Fluoride: The Article

Originally published in the house journal of the NZ Charter of Health Practitioners. (Slightly adapted and expanded for website publication.)

Too much of a good thing?

At our annual TFH conference a year or two back I listened to a representative of the Pure Water Association speak about fluoride. It was a thoughtful and thought-provoking talk. Helensville water is not fluoridated, but I decided to go for fluoride-free toothpaste anyway.

After some difficulty, I eventually tracked some down in the health food (!) section at Big Fresh, manufactured by Red Seal, a firm with a long involvement in health products in NZ.On the side of the carton, and the tube, was the message: "Fluoride-free, because you can have too much of a good thing."

Hang on a minute, mate.

Now nobody I know would buy it if they weren’t anti-fluoride to start with. For one thing, it’s not displayed with the other toothpaste. You have to know it exists, and you have to be determined to find it.

So what’s this coy little message about. This is screwy. I shook my head,grabbed a Mint-flavoured tube, as I’m not sure how the kids would tolerate the Tea Tree flavoured variety, and headed home.

(Later I returned to Big Fresh, Woolworths and so on, and found Colgate Ultrabrite at floor level in the bottom right hand corner of the main display. It’s the only one. This display pattern is fairly standard in most supermarkets.)

Sensational

A few months later, I was given a longish article from the Guardian putting the case against fluoride. Would I summarise it for the Charter Magazine. I read it and politely declined. It seemed to me there were too many statements in it that I can’t easily check in a hurry, and it was fairly sensational in its allegations.

I decided to find out a bit more and write something with more of a local flavour. I might even prompt a few questions to MPs, this being an election year.

Code of Rights

I write to the local branch of Colgate, to the Auckland Regional Council, to Big Fresh, and to the Pure Water Association. All except the ARC reply within a day or two.

The ARC does not bother to reply at all.

While I am waiting, I take a look at the Code of Health and Disability Services Consumers Rights (which, just by the way, we are required to have in our consulting rooms for our clients to read).

The only reason to add fluoride to public water is because it allegedly strengthens teeth and reduces tooth decay, so on the face of it we are dealing with a health service. The Code says, Every provider is subject to the duties in this code, and Every consumer has the rights in this code.

A bit further down, it says, Every consumer has the right to refuse services, or to withdraw consent to services. (There’s a provision for the unconscious and the insane to be treated without their consent, but it seems to be our right as conscious and sane consumers to refuse treatment.)

Fluoride is not a Medicine (??)

The problem as I discover later is that local bodies are apparently not administering a medicine or a treatment at all, they are "adjusting the level of a naturally occurring substance to optimal levels for public health". You work it out. (And just by the way, these "optimal" and "scientifically determined" levels have remained the same for fifty years, even though public exposure to fluoride from other sources has increased enormously in that time.)

In the early days of fluoridation in New Zealand, the Lower Hutt Council was taken all the way to the Privy Council to determine the right of a local body to add fluoride to the drinking water. At that time, all the information about fluoride available to the court pointed it being highly effective in promoting healthier teeth. The questions to be determined by their lordships were whether, in relation to existing legislation, it was legal to add fluoride.

It was determined that such powers existed, and that fluoride was not an added medicine, but a naturally occurring ingredient in all water and that there was an optimum level of fluoride for maximum public health benefit. This level was determined in the late 1940's, without evidence ever being provided, to be approximately 1 part in a million.

Note that since then, public consumption of fluoride as toothpaste, wine, tea, red meat, reconstituted fruit juice, etc, has increased dramatically. The recommended optimum level of fluoride in public water has never been altered.

A Widely Distributed Natural Substance

Colgate is first to reply. They send me an unsourced but highly reassuring article dealing with fluoridation of water rather than toothpaste. Fluoride compounds are described as "substances which are widely distributed in nature and found in many foods we eat…[They have] …always been a component of man’s body, fluids, tissues and skeleton."

Nothing inaccurate about that. Now, let’s have a look at methods laid down for handling this widely distributed natural substance at the Wainuiomata Treatment Station :

We had to undress and put on special overalls, special boots and gloves. Every part of us was sealed entirely, including the hair and the head, and we wore breathing apparatus with replaceable filters and eyeglasses to protect us from the toxic dust……

(Afterwards) we would walk over to a special room, close the door behind us, and strip off all our clothing and equipment. This would be dropped through a hole direct into a form of washing machine which gave an initial rinse. We would then shower, scrub our fingernails, and all the orifices of our body as carefully as possible and then step out into another area, dry ourselves, and get dressed again. …

[The overalls are later washed twice before re-use.]"

Sodium fluoride, folks. Give it a big hand. Isn’t nature wonderful!

(This is one of the main forms of fluoride in toothpaste, incidentally, at a typical concentration of just over 0.2%, or 2000 parts per million.)

Now you can’t call the Colgate article inaccurate, but the impression it leaves me with is that this fluoride stuff is a bit like limestone or rust: pretty harmless, universal, stuff. And that's just not true.

(Hydrofluosilicic Acid, which is the fluoride source used on Auckland’s water, is classed as Corrosive, Class 8 Dangerous Goods, Hazchem 2 – and it can’t be filtered out of your water.)

In the water and the toothpaste?

The main reason I wrote to Colgate was to find out why nearly all the toothpaste is fluoridated, even in Auckland where you can’t escape fluoridated water without your own rainwater tank. There is one paragraph of three lines, headed "Should Fluoridated Toothpaste and Other Topical Fluorides be Used if the Water is Fluoridated?"

"Yes. The amount of fluoride ingested by proper use of fluoridated toothpaste, rinses, or treatment in a dental office, is small. These methods provide additional benefit even in fluoridated communities."

The additional benefits are not specified. I am not exactly sure, either, what they mean by "proper use" of these substances.

If that means not swallowing the toothpaste, as is widely recommended overseas, then marketing it in bubble gum flavours for kids seems a bit tough.

(Toothpaste – including the bubble gum favour referred to above – is fluoridated at approximately 2000 times the concentration in treated water. Swallowing 1ml of toothpaste doubles the daily intake of fluoride as recommended in the Colgate article, even before you start drinking fluoridated water.

Remember, this stuff is more toxic than lead and almost as toxic as arsenic, and the maximum levels allowed for these are 1 part in 67,000,000, for lead, and 1 part in 100,000,000 for arsenic.)

Warning Labels

In India where much of the water is naturally fluoridated, toothpaste containing fluoride is required by Health Regulations (1995) to carry the warning, "This toothpaste contains fluoride and should not be used by children under seven years of age."

Incidentally, studies in India suggest strongly that in the absence of good nutrition, (i.e., plenty of calcium sources), fluoride acts to leach out calcium from the body and increase the rate of tooth decay. It is not a substitute for good nutrition.

50% Retention Rate

Fluoride does accumulate in the system. Figures vary from study to study, but it looks like about 50% of it is retained. So even at apparently minimal exposure levels, the effect over half a lifetime is considerable - and that's when some of the other effects of fluoride begin to become apparent.

One early symptom of excess fluoride build up is dental fluorosis, or mottling of the teeth. (It’s also permanent.) A survey by the University of Connecticut studied 916 children up to 8 years of age, and found 70% of children using fluoridated toothpaste developed dental fluorosis.

So, "proper" use of fluoridated toothpaste it had better be.

Don't swallow it!!

Patronising

The opposition to fluoridation is addressed firmly in the Colgate leaflet.

1. People don’t understand technical and scientific matters. (That’s you, dear reader, in case you missed the point.)

2. Much of the information available is sensational, ill-informed, incomplete, or misleading. (Much of whose information?)

3. There is a feeling by some individuals that "medication", however beneficial, is inconsistent with democratic principles. (Well, so long as its just a few individuals, who cares? And we don’t need to worry about that silly old Code, do we?)

Crackpots?

These are somewhat patronising: they remind me of John Colquhoun’s comment that dentists in training are typically given only the pro-fluoride perspective, and are encouraged to believe that only misinformed lay people and a few crackpot professionals support the opposite view.

Now, I happen to be one of those people who aren’t that good on technical stuff. Colgate did get that bit right.

But you’d think they’d know about John Colquhoun, formerly Principal Dental Officer for the Department of Health in Auckland, and now editor of "Fluoride", the quarterly journal of the International Society for Fluoride Research.

You’d think they’d know about Dr Charles Heyd, former president of the American Medical Association.

And if you look at the International Society for Fluoride Research, there isn’t a member of the large Advisory Editorial Board who isn’t a doctor or a professor.

You’d think Colgate would have to know about that. You’d think they’d be aware of the alphabet of qualifications behind most of the research being quoted by the anti-fluoridation people.

Perhaps they just haven’t read it. Perhaps they’re still categorising critics of fluoridation as nutters and cranks, just a few individuals here and there. I mean, a bit later on in the Colgate article it says, under the heading, "Does Fluoridation Have Side Effects?":

"No. Of the numerous ills that have been attributed to fluoridation … none has ever been shown to be valid. From the vast quantities of clinical and research material, there is no scientific evidence that fluoridation has toxic, carcinogenic, mutagenic, or allergic effects on humans."

This statement dismisses or ignores some pretty impressive-looking research. It's also a sneaky way of ducking all the research that has been done on laboratory animals.

Unusual Research Methods

Mind you, even our own Public Health Commission has an unusual way of conducting research at times. In their 1995 report, recommending the continuation and extension of water fluoridation, they published a graph compiled from School Dental Clinic records showing the dramatic decline in tooth decay rates among 12 and 13 year olds since 1977.

What they do not mention is that the decline is much the same in both fluoridated areas and non-fluoridated areas.

If anything, the non-fluoridated areas do slightly better. Nor is it mentioned that decay rates are virtually identical in both types of area, overall.

Tooth decay in New Zealand children has been declining steadily since the 1930’s.To be fair, it might just be that most kids by default use fluoridated toothpaste, the other kind not being easy to come by, and it might just be that fluoride toothpaste by itself does the job.

(But fluoride toothpaste sales did not take off until the mid-late seventies, and tooth decay rates have been declining since the late thirties.)

On the other hand, it might have something to do with the fact that national nutrition has changed quite a bit since the days when my mother used to put the cabbage on and then start peeling the potatoes.

On the face of it, I think we can rule out fluoridation of water as a factor in reduced tooth decay, at least in respect of these records.

If they’ve got as much good research going for them as they reckon they have, why on earth do this sort of thing?

John Colquhoun also describes a 1992 study involving five year olds in four communities in the South Island, two fluoridated, one that had ceased fluoridation, and one unfluoridated. He points out that tooth decay rates vary widely among New Zealand communities, both fluoridated and unfluoridated.

The authors of this study just happened to select an unfluoridated community with a high decay rate, two fluoridated communities with low decay rates and a fourth community, recently having ceased fluoridation, with a medium decay rate (though even then, they do not point out that the medium decay rates prevailed during fluoridation as well as after it had ceased.)

Their study was given considerable publicity as an example of the effectiveness of fluoride in reducing tooth decay. A similar approach might equally have been employed to support the opposite thesis. At the time they made this selection the results for all communities were available to them through the school dental service, and investigation of a wider sample would have failed to support their ultimate conclusion.

When the larger picture is embraced, differences are minimal, and certainly not the 50-60% improvement in decay rates often claimed for fluoridation.

John Colquhoun comments, "I do not believe that the selection and bias that apparently occurred was necessarily deliberate. Enthusiasts for a theory can fool themselves very often, and persuade themselves and others that their results are genuinely scientific."

Small Fry Indeed

Now just to hand are a couple of extremely interesting documents.

If we have reservations about the use our own Public Health Commission makes of statistics, we are once again going to learn that alongside the USA (except of course in yachting) we are small fry indeed.

One is contained in Fluoride Watershed, the journal of the National Pure Water Association in the UK, vol 3, No 3, October 1997. Written by Joel Griffiths and Chris Bryson, it is a review of World War II documents recently declassified in the United States. The other is an item in The Australian Fluoridation News vol 34, no 3, May-June 1998 with information sourced to the New York Times, 24/2/98.

If we accept them at face value, they suggest that fluoride’s toxic properties were well known by the end of WWII. However, because of its vital role in the production of atomic bombs , a massive government cover-up of fluoride toxicity took place, and a "research" programme was set up to supply evidence "useful in litigation".

Dangerous waste

According to the New York Times, 24 February, 1998, the US Government has in storage 28,000 metal canisters of the volatile chemical, uranium hexafluoride. Each canister is about 1.2 m across and 3.6 m long and weighs about 14 tonnes.

They are rusting and not necessarily safe to move.They are a by-product of the Manhattan Project, the nuclear arms race and the Cold War. Fluorine is an essential element in the production of bomb-grade uranium and plutonium for nuclear bombs. While Federal Law requires a plan for the disposal of waste from manufacturing processes, these canisters are officially classed as "resources", and no plan for their disposal is required. As early as April 1944, Harold C. Hodge, a senior toxicologist with the Manhattan Project, wrote,

"Clinical evidence suggests that uranium hexafluoride may have a rather marked central nervous system effect … It seems most likely that the F [code for Fluoride] rather than the T [code for Uranium] component is the causative factor."

[A little research into tranquillisers, anti-psychotics, and anti-depressants will confirm the leading part played in these by fluoride compounds.]

"Since work with these compounds is essential, it will be necessary to know in advance what mental events occur after exposure. This is important not only to protect a given individual but also to prevent a confused workman from injuring others by improperly performing his duties."

This request occurs at the height of Manhattan Project focus on manufacturing the first Atomic Bomb. This memo is requesting that funds and energy be diverted from the Bomb into researching the neurotoxic effects of fluoride.

A supporting document referred to in the memo is still missing either classified or destroyed. But it must have contained some startling information as the research, still classified, was approved the same day the request was received.

Accidents will happen...

When a chemical spill occurred at the du Pont chemical works in New Jersey where fluoride was being manufactured for the Manhattan Project, a series of subsequent laboratory reports from two counties downwind indicated

• elevated blood-fluoride levels in human beings,

• peach crops were devastated,

• there was excessive fluoride content in vegetable produce, and

• presence of crippled cattle and horses displaying classic symptoms of fluoride poisoning,

• and so on.

The Food and Drug Administration threatened to embargo local produce from sale. The farmers sued and the combined efforts of several government departments focussed on doing whatever was necessary to avoid the PR disaster that would follow du Pont losing, or even fighting, the case.

It was eventually settled out of court. The FDA embargo never eventuated. Harold Hodge wrote to Colonel Warren, the Medical Section chief,

"Would there be any use in making attempts to counteract the local fear of fluoride on the part of the residents of Salem and Gloucester counties through lectures on fluoride toxicology, and perhaps the usefulness of fluoride in tooth health."

Such lectures did indeed follow, not just locally but nationally and internationally. Hodge was a key figure in research carried out at Rochester University which established the "safety" of fluoride, and its beneficial effects on teeth.

None of the published reports recorded the association of some of the principal investigators with the Manhattan Project. Hodge later became known as "the father of fluoridation".

"Evidence" to pre-empt civil litigation

The "research" programme instituted to examine the toxic properties of fluoride, was largely designed by scientists working on the nuclear programme, with the expressed purpose of providing evidence that might be useful to the government in the event of envisaged civil litigation .

Politics does not enter the picture

In the 1980’s Phyllis Mullenix developed a sensitive test using animal models to ascertain the effects of neurotoxins on the central nervous system. As a result, she was asked to head the department of toxicology at the Forsyth Dental Institute in Boston.

"Everything went well until she … [began]… using her system to test the effects of fluoride. She noted disruptions to the behaviour pattern of rats, and concluded that fluoride adversely affected the brain.

"She went on to show that fluoride accumulated in brain tissue, and that its effects depended on the age of exposure (the younger were more vulnerable). She also determined that these effects were measurable at a lower level of exposure to fluoride than was necessary to produce damage to bones.

"In order to receive her next tranche of funding, she presented her interim findings to representatives of the major manufacturers of toothpaste. She was asked, "Are you telling us that we’re reducing children’s IQs by putting fluoride in toothpaste?" She replied, "Well, basically, yes."

She did not receive further funding.

And, although her paper was peer-reviewed and subsequently published in Neurotoxicology and Teratology she was told that her work ‘was not relevant to dentistry’ and sacked from her post at the Forsyth. (She retained her second post, at Harvard Medical School.) "She sued the Forsyth for wrongful dismissal, and [in May, 1997,] won what is believed to be a substantial out-of-court settlement."

When she applied for funds to the US National Institutes of Health so as to continue and extend her investigation she was turned down, and told flatly, "Fluoride does not have central nervous system effects."

A spokesman for the NIH panel described Dr Mullenix’ allegations of institutional bias as far-fetched. "We strive very hard at NIH to make sure that politics does not enter the picture."

Why is all this important to us in New Zealand?

Pure water?

In 1964, a case was taken as far as the Privy Council in respect of the fluoridation of water. Their Lordships ruled that the addition of fluoride to the public water supply by a local authority was admissible as part of a water purification process. The ruling of the Privy Council effectively meant that water that has been fluoridated can be described as "pure water". "It is no more pure and no less pure after fluoride has been added".

Fluoride, more toxic than lead, need not be declared as an additive.

In the minds of many in local and national government the issue ceased to be in doubt. The battle against fluoridation had been fought and lost in the highest court in the land. Now go away and stop bothering us. We’ve got a job to do.

The unchallenged "evidence of the highest possible quality" about the benefits of fluoridation and its total harmlessness was largely founded on the research carried out by Hodge and others at Rochester University, or on comparable research of a similar nature.

If the information we have today had been available to the courts, it is by no means certain that fluoridation would have won the day in 1964, or even got as far as the Privy Council.

Certainly we need to revisit the "optimum" fluoride concentration of 1 ppm. If it ever was accurate, it has long ceased to reflect the same total fluoride exposure of the 1940's.

More recently, research carried out in Canada determined that any value to be had from fluoride was to be had from topical application, not from ingesting it.

Change in public response

At the moment, both National and Labour parties support extending fluoridation of public water supplies as much as possible. In recent years, however, there has been a shift in public awareness. 15 years ago, 80% of the population could safely be expected to support fluoridation. Since then a number of local bodies have opted, by popular vote, to stop it.

The vote in North Shore City was 58%:42% in favour of continuance, but even that is a marked shift from the position a few years ago. The change in awareness is already happening, but it needs to continue further still. Members of both major parties need to get the word up top to party policy makers. Unfortunately, Annette King, the present Minister of Health in New Zealand is an ardent advocate of fluoridation and has been looking for ways to make it compulsory.

American Influence

Fluoridation is not universally accepted. On the contrary most of the world has rejected it. Some have banned it.

It’s one subject Ian Paisley and the IRA are in total agreement on.

Its practice is largely a function of American influence. World-wide, far more public water supplies have ceased fluoridation, than are switching to it.

The Pure Water Association recommends that fluoride be a major issue during this year’s local body elections, and this is where we as health service providers can be influential. The principal method adopted by those in favour of fluoridation is dismissal, to deny that a debate even exists, to assert that antifluoridation is a crank position that can and should be safely ignored.

Professor Paul Connett, a toxicologist, travels the world from time to time to provide support for local campaigners against fluoridation. It is so difficult to get any local advocate of fluoride to debate this subject that Paul frequently has a large inflatable chicken on stage with him to represent the pro-fluoride side of the debate.

I believe we owe it to our clients to consider personally the information that is available and provide them with appropriate advice, for now and in the three years leading up to the next local body elections. The article by Griffiths and Bryson underlines the absolute need to examine carefully and critically the "evidence" that our public authorities (and toothpaste companies) have been reliant on to date, and especially that generated in the USA during the period of the Cold War.

DCW 6 August, 1998 (revised and expanded 16 July, 2004)

Fluoride Home Page

The Politics of Fluoride

Fluoride: The Article

Because we can... An(other) Unfortunate Experiment

The Science of Fluoride

Three Questions

Concentration, Dose and Dosage

Fluoride and the Law

1964 Revisited

Privy Council Decision