Do the Authorities Add a Toxin to Our Water Supplies?

Adding fluoride to the community water supply is a topic that still arouses some public concern.

Free to use Photo by Kelly : https://www.pexels.com/photo/a-water-reservoir-on-a-mountain-lake-2887788/

Almost always, I drink water directly from the tap as the water in our area is known to be safe. However, it hardly mattered to me that apart from chlorination, the authorities added fluoride to the drinking water. Only when someone brings this up does the fact of fluoridation cross my mind!

In early August, a friend of mine, a retired chemist, called me one cold morning and asked whether I could help him prepare a convincing case against a proposal from his local council. Not being a chemist, I was concerned. He promised he would provide all the ideas. My task was to write a compelling document to be sent to the councillors in his area. It was about his local council’s suggestion to fluoridate drinking water.

After having a look at the ideas, he sent me, it was obvious that he would struggle to make a knock-out case for or against the proposal. The exercise opened my eyes to something I never paid much attention to and launched me into a brief investigation.

A Bit of History

Fluoridation first started in the USA as a prophylaxis or a preventive step against tooth decay [9]. A young dental school graduate named Andrew McKay who started a practice in Colorado Springs, Colorado, USA discovered that many of the residents suffered from a condition of discolouration of teeth known as “Colorado brown stain”. McKay started a collaboration with a well-known dentist G. V. Black who worked with him until 1915. They found that while the affliction appeared mainly in the secondary teeth of the local children who were at risk, the patients with such discolouration had less tooth decay [8].

After Black’s death, McKay crossed the Rock Mountains to go to Oakley, Idaho where he met with parents whose children had also developed brown stains on their teeth. Parents complained that the discolouration appeared after consuming water from a new communal pipeline. He advised town leaders to stop using the new pipeline and directed them to a new water source. Within a few years, younger children in Oakley had normal secondary teeth. He thus figured out that the water supply could be responsible for the brown stain.

The Aluminium Company of America (ALCOA) became very concerned when the children around its site in Bauxite, Arkansas developed brown stains. People were complaining the cookware of ALCOVA was responsible. In 1909, ALCOA had drilled three groundwater wells to supply water to the town. The stain appeared after a few years. A chemical analysis of water in 1930 found that the water supply to Bauxite had a high concentration of the chemical element Fluorine [11]. This was communicated to McKay.

Through the animal experiments done later by Arizona State University, the link between tooth staining and fluoride was established. Now enter the newly appointed chief scientist of the dental research section of The National Institute of Health, Dr T. H. Dean who picked up McKay’s observation of resistance of the stained teeth to decay. Then in the US, dental caries had become a huge problem. Thus, Dean wanted to see whether there is a level of fluoride that prevents dental caries while not causing serious staining or fluorosis. They started epidemiological research targeting towns with fluoride-rich water supplies and came up with a safe level of 1 milligram per litre of water [11]. In 1945, Grand Rapids in the state of Michigan started water fluoridation, a world first while Muskegon in Michigan acted as the control city [11] where fluoridation was not done to compare it to Grand Rapids. Dean wanted to study the effect of fluoridation over the following 15 years. However, just after an 11-year follow-up covering almost 30,000 school children, the National Institute of Health (NIH) could show a 60% reduction in dental caries [8]. Thus made was the case for water fluoridation! However, some authours, quoting previous work, say that the effectiveness of fluoridation was not based on randomized controlled experiments generally used to confirm causation [1].

Apart from adding fluoride to water, there are other means like milk supply and sea salt production, of ingesting additional fluoride. Another popular approach is to add fluoride to the toothpaste. But World Health Organisation recommended the fluoridation of water supply as the main method of delivery [1].

Fluoridation of Water

Fluoride is the ionic form of the 13th most abundant element in the earth’s crust and can be released into the environment through the weathering of the minerals. Thus, water can naturally contain fluoride and in some localities around the world, high fluoride content in the groundwater can even cause adverse health effects such as dental fluorosis. The Food and Drug Administration of the US has labelled fluoride as an “unapproved new drug” [1].

Several countries like the USA, Ireland, Australia and New Zealand add fluoride to their public water supplies. By 2012, of the population with access to fluoridated water, only about 15% had water with naturally occurring fluoride as the rest had water with the added fluoride [1]. It has been reported that about 50% of fluoride ingested is absorbed in the bones and teeth and the rest is passed in urine [10].

Fluoride administered in fluoridation is derived from certain mineral rock, commonly used in the production of fertilizer, via the extraction of it in gaseous form. Fluoride can be added to the water as sodium fluoride or other compounds containing fluoride and silicon, derived using the gaseous form of fluoride [7].

Even though dental caries in early childhood are caused by a combination of environmental, behavioural, socioeconomic factors, and biological factors, fluoride in the right dosages is known to help reduce the disease [5]. Fluoridation started as a topical application to teeth to prevent oral cavities. Most of the ingested fluorides reach teeth via saliva [10]. The main benefits of fluoridation on teeth come from:

1. Reducing the dissolution of enamel

2. Recovery of weakened enamel

3. Slowing the activity of bacteria that cause decay.

The National Health and Medical Research Council (NHMRC) of Australia claims that in the Australian experience, water fluoridation reduces tooth decay by 26 to 44% in children and adolescents, and by about 27% in adults [7]. In the case of children, the above figure amounts to a reduction from the original result of 60% published by American researchers.

Pros and Cons of Water Fluoridation

NHMRC and several health authorities around the world tell us that water fluoridation is safe [2]. The safe level of fluoride concentration in water according to EAPD (The European Academy of Paediatric Dentistry) is 0.5–1.1 milligrams in a litre [5].

People who do not like water fluoridation complain about not having a choice in the matter, i.e. medication without consent. Even when they do not want fluoride, which they consider toxic, in their water, the water supply authorities add the chemical before distribution. They, as consumers, are also required to pay extra for their water at the tap for adding fluoride. Once added, they cannot remove the chemical by a common method like boiling.

Another concern expressed about water fluoridation is that the amount of water intake of each person cannot be controlled. If a child drinks two glasses of water, she or he gets less fluoride than a child drinking five glasses of water. However, it is said that at the current recommended level an average person needs to drink 10 litres or more of water to reach the upper limit of 10 milligrams of fluoride intake in a day [7]. Fluoride ingestion through multiple means like water fluoridation and toothpaste etc can breach the daily optimal level.

Even though there are some concerns about the benefits of fluoride, in many academic circles, it is taboo to study fluoride [2]. Researchers who published an article based on controlled experiments showing that sodium fluoride is neurotoxic to developing rats were highly criticised [2]. The study showed it is not the intake but the levels of fluoride in plasma is a more important predictor of toxicity [6]. Similarly, another article, not based on a controlled experiment claims that the mother’s exposure “to higher levels of fluoride during pregnancy was associated with lower IQ scores in children aged 3 to 4 years” [4].

From 1980 to 2012, the number of diagnoses of diabetes in US adults had nearly quadrupled [3]. Research using data collected by the authorities in the US looked at the prevalence of diabetes in the US and the concentration of fluoride in water. This study using statistical analyses concluded that “Community water fluoridation is associated with epidemiological outcomes for diabetes” [3]. Unfortunately, not being a randomized trial, this study can only prove an association but not a causation.

A Federal Court trial against the Environmental Protection Agency (EPA) to challenge water fluoridation in the USA started in San Francisco. The trial, Food & Water Watch Inc. v. EPA, N.D. Cal., №17-cv-02162, was set to start on 1/31/24. (source: https://news.bloomberglaw.com/environment-and-energy/fluoride-science-on-trial-in-case-with-broader-chemical-impacts))

Conclusion

A thorough evaluation done by NHMRC of all relevant research, in 2017 strongly recommended water fluoridation in Australia, at a level of 0.6 to 1.1 milligrams per litre as a safe, effective and ethical way to reduce tooth decay. The organisation affirmed that there was no reliable evidence of an association between public water fluoridation and other human health conditions including cancer, cognitive functions, intelligence, kidney health, musculoskeletal health or thyroid health. According to this report, the 2015 reports by the health authorities in New Zealand and the United States found public water fluoridation to be beneficial to reduce tooth decay while the 2015 report by the Ireland authorities could not find strong evidence for any negative health effect of community water fluoridation.

Over about 75 years, water fluoridation has spread over many parts of the world and the practice is considered safe. However, it is scientifically prudent to keep an open mind about water fluoridation and review any new evidence for or against it with due care. Furthermore, to address the concerns coming from sections of the public, investigating the efficacy of topical application directly to the teeth [1] vs. the fluoridation of the public water supply and discovering other alternative caries reduction methods not involving fluoride [10] should be funded. New research using proper scientific methodologies including randomized controlled experiments should be encouraged to confirm the effectiveness and safety of water fluoridation.

The month of August is special in the discussion of this topic. World Water Week 2024 starts on 24 the of August. Being a global conference held since 1991, it provides a platform to discuss many issues relevant to water. Perhaps, the fluoridation debate has relevance to this month in which the water week falls. Hope such conferences will provide an open forum for a healthy and unbiased debate based on sound research from around the globe.

Reference

[1] Aoun A, Darwiche F, Al Hayek S, Doumit J. (2018) The Fluoride Debate: The Pros and Cons of Fluoridation. Prev Nutr Food Sci. 2018 Sep;23(3):171–180. doi: 10.3746/pnf.2018.23.3.171.

[2] Christine T and Green R (2020) Controversy: The evolving science of fluoride: when new evidence doesn’t conform with existing beliefs, Pediatric Research (2021) 90:1093–1095; https://doi.org/10.1038/s41390-020-0973-8

[3] Fluegge K. (2016). Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health, 2016; DOI: 10.2166/wh.2016.012

[4] Green R, Lanphear B, Hornung R, et al. (2019) Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada. JAMA Pediatr. 2019;173(10):940–948. doi:10.1001/jamapediatrics.2019.1729

[5] Molczyk-Sienczak, J et al (2023) Fluoride prophylaxis — poison or simple way to get rid of early childhood caries (ECC) — review. Journal of Education, Health and Sport. 2023;24(1):87–98, eISSN2391–8306. doi: http://dx.doi.org/10.12775/JEHS.2023.24.01.009

[6] Mullenix PJ, Denbesten PK, Schunior A, Kernan WJ. (1995) Neurotoxicity of sodium fluoride in rats. Neurotoxicol Teratol. 1995 Mar-Apr;17(2):169–77. doi: 10.1016/0892–0362(94)00070-t.

[7] National Health and Medical Research Council (2017), Water Fluoridation and Human Health in Australia: Questions and Answers https://www.nhmrc.gov.au/sites/default/files/documents/attachments/water-fluoridationqa.pdf

[8] National Institute of Dental and Craniofacial Research (2018), The Story of Fluoridation

https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation

Retrieved 3/8/2024

[9] National Museum of Australia Introduction of fluoride,

https://www.nma.gov.au/defining-moments/resources/introduction-of-fluoride

Retrieved 3/8/2024

[10] Peckham, S and Awofeso, N (2014) Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention, Hindawi Publishing Corporation,e Scientific World Journal, Volume 2014, Article ID 293019,

http://dx.doi.org/10.1155/2014/293019

[11] Zelko, F (2018) Toxic Treatment: Fluoride’s Transformation from Industrial Waste to Public Health Miracle, in Origins: Current Events in Historical Perspective,

https://origins.osu.edu/article/toxic-treatment-fluorides-transformation-industrial-waste-public-health-miracle?language_content_entity=en

Retrieved 3/8/2024