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Water Fluoridation - Therapy or Fallacy?

by Sheila L.M. Gibson(more info)

listed in dentistry, originally published in issue 24 - January 1998

Water fluoridation – is this really a way to improve dental health, or is it another nail in our coffins, causing hip fractures, dental fluorosis, immune system problems and, possibly, cancer?

In 1936, fluoride was considered to be a general protoplasmic poison, and the Journal of the American Dental Association warned that detectable signs of fluoride toxicity appear from drinking water containing one or more parts per million (ppm) of fluoride.

All that was soon to change.

Moderately severe dental fluorosis in an eight-year-old boy showing discoloration
Moderately severe dental fluorosis in an eight-year-old boy showing discoloration
Moderately severe dental fluorosis in a nine-year-old boy showing discoloration and pitting.
Moderately severe dental fluorosis in a nine-year-old boy showing discoloration and pitting.

During the early part of the twentieth century industrial fluoride emissions from the aluminium, iron smelting, brick, glass and ceramics industries was posing an increasing problem because of their devastating effects on trees and crops, farm animals, wild life and people. The installation of scrubbers in factory chimneys to reduce these fluoride emissions left the fluoride-producing industries with the problem of how to dispose safely, and without crippling costs, of their toxic fluoride wastes. The more recent growth of the phosphate fertiliser industry has added substantially to the volume of fluoride wastes produced.

It had been noted in the 1920s that people living in parts of Texas and Colorado had mottled, brown-stained teeth which seemed to be more than usually resistant to dental decay. In 1931, scientists discovered that this tooth defect was due to fluoride in the drinking water. Further studies of children living in naturally fluoridated areas confirmed their lower incidence of dental decay. It was a biochemist named Gerald Cox, sponsored by the American aluminium giant ALCOA (Aluminum Company of America) who first suggested that if naturally fluoridated water prevented tooth decay, then it was only logical to add fluoride to all drinking water to achieve the same benefits for all people. From being a troublesome industrial pollutant, fluoride suddenly became a desirable medication, and the fluoride-producing industries had a market for their toxic wastes.

Although at first there was considerable scientific and medical doubt about the wisdom of mass-medicating the water supplies with fluoride, the first trial of water fluoridation was begun in 1945 in Newburgh, New York State, with Kingston, New York as its 'control' city. Grand Rapids, Michigan was also experimentally fluoridated, with another Michigan city as its 'control'. The experiment was scheduled to run for 10–15 years. However, after only 3 years of fluoridation, it was announced that dental health in children in Newburgh had improved by about 31%, with the youngest age groups benefiting most. These results were widely publicised, and many more fluoridation schemes were implemented, including the 'controls' for the fluoridated cities, thus aborting any possibility of long-term scientific study.

In the enthusiasm engendered in the US by a carefully orchestrated propaganda campaign, it was forgotten that fluoride is one of the most toxic substances present in the Earth's crust – more toxic than lead and only marginally less so than arsenic and mercury – with documented adverse effects on bones, teeth, stomach, liver, kidneys and thyroid gland. Ignored were the findings of Dr Robert Weaver's studies in North and South Shields, on Tyneside,[1],[2] which showed that fluoride merely delays tooth eruption by about one year, but does not offer any long-term benefits to teeth in the way of resistance to decay. Weaver also noticed an increased infant mortality rate in naturally fluoridated South Shields compared with unfluoridated North Shields. Other workers also observed the phenomenon of delayed tooth eruption in both the deciduous and the permanent teeth.[3–6]

H. Trendley Dean,[7] who conducted the original studies of naturally fluoridated teeth in the 1930s, had observed that at concentrations of fluoride in the water around 1 ppm, approximately 10% of the population had mottled teeth, now recognised as dental fluorosis, and that at higher concentrations the prevalence of dental fluorosis rose rapidly. It was also recognised that dental fluorosis was the first visible sign of fluoride toxicity. The dilemma facing the early fluoridationists was therefore how to judge the dose for maximum benefit to teeth, without incurring adverse health effects. All this, however, was forgotten in the fervour to fluoridate America in the 1950s, ostensibly to prevent dental decay. All objectors were dismissed as cranks who obviously did not care for the health of the nation.

As water fluoridation schemes spread across the US, and extended to Canada, Britain, Australia, New Zealand and South Africa, dentists eagerly awaited the results of studies showing improvements in children's teeth. They never materialised. Instead, by the 1980s it was obvious that dental health was improving in all Westernised, industrial countries, in both fluoridated and non-fluoridated areas alike.[8] Nor were the improvements in non-fluoridated areas related to the use of fluoridated toothpaste. What was benefiting the teeth was better diet and improved dental hygiene. It became increasingly apparent, with study after study published from the US, Canada and New Zealand,[9–12] that water fluoridation had not contributed to improvements in dental health. The figures published by the British Association for the Study of Community Dentistry (BASCD), in 1990,[13] showed no benefits to teeth from water fluoridation. Some studies even suggest that dental health is worse in fluoridated areas. Figures for Birmingham, fluoridated in 1964, showed, by 1992, an 85% increase in the number of dentists for a 15% drop in population. This suggests that fluoride, far from being a cheap and economic way of preventing tooth decay, is ineffective and expensive. Dental health estimates from the US show a similar dismal picture. Dental expenditure in 1990 was $34 billion, rose to $36.8 billion in 1991, and was nearly $40 billion in 1992. It is projected to be $63 billion by the year 2000, and this for a country which has been more than 50% fluoridated for more than 50 years!

Concern is also expressed over the prevalence of dental fluorosis in the US. The National Research Council of America, in its 1993 publication "Health Effects of Ingested Fluoride"[14] admitted that by the 1980s where the fluoride content of the water was around 1 ppm, 22% of the population now had dental fluorosis, compared with 10% in the 1930s. At 1.8–2.2 ppm, 53% of the population had dental fluorosis and at concentrations greater than 3.7 ppm, 84% had dental fluorosis. In effect, between one fifth and four fifths of the fluoridated population of the US is showing visible signs of fluoride toxicity.

Which brings us to a consideration of the knock-on effects of fluoridation on the environment. Once fluoride is into the food chain, it stays there, and as it is not biodegradable, it accumulates. Nature in her wisdom, locked up most of the fluoride present in the Earth's crust in the form of complex fluoride ores, buried deep within the crust, but man has mined these ores and released the fluoride freely into the environment, where it is continually accumulating. The increase in dental fluorosis from 10% to 22% in areas with a water fluoride concentration of around 1ppm, occurs because, in addition to the water drunk, all foods and beverages manufactured in fluoridated areas, and all food cooked with fluoridated drinking water, also contains added fluoride.

It is also added inadvertently to all crops watered with fluoridated water, and gets into sewage, rivers and the ground water. It is used in pesticides, herbicides, medicines and anaesthetics. The environmental effects were not taken into account when fluoridation was first mooted, and now poses a problem on the scale of the toxic industrial emissions of the early part of this century.

A 1994 paper by Fejerskov et al,[15] in Advances in Dental Research, a prestigious American dental journal, effectively showed that there is a linear relationship between the dose of fluoride and the degree of fluorosis of the tooth enamel, even at very low doses. Even at a very low intake of fluoride from water, some fluorosis will be found, which suggests that there is no safe dose of fluoride. This throws doubt on all claims that water fluoridation is safe. There is no documented evidence that safety studies have ever been carried out, and a recent communication (July 1997) from the Birmingham Health Authority assures us that they have no facility to collect biological samples in Birmingham. It is clear that Birmingham has never monitored the safety of its fluoridation scheme. Birmingham has one of the highest infant mortality rates in the country.

Although it has been claimed that fluoride is an essential nutrient, there is no scientific evidence to support this suggestion, despite numerous animal experiments. The Report of the Department of Health and Social Subjects, No. 41, Dietary Reference Values, Chapter 36 on fluoride (HMSO 1996) states: "No essential function for fluoride has been proven in humans." This accords with scientific opinion world-wide. Fluoride was recently removed from the US list of essential nutrients. It is now suspected that it is the other trace elements, such as magnesium, manganese, zinc, copper and cobalt, which occur along with fluoride in most naturally fluoridated waters, which are responsible for the improved dental health seen in these areas. Soft fluoridated waters, such as are found in some areas of Turkey and the Punjab, cause crippling skeletal and severe dental fluorosis at fluoride levels not much higher than those found in Texas and Colorado.[16],[17]

The co-discoverer of streptomycin, Albert Schatz, PhD, while studying health in Chile in the 1960s[18] found that in populations on borderline nutrition, deficient in essential trace elements, water fluoridation at 1 ppm had a devastating effect on health and produced high neonatal death rates. It also adversely affected their previously good dental health. His findings induced the Chilean Government to abandon its water fluoridation schemes.

Schatz's findings are not really surprising. We now know that fluoride inhibits a wide range of enzymes (biological catalysts) in the body and at the soft tissue fluoride levels found in people living in fluoridated areas, it is likely that over 100 enzymes are inhibited. Fluoride either inhibits enzymes by distorting their molecular structure, as in the case of cytochrome C peroxidase,[19] or by combining with their essential trace-element co-factors. People who are deficient in these trace elements are therefore more at risk from the toxic effects of fluoride than people who are well nourished.

In health about 50% of the fluoride ingested is excreted in the urine, the rest being stored in the body, principally in the bones and teeth, with some in the soft tissues. It used to be thought that fluoride strengthened bones because fluorosed bones are more dense on x-ray, and it was standard practice in the 1970s and 1980s to use sodium fluoride to treat osteoporosis, in the expectation that it would reduce the tendency for hip fractures. This practice has now been largely discontinued (to be replaced by HRT!) since it was discovered that osteoporotic patients treated with fluoride were more likely, not less likely, to sustain hip fractures.[20–22] Several recent studies show that elderly people living in fluoridated areas are also more likely to suffer hip fractures than those living in non-fluoridated areas.[23–26]

A recent Polish study,[27] using x-ray assessments of the distal metaphyses (growing areas of the long bones), in children with dental fluorosis showed abnormalities when compared with children free from dental fluorosis. The changes were particularly apparent in boys and in younger children. A small angle x-ray scattering study of the bones of patients with osteoporosis treated with fluoride[28] likewise showed bone abnormalities. Fluoride causes abnormal mineralisation of bone,[29] causing the bone to appear denser on x-ray, but in fact weakening the structure. Two studies, by the US Public Health Service and the New Jersey Department of Health,[30],[31] found an increase in osteosarcoma, a rare bone cancer, in young men living in fluoridated areas. This finding is interesting in view of the bone abnormalities found in young boys with dental fluorosis.

The link between water fluoridation and a rise in cancer death rates has been hotly disputed for over three decades. The findings with regard to osteosarcoma are suggestive. A number of laboratory studies in animals show that fluoride predisposes to genetic damage,[32–35] one mechanism for inducing cancer, and the US National Toxicology Program showed that fluoride is a "probable human carcinogen". This finding alone should have led to the discontinuation of all water fluoridation schemes. However, the results of the study were suppressed and although Dr William Marcus successfully exposed the cover-up, nothing further has been done.

Both my own,[36] and other studies[37],[38] have demonstrated inhibitory effects of fluoride on the functional abilities of white blood cells, an integral part of the immune system. Interference with immune system function is another way in which fluoride could predispose sensitive individuals to cancer, since one of the functions of the immune system is to find and destroy developing cancer cells.

Adverse effects of fluoride on teeth, bones, kidneys, heart and blood vessels, the gastrointestinal tract, thryoid and parathyroid glands, eyes, skin, immune system and our genetic structure are now documented. That fluoride also has an adverse effect on the brain has been known since 1944, if not earlier. This information came to light recently with the declassification of certain US military documents. This effect of fluoride has been confirmed in rats by Dr Phyllis Mullenix[39] and in children in China (Zhao et al[40]).

It is incredible, with all the evidence of harm now available, that both the British Dental Association and the British Medical Association are still calling for an extension of the water fluoridation schemes in Britain. Public opinion is against it, and in virtually all instances where it has been put to a vote, the idea of water fluoridation has been soundly rejected. Even if fluoride did improve dental health, it is unethical to mass-medicate whole populations irrespective of their need or their state of health. No doctor would consider prescribing medication for a patient he has never seen and whom he could not monitor for adverse reactions, yet this is precisely what water fluoridation does. Not only is it unethical, but the measure is still being pushed despite the lack of efficacy and the mounting evidence of harm.

The tide, however, is beginning to turn. The National Federation of Federal Employees, the Union of more than 1,200 Government Scientists at the US Environmental Protection Agency, recently voted unanimously to support a California initiative to ban water fluoridation. Earlier this year (April 1997), the US Food and Drug Administration acknowledged that fluoride is a poison and that all tubes of fluoridated toothpaste sold in the US must carry a warning to this effect.

It is to be hoped that the 1936 situation will soon be restored and that water fluoridation, together with other forms of fluoride medication such as drops, tablets and toothpaste, will soon be a thing of the past. Let us ensure, however, that the lessons of this long fluoride experiment which has been so costly to both human and environmental health, will finally be learned.



1 WEAVER, R. Fluorine and dental caries: further investigations on Tyneside and in Sunderland. BDJ, 1944, 77, 185–193.
2 WEAVER, R. The inhibition of dental caries by fluorine. Proc. Roy. Soc. Med., 1948, 41, 284–290.
3 AINSWORTH, N. J. Mottled teeth. BDJ, 1933, 55, 233–250.
4 LEMMON, J. H. Mottled enamel of teeth in children. Texas State J. Med., 1934, 30, 332–336.
5. SUTTON, P. R. N. Fluoridation, Second Edition, Melbourne and Cambridge University Presses, 1960.
6 FELTMAN, R. and KOSEL, G. Prenatal and postnatal ingestion of fluoride – Fourteen years of investigation – Final Report. J. Dent. Med., 1961, 16, 190–199.
7 DEAN, H. T. Investigation of physiological effects by the epidemiological method. In F. R. Moulton, Ed.: Fluorine and Dental Health, 1942, 23–31.
8 DIESENDORF, M. The mystery of declining tooth decay. Nature, 1986, 322, 125.
9 COLQUHOUN, J. Influence of social class and fluoridation on child dental health. Oral Epidemiol. 1985, 13, 37–41.
10 GRAY, A. S. Fluoridation. Time for a new base line? J. Canad. Dent. Ass., 1987, 53, 763–765.
11 HILDEBOLT, M., ELVIN-LEWIS, S. et al. Prevalences among geochemical regions of Missouri. Am. J. Phys. Anthropol., 1989, 78, 79–92.
12 YIAMOUYIANNIS, J. A. Water fluoridation and tooth decay: results from the 1986–1987 National Survey of US schoolchildren. Fluoride, 1990, 23, 55–67.
13 Survey co-ordinated by the British Association for the Study of Community Dentistry, 1988–89. Community Dental Health, 1990, 7.
14 Health Effects of Ingested Fluoride. National Research Council, National Academy Press, Washington, DC, 1993.
15 FEJERSKOV, O., LARSEN, M. J. et al. Dental tissue effects of fluoride. Adv. Dent. Res., 1994, 8, 15–31.
16 JOLLY, S. S., PRASAD, S. et al. Human fluoride intoxication in Punjab. Fluoride, 1971, 4, 64–79.
17 JOLLY, S. S., PRASAD, S. et al. Endemic fluorosis in Punjab. 1. Skeletal aspect. Fluoride. 1973, 6, 4–18.
18 SCHATZ, A. Affidavit in support of motion for summary judgment, circuit court, Fond du Lac County, Wisconsin, 1993.
19 EDWARDS, S. L., POULOS, T. L. and KRAUT, J. The crystal structure of fluoride-inhibited cytochrome c peroxidase. J. Biol. Chem., 1984, 259, 12984–12988.
20 HEDLUND, L. R. and GALLAGHER, J. C. Increased incidence of hip fracture in osteoporotic women treated with sodium fluoride. J. Bone Min. Res., 1989, 4, 223–225.
21 ORCEL, Ph, de VERNEJOUL, M. C. et al. Stress fractures of the lower limbs in osteoporotic patients treated with fluoride. J. Bone Min. Res., 1990, 5, suppl. 1, s 191–194.
22 GUTTERIDGE, D. H., PRICE, R. I., et al. Spontaneous hip fractures in fluoride-treated patients: potential causative factors. J. Bon Min. Res., 1990, 5, suppl. 1, s 205–215.
23 COOPER, C., WICKHAM, C. A. C. and BARKER, D. J. R. Water fluoridation and hip fracture, (letter), JAMA, 1991, 266, 513.
24 DANIELSON, C., LYON, J. L. et al. Hip fractures and fluoridation in Utah's elderly population, JAMA, 1992, 268, 746–748.
25 LEE, J. R. Fluoridation and osteoporosis, '92. Fluoride. 1992, 25, 162–164.
26 JACQMIN-GADDA, H., COMMENGES, D. and DARTIGUES, J-F. Fluorine concentration in drinking water and fractures in the elderly. (Letter). JAMA, 1995, 273, 775–776.
27 CHLEBNA-SOKOL, D. and CZERWINSKI, E. Bone structure assessment on radiographs of distal radial metaphysis in children with dental fluorosis. Fluoride, 1993, 26, 37–44.
28 FRATZL, P., ROSCHGER, P. et al. Abnormal bone mineralisation after fluoride treatment in osteoporosis: a small-angle x-ray-scattering study. J. Bone Min. Res., 1994, 9, 1541–1549.
29 CARTER, D. R. and BEAUPRE, G. S. Effects of fluoride treatment on bone strength. J. Bone Min. Res., 1990, 5, suppl. 1, s 177–184.
30 HOOVER, R.N., DEVESA, S., et al. Review of fluoride. Benefits and risks. Public Health Service, USA, 1991, Appendix F 1–7.
31 COHN, P. D. A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males. New Jersey Department of Environmental Protection and Energy and the New Jersey Department of Health, 1992.
32 TSUTSUI, T., SUZUKI, N. et al. Cytotoxicity, chromosome aberrations and unscheduled DNA synthesis in cultured human diploid fibroblasts induced by sodium fluoride. Mutation Res., 1984, 139, 193–198.
33 THOMSON, E. J., KILANOWSKI, F. M. and PERRY, P. E. The effect of fluoride on chromosome aberration and sister-chromatid exchange frequencies in cultured human lymphocytes. Mutation Res., 1985, 144, 89–92.
34 COLE, J., MURIEL, W. J. and BRIDGE, B.A. The mutagenicity of sodium fluoride to L5178Y (wild-type and TK +/- <[>3.7.2 C]) mouse lymphoma cells. Mutagenesis, 1986, 1, 157–167.
35 AARDEMA, M. J., GIBSON, D. P. and le BOEUF, R. A. Sodium fluoride-induced chromosome aberrations in different stages of the cell cycle: a proposed mechanism. Mutation Res., 1989, 223, 191–203.
36 GIBSON, S. L. M. Effects of fluoride on immune system function. Complementary Med. Res., 1992, 6, 111–113.
37 GABLER, W. L. and LEONG, P. A. Fluoride inhibition of polymorphonuclear leukocytes. J. Dent. Res., 1979, 58, 1933–39.
38 GOMEZ-UBRIC, J. L., LEIBANA, J. et al. In vitro immune modulation of polymorphonuclear leukocyte adhesiveness by sodium fluoride. Europ. J. Clin. Invest., 1992, 22, 659–661.
39 MULLENIX, P. J., DENBESTEN, P. K., et al. Neurotoxicity of sodium fluoride in rats. Neurotoxicol. Teratol., 1995, 17, 169–177.
40 ZHAO, L. B. et al. Effect of a high fluoride water supply on children's intelligence. Fluoride, 1996, 29, 190–192


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About Sheila L.M. Gibson

Sheila L.M. Gibson, MD, BSc, MFHom. Research Physician, Department of Clinical Pharmacognosy, Glasgow Homoeopathic Hospital.

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