Water Fluoridation
An Obsolete Practice
Paul Connett, PhD
Director, Fluoride Action Network
FluorideALERT.org
Murdoch University, Feb 23, 2014
Introduction
I
have spent 28 years fighting
incineration (and promoting more
sustainable ways of handling
waste) (1985-present)
 This has taken me to 49 states in
US, 7 provinces in Canada and 60
other countries
Sostenibilita’
I
have spent nearly 18 years
fighting water fluoridation first as
a professor of chemistry
specializing in environmental
chemistry and toxicology, and now
as director of the Fluoride Action
Network.
 This research effort culminated in
the publication of The Case
Against Fluoride in Oct, 2010.
James Beck, MD, PhD, A retired professor of Physics from Calgary
HS Micklem, D Phil (Oxon) A retired professor of Biology from Edinbrgh
Book published
by Chelsea Green
October, 2010
Can be ordered
on Amazon.com
Contains
80 pages
of references
to the
Scientific
literature
Definition of an Educated Person
An educated person is someone
Who can entertain his or herself,
Who can entertain a friend and
Who can entertain a NEW IDEA!
Outline of my presentation
1. Four simple facts that opened my mind in 1996.
2. The better ways of fighting tooth decay.
3. The events that have made fluoridation obsolete.
4. Estimating a safe dose of fluoride to protect
children from lowered IQ
5. Why do health agencies and others continue to
promote this obsolete practice?
6. The regrettable tactics used by public health
officials.
Part 1.
The four simple facts that opened
my mind in 1996
1) There is not one single process in the
human body that needs fluoride to
function properly. There is no
evidence that fluoride is an essential
nutrient.
2) On the other hand there are many
biological components and processes
that are potentially harmed by
fluoride, e.g. fluoride inhibits
enzymes, switches on G-proteins
etc…
3) The level of fluoride in mothers’ milk
is EXTREMELY LOW (0.004 ppm,
NRC , 2006, p. 40)
This means that, a bottle-fed baby in a
fluoridated community (0.7 – 1.2 ppm)
is getting 175-300 times the fluoride
dose that nature intended.
4) Fluoride accumulates in the
bones and poses LIFELONG
risks in the form of arthritis and
increased bone fractures in the
elderly (especially HIP fractures)
Part 2.
The better ways of
fighting tooth decay
The vast majority of
countries do NOT
fluoridate their water
97% of Western European population now
drinks Non-Fluoridated Water
Austria
Belgium
Denmark
Finland
France
Germany
Greece
Iceland
Italy
Luxembourg
Netherlands
Northern Ireland
Norway
Scotland
Sweden
Switzerland
97% of Western European population now
drinks Non-Fluoridated Water
Austria*
Belgium
Denmark
Finland
France*
Germany*
Greece
Iceland
Italy
Luxembourg
Netherlands
Northern Ireland
Norway
Scotland
Sweden
Switzerland*
*Some fluoridate their salt
According to WHO data
tooth decay in 12-year-olds
is coming down as fast
in F as NF countries
SOURCE: World Health Organization. (Data online)
Better Alternatives
Most of the tooth decay today is concentrated
in low-income families.
We need to target those families with better
dental education and better diet.
They do not need to swallow a substance that
could put them at greater disadvantage.
Fluoride’s toxic effects are made worse by
poor diet.
Better Alternatives
Everyone agrees that fluoride’s benefits are
TOPICAL (discussed later) so we should
provide topical treatments.
These could be provided as fluoride varnishes
or more simply with brushing with
fluoridated toothpaste.
Better still we should encourage the use of
XYLITOL toothpaste. Xylitol toothpaste
has been used for over 30 years in Finland
and Japan
Better Alternatives
In Wichita, Kansas there is a program where
children in schools in low-income areas are
being given xylitol mints
On Wed Feb 19, I presented before the
Parliamentary Committee on Health and
Education and urged them to investigate the
programs in Europe which have reduced
tooth decay in low–income families without
forcing fluoridation on the whole
population. I cited the program in Scotland.
Scotland
Instead of water fluoridation, the newly devolved
Scottish Government opted, in its 2005 dental
action plan (their Childsmile program), to pursue:
 a) school-based toothbrushing schemes;
 b) the offering of healthy snacks and drinks to
children;
 c) oral health advice to children and families on
healthy weaning, diet, teething and toothbrushing;
 d) annual dental check-ups and treatment if
required, and

Scotland
 e)
fluoride varnish applications (Healthier
Scotland, Scottish Government, 2013).
 The proportion of children aged 4–6 years
 without obvious dental decay has risen
from 42.3% in 1996 to
 67% in 2012

Information Services Division, Scotland, 2012.
Scotland
Nursery school toothbrushing is the most likely
contributor to the improved oral health in fiveyear-old Scottish children (Macpherson, 2013).
 The proportion of children aged 10–12 years
without obvious dental decay rose from
 52.9% in 2005 to
 69.4% in 2011 and
 72.8% in 2013
 (Information Services Division Scotland, 2013).

A recent BBC report from Scotland
 “A
scheme to encourage nursery children to
brush their teeth has saved more than £6m in
dental costs, according to a new study.
 Childsmile involves staff at all Scottish
nurseries offering free supervised
toothbrushing every day.
 It emphasises the importance of
toothbrushing and helps parents establish a
healthy diet from the earliest stage.
Scotland
Glasgow
researchers found
that the scheme had reduced
the cost of treating dental
disease in five-year-olds by
more than half between 2001
and 2010.”
 In
short our kids need
 MORE BRUSHING!
 MORE FRUIT AND VEGETABLES!
 LESS SUGAR!
 Less sugar means less tooth decay and less
OBESITY
 Less obesity means less diabetes and fewer
heart attacks
 In other words education to promote less
sugar consumption is a very good
investment!
We need
EDUCATION
not FLUORIDATION
to fight tooth decay and
obesity.
Part 3
The events that have made
fluoridation obsolete
Event 1.
Starting in 1982 a number of articles
began to appear in major journals
indicating that there was very little
difference in tooth decay between
fluoridated and non-fluoridated
communities
Leverett in Science, 1982
Colquhoun, 1984,’85,’87
Diesendorf in Nature, 1986
Gray, 1987
In 1990 the U.S. National
Institute of Dental Research
survey was published. This
survey (1986-87) examined
the teeth of over 39,000
children in 84 communities
The NIDR survey(1990)
 Brunelle
and Carlos compared DMFS
(= decayed, missing and filled
permanent tooth SURFACES) between
children who had spent all their lives in
a Fluoridated Community with those
who had spent all their lives in a NonFluoridated one (Table 6)
Decayed Missing and Filled surfaces (DMFS)
There are 4 surfaces to the top six and bottom six cutting
teeth and 5 surfaces on all the other teeth.
128 tooth surfaces in all.
Brunelle and Carlos (1990) (Table 6)
2.8
DMFS
F
The largest US survey of tooth decay
3.4
DMFS
NF
2.8
DMFS
F
Brunelle and Carlos, 1990
3.4
DMFS
NF
2.8
DMFS
F
Average difference (for 5 - 17 year olds) in DMFS
= 0.6 tooth surfaces
Not only was this saving very
small (0.6 of one tooth
surface) but it was not even
shown to be statistically
significant!
Warren et al. (2009)
(the “Iowa” study) examined
the relationship between the
amount of fluoride ingested
by children and level of
tooth decay
They found no relationship. The
authors state:
“These findings suggest that
achieving a caries-free status
may have relatively little to do
with fluoride intake…”
Warren et al., 2009
The claim that swallowing fluoride
lowers tooth decay is still unproven!
After 68 years there has been no
randomized control trial (RCT)
demonstrating effectiveness.
Grade B studies are complicated by
the difficulty of controlling all the
confounding variables that can
influence tooth decay rates.
Event 2, in 1999, the CDC
conceded that the
predominant benefit of
fluoride is TOPICAL not
SYSTEMIC.
This fact probably explains why the
evidence of fluoridation’s benefits
is so weak
CDC, MMWR, 48(41); 933-940,
Oct 22, 1999
 “Fluoride’s
caries-preventive
properties initially were attributed
to changes in enamel during tooth
development...
CDC, MMWR, 48(41); 933-940,
Oct 22, 1999
 “Fluoride’s
caries-preventive
properties initially were attributed
to changes in enamel during tooth
development... However, laboratory
and epidemiologic research suggest
that fluoride prevents dental caries
predominantly after eruption of the
tooth into the mouth, and its actions
primarily are topical…”
If fluoride works primarily on the outside
of the tooth not from inside the body
Why swallow fluoride and expose every
tissue of the body to a toxic substance,
when you can brush it on your teeth and
spit it out?
And why put it in the drinking water and
force it on people who don’t want it?
Event 3, In 2006 the U.S. National
Research Council published its 3year review (NRC, 2006).
The panel chosen was the first
balanced panel in the history of
fluoridation in the U.S.
NRC (2006)
NRC (2006) review showed that
fluoride (they didn’t review
fluoridation per se) caused many
health problems.
But the American Dental Association
claimed on the day it was published that
the NRC only looked at levels of fluoride
between 2 and 4 ppm, which was not
relevant to water fluoridation at 0.7 to 1.2
ppm.
 Six
days later, the Oral Health Division
of the Centers for Disease Control and
Prevention (CDC) declared on its Web
page,
 “The findings of the NRC report are
consistent with CDC’s assessment that
water is safe and healthy at the levels used
for water fluoridation (0.7–1.2 mg/L).”
In 2007, the NHMRC dismissed the
findings of the NRC review:
“The NAS report refers to the adverse
health effects from fluoride at 2–4
mg/L, the reader is alerted to the fact
that fluoridation of Australia’s
drinking water occurs in the range of
0.6 to 1.1 mg/L.”
These statements from the ADA,
CDC and NHMRC are
political not scientific
statements.
They were more intent on
protecting the fluoridation
program than protecting the
public’s health.
These statements by the ADA, CDC and
NHMRC indicate three things:
1) They don’t know the difference between
concentration and dose. There would be
overlap in dose for two populations drinking 1
and 2 ppm (and even 4 ppm) fluoridated water
respectively.
2)They have little notion of the basics of
regulatory toxicology. You can’t declare
safety before you have done a careful risk
assessment (margin of safety analysis)
3) The ADA, CDC and
NHMRC can’t read!
In Chapter 2 of the NRC (2006) review
there is an exposure analysis that
shows that subsets of U.S.
population drinking F -water at 1
ppm (including bottle-fed infants) are
exceeding EPA’s safe reference
dose (0.06 mg fluoride/kg
See Figure 2-8 on page 85
(NRC, 2006)
 This
FIGURE shows
estimated average intake of
fluoride from all sources, at 1
ppm in drinking water for
various age ranges
Event 4, in 2010, the U.S. Centers for
Disease Control and Prevention
(CDC) published dental fluorosis
figures that confirm that American
kids are being hugely over-exposed
to fluoride
Context on Dental Fluorosis
Early promoters thought that at 1 ppm F
they could reduce tooth decay and limit
dental fluorosis to 10% of children in
its very mild form.
CDC (2010)
Beltrán-Aguilar et al. Prevalence and Severity
of Dental Fluorosis in the United States,
1999-2004
41% of ALL American children
aged 12-15 (average from both
fluoridated and non-fluoridated
communities) had dental fluorosis
CDC, 2010
41%
Impacts up to 25% of tooth surface
Very Mild Dental Fluorosis
CDC, 2010
41%
Impacts up to 50% of tooth surface
Mild Dental Fluorosis
CDC, 2010
41%
Impacts 100% of tooth surface
Moderate- Severe
Dental Fluorosis
A KEY QUESTION
When fluoride is damaging the
baby’s growing tooth cells
(causing dental fluorosis) what is it
doing to its other developing
tissues?
Event 5, Since 1991
extensive evidence has
emerged that fluoride
damages the brains of
animals and humans
Over 40 animal studies show that prolonged
exposure to fluoride can damage the brain.
19 animal studies report that mice or rats
ingesting fluoride have an impaired capacity to
learn and remember.
12 studies (7 human, 5 animal) link fluoride with
neurobehavioral deficits
3 human studies link fluoride exposure with
impaired fetal brain development
37 out of 43 published studies show that
fluoride lowers IQ
Xiang et al. (2003 a,b)




Compared children in two villages ( <0.7 ppm
versus 2.5 - 4.5 ppm F in water)
Controlled for lead exposure and iodine
intake, and other key variables (NOTE: both
lead exposure and low iodine also lower IQ).
Found a drop of 5-10 IQ points across the
whole age range
The whole IQ curve shifted for both males and
females
Xiang et al. (2003 a,b)
MALES
The Harvard review
 Choi
et al (the team included Philippe
Grandjean) did a meta-analysis of 27
studies comparing IQ in “high” versus
“low” fluoride villages .
 The study was published in
Environmental Health Perspectives
(published by NIEHS)
Harvard meta-analysis of 27 studies
 The
Harvard team acknowledged
that there were weaknesses in many
of the studies, however…
 …the
results were remarkably
consistent
 In 26 of the 27 studies there was
lower average IQ in the “high”
versus low-fluoride villages.
 Average IQ lowering was about 7
IQ points.
Promoters claim that the fluoride
levels in the “High Fluoride” villages
were so high that they are not
relevant to fluoridation programs?
 THIS
IS NOT TRUE. In nine of the
studies the “high fluoride village” had
concentrations less than 3 ppm
Comparing
concentrations is
simplistic. What is
needed is a Margin of
Safety Analysis
Part 4.
A Margin of Safety Analysis.
Estimating a safe dose of
fluoride which would protect all
children in a large population
from lowered IQ
Our task is to find the No
Observable Adverse Effect
Level (NOAEL) and
divide by a Margin of
Safety of 10 to protect the
whole population
For this Margin of
Safety analysis we will
select the study with the
lowest concentration
where lowered IQ
(harm) was found
STEP 1. Convert the concentration at
which harm found (1.8 ppm = 1.8
mg/Liter) to a DOSE.
STEP 1. Convert the concentration at
which harm found (1.8 ppm = 1.8
mg/Liter) to a DOSE.
If the children drank one liter per day
they would get 1.8 mg/day (1.8
mg/liter x 1 liter/day)
STEP 1. Convert the concentration at
which harm found (1.8 ppm = 1.8
mg/Liter) to a DOSE.
If the children drank one liter per day
they would get 1.8 mg/day (1.8
mg/liter x 1 liter/day)
If the children drank half a liter per
day they would get 0.9 mg/day
STEP 1. Convert the concentration at
which harm found (1.8 ppm = 1.8
mg/Liter) to a DOSE.
If the children drank one liter per day
they would get 1.8 mg/day (1.8
mg/liter x 1.0 liter/day)
If the children drank half a liter per
day they would get 0.9 mg/day
If the children drank 2 liters per day
they would get 3.6 mg/day
RANGE = 0.9 – 3.6 mg/day
RANGE = 0.9 – 3.6 mg/day
STEP 2. Determining the LOAEL. Take
the lowest end of this range
The LOAEL = 0.9 mg/day.
RANGE = 0.9 – 3.6 mg/day
STEP 2. Determining the LOAEL. Take
the lowest end of this range
The LOAEL = 0.9 mg/day.
STEP 3. Determining the NOAEL.
Divide the LOAEL by 10
The NOAEL = 0.09 mg/day
STEP 4. Applying a safety margin of
10 to protect whole population
(including the most vulnerable).
STEP 4. Apply a safety margin of 10
to the NOAEL to find a safe level that
will protect whole population
(including the most vulnerable).
We will divide the NOAEL of 0.09 mg/day
by 10 = 0.009 mg/day
STEP 4.
Thus the SAFE DOSE sufficient to protect
everyone in a large population = 0.009
mg/day
STEP 5. Estimating how much water
children could drink of fluoridated
water at 1 ppm without exceeding this
safe dose of 0.009 mg/day.
STEP 5. Estimating how much water
children could drink of fluoridated
water at 1 ppm without exceeding this
safe dose of 0.009 mg/day.
Children should not drink more than
0.009 L per day of fluoridated water at 1.0
ppm - calculation
0.009 L/day x 1 mg/liter = 0.009 mg/day.
0.009 L = 9 ml or two teaspoons!
In other words - using standard
regulatory toxicological procedures - in
order to protect all children (including the
most sensitive) from lowered IQ they
should not drink more than two teaspoons
of fluoridated water per day.
Sensitivity analysis –
if we drop one safety factor of 10 –
Children shouldn’t drink more than 90 ml
of water at 1 ppm fluoride (half a glass)
If we drop both safety factors of 10 –
children shouldn’t drink more than 900 ml of
water at 1 ppm fluoride (more than a quart)
Simply put –
If fluoride lowers the IQ of children
drinking water at 1.8 ppm fluoride in
a small study group
It is not safe (protective against
lowered IQ ) for all the children in
a large population drinking fluoridated
water at 0.6 to 1.1 ppm.
Another criticism of these IQ
studies is that there was no
measure of individual exposure,
However, 11 of the 37 IQ studies
found an association between
lowered IQ and fluoride levels in
the children’s urine
Xiang found an association between
lowered IQ and PLASMA fluoride
levels
Xiang et al., 2011
Ding et al. 2011
Xiang (2012). Children’s IQ versus Levels of fluoride in the serum (children
from both villages combined, personal communication with Paul Connett) . The
higher the levels of fluoride in the plasma the lower the levels of IQ.
Dr. Philippe Grandjean
“Fluoride seems to fit in with lead, mercury,
and other poisons that cause chemical brain
drain. The effect of each toxicant may seem
small, but the combined damage on a
population scale can be serious, especially
because the brain power of the next
generation is crucial to all of us.” (Harvard
Press Release)
IQ and population
Number of Kids
With a
Specific IQ
IQ
100
IQ and population
Number of Kids
With a
Specific IQ
Mentally
handicapped
IQ
100
Very Bright
IQ and population
Number of Kids
With a
Specific IQ
IQ
95 100
IQ and population
Number of Kids
With a
Specific IQ
Mentally
handicapped
IQ
95 100
Very Bright
Event 6, Fluoridation may
actually be killing a few
young boys each year
Bassin et al., 2006
Osteosarcoma
 Bassin
found that young boys exposed to
fluoridated water in their 6th,7th or 8th
years, had a 5-7 fold increase in
developing osteosarcoma by the age of
20, compared to non-exposed boys.
 Her 2006 study has never been refuted.
 The study promised by Douglass (Kim et
al., 2011) failed to do so.
We can anticipate more evidence that
fluoridation causes other health
affects:
1. lowered thyroid function,
2. arthritis,
3. hip fractures in the elderly, and
4. the fact that some individuals are
very sensitive to fluoride
BUT LET’s KEEP IT SIMPLE
No risk is acceptable if it is avoidable.
There is no need to swallow fluoride.
Other countries have demonstrated that
there are other – and better - ways of
fighting tooth decay without forcing
water fluoridation on the whole
population.
Fluoridation is an obsolete practice and it is
time to end it
Part 5
Why do health agencies and
others continue to promote
this obsolete practice?
Motivations?
Many dentists and doctors are fiercely
proud of this public health policy and
do not question its safety and
effectiveness.
That is the problem – they do not
question it.
It has fossilized into a belief system.
Motivations?
There are some entities with economic
interests and liabilities:
1)
2)
3)
4)
5)
The sugar lobby;
dental researchers for whom fluoridation is
the gravy train;
the phosphate fertilizer industry;
toothpaste manufacturers;
The dental organizations that endorse
fluoridated products (e.g. American Dental
Association).
Motivations?
6) the industries that use fluoride or
release fluoride in their manufacturing
processes. They have exposed both
the environment and their own
workers to this highly toxic substance
and are worried about liabilities (see
The Fluoride Deception by Chris
Bryson and also examine the role of
the ACSH)
Motivations?
7) Public health agencies.
Are they worried that if fluoridation falls that
it will erode the public’s trust, which in turn
may undermine other public practices (e.g.
vaccination)?
Are they defending these other practices by
proxy?
Part 6
The regrettable tactics used
by some civil servants in the
promotion of fluoridation
Queensland Health’s
promotion of “mandatory”
statewide fluoridation)
(2007)
Queenslanders were told
Fluoridated Townsville has
65% less tooth decay than
Non-Fluoridated Brisbane

“ In Townsville, water
supplies have been
fluoridated since 1964,
resulting in 65% less
tooth decay in children
than those in
Brisbane”
Qld Health newspaper ads Dec
2007
How did they get the 65% less decay ?
“ Teeth exposed to
fluoridated water”
Qld Health 2007
“ Teeth exposed to
fluoridated water”
Qld Health 2007
“ Teeth without exposure
to fluoridated water”
Qld Health 2007
Medical officer of health Dr. Hazel Lynn holds up a
picture of a child's teeth. Lynn said water fluoridation
prevents tooth decay and is a safe practice. (Owen
Sound, Sun Times, Jan 31, 2014)
Dr. Peter Cooney
 Dr.
Peter Cooney, the Chief Dental
Officer of Canada, told an
audience in Dryden, Ontario (April
1, 2008),
 “I walked down your High Street
today, and I didn’t see anyone
growing horns, and you have been
fluoridated for 40 years!”
Health agencies frequently pick profluoridation panels to rubber stamp
fluoridation (Irish Fluoridation Forum,
2002; Australian NHMRC, 2007 and
Health Canada, 2011).
In 2007, Health Canada chose SIX experts to
review the fluoridation literature –
FOUR of them were well-known profluoridation dental researchers!
What we have here are public
servants betraying the public’s trust.
This is not healthy in a democratic
society.
The best way to regain the public’s
trust is to end this obsolete practice as
soon as possible.
Hopefully, both proponents and
opponents of fluoridation can work
together to put in place Scottish type
programs in WA to help fight tooth
decay in low income families without
continuing to force fluoridated water
on people who don’t want it and
without imposing unnecessary health
risks.
EXTRA SLIDES
Protecting our babies from fluoride
Mothers’ milk protects the baby from
lowered IQ but formula made up with
fluoridated tap water does not.
Further calculations show that a
bottle-fed baby would get 180-300
times the safe dose!
Safe dose for a 7 kg baby
 To
calculate safe dose for a baby we
have to take into account bodyweight
 Supposing the safe dose for 20 kg
child was 0.009 mg Fluoride per day
 Safe dose for a 7 kg baby =0.009
mg/day multiplied by bodyweight
ratio 7/20 = 0.009 x 7/20 = 0.00315
mg/day
Breast–fed versus bottle-fed baby
 Breast-fed

baby
drinking 800 ml at 0.004 mg/L
=
0.8 L x 0.004 mg/L = 0.0032 mg/day
 We estimated safe dose for a 7 kg
baby as 0.00315 mg/day – so a breastfed baby is OK as far as lowered IQ is
concerned.
Breast–fed versus bottle-fed baby
 Bottle-fed baby
 drinking 800 ml at 0.7 mg/L
=
0.8 L x 0.7 mg/L = 0.56 mg/day
 We estimated safe dose for a 7 kg
baby as 0.00315 mg/day – so a bottlefed baby (at 0.7 ppm) gets 180 times
too much fluoride to protect against
lowered IQ.
Breast–fed versus bottle-fed baby
 Bottle-fed baby
 drinking 800 ml at 1.2 mg/L
=
0.8 L x 1.2 mg/L = 0.96 mg/day
 We estimated safe dose for a 7 kg
baby as 0.00315 mg/day – so a bottlefed baby (at 1.2 ppm) gets 300 times
too much fluoride to protect against
lowered IQ.
Mothers’ milk protects the baby from
lowered IQ but formula made up with
fluoridated tap water does not!