| Index -
Note the common themes in the 60th
33rd
and 10th Fluoridation Anniversary summary boxes
below: Nearly all scientists, dentists & health professionals support
Fluoridation and a relatively small but vocal minority opposes it. |
 |
| Fluoride Related Books, Articles and Position
Statements |
| > |
American Academy of Dentistry |
| > |
Water fluoridation From Wikipedia |
| > |
Committee on Fluoride in Drinking Water, National Research Council
- 2006 |
| > |
SCHER Review:
Human Exposure to Fluoride |
| > |
NSF Fact Sheet on Fluoridation Chemicals |
| > |
Australian Government National Health and Medical Research Council - 2007 |
| > |
The Science of Fluoride |
| > |
Linus Pauling Institute Micronutrient Information Center |
| > |
The Canadian Dental Association (CDA)
|
| > |
World Health Organization (WHO) |
| > |
The American Academy of Pediatric Dentistry |
| > |
The Centers for Disease Control and Prevention |
| > |
National Cancer Institute |
| > |
American Medical Association |
| > |
Pew Report |
| > |
American Public Health Association |
| > |
Fluoride Information Network |
| > |
Healthy Teeth For A Lifetime |
| > |
On Tap Magazine - To Fluoridate or not |
| > |
When public action undermines public health: a critical examination of antifluoridationist literature |
| > |
Review: “50 Reasons to oppose fluoridation” |
| > |
FluorideInfo.org |
| > |
Health Effects of Ingested Fluoride
- 1993 |
| > |
Fort Collins, Colorado, Fluoride Technical Study Group Report |
| > |
Top Cairns dentist defends fluoride |
| > |
The first community trial of water fluoridation |
| > |
History of Water Fluoridation |
| > |
The National Center for Fluoridation |
| > |
DentalWatch.org |
| > |
Review of Fluoride: Benefits and Risks |
| > |
Abuse of the Scientific Literature
in an Antifluoridation Pamphlet |
| > |
The Campaign for Dental Health |
| > |
Fluoride exposure and IQ |
| > |
Wikipedia - Water Fluoridation &
- Water Fluoridation Controversy |
| > |
Drinking Water and Health, Volume 1 (1977) |
|
|
Links to and summaries of 72 Fluoride Articles: National Library of Medicine 1955 - 2011 |
|
The Fluoride Wars: How a modest Public Health
Measure Became America's Longest Running Melodrama. R. Allan Freeze &
Jay H. Lehr, published by A John Wiley & Sons, Inc. (2009) The authors
provide a detailed and entertaining look at the history of water fluoridation
and the rise of the anti-fluoridation movement. They weave tales of the
scientists who discovered the protective power of fluoride against dental decay,
who established the fluoridation treatment processes and promoted the practice,
and those who had concerns about public water fluoridation and were marginalized
by the scientific and medical establishment and driven to the anti-fluoride
movements.
http://www.ada.org/fluoride.aspx
American Academy of Dentistry (ADA) -
Fluoride & Fluoridation - This 72-page booklet with 358 references is a
comprehensive encyclopedia of fluoridation facts. The ADA
Fluoridation Facts (Free PDF Booklet)
includes information from scientific research in a
helpful question and answer format that addresses and rebuts the major anti-fluoride
claims. Some important sections:
> Executive Summary (page 4)
> How to review and evaluate scientific research (page 7)
Additional fluoride & fluoridation
resources.
http://en.wikipedia.org/wiki/Water_fluoridation
Water fluoridation
From Wikipedia, the free encyclopedia - Existing evidence strongly suggests
that water fluoridation reduces tooth decay. There is also consistent evidence
that it causes dental fluorosis, most of which is mild and not usually of
aesthetic concern. There is no clear evidence of other adverse effects.
Moderate-quality research exists as to water fluoridation's effectiveness and
its potential association with cancer; research into other potential adverse
effects has been almost all of low quality. Little high-quality research has
been performed.
Committee on Fluoride in Drinking Water, National Research
Council -
Fluoride in Drinking Water: A Scientific Review of EPA's Standards (2006): Because new research on fluoride is now available and because the Safe Drinking Water Act requires periodic reassessment of regulations for drinking water contaminants, EPA requested that the NRC evaluate the adequacy of its MCLG and SMCL for fluoride to protect public health. In response to EPA’s request, the NRC convened the Committee on Fluoride in Drinking Water, which prepared this report. The committee was charged to review toxicologic, epidemiologic, and clinical data on fluoride, particularly data published since 1993, and exposure data on orally ingested fluoride from drinking water and other sources.
This report presents the committee’s review of the scientific basis of EPA’s MCLG and SMCL for fluoride, and their adequacy for protecting children and others from adverse health effects. The committee considers the relative contribution of various sources of fluoride (e.g., drinking water, food, dental hygiene products) to total exposure, and identifies data gaps and makes recommendations for future research relevant to setting the MCLG and SMCL for fluoride. Addressing questions of economics, risk-benefit assessment, or water-treatment technology was not part of the committee’s charge.
American Dental Association response to the report,
3/22/06.
Point by point comparison with the 1993 National Research Council
Fluoride report
http://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_139.pdf
Critical review of any new evidence on the hazard profile, health
effects, and human exposure to fluoride and the fluoridating
agents of drinking water: Scientific evidence for the
protective effect of topical fluoride application is strong, while the respective data for
systemic application via drinking water are less convincing. No obvious advantage
appears in favour of water fluoridation as compared with topical application of fluoride.
However, an advantage in favour of water fluoridation is that caries prevention may
reach disadvantaged children from the lower socioeconomic groups. (SCHER adopted this opinion by written procedure on 16 May 2011)
Conclusions specific to health effects of fluoride:
--Hydrolysis of hexafluorosilicates, used for drinking water fluoridation, to fluoride was
rapid and the release of fluoride ion was essentially complete. Therefore, the fluoride ion
is considered the only relevant substance with respect to this opinion.
--Enamel fluorosis seen in areas with fluoridated water (0.7–1.2 mg/L F) has been
attributed to early tooth brushing behaviours, and inappropriate high fluoride intake, i.e. use of infant formula prepared with fluoridated drinking water.
--There is no clear association of bone fracture risk
with water fluoridation and fluoridation at levels of 0.6 to 1.1 mg/L
may actually lower overall fracture risk.
--There are conflicting reports on genotoxic effects in humans.
... The quality of the
former studies [showing genotoxicity] is questionable.
--SCHER agrees that epidemiological studies do not indicate a clear link between fluoride in
drinking water, and osteosarcoma and cancer in general. There is no evidence from
animal studies to support the link, thus fluoride cannot be classified as carcinogenic.
--Available human studies do not clearly support the conclusion that fluoride in drinking
water impairs children’s neurodevelopment at levels permitted in the EU.
The limited animal data can also not support the link between fluoride
exposure and neurotoxicity at relevant non-toxic doses.
--A systematic evaluation of the human studies does not suggest a
potential thyroid effect at realistic exposures to fluoride. The absence
of thyroid effects in rodents after long-term fluoride administration
and the much higher sensitivity of rodents to changes in thyroid related
endocrinology as compared with humans do not support a role for fluoride
induced thyroid perturbations in humans.
--There is no new evidence from human studies indicating that fluoride in drinking water
influences male and female reproductive capacity.
A common argument used by fluoridation opponents is “…after being captured in the scrubbers, the fluoride acid (hydrofluorosilicic acid), a classified hazardous waste, is barreled up and sold, unrefined, to communities across the country. Communities add hydrofluorosilicic acid to their water supplies as the primary fluoride chemical for water fluoridation.”
http://www.fluoridealert.org/phosphate/overview.htm - with the implication, of course, that the products used in community water treatment plants to fluoridate the water is a witches brew of deadly chemicals.
The truth is that water treatment plants that add fluoride to drinking
water do so with products that are rigorously tested and certified by NSF
International to be safe
and free of harmful levels of toxic chemicals.
http://www.nsf.org/business/water_distribution/pdf/NSF_Fact_Sheet.pdf
NSF Fact Sheet on Fluoridation Chemicals:
According to the latest Association of State Drinking Water Administrators Survey on State Adoption of NSF/ANSI Standards 60 and 61, 45 states require that chemicals used in treating potable water must meet Standard 60 requirements. If you have questions on your state's requirements, or how the NSF/ANSI Standard 60 certified products are used in your state, you should contact your state's Drinking Water Administrator.
Standard 60 was developed to establish minimum requirements for the control of potential adverse human health effects from products added directly to water during its treatment, storage and distribution. The standard requires a full formulation disclosure of each chemical ingredient in a product. It also requires a toxicology review to determine that the product is safe at its maximum use level and to evaluate potential contaminants in the product. The standard requires testing of the treatment chemical products, typically by dosing these in water at 10 times the maximum use level, so that trace levels of contaminants can be detected. A toxicology evaluation of test results is required to determine if any contaminant concentrations have the potential to cause adverse human health effects.
Table 1 documents that there is no contamination of drinking water from the fluoridation products NSF has tested and certified.
|
2005: 60th Anniversary of Community
Water Fluoridationn
The
American Dental Association released an updated version of
Fluoridation Facts. If you have any questions about fluoridation
(and are willing to consider the subject with an open mind) this paper
addresses nearly all of the anti-fluoride arguments, clearly describes
how to evaluate available evidence on the subject, and concludes:
"Support for fluoridation among scientists, and health professionals,
including physicians and dentists, is nearly universal."
"...Opposition to fluoridation has existed since the initiation of the first community programs in 1945 and continues today with over 60 years of practical experience showing fluoridation to be safe and effective."
"...An article that appeared in the local newspapers shortly after the first fluoridation program was implemented in Grand Rapids, Michigan, noted that the fluoridation program was slated to commence January 1 but did not actually begin until January 25. Interestingly, health officials in Grand Rapids began receiving complaints of physical ailments attributed to fluoridation from citizens weeks before fluoride was actually added to the water." |
|
A systematic review of the efficacy and safety of Fluoridation (a 189 page
paper from the Australian Government National Health and Medical Research
Council - 2007). The Executive Summary starting on page 12 of the
Part-A pdf file provides an overview
of and conclusions from the remaining 150+ pages)
NHMRC Recommendation:
(2-page summary). The paper reviews 77 studies selected from over 5,400
papers published on fluoride/fluoridation between 1996 and 2006. Criteria
for inclusion and exclusion in the review can be found in the paper, and a list
of the excluded papers can be found in Part-B.
Conclusions:
Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide
exposure to the caries prevention effects of fluoride. It is recommended that water be fluoridated in the target range of
0.6 to 1.1 mg/L, depending on climate, to balance reduction of dental caries and occurrence of dental fluorosis.
http://www.fluoridescience.org/media/Flouride-Booklet-Generic-forDL_v1c.pdf
The Science of Fluoride: This publication pulls together the official policy statements and consumer information on fluoride from the nation’s leading scientific and advocacy organizations that support community water fluoridation. It is an effort to give you the whole truth about fluoride — its benefits, its risks and its history.
...
Fluoridation of community water systems is not the only way to administer fluoride and reduce cavities. Some countries in Europe put fluoride in salt. Some invest heavily in school-based dental programs. Many countries rely on socialized medicine to ensure regular dental care and fluoride treatments. The American model allows individual states or communities to decide on the best ways to protect oral health. Since the 1940s, many have relied upon community water fluoridation. To date, about two-thirds of the nation adds fluoride to its water, one reason once common dental problems are now at an all-time low.
http://lpi.oregonstate.edu/infocenter/minerals/fluoride/e/
Linus Pauling Institute Micronutrient Information Center: Although its role in the prevention of dental caries (tooth decay) is well established, fluoride is not generally considered an essential mineral element because humans do not require it for growth or to sustain life. However, if one considers the prevention of chronic disease (dental caries) an important criterion in determining essentiality, then fluoride might well be considered an essential trace element.
http://www.cda-adc.ca/_files/position_statements/fluorides.pdf
The Canadian Dental Association (CDA) supports fluoridation of municipal drinking water (at minimum levels required for efficacy
as recommended by the Federal-Provincial Subcommittee on Drinking Water) as a safe, effective
and economical means of preventing dental caries in all age groups. Fluoride levels in the water
supplies should be monitored and adjusted to ensure consistency in concentrations and avoid
fluctuations.
http://www.who.int/water_sanitation_health/oralhealth/en/index2.html
World Health Organization (WHO) - Water fluoridation in low fluoride-containing water supplies helps to maintain optimal dental tissue development and dental enamel resistance against caries attack during the entire life span. Fluoride in drinking water acts mainly through its retention in dental plaque and saliva. Frequent consumption of drinking water and products made with fluoridated water maintain intra-oral fluoride levels. People of all ages, including the elderly, benefit from community water fluoridation.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626340/pdf/16211158.pdf
The effective use of fluorides in public health: Common themes are the concern to reduce demands for compliance with fluoride regimes that rely upon action by individuals
and their families, and the issue of cost. We recommend that a community should use no more than one systemic fluoride (i.e. water
or salt or milk fluoridation) combined with the use of fluoride toothpastes, and that the prevalence of dental fluorosis should be
monitored in order to detect increases in or higher-than-acceptable levels. (Jones S, et. al. - Bulletin of the World Health Organization | September 2005, 83 (9))
http://www.aapd.org/media/Policies_Guidelines/P_FluorideUse.pdf
The American Academy of Pediatric Dentistry (AAPD) - ...affirming that
fluoride is a safe and effective adjunct in reducing the risk of caries and
reversing enamel demineralization, encourages public health officials, health
care providers, and parents/caregivers to optimize fluoride exposure.The
adjustment of the fluoride level in community water supplies to optimal
concentration is the most beneficial and inexpensive method of reducing the
occurrence of caries. Epidemiologic data within the last half-century indicate
reductions in caries of 55 to 60% and recent data still shows caries reduction
of approximately 25%, without significant enamel fluorosis, when domestic water
supplies are fluoridated at an optimal level. Evidence accumulated from
long-term use of fluorides has demonstrated that the cost of oral health care
for children can be reduced by as much as 50%.
1978:
33rd Anniversary of
Community Water Fluoridation
GK Tokuhata, et al.
described the anti-fluoridation sentiment,
"However, controversy (maintained by a segment of the general public and professional community) continues regarding possible adverse effects of fluoridation on human health. The National Cancer Institute and the National Heart and Lung Institute have recently issued statements that refute claims suggesting a relationship between fluoridated water and mortality from cancer and heart disease."
Their paper emphasizes the scrutiny to which fluoridation has been subject, "Fewer health measures have been accorded more clinical and laboratory research, epidemiologic study, massive clinical trials of total community populations, and public attention) both favorable and adverse) than the fluoridation of public water supplies. As a result, knowledge of the dental and nondental physiological effects of fluoridation has increased significantly since Grand Rapids, Mich., was first experimentally fluoridated in 1945. There is now considerable evidence that fluoridation of community water supplies is both effective and safe."
|
|
http://www.cdc.gov/FLUORIDATION/
The Centers for Disease Control and Prevention (CDC): Community water fluoridation prevents tooth decay safely and effectively. CDC identifies it as one of 10 great public health achievements of the 20th century.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm - Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States
http://www.cdc.gov/fluoridation/safety/health_effects.htm - The weight of the peer-reviewed scientific evidence does not support an association between water fluoridation and any adverse health effect or systemic disorder, including an increased risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, immune disorders, low intelligence, renal disorders, Alzheimer disease, or allergic reactions. Additional information can be found on the Safety page.
http://www.cancer.gov/cancertopics/factsheet/Risk/fluoridated-water
National Cancer Institute: Key Points -
Fluoride prevents and can even reverse tooth decay.
More than 60 percent of the U.S. population on public water supply systems has access to water fluoridated at approximately 1 part fluoride per million parts water—the optimal level for preventing tooth decay.
Many studies, in both humans and animals, have shown no association between fluoridated water and risk for cancer.
http://jama.ama-assn.org/cgi/content/full/283/10/1283
American Medical Association (AMA): Fluoridation of community drinking water is a major factor responsible for the decline in dental caries (tooth decay) during the second half of the 20th century. The history of water fluoridation is a classic example of clinical observation leading to epidemiologic investigation and community-based public health intervention. Although other fluoride-containing products are available, water fluoridation remains the most equitable and cost-effective method of delivering fluoride to all members of most communities, regardless of age, educational attainment, or income level.
Safety of Water Fluoridation:
Early investigations into the physiologic effects of fluoride in drinking water predated the first community field trials. Since 1950, opponents of water fluoridation have claimed it increased the risk for cancer, Down syndrome, heart disease, osteoporosis and bone fracture, acquired immunodeficiency syndrome, low intelligence, Alzheimer disease, allergic reactions, and other health conditions. The safety and effectiveness of water fluoridation have been re-evaluated frequently, and no credible evidence supports an association between fluoridation and any of these conditions.
(2000)
http://www.pewtrusts.org/news_room_detail.aspx?id=57449 -
Full Report
Pew Report Finds Majority of States Fail to Ensure Proper Dental Health and
Access to Care for Children.
Report Shows Need for Low-Cost Solutions: The report highlights four proven
solutions that can improve both the dental health of children and their access
to care. Solution
#2 - Community water fluoridation: Water fluoridation stands out as one of the
most effective public health interventions that the United States has ever
undertaken. Fluoride counteracts tooth decay and, in fact, strengthens the
teeth.
A 2008 study found that women who grew up in communities with
fluoridated water earned approximately 4 percent more than women who did not.
The effect was almost exclusively concentrated among women from low-income
families, and fluoride exposure in childhood was found to have a robust,
statistically significant effect on income, even after controlling for a variety
of trends and community-level variables. The authors of the study attributed
this difference primarily to consumer and employer discrimination against women
with missing or damaged teeth. (Published February, 2010)
http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1373
American Public Health Association - Community Water Fluoridation in the
United States, 2008 Policy Statement: Since 1950,5 APHA has supported CWF as
a safe and effective public health measure for the prevention of dental caries
(tooth decay), reaffirming this policy in 1955, 1956, 1959, 1963, 1965, 1969,
1974, 1975, 1976, 1977,,16 1979, 1980, 1982, 1992, 1997, 2000, 2001, and 2006.
http://fluorideinfo.org/index.html
Fluoride Information Network: This web site presents the best known, best
substantiated and most truthful information about fluoride. We are
educators, medical and public health practitioners, dentists, parents and
concerned citizens who have thoroughly researched the issues of fluoride in
community water sources. We deeply care about dental health, safe drinking
water, health equity across socio-economic groups and fiscal responsibility in
homes and whole communities. We Support Fluoride in our Community Water...
Articles include a
review of
"The Fluoride Deception".
http://www.healthyteeth.us/index.html
Healthy Teeth For A Lifetime: This website contains an interesting
selection of information about fluoridation benefits, and contains one of the
few summaries I found that address anti-fluoridation arguments about the
source and safety of fluorosisicates used in fluoridation. The section
on
Questions and Answers is useful too.
1955: 10th
Anniversary of Community Water Fluoridation
Francis Heyroth, M.D. wrote an
early descriptions of the Fluoridation controversyy in 1955,
"The extravagance of the variously motivated statements frequently heard in opposition to fluoridation wherever it is under consideration may lead officials who must explain this prophylactic measure to the public to discount the fact that many citizens still remain unconvinced of the safety of this procedure, despite the assurances of medical, dental, and public health authorities."
Heyroth concludes, "The evidence as a whole is consistent in offering assurance that bringing the fluoride concentration in communal water supplies to that known to be optimal for dental health is a prophylactic public health procedure which has an ample margin of safety."
|
|
http://www.nesc.wvu.edu/ndwc/articles/OT/FA04/Flouride.pdff
To Fluoridate or not: Some Communities Still Struggle for Answers.
On Tap Magazine,
Fall 2004
> Stronger teeth, fewer cavities—and ultimately—
fewer trips to the dentist. Fluoridating public water is
a community health measure that helps prevent tooth
decay. How could anyone find fault with it?
> “Fluoridation is the most cost-effective, practical, and safe
means for reducing the occurrence of tooth decay in a
community.” —Former Surgeon General David Satcher, 2001.
>
Like many chemicals and simpler
substances we encounter in
life, fluoride in large doses or in
a concentrated form can hurt us.
Studies showing harm from
ingesting excessive amounts of
fluoride have helped fuel public
fears. But large amounts of plenty
of things can be toxic. The
ADA lists normally innocent
things like salt, iron, vitamins A
and D, oxygen, and even plain
water as being harmful in large
quantities.
>
CDC Asserts Safety Fluoride: "Some people worry that with
all the potential fluoride sources
that are available we might be
overdosing on the stuff". Kip Duchon, the national fluoridation
engineer with the CDC in
Atlanta, says that is unlikely.
“We’re not talking about a lot
of fluoride in water,” he says. “All
the research shows that even with
these other methods you’re really
not anywhere near overdosing.”
http://www.ncbi.nlm.nih.gov/pubmed/18067684
When public action undermines public health: a critical
examination of antifluoridationist literature
SUMMARY: Water fluoridation is an important public health initiative that has
been found to be safe and effective. Nonetheless, the implementation of water
fluoridation is still regularly interrupted by a relatively small group of
individuals who use misinformation and rhetoric to induce doubts in the minds of
the public and government officials. It is important that public health
officials are aware of these tactics so that they can better counter their
negative effect.
Free - Full Article (2007)
http://www.dohc.ie/other_health_issues/dental_research/critical_fifty.pdf?direct=1
A critical appraisal of, and commentary on,
“50 Reasons to oppose fluoridation”: The author of the ‘50 Reasons’ document has stated (in one of the many versions of the
‘50 Reasons’ document) that “the ‘50 Reasons’ offered in this article for opposing
fluoridation are based on a thorough review of the scientific literature as regards both
the risks and benefits of being exposed to the fluoride ion.” However, as already noted,
the ‘50 Reasons’ document fails to conform to any generally accepted principles for
assembling, evaluating and interpreting medical research. There is no explicit statement
of the questions being addressed; no systematic search for pertinent research; no use of
a
priori selection criteria to separate relevant from irrelevant research; no critical appraisal
of studies to determine their validity and no integration of evidence based on sources of
evidence, research design, direction and magnitude of clinical outcomes, coherence and
precision. No conclusions can or should be drawn from this poor quality document.
[Note that the 50 reasons document that this critique
references is updated regularly. This paper discusses versions
available before 2005, but it illustrates the overall methodology of
fluoridation opponents.]
http://fluorideinfo.org/index.html
Fluoride Information: Is Fluoride good to have in your drinking
water?
There is a lot of information available about fluoride but the information is also sometimes conflicting. Some leads us to believe fluoride in drinking water is a good thing; and some says just the opposite! Even information in clear opposition claims to have solid scientific backing – how can this be? This situation led us to ask: How can a person make an informed decision about whether fluoride is good or bad when everything they hear is so conflicting?
This web site presents the best known, best substantiated and most truthful information about fluoride.
We are educators, medical and public health practitioners, dentists, parents and concerned citizens who have thoroughly researched the issues of fluoride in community water sources. We deeply care about dental health, safe drinking water, health equity across socio-economic groups and fiscal responsibility in homes and whole communities.
Health Effects of Ingested Fluoride
Free Online Book
Authors:
Subcommittee on Health Effects of Ingested Fluoride, National Research Council
Description: This 1993 book reviews the effects on health of fluoride ingested from various sources. Those health effects reviewed include dental fluorosis; bone fracture; effects on renal, reproductive, and gastrointestinal systems; and genotoxicity
and carcinogenicity. The book also reviews the Environmental Protection
Agency's current drinking-water standard for fluoride and considers
future research needs.
Point by point comparison with the 2006 National Research Council
Fluoride report.
http://www.healthdistrict.org/fluoridereport/FTSG.htm
Fort Collins, Colorado,
Fluoride Technical Study Group Report: The Health District was a participant in the Fluoride Technical Study Group, which included community members with an interest in community drinking water fluoridation and with specific technical, medical or scientific capabilities. The group met at least once a month between December 2001 and December 2002.
The group presented a report to the Fort Collins City Council which voted to continue fluoridation of city water supplies in July 2003. The findings of the report prompted the Health District's Board of Directors to vote to recommend that the city continue fluoridation.
Local PBS Radio Report on the issue
http://www.cpr.org/co_matters#load_category_page|colorado_matters (search on fluoride)
Fort Collins voters will soon decide on an initiative that would stop
fluoridating the city’s water.
Part 1) Pati Caputto, a clinical
nutritionist and leader of Clean Water Advocates, a group campaigning
against fluoridation, shares her perspective.
http://www.cpr.org/co_matters/#load_article|legacy-archive-1890
Part 2) Dr. Greg Evans, a pediatric
dentist and member of the Vote No On 2 committee, shares his
perspective.
http://www.cpr.org/co_matters/#load_article|legacy-archive-1891
http://www.cairns.com.au/article/2009/12/24/84185_local-news.html
Top Cairns dentist defends fluoride: Queensland Health Cairns district director of oral health Robyn Boase said the effect dental decay had on children was far more of a concern than the effect of fluoride on the human body.
"Fluoride has come up trumps in preventing dental decay and not causing any side effects," Dr. Boase said.
"It helps stabilize the mineral content of bones and teeth.
"I think people forget that dental decay is extremely toxic.
"We have a condition called early childhood caries. It’s the most frequent cause of
hospitalization in children up to age 4.
"People don’t get hospitalized from drinking fluoridated water. They get
hospitalized from dental decay."
http://www.who.int/bulletin/volumes/84/9/05-028209.pdf
One in a million: The first community trial of water fluoridation -
January 1, 1945 in Grand Rapids Michigan.
Fluoridation of water.
Hearings before the Committee on Interstate and Foreign Commerce, House
of Representatives, Eighty-third Congress, second session, on H. R.
2341. A bill to protect the public health from the dangers of
fluorination of water. May 25, 26, 27, 1954.
The 491 page record of a debate on water fluoridation 9 years after the
introduction of community water fluoridation in Grand Rapids Michigan.
The first two thirds of the document is largely anti-fluoride arguments
and the last third is the pro-fluoride rebuttal. Things have not
changed much in the decades since this debate.
http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html
History of Water Fluoridation, Joe
Mullen, Dr.
(British Dental Journal 199, 1 - 4 (2005)
Water fluoridation has been described by the Centre for Disease Control as one of the ten most important public health advances of the 20th Century1. In this brief paper, I will describe the history of water fluoridation and discuss the value of this policy in the early years of the 21st Century.
http://waterfluoridationcenter.org/
The National Center for Fluoridation was developed in 1996, with the Center's Internet web site being established in 1998 to serve as a central repository for information regarding all aspects of community water fluoridation. The Center became a major program of Oral Health America in 2004. Currently, the Center's web site provides a means to link site visitors to a fairly substantial number of fluoridation, consumer protection, public health, & public health dentistry websites. Archival information, which includes consumer information, scientific documents, databases, multimedia productions, legal transcripts, educational materials, & other documents related to fluoridation research, litigation, legislation, & policy development, is being added to the web site's NCF Reference Library.
http://www.dentalwatch.org/fl/orgs.html
DentalWatch.org: About 100 nationally and internationally known
organizations including the Center for Disease Control, the American Dental
Association, the American Medical Association, the American Public Health
Association, the National Kidney Foundation, the World Health Organization, the
American Cancer Society, the American Water Works Association, the National
Association of City and County Health Officials as well as the last four US
Surgeons General endorse water fluoridation." Go to for the whole list.
http://www.dentalwatch.org/index.html - 14 Fluoridation Facts Articles (about
1/2 way down), including:
http://www.dentalwatch.org/fl/fluoride.html - Fluoridation: Don't Let the Poisonmongers Scare You!
http://health.gov/environment/ReviewofFluoride/
Review of Fluoride: Benefits and Risks
Report of the ad hoc subcommittee on fluoride
of the committee to coordinate environmental health and related
programs.
Extensive studies over the past 50 years have established that individuals whose drinking water is fluoridated show a reduction in dental caries. Although the comparative degree of measurable benefit has been reduced recently as other fluoride sources have become available in non-fluoridated areas, the benefits of water fluoridation are still clearly evident. Fewer caries are associated with fewer abscesses and extractions of teeth and with improved health. The health and economic benefits of water fluoridation accrue to individuals of all ages and socioeconomic groups, especially to poor children.
(1991)
http://www.rathinker.co.kr/paranormal/altmedi/abuseofliterature.htm
Abuse of the Scientific Literature in an Antifluoridation Pamphlet (1988):
A number of specific techniques have been used by antifluoridationists in their attempts to prevent fluoridation of public water supplies. For instance, by repeatedly alleging that fluoride causes cancer, kidney disease, heart disease, and other serious maladies, fluorophobics persuade some people that their claims are true, even though no scientifically valid evidence exists to corroborate their allegations. The public tends to believe such claims, assuming that their repeated appearance in print, most often in letters-to-the-editor columns, is evidence of their validity and that "authorities" would "never" allow unproven claims to be printed.
Antifluoridationists have also become masters of the use of half-truths and innuendo.
Among the most serious violations of the scientific ethic are those with which this monograph focuses and which can be categorized as abusive uses of the scientific literature. Opponents of fluoridation frequently quote statements that are out of date, taken out of context, or misrepresentations of legitimate scientific research. Numerous examples of this
technique are apparent when one reviews closely the popular antifluoride pamphlet, "Lifesavers [sic] Guide to Fluoridation".'
[and
The Aging Factor (still promoted by the Fluoride Action Network).
Both books are by John Yiamouyiannis]
As will be illustrated repeatedly in the following pages, many references for the pamphlet's claims of hazard are from obscure or hard-to-locate journals. Those articles referred to as containing the most convincing tifluoride arguments are usually not from recognized peer-reviewed journals and often are authored by the same antifluoridationists editing the controversial journals.
Painstaking library research by Wulf and colleagues has shown that many of the references used actually support fluoridation, with works of respected fluoride researchers selectively quoted and misrepresented in order to appear to discourage the use of fluorides. The average consumer, unable to properly evaluate misinformation and misrepresentations in the antifluoride literature, falls prey to what amounts to a marketing fraud.
Nothing summarizes the situation better than the often-repeated
quotation from a 1978 Consumer Reports article, "The simple truth is that there's no "scientific controversy" over the safety of fluoridation. The practice is safe, economical, and beneficial. The survival of this fake controversy represents, in CU's [Consumers' Union] opinion, one of the major triumphs of quackery over science in our generation."
[This is an interesting, though dated, analysis of 250 anti-fluoride
references provided by one of the most active and influential
fluoridation opponents,
John Yiamouyiannis.
The original book provides an analysis of each reference - the linked
article is a summary. The specific references used by today's fluoride opponents are
different, but the way that references are used and abused remain the
same]
http://www.ilikemyteeth.org/
The Campaign for Dental Health was created to ensure every American has access to the cheapest, most effective way to protect teeth — water fluoridation. We are a network of local children’s and oral health advocates, health professionals and scientists who are working together to preserve our nation’s gains in oral health. We believe, quite simply, that life is better with teeth.
http://www.fairbanksalaska.us/wp-content/uploads/2011/07/20090211Bazian-Review-IQ-Studies.pdf
Fluoride and IQ: One of the newer health claims made by fluoridation
opponents is that fluoride exposure from drinking water, even at
fluoride levels around 2.5 - 4 mg/l, can lower IQ. Recent papers
that report a correlation between high fluoride levels and low IQ scores
are reviewed in the Bazian Review of IQ Studies:
The summary states - The primary studies reviewed were conducted in China, Mexico, Iran and India. They sought to
investigate whether high environmental exposure to fluoride or arsenic or low exposure to iodine, was
associated with lower IQ and used observational (cross sectional and ecological) methods.
In our appraisals we found that the study design and methods used by many of the researchers had
serious limitations. The lack of a thorough consideration of confounding as a source of bias means
that, from these studies alone, it is uncertain how far fluoride is responsible for any impairment in
intellectual development seen. The amount of naturally occurring fluoride in drinking water and from
other sources and the socioeconomic characteristics in the areas studied is different from the UK and
so these studies do not have direct application to the local population of Southampton.
Specifically:
--The authors of the primary observational studies have not consistently adjusted for the
following confounding factors: the differences in environmental arsenic and iodine in water,
parental education, and socioeconomic measures between the populations. There is a
possibility that some or all of the impairment in IQ can be explained by these or other
unmeasured or unknown factors.
--The authors of one of the systematic reviews have combined the results of these confounded
observational studies into summary measures by meta analysis in a way that is not
statistically appropriate or valid. The authors’ interpretation of the results is incorrect.
--The findings are unlikely to be directly applicable to the population of Southampton because
the level of fluoride found in the high fluoride areas in this research was generally higher
than that intended for use in water fluoridation schemes (1ppm), or was confounded by
varying levels of other chemicals in drinking water that are not a problem in the UK (iodine
or arsenic).
--Sources of fluoride exposure exist in these settings that do not exist in the UK setting, for
example, burning high fluoride coal and eating contaminated grain, which can substantially
contribute to fluoride exposure.
http://en.wikipedia.org/wiki/Water_fluoridation
- Wikipedia Article
Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water refers to water that contains fluoride (either naturally occurring or artificially added) at a level that is effective for preventing cavities.
http://en.wikipedia.org/wiki/Water_fluoridation_controversy - Wikipedia Article
Water fluoridation controversy refers to moral, ethical, and safety
concerns regarding the
fluoridation of public
water supplies. The controversy occurs mainly in English-speaking
countries, as
Continental Europe does not practice water fluoridation, although some
continental countries fluoridate salt.
http://www.nap.edu/catalog.php?record_id=1780#toc
Drinking Water and Health, Volume 1: This scientific study specifically considered potential adverse health effects of substances in drinking water. The central effort of the study was an assessment of the long-term biological effects of ingesting the variety of different substances present in trace amounts in drinking water. The volume included an extensive analysis on fluoride intake and concluded that “There is no generally accepted evidence that anyone has been harmed by drinking water with fluoride concentrations considered optimal.” Only two adverse health effects were identified including dental fluorosis and skeletal fluorosis “occurring when fluoride is at levels in excess of the concentrations recommended for good oral health.”
(Fluoride, pages 369 - 434)
The
National Library
of Medicine makes medical and scientific journal abstracts and some entire
articles available
to the general public. Most journals represented publish
peer-reviewed studies for much of the medical and scientific research world wide.
Below are some
examples of research from the 1950s through 2011 on fluoride and fluoridation to counter the argument
that there is NO recent evidence that water fluoridation is beneficial or safe.
As
mentioned elsewhere, there are also a few studies listed which examine possible risks.
I encourage you to search the National Library of Medicine and evaluate for
yourself the evidence for and against community drinking water fluoridation.
Search www.pubmed.gov for terms related to
water fluoridation. A search on general topics like, water fluoridation,
will return a huge number of results (5,800 in August 2010), but
it is a good way to find other words to include that limit the search. For
example you can reduce the number of results to a more manageable size by using
more restrictive search terms like: water fluoridation safety (95 results);
water fluoridation benefits (157 results); water fluoridation risk (363
results); community water fluoridation (616 results); water fluoridation and caries (2,868 results)
fluoridation health (1,870 results); water fluoridation cancer
(142 results - note that virtually none of the papers actually study the link
between fluoridation and cancer); water fluoridation brain (8 results -
note the paper on fluoride-induced oxidative stress used concentrations of
fluoride in the water 100-200 times greater than found in fluoridated water);
water fluoridation IQ (1 result); water fluoridation fractures (87
results); fluoridation ethical (14 results); fluoridation cost
(348 results). If you take time to look through the medical literature on
any aspect of fluoridation, I am confident you will discover that papers which
support the effectiveness and safety of fluoridation outnumber those which
report risks of fluoridation (at recommended levels) by many times.
Fluoridation opponents list many papers which document
claims that fluoridation is harmful and not effective on their websites.
Many of these papers are not archived at the National Library of Medicine. This
typically means the papers have not been published in recognized peer-reviewed
journals. The reason usually given is that the traditional dental, medical
and scientific communities are so committed to community water fluoridation that
they actively block funding and publication of any research that might uncover
health risks of fluoridation. There is, of course another explanation:
that the majority of research that shows health risks of fluoridation, beyond
the risks of dental fluorosis, is simply not of high enough quality to be
published in a peer reviewed journal. The publication,
Fluoridation Facts, produced by the American
Dental Association, describes some of the conditions under which conclusions
reached by a study might not be acceptable for publication.
http://www.ncbi.nlm.nih.gov/pubmed/22161414
Fluoride supplements (tablets, drops, lozenges or chewing gums) for preventing dental caries in children:
BACKGROUND: Dietary fluoride supplements were first introduced to provide systemic fluoride in areas where water fluoridation is not available. Since 1990, the use of fluoride supplements in caries prevention has been re-evaluated in several countries. MAIN RESULTS: We included 11 studies in the review involving 7196 children.In permanent teeth, when fluoride supplements were compared with no fluoride supplement (three studies), the use of fluoride supplements was associated with a 24% (95% confidence interval (CI) 16 to 33%) reduction in decayed, missing and filled surfaces (D(M)FS). AUTHORS' CONCLUSIONS: This review suggests that the use of fluoride supplements is associated with a reduction in caries increment when compared with no fluoride supplement in permanent teeth. The effect of fluoride supplements was unclear on deciduous teeth. When compared with the administration of topical fluorides, no differential effect was observed. We rated 10 trials as being at unclear risk of bias and one at high risk of bias, and therefore the trials provide weak evidence about the efficacy of fluoride supplements.
(Tubert-Jeannin S, et. al. - Cochrane Database Syst Rev. 2011 Dec
7;12:CD007592.)
http://www.ncbi.nlm.nih.gov/pubmed/21799046 (copy
of the paper)
An Assessment of Bone Fluoride and Osteosarcoma: No significant association between bone fluoride levels and osteosarcoma risk was detected in our case-control study, based on controls with other tumor diagnoses.
(Kim FM, et. al. - J Dent Res. 2011 Oct;90(10):1171-1176. Epub 2011 Jul 28)
(discussion
of paper)
http://www.ncbi.nlm.nih.gov/pubmed/21599939
-
Free Article
Validation of a multifactorial risk factor model used for predicting future caries risk with
Nevada adolescents: {logistic regression analysis indicated that youth living in
non-fluoridated areas of Nevada had greater odds of developing tooth decay than
those who lived in the county with fluoridated water - RJ}
(Ditmyer MM, et. al. - BMC Oral Health. 2011; 11: 18. Published online 2011 May 20)
Related article:
http://www.ncbi.nlm.nih.gov/pubmed/20857070
-
Free Article
Inequalities of caries experience in Nevada youth expressed by DMFT index vs. Significant Caries Index (SiC) over time: At the community level, action should focus on retaining and expanding the community fluoridation program as an effective preventive measure.
(Ditmyer MM, et. al. - BMC Oral Health. 2011 Apr 5;11:12)
http://www.ncbi.nlm.nih.gov/pubmed/20857070
-
Free Article
Fluoride: its role in dentistry: In spite of decades of research on fluoride and the recognition of its role as the cornerstone of dental caries reduction in the last fifty years, questions still arise on its use at community, self-applied and professional application levels. Which method of fluoride delivery should be used? How and when should it be used? How can its benefits be maximized and still reduce the risks associated with its use? These are only some of the challenging questions facing us daily. The aim of this paper is to present scientific background to understand the importance of each method of fluoride use considering the current caries epidemiological scenario, and to discuss how individual or combined methods can be used based on the best evidence available.
(Tenuta LM, Cury JA - Braz Oral Res. 2010;24 Suppl 1:9-17) {a very good
summary of the role of the fluoride ion, saliva, and oral ecology on the process
of tooth decay - RJ}
http://www.publichealthreports.org/archives/issuecontents.cfm?Volume=125&Issue=5
(requires subscription)
Geographic Variation in Medicaid
Claims for Dental Procedures in
New York State: Role of Fluoridation
Under Contemporary Conditions: Results. Compared with the predominantly fluoridated counties, the mean
number of restorative, endodontic, and extraction procedures per recipient was
33.4% higher in less fluoridated counties.
Conclusions. We found that the mean number of claims for caries related
services for children in the NYS Medicaid
program was correlated with the extent of fluoridation
in a county. These annual decreases in claims per recipient,
when applied to lifetime exposure of the whole
population, have large societal benefits. These findings, when added to the already existing weight of
evidence, have implications for promoting policies at the federal and state
levels to strengthen the fluoridation program. (Kumar, JV, et. al. - Public Health Reports, September–October 2010, Volume 125 p647)
Geographic Variation in Medicaid
Claims for Dental Procedures in
New York State: Role of Fluoridation
Under Contemporary Conditions: Results. Children from every age group had greater caries prevalence and
more caries experience in areas with negligible fluoride concentrations in the
water (<0.3 parts per million [ppm]) than in optimally fluoridated areas (>0.7 ppm).
Conclusions. This study demonstrates the continued community effectiveness
of water fluoridation and provides support for the extension of this important
oral health intervention to populations currently without access to fluoridated
water. (Armfield, JM - Public Health Reports, September–October 2010, Volume 125 p655-664)
http://www.ncbi.nlm.nih.gov/pubmed/20545833
What we know and do not know about fluoride: Summary: There is much that
we know about fluoride as it relates to human health in general and dental
health in particular. Some of the information that is known concerning water
fluoridation and dental fluorosis is listed. What we do not know about fluoride
is discussed in more detail, namely the efficacy of lower levels of fluoride in
drinking water, the effect of discontinuing fluoride in drinking water in the
absence of additional preventive measures, the prevalence of fluorosis and
whether or not this presents a cosmetic problem. Other issues discussed include
the actual amount of fluoride ingested from all sources, whether low-fluoride
dentifrices are as efficacious as conventional dentifrices in caries protection
and reducing enamel fluorosis, the role of socioeconomic factors in determining
caries prevalence, and the effects of bottled water use on caries prevalence in
fluoridated communities. (Newbrun E. - J Public Health Dent. 2010 Jun 2. [Epub
ahead of print])
http://www.ncbi.nlm.nih.gov/pubmed/20415910
The impact of changing dental needs on cost savings from fluoridation:
CONCLUSION: Community water fluoridation remains a cost-effective preventive
measure in Australia. (Campain AC, et. al.- Aust Dent J. 2010 Mar;55(1):37-44)
http://www.ncbi.nlm.nih.gov/pubmed/20406153
Drinking water fluoridation in South East Queensland: a cost-effectiveness
evaluation: CONCLUSION: Fluoridation remains still a very cost-effective
measure for reducing dental decay. (Ciketic S, et. al. - Health Promot J Austr.
2010 Apr;21(1):51-6)
http://www.ncbi.nlm.nih.gov/pubmed/20415937
Water fluoridation in the Blue Mountains reduces risk of tooth decay:
CONCLUSIONS: Tooth decay reduction observed in the Blue Mountains corresponds to
high rates reported elsewhere and demonstrates the substantial benefits of water
fluoridation. (Evans RW, et. al. - Aust Dent J. 2009 Dec;54(4):368-73)
http://www.ncbi.nlm.nih.gov/pubmed/20858781
The long-term effects of water fluoridation on the human skeleton: Municipal water fluoridation has notably reduced the incidence of dental caries and is widely considered a public health success. However, ingested fluoride is sequestered into bone, as well as teeth, and data on the long-term effect of exposure to these very low doses of fluoride remain inconclusive. Epidemiological studies suggest that effects of fluoride on bone are minimal. We hypothesized that the direct measurement of bone tissue from individuals residing in municipalities with and without fluoridated water would reveal a relationship between fluoride content and structural or mechanical properties of bone. However, consonant with the epidemiological data, only a weak relationship among fluoride exposure, accumulated fluoride, and the physical characteristics of bone was observed. Analysis of our data suggests that the variability in heterogenous urban populations may be too high for the effects, if any, of low-level fluoride administration on skeletal tissue to be discerned.
(Chachra D, et.
al. - J Dent Res. 2010 Nov;89(11):1219-23)
http://www.ncbi.nlm.nih.gov/pubmed/20640347 -
Free Article
Epidemiology of fluorosis and dental caries according to different types of
water supplies: Conclusions: Only the schoolchildren in the WTS {fluoridated
water} group presented a DMFT index {the total number of teeth with caries
experience, including decayed teeth} below 3, probably because of the better
water fluoridation, demonstrating the efficacy of this method; thus, this
preventive measure should be recommended for our population. (Franzolin Sde O, et.
al. - Cien Saude Colet. 2010 Jun;15 Suppl 1:1841-7)
http://www.ncbi.nlm.nih.gov/pubmed/20724674
The association between community water fluoridation (CWF) and adult tooth loss:
CONCLUSIONS: This study suggests that the benefits of CWF may be larger than previously believed and that CWF has a lasting improvement in racial/ethnic and economic disparities in oral health. (Neidell M, et. al. - Am J Public Health. 2010 Oct;100(10):1980-5)
http://www.ncbi.nlm.nih.gov/pubmed/21067620 -
Free Article
A case-control study of determinants for high and low dental caries prevalence in Nevada youth:
Community water fluoridation has been documented as the most cost-effective, equitable, and safe community-based approach to improving oral health. Participants living in areas without community water fluoridation in Nevada were almost 2 times more likely to present with higher DMFT indices. The benefits of water fluoridation are proportionally higher for people who do not have regular access to other sources of fluoride. Therefore, dental professionals should counsel patients living in non-fluoridated geographic areas on the importance of using other sources of fluoride. It is of special significance that several futile attempts have been made in Nevada to introduce community water fluoridation to other counties, such as Washoe County, which comprises around 15% of the population. (Ditmyer M, et. al. - BMC Oral Health. 2010 Nov 11;10:24)
http://www.ncbi.nlm.nih.gov/pubmed/19772843 (Full
Article)
Water fluoridation: AIM: This was to present a summary of the evidence from systematic reviews of
the effectiveness and safety of water fluoridation
RESULTS: Of the 59 publications identified, 3 systematic reviews and 3
guidelines were included in this review. While the reviews themselves were of
good methodological quality, the studies included in the reviews were generally
of moderate to low quality. The results of the three reviews showed that water
fluoridation is effective at reducing caries in children and adults. With the
exception of dental fluorosis, no association between adverse effects and water
fluoridation has been established. Water fluoridation reduces caries for all
social classes, and there is some evidence that it may reduce the oral health
gap between social classes.
CONCLUSION: Water fluoridation, where technically feasible and culturally
acceptable, remains a relevant and valid choice as a population measure for the
prevention of dental caries. (Parnell C, et. al. - Eur Arch Paediatr Dent. 2009
Sep;10(3):141-8)
http://www.ncbi.nlm.nih.gov/pubmed/19571049 -
Free
Article
The Association Between Enamel Fluorosis and Dental Caries in U.S. Schoolchildren:
Conclusion. This study’s findings suggest that molars with fluorosis are more resistant to caries than are molars without fluorosis.
Clinical Implications. The results highlight the need for those considering policies regarding reduction in fluoride exposure to take into consideration the caries-preventive benefits associated with milder forms of enamel fluorosis.
(Hiroko, I, et. al. - J Am Dent Assoc, Vol 140, No 7, 855-862, 2009)
http://www.ncbi.nlm.nih.gov/pubmed/192369133
Appetitive-based learning in rats: lack of effect of chronic exposure to fluoride:
CONCLUSION: Chronic ingestion of fluoride {by rats} at levels up to 230 times
more than that experienced by humans whose main source of fluoride is
fluoridated water had no significant effect on appetitive-based
learning.(Whitford, GM, et. al. - Neurotoxicol Teratol. 2009 Jul-Aug;31(4):210-5)
http://www.ncbi.nlm.nih.gov/pubmed/196949322
Risk perception and water fluoridation support and opposition in Australia:
Objectives: A considerable body of evidence confirms that water fluoridation effectively reduces the community incidence of dental caries with minimal side effects. However, proposals to introduce this widely endorsed public-health measure are often perceived as controversial, and public opinion frequently plays a role in the outcome. Despite this, the public's perception of risk associated with water fluoridation has not been well researched and remains poorly understood.
Our objectives were to determine whether risk perceptions reflecting various
"outrage" factors are associated with water fluoridation support and opposition.
Conclusion: Outrage factors are important aspects of the public's perception of
risk in relation to water fluoridation. Given that water fluoridation appears to
be a low-risk, high-outrage controversy, efforts to mitigate the level of public
outrage, rather than continuing to deny possible hazards, may offer a worthwhile
strategy in gaining public acceptance for the extension of water fluoridation. (Armfield,
JM and Akers, HF - J Public Health Dent. 2009 Aug 20)
http://www.ncbi.nlm.nih.gov/pubmed/19797552
Assessing a potential risk factor for enamel fluorosis: a preliminary
evaluation of fluoride content in infant formulas: Some infants aged between
birth and 6 months who consume powdered and liquid concentrate formulas
reconstituted with water containing 1.0 part per million fluoride likely will
exceed the upper tolerable limit of fluoride. CONCLUSIONS: When powdered or
liquid concentrate infant formulas are the primary source of nutrition, some
infants are likely to exceed the recommended fluoride upper limit if the formula
is reconstituted with water containing 1.0 ppm fluoride. On the other hand, when
the fluoride concentration in water used to reconstitute infant formulas is
below 0.4 ppm, it is likely that infants between 6 and 12 months of age will be
exposed to fluoride at levels below IOM's recommended adequate intake level.
(Siew, C et al. - J Am Dent Assoc. 2009 Oct;140(10):1228-36)
http://www.ncbi.nlm.nih.gov/pubmed/19947132
A controlled study of risk factors for enamel hypoplasia in the permanent dentition: PURPOSE: The purpose of this study was to investigate risk factors for enamel hypoplasia (EH) and enamel opacity (EO) in the permanent teeth of healthy schoolchildren from a nonfluoridated
community in Australia. CONCLUSIONS: Children with low socioeconomic status, histories of respiratory or chickenpox infections, exposure to cigarette-smoking, urinary tract infections, otitis, and use of adult toothpaste are predisposed to enamel hypoplasia. By contrast, drinking optimally fluoridated water at 0 to 3 years old reduces the risk for enamel opacities.
(Ford, D et al. - Pediatr Dent. 2009 Sep-Oct;31(5):382-8)
http://www.ncbi.nlm.nih.gov/pubmed/19820737
Evidence that fluoride in the infant formula causes enamel fluorosis weak:
CONCLUSIONS: Infant formula consumption may be associated with an increased risk
of developing at least some detectable level of enamel fluorosis, but this
depends on the level of fluoride in the water supply. The evidence that the
fluoride in the infant formula caused enamel fluorosis was weak, as other
mechanisms could explain the observed association. (Edwards, M -
Evid Based Dent. 2009;10(3):73)
http://www.ncbi.nlm.nih.gov/pubmed/19630837
Association of natural
fluoride in community water supplies with dental health of children in remote
indigenous communities - implications for policy:
OBJECTIVE: To map the geographic distribution of fluoride in water supplies and
child dental caries in remote Indigenous communities of the Northern Territory
(NT). To examine the association between fluoride levels, household and
community factors, access to services and child dental caries in these
communities and to model the impact on the caries experience of children of
introducing water fluoridation. CONCLUSIONS AND IMPLICATIONS: Introduction
of fluoridation of water supplies into communities with inadequate natural
fluoride is a vital measure for improving the dental health of children living
in remote NT communities. (Bailie, RS, et al. - Aust N Z J Public Health. 2009
Jun;33(3):205-11)
http://www.ncbi.nlm.nih.gov/pubmed/19627654
Water fluoridation in Canada: past and present: Water fluoridation
remains a contentious issue in Canada and many communities choose not to
fluoridate their water supply. As of 2007, 45.1% of the Canadian population had
access to fluoridated water supplies. The main arguments for and against
fluoridation have changed very little over the years, with supporters (including
the World Health Organization and Health Canada) citing evidence that shows
fluoridation as a safe and effective method of caries prevention, while
detractors cite high costs and potential health risks. This article provides an
historical overview and a current snapshot of water fluoridation in Canada. It
concludes that the ultimate advantage of fluoridation is that it helps everyone
in a community, regardless of socioeconomic status. (Rabb-Waytowich D - J Can
Dent Assoc. 2009 Jul;75(6):451-4)
http://www.ncbi.nlm.nih.gov/pubmed/18515990
Effects of long-term fluoride in drinking water on risks of hip fracture of the elderly: an ecologic study based on database of hospitalization episodes, OBJECTIVES: Fluoridation of drinking water is known to decrease dental caries,
particularly in children. However, the effects of fluoridated water on bone over
several decades are still in controversy. To assess the risk of hip fracture
related to water fluoridation, we evaluated the hip fracture-related
hospitalizations of the elderly between a fluoridated city and non-fluoridated
cities in Korea.
CONCLUSIONS: We cannot conclude that fluoridation of drinking water increases
the risk of hip fracture in the elderly. (Park EY, et. al. - J Prev Med Public
Health. 2008 May;41(3):147-52)
http://www.ncbi.nlm.nih.gov/pubmed/19320724
Prevalence and extent of dental caries, dental fluorosis, and developmental enamel defects in Lithuanian teenage populations with different fluoride exposures:
The aim of this study was to describe the pattern of dental caries, dental fluorosis, and developmental defects of non-fluoride origin in Lithuanian children born and raised in regions with 1.1 ppm (1.1 mg/l F) and 0.3 ppm (0.3 mg/l F) water fluoride levels, respectively. All permanent surfaces/teeth of 300 teenagers were examined for dental caries, dental fluorosis, and non-fluoride developmental defects. The caries prevalence of the study population was 100%. The mean number of decayed surfaces (DS) differed only slightly and statistically insignificantly between the '1.1 ppm fluoride' and '0.3 ppm fluoride' groups (19.6 and 18.1, respectively). However, a greater number of inactive lesions and fewer fillings were found in the '1.1 ppm fluoride' group than in the '0.3 ppm fluoride' group (mean difference 1.18 and -2.80, respectively). The prevalence of dental fluorosis was 45% and 21%, respectively; the prevalence of non-fluoride opacities was 8% and 19%, respectively; and the prevalence of hypoplasia was 12% and 16%, respectively, in the '1.1 ppm fluoride' and '0.3 ppm fluoride' groups. Higher caries levels were noted in children with no fluorosis compared to those with fluorosis recorded (mean DS difference, 3.43). The results lend support to the hypothesis that the presence of fluoride in the oral environment promotes lesion arrest rather than inhibiting the initiation of new lesions.
(Machiulskiene V, et. al. - Eur J Oral Sci. 2009 Apr;117(2):154-60)
http://www.ncbi.nlm.nih.gov/pubmed/19839282
Public opinions on community water fluoridation: BACKGROUND: Community
water fluoridation (CWF) is currently experiencing social resistance in Canada.
Petitions have been publicly registered, municipal plebiscites have occurred,
and media attention is growing... RESULTS: Approximately 1 in 2 Canadian
adults surveyed knew about CWF. Of these, 80% understood its intended use,
approximately 60% believed that it was both safe and effective, and 62%
supported the idea of having fluoride added to their local drinking water. Those
with greater incomes [OR=1.4; p<0.001] and education [OR=1.6; p<0.001] were more
likely to know about CWF. Those with greater incomes [OR=1.3; p<0.03] and those
who visited the dentist more frequently [OR=1.8; p<0.002] were more likely to
support CWF, and those with children [OR=0.5; p<0.02], those who accessed dental
care using public insurance [OR=0.2; p<0.03], and those who avoided fluoride
[OR=0.04; p<0.001] were less likely to support CWF. CONCLUSION: It appears
that Canadians still support CWF. In moving forward, policy leaders will need to
attend to two distinct challenges: the influence of anti-fluoride sentiment, and
the potential risks created by avoiding fluoride. (Quiñonez CR, Locker D. - Can
J Public Health. 2009 Mar-Apr;100(2):96-100)
{Ironically, the segment of the population most at risk for dental disease and
the group most likely to benefit from water fluoridation policies is often the group
most opposed to the practice. RJ}
http://www.ncbi.nlm.nih.gov/pubmed/19281105
The global increase in dental caries. A pending public health crisis: A
current review of the available epidemiological data from many countries clearly
indicates that there is a marked increase in the prevalence of dental caries.
This global increase in dental caries prevalence affects children as well as
adults, primary as well as permanent teeth, and coronal as well as root
surfaces. This increase in dental caries signals a pending public health crisis.
Although there are differences of opinion regarding the cause of this global
dental caries increase, the remedy is well known: a return to the public health
strategies that were so successful in the past, a renewed campaign for water
fluoridation, topical fluoride application, the use of fluoride rinses, a return
to school oral health educational programs, an emphasis on proper tooth brushing
with a fluoride dentifrice, as well as flossing, a proper diet and regular
dental office visits. (Bagramian RA, et al. - Am J Dent. 2009 Feb;22(1):3-8)
http://www.ncbi.nlm.nih.gov/pubmed/18584000
A systematic review of the efficacy and safety of fluoridation: SCOPE AND PURPOSE: The systematic review was commissioned by the Australian National Health and Medical Research Council (NHMRC) to evaluate the scientific literature relating to the health effects of fluoride and fluoridation. The systematic review's research questions relate to the caries-reducing benefits and associated potential health risks of providing fluoride systemically (via addition to water, milk and salt) and the use of topical fluoride agents, such as toothpaste, gel, varnish and mouthrinse. … RECOMMENDATIONS: Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride. It is recommended (see also
www.nhmrc.gov.au/_files_nhmrc/file/media/media/rel07/Fluoride_Flyer.pdf)
that water be fluoridated in the target range of 0.6-1.1 mg/l, depending on the
climate, to balance reduction of dental caries and occurrence of dental
fluorosis (Yeung, CA - Evid Based Dent. 2008;9(2):39-43) (Download
Part A -
Part B)
http://www.ncbi.nlm.nih.gov/pubmed/18422709
Lifetime fluoridation exposure and dental caries experience in a military population: OBJECTIVES: To determine whether exposure to fluoride in drinking water is
associated with caries experience in Australian Defence Force (ADF) personnel.
CONCLUSIONS: Degree of lifetime exposure to fluoridated drinking water was
inversely associated with DMFT in a dose-response manner among this adult
military population. (Mahoney, G, et al. - Community Dent Oral Epidemiol. 2008 Dec;36(6):485-92) {Translation - the greater the exposure to
fluoridated drinking water the lower the rate of DMFT (the number of decayed,
missing and filled teeth) - RJ.}
http://www.ncbi.nlm.nih.gov/pubmed/18514162
Pharmacokinetics of ingested fluoride: lack of effect of chemical compound,
CONCLUSIONS: Considered together with published reports, the present findings
support the conclusion that the major features of fluoride metabolism are not
affected differently by the chemical compounds commonly used to fluoridate water
nor are they affected by whether the fluoride is present naturally or added
artificially. (Whitford, GM, et al. - Arch Oral Biol. 2008 Nov;53(11):1037-41)
http://www.ncbi.nlm.nih.gov/pubmed/18694870 -
Free Article
Is Water Fluoridation Still Necessary? Water fluoridation has been promoted in many countries as an organized community effort to control dental caries. With the availability of fluorides targeted at individuals and the decline in dental caries, the need for fluoridation has been questioned. Recent reports show that water fluoridation, a community-level intervention, continues to be an efficient method for the delivery of fluoride in many countries. The advantages include its ability to deliver low levels of fluoride to saliva frequently, with high reach, at low cost, and with substantial cost savings. Water fluoridation has the potential to reduce oral health disparities by creating a healthy environment. Other forms of fluoride, such as fluoride toothpaste, and clinical interventions complement dental caries control strategies.
(Kumar, JV - Adv Dent Res 20:8-12, July, 2008)
http://www.ncbi.nlm.nih.gov/pubmed/18329450
Fluorides in dental public health programs: The use of fluorides in dental public health programs has a long history. With the availability of fluoridation and other forms of fluorides, dental caries have declined dramatically in the United States. This article reviews some of the ways fluorides are used in public health programs and discusses issues related to their effectiveness, cost, and policy.
(Kumar JV, Moss ME, - Dent Clin North Am. 2008 Apr;52(2):387-401, vii. )
http://www.ncbi.nlm.nih.gov/pubmed/18333872
European citizens' opinions on water fluoridation: OBJECTIVES: To
understand European citizens' opinions on water fluoridation, as part of
research on their attitudes to the tensions between private and public interest.
CONCLUSIONS: While the vast majority of people opposed water fluoridation, this
may be indicative of shifts away from public support of population interventions
towards private interventions, as well as reduced trust in public agencies. Thus
if research were to demonstrate more clear benefits of water fluoridation over
and above that which can be achieved by use of fluoride toothpaste, then the
public may become more supportive. However, lobby groups are likely to remain
influential. (Griffin, M, et al. - Community Dent Oral Epidemiol. 2008
Apr;36(2):95-102)
http://www.ncbi.nlm.nih.gov/pubmed/18319589
Prospective study of the association between fluoride intake and dental fluorosis in permanent teeth:
CONCLUSIONS: There was no difference between children with and without fluorosis
in the permanent central incisors and first molars regarding fluoride intake.
However, this study has limitations that must be recognized: fluoride intake was
only measured once, and there were no children in the sample with severe degrees
of dental fluorosis. (Martins, CC, et al. - Caries Res. 2008;42(2):125-33)
http://www.ncbi.nlm.nih.gov/pubmed/18515990
Effects of long-term fluoride in drinking water on risks of hip fracture of the elderly: an ecologic study based on database of hospitalization episodes:
CONCLUSIONS: We
cannot conclude that fluoridation of drinking water increases the risk of hip
fracture in the elderly. (Park EY, et al. - J Prev Med Public Health. 2008
May;41(3):147-52)
http://www.ncbi.nlm.nih.gov/pubmed/18661604
Dental caries of lifetime residents in Baixo Guandu, Brazil, fluoridated since 1953--a brief communication: The addition of fluoride to public water supplies was an important ally in the
improvement of the oral health of Baixo Guandu inhabitants. (Saliba, NA, et al.
- J Public Health Dent. 2008 Spring;68(2):119-21)
http://www.ncbi.nlm.nih.gov/pubmed/18259663
The ethical dilemma of water fluoridation: The aim of this study is to analyze some of the ethical arguments for and
against water fluoridation and to determine if empirical data allow to decide if
there are correct policies from a bioethical perspective. Autonomy, compulsory
medication (mass medication), precautionary principle, justice in health care
and ethics of protection are discussed. It is concluded that fluoridation is
beneficial and that there is no ethical reason to oppose it, based on a
specific kind of ethics developed to analyze and clarify complex public health
issues. (Mendoza, VC - Rev Med Chil. 2007 Nov;135(11):1487-93. )
http://www.ncbi.nlm.nih.gov/pubmed/18087993
A comparison of dental treatment utilization and costs by HMO members living in fluoridated and nonfluoridated areas:
OBJECTIVES: To compare dental treatment experiences and costs in members of a
health maintenance organization (HMO) in areas with and without community water
fluoridation.
RESULTS: Community water fluoridation was associated with reduced total and
restorative costs among members with one or more visits, but the magnitude and
direction of the effect varied with locale and age and the effects were
generally small. In two locales, the cost of restorations was higher in
nonfluoridated areas in young people (<age 18) and older adults (>age 58). In
younger adults, the opposite effect was observed. The impact of fluoridation may
be attenuated by higher use of preventive procedures, in particular supplemental
fluorides, in the nonfluoridated areas. (Maupomé G,, et al. - J Public Health
Dent. 2007 Fall;67(4):224-33) Paper
discussed here.
http://www.ncbi.nlm.nih.gov/pubmed/17891121
Fluoride prevents caries among adults of all ages: CONCLUSIONS: To date,
no systematic reviews have found fluoride to be effective in preventing dental
caries in adults. The objective of this meta-analysis was to examine the
effectiveness of self- and professionally applied fluoride and water
fluoridation among adults. ...These findings suggest that fluoride is
effective in preventing caries in adults of all ages. (Yeung, CA - Evid Based
Dent. 2007;8(3):72-3)
http://www.ncbi.nlm.nih.gov/pubmed/17452559
Effectiveness of fluoride in preventing caries in adults: These findings
suggest that fluoride {topical and water fluoridation} prevents caries among
adults of all ages. (Griffin, SO, et al. - J Dent Res. 2007 May;86(5):410-5)
http://www.ncbi.nlm.nih.gov/pubmed/17333303
Community water fluoridation and caries prevention: a critical review:
The aim of this paper was to critically review the current role of community
water fluoridation in preventing dental caries. Original articles and reviews
published in English language from January 2001 to June 2006 were selected
through MEDLINE database. Other sources were taken from the references of the
selected papers. For the past 50 years community water fluoridation has been
considered the milestone of caries prevention and as one of the major public
health measures of the 20th century. However, it is now accepted that the
primary cariostatic action of fluoride occurs after tooth eruption. Moreover,
the caries reduction directly attributable to water fluoridation have declined
in the last decades as the use of topical fluoride had become more widespread,
whereas enamel fluorosis has been reported as an emerging problem in fluoridated
areas. Several studies conducted in fluoridated and nonfluoridated communities
suggested that this method of delivering fluoride may be unnecessary for caries
prevention, particularly in the industrialized countries where the caries level
has became low. Although water fluoridation may still be a relevant public
health measure in poor and disadvantaged populations, the use of topical
fluoride offers an optimal opportunity to prevent caries among people living in
both industrialized and developing countries. (Pizzo, G, et al. - Clin Oral
Investig. 2007 Sep;11(3):189-93)
http://www.ncbi.nlm.nih.gov/pubmed/17167257
Effects of water fluoride exposure at crown completion and maturation on
caries of permanent first molars: Pre-eruptive fluoride exposure has been
shown to be important for caries prevention. This paper aimed to determine the
relative effects of water fluoride exposure during crown completion (CC) and
maturation on caries experience in first permanent molars... In conclusion a
high exposure at CC was important for caries prevention irrespective of the
effect of exposure at maturation and post-eruption. The strongest
caries-preventive effect was produced by a high exposure at CC supplemented by a
high exposure at maturation and/or post-eruption, but the latter two phases
could not produce a significant caries-preventive effect on their own. Since
most of the caries occurred on pit and fissure surfaces, the findings relate to
this class of lesion. (Singh KA, et. al. - Caries Res. 2007;41(1):34-42)
http://www.ncbi.nlm.nih.gov/pubmed/16774166
Fluoride: a controversy revisited: The purpose of this article is to
provide a review of the small but loud debate that has surrounded fluoride over
the past 50 years. The benefits of fluoridation and its effect on public health
are well known throughout the dental community. What is far less well known are
the objections from people--in the tradition of the old amalgam and radiograph
radiation debates-who feel that fluoride has adverse effects serious enough to
warrant a cessation of its use. This article will present both sides of the
issue, not to influence the reader, but to allow the reader to realize that this
issue exists and to understand what the key arguments are. (Ananian, A. et al. -
N Y State Dent J. 2006 Apr-May;72(3):14-8)
http://www.ncbi.nlm.nih.gov/pubmed/16683594
Reexamination of hexafluorosilicate hydrolysis by 19F NMR and pH measurement:
The dissociation of hexafluorosilicate has been reinvestigated due to recent
suggestions that fluorosilicate intermediates may be present in appreciable
concentrations in drinking water... The buffer capacity of all of these
systems was found to be insufficient to prevent acidic shifts in pH when
hexafluorosilicate was added. The pH change is sufficient explanation for the
observed inhibition of acetylcholinesterase that was previously attributed to
hexafluorosilicate hydrolysis intermediates. (Finney, WF, et al. - Environ Sci
Technol. 2006 Apr 15;40(8):2572-7)
http://www.ncbi.nlm.nih.gov/pubmed/16555718
Dental caries and enamel fluorosis among the fluoridated population in the Republic of Ireland and non fluoridated population in Northern Ireland in 2002:
CONCLUSIONS: In 2002 apart from 8-year-olds, caries levels were lower amongst
children resident in fluoridated communities in RoI than amongst corresponding
age groups in non-fluoridated NI. Caries has declined in fluoridated and non
fluoridated groups in both jurisdictions since the early 1960s. In RoI fluorosis
levels were higher amongst lifetime residents of fluoridated communities and
have increased since 1984. (Whelton, H, et al. - Community Dent Health. 2006
Mar;23(1):37-43)
http://www.ncbi.nlm.nih.gov/pubmed/16263039 -
Free Full Article
Costs and savings associated with community water fluoridation programs in Colorado:
CONCLUSION: Colorado realizes significant annual savings from CWFPs; additional
savings and reductions in morbidity could be achieved if fluoridation programs
were implemented in other areas. (O'Connell, JM, et al. - Prev Chronic Dis. 2005
Nov;2 Spec no:A06)
http://ehp.niehs.nih.gov/members/2005/8319/8319.html
Blood Lead Concentrations in Children and Method of Water Fluoridation in the United States, 1988-1994: Given these findings, our analyses, though not definitive, do not support concerns that silicofluorides in community water systems cause higher PbB concentrations in children. Current evidence does not provide a basis for changing water fluoridation
practices, which have a clear public health benefit. (Macek, MD, et al. - Environmental Health Perspectives Volume 114, Number 1, January 2006)
http://www.ncbi.nlm.nih.gov/pubmed/16246928
Bioavailability of fluoride in drinking water: a human experimental study:
It has been suggested that systemic fluoride absorption from drinking water may
be influenced by the type of fluoride compound in the water and by water
hardness. Using a human double-blind cross-over trial, we conducted this study
to measure c(max), T(max), and Area Under the Curve (AUC) for plasma F
concentration against time, following the ingestion of naturally fluoridated
hard and soft waters, artificially fluoridated hard and soft waters, and a
reference water. Mean AUC over 0 to 8 hours was 1330, 1440, 1679, 1566, and 1328
ng F.min.mL(-1) for naturally fluoridated soft, naturally fluoridated hard,
artificially fluoridated soft, artificially fluoridated hard, and reference
waters, respectively, with no statistically significant differences among waters
for AUC, c(max), or T(max). Any differences in fluoride bioavailability
between drinking waters in which fluoride is present naturally or added
artificially, or the waters are hard or soft, were small compared with large
within- and between-subject variations in F absorption. (Maguire, A,
et al. - J Dent Res. 2005 Nov;84(11):989-93)
http://www.ncbi.nlm.nih.gov/pubmed/16183366
Position of the American Dietetic Association: the impact of fluoride on health,
The American Dietetic Association reaffirms that fluoride is an important
element for all mineralized tissues in the body. Appropriate fluoride exposure
and usage is beneficial to bone and tooth integrity and, as such, has an
important, positive impact on oral health as well as general health throughout
life. The American Dietetic Association strongly reaffirms its endorsement of
the appropriate use of systemic and topical fluorides, including water
fluoridation, at appropriate levels as an important public health measure
throughout the life span. (Palmer, C, et al. - J Am Diet Assoc. 2005
Oct;105(10):1620-8)
http://www.sfphes.org/water/fluoride/Osteosarcoma_fluoride_fact_sheet.pdf
Current scientific evidence: Water fluoridation is not associated with osteosarcoma
- The current scientific literature does not support an association between osteosarcoma and drinking water fluoridation, even though in cellular studies, fluoride acts as a mitogen on osteoblasts, and this defines a biologically plausible pathway for it to play a role in the development of osteosarcoma. (San
Francisco Department of Public Health, Occupational and Environmental Health
Section,
October 2005)
http://jn.nutrition.org/content/135/9/2247.full
Elevated Serum Fluoride Concentrations in Women Are Not Related to Fractures and Bone Mineral Density
- Serum fluoride concentrations were not related to incident osteoporotic fractures with 4 y of observation. Serum fluoride concentrations were not associated with BMD or osteoporotic fractures among female residents of communities with water fluoride concentrations of 52.6 or 210.4 µmol/L.
(Sowers M, et. al. - J. Nutr. 135:2247-2252, September 2005)
http://www.ncbi.nlm.nih.gov/pubmed/15541159
Relative effects of pre- and post-eruption water fluoride on caries experience by surface type of permanent first molars:
CONCLUSIONS: Pre-eruption exposure {to fluoridated water} was important for a
caries preventive effect on first permanent molars in children 6-15 years old
since post-eruption exposure alone could not lower caries levels significantly.
(Singh, KA, Spencer, AJ - Community Dent Oral Epidemiol. 2004 Dec;32(6):435-46)
http://www.ncbi.nlm.nih.gov/pubmed/15475904
Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation.
CONCLUSION: Children in non-fluoridated districts are 1.5 times more likely to
have smooth surface wear compared with children in fluoridated districts.
Fluoridation and use of fluoridated toothpaste twice a day provide added
protection from dental erosion. The risk of tooth wear is greater with
increasing affluence. (Bardsley, PF, et al. - Br Dent J. 2004 Oct
9;197(7):413-6; discussion 399)
http://www.ncbi.nlm.nih.gov/pubmed/15341615
Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach:
Research on the oral health effects of fluoride started around 100 years ago;
the focus has been on the link between water and fluorides and dental caries and
fluorosis, topical fluoride applications, fluoride toothpastes, and salt and
milk fluoridation. Most recently, efforts have been made to summarize the
extensive database through systematic reviews. Such reviews concluded that water
fluoridation and use of fluoride toothpastes and mouthrinses significantly
reduce the prevalence of dental caries. (Petersen PE, Lennon MA - Community
Dent Oral Epidemiol. 2004 Oct;32(5):319-21)
http://www.ncbi.nlm.nih.gov/pubmed/15337352
Relationship between fluorine in drinking water and dental health of residents in some large cities in China:
Our results, together with the previous study, suggest that: (1) dental caries
of the study population can be reduced by drinking water fluoridation and that
(2) other factors such as economic level, weather, lifestyle, food habits,
living condition, etc., of a city can also affect the incidence of dental caries
that cannot be predicted by fluoridation alone. Research on the relation between
index of fluorosis (IF) and the fluorine concentration in drinking water for the
four high fluorine villages showed that the recommended concentration of
fluorine in drinking water can protect from dental fluorosis. (Wang, B, et al. -
Environ Int. 2004 Oct;30(8):1067-73)
http://www.ncbi.nlm.nih.gov/pubmed/15370629
Caries experience among schoolchildren in relation to community fluoridation status and town size:
{in São Paulo State, Brazil} Caries experience and prevalence were significantly
lower in fluoridated areas (1.9 DMFT, 2.1 dmft, 20% caries free) than in
non-fluoridated areas (2.4 DMFT, 2.4 dmft, 13% caries free). The results
suggest that water fluoridation is an essential public health measure and that
town size may affect caries distribution in the Southeast area of São Paulo
State. (Tagliaferro EP, et al. - Acta Odontol Scand. 2004 Jun;62(3):124-8)
http://www.ncbi.nlm.nih.gov/pubmed/15180079
Caries prevalence in a rural Chilean community after cessation of a powdered milk fluoridation program:
CONCLUSIONS: Termination of the powdered milk fluoridation scheme resulted in a
deterioration of the dental health of children. After three years, dental caries
prevalence was higher than that reached at the end of the scheme and equivalent
to that of the control community without fluoride exposure. These results
emphasize the need to establish and maintain an alternative mechanism of
community-based fluoridation of proven effectiveness for the prevention of
dental caries in communities where water fluoridation is not available. (Mariño
RJ, et al. - J Public Health Dent. 2004 Spring;64(2):101-5)
http://www.ncbi.nlm.nih.gov/pubmed/15107774
Fluoride toxicity: CONCLUSIONS: Many years have passed since
domestic water fluoridation was adopted to reduce the incidence of caries in
developed countries; however, since there is an additional dose of fluorides
ingested with foods and drinks prepared with such waters, the problem has
emerged of possible adverse effects on health associated to them, so that in
some countries fluorine integrator selling is allowed only with preventive
medical prescription. ...At encephalic level, then, high doses of fluorine
cause the onset of neurological symptoms and of a decreased spontaneous motor
activity due to a reduction in the number of nicotinic acetylcholine receptors.
Nevertheless, epidemiological studies about fluoride toxicity have established
that such oligoelement may be safely used at odontoiatric dosages. (Giachini M,
Pierleoni F - Minerva Stomatol. 2004 Apr;53(4):171-7)
http://www.ncbi.nlm.nih.gov/pubmed/15346876
Water fluoridation and dental caries in 5- and 12-year-old children from Canterbury and Wellington:
Multivariable analysis confirmed the independent association between water
fluoridation and better dental health. CONCLUSIONS: This results of this study
show children living in a fluoridated area to have significantly better oral
health compared to those not in a fluoridated area. These differences are
greater for Maori and Pacific children and children of low socio-economic
status. (Lee M, Dennison PJ - N Z Dent J. 2004 Mar;100(1):10-5)
http://www.ncbi.nlm.nih.gov/pubmed/15067887 History of fluoride prevention:
successes and problems (literature review): Recent scientific views, however, confirmed a weak pre-, and peri-eruptive, as well as a strong posteruptive effect of systemically applied fluorides. In countries where caries prevalence is high, but the majority of the population cannot afford fluoridated toothpastes due to low socio-economic conditions, the introduction and extension of salt fluoridation to the whole population is well founded and recommended from a public health view.
(Bánóczy J, Marthaler TM - Fogorv Sz. 2004 Feb;97(1):3-10)
http://www.ncbi.nlm.nih.gov/pubmed/14631907
Optimal fluoride level in drinking water and public health: Water
fluoridation is a safe, efficient, and well-proven way of preventing dental
decay in the community. In countries such as Israel, where dental care is not
covered by the national insurance law, this has an important role in reducing
social inequalities in health care. For toddlers and children, water
fluoridation is the only way of promoting dental health without a need for
regular visits to dental clinics, and without regard to parent awareness and
motivation. The other methods of fluoride supplementation do not succeed in
reaching the level of safety and cost-efficiency of water fluoridation, and
their use is successful only among upper socio-economic classes. Water
fluoridation has been defined by the US CDC as one of the main achievements in
health care during the 20th century. In spite of the legal difficulties raised
by various activist groups, the use of water fluoridation is growing steadily
among developed as well as third world countries. The Israeli bylaw of national
water fluoridation that is in effect will enable the safe improvement of the
overall dental health status of the population at an extremely low cost. (Karsenty
E, et al. - Harefuah. 2003 Nov;142(11):754-8, 806)
http://www.ncbi.nlm.nih.gov/pubmed/15645934
Successes and drawbacks in the caries-preventive use of fluorides--lessons to be
learnt from history: Water fluoridation was the first breakthrough in the
practice of preventive cariology on a community level and has remained one of
the cornerstones of prevention in dentistry. The concepts regarding the
mechanisms of the caries-inhibitory effect, however, have changed in several
respects. Today there is general agreement that topical effects on the erupted
enamel are most important. The contention that there is no pre-eruptive effect
whatsoever has created confusion; there is in fact evidence for a minor
pre-eruptive protective effect. Around 1980 many experts believed that fluorides
should not be used in high concentrations, for instance above those in
dentifrices, because this could block remineralisation in the body of pre-cavity
lesions. However, it is now known that such undesirable effects are negligible
or non-existent. (Marthaler TM - Oral Health Prev Dent. 2003;1(2):129-40)
http://www.ncbi.nlm.nih.gov/pubmed/12734021
An update on fluorides and fluorosis: Decisions concerning use of
fluoride in its many forms for caries prevention are more complicated now than
in the past because of the need to balance these benefits with the risks of
dental fluorosis. This article reviews pertinent literature concerning dental
fluorosis (definition, appearance, prevalence), pre- and post-eruptive use of
fluoride, esthetic perceptions of dental fluorosis, fluoride levels of beverages
and foods, the Iowa Fluoride Study, and the U.S. Centers for Disease Control and
Prevention's "Recommendations for Using Fluoride to Prevent and Control Dental
Caries in the United States." Water fluoridation and use of fluoride dentifrice
are the most efficient and cost-effective ways to prevent dental caries; other
modalities should be targeted toward high-risk individuals. (Levy SM - Dent Clin
North Am. 2003 Apr;47(2):225-43)
http://www.ncbi.nlm.nih.gov/pubmed/12739679
History of water fluoridation: Analyses showed that maximum protection against
caries is obtained when teeth erupt into an environment with low concentrations
of ionic fluoride. The similarity in caries reductions obtained in water
fluoridation studies and long-term studies with topically administered fluoride
regimens, including fluoride-containing dentifrices, indicates that the
pre-eruptive effect of fluoride is of borderline significance relative to the
more significant post-eruptive effect. It has taken a long time to show that
water fluoridation and topical fluoride programs were thus important measures
for the control of caries at the community level.
(Kargul B, et. alI. - J Clin Pediatr Dent. 2003 Spring;27(3):213-7)
http://www.ncbi.nlm.nih.gov/pubmed/12699229
Current and future role of fluoride in nutrition: Fluoride continues to be the cornerstone of dental caries prevention in North America and throughout the world, and there are a variety of sources of fluoride that may contribute to the dietary intakes of fluoride. Although the severe effect of chronic exposures to high levels of fluoride--skeletal fluorosis--is extremely rare in North America, dental fluorosis has become more prevalent. To address the increase in dental fluorosis prevalence, recommendations have been made to reduce fluoride ingestion early in life. These recommendations have included the introduction of lower concentration fluoride dentifrice for use by young children, labeling of the fluoride concentration of bottled water, and revised fluoride supplement guidelines to reduce or eliminate their use. Because our knowledge is incomplete regarding the amount, duration, and timing of fluoride ingestion that can result in dental fluorosis, however, further research is clearly needed before definitive recommendations can be made regarding the use of fluorides, including recommended intakes of fluoride in the diet.
(Warren JJ, Levy SM - Dent Clin North Am. 2003 Apr;47(2):225-43)
http://www.ncbi.nlm.nih.gov/pubmed/14595871
Decline in enamel hypoplasia in relation to fluoridation in Australians: Enamel hypoplasias are thought to represent calcification disruption indicative of metabolic stress during development. Hypoplasias of permanent maxillary central incisors and mandibular canines have undergone a notable reduction in frequency between Euro-Australian twins born around 1965 and those born ca. 1990. Even when scored very liberally these linear defects are 3.1-4.6 times as prevalent in the earlier Australians, and the discrepancy is proportionately greater among strictly scored defects. Likely correlates of this secular trend logically include reduced childhood fevers and clinical intervention to reduce circum-natal stresses acting on cotwins. However, fluoridation of metropolitan water has emerged as the statistically strongest hypoplasia-preventing factor.
(Corruccini RS, Townsend GC - Am J Hum Biol. 2003 Nov-Dec;15(6):795-9
http://www.ncbi.nlm.nih.gov/pubmed/12508513
Fluoridation at fifty: what have we learned? The question posed by the title of this article encompasses more than just the law and science applied to fluoridation. A review of the history and present status of fluoridation policy development and implementation makes it quickly apparent that the lessons learned are applicable to a wide range of public health policy and that the public health community needs to be very concerned about the status and trends of legal precedent. Indeed, in the context of recent U. S. Supreme Court decisions,
the need for a comprehensive and coordinated effort to educate the public, legislators, and jurists about the safety and efficacy of community water fluoridation is clear.
Two fundamental issues are at the core of this article: (1) the use of science
in formulating and defending public health policy, and (2) how to connect
scientific fact with the legal process in connection with the actual
circumstances regarding a community's health status. The opening section of this
article presents an analysis of fluoridation's great success in preventing
dental caries over the past 50 years, along with a discussion of current data
scientifically demonstrating that fluoride is safe when properly utilized. A
second section provides an overview of one state's legislative experience in
mandating fluoridation and the political challenges encountered. A final section
discusses the legal issues associated with fluoridation, including the bases of
legal challenges to public laws mandating it. (Pratt, E, et al. - J Law Med
Ethics. 2002 Fall;30 (3 Suppl):117-21)
Free Article:
The York Review – A systematic review of public water fluoridation: a
commentary: The body of evidence available on the efficacy and safety of water fluoridation was of lower quantity and quality than had previously been reported.
> The best available evidence (from studies that met inclusion criteria) suggests that fluoridation of drinking water supplies reduces caries prevalence but is associated with dental fluorosis.
> The balance of the evidence did not show an association between any fractures and water fluoridation.
> No associations between water fluoridation and human cancer were found. (Treasure, ET,
et al. - British Dental Journal 192, 495 - 497 (2002))
another commentary
http://www.ncbi.nlm.nih.gov/pubmed/11918578
A blind caries and fluorosis prevalence study of school-children in naturally fluoridated and nonfluoridated townships of Morayshire, Scotland: CONCLUSIONS: Considerable caries benefit has accrued to those Morayshire rural
children who have received naturally fluoridated water (at 1 ppm) throughout
their lives, as compared to their socioeconomically similar, nonfluoridated
rural counterparts. Furthermore, in spite of all but two subjects claiming to
have brushed regularly with fluoridated dentifrice (and no evidence of the
availability of nonfluoridated toothpaste being purchasable in the five
townships), only borderline mild fluorosis disadvantages have been noted
clinically, and none by the subjects' own aesthetic perceptions. Finally, no
evidence was found to suggest any delay in permanent tooth eruption patterns of
the F subjects. It would seem appropriate therefore, that adjustment of Scots'
drinking waters' natural fluoride levels to 1 ppm should be pursued to extend
similar dental advantages to the vast majority of that population (both young
and old) which, it is well documented, has the worst dental health of mainland
UK. (Stephen, KW, et al. - Community Dent Oral Epidemiol. 2002 Feb;30(1):70-9)
http://www.ncbi.nlm.nih.gov/pubmed/11495635 -
Free
Article
Association of Down's syndrome and water fluoride level: a systematic review of the evidence: BACKGROUND: A review of the safety and efficacy of drinking water fluoridation was commissioned by the UK Department of Health to investigate whether the evidence supported a beneficial effect of water fluoridation and whether there was any evidence of adverse effects. Down's syndrome was one of the adverse effects reported. The aim of this review is to examine the evidence for an association between water fluoride level and Down's syndrome. … CONCLUSIONS: The evidence of an association between water fluoride level and Down's syndrome incidence is inconclusive.
(Whiting P, et al. - BMC Public Health. 2001;1:6. Epub 2001 Jul 24)
Free Article:
Water fluoridation: Community fluoridation — are there benefits? Objective: To compare changes in dental health between non-fluoridated Stourbridge and the towns of Dudley, Sedgeley and Coseley, Brierley Hill and Kingswinford, and Halesowen
that were artificially fluoridated in 1987. Conclusion: Drinking water
fluoridation is associated with an increase in the percentage of 5-year-old
children with no experience of tooth decay (Treasure, E - British Dental Journal
190, 26 (2001)
http://www.ncbi.nlm.nih.gov/pubmed/11341339
Effect of long-term exposure to fluoride in drinking water on risks of bone
fractures: It is concluded that long-term fluoride exposure from drinking
water containing > or =4.32 ppm increases the risk of overall fractures as well
as hip fractures. Water fluoride levels at 1.00-1.06 ppm decrease the risk of
overall fractures relative to negligible fluoride in water; however, there does
not appear to be similar protective benefits for the risk of hip fractures. (Li
Y, et. al. - J Bone Miner Res. 2001 May;16(5):932-9)
http://www.ncbi.nlm.nih.gov/pubmed/11021861
Free Article
Systematic review of water fluoridation: OBJECTIVE: To review the safety and efficacy of fluoridation of drinking water. DESIGN: Search of 25 electronic databases and world wide web. Relevant journals hand searched; further information requested from authors. Inclusion criteria were a predefined hierarchy of evidence and objectives. Study validity was assessed with checklists. Two reviewers independently screened sources, extracted data, and assessed validity. …RESULTS: 214 studies were included. The quality of studies was low to moderate. …CONCLUSIONS: The evidence of a beneficial reduction in caries should be considered together with the increased prevalence of dental fluorosis. There was no clear evidence of other potential adverse effects.
(McDonagh MS, et al. - BMJ. 2000 Oct 7;321(7265):855-9)
http://www.ncbi.nlm.nih.gov/pubmed/11021862
Free Article
Community water fluoridation, bone mineral density, and fractures:
prospective study of effects in older women: CONCLUSIONS: Long term exposure to
fluoridated drinking water does not increase the risk of fracture. (Phipps KR,
et. al.- BMJ. 2000 Oct 7;321(7265):860-4)
http://www.ncbi.nlm.nih.gov/pubmed/10860326
Free Article
Risk of enamel fluorosis in nonfluoridated and optimally fluoridated
populations: considerations for the dental professional: CONCLUSIONS: Enamel fluorosis in the nonfluoridated study sample was attributed to fluoride supplementation under the pre-1994 protocol and early toothbrushing behaviors. Enamel fluorosis in the optimally fluoridated study sample was attributed to early toothbrushing behaviors, inappropriate fluoride supplementation and the use of infant formula in the form of a powdered concentrate. CLINICAL IMPLICATIONS: By advising parents about the best early use of fluoride agents, health professionals play an important role in reducing the prevalence of clinically noticeable enamel fluorosis.
(David G. Pendrys - J Am Dent Assoc. 2000 Jun;131(6):746-55.
http://www.ncbi.nlm.nih.gov/pubmed/10846267
Indigenous Australian dental health: a brief review of caries experience:
Abstract
- The indigenous community in Australia is an at risk population for oral diseases such as dental caries. The majority of communities are isolated and dental services in these areas are limited. Oral hygiene standards are poor and this combined with a diet rich in refined carbohydrates has led to high incidences of dental caries. In addition, diabetes, which is related to obesity (and a diet high in sugar and fat) has been linked to increases in oral disease. Caries prevalence was found to be low in areas where fluoridation levels in the water were high. The fact that the fluoride supplementation appears to improve oral health to a significant degree suggests that implementation of fluoride treatment programmes for school children and, where viable, fluoridation of water sources would be appropriate. In addition, dental education programmes should receive high priority.
(Martin-Iverson N, et. al. - Aust Dent J. 2000 Mar;45(1):17-20.)
http://www.ncbi.nlm.nih.gov/pubmed/10077350
Drinking water fluoridation and bone: Accordingly, in most epidemiological studies in humans bone mass was not altered
by optimal drinking water fluoridation. In contrast, studies on the effect on
hip fracture rate gave conflicting results ranging from an increased fracture
incidence to no effect, and to a decreased fracture rate. As only ecological
studies have been performed, they may be biased by unknown confounding factors
-- the so-called ecological fallacy. However, the combined results of
these studies indicate that any increase or decrease in fracture rate is likely
to be small. It has been calculated that appropriately designed cohort studies
to solve the problem require a sample size of >400,000 subjects. Such studies
will not be performed in the foreseeable future. Future investigations in humans
should, therefore, concentrate on the effect of long-term drinking water
fluoridation on bone fluoride content and bone strength.(Allolio B, Lehmann R - Exp Clin Endocrinol
Diabetes. 1999;107(1):12-20)
http://www.ncbi.nlm.nih.gov/pubmed/8897755
Fluoridation--the Israel experience: There have been suggestions, mainly in the lay press, that fluoridation might affect immunity. Careful examination of various studies on fluoride and immune function do not support this suggestion. Whilst fluoride at high concentrations can have inhibitory effects on lymphocyte and polymorphonuclear leucocyte function, these concentrations are many times higher than levels which would be expected from fluoridation. Fluoride can act as an immunological adjuvant. There is no evidence of any deleterious effect on specific immunity following fluoridation nor any confirmed reports of allergic reactions. (Challacombe SJ - Community Dent Health. 1996 Sep;13 Suppl 2:69-71)
http://www.ncbi.nlm.nih.gov/pubmed/8897750
Fluoridation--the Israel experience: Epidemiological studies have shown that 5- and 12-year-old children living in
fluoridated areas (in Israel) have considerably less dental caries than those
receiving unfluoridated water. (Kelman AM - Community Dent Health. 1996 Sep;13 Suppl
2:42-6)
http://www.ncbi.nlm.nih.gov/pubmed/9034970
The effectiveness of community water fluoridation in the United States: Grand Rapids, the first city in the world to implement controlled water
fluoridation, has served as a model for thousands of other communities.
Fluoridation is one of the greatest public health and disease-preventive
measures of all time. Its advantages include effectiveness for all, ease of
delivery, safety, equity, and low cost. Today, nearly 56 percent of the US
population lives in fluoridated communities (62% of those on central water
supplies). Previously observed caries reductions of one-half to two-thirds
are no longer attainable in the United States because other fluoride methods and
products have reduced the caries prevalence in all areas, thus diluting the
measurement of effectiveness, and because benefits of fluoridation are dispersed
in many ways to persons in nonfluoridated areas. Water fluoridation itself,
however, remains as effective as it ever was among groups at high risk to dental
caries. Contrary to early beliefs that stressed the importance of preeruptive
fluoride exposure, fluoridation also provides an important source of topical
fluoride and facilitates remineralization. Although data on effectiveness and
safety are compelling, future progress of water fluoridation will be affected by
economic, political, and public perception factors. (Horowitz, HS - J Public
Health Dent. 1996;56(5 Spec No):253-8)
http://www.ncbi.nlm.nih.gov/pubmed/8897754
Water fluoridation and osteoporotic fracture: Data on the relationship
between fluoride intake and hip fracture risk at the individual level, and data
relating fluoridation to bone mineral density are required. Until these become
available, the burden of evidence suggesting that fluoridation might be a risk
factor for hip fracture is weak and not sufficient to retard the progress of the
water fluoridation programme.
(Hillier S, Inskip H, Coggon D, Cooper C. - Community Dent Health. 1996 Sep;13
Suppl 2:63-8)
http://www.ncbi.nlm.nih.gov/pubmed/8897753
Cancer and fluoridation: The present paper gives a brief overview of the
evidence that fluoride in drinking water has not been shown to cause an increase
in the risk of developing cancer and of the errors in the analyses that purport
to show such an increase. (Cook-Mozaffari P. - Community Dent Health. 1996
Sep;13 Suppl 2:56-62)
http://www.ncbi.nlm.nih.gov/pubmed/8897751
Thirty-eight years of water fluoridation--the Singapore scenario: Singapore is the first country in Asia to institute a comprehensive fluoridation programme which covers 100 per cent of the population. The water was fluoridated at 0.7 ppm fluoride using sodium silicofluoride. The
ten year study on the effects of water fluoridation in Singapore showed a
decrease in caries prevalence in the children. In the permanent dentition the
reduction was 52.3 per cent for Chinese and 31 per cent for Malays in the 7 to 9
year old age group. A similar trend was observed in the mixed dentition in which
the decrease was 32.5 per cent for Chinese and 30.6 per cent for Malays. Because
of the availability and use of other fluoride products, dental fluorosis was
observed in children in later years. Although the decline in dental caries after
10 years of water fluoridation was not comparable to those achieved in other
countries, this study further documents water fluoridation as the most
cost-effective public health measure for the prevention of dental caries. (Loh, T - Community Dent Health. 1996 Sep;13 Suppl
2:47-50)
http://www.ncbi.nlm.nih.gov/pubmed/8741788
Free Article
Drinking water and cancer: Any and all chemicals generated by human activity can and will find their way into water supplies. The types and quantities of carcinogens present in drinking water at the point of consumption will differ depending on whether they result from contamination of the source water, arise as a consequence of treatment processes, or enter as the water is conveyed to the user. Source-water contaminants of concern include arsenic, asbestos, radon, agricultural chemicals, and hazardous waste. Of these, the strongest evidence for a cancer risk involves arsenic, which is linked to cancers of the liver, lung, bladder, and kidney. The use of chlorine for water treatment to reduce the risk of infectious disease may account for a substantial portion of the cancer risk associated with drinking water. The by-products of chlorination are associated with increased risk of bladder and rectal cancer, possibly accounting for 5000 cases of bladder cancer and 8000 cases of rectal cancer per year in the United States. Fluoridation of water has received great scrutiny but appears to pose little or no cancer risk.
(Morris RD - Environ Health Perspect. 1995 Nov;103 Suppl 8:225-31)
http://www.ncbi.nlm.nih.gov/pubmed/7503344
Free Article
Fluoride exposure and childhood osteosarcoma: a case-control study; CONCLUSIONS: Fluoride exposure does not increase the risk of osteosarcoma and may be protective in males. The protective effect may not be directly due to fluoride exposure but to other factors associated with good dental hygiene. There is also biologic plausibility for a protective effect.
(Gelberg KH, et. al. - Am J Public Health. 1995 Dec;85(12):1678-83)
http://www.ncbi.nlm.nih.gov/pubmed/7484283
Effects of fluoridated drinking water on bone mass and fractures: the study
of osteoporotic fractures: Our results do not support the findings from
recent ecological studies which showed an increased risk of hip fracture among
individuals exposed to fluoridated public water. (Cauley JA, et. al. - J Bone
Miner Res. 1995 Jul;10(7):1076-86)
http://www.ncbi.nlm.nih.gov/pubmed/8259189
Free Article
Acute fluoride poisoning from a public water system: In May 1992,
excess fluoride in one of two public water systems serving a village in Alaska
caused an outbreak of acute fluoride poisoning. ...We estimated that 296
people were poisoned; 1 person died. ...The
fluoride concentration of a water sample from the implicated well was 150 mg per
liter {150 times normal}, and that of a sample from the other system
was 1.1 mg per liter. Failure to monitor and respond appropriately to elevated
fluoride concentrations, an unreliable control system, and a mechanism that
allowed fluoride concentrate to enter the well led to this outbreak.
Discussion: …The findings of our investigation should be of concern both to
health care providers of patients with acute fluoride poisoning and to public
health and other officials responsible for water fluoridation. The efficacy of
fluoridation in preventing dental caries has been well documented, and the
safety of this practice is supported by the extreme rarity of incidents of overfluoridation.
We believe that the practice of fluoridation of public water systems should
continue. However, public health officials must make certain that standard
safety equipment is installed, that water-system operators are properly trained,
and that routine, systematic monitoring and follow-up of fluoride concentrations
in water systems and inspection of fluoridation units are undertaken. (Gessner BD,
et al. - N Engl J Med. 1994 Jan 13;330(2):95-9)
http://www.ncbi.nlm.nih.gov/pubmed/2066482
Dental caries and fluoride exposure in Western Australia: Bivariate analysis revealed all fluoride exposure to be associated with
reduced caries experience, but there were large correlations between some
variables. When unconditional logistic regression analysis was used, the most
important (p less than 0.05) odds ratios associated with no caries experience
were for residence in a fluoridated area from four to 12 years of age and early
use of toothpaste. (Riordan, PJ - J Dent Res. 1991 Jul;70(7):1029-34)
http://www.ncbi.nlm.nih.gov/pubmed/1819282
Free Article
Caries prevention--fluoride: reaction paper: Although the prevalence of
caries has declined in young persons in developed countries, there is still a
need for water fluoridation. The effectiveness of fluoride is dependent on the
ambient levels of fluoride in the oral cavity. Fluoride appears to exert the
bulk of its protective effect locally by promoting remineralization of early
carious lesions. Nevertheless, fluoride tablets continue to be prescribed as if
the action of fluoride is expressed systemically. There is an urgent need to
explore the clearance of fluoride from the mouth and to develop methods to
ensure constant levels of fluoride in the oral cavity, thereby reducing both the
need for frequent exposure and the amount necessary for clinical effect. (Bowen WH - Adv Dent Res. 1991 Dec;5:46-9)
{Often, when controversial papers are published, like the
Clarkson paper below, others are offered an opportunity to respond immediately}
http://www.ncbi.nlm.nih.gov/pubmed/1819281
Free Article
Caries prevention--fluoride: Convincing evidence exists that fluoride has a major effect on
the demineralization and remineralization of dental hard tissues,
and that it interferes with the acid production from "cariogenic"
bacteria. However, it has also been shown to be physiologically
harmful if fluoride concentrations and/or exposure periods are
inappropriate. ...The benefits and problems associated with the systemic route of fluoride administration are discussed with special reference to caries control and fluoride's mechanism of action and its toxic effect. The same discussions are focused on the role of the topical effects of fluoride, with particular emphasis placed upon: low vs. high fluoride concentrations; calcium fluoride vs. fluorhydroxyapatite; and fluoride distribution, in both the mouth and in the teeth. The benefits and problems associated with the systemic route of fluoride administration are discussed with special reference to caries control and fluoride's mechanism of action and its toxic effect. The same discussions are focused on the role of the topical effects of fluoride, with particular emphasis placed upon: low vs. high fluoride concentrations; calcium fluoride vs. fluorhydroxyapatite; and fluoride distribution, in both the mouth and in the teeth. The benefits and problems associated with the systemic route of fluoride administration are discussed with special reference to caries control and fluoride's mechanism of action and its toxic effect. The same discussions are focused on the role of the topical effects of fluoride, with particular emphasis placed upon: low vs. high fluoride concentrations; calcium fluoride vs. fluorhydroxyapatite; and fluoride distribution, in both the mouth and in the teeth.
(Clarkson BH - Adv Dent Res. 1991 Dec;5:41-5)
http://www.ncbi.nlm.nih.gov/pubmed/12637966
NTP Toxicology and Carcinogenesis Studies of Sodium Fluoride (CAS No. 7681-49-4)in F344/N Rats and B6C3F1 Mice (Drinking Water Studies): There was no evidence of carcinogenic activity in female F344/N rats
receiving sodium fluoride at concentrations of 25, 100, or 175 ppm (11, 45, or
79 ppm fluoride) in drinking water for 2 years. There was no evidence of
carcinogenic activity of sodium fluoride in male or female mice receiving sodium
fluoride at concentrations of 25, 100, or 175 ppm in drinking water for 2 years.
Dosed rats had lesions typical of fluorosis of the teeth and female rats
receiving drinking water containing 175 ppm sodium fluoride had increased
osteosclerosis of long bones. (Natl Toxicol Program Tech Rep Ser. 1990
Dec;393:1-448)
http://www.ncbi.nlm.nih.gov/pubmed/2129630
Free Article
Fluoride: Benefits And Risks of Exposure: Together, these studies indicate that fluoride
in drinking water is beneficial to dental health.
However, recent studies have reported declines in caries
prevalence in nonfluoridated areas that are comparable in magnitude
to declines noted in fluoridated areas. While these estimates
of caries decreases in nonfluoridated areas appear
accurate, conclusions cannot be drawn from these studies concerning
the independent effects of fluoridated drinking water
on caries prevalence since other possible sources of fluoride
exposure were not measured. Fluoride sources, other than in
drinking water, may provide a level of caries protection similar
to fluoridated drinking water.
(Laurence S, et al. - Crit Rev Oral Biol Med. 1990;1(4):261-81)
http://www.jbjs.org.uk/cgi/reprint/71-B/1/111
Free Article
Treatment of Bone Weakness in Patients with Femoral Neck Fracture by Fluoride,
Calcium, and Vitamin D: Twenty-three of 46 patients, aged 56 to 95 years, with fracture of the femoral neck (FNF) completed the
first trial of 10 months treatment with oral sodium fluoride 60 mg and calcium 1800 mg on alternate days and
1 ıtg of vitamin D1 daily. In 17 patients the treatment improved the amount and quality of trabecular bone. Cortical thickness
increased in nine patients and there were no losses of amount or mineralisation. The treatment was well
tolerated by most patients and there were no major side-effects or signs of bone demineralisation. The study
also revealed an unexpected rapid post-fracture deterioration of bone tissue in untreated FNF patients; thus
there is an increased risk of further fractures which calls for the use of an effective treatment to increase bone
mass. (Mackie et al. - J Bone Joint Surg Br 1989 71-B (1): 111)
http://www.ncbi.nlm.nih.gov/pubmed/4025650
Free Article
Fluorides, facts and fanatics: public health advocacy shouldn't stop at the courthouse door:
One of the more controversial American public health issues is fluoridation of municipal water supplies. Opponents occasionally succeed in halting fluoridation through local referenda, but the courts usually uphold fluoridation laws. In 1982, however, an Illinois trial judge ruled that a state law authorizing fluoridation was unconstitutional. Although unimpressed by the plaintiff's evidence purporting to show fluoridation's risks, the judge was compelled to rule against the state because it had failed to counter with evidence on the safety of fluoridated water. Christoffel analyzes the trial court's decision and its subsequent reversal by the Illinois Supreme Court. He urges public health professionals to assume advocacy roles by ensuring that the scientific rationale behind public health regulations becomes part of the legislative record and by forcefully supporting public health policies in all forums, including the courts.
(Christoffel T - Am J Public Health. 1985 Aug;75(8):888-91)
http://www.ncbi.nlm.nih.gov/pubmed/3917599
Free Article
Thirty years of fluoridation: a review:
Fluoride contributes to stability of both teeth and bones and to reduction of caries, especially if ingested before eruption of teeth. Reduction of caries continues at about 60% in persons drinking fluoridated water only as long as fluoride washes over teeth. One-half the population of the US does not have access to water with an optimal fluoride concentration of about 1 mg/L. Misinformation about fluoridation contributes to reluctance of communities to supplement the natural but inadequate fluoride of those water supplies. Fluoridation of water has no positive or negative effect on incidence or mortality rates due to cancer, heart disease, intracranial lesions, nephritis, cirrhosis, mongoloid births, or from all causes together. The collective decision to increase the natural fluoride content of water supplies is not an infringement of civil rights, nor does it establish a precedent in the binding sense of the law. Supplemental fluoride in water makes it available to all members of the community in a safe, practical, economical and reliable manner. Fluoridation saves money in dental costs and time lost from work. Fluoridation is an appropriate action of government in promoting the health and welfare of society.
(Richmond VL - Am J Clin Nutr. 1985 Jan;41(1):129-38)
http://www.ncbi.nlm.nih.gov/pubmed/6384648
Fluorine and thyroid gland function: a review of the literature: Published data failed to support the view that fluoride, in doses recommended for caries prevention, adversely affects the thyroid.
(Bürgi H, et. al. - Klin Wochenschr. 1984 Jun 15;62(12):564-9)
http://www.ncbi.nlm.nih.gov/pubmed/6360403
Free Article
The alleged association between artificial fluoridation of water supplies and cancer
- a review:
Since 1945, artificial fluoridation of water supplies has been used with success to reduce the incidence of dental caries in many areas where the natural fluoride content of the water is low. However, since 1975, it has been maintained that such artificial fluoridation is followed by an increased risk of cancer. These allegations originate from a single source. The present review, which covers re-examinations of the same data as well as evidence from scientific and governmental bodies in many countries, shows these assertions to be erroneous.
(J. Clemmesen - Bull World Health Organ. 1983; 61(5): 871–883)
http://www.ncbi.nlm.nih.gov/pubmed/7338695
Free Article
Fluoridation of water supplies and cancer mortality
I: A search for an effect in the UK on risk of death from cancer: Claims that the mortality from cancer has been
increased in urban populations as a result of the
fluoridation of water supplies have been given
publicity in the press and on the radio and television,
and questions have consequently been asked in
Parliament with a view to stopping plans for further
fluoridation. These. claims have been based on an
analysis of the trend in cancer mortality rates in
American towns by Yiamouyiannis and Burk1" and more recently on an analysis of
crude cancer mortality in two British towns-Birmingham, where the water supply
was fluoridated in October 1964, and Manchester, where there has been no
fluoridation. CONCLUSION: Examination of the trend in mortality for cancer in
the seven cities in England and Wales with populations of over 400 000* and in
England and Wales as a whole between 1959-63 and 1974-8 provides no reason to
suppose that any unique factor, such as fluoridation of the water supplies, has
affected the death rate for cancer in Birmingham since 1964. (Paula Cook-Mozaffari,
et al. - Journal of Epidemiology and Community Health, 1981, 35, 227-232)
http://www.ncbi.nlm.nih.gov/pubmed/7338696
Free Article
Fluoridation of water supplies and cancer mortality II: Mortality trends
after fluoridation: In the past two years much publicity has been given to
Burk's claim that the mortality from cancer in
Birmingham increased sharply following fluoridation
of the water supply in 1964 and, specifically, that it
increased more sharply than in other British towns.
This claim is not supported by detailed examination
of age-standardised mortality rates in England and
Wales' and we have, therefore, re-examined the data
to see what led Burk to his conclusion.
Conclusions
Claims that unusual increases in cancer mortality
have occurred in England after fluoridation have
been examined and have been shown to rest on
incorrect arithmetic, on the use of inappropriate
statistical methods, and on examination of too
restricted a part of the available data.
Studies from other parts of the world which have
examined trends in cancer mortality after
fluoridation, or which have made geographical
comparisons between fluoridated and unfluoridated
areas, have been reviewed. There is no evidence
either from England and Wales or from elsewhere in
the world that the addition of fluoride to water
supplies has increased the risk of dying from cancer. (Paula Cook-Mozaffari - Journal of Epidemiology and Community Health, 1981, 35, 233-238)
http://www.ncbi.nlm.nih.gov/pubmed/622448
Free Article
Fluoridation and mortality--an epidemiologic study of Pennsylvania communities:
Fewer health measures have been accorded more clinical and laboratory research, epidemiologic study, massive clinical trials of total community populations, and public attention )both favorable and adverse) than the fluoridation of public water supplies. As a result, knowledge of the dental and nondental physiological effects of fluoridation has increased significantly since Grand Rapids, Mich., was first experimentally fluoridated in 1945. There is now considerable evidence that fluoridation of community water supplies is both effective and safe. In 1975, the Council on Foods and Nutrition of the Americal Medical Association updated its earlier statement confirming the efficacy and
safety of fluoridation under controlled administration. Jackson provides a list of 22 statements and findings supportive of fluoridation from lay, legal, and professional groups throughout the world.
However, controversy (maintained by a segment
of the general public and professional community)
continues regarding possible adverse effects of fluoridation
on human health. The National Cancer
Institute and the National Heart and Lung Institute have recently issued statements that refute
claims suggesting a relationship between fluoridated water and mortality from cancer and heart disease.
No clear evidence was found to
suggest that fluoridation under controlled
administration adversely affects
overall mortality or diabetes
mortality. Under controlled administration,
fluoridation may have no significant
effect on either mortality rate.
The inconsistent relationships found
between high levels of fluoride and cerebrovascular disease mortality require
further investigation. (Tokuhata, GK, et al. - Public Health Reports, Vol. 93, January-February 1978, pp. 60-68)
Free
Article
Statewide Antifluoridation Initiatives: A New Challenge to Health Workers - Fluoridation of municipal drinking waters remains an issue
of contention in the western United States. Spirited campaigns
recently have been waged in Oregon and Washington
by those who oppose fluoridation. The approach of the opposition
was unique: statewide prohibition campaigns launched
simultaneously in neighboring states. The enabling vehicle
for introduction of these campaigns was the public initiative
process. ...A disquieting aspect of these recent campaigns was the
central role in each state of the
National Health Federation.
The Federation, based in Monrovia, California, is "dedicated
to the protection of health freedoms," emphasizing
that the patient should be free to choose alternate forms of
health care, and that the choice should be free of governmental
restriction or "monopolistic control". ...The Federation challenges
pasteurization of milk, fluoridation of public water supplies
and immunizations, and promotes Laetrile, Krebiozen,
mega-vitamin therapy, naturopathic medicine, chelation
therapy, and a variety of alternative health care practices.
(Caswell A, et. al - AJPH January, 1978, Vol. 68, No. 1)
http://www.ncbi.nlm.nih.gov/pubmed/135009
Water fluoridation and congenital malformations: no association -The incidence of selected congenital malformations in areas with fluoride supplementation of public water supplies was compared with the incidence in areas where the water supply is deficient in fluoride. Comparison of the incidences of several common birth defects (including Down's syndrome) in fluoridated and nonfluoridated
areas revealed no substantial or significant differences in which there was a
consistent pattern for both sets of data. (Erickson JD - J Am Dent Assoc. 1976
Nov;93(5):981-4)
http://www.ncbi.nlm.nih.gov/pubmed/13007869
Free Article
Urinary fluoride levels associated with use of fluoridated waters: Surveys in two areas contribute additional evidence that no hazard of cumulative toxic fluorosis is associated with the use of fluoridated water containing 100m fluoride. Within 1 week, the concentration of fluoride in the urine equaled that in the drinking water for adults. For children, the period of adjustment was considerably longer {3-5 years}.. (Zipkin, RC - Public Health Rep. 1956 August; 71(8): 767–772)
http://www.ncbi.nlm.nih.gov/pubmed/13007869
Free Article
Toxicological Evidence for the Safety of the Fluoridation of Public Water Supplies: The extravagance of the variously motivated statements frequently heard in opposition to fluoridation wherever it is under consideration may lead officials who must explain this prophylactic measure to the public to discount the fact that many citizens still remain unconvinced of the safety of this procedure, despite the assurances of medical, dental, and public health authorities.
CONCLUSIONS: The results of animal experimentation show that the prolonged intake of quantities of fluoride too small to induce dental fluorosis does not give rise to any of the nondental manifestations of chronic intoxication by fluorides. Epidemiologic data and clinical and radiographic examinations of exposed industrial workers indicate that only when the fluoride content of a water supply exceeds 5 or 6 ppm will its prolonged usage give rise to detectable osseous changes and then only in the most susceptible persons. The evidence as a whole is consistent in offering assurance that bringing the fluoride concentration in communal water supplies to that known to be optimal for dental health is a prophylactic public health procedure which has an ample margin of safety.
(Francis F. Heyroth, M.D. -
Am J Public Health Nations Health.
1952 December;
42(12):
1568–1575)
Free Article
Studies on Mass Control of Dental Caries Through Fluoridation of the Public Water Supply:
Summary -
Fluoridation of the Grand Rapids public water supply began in
January 1945. Analysis of the 1949 dental examinations at Grand
Rapids shows a reduced amount of dental caries experience when
compared with the pre-fluoridation rates of 1944-45. The findings
indicate that the reduction is most pronounced in the younger age
groups whose dentition was largely calcified following the addition
of one part per million of fluoride (F) to the previously fluoride-free
public water supply. Sufficient time has not elapsed to evaluate
water fluoridation in the older age groups.
(Dean HE, et. al. - Public Health Rep. 1950 October 27; 65(43): 1383–1418) [This
article starts about 1/2 way through the document - RJ]
Free Article
The Newburgh-Kingston Caries Fluorine Study (Dental Findings after Three Years of Water Fluoridation):
SUMMARY
1) The DMF rate for permanent teeth shows
a consistent downward trend in Newburgh
from 21.0 to 14.8 per 100 permanent teeth.
This indicates a saving of 6.5 permanent teeth
per 100 in Newburgh as compared with a rate
of 21.3 per 100 in Kingston at the last examination.
This represents a saving of 30
per cent.
2) Among first molars, which account for
the major part of the caries problem in
children, after three years of fluoride experience,
Newburgh's rate was 48.0 DMF per
100 first molars, while Kingston's was 58.7, or
a difference of 10.7 DMF per 100 first molars.
This represents a saving of 18 per cent in DMF
first molars.
3) The greatest benefits are noted in the
younger age groups.
4) The differences between Newburgh and
Kingston as represented in these data suggest
the possibility of benefits from exposure to
fluoridated water subsequent to enamel calcification
and subsequent to eruption of the first
molars.
5) We cannot entirely rule out the possibility
of variation in the interpretations of the
examiners. The fact that more than one
examiner was used might alter the differences
between Newburgh and Kingston to some extent.
However, the size of the differences
in the DMF rates of the two cities is
such that it is unlikely that an examiner bias
could vitiate them.
6) These data are preliminary and it will be
necessary to continue collecting data for the
proposed duration of the study, that is,
through 1954 to 1956, to obtain additional information concerning the caries
prophylactic value of fluorine.
(David B, et. al. - Am J Public Health Nations Health. 1950 June; 40(6): 716–724)
Studies of three other common water contaminants on health:
Caffeine, Alcohol, and Sugar
Compared to the potential health risks of caffeine, alcohol and sugar, fluoride hardly
registers. These are just a few of the papers that you can find during a brieformation concerning the caries prophyladdfdfdrmation concerning, the caries prophylactic
value of fluorine.ormation concerning, the caries prophylactic
value of fluorine.
search of PubMed.
This is not an attempt to start a crusade against these contaminants, rather
it's an effort to show how nearly any scientific topic can generate research
papers that support nearly any conclusion possible. Reliable conclusions
about complex issues can not be drawn from a quick overview of the research or
by studying a list of papers that has been collected to support a specific
viewpoint.
In the rather haphazard listing below you can build lists in support of great
harm from the contaminants or a list that shows no harm to health. One
would need to carefully study the design, methods, results and analyses of each
paper and have expert knowledge of the topic to determine which studies were
well conducted with valid conclusions and which were not. Without the
understanding to personally evaluate all of the evidence for a topic one must
rely on the believability and trustworthiness of the expert scientific community
to make a decision on what to believe.
In the case of fluoridation, the mainstream dental, scientific, and medical
communities are in support of the safety and effectiveness of drinking water
fluoridation.
Coffee and Caffeine
Maternal Consumption of Coffee and Caffeine-containing Beverages and
Oral Clefts: (2009) A Population-based Case-Control Study in Norway:
Compared with that for no coffee consumption, the adjusted odds ratios for cleft
lip with or without cleft palate were 1.39 (95% confidence interval: 1.01, 1.92)
for less than 3 cups a day and 1.59 (95% confidence interval: 1.05, 2.39) for 3
cups or more.
High
dietary caffeine consumption is associated with a modest increase in headache
prevalence: (2009) In the multivariate analyses, adjusting for age,
gender, smoking, and level of education as confounding factors, a weak but
significant association (OR = 1.16, 95% CI 1.09-1.23) was found between high
caffeine consumption and prevalence of infrequent headache.
Caffeine
Induces Cell Death via Activation of Apoptotic Signal and Inactivation of
Survival Signal in Human Osteoblasts: (2008) Caffeine consumption is a
risk factor for osteoporosis... Here, we show that cell viability decreases in
osteoblasts treated with caffeine in a dose-dependent manner.
The face of chronic migraine: epidemiology, demographics, and treatment
strategies: (2009) Aside from analgesic overuse, other modifiable risk
factors associated with the development of chronic migraine and CDH must be
addressed including obesity and caffeine use...
Coffee and cardiovascular disease risk: yin and yang: (2008)
Many epidemiological studies have addressed the effects of coffee on
cardiovascular disease. Most case-control studies suggest an increased risk in
high coffee consumers, whereas cohort studies indicate no clear association with
cardiovascular risk... Moreover, coffee contains several biologically active
substances that may have either beneficial or harmful effects on the
cardiovascular system. The development of complete/partial tolerance to some
caffeine effects in habitual drinkers adds to the complexity of coffee effects.
Variation in cup size and methods of coffee preparation may also explain some
conflicting results.
Habitual coffee consumption and blood pressure: An epidemiological
perspective: (2008) This paper summarizes the current epidemiological
evidence on coffee consumption in relation to blood pressure (BP) and risk of
hypertension.
Free Article
Coffee and
caffeine intake and the risk of ovarian cancer: the Iowa Women's Health Study:
(2008) Our results suggest that a component of coffee other than caffeine,
or in combination with caffeine, may be associated with increased risk of
ovarian cancer in postmenopausal women who drink five or more cups of coffee a
day.
Free Article
Potential teratogenic and neurodevelopmental consequences of coffee and
caffeine exposure: a review on human and animal data: (1994) The
teratogenic effect of caffeine has been clearly demonstrated in rodents. The
sensitivity of different animals species is variable. In humans, caffeine does
not present any teratogenic risk. The increased risk of the most common
congenital malformations entailed by moderate consumption of caffeine is very
slight. However, caffeine potentiates the teratogenic effect of other
substances, such as tobacco, alcohol, and acts synergistically with ergotamine
and propranolol to induce materno-fetal vasoconstrictions leading to
malformations induced by ischemia. Therefore, even though caffeine does not seem
to be harmful to the human fetus when intake is moderate and spread out over the
day, some associations, especially with alcohol, tobacco, and vasoconstrictive
or anti-migraine medications should be avoided. Maternal consumption of caffeine
affects brain composition, especially in case of a low-protein diet and also
seems to interfere with zinc fixation in brain. Maternal exposure to caffeine
induces also long-term consequences on sleep, locomotion, learning abilities,
emotivity, and anxiety in rat offspring, whereas in humans, more studies are
needed to ascertain long-term behavioral effects of caffeine ingestion by
pregnant mothers.
Alcohol
First-trimester
maternal alcohol consumption and the risk of infant oral clefts in Norway:
(2008) Compared with nondrinkers, women who reported binge-level drinking
(>or=5 drinks per sitting) were more likely to have an infant with cleft lip
with or without cleft palate (odds ratio = 2.2, 95% confidence interval: 1.1,
4.2) and cleft palate only (odds ratio = 2.6, 95% confidence interval: 1.2,
5.6).
Maternal periconceptional alcohol consumption and risk for orofacial
clefts: (1999) However, for women who reported weekly or more
frequent episodes of consuming >/=5 drinks per drinking occasion compared with
those who did not, we observed increased risks for isolated (no other major
congenital anomaly) cleft lip with or without cleft palate, odds ratio = 3.4
(95% confidence interval, 1.1 to 9.7); multiple cleft lip with or without cleft
palate, odds ratio = 4.6 (1. 2 to 18.8); and "known syndrome" clefts, odds ratio
= 6.9 (1.9 to 28. 6).
Carcinogenicity of acetaldehyde in alcoholic beverages: (2009) In
addition to being produced in ethanol metabolism, acetaldehyde occurs naturally
in alcoholic beverages. Limited epidemiological evidence points to acetaldehyde
as an independent risk factor for cancer during alcohol consumption, in addition
to the effects of ethanol.
Chronic
effects of low to moderate alcohol consumption on structural and functional
properties of the brain: (2009) beneficial or not? The changes reported
in brain shrinkage, grey matter and white matter volume, as a result of low to
moderate alcohol consumption sooner offer support for the contention that such
drinking decreases brain health than for its beneficial effect.
The
role of alcohol in oral carcinogenesis with particular reference to
alcohol-containing mouthwashes: (2008) On the basis of this review, we
believe that there is now sufficient evidence to accept the proposition that
alcohol-containing mouthwashes contribute to the increased risk of development
of oral cancer and further feel that it is inadvisable for oral healthcare
professionals to recommend the long-term use of alcohol-containing mouthwashes.
sugar pancreatic cancer 3,745 results (775 free articles) February 2010 (add the search term risk – 147 results - 35 free papers)
Crit Rev Food Sci Nutr. 2010 Jan;50(1):1-19.
Is sugar consumption detrimental to health? A review of the evidence 1995-2006.
Ruxton CH, et al.
Many countries set quantitative targets for added sugars, justifying this by expressing concern about the likely impact of sugar on weight control, dental health, diet quality, or metabolic syndrome. This review considers whether current intakes of sugar are harmful to health, and analyses recent literature using a systematic approach to collate, rank, and evaluate published studies from 1995-2006. Results from high quality obesity studies did not suggest a positive association between body mass index and sugar intake. Some studies, specifically on sweetened beverages, highlighted a potential concern in relation to obesity risk, although these were limited by important methodological issues. Diet adequacy appeared to be achieved across sugar intakes of 6 to 20% energy, depending on subject age. Studies on metabolic syndrome reported no adverse effects of sugar in the long-term, even at intakes of 40-50% energy. The evidence for colorectal cancer suggested an association with sugar, but this appeared to have been confounded by energy intake and glycemic load. There was no credible evidence linking sugar with attention-deficit, dementia, or depression. Regarding dental caries, combinations of sugar amount/frequency, fluoride exposure, and food adhesiveness were more reliable predictors of caries risk than the amount of sugar alone. Overall, the available evidence did not support a single quantitative sugar guideline covering all health issues.
Cancer Epidemiol Biomarkers Prev. 2010 Feb;19(2):447-55.
Soft drink and juice consumption and risk of pancreatic cancer: the Singapore Chinese Health Study.
Mueller NT, et al.
CONCLUSION: Regular consumption of soft drinks may play an independent role in the development of pancreatic cancer.
Cancer Causes Control. 2009 Nov 29.
Dietary habits and risk of pancreatic cancer: an Italian case-control study.
Polesel J, et al.
CONCLUSIONS: The present study supports an inverse association between fruits and vegetables and pancreatic cancer risk, and it confirms a direct relation with meat. The increased risk for table sugar suggests that insulin resistance may play a role in pancreatic carcinogenesis.
Cancer Epidemiol Biomarkers Prev. 2009 Apr;18(4):1144-51.
Glycemic index, carbohydrates, glycemic load, and the risk of pancreatic cancer in a prospective cohort study.
Jiao L, et al.
Participants with high free fructose and glucose intake were at a greater risk of developing pancreatic cancer. Our results do not support an association between glycemic index, total or available carbohydrate intake, and glycemic load and pancreatic cancer risk. The higher risk associated with high free fructose intake needs further confirmation and elucidation.
Cancer Causes Control. 2009 Aug;20(6):835-46.
Free Article:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2694313/?tool=pubmed
Sweets, sweetened beverages, and risk of pancreatic cancer in a large population-based case-control study. Chan JM,
et al. CONCLUSION: These results provide limited support for the hypothesis that sweets or sugars increase pancreatic cancer risk.
Am J Clin Nutr. 2008 Aug;88(2):431-40.
Added sugar and sugar-sweetened foods and beverages and the risk of pancreatic cancer in the National Institutes of Health-AARP Diet and Health Study. Bao Y, Stolzenberg-Solomon R, Jiao L, Silverman DT,
et al. CONCLUSION: Our results do not support the hypothesis that consumption of added sugar or of sugar-sweetened foods and beverages is associated with overall risk of pancreatic cancer.
Am J Clin Nutr. 2009 Feb;89(2):568-76.
Free Article: http://www.ajcn.org/cgi/content/full/89/2/568
Glycemic index, glycemic load, and risk of digestive tract neoplasms: a systematic review and meta-analysis.
Mulholland HG, et al.
BACKGROUND: Habitual consumption of diets with a high glycemic index (GI) and a high glycemic load (GL) may influence cancer risk via hyperinsulinemia and the insulin-like growth factor axis. CONCLUSIONS: The findings from our meta-analyses indicate that GI and GL intakes are not associated with risk of colorectal or pancreatic cancers. There were insufficient data available regarding other digestive tract cancers to make any conclusions about GI or GL intake and risk.
Am J Clin Nutr. 2008 Jun;87(6):1793-801.
Free Article: http://www.ajcn.org/cgi/content/full/87/6/1793
Glycemic index, glycemic load, and cancer risk: a meta-analysis.
Gnagnarella P, et al.
CONCLUSION: This comprehensive meta-analysis of Glycemic Index and Glycemic Load and cancer risk suggested an overall direct association with colorectal and endometrial cancer.
Am J Clin Nutr. 2008 Mar;87(3):627-37.
Glycemic index, glycemic load, and chronic disease risk--a meta-analysis of observational studies.
Barclay AW, et al.
CONCLUSIONS: Low-GI and/or low-GL diets are independently associated with a reduced risk of certain chronic diseases (type 2 diabetes, coronary heart disease. In diabetes and heart disease, gallbladder disease & breast cancer), the protection is comparable with that seen for whole grain and high fiber intakes. The findings support the hypothesis that higher postprandial glycemia is a universal mechanism for disease progression.
Clin Gastroenterol Hepatol. 2008 Mar;6(3):275-82.
Pancreatic cancer: a review of the evidence on causation. Hart AR, et
al.
Pancreatic cancer kills more than 250,000 people each year worldwide and has a poor prognosis. The aim of this article is to critically review the epidemiologic evidence for exposures that may either increase or decrease the risk. A Medline search was performed for epidemiologic studies and reviews published up to April 2007. Consistent evidence of a positive association was found for family history and cigarette smoking. Many studies documented a positive association with diabetes mellitus and chronic pancreatitis, although the etiologic mechanisms are unclear. Other associations were detected, but the results were either inconsistent or from few studies. These included positive associations with red meat, sugar, fat, body mass index, gallstones, and Helicobacter pylori, and protective effects of increasing parity, dietary folate, aspirin, and statins. There was no evidence linking alcohol or coffee consumption with an increased risk of pancreatic cancer. The associations with many exposures need to be clarified from further epidemiologic work in which there is both precise measurement of risk factors, adjustment for potential confounders, and, for dietary studies, information recorded on the method of food preparation and pattern of consumption. Such work is important to reduce the incidence of this fatal disease.
Am J Clin Nutr. 2008 Apr;87(4):970-7.
Free Article: http://www.ajcn.org/cgi/content/full/87/4/970
Glycemic load, glycemic index, and pancreatic cancer risk in the Netherlands Cohort Study.
Heinen MM, et al.
CONCLUSIONS: Overall, our findings do not support the hypothesis that GL, GI, or intake of carbohydrates and mono- and disaccharides are positively associated with pancreatic cancer risk. This is in agreement with previous prospective studies that investigated the relation between GL and GI and pancreatic cancer risk.
Am J Clin Nutr. 2008 Aug;88(2):431-40.
Free Article: http://www.ajcn.org/cgi/content/full/88/2/431
Added sugar and sugar-sweetened foods and beverages and the risk of pancreatic cancer in the National Institutes of Health-AARP Diet and Health Study.
Bao Y, et al.
BACKGROUND: Although it has been hypothesized that hyperglycemia, hyperinsulinemia, and insulin resistance are involved in the development of pancreatic cancer, results from epidemiologic studies of added sugar intake are inconclusive. CONCLUSION: Our results do not support the hypothesis that consumption of added sugar or of sugar-sweetened foods and beverages is associated with overall risk of pancreatic cancer.
Am J Clin Nutr. 2007 Nov;86(5):1495-501.
Free Article: http://www.ajcn.org/cgi/content/full/86/5/1495
Dietary glycemic load, added sugars, and carbohydrates as risk factors for pancreatic cancer: the Multiethnic Cohort Study.
Nöthlings U, et al.
Discussion: In the Multiethnic Cohort Study, high sugar intake—specifically, fructose intake—was associated with a greater risk of pancreatic cancer. This association was not reflected in the consumption of sodas, but we did observe a greater risk with a higher intake of fruit and juices. Statistical evidence for an interaction of sucrose intake with BMI was present, and it showed a higher risk of pancreatic cancer in overweight or obese study participants with higher sucrose consumption.
To date, 4 prospective studies have investigated dietary GL and various carbohydrates in relation to pancreatic cancer risk. Two of these studies found no association for GL, GI, total carbohydrates, total sugar, sucrose, or fructose, and one study found a greater risk with higher dietary GL, GI, and fructose intake in sedentary women with a BMI 25, but not in the overall cohort. In the present study, fructose intake was associated with the highest risk of pancreatic cancer. A subsequent analysis of high consumption of soft drinks in this same study population showed significantly greater risks in women but not in men. The present study also found a positive association between fructose intake and pancreatic cancer risk, but we did not see a greater risk with higher intake of sodas; these results did not differ significantly between men and women.
...The finding of a greater risk with higher fruit and juices intake was surprising, and it merits some discussion. Fruit, most often in combination with vegetables, generally is thought to have beneficial effects in terms of cancer prevention at various sites, including the pancreas. To date, 7 prospective studies have reported on fruit intake and pancreatic cancer risk, and none detected a significant association, either positive or inverse. A recent study from Sweden included 135 pancreatic cancer cases in a cohort of 81 922 men and women . When the highest and lowest quartiles were compared, overall fruit intake was not significantly associated with pancreatic cancer risk, nor was citrus fruit intake.
CONCLUSIONS: High fructose and sucrose intakes may play a role in pancreatic cancer etiology. Conditions such as overweight or obesity in which a degree of insulin resistance may be present may also be important.
Cancer Causes Control. 2007 Apr;18(3):287-94.
Glycemic load, glycemic index, and carbohydrate intake in relation to
pancreatic cancer risk in a large US cohort. Patel AV, et. al.
CONCLUSION: Overall, our data do not support the hypothesis that glycemic load or index, or carbohydrate intake are associated with a substantial increase in pancreatic cancer risk; however, a weak positive association cannot be ruled out.
Am J Clin Nutr. 2006 Nov;84(5):1171-6.
Free Article http://www.ajcn.org/cgi/content/full/84/5/1171
Consumption of sugar and sugar-sweetened foods and the risk of pancreatic cancer in a prospective study.
Larsson SC, et. al.
CONCLUSION: High consumption of sugar and high-sugar foods may be associated with a greater risk of pancreatic cancer.
Cancer Epidemiol Biomarkers Prev. 2005 Sep;14(9):2098-105.
Free Article:
http://cebp.aacrjournals.org/content/14/9/2098.long
Sugar-sweetened soft drink consumption and risk of pancreatic cancer in two prospective cohorts.
Schernhammer ES, et al.
CONCLUSION: Although soft drink consumption did not influence pancreatic cancer risk among men, consumption of sugar-sweetened soft drinks may be associated with a modest but significant increase in risk among women who have an underlying degree of insulin resistance.
Cancer Causes Control. 2005 May;16(4):431-6.
Glycemic index, glycemic load, and pancreatic cancer risk (Canada). Silvera SA,
et. al.
Our data suggest that overall lycemic index and glycemic load, as well as total sugar and total carbohydrate intake, are not associated with pancreatic cancer risk. However, given the limited literature regarding the role of diet in the etiology of pancreatic cancer, particularly with respect to glycemic index/load, further investigation is warranted.
Minerva Chir. 2004 Apr;59(2):99-111.
Epidemiology of pancreatic cancer.
Michaud DS.
A known cause of pancreatic cancer is tobacco smoking. This risk factor is likely to explain some of the international variations and gender differences. A number of studies observed a reduction in pancreatic cancer risk within a decade after smoking cessation, when compared to current smokers. With tobacco smoking as an exception, risk factors for pancreatic cancer are not well-established. ...Chronic pancreatitis and diabetes mellitus are medical conditions that have been consistently related to pancreatic cancer. Data from numerous studies suggest that these conditions are likely to be causally related to pancreatic cancer, rather than being consequences of the cancer. Recent cohort studies, which are less prone to biases than case-control studies, suggest that obesity increases the risk of pancreatic cancer. Other studies support the hypothesis that glucose intolerance and hyperinsulinemia are important in the development of pancreatic cancer. Other potential risk factors include physical inactivity, aspirin use, occupational exposure to certain pesticides, and dietary factors such as carbohydrate or sugar intake.
JJ Natl Cancer Inst. 2002 Sep 4;94(17):1293-300.
Free Article:
http://jnci.oxfordjournals.org/cgi/content/full/94/17/1293
Dietary sugar, glycemic load, and pancreatic cancer risk in a prospective study.
Michaud DS, et al.
CONCLUSION: Our data support other findings that impaired glucose metabolism may play a role in pancreatic cancer etiology. A diet high in glycemic load may increase the risk of pancreatic cancer in women who already have an underlying degree of insulin resistance
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