Fluoride & Asheville

Water fluoridation in Asheville - it's time to take another look

A 1965 referendum presented Asheville voters with an opportunity.  Water fluoridation would “supply an element now missing from the public water supply … necessary to reduce dental decay,” the ballot said. Fluoridation could prevent 60% of dental cavities, the Buncombe County Board of Health had predicted. Voters signed on, and Asheville joined communities across the nation in fluoridating its water. 

Fifty years later, it’s time to reconsider.  Science has continued to question and learn. Today we know:

  • Despite widespread water fluoridation, dental decay remains the leading chronic disease among American children
  • Swallowing fluoride is not necessary; the effects of fluoride are almost entirely topical, to the tooth surface, before swallowing
  • After swallowing, fluoride accumulates in the body over time, and long-term overexposure carries serious health risks

As a dentist, I’m concerned. We need new and more effective strategies to combat tooth decay. Mainly we need to summon the political and cultural will to nourish our children and ourselves with real food.  This is a whole health issue.  Our teeth reflect the health of our bodies. What truly nourishes the teeth will also nourish the body.

The Asheville Citizen-Times has allowed me to summarize my concerns:

Water fluoridation faces tipping point

Here's more from recent science:

2002 – The first comprehensive review finds little to support fluoridation

Researchers sought to gather and review all pertinent literature about water fluoridation, published and unpublished, in all languages.  They could find no prior systematic review of the subject.  They found the existing data to be scant, of questionable quality, and insufficient to address possible health risks.  Prior studies had concluded that that fluoride reduces cavities, but the amount of this reduction was not clear, the York group said. “One or a few” good studies “would add considerably to the current knowledge about efficacy and safety of water fluoridation,” the study concluded. – “The York Review – A systematic review of public water fluoridation,” British Dental Journal

2006 – National Research Council issues cautions

Too much fluoride over many years can pose serious risks of unknown proportions, the National Research Council of the Academies of Sciences confirmed.  A committee examined the wide body of research and said that long-term excess fluoride may weaken teeth and bones and may contribute to bone fractures.  It expressed potential concerns about side effects in children, kidney patients, the brain, the thyroid, possibly even cancer.  It noted there are many sources of exposure in addition to tap water and cautioned that relative to body weight, “infants and young children are exposed to three to four times as much fluoride exposure as adults.” – Fluoride in Drinking Water, A Scientific Review of EPA’s Standards”

2007 - Cavities decline with or without fluoride

Tooth decay rates have been falling similarly in European children who do and do not receive fluoride in water or salt.  There have been no randomized trials of water fluoridation, and the evidence both pro and con is relatively poor.  It would be extremely difficult to scientifically link events such as hip fracture in the elderly to life-time exposure of fluoride.  However, even small, relative health risks could translate to thousands of people in England alone -- “Adding fluoride to water supplies,” BMJ (formerly the British Medical Journal)

2008 - Kidney patient risk

The American Kidney Foundation acknowledged the injury and death of dialysis patients from accidental fluoride overdose.  The foundation took no position on fluoride intake by kidney patients, but said “Individuals with CKD should be notified of the potential risk of fluoride exposure.”

2012 – Fluoride linked to lower IQs in children

Children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas --  “Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis,” Environmental Health Perspectives

2013 – Isn’t fluoride natural?

The fluoride ion is identical in different fluoride compounds, but the compounds actually used differ hugely.  Natural calcium fluoride is poorly absorbed by the body.  Fluorosilicic acid (the type of fluoride added to Asheville’s water) is a waste product of fertilizer manufacturing, and is not a source for fluoride in any natural water supply.  Synthetic industrial fluorides are easily absorbed and listed as toxic. Toxicity depends on environmental factors.  Soft water (as in Asheville) permits more absorption than hard water.  Since water fluoridation began in 1945 (1965 in Asheville), no one has yet experienced it for a full average 75-year lifespan.  Premature death has been reported in horses, frogs, chinchillas and alligators who consumed artificially fluoridated water for extended periods. – “Physiologic Conditions Affect Toxicity of Ingested Industrial Fluoride,” Journal of Environmental and Public Health

2014 - Alternatives to fluoridation “urgently needed”

Fluoride’s effect on teeth is almost exclusively topical, and not systemic, as once believed, and fluoride is not essential to human physiology. Fluoride competes with magnesium and calcium in teeth and bones, and may increase the risk of tooth decay in people deficient in magnesium and calcium.  The study concludes, “The available evidence shows that fluoride has a potential to cause major adverse human health problems, while having only a modest dental caries prevention effect…  Public health approaches for global dental caries reduction that do not involve systemic ingestion of fluoride are urgently needed.” – “Water Fluoridation: A critical review of the physiological effects of ingested fluoride as a public health intervention,” Scientific World Journal

2014 – Sugar, the real problem

Among Nigerian adults eating little sugar, only 2% had experienced tooth decay, compared with 92% of U.S. adults.  Nigeria’s water is not fluoridated.  To effectively fight tooth decay, sugar consumption should be limited to 3% or less of total energy intake.  Even extensive use of fluoride cannot overcome high sugar intake.  Sugar-induced cavities are a cumulative disease that continue to increase as a person ages, and the “major burden increases markedly after 32 years of age,” the study warns.  – “A Reappraisal of the quantitative relationship between sugar intake and dental caries,” BMC Public Health

2015 – Thyroid suppression

In the first population-level study of fluoridation and the thyroid, researchers found a significantly higher prevalence of hypothyroidism in areas with high fluoride levels, compared with areas with low fluoride levels.  This confirmation of earlier hypotheses raises “substantial cause for public health concern,” the study said, concluding that dental interventions should “stop relying on ingested fluoride and switch to topical fluoride-based and non-fluoride interventions.”  -- “Are fluoride levels in drinking water associated with hypothyroidism prevalence in England?”  Journal of Epidemiology Community Health

2015 – Attention deficit disorder in children

Reports of attention-deficit hyperactivity disorder are higher in fluoridated communities than non-fluoridated communities. – “Exposure to fluoridated water and attention deficit hyperactivity disorder prevalence among children and adolescents in the United States: an ecological association,” Environmental Health

2015 – Sugar industry promoted the fluoride alternative

The National Institute of Dental Research Launched the National Caries Program in 1971, with a goal to eradicate tooth decay within a decade.  A collection of sugar industry documents dated 1959 to 1971 was located, showing that the sugar lobby was directly involved in this initiative and strongly influenced the resulting emphasis on expanded water fluoridation and other alternatives to limiting sugar consumption.  The study concludes that an opportunity was lost, and currently tooth decay remains “the leading chronic disease of children and adolescents.” -- “Sugar Industry Influence on Dental Research,” PLOS (Public Library of Science) Media

2015 – International science collaborative questions fluoride’s benefits

The Cochrane Oral Health group searched for every fluoridation study it could find and then narrowed the list to the 107 studies that contained sufficient data for analysis.  It found data suggesting a reduction of childhood cavities, but not in adults.  The researchers expressed “limited confidence” in the evidence, citing questionable quality, widely varying results, and high likelihood of bias. Most of the available evidence came before 1975, before fluoride toothpastes and other preventive methods became prevalent.  The group concluded that there is very little solid, up-to-date evidence, that has evaluated the effectiveness of water fluoridation to prevent cavities. -- “Water fluoridation for prevention of dental caries,” The Cochrane Collaboration, an international non-profit of academics which performs and publishes systematic reviews of medical research.