Fluoridation opponents (FOs) frequently chime in with their completely spurious arguments that fluoride is a medicine or drug that can’t be ethically be added to drinking water.  Why are FOs only concerned about personal choice only when it comes to fluoridation?  Their arguments apply equally well to the well-established practice of chlorination or other disinfectant processes.  If their arguments against fluoridation are legitimate, then for exactly the same reasons described below, chlorination should be halted and everyone should be given the personal choice to chlorinate (or otherwise disinfect) their own water. 

 

The attempt to classify the fluoride ion as a medicine or drug is a ‘smoke and mirror’ strategy to create an artificial distinction in the public’s mind between the water treatment chemicals chlorine and fluorine, and such an arbitrary classification is meaningless.

 

Fortunately, the fear-evoking claims against fluoridation are not legitimate and they are not supported by the overwhelming majority of scientific evidence (like the study described in the story) or endorsed by the medical, dental or scientific communities.

 

Facts: 

1)    Chlorination vs. fluoridation

a.    There is no water treatment process that will have no risks to anyone, anywhere under any circumstances.  Just delivering treated water through miles of pipes introduces risks.  The purpose of water treatment and distribution is to use processes that are demonstrated to provide the most benefits to the most people while minimizing risks to anyone. 

b.    The only way all risks of community water treatment could be eliminated would be to stop it entirely and make everyone responsible for their own water purification – which, of course, would introduce another set of risks to the community. 

c.    FOs are too focused on their passionate mission of demonizing the fluoride ion to realize that all their arguments against fluoridation are equally valid against chlorination and other disinfection processes.

d.    The same arguments below that show the similarity of chlorination for fluoridation can be used for other disinfection treatments.

2)    Toxicity of water treatment additive

a.    Chlorination involves the addition of chlorine gas or the hypochlorite ion to water – both additives are toxic at sufficiently high levels.

b.    Fluoridation involved the addition of the fluoride ion, typically as fluorosilicic acid. sodium fluorosilicate or sodium fluoride.  All compounds used quickly dissociate into free fluoride ions.  All additives are toxic at sufficiently high levels.

3)    Benefits

a.    Chlorine is added to drinking water to provide proven health benefits to the majority of community members.  The action is to kill pathogens that can cause diseases in a community.

b.    Fluoride ions are added to drinking water to provide proven health benefits to the majority of community members.  The action is to strengthen the tooth enamel and remineralize decayed areas reducing dental decay and associated health issues in a community.

4)    Choice

a.    Chlorination of community drinking water is not a personal choice – if regulators decide disinfection is needed, the entire community that drinks the water is affected unless individuals choose to treat their own water or find other sources.

b.    When officials examine the evidence and decide fluoridation of community drinking water is beneficial, it is not a personal choice – the entire community will drink fluoridated water unless they choose to treat their own water or find other sources.

5)    Naturally found in water

a.    Chlorination and other disinfection processes involve the addition of chemicals (chlorine gas, sodium or calcium hypochlorite, chlorine dioxide, chloramine, etc.) to treat water that are not normally present in source water.

b.    Fluoridation adds a small amount of the fluoride ion, a naturally occurring element in source water, to treat water.

6)    Disinfection Byproducts

a.    Chlorination and other disinfection processes usually create a ‘witches brew’ of toxic disinfection byproducts – to use terminology of FOs.  Regulations ensure that levels of disinfection byproducts are below harmful (to most people) levels.
https://en.wikipedia.org/wiki/Water_chlorination

b.    Fluoridation does not create additional contaminants in the treated water, although trace amounts of other contaminants may be present in fluoride additives.  Regulations ensure that any other contaminants are far below allowable or harmful (to most people) levels.

7)    The NFPA health hazard of 4 also applies to chlorine – the description reads, “Very short exposure could cause death or serious residual injury even though prompt medical attention was given.”   http://www.praxair.com/~/media/North%20America/US/Documents/SDS/Chlorine%20Cl%202Safety%20Data%20Sheet%20SDS%20P4580.pdf

8)    Risks

a.    Disinfection byproducts (at levels below maximum contaminant levels permitted in drinking water) may potentially cause health problems for a very small percentage of community members, but the benefits to the community of disinfection far outweigh the known risks.

b.    Fluoridation at optimal levels may potentially cause health problems for a very small percentage of community members, but the benefits to the community far outweigh the known risks.  After more than 70 years of research the only established risk of continual exposure to more than five times the optimal levels of fluoride (~2 ppm) is mild dental fluorosis in some individuals.

9)    Medicine

a.    The attempt to classify the fluoride ion as a medicine is a ‘smoke and mirror’ strategy to create an artificial distinction in the public’s mind between the water treatment chemicals chlorine and fluorine, and such an arbitrary classification is meaningless.  Attempts by FOs to have the fluoride ion legally classified as a medicine have failed, so they make up their own definitions.

b.    Chlorination does not involve adding a medicine/drug to the drinking water.  Regardless of whether or not chlorine is classified as a medicine, a water treatment chemical,  or a chemical weapon used during WW1, chlorine and the byproducts produced by chlorination, are ingested into the body and absorbed.  Since benefits are shown by scientific evidence to be significantly greater than risks, an arbitrary classification does not matter.  Chlorine and some of the disinfection byproducts are also released into the air when using chlorinated water, and they are inhaled and absorbed into the body.

c.    Fluoridation does not involve adding a medicine/drug to the drinking water.  Regardless of whether or not the fluoride ion is classified as a medicine, a water treatment chemical, or a rat poison, fluoride ions are ingested into the body and absorbed.  Since benefits are shown by scientific evidence to be significantly greater than risks, an arbitrary classification does not matter.  The fluoride ion is not released into the air from fluoridated water. 

10)  Options

a.    If a water customer does not like to ingest any chlorine or disinfection byproducts they are free to use a filter or distillation to remove the contaminants or choose another source.  They are not free to insist on removing the benefits to other members of the community.

b.    If a water customer does not like to ingest any of the fluoride ions they are free to use a filter or distillation to remove the contaminant or choose another source.  They are not free to insist on removing the benefits to other members of the community.

11)   Dose

a.    FOs make it a point to emphasize that, because people drink different amounts of water, people can be exposed to different amounts of fluoride.  Obviously, the same argument means that those who drink more water are exposed to more disinfectants and their byproducts and other contaminants that might be in their water.  FOs don’t seem to understand that when setting the Maximum Contaminant Levels (MCL) for disinfectants, disinfection byproducts, the fluoride ion and other contaminants, they took into account the fact that people drink different amounts of water. From the EPA site, the MCL is defined as, “The highest level of a contaminant that EPA allows in drinking water. MCLs ensure that drinking water does not pose either a short-term or long-term health risk. EPA sets MCLs at levels that are economically and technologically feasible.”  For individuals to exceed established safe levels of fluoride, disinfection byproducts, or other contaminants that are harmful at high levels, they would need to continually drink so much water they would be more at risk of water intoxication than of experiencing significant risk of harm from contaminants.  If people are not comfortable with the EPA standards or if they drink significantly more water than normal, they are free to make other choices.

b.    The Maximum Residual Disinfectant Level (MRDL) for chlorine and chloramine = 4.0 mg/l.  The MCLs for the disinfection byproducts, bromate = 0.01 mg/l, chlorite = 1.0 mg/l, HAAS = 0.06 mg/l, TTHMs = 0.08 mg/l

c.     The MCL for the fluoride ion is 4.0 mg/l – over five times the optimal level.

d.    http://water.epa.gov/drink/contaminants/

12)   Necessity of treatment

a.    There are situations when disinfection of the source water is not needed - if pathogens are not found in the source water.

b.  There are situations when fluoridation is not necessary - if average natural fluoride levels at or above 0.7 ppm.  There are also situations when levels of naturally occurring fluoride ions are reduced in the treated water - When F+ levels are above 4.0 ppm (the EPA MCL) or if a water treatment company decides to reduce natural levels that are below the MCL but higher than levels that may begin to cause noticeable fluorosis ~2.0ppm.