?

• It is possible to have low caries without F intake: It is possible to have low caries without F intake: e.g. Australian Aborigines on original diet; Hopewood e.g. Australian Aborigines on original diet; Hopewood orphanage Australia in 1950s; most of EU todayorphanage Australia in 1950s; most of EU today.

• Public health officials can influence children’s diet,Public health officials can influence children’s diet, e.g. by public education and controls on foods sold in e.g. by public education and controls on foods sold in school shops & canteens.school shops & canteens.

• Daily, supervised F toothbrushing and/or rinsing (at Daily, supervised F toothbrushing and/or rinsing (at say 2 ppm) programs in elementary schools are low-say 2 ppm) programs in elementary schools are low-risk (for children older than 5 years) and assist low-risk (for children older than 5 years) and assist low-income groups.income groups.

POLITICAL & EQUITY ASPECTSPOLITICAL & EQUITY ASPECTS

• The principal risk factors for dental caries are poverty and poor The principal risk factors for dental caries are poverty and poor diet, not the absence of fluoridation.diet, not the absence of fluoridation.

• Governments use fluoridation to justify cuts to dental health Governments use fluoridation to justify cuts to dental health programs for school children & aged.programs for school children & aged.

• They cynically peddle myth that fluoridation helps the poor.They cynically peddle myth that fluoridation helps the poor.

• But the poor have highest prevalence of dental caries, with or But the poor have highest prevalence of dental caries, with or without fluoridation (even in Sydney).without fluoridation (even in Sydney).

• The poor ingest a chronic poison that they cannot afford to avoid.The poor ingest a chronic poison that they cannot afford to avoid.

• The poor are more susceptible to fluoride-induced diseases.The poor are more susceptible to fluoride-induced diseases.

• Governments use fluoridation to distract attention away from real Governments use fluoridation to distract attention away from real causes of tooth decay that are politically too hard. causes of tooth decay that are politically too hard.

CONCLUSIONCONCLUSION

• Fluoridation is mass medication with uncontrolled dose. Fluoridation is mass medication with uncontrolled dose. Unethical.Unethical.

• Negligible benefit from ingesting FNegligible benefit from ingesting F- - ..

• At best fluoridated water, acting at tooth surfaces, reduces tooth At best fluoridated water, acting at tooth surfaces, reduces tooth decay in a fraction of 1% of tooth surfaces.decay in a fraction of 1% of tooth surfaces.

• Ingestion of FIngestion of F-- damages teeth via dental fluorosis and damages damages teeth via dental fluorosis and damages bones via skeletal fluorosis and hip fractures.bones via skeletal fluorosis and hip fractures.

• Worrying biological effects and lab & animal experiments.Worrying biological effects and lab & animal experiments.

• Chronic toxicity from impurities in silicofluoride wastes from Chronic toxicity from impurities in silicofluoride wastes from phosphate fertiliser industry. phosphate fertiliser industry.

• Given this evidence, Local and State Govts would be socially Given this evidence, Local and State Govts would be socially irresponsible and open to litigation for supporting fluoridation.irresponsible and open to litigation for supporting fluoridation.

FURTHER READINGFURTHER READING

• Web site of of Fluoride Action Network, convened by Dr Paul Connett, Professor of Chemistry, St Lawrence University, USA: www.fluoridealert.org ;

• Mark Diesendorf, 2003, ‘A kick in the teeth for scientific debate’, Australasian Science volume 24, no. 8, pp 35-37, September.(A referenced version may be downloaded from www.sustainbilitycentre.com.au/FluoridePublics.html)