HHS and EPA announce new scientific assessments and actions on fluoride

The U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) today are announcing important steps to ensure that standards and guidelines on fluoride in drinking water continue to provide the maximum protection to the American people to support good dental health, especially in children. HHS is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and EPA is initiating review of the maximum amount of fluoride allowed in drinking water.

These actions will maximize the health benefits of water fluoridation, an important tool in the prevention of tooth decay, while reducing the possibility of children receiving too much fluoride. The Centers for Disease Control and Prevention named the fluoridation of drinking water one of the ten great public health achievements of the 20th century.

“One of water fluoridation’s biggest advantages is that it benefits all residents of a community—at home, work, school, or play,” said HHS Assistant Secretary for Health Howard K. Koh, MD, MPH. “Today’s announcement is part of our ongoing support of appropriate fluoridation for community water systems, and its effectiveness in preventing tooth decay throughout one’s lifetime.”

“Today both HHS and EPA are making announcements on fluoride based on the most up to date scientific data,” said EPA Assistant Administrator for the Office of Water, Peter Silva. “EPA’s new analysis will help us make sure that people benefit from tooth decay prevention while at the same time avoiding the unwanted health effects from too much fluoride.”

HHS and EPA reached an understanding of the latest science on fluoride and its effect on tooth decay prevention and the development of dental fluorosis that may occur with excess fluoride consumption during the tooth forming years, age 8 and younger. Dental fluorosis in the United States appears mostly in the very mild or mild form – as barely visible lacy white markings or spots on the enamel. The severe form of dental fluorosis, with staining and pitting of the tooth surface, is rare in the United States.

There are several reasons for the changes seen over time, including that Americans have access to more sources of fluoride than they did when water fluoridation was first introduced in the United States in the 1940s. Water is now one of several sources of fluoride. Other common sources include dental products such as toothpaste and mouth rinses, prescription fluoride supplements, and fluoride applied by dental professionals. Water fluoridation and fluoride toothpaste are largely responsible for the significant decline in tooth decay in the U.S. over the past several decades.

HHS’ proposed recommendation of 0.7 milligrams of fluoride per liter of water replaces the current recommended range of 0.7 to 1.2 milligrams. This updated recommendation is based on recent EPA and HHS scientific assessments to balance the benefits of preventing tooth decay while limiting any unwanted health effects. These scientific assessments will also guide EPA in making a determination of whether to lower the maximum amount of fluoride allowed in drinking water, which is set to prevent adverse health effects.

The new EPA assessments of fluoride were undertaken in response to findings of the National Academies of Science (NAS). At EPA’s request, in 2006 NAS reviewed new data on fluoride and issued a report recommending that EPA update its health and exposure assessments to take into account bone and dental effects and to consider all sources of fluoride. In addition to EPA’s new assessments and the NAS report, HHS also considered current levels of tooth decay and dental fluorosis and fluid consumption across the United States.

The notice of the proposed recommendation will be published in the Federal Register soon and HHS will accept comments from the public and stakeholders on the proposed recommendation for 30 days at CWFcomments@cdc.gov. HHS is expecting to publish final guidance for community water fluoridation by spring 2011. You may view a prepublication version of the proposed recommendation at ­­­­­­­­­­­­­­­­­­­ http://www.hhs.gov/news/press/2011pres/01/pre_pub_frn_fluoride.html. Comments regarding the EPA documents, Fluoride: Dose-Response Analysis For Non-cancer Effects and Fluoride: Exposure and Relative Source Contribution Analysis should be sent to EPA at FluorideScience@epa.gov. The documents can be found at http://water.epa.gov/action/advisories/drinking/fluoride_index.cfm

For more information about community water fluoridation, as well as information for health care providers and individuals on how to prevent tooth decay and reduce the chance of children developing dental fluorosis, visit http://www.cdc.gov/fluoridation. For information about the national drinking water regulations for fluoride, visit: http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm


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Substantial Consumption of Fluoride Increases Chance of Mild Fluorosis

/PRNewswire/ -- Young children who consume substantial amounts of fluoride through infant formula and other beverages mixed with fluoridated water or by swallowing fluoride toothpaste have an increased chance of developing mild enamel fluorosis, according to research published in the October issue of The Journal of the American Dental Association and supported by the National Institute of Dental and Craniofacial Research. Children can continue using fluoridated water and fluoride toothpaste because fluoride has been proven to prevent tooth decay, and mild fluorosis does not negatively affect dental health or quality of life.

"Nearly all of the fluorosis in our study participants was mild. A recent review of the effects of mild dental fluorosis on oral health-related quality of life concluded that the effect of mild fluorosis was not adverse and could even be favorable," according to the study. "This suggests that concerns about mild dental fluorosis may be exaggerated. Therefore, no general recommendations to avoid use of fluoridated water in reconstituting infant formula are warranted."

According to the American Dental Association, mild enamel fluorosis appears as barely noticeable faint white lines or streaks on tooth enamel that may occur when children ingest excess fluoride while their teeth are developing.

Researchers concluded that substantial fluoride consumption from beverages with fluoridated water, including infant formula, by children between the ages of 3 to 9 months, elevates a child's prospect of developing mild enamel fluorosis. Substantial fluoride consumption from beverages with fluoridated water and from fluoride toothpaste by children between the ages of 16 to 36 months also elevates a child's probability of developing mild enamel fluorosis.

The American Academy of Pediatrics recommends breastfeeding for infants. If parents are concerned about reducing the chances of their infants developing mild fluorosis through consuming substantial amounts of infant formula mixed with fluoridated water, the researchers suggest that they consult with their family dentist or physician. The researchers also encourage parents to follow recommendations to use small (smear or pea-sized) amounts of fluoridated toothpaste and ensure proper supervision of the child's tooth brushing.

Researchers recruited mothers of newborn infants from eight Iowa hospital postpartum wards between 1992 and 1995 for their children's participation in what would become known as the Iowa Fluoride Study, an investigation of dietary and non-dietary fluoride exposures, dental fluorosis and dental cavities. Researchers sent questionnaires to the parents at regular intervals and 630 children underwent visual dental examinations using standardized techniques and portable equipment. The leader of the research team was Steven M. Levy, D.D.S., M.P.H., the Wright-Bush-Shreves Endowed Professor of Research in the Department of Preventive and Community Dentistry at the University of Iowa's College of Dentistry and Professor of Epidemiology at the College of Public Health.

Note: Although this study appears in The Journal of the American Dental Association, it does not necessarily reflect the policies or opinions of the American Dental Association.

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Study Links Fluoride to Pre-term Birth and Anemia in Pregnancy

/PRNewswire/ -- Fluoride avoidance reduced anemia in pregnant women, decreased pre-term births and enhanced babies' birth-weight, concludes leading fluoride expert, AK Susheela and colleagues, in a study published in Current Science (May 2010). http://www.fluorideandfluorosis.com/Anemia/Current%20Science%20Reprint.pdf

Susheela's team explains that anemia in pregnancy, which can lead to maternal and infant mortality, continues to plague many countries despite nutritional counseling and maternal iron and folic acid supplementation. This is the first examination of fluoride as an additional risk factor for anemia and low-birth-weight babies.

Anemic pregnant women living in India, whose urine contained 1 mg/L fluoride or more, were separated into two groups. The experimental group avoided fluoride in water, food and other sources and ate a nutritious diet per instruction. The control group received no instructions. Both groups supplemented with iron and folic acid.

Results reveal that anemia was reduced and pre-term and low-birth-weight babies were considerably fewer in the fluoride-avoidance group as compared to the control. Two stillbirths occurred in the control group, none in the experimental group.

Susheela et al. writes, "Maternal and child under-nutrition and anemia is not necessarily due to insufficient food intake but because of the derangement of nutrient absorption due to damage caused to GI (gastrointestinal) mucosa by ingestion of undesired chemical substances, viz. fluoride through food, water and other sources."

Fluoride avoidance regenerated the intestinal lining which enhanced the absorption of nutrients as evidenced by the reduction in urinary fluoride followed by rise in hemoglobin levels, they report.

Could the same thing be happening in the United States? State University of New York researchers found more premature births in fluoridated than non-fluoridated upstate New York communities, according to a presentation made at the 2009 American Public Health Association's annual meeting.

Previous published research shows fluoride can interfere with the reproductive system (http://www.fluoridealert.org/health/repro).

Current Science reports that adverse reactions of fluoride consumption are known to occur including reducing red blood cells, reducing blood folic acid activity, inhibiting vitamin B12 production and the nonabsorption of nutrients for hemoglobin biosynthesis.

"Citizens must demand that water fluoridation be stopped," says attorney Paul Beeber, President, New York State Coalition Opposed to Fluoridation, Inc. "It's disturbing that public-health officials and organized dentistry continue to ignore the overwhelming evidence revealing fluoride to be non-nutritive, unnecessary and unsafe," says Beeber.

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Fluoride Could be Contributing to Early Puberty, Studies Show

/PRNewswire/ -- The medical and public health community is shocked by the news that young American girls are reaching puberty at ages as young as 7 years (1). However, according to Paul Connett, PhD, Director of the Fluoride Action Network, "If fluoride's dangers had not been taken off the scientific radar screen by the US Public Health Service when it prematurely endorsed fluoridation in 1950, maybe key warning signals would not have been ignored for over 50 years."

In 1956, it was reported, after one of the first fluoridation trials (1945-55) had been completed in Newburgh/Kingston NY, that young girls were starting to menstruate on average five months earlier in fluoridated Newburgh compared to non-fluoridated Kingston (2). This result was ignored and there was no follow-up research.

In 1997, Dr. Jennifer Luke in the UK, as part of her PhD thesis (3), reported that fluoride accumulates in the human pineal gland. The pineal gland produces the important hormone melatonin which acts like a biological clock. One of the processes it is thought to control is the onset of puberty. Luke published this work in 2001 but the result has been ignored and no fluoridating country has attempted to repeat her findings, something which would be easy to do if there was the will to do so.

Luke also found that animals exposed to fluoride had lowered melatonin levels and showed signs of reaching puberty earlier. Again this result has been ignored and no fluoridating government has attempted to repeat Luke's work.

Connett says, "We are not saying that exposure to fluoride is a definite cause of early puberty in girls, but not pursuing this possibility is bad for science, bad for medicine and bad for public health."

Simply put: if you don't look, you don't find. The medical community is being kept in the dark on the possibility that fluoride, a highly toxic substance, which is deliberately added to the drinking water of 184 million Americans daily, is causing a variety of harms from the subtle to the serious.

Connett says, "Apparently, it has become more important for the American Dental Association and the Centers for Disease Control and Prevention and other agencies of the US Department of Health and Human Services to protect this outdated, unethical, ineffective and the dangerous practice than it is to protect the health of the American people. Key research is not being done. Doctors are not being warned."

This and other tragic aspects of the US's peculiar obsession with fluoridation are to be documented in an upcoming book co-authored by Connett. The book, titled "The Case Against Fluoride: How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep it There," will be published by Chelsea Green in early October of this year.

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