Submission to Hamilton City Council (HCC) regarding Water Fluoridation.

Transcription

1 Submission to Hamilton City Council (HCC) regarding Water Fluoridation. Greg Oosterbaan, 6 Howell Avenue, Hamilton. Ph gregdo@xtra.co.nz 31 st March

2 Contents Personal presentation Appendix 13 What are they fluoridating with? From FANNZ website 16 NZ - Fluoridation status by council From FANNZ website 21 HYDROFLUOROSILICIC ACID AND WATER FLUORIDATION (The Process of Production) 24 Material Safety Data Sheet - SODIUM FLUORIDE 29 Studies on Tooth Decay Rates After Water Fluoridation Is Stopped Fluoride Action Network February Supplementary submission to the Inquiry into how to prevent child abuse and improve children's health outcomes Katherine Smith 38 FLUOROSIS 40 Dental Fluorosis Incidence in New Zealand 2

3 44 Fluoride Is Not an Essential Nutrient Fluoride Action Network August 2012 By Michael Connett 46 Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries F.A.N. July 2012 By Michael Connett 51 World Health Organisation Figures statistics on dental health of 12 year olds. 53 The Hastings Fluoridation Experiment 55 The Hastings Fluoridation Experiment: Science or Swindle? By John Colquhoun and Robert Mann ( 69 Why I Changed My Mind About Water Fluoridation John Colquhoun 83 Fluoride & Intelligence: The 36 Studies Fluoride Action Network By Michael Connett& Tara Blank, PhD UPDATED December 9, (New Zealand) Institute of Directors. (IoD) NZ/PB/Legislation/Bills/b/c/8/00DBHOH_BILL11034_1-Natural-Healthand-Supplementary-Products-Bill.htm Nuclear and radiation accidents From Wikipedia. 3

4 Water Fluoridation My Submission Against the Practice. Many of the references against water fluoridation are to be found on FANNZ and FAN websites and are likely to be repeated through these submissions, including this presentation. This does not detract from the importance and authenticity of these references. I have tried to be as accurate and comprehensive as possible but must respect the need to be as concise as possible, in respect of the mammoth amount of study which you must do related to this subject. These first few pages are my discussion around the many references which I have included and are an expression of my own, personal opinion as a concerned parent and resident of Hamilton city. It is recognized that you strive to do your best in your elected role as a Hamilton City Council (HCC) councilor. One of my basic human rights is the right to life. Without water (H2O), Life is impossible - water is a vital nutrient. I have a basic human right to water (H2O) and whatever minerals are present at their normal level, for that natural environment. I pay local authority rates and this local authority is charged with providing me, and all other residents of HCC catchment, with water. If there is a substance added, which I wish to avoid, Hamilton City Council (HCC) has a responsibility to provide me with a suitable filtration system, to remove any supplements which I (and my family members) wish to avoid or to not add the supplement in the first place. I have a basic human right to freedom of choice. I choose to not consume fluoridated water (beyond the naturally-occurring levels), whether pharmaceutical or industrial grade. Fluoride is not even a necessary nutrient - water is. So as to not violate my basic human rights, HCC has a legal, moral and ethical duty to provide me (and all other residents who freely choose to not consume added fluoride) with water which does not have supplemented fluoride. Presently, my human rights are being violated regarding water fluoridation. I ask that this practice is terminated. 4

5 The New Zealand Institute of Directors (IoD) is a well-respected organisation. The Institute s 2012 publication, The Four Pillars of Governance Best Practice for New Zealand Governors, is a guide for it s members. In the publication (page 87-) the issue of ethics is discussed. This concerns the different values which people hold and the need to respect other people s values, wishes, opinions and freedom of choice. It is crucial that the decision regarding water fluoridation is based on ethical values and respect for freedom of choice an internationally respected basic human right which must be upheld in a democratic society. Waikato region. In our Waikato District, the local authorities of Hauraki, Matamata-Piako, Otorohanga, Waitomo and Waipa do not fluoridate their public water supply. I am not aware of any sound scientific evidence showing significantly higher levels of dental caries in these un-fluoridated localities, relative to Hamilton which has been fluoridated. There are a number of data comparisons but these, I believe, are not standardized and are very subjective and would therefore be scientifically invalid. Any research data or data analysis must be validated to a standard where any report is acceptable for publication in an appropriate international scientific journal. There are no bus-loads of dentists commuting to these outlying towns from Hamilton. There are no unemployed dentists in Hamilton. There are dental caries amongst the young residents of Hamilton. Honest consideration of the above will result in the conclusion that adding fluoride to Hamilton s water supply does not endow magical powers of dental health on the consumers. Indeed there is ample, valid scientific evidence of the opposite. A growing list of Local Authorities worldwide (including New Zealand) are reversing the practice based on similar information as you receive from health authorities and also those who present a sound, scientifically-supported argument in opposition. Also, please note that authority is in the legislative sense and does not necessarily guarantee authenticity. 5

6 Privy Council (1963) the addition of fluoride adds no impurity and the water remains not only water but pure water and becomes greatly improved and still natural water containing no foreign elements This decision is fifty years old and obviously must be revisited, based on comprehensive research in the interim. Hydrofluorosilicic acid (H 2 SiF 6 ) is the form of fluoride delivered in the Hamilton water supply. This is an inorganic compound and a bi-product of the fertiliser industry and is, I believe, a foreign element. 6

7 From Waikato DHB website public access. Who has water fluoridation currently? Over 300 million people in 39 countries have access to fluoridated drinking water. These include Australia, Canada, Ireland, Israel, Singapore, Spain, the United Kingdom, and the United States. In contrast with the above quote from the DHB website, the vast majority of the world does not have added fluoride to the water supply. In Europe, approximately 97% is not fluoridated. I am not aware of any country where there is public protest to have fluoride added to the public water supply. The only public protest which I am aware of is people resisting enforced fluoridation. For more robust data of the global situation, see the WHO research results in the appendix. Statement of Waikato DHB position (WDHB) Support further research into the benefits and potential risks of water fluoridation, and into appropriate alternatives to water fluoridation in communities where fluoridation is not feasible. What internationally referenced, scientifically valid (and externally validated) research has Waikato DHB (WDHB) engaged in to study the safety and effectiveness of water fluoridation? For example, a very valid project would be a meta-analysis to scientifically challenge and disprove the research presented on FANNZ website and Dr. Paul Connett s publications. Has such a project been conducted and what are the results? Has WDHB supported the case for water fluoridation with evidence which refutes the case presented against water fluoridation? Have the presenters of the case against water fluoridation supported their case with evidence which refutes the case for water fluoridation? Provision of objective support (not simplistic, un-supported comment) against opposition presentation is a valid approach. 7

8 I contend that Fluoride, in the form of Hydrofluorosilicic acid (H 2 SiF 6 ), is being delivered to the whole population, as a supplement ( natural levels are being topped up [i.e. supplemented] WDHB web site), without individual medical prescription but on the authority of and promotion by medical staff on MoH and DHB payroll. See the NZ Government Natural-Health-and-Supplementary-Products-Bill. Is the practice of water fluoridation as a supplement, as is my contention, addressed in this bill either directly or by implication? The diversity of our population in age, size, weight, metabolic rate, physiological capacity, health status, daily work and recreation tasks, etc dictates that there is a vast spread of water consumption between people and individual dose of added fluoride is also broad and not controllable. There is individualised dose of prescription medicines / supplements to multitudes of people - the individuality is respected and negative consequences are monitored for. This is not so for the health supplement Fluoride. Hydrofluorosilicic acid (H 2 SiF 6 ) is the form of fluoride delivered in the Hamilton water supply. This is an inorganic compound and a bi-product of the fertiliser industry. Does Hydrofluorosilicic acid (H 2 SiF 6 ) break down in water (to become another, organic compound) or remain in it s inorganic form? I am not fully familiar with the chemistry of the solutions involved but the information can be requested from authoritative scientists representing cases for and against water fluoridation. It would be important to clarify the bioavailability and human biosafety of ingested Hydrofluorosilicic acid (H 2 SiF 6 ) I did a web search for Hydrofluorosilicic acid (H 2 SiF 6 ) on NZ Parliament web site (ttp:// but found no results. It is therefore likely that little, if any, study has been conducted into the human bio-safety of this inorganic compound (if ingested regularly over many years) which is added to Hamilton water supply, as a dietary / nutritional supplement. 8

9 Supplementary submission to the (NZ Government) Inquiry into how to prevent child abuse and improve children's health outcomes by Katherine Smith presents excellent support against fluoridation see Appendix In her submission, Kathryn Smith presents strong, referenced evidence that added fluoride increases the risk of ; Down Syndrome, anaemia in pregnancy, premature labour, infant mortality and reduced intelligence in children. My opinion, based on study of objective and scientifically-validated information, that water fluoridation is ineffective and unsafe is well supported and referenced byfannz and Fluoridation Free New Zealand(and other opponents) and I refer you to their research data, rather than add the same references to this document. I simply add my support to the other presentations in opposition to water fluoridation, and to their references. Opposition presentation will also include evidenced information for the challenges to supporters of fluoridation The York Report, the Hastings/Napier and Auckland studies, etc. Please also accept my support of those references. 9

10 We re all different. We re all different so don t treat us all the same. Each resident is a unique individual with different tolerances for substances which we ingest. We all have the capacity for reasonable stresses whether that be work pace, sleep deprivation, dietary fat / sugar, air pollution or ingested toxins. When our exposure to external stresses is prolonged, our bodies begin to express disease. In the health sector, these are what are called preventable conditions. Humans, as well as all other animals, have a capacity for health, given the right environment. Human ill-health originates external to the sufferer. Also, people become ill from excess, not lack except in very, very rare circumstances. We need a reasonable amount of what is positive but, in excess, this has negative impact. Excess physical effort can cause stroke, heart attack or physical injury. Excess sunlight can cause melanoma. Excess fat-soluble supplements can cause liver injury. Excess heavy metals (eg mercury or aluminium) in our food or water can cause liver or nerve injury. Excess Fluoride can cause bone and nerve, injury well referenced. All health-conscious people are doing their best to minimise exposure to these stressors workplace stress, sunburn, pesticide residues on our food, heavy metals in our sea fish, etc. HCC, along with all other local authorities, puts much effort into reducing the amount of toxins in our water supply, and then add Hydrofluorosilicic acid go figure! The annual dollar cost of Hydrofluorosilicic acid is reputed to be $40,000. To this must be added the monitoring probes and pumps plus the maintenance and replacement costs. I believe that these costs are not insignificant. Add to this the labour cost per hour for monitoring, maintaining and replacing the machinery, along 10

11 with the cost per hour of responding to alarms, if there is equipment malfunction and the acid is being added at an excessive rate. Does HCC have an emergency plan if the equipment goes faulty and excessive levels of Hydrofluorosilicic acid are added to our public water supply? Yes, equipment does go faulty and yes, it could happen to us. The odds are low but so were the odds of nuclear accidents at; Sellafield, Cumberland, United Kingdom Three Mile Island, Pennsylvania, United States Lucens reactor, Vaud, Switzerland Chernobyl, Ukrainian SSR Fukui Prefecture, Japan,Etc To date there have been 99 accidents at nuclear power plants with safety standards well in advance of HCC fluoride monitoring equipment, etc. I am offering an extreme example but the same principles apply even well-maintained equipment fails and there is harm to humans, animals, birds and fish and the extended environment. We don t want plant failure in Hamilton, related to fluoridation, but the risk exists. Is there an accompanying plan? Humans err this is a fact of life. If we must err, let it be on the side of caution. This is particularly true if the potential negative includes human harm. We all know that the major issue with dental caries in children is excess of lollysucking, soft drink swilling, chocolate chewing, pie eating as well as poor dental hygiene. Please don t add a known poison to my water to solve that problem. If this were a legal hearing, Water Fluoridation (the accused) has not been proven beyond reasonable doubt to be effective in reducing dental caries. Equally, Water Fluoridation (the accused) has not been proven beyond reasonable doubt to be safe for all of our residents. You were elected into this position of influence and you strive to do your best in your role as a HCC councillor. These challenging decisions arise not too infrequently. When making these important decisions, we use the brain, heart and gut. The brain will analyse the differing technical information, the heart-felt desire will strive for 11

12 positive influence on Hamilton residents and the gut feeling will let you know if it feels right to add Hydrofluorosilicic acid (H 2 SiF 6 ) to the water supply. My gut feeling is that adding an inorganic compound an acid by-product of the fertiliser industry to our drinking water doesn t feel right. What is your gut feeling? Thank you for your consideration of my submission against continued water fluoridation of Hamilton s drinking water. The views expressed are my own, personal views and opinions as I strive to have the best possible environment for all of us. It s a balance between doing good and avoiding harm. In this instance, I believe, it s best to ensure that we avoid harm. That is what has been decided in many such local authority debates around the country and the rest of the world. Greg Oosterbaan 31 March

13 APPENDIX. What are they fluoridating with? From FANNZ website Help us complete this list by contacting your local council or water treatment facility and finding out: 1. which compound is used to fluoridate your water; 2. the target dose of fluoride; 3. the annual cost of operation (materials, training, equipment maintenance, etc.); 4. the supplier (company and country); 5. chemical composition, including levels of known contaminants. Materials Safety data: Hydrofluorosilicic acid (H 2 SiF 6 ) Sodium fluorosilicate (Na 2 SiF 6 ) Sodium fluoride (NaF) Click on location hyperlinks (where available) for more details. Pukekohe Location Sodium Sodium Hydrofluorosilicic Target F Annual Supplier fluorosilicate fluoride acid (H 2 SiF 6 ) dose cost (Na 2 SiF 6 ) (NaF) (mg/l) Auckland x Orica Balclutha x 0.85 $15,000 Kauri NZ Dunedin x 0.85 $38,154 DC Rosser Ltd, importing Na 2 SiF 6 from Prayon 13

14 (Belgium) Gisborne x 0.80 $14,000 Orica Greater x x 0.85 $182,000 Na 2 SiF 6 from Wellington (varies + Consolidated between $80,000 Chemical ) training Company costs Australia, H 2 SiF 6 from Orica (NZ) Kapiti x $13,213 Orica (importing Na 2 SiF 6 from India) Hamilton x ppm $40,000 Orica Hastings x c per person Orica Hawera, Normanby, Okaiawa, Ohawe x $2,000 Orica Masterton x 0.8 Orica New Plymouth x 0.7 $35,000 Orica Palmerston North 0.8ppm $42,000 Orica Pukekohe x $5,000- $6,000 Orica Taumarunui x $6,500 Orica 14

15 Taupo x x DC Rosser Ltd supplies Na 2 SiF 6, Orica supplies H 2 SiF 6 (from , will be Orica H 2 SiF 6 exclusively) Thames x 0.8 $2,500 Orica Tokorua x (18% in undiluted form) $5,000 Orica Whakatane, Ohope x $10,300 Orica 15

16 NZ - Fluoridation status by council North Island Northland Far North District Council no (Kaitaia, Kaikohe stopped 31st March 09) Kaipara District Council Whangarei District Council Auckland Super City no no yes (except Onehunga) Waikato Hamilton City Council Hauraki District Council Matamata-Piako District Council Otorohanga District Council South Waikato District Council yes no no no yes, but only Tokoroa Thames-Coromandel District Council yes Waikato District Council Waipa District Council Waitomo District Council yes no no Bay of Plenty 16

17 Kawerau District Council Opotiki District Council Rotorua District Council Taupo District Council Tauranga City Council Western Bay of Plenty District Council Whakatane District Council no no no yes no no yes Taranaki New Plymouth District Council no (stopped October 2011) South Taranaki District Council Stratford District Council yes yes Gisborne Gisborne District Council yes Hawke's Bay Central Hawke's Bay District Council no (stopped September 2012) Hastings District Council Napier City Council Wairoa District Council yes no no Wellington Carterton District Council no 17

18 Hutt City Council Kapiti Coast District Council Masterton District Council Porirua City Council South Wairarapa District Council Upper Hutt City Council Wellington City Council yes yes yes yes no yes yes Manawatu-Wanganui Horowhenua District Council Manawatu District Council Palmerston North City Council Rangitikei District Council no yes, but only Feilding yes no Ruapehu District Council no (stopped June 2011) Tararua District Council Wanganui District Council no no South Island Tasman Tasman District Council no Nelson Nelson City Council no 18

19 Marlborough Marlborough District Council no West Coast Buller District Council Grey District Council Westland District Council no no no Canterbury Ashburton District Council Christchurch City Council Hurunui District Council Kaikoura District Council Mackenzie District Council Selwyn District Council Timaru District Council Waimakariri District Council Waimate District Council yes - but only Methven no no no no no no no no Chatham Islands Chatham Islands Council no Otago Central Otago District Council no - but have agreed (2102) to start fluoridating Ranfurly 19

20 Clutha District Council Dunedin City Council Queenstown-Lakes District Council Waitaki District Council yes - Milton, Kaitangata and Tapanui only started in 2011 yes no no Southland Gore District Council Invercargill City Council Southland District Council no yes no Total Total number of councils 67 Total fluoridating 23 (if we count Ashburton District - only small town of Methven) 20

21 HYDROFLUOROSILICIC ACID AND WATER FLUORIDATION Hydrofluorosilicic acid m anufact ure can be view ed as a t w o-st ep process, although in reality it is carried out in four steps to ensure that the right concentration of acid is obtained. Step 1 - Production of SiF4 Th e superphosphate production process results in the evolution of carbon dioxide, steam and SiF4. Th i s Si F4 is an environmental pollutant and so is removed from the gas stream and used to produce fluorosilicic acid. Step 2 - Hydrolysis of SiF4 Th e Si F4 is removed from the gas stream by contacting the gas with water droplets. This water hydrolyses the SiF4 as f o llo w s: 3Si F4 + 2H2O 2H2Si F6 + Si O2 The resultant hydrofluorosilicic acid (H2Si F6) is used for fluoridating drinking water. INTRODUCTION In many cities in the western world, drinking water is fluoridated to help prevent people.s teeth from decaying. Fluorine achieves this by replacing hydroxyapatite (Ca5(PO4)3OH) with fluoroapatite (Ca5(PO4)3F). Fluoroap at it e is m ore resist ant t o acid at t ack and thus teeth which contain even a small proportion of fluoroapatite are less likely to decay. The relevant reactions are as follows: Tooth decay: Ca5(PO4)3OH(s) + 4H3O+ (aq) 5Ca2+ (aq) + 3HPO4 2-(aq) + 5H2O(l) Fluoridation: Ca5(PO4)3OH(s) + F-(aq) Ca5(PO4)3F(s) + OH-(aq) Fluorid at ion of w at er in New Zealand is largely accep t ed (No it is not!), and there are only two major cities that do not adjust the fluoride level of their water supply. Referendum is becoming the norm for determining public opinion on whether to fluoridate or not. Three chemicals are in common use for this purpose, namely sodium fluoride, sodium fluosilicate and hydrofluorosilicic acid (HFA). 21

22 Sodium fluoride Sodium fluoride is a white powder, moderately soluble in water (about 3% w/w). For water I-Ch e m i cals-c-hydrofluorosilicic acid-2 fluoridation p ur p o ses it is usual t o p r ep are a sat urat ed solut ion in w at er and inject this solution into the bulk water. However, sodium fluoride is the most expensive of the three and for this reason is not widely used. Sodium fluorosilicate Sodium fluorosilicate is a white powder sparingly soluble in water (about 0.6% w/w). This low solubility means that it is not feasible to use a saturated solution so dry solid is fed into bulk water at the appropriate rate. However, it can be difficult to control small flows of solid and this aspect of fluoridation equipment must be well designed and carefully monitored. Nevertheless, the fluorosilicate is widely used as it is significantly cheaper than the fluoride salt. Hydrofluorosilicic acid Hydrofluorosilicic acid has several advantages. Being a liquid, it is easy to handle and to meter accurately into the bulk water. Plant operators do not have to manually handle fine powders. The acid is also the cheapest source of fluorine. However, it is corrosive and tends to fume, particularly at concentrations of above 20%. Its main drawback is that it is a comparatively dilute source of fluoride. 15% acid contains just under 12% fluorine by mass, whereas sodium fluoride contains 47% and sodium fluorosilicate 60%. Over long distance transport costs can make so lid chem icals m ore at t ract ive. All manufacturers of superphosphate produce hydrofluorosilicic acid as a b y-product. THE HYDROFLUOROSILICIC ACID MANUFACTURING PROCESS Step 1 - Production of SiF4 Superphosphate is manufactured by mixing together finely ground phosphate rock and sulfuric acid. A vigorous reaction occurs with considerable gas evolution. The gases given off are mainly steam and carbon dioxide, but there is also a small quantity of silicon tetrafluoride released (seeprevious article). Uncontrolled release of this gas to 22

23 atmosphere could cause significant pollution so every fertiliser works has a gas scrub b er as an int egral p art of it s m anuf act ure p lant. Step 2 - Hydrolysis of SiF4 Silicon tetrafluoride reacts readily with water, so it is removed from the other gases by a gas scrubber that is essentially a means of contacting the gas stream with finely divided droplets of water. The reaction with water hydrolyses the silicon tetrafluoride according to the equation: 3Si F4 + 2H2O 2H2Si F6 + Si O2 In this way 99% of the fluoride is removed from the gas stream, leaving only a very small quantity to be emitted. These emissions are covered b y a d ischarge p erm it and less t han 0.1 g s-1 fluoride is discharged to the atmosphere. The liquid from the scrubber is usually a dilute solution of hydrofluorosilicic acid, with a small amount of solid silica suspended in it. This dilute hydrofluorosilicic acid can be partially substituted for sulfuric acid in the production of superphosphate. In the New Plymouth works of Farmers Fertiliser Ltd the scrubbing p r o cess h as b een modified so as to produce an acid suitable for water fluoridation. In this w o r ks t h e scr ub b in g I-Ch e m i cals-c-hydrofluorosilicic acid-3 p r o cess is divided into three stages with acid of different concentration in each. This yields an acid containing about 20% H2SiF6 which is acceptable to local authorities. The superphosphate article has a flowsheet showing a typical scrubber installation for hydrofluorosilicic acid production. Water and gas are made to flow.countercurrent. to each other so that gas rich in fluoride is contacted by strong acid and gas weak in fluoride meets very dilute acid. Strong acid is pumped away from the first scrubber and settled to remove silica before being sold. ENVIRONMENTAL AND FINANCIAL CONSIDERATIONS This process removes fluoride from the gas stream, thus preventing an environmental hazard, but it does have its problems. The 20% acid is very corrosive to most metals, so scrubbing equipment is more costly than that used with plain water sprays. However, the demand in the North Island is sufficient to justify economic recovery. Written by C.W. Harland (Farmers Fertiliser Ltd), revised by Lisa Donaldson (IChem Ltd) and Jenny Simpson (Farmers Fertiliser Ltd) with sum m ary box and editing by Heather Wansbrough. 23

24 0ORICA.pdf Material Safety Data Sheet 1. IDENTIFICATION OF THE MATERIAL AND SUPPLIER Product Name: SODIUM FLUORIDE Recommended Use: Water fluoridation, steel degassing, wood and adhesive preservative, electroplating, glass manufacture, disinfectant. Supplier: Orica Australia Pty Ltd ABN: Street Address: 1 Nicholson Street, Melbourne 3000, Australia Telephone Number: Facsimile: Emergency Telephone: (ALL HOURS) 2. HAZARDS IDENTIFICATION This material is hazardous according to criteria of Safe Work Australia; HAZARDOUS SUBSTANCE. Classified as Dangerous Goods by the criteria of the Australian Dangerous Goods Code (ADG Code) for Transport byroad and Rail; DANGEROUS GOODS. Risk Phrases: Toxic if swallowed. Contact with acids liberates very toxic gas. Irritating to eyes and skin. Safety Phrases: Do not breathe dust. Avoid contact with skin and eyes. In case of contact with eyes, rinse immediately with plenty of water and seek medical advice. Wear suitable protective clothing, gloves and eye/face protection. In case of accident or if you feel unwell, seek medical advice immediately (show the label whenever possible). Poisons Schedule: S6 Poison. 3. COMPOSITION/INFORMATION ON INGREDIENTS Components CAS Number Proportion Risk Phrases Sodium fluoride >=98% R25, R32, R36/38 4. FIRST AID MEASURES For advice, contact a Poisons Information Centre (e.g. phone Australia ; New Zealand ) or a doctor at once. Urgent hospital treatment is likely to be needed. Inhalation: Remove victim from area of exposure - avoid becoming a casualty. Remove contaminated clothing and loosen remaining clothing. Allow patient to assume most comfortable position and keep warm. Keep at rest until fully recovered. Seek medical advice if effects persist. Skin Contact: If skin or hair contact occurs, immediately remove any contaminated clothing and wash skin and hair thoroughly with running water. If swelling, redness, blistering or irritation occurs seek medical assistance. Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: Version: 4 Material Safety Data Sheet 24

25 Eye Contact: If in eyes, hold eyelids apart and flush the eye continuously with running water. Continue flushing until advised to stop by a Poisons Information Centre or a doctor, or for at least 15 minutes. Ingestion: Immediately rinse mouth with water. If swallowed, do NOT induce vomiting. Give a glass of water. Seek immediate medical assistance. Medical attention and special treatment: Treat symptomatically. 5. FIRE FIGHTING MEASURES Hazards from combustion products: Non-combustible material. Precautions for fire fighters and special protective equipment: Decomposes on heating emitting toxic fumes, including those of hydrogen fluoride, and sodium oxide. Fire fighters to wear self-contained breathing apparatus and suitable protective clothing if risk of exposure to products of decomposition. Suitable Extinguishing Media: Not combustible, however, if material is involved in a fire use: Fine water spray, normal foam, dry agent (carbon dioxide, dry chemical powder). Hazchem Code: 2Z 6. ACCIDENTAL RELEASE MEASURES Emergency procedures: If contamination of sewers or waterways has occurred advise local emergency services. Methods and materials for containment and clean up: Wear protective equipment to prevent skin and eye contact. Avoid breathing in dust. Work up wind or increase ventilation. Collect and seal in properly labelled containers or drums for disposal. 7. HANDLING AND STORAGE This material is a Scheduled Poison S6 and must be stored, maintained and used in accordance with the relevant regulations. Conditions for safe storage: Store in a cool, dry, well ventilated place and out of direct sunlight. Protect from moisture. Store away from foodstuffs. Store away from incompatible materials described in Section 10. Keep containers closed when not in use check regularly for spills. Precautions for safe handling: Avoid skin and eye contact and breathing in dust. Avoid handling which leads to dust formation. Keep out of reach of children. 8. EXPOSURE CONTROLS/PERSONAL PROTECTION Occupational Exposure Limits: No value assigned for this specific material by the National Occupational Health and Safety Commission. However, Exposure Standard(s) for constituent(s): Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: Version: 4 Material Safety Data Sheet Fluorides (as F): 8hr TWA = 2.5 mg/m3 As published by the National Occupational Health and Safety Commission. TWA - The time-weighted average airborne concentration over an eight-hour working day, for a fiveday working week over an entire working life. These Exposure Standards are guides to be used in the control of occupational health hazards. All atmospheric contamination should be kept to as low a level as is workable. These exposure standards should not be used as fine dividing lines between safe and dangerous concentrations of chemicals. They are not a measure of relative toxicity. Engineering controls: 25

26 Ensure ventilation is adequate and that air concentrations of components are controlled below quoted Exposure Standards. Avoid generating and breathing in dusts. Use with local exhaust ventilation or while wearing dust mask. Keep containers closed when not in use. Personal Protective Equipment: The selection of PPE is dependant on a detailed risk assessment. The risk assessment should consider the work situation, the physical form of the chemical, the handling methods, and environmental factors. Orica Personal Protection Guide No. 1, 1998: F - OVERALLS, SAFETY SHOES, CHEMICAL GOGGLES, GLOVES, DUST MASK. Wear overalls, chemical goggles and impervious gloves. Avoid generating and inhaling dusts. If dust exists, wear dust mask/respirator meeting the requirements of AS/NZS 1715 and AS/NZS Always wash hands before smoking, eating, drinking or using the toilet. Wash contaminated clothing and other protective equipment before storage or re-use. 9. PHYSICAL AND CHEMICAL PROPERTIES Physical state: Powder or Crystals Colour: White or Colourless Odour: Odourless Molecular Formula: NaF Specific Gravity: 20 C Relative Vapour Density (air=1): 1.45 Vapour Pressure (20 C): Not available Flash Point ( C): Not applicable Flammability Limits (%): Not applicable Autoignition Temperature ( C): Not applicable Solubility in water (g/l): 40 Melting Point/Range ( C): 988 Boiling Point/Range ( C): 1695 ph: 7.4 (freshly prepared saturated solution) Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: Version: 4 Material Safety Data Sheet 10. STABILITY AND REACTIVITY Chemical stability: Stable under normal conditions. Conditions to avoid: Avoid dust generation. Incompatible materials: Incompatible with acids. Hazardous decomposition products: Hydrogen fluoride. Sodium oxide. Hazardous reactions: Hazardous polymerisation will not occur. 11. TOXICOLOGICAL INFORMATION No adverse health effects expected if the product is handled in accordance with this Safety Data Sheet and the product label. Symptoms or effects that may arise if the product is mishandled and overexposure occurs are: Ingestion: Swallowing may result in nausea, vomiting, and abdominal pain. Swallowing large amounts may cause muscle spasms, coma and death from respiratory failure. Eye contact: An eye irritant. Skin contact: Contact with skin will result in irritation. Inhalation: Breathing in dust may result in respiratory irritation. Long Term Effects: Chronic fluorine poisoning is possible. Intake of more than 1.5 mg/l of fluoride can cause dental fluorosis with amounts of greater than 4 mg/l possibly causing skeletal fluorosis. Symptoms include weight loss, brittle bones, anaemia, weakness, and stiffness of joints. 26

27 Toxicological Data: Oral LD50 (rat): 31 mg/kg. Oral LD50 (mice): 44 mg/kg. 12. ECOLOGICAL INFORMATION Ecotoxicity Avoid contaminating waterways. 13. DISPOSAL CONSIDERATIONS Disposal methods: Refer to Waste Management Authority. Dispose of material through a licensed waste contractor. 14. TRANSPORT INFORMATION Road and Rail Transport Classified as Dangerous Goods by the criteria of the Australian Dangerous Goods Code (ADG Code) for Transport by Road and Rail; DANGEROUS GOODS. Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: Version: 4 Material Safety Data Sheet 6 TOXIC UN No: 1690 Class-primary 6.1 Toxic Packing Group: III Proper Shipping Name: SODIUM FLUORIDE Hazchem Code: 2Z Marine Transport Classified as Dangerous Goods by the criteria of the International Maritime Dangerous Goods Code (IMDG Code) for transport by sea; DANGEROUS GOODS. This material is classified as a Marine Pollutant (P) according to the International Maritime Dangerous Goods Code. UN No: 1690 Class-primary: 6.1 Toxic Packing Group: III Proper Shipping Name: SODIUM FLUORIDE, SOLID Air Transport Classified as Dangerous Goods by the criteria of the International Air Transport Association (IATA) Dangerous Goods Regulations for transport by air; DANGEROUS GOODS. UN No: 1690 Class-primary: 6.1 Toxic Packing Group: III Proper Shipping Name: SODIUM FLUORIDE 15. REGULATORY INFORMATION Classification: This material is hazardous according to criteria of Safe Work Australia; HAZARDOUS SUBSTANCE. Hazard Category: T : Toxic Xi: Irritant Risk Phrase(s): R25: Toxic if swallowed. R32: Contact with acids liberates very toxic gas. R36/38: Irritating to eyes and skin. Safety Phrase(s): S22: Do not breathe dust. S24/25: Avoid contact with skin and eyes. S26: In case of contact with eyes, rinse immediately with plenty of water and seek medical advice. S36/37/39: Wear suitable protective clothing, gloves and eye/face protection. 27

28 S45: In case of accident or if you feel unwell, seek medical advice immediately (show the label whenever possible). Poisons Schedule: S6 Poison. This material is listed on the Australian Inventory of Chemical Substances (AICS). Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: Version: 4 Material Safety Data Sheet 16. OTHER INFORMATION `Registry of Toxic Effects of Chemical Substances'. Ed. D. Sweet, US Dept. of Health & Human Services: Cincinatti, This material safety data sheet has been prepared by SH&E Shared Services, Orica. Reason(s) for Issue: Revised Primary MSDS Alignment to HSNO requirements This MSDS summarises to our best knowledge at the date of issue, the chemical health and safety hazards of the material and general guidance on how to safely handle the material in the workplace. Since Orica Limited cannot anticipate or control the conditions under which the product may be used, each user must, prior to usage, assess and control the risks arising from its use of the material. If clarification or further information is needed, the user should contact their Orica representative or Orica Limited. Orica Limited's responsibility for the material as sold is subject to the terms and conditions of sale, a copy of which is available upon request. Product Name: SODIUM FLUORIDE Issued: 17/10/2008 Substance No: Version: 4 28

29 Studies on Tooth Decay Rates After Water Fluoridation Is Stopped Fluoride Action Network February 2001 ow nelement article.resize 2 31 For decades, the American Dental Association (ADA) has long warned that if communities end their water fluoridation programs, the rate of tooth decay will increase. In it s Fluoridation Facts brochure, the ADA states: Dental decay can be expected to increase if water fluoridation in a community is discontinued for one year or more, even if topical products such as fluoride toothpaste and fluoride rinses are widely used. At the turn of the 21st century, however, a flurry of 4 published studies reported that tooth decay rates did not increase in communities that had ended fluoridation. In fact, in each of the studies, the rate of tooth decay continued to decrease. The fact that tooth decay decreased following the end of fluoridation is consistent with the fact that tooth decay rates in all western nations have sharply declined over the past 50 years irrespective of whether the country fluoridates its water, or not. 1. Canada: Fluoridation Cessation Studies The prevalence of caries decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community. SOURCE: Maupome G, Clark DC, Levy SM, Berkowitz J. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: Finland The fact that no increase in caries was found in Kuopio despite discontinuation of water fluoridation and decrease in preventive procedures suggests that not all of these measures were necessary for each child. SOURCE: Seppa L, Karkkainen S, Hausen H. (2000). Caries Trends in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: Germany 29

30 In contrast to the anticipated increase in dental caries following the cessation of water fluoridation in the cities Chemnitz and Plauen, a significant fall in caries prevalence was observed. SOURCE: Kunzel W, Fischer T, Lorenz R, Bruhmann S. (2000). Decline of caries prevalence after the cessation of water fluoridation in the former East Germany. Community Dentistry and Oral Epidemiology 28: Cuba In 1997, following the cessation of drinking water fluoridation, in contrast to an expected rise in caries prevalence, DMFT and DMFS values remained at a low level for the 6- to 9-year-olds and appeared to decrease for the 10/11-year-olds. In the 12/13-year-olds, there was a significant decrease, while the percentage of cariesfree children of this age group had increased SOURCE: Kunzel W, Fischer T. (2000). Caries prevalence after cessation of water fluoridation in La Salud, Cuba. Caries Research 34:

31 Supplementary submission to the Inquiry into how to prevent child abuse and improve children's health outcomes Katherine Smith Many NZ towns and cities add fluoride (often as hydrofluorosilicic acid) to town water supplies. This exposes the population to avoidable health risks. Risks pertaining to pregnant women, babies and young children include: 1) Increased risk of Down Syndrome The rate of children born with Down Syndrome is higher in in towns and cities where the water is fluoridated and in areas where the water is fluoridated mothers of children with Down Syndrome are likely to be younger than mothers of children with Down Syndrome living in nonfluoridated communities. Below is a summary of one paper on this issue: FLUORIDE-LINKED DOWN SYNDROME BIRTHS AND THEIR ESTIMATED OCCURRENCE DUE TO WATER FLUORIDATION Kosei Takahashi* Okegawa City, Saitama, Japan SUMMARY: Down syndrome (DS) birth rates (BR) as a function of maternal age exhibit a relatively flat linear regression line for younger mothers and a fairly steep one for older mothers with the second line intersecting the first line a little above maternal age 30. Consequently, overall DS-BR for all maternal ages are not a very reliable parameter for detecting environmental influences, since theymay be strongly affected by the ratio of the number of younger to older mothers. For this reason, data for mothers under age 30 were selected to detect an association between water fluoridation and DS for which the lower maternal age regression would be a much smaller contributing factor. The early research of I Rapaport indicating a link between fluoride in drinking water and Down syndrome was followed by studies claiming there was no such association. Application of sound methodology to the data in those later investigations shows that none of the criticisms against Rapaport's work are valid. For example, in the data of J D Erickson on maternal age-specific DS births in Metropolitan Atlanta, Georgia, when the three youngest maternal age subgroups are reasonably combined into single groups for areas with and without water fluoridation, a highly 31

32 significant association (P < 0.005) is revealed between fluoridated water and DS births. It also appears that the dose-response line (DRL) of DS-BR for daily fluoride intake may have no allowable level that does not induce fluoridelinked DS births. Therefore fluoride may be one of the major causes of DS other than aging of mothers. The number of excess DS births due to water fluoridation is estimated to be several thousand cases annually throughout the world. Key Words: Down syndrome; Down syndrome births; Fluoridation; Fluoride intake. *Department of Internal Medicine and Biostatistics, Tokyo University Medical School, Tokyo, Japan (retired). Home address: Kosei Takahashi MD PhD, Kano 1788, Okegawa City, Saitama, Japan. The full text article is at this link: A more general summary of some of the research on fluoride and Down Syndrome may be read at this link. It should be noted that the government has recently introduced prenatal screening in the first trimester of pregnancy to try to identify babies who have this condition very early in their development. This screening was introduced without adequate consultation with the community of families with Down Syndrome children. It has caused considerable alarm and offence as it has been interpreted (and correctly in my view) to be a eugenics project that has the aim of selectively targeting people with Down Syndrome for elimination due to their perceived disabilities. Overseas where this type of screening has been introduced, 90% of babies with Down Syndrome have been aborted. There have been disturbing reports that some NZ parents have been pressured to abort on the basis of these tests showing that a baby may have Down Syndrome. (See: Syndrome-mother ) Research into the after effects of abortion has shown that termination of a wanted pregnancy has a higher likelihood of causing adverse Page 2 of 7 24/05/2012 outcomes for the mother, such as depression. If the government really wants to to reduce the numbers of children who are born with Down Syndrome, ending water fluoridation and putting warning labels on products that contain high levels of fluoride such as fluoride toothpastes, chewing gums etc would seem to be a much more humane and life affirming approach than promoting pre-natal testing and abortions. 32

33 2) Increased risk of anaemia in pregnancy Research in India (where water from some wells is naturally high in fluoride, and some people use "black salt" and drink black tea which has a high fluoride content) has found that reducing fluoride consumption and nutritional counselling helps resolve anaemia in pregnant mothers. The proportion of mothers who received this intervention whose babies were born premature or with a low birth weight was also substantially reduced. (The reduction in fluoride intake would be expected to help reduce anaemia even without the additional nutritional counseling as fluoride has toxic effects on the microvilli of the intestinal tract, reducing nutrient absorbtion; reducing fluoride intake allows these microvilli to nregenerate.) Below is an excerpt from the abstract: "Anaemia in pregnancy and low birth weight babies, a serious public health problem, troubles India and several other nations. This article reports the results of a approach to address the issue. Women up to 20 week pregnancy with haemoglobin (Hb) 9.0 g/dl or less, those with urinary fluoride beyond 1.0 mg/l and not suffering from any other ailments, were selected. Out of the 205 pregnant women attending antenatal clinics (ANCs) during 1st and 2nd trimesters, the sample and control groups were selected through computerized random sampling procedure. "Ninety pregnant women formed the sample group and 115 formed the control group. The sample group was introduced to two interventions, viz.: (1) removal of fluoride from ingestion through drinking water, food and other sources, (2) counselling based intake of essential nutrients, viz. calcium, iron, folic acid, vitamins C, E and other antioxidants through dairy products, vegetables and fruits. No intervention was introduced for the control group. Sample and control groups were monitored for urinary fluoride and Hb until delivery during their visits to ANC. Birth weight of the babies were recorded from the labour room register. Results reveal that (1) the urine fluoride levels decreased in 67% and Page 3 of 7 24/05/ % of the pregnant women respectively, who attended ANCs during 1st and 2nd trimester of pregnancy. (3) An increase in Hb upon withdrawal of fluoride followed by nutritional intervention in 73% and 83% respectively has also been recorded. (3) Body mass index (BMI) also enhanced. (4) The percentage of pre-term deliveries was decreased in sample group compared to control. (5) Birth weight of babies enhanced in 80% and 77% in sample group women who attended ANC in 1st and 2nd trimester respectively as opposed to 49% and 47% respectively in the control group. (6) The number of low birth weight babies was reduced to 33

34 20% and 23% respectively in sample as opposed to 51% and 53% in control groups. Effective interventional approach to control anaemia in pregnant women A. K. Susheela1, N. K. Mondal1, Rashmi Gupta1, Kamla Ganesh1, Shashikant Brahmankar1, Shammi Bhasin2 and G. Gupta2 CURRENT SCIENCE, VOL. 98, NO. 10, 25 MAY 2010; Fluorosis Research and Rural Development Foundation, 34, I.P. Extension, Delhi , India 2Department of OBGY, Deen Dayal Upadhyay Hospital, Hari Nagar, New Delhi , India More information on this issue, may be read at this link: 3) Increased risk of premature labour A recent (2009) American study found increased risks of premature labour and birth for pregnant women living in areas where the water is fluoridated. This risk remained even after taking into account other variables such as poverty although the study also showed that poor women and their babies are more vulnerable to the toxic effects of fluoride than wealthier women. Below is an excerpt from the study's abstract: "The annual incidence of preterm birth (PTB) (<37 weeks gestation) in the United States is approximately 10% and is associated with considerable morbidity and mortality. Current literature suggests an association between periodontal disease and PTB. Domestic water fluoridation is thought to have lessened the burden of dental disease. Theoretically, one would expect water fluoridation to be protective against PTB. The aim of our study was to examine Page 4 of 7 24/05/2012 the relationship between municipal water fluoridation and PTB. A retrospective, cohort study was conducted using the Statewide Planning and Research Cooperative System(SPARCS) database. Inclusion criteria were 1) women with live singleton births between 1993 and 2002 (ICD-9- CM); 2) residence in Upstate New York State; 3) residence in a zip code fully contained within a county; and 4) residence in a county where municipal water fluoride content was uniformly therapeutic ( 1.0 mg/l) or sub-therapeutic(<1.0 mg/l). "Domestic water fluoridation was associated with an increased risk of PTB (9545 (6.34%) PTB among women exposed to domestic water fluoridation versus (5.52%) PTB among those unexposed, p < )). This relationship was most pronounced among women in the lowest SES groups (>10% poverty) and those of non-white racial origin. Domestic water fluoridation was independently associated with an increased risk of PTB in 34

35 logistic regression, after controlling for age, race/ethnicity, neighborhood poverty level, hypertension, and diabetes." 4) Increased infant mortality The government in Chile ceased water fluoridation after an increase in infant mortality was experienced in fluoridated areas. Dr Albert Schatz (discoverer of the antibiotic streptomycin used in the treatment of tuberculosis) found that water fluoridation was associated with increased congenital malformations and increased infant mortality. A table of data from Chilean Government records is presented below. Curico was fluoridated at one part per million. There was 0.0% fluoride in the water at San Fernando. Original source: Schatz A. Increased Death Rates in Chile with Artificial Fluoridation ofdrinking Water, with Implications for other Countries. Journal of Arts Humanities and Science :1-17. Cause of Death City Deaths Congenital malformations Curico (fluoride) 3.1 % Extra deaths = 244% San Fernando 0.9 % Digestive system Curico (fluoride) 18 per 10,000 Extra deaths = 50% San Fernando 12 per 10,000 Total infant mortality Curico (fluoride) 56.5 per 10,000 Extra deaths = 69% San Fernando 33.4 per 10,000 All causes, all age groups Curico (fluoride) 2255 Extra deaths = 16% San Fernando 1003 Page 5 of 7 24/05/2012 In the USA American PhD biochemist, Dr John Yiamouyiannis compared 10 fluoridated USA cities with 10 non-fluoridated ones. Between 1950 and 1969, the infant mortality rate per 1000 live births for nonwhites in the non-fluoridated cities fell by 9.03/thousand. In the fluoridated cities the drop was only 1.93/thousand = 4.7 times better in non-fluoridated cities For white Americans regarded in the States as better nourished than nonwhites the non-fluoridated city rate fell by 5.22/thousand while the fluoridated decrease was only 3.33/thousand 35

36 = 1.7 times better in non-fluoridated cities Note: total rates: Risk of PTB 6.34% in women exposed to water fluoridation Risk of PTB 5.52% in women NOT exposed to water fluoridation Difference 15% 5) Neurotoxic effects of fluoride may reduce children's intelligence A major review of neurotoxic agents that have potential to cause developmental neurotoxicity noted that fluoride has been shown to have neurotoxic effects in animals and that children with high fluoride intakes (through drinking well water that contains high levels of the fluoride) have lower IQs /fulltext Please note that the even though the American Dental Association supports the use of fluoridated products (including water) it recognises that using fluoridated water to make up powdered infant formula may increase the risk of dental flourosis in babies. (Dental fluorosis is the name given to tooth enamels that has been discoloured and damaged due to accumulation of toxic levels of fluoride.) Human breast milk contains negligible fluoride ( ppm fluoride) whereas the fluoride content of fluoridated water is around 1 ppm. Formula fed babies whose powdered breast milk substitutes are made up with fluoridated tap water are therefore receiving at least 100 times more fluoride than their breast-fed peers. Given the neurotoxicity of fluoride this may help to account for the fact that breast fed babies are more intelligent than those fed on formula although there are many other possible explanations. Recommendations: In order to reduce the risk of birth defects, premature births, excess infant mortality and neurotoxic effects associated with fluoride consumption, the government should do the following: 1) End water fluoridation immediately 2) Put warning labels of fluoridated toothpaste, chewing gums etc so that people realise that the fluoride these contain poses a health risk 3) Produce a pamphlet for parents (including prospective parents in the preconceptual period) about the risks of products containing fluoride to the health of their developing baby (in utero and subsequently) such as fluoride containing toothpaste, gums etc as well as foods that contain high levels of fluoride such as black tea 36

37 Another Submission by Kathryn Smith nesm.pdf 37

38 FLUOROSIS When fluoride was first added to water in the 1940s as a means of preventing tooth decay, not a single dental product contained fluoride: no fluoride toothpastes, no fluoride mouth-rinses, no fluoride varnishes, and no fluoride gels. In the past 60 years, as one fluoride product after another entered the market, exposure to fluoride increased considerably, particularly among children. Exposure from other sources has increased as well. Other sources include processed foods made with fluoridated water, fluoride-containing pesticides, bottled teas, fluorinated pharmaceuticals, teflon pans, and mechanically deboned chicken. Taken together, the glut of fluoride sources in the modern diet has created a toxic cocktail, one that has caused a dramatic increase in dental fluorosis (a tooth defect caused by excess fluoride intake) over the past 60 years. The problem with fluoride, therefore, is not that children are receiving too little, but that they are receiving too much. Even advocates of fluoridation have begun to recognize this problem. In January 2011, the U.S. Department of Health and Human Services (DHHS) announced its recommendation that water fluoridation programs (which generally add 1 ppm 38

39 fluoride to water) should lower the levels added to 0.7 ppm. This reduction, however, does little to solve the problem, as many children will continue to ingest more fluoride than is recommended, or safe. 39

40 Dental Fluorosis Incidence in New Zealand Dental fluorosis is a defect in tooth enamel caused by fluoride poisoning of the body cells that make the tooth enamel. It appears as discolouration of the tooth, from white flecks to brown or black staining in advanced cases. It is the first sign of fluoride poisoning of children while their teeth are forming. The US National Research Council's 2006 report identified a number of studies linking dental fluorosis with other more serious adverse health effects. Two studies have been conducted in NZ since the Southland study 2005 (below) and the Auckland study The Auckland Study 2008 Prevalence of enamel defects and dental caries among 9-year-old Auckland children. Schulter PJ, Kanagaratnam S, Durward CS, Mahood R NZ Dental Journal December 2008 (p ) Summary This study found that water fluoridation increases the incidence of dental fluorosis, but has no lasting benefit in reducing tooth decay. The study concluded that there had not been a significant increase in fluorosis incidence since the 1980s (which was already 3 times higher than predicted when fluoridation was first proposed). The levels reported then were around 25% to 28% (Colquhoun, 1985). Dental fluorosis incidence 29.1% of fluoridated children had dental fluorosis compared with 14.7% of unfluoridated children Diffuse opacities (dental fluorosis) were the predominant tooth defects Tooth decay rates 40

41 There was no difference in tooth decay rates in the permanent teeth (this differs from the Southland study, but at age 9 there is often an apparent benefit, likely due to delayed tooth eruption caused by fluoridation, that disappears by age 12 to 15 see Armfield and Spencer, 2004) There was no statistically significant difference in tooth decay rates in deciduous ( baby ) teeth based on affected tooth surfaces (dmfs score) Fluoridated children had less tooth decay in deciduous teeth on a per tooth basis (dmft) and number of children caries free (62% v 55%) The study noted that: international research shows that the increase in dental fluorosis levels is directly related to total fluoride intake, and detectable even at small differences in intake the swallowing of fluoride toothpaste by very young children (perhaps 50% of that placed on the toothbrush) is a risk factor (note the Ministry of Health, NZ Dental Association, and Plunket advocate practices that significantly increase the amount of fluoride swallowed by young children) the effect of fluoride in (allegedly) reducing tooth decay is primarily due to topical effect after the tooth has erupted (i.e. not from swallowing it). fluoride tablets taken before tooth eruption have little effect on tooth decay but present a clear risk for fluorosis. Method This study examined 310 fluoridated and 302 unfluoridated children, based on current fluoridation status. About half the children had intermittent residence in fluoridated areas, and some were unknown. It is not stated when the exposure occurred, even though international studies show that it is the time of exposure that is critical in causing fluorosis the first 6 months is most critical if bottle fed, with reducing but significant risk up to age 4. The 2005 Southland study also showed a higher incidence of fluorosis in those who had lived in fluoridated areas up to age 4. The study did not separate out those who had had lifelong exposure to fluoridation, though it utilised a complex statistical modelling to counteract, in part, this shortfall. We do not consider the other justifications tenable if the purpose was to determine the effects of water fluoridation. 41

42 Socio economic status was determined by the school decile rating, rather than the SES status of each child. Although this approach is not considered appropriate, the results suggest it has not significantly impaired the study. There was a significant difference in SES status between fluoridated and unfluoridated children (the unfluoridated children has the lower SES status, which international studies show is the main factor in higher levels of tooth decay). Many of the first molar permanent teeth, at higher risk of decay than other teeth, were fissuresealed. This would corrupt the caries results, but, if so, seems to demonstrate that fissure-sealing is a more effective method of caries prevention than fluoridated water. The Southland Study 2005 Enamel defects and dental caries among Southland children Mackay T D, Thomson W M, NZ Dental Journal 101, No. 2, June 2005 (p35-43) Key findings from this study were as follows. Dental fluorosis incidence There were no socioeconomic differences in relation to dental fluorosis The prevalence of diffuse opacities (and therefore the overall prevalence of any defect) was higher amongst those who continuously resided in fluoridated areas up to the age of 4. (Note: This should be read in conjunction with the 2008 Auckland study, which did not consider the age of exposure) Tooth decay rates Socioeconomic status (SES) did not affect tooth decay rates (note: international studies show that SES is the main determinant of dental health/ tooth decay. See in particular Armfield and Spencer 2004) There was no benefit from fluoridation to the deciduous ( baby ) teeth There was no benefit to permanent teeth in the initial results. Following furtehr data manipulation, it was claimed that those 9 year olds who lived all their lives in fluoridated areas had half the decay (equating to ½ a filling) than those who had never lived in a fluoridated area. This finding conflicts with the 2008 Auckland study, which found no such benefit. However, at age 9 there are few permanent teeth, and they have had only brief exposure to decay, as noted in the Auckland study. 12 years old is the WHO-prescribed 42

43 age for examining permanent teeth effects. International studies show there is often an apparent benefit at younger ages, likely due to delayed tooth eruption caused by fluoridation, but which disappears by age 12 to 15 see Armfield and Spencer (2004); Newbrun (1989). Implications of increased dental fluorosis The study notes that the clinical and public health significance of [diffuse opacities (i.e. dental fluorosis) remains unclear. In other words, we do not know what associated health risks there may be! The US National Research Council Review, published in 2006, found a number of studies linking dental fluorosis to other adverse health effects. Method 436 children between the ages of 9 and 10 were examined. 137 children had not lived in fluoridated communities (but may have been given fluoride tablets the analysis does not control for this; 116 had intermittent residence in fluoridated communities; and 183 had always lived in fluoridated communities. Socioeconomic status was determined by the school decile rating, rather than the SES status of each child. This approach is not considered appropriate. It is not clear from the results whether this has had a significant impact. Although a range of intersecting population characteristics was recorded, individual analysis tables look at only one factor at a time. These results are therefore meaningless, as a correlation between high decile and fluoridation status, for example, precludes any conclusion as to which factor was relevant. The fact that high decile children had the highest rates of dental fluorosis suggests there was such a correlation. The use of fluoride tablet would be exclusively among non-fluoridated children (including, possibly, intermittently fluoridated). Without controlling for this in each set of results, an unfluoridated child becomes a fluoridated child for analytical purposes. The authors conducted a multivariate analysis for permanent tooth decay only. This approach is intended to find a common factor giving rise to results. There are many ways of conducting such an analaysis. It is not possible to determine whether the particular approach used was appropriate or not without the raw data. On the face of it, it appears that the data may have been manipulated to show a desired result when that result was not shown by standard analysis. As the saying goes "you can 'prove' anything with statistics." 43

44 Overall, we feel compelled to recommend that their conclusions be viewed with extreme caution without an independent statistical analysis being available. Fluoride Is Not an Essential Nutrient Fluoride Action Network August 2012 By Michael Connett In the 1950s, dentists believed that fluoride was a nutrient. A nutrient is a vitamin or mineral that is necessary for good health. Dentists believed that fluoride ingestion during childhood was necessary for strong, healthy teeth. A fluoride deficiency was thus believed to cause cavities, just like a deficiency of calcium can cause osteoporosis, or a deficiency of vitamin-d can cause rickets. It is now known, however, that fluoride is not a nutrient. As acknowledged by the CDC, the fluoride content of a tooth has little bearing on whether or not the tooth will develop a cavity. According to the CDC: The prevalence of dental caries in a population is not inversely related to the concentration of fluoride in enamel, and a higher concentration of enamel fluoride is not necessarily more efficacious in preventing dental caries. SOURCE: CDC (2001). Recommendations for using fluoride to prevent and control dental caries in the United States. Mortality and Morbidity Weekly Review 50(RR14):1-42. In short, people can have perfect teeth without consuming fluoridated water or any other fluoride product. As with teeth, no other tissue or cellular process requires fluoride. Accordingly, it is now accepted that fluoride is not an essential nutrient. Excerpts from the Scientific Literature: Safe, responsible, and sustainable use of fluorides is dependent on decision makers (whether they be politicians or parents) having a firm grasp on three key principles: (i) fluorine is not so much essential as it is everywhere, (ii) recent human activities have significantly increased fluorine exposures to the biosphere, and (iii) fluorine has biogeochemical effects beyond bones and teeth. SOURCE: Finkelman RB, et al. (2011). Medical geology issues in North America. in O. Selinus, et al. (eds). Medical Geology. Springer Publishing. Fluoride is not essential for human growth and development. SOURCE: European Commission. (2011). 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 Committee on Health and Environmental Risks (SCHER). Fluoride is not in any natural human metabolic pathway. SOURCE: Cheng KK, et al. (2007). Adding fluoride to water supplies. British Medical Journal 335:

45 [F]luoride is no longer considered an essential factor for human growth and development. SOURCE: National Research Council (1993). Health Effects of Ingested Fluoride. National Academy Press, Washington DC. p. 30. These contradictory results do not justify a classification of fluorine as an essential element, according to accepted standards. SOURCE: National Academy of Sciences. (1989). Recommended Dietary Allowances: 10th Edition. Commission on Life Sciences, National Research Council, National Academy Press. p Statements from U.S. Government Agencies: In summary, FDA does not list fluorine as an essential nutrient. SOURCE: Food & Drug Administration, October The United States Public Health Service does not say that sodium fluoride is an essential mineral nutrient. SOURCE: U.S. Public Health Service, May 10, Sodium fluoride used for therapeutic effect would be a drug, not a mineral nutrient. Fluoride has not been determined essential to human health. A minimum daily requirement for sodium fluoride has not been established. SOURCE: Food & Drug Administration, August 15, The Institute of Medicine Report (1997) Some commentators have cited a 1997 report from the Institute of Medicine (IOM) as demonstrating that fluoride is an essential nutrient. The IOM report, however, does not do so a fact confirmed by both the President of the Institute of Medicine (Kenneth Shine), as well as the President of the National Academy of Sciences (Bruce Alberts). In a jointly authored letter on November 18, 1998, Alberts and Shine unequivocally stated: Nowhere in the report is it stated that fluoride is an essential nutrient. If any speaker or panel member at the September 23rd workshop referred to fluoride as such, they misspoke. As was stated in Recommended Dietary Allowances 10th Edition, which we published in 1989: These contradictory results do not justify a classification of fluoride as an essential element, according to accepted standards. 45

46 Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries F.A.N. July 2012 By Michael Connett Fluoride advocates often claim that the reduction in tooth decay that has occurred since the 1950s is the result of the widespread introduction of fluoridated water. In 1999, for example, the Centers for Disease Control stated that as a result [of water fluoridation], dental caries declined precipitously during the second half of the 20th century. As support for this assertion, the CDC published the following figure: SOURCE: Centers for Disease Control (1999). Achievements in Public Health, : Fluoridation of Drinking Water to Prevent Dental Caries. MMWR 48: What the CDC failed to mention is that tooth decay rates have precipitously declined in all western countries, irrespective of whether the country ever fluoridated its water. Indeed, most western countries do not fluoridate their water and yet their tooth decay rates have declined at the same rate as the U.S. and other fluoridated countries. This fact, which is widely acknowledged in the dental literature (see below), can be quickly demonstrated by examining the World Health Organization s (WHO) data on tooth decay trends in each country. The following two figures and table, for example, compare the tooth decay trends in western countries with, and without, water (or salt) fluoridation. 46

47 47

48 48

49 DMFT (Decayed, Missing & Filled teeth) Status for 12 year olds by Country - World Health Organization Data (2012) - Country DMFTs Year Status* Denmark No water fluoridation. No salt fluoridation. Germany No water fluoridation. 67% salt fluoridation. England % water fluoridation. No salt fluoridation. Netherlands* No water fluoridation. No salt fluoridation. Switzerland** No water fluoridation. 88% salt fluoridation. Belgium No water fluoridation. No salt fluoridation. Sweden No water fluoridation. No salt fluoridation. Australia % water fluoridation. No salt fluoridation. Austria No water fluoridation. 6% salt fluoridation. Ireland % water fluoridation in study. No salt fluoridation. Italy No water fluoridation. No salt fluoridation. United States % water fluoridation. No salt fluoridation. Finland No water fluoridation. No salt fluoridation. 49

50 France No water fluoridation. 65% salt fluoridation. Spain % water fluoridation. 10% salt fluoridation. Greece No water fluoridation. No salt fluoridation. Iceland No water fluoridation. No salt fluoridation. New Zealand % water fluoridation. No salt fluoridation. Japan No water fluoridation. No salt fluoridation. Norway No water fluoridation. No salt fluoridation. * The Hague ** Zurich Tooth Decay data from: World Health Organization Collaborating Centre for Education, Training, and Research in Oral Health, Malmö University, Sweden. Salt fluoridation data from: Gotzfried F. (2006). Legal aspects of fluoride in salt, particularly within the EU. Schweiz Monatsschr Zahnmed 116:

51 World Health Organisation Figures statistics on dental health of 12 year olds "Fluoridation is the greatest fraud that has ever been perpetrated, and it has been perpetrated on more people than any other." - Dr. Albert Schatz, biochemist and co-discoverer of streptomycin Improvement is the same in fluoridated and non-fluoridated countries Country Year DMFT Year DMFT Fluoridation status Ireland % Finland Nil Denmark Nil UK (GB&NI) % Sweden Nil Holland Nil Switzerland Nil France Nil Norway Nil Spain one city only Germany (E) Nil Germany (W) 2.6 Nil Belgium Nil Austria Nil 51

52 Italy Nil Portugal Nil These figures are charted below, with New Zealand's figures added for comparison. Note that Ireland has around 70% fluoridation 52

53 The Hastings Fluoridation Experiment Five decades ago, two neighbouring towns, Hastings and Napier, were selected for the first fluoridation experiment in New Zealand: fluoridation was implemented in Hastings, with nonfluoridated Napier acting as the control. This arrangement has not changed. Data shows that even after 50 years, fluoridation has conferred no benefit to Hastings inhabitants, regardless of social status. Figures based on data obtained under the Official Information Act: 53

54 In fact, the NZ Government knew fluoridation was having no benefit, but had seemingly committed to fluoridation policy before the experiment began, as this letter shows: 54

55 The Hastings Fluoridation Experiment: Science or Swindle? By John Colquhoun and Robert Mann ( Those in favour of fluoridation have hailed the Hastings Fluoridation Scheme in New Zealand as valuable evidence of the benefits on children's teeth of fluoride. However, studies of the scheme such as by the authors show it to be seriously flawed from a scientific point of view. In fact, the data reveal no positive advantage to children's health as a result of being exposed to fluoride in water. The controversy over fluoridation or public water supplies is normally seen as a weighing of costs against benefit. The costs, apart from financial inputs, are claimed to be various illnesses what have proved difficult to quantify or even to attribute to fluoridation. The benefit is taken to be causation of major decreases in tooth decay. One of the surveys usually cited as showing this benefit has now been found to show no such thing. The Hastings fluoridation study in New Zealand, (New Zealand Dental Journal, vols. 54, 55, 58, 59, 61, 67), is listed in textbooks throughout the world as an important study confirming the effectiveness of water fluoridation (e.g. J.J. Murray, Fluoride in Caries Prevention. Wright, Bristol, 1982). Data from the study were used by Backer Dirks, the distinguished European researcher and advocate of fluoridation, in one of his better known and oft-cited published papers (Caries Research, vol. 8, suppl. p2.). Professor Murray's book, after reviewing the famous United States trials, saying of the Backer Dirks and Hastings studies they reinforced the European finding because ''free smooth-surface caries was reduced by 87 per cent... approximal caries by 73 per cent... and occlusal surface caries by 39 per cent " The greatest reductions were among 6-year-olds - 74 per cent by 1961 and 87 per cent by

56 but the greatest part of these had occurred in the first few years of the project: 42 per cent by 1957 and 61 per cent by These spectacular reductions, following a Commission of Inquiry report in favour of fluoridation (Government Printer, Wellington, 1957), led to acceptance of widespread fluoridation in New Zealand. Hastings was chosen for such an experiment because its Council had already decided to fluoridate its water supply, the first to do so in New Zealand following an approach from the local branch of the Dental Association. It was considered to be a 'typical' New Zealand population, and therefore ideally suitable. At first described as an 'experiment' with a neighbouring town Napier, using essentially the same groundwater unfluoridated (0.15 ppm), as ''an ideal control" (Cabinet decision, March 1952, National Archives), the project was later changed to a before-and-after 'demonstration' (NZ Dental J., vol. 59, p.219). Editor's note: If anyone has any doubts about American influence, it should be noted that Dr. Frank Bull, fluoridation promoter extraordinaire, said at the infamous 1952 conference of US State Dental Directors: "We never conduct "experiments." We have told the public fluoridation is proven effective. We conduct "demonstrations"" The study's initial dental surveys of children in the two towns were not carried out until late 1954, almost two years after Hastings was first fluoridated. The follow-up survey in 1957 was reported to show a dramatic reduction in dental decay in Hastings after only 27 months of 'continuous fluoridation'. However, both the first and follow-up surveys had shown that the younger (under 10-year-old) control children had significantly less decay than the children of the same age in Hastings. It was said that a special protective factor - the trace element molybdenum in recent marine soil - had caused Napier decay rates to be below the average for the country. Because of that difference, the decision was made to discontinue the use of Napier as a control. Child dental decay rates being very high in New Zealand, it was reasoned that further continuous and marked reduction in dental decay among Hastings children would establish the effectiveness of fluoridation. The Hastings study was carried out by Mr (later Dr) T.G. Ludwig, who replaced Dr R.E.T. Hewat as Dental Research Officer of the New Zealand Medical Research 56

57 Council. Both have since died. Ludwig worked under the direction of the Fluoridation Committee of the Department of Health in Wellington. Most members of that Committee were officers of that Department. Co-opted on to it was a representative of the New Zealand Dental Association, Colonel (now Brigadier) J. Ferris Fuller. The latter became its chairman, and soon assumed a major role in direction of the Hastings operation. Ludwig's work also required the approval of the Dental Research Committee of the Medical Research Council, centred in Dunedin with the University of Otago's Dental Faculty, which followed the project closely. Colonel Fuller later became chairman of that Committee as well. The New Zealand Official Information Act 1982 has made available for public perusal the archives of government departments. Department of Health Head Office files (nos. 125/299, 125/299/1, 2 & 3 and 124/30/31 & 33) now held in National Archives, Wellington, and other official and professional sources, reveal a considerable amount of information not in agreement with the currently accepted published version of the Hastings fluoridation study: 1) The claimed reductions in decay, which were greatest for the younger children, were brought about partly, if not mainly, by a local change in diagnostic procedure following the introduction or fluoridation 2) Reductions over such short periods are, by today's statistical standards, beyond the ''limit of credibility'' for genuine decay reductions. 3) A reduction in dental decay occurred in other, non-fluoridated, places throughout New Zealand during the time of the studv, making it difficult for public health officials to present convincing statistics showing that the claimed reductions were related to fluoridation. The reduction occurred in the control town as elsewhere. Change in diagnostic Procedure Most of the younger children involved in the experiment received their dental treatment regularly at school dental clinics, staffed by the then unique New Zealand grade of dentist called ''school dental nurse". In a 1957 report to the Fluoridation 57

58 Committee, entitled ''Investigation of diagnostic standards of dental nurses in Hastings and Napier", Ludwig expressed concern that "the meticulous diagnostic standards of the dental nurses in Hastings might overshadow any improvement in the caries prevalence resulting from fluoridation". During the latter part of 1955, he wrote, he met each nurse and explained to her the diagnostic standards required by the study and illustrated these standards by examining a number of children in company with her. "While this procedure enabled one or two nurses to cooperate effectively by taking a more lenient view of possible very early carious lesions it did not seem to be successful generally " The report continued: "To determine the actual extent of the problem the following course was adopted. Each dental nurse operating in Hastings and Napier was asked to examine twenty children, recording her findings and then to leave these children untreated until further notice. The nurses were not informed of the purpose of the examinations. The dental research officer and the Principal Dental Officer for Hawke's Bay then visited the Hastings and Napier clinics and examined suitable children previously examined by the nurses. The results of the three examiners were then compared and those for Hastings are given in Table 1. The results for Napier are given in Table 2 and include the results of the nurses and of the dental research officer only. The findings tabulated apply only to carious lesions upon the occlusal surfaces of molars. Tables 1 and 2. Reproduced exactly from T.G. Ludwig's report to Fluoridation Committee: "Investigation of diagnostic standards of dental nurses in Hastings and Napier." The "diagnostic standards required" after the experiment's initial dental examinations called for a reduction in the number of cavities requiring filling to almost a quarter of the number found by the dental nurses using their earlier standards. TABLE 1 Comparison of Diagnostic Standards of Hastings Dental Nurses, T.G. Ludwig and Principal Dental Officer (Gisborne) 58

59 Hastings Nurses T.G.L. P.D.O. No. of Patients Examined No. Lesions Diagnosed as Carious Average Number of Lesions per Child TABLE 2 Comparison of Diagnostic Standards of Napier Dental Nurses and Dental Research Officer Napier Dental Nurses * D.R.O. No. of Patients Examined No. of Teeth Diagnosed as Carious Average No. Teeth Carious per Child * Note: Given as T.G.L. in original article. Source: Department of Health file: Hastings Study, , National Archives, Wellington. These tables summarised the results of the dental research officer for 7 Hastings and 4 Napier school dental nurses. They show that on average the dental nurses, even after two years of persuasion to alter their earlier standards which were still maintained in the rest of New Zealand, were still finding almost four times as many cavities requiring fillings as the new diagnostic standards required. Subsequently, Ludwig reported to the Department on which dental nurses were and were not 'cooperating'. The problem was also discussed with private dental practitioners in the two towns. Most of the permanent tooth fillings for 6- and 7-year-old children were in the 59

60 "occlusal surfaces of molars" mentioned above. This change in diagnostic procedure followed much discussion within the Fluoridation Committee. In 1954, it had been agreed to instruct school dental nurses in Hastings and Napier to cease inserting 'prophylactic fillings' - that is, small fillings placed, as a preventive measure, in precarious (not decayed but considered likely to decay) fissures on the occlusal (biting) surfaces of permanent molar teeth - and also to discontinue applying fluoride solution topically. In a report sent to the Committee in 1957 entitled ''Effect of prophylactic fillings and examination criteria on the results to be expected from fluoridation" a Dental Faculty member recommended "a re-evaluation of the criteria now used in deciding when a cavity should be filled" and "that no cavity should be filled until the lesion has penetrated the enamel." It was originally intended to record changing decay rates in both Hastings and Napier so that the difference between them would show the fluoride effect. There can be no doubt that Ludwig and the Committee members sincerely believed, in the authors' view correctly, that dental nurses and private dentists were filling many teeth which should not definitely be classed as 'carious'. They also believed that such a meticulous filling practice could prevent a fair test of fluoridation in Hastings. But the change in diagnostic standard which they implemented must have contributed substantially to the reductions reported. Ludwig measured caries prevalence using the 'DMF' measure (average number of decayed missing and filled teeth). Because the children examined, like all children in New Zealand at that time, had been receiving regular six-monthly dental treatments, the measure was largely of the number of fillings. Thus the first recorded DMF scores consisted largely of a count of fillings which had been inserted using the earlier criteria for finding cavities. It is clear that the results eventually published, for Hastings only, claiming to show the effect of water fluoridation, were partly if not mainly the result of the change in diagnostic procedure. The 6- and 7-year-olds, whose occlusal surfaces of molars were in 1594 filled much earlier and more often, would be the most affected by the change and showed the greatest reductions. Also, smooth toothsurface cavities ('approximal' or between-teeth and 'gingival' or near-the-gum) reported by Ludwig and later by Backer Dirks to be the most reduced by fluoridation, were similarly in 1954 filled much earlier than the stage of ''penetration of the 60

61 enamel'' described above. In none of the published papers on the Hastings study was the change in diagnostic standards reported. No explanation has been offered for that omission. Limit of Credibility The claimed large reductions in Hastings are beyond what is today regarded as the ''limit of credibility" for genuine reductions in decay prevalence. According to Alman (Journal of Dental Research, vol. 61 special, p.1361), annualized reduction rate of 10 to 12 per cent becomes an ''upper limit of credibility" and rates well above ten per cent suggest that we may be looking at a data-set-dependency, where the high level of change may combine true changes in caries prevalence with factors relating to changes in the population sampled or with inadvertent changes in diagnostic standards''. The annualized rate is not the percentage over a period divided by the number of years, but is the rate for each single year which would result, when calculated like compound interest, in the percentage reduction over that period. In the Hastings study the spectacular reductions, for 5- to 7-y~olds were mostly beyond the limit of credibility, annualised rates varying between 13 per cent and 20 per cent. Ludwig reported, in each published part of his study, the total reduction since 1954 for each age group, which was very impressively expressed as a percentage. Thus in each later report it was not clear that many reductions since the previous report were quite small, after the first big ones (Figure 1). These large reductions carried through to some extent as the children grew older. The effect is shown in Figure 2 (In Figure 1 the 6- to 8-year-olds in the first stage became the 8- to 10-year-olds in the next stage, 2+ years later). A part of the carried-through difference must have been due to a real decay decline, now known to be occurring everywhere. The change in diagnosis, rather fluoridation, explains the big early reductions. Those big reductions were rather deceptive. Obviously, delaying one filling in a 6- or 7-year-old, whose DMF has reached only 2 or 3, can result in a 30 to 50 per cent reduction. But by the time the child is 15 or 16, with a much higher DMF, the reduction carried through was a much smaller percentage. Thus the difference between the 6-year-old DMFs in Figure 2 is 74 per cent, while the carried-through 61

62 reduction in the two DMFs by the time the children reached 15, is only 13 per cent for the 6.5 year period - an annualised decline of 2 per cent. Figures 1 & 1A Figure 1. Graph compiled from published results of reductions in dmf and DMF teeth, and in percentages with decay, of younger Hastings children between 1954 and The national reduction in 5-year-old dental decay (dmf and percent with decay) is also shown. Early steep declines, after the changed method of diagnosing for fillings, were followed by declines of similar steepness to that occurring for 5- year-olds throughout new Zealand without water fluoridation. Dotted Lines: the percentage of 5-year-olds with decayed teeth (100 percent caries free). Solid Lines: the average number of decayed, missing and filled teeth ('dmf' primary teeth of five-year-olds, and 'DMF' permanent teeth of 6- to 10-year-olds). Figure 2 62

63 Figure 2: The increase in mean DMFT (decayed, missing and filled teeth) of groups of children as they grow older after their fist examination in the study. The suddenly lowered DMFT carried through and 9 or 10 years later was similar to the gradual 5- year-old decline elsewhere. Subjects for the study were all available Hastings schoolchildren of European extraction aged 5 to 16 years (except in 1970) who had lived in the city and consumed fluoridated water throughout life. Number in each age group varied from 259 (5-year) to 24 (16-year). The groups were thus approximately the same children between 1954 and 1970, though reducing in number with some overlapping of content of the groups in intervening years. Figure 2 is compiled from the published results for those children who were examined at age 6 or 7 years and again at 15 or 16 years. Source: Ludwig, op. cit. Decay reduction in non-fluoridated Places A reduction in dental decay of primary teeth at an annualised rate around 4 per cent, shown by continuously collected statistics for 5-year-olds (Health Department Annual Reports, and NZ Dental Journal vol. 48, p.160, vol. 80, p.14), has occurred throughout New Zealand over the past 50 years (see Figure 1A). An equally steep though less continuously recorded decline in year-olds' permanent tooth decay has also occurred, in recent years slightly steeper in nonfluoridated areas (Fulton, WHO monograph no 4, Health Department Annual Report, 1984) In 1962 the Director of the Dental Division of the Health Department, Dr Leslie, in response to a request for dental clinic statistics showing the reported spectacular effects of fluoridation, wrote to the Fluoridation Committee. From dental records of the entire primary school population of New Zealand, he was unable to produce convincing figures showing an advantage from Hastings fluoridation. The 'simple method' he hoped for seems to have been devised. Population dental figures which would have shown relative effects of fluoridation, like those for 5-year-olds, were not collected, and were discontinued for 5year-olds ever since, only selected sample statistics have been presented to defend fluoridation. For Hastings, two articles compared the filling rates in Hastings with other patient 63

64 groups without fluoridation experience (NZ School Dental Service Gazette, vol. 24, p.55, NZ Dental Journal, vol. 62, p.32). In these studies there was no consideration of socioeconomic or ethnic differences between the Hastings and the other groups, nor of differences in decay prevalences between the groups before Hastings was fluoridated. In explanation of Dr Leslie's letter, it is now conceded that there was a reduction in dental decay occurring in New Zealand, over and above the fluoridation effect, during the time of the Hastings study, although treatment records cannot be considered a satisfactory epidemiological tool (D.J. Beck letter to J.C.). However, one would have expected a dental decay reduction of 74 per cent claimed to have resulted from Hastings fluoridation by 1961, to be reflected in treatment requirements. The Department's dental research officer found the same difficulty for Havelock North which was fluoridated along with Hastings, and stated of the years 1955 to "There has been a reduction in the caries incidence for all New Zealand in this period''. He concluded: "It is recommended that an investigation into the effect of fluoridation in Havelock North not be carried out." (File 124/30/33, May21, 1965). No 'before and after' studies, using controls, have ever been carried out to demonstrate the effectiveness of water fluoridation under New Zealand conditions. Napier Reduction According to Fuller. (Letter to J.C.), surveys by Ludwig of Napier children in 1957 and 1961 showed that the change in diagnostic criteria had reduced filling rates only slightly there, indicating that the Hastings reductions were due mainly to fluoridation. Only the 1957 results of those surveys seem to leave been published (Soil Science, vol. 92, p.359). Abandonment of Napier as a control after 1957, and consequent lifting of pressure on school dental operators to delay fillings, would have resulted in the national reduction being less evident in Napier between 1957 and Dental clinic records examined by one author (National collection of School Dental Service patient history charts, Department of Health, Wellington) suggest that the overall 64

65 Napier reduction, over a longer period than the brief one observed by Ludwig, was comparable to the national one (see Figure 3). Figure 3: Napier decay reductions. Declines in mean number of decayed, missing and filled teeth (dmf, 5-year-olds, broken line) and permanent teeth (DMF, 7- to 10- year-olds, solid lines) between 1944 and The overall downward trends are similar to the national decline in dmf for 5-year-olds. Source: 259 dental history charts from Napier school dental clinics. In later part of the period older children were treated by private dentists. Who was Right? The discovery revealed by Ludwig's initial dental surveys in the two towns - that younger children, the ones expected to show the greatest benefit from fluoride, had up to 58 per cent less decay in the un-fluoridated control town - caused considerable embarrassment. The explanation - a trace element in Napier soil causing below average decay there (Nature, vol. 186, p695) - was simply not believed by the opponents of fluoridation. The discovery of the decay difference was not made until well after fluoridation had commenced. It was alleged by opponents that fluoride must have damaged Hastings children 5 teeth. The subsequently published figures on the dental status of virtually the entire 5-year-old population of New Zealand show that Ludwig's published figures for Napier 5-year-olds' dental health at that time (Soil Science, vol. 92, p359) were not below the national average. But the decay prevalence of Hastings 5-yearolds was well above average. Early Doubts The reason for the initial surveys being undertaken after fluoridation had commenced was the replacement of Hewat. The experiment had been commenced by him in 1952, when he carried out pre-fluoridation dental examinations of Hastings children. The results were not published. They are not in Department of Health files. Fuller, 65

66 when he sought to examine them years later, found they had been destroyed in one of the Department's ''periodical purges of records" (letter J.C.). The Medical Research Council whose records at that period were held by the Department of Health, has none on the Hastings experiment. As well as the rather crude and subjectively influenced DMF measure used in United States studies and later by Ludwig, Hewat used a more precise and complex 'caries index' and 'annual caries attack rate', based on the proportion of tooth surfaces diseased after allowing for their period of exposure since eruption (Hewat and Eastcott, Dental Caries in New Zealand, Medical Research Council of New Zealand, 1955). Following the replacement of Hewat, there was in 1954 a complete new start. According to Fuller, Ludwig "simply could not calibrate against Hewat'' Although willing to submit fluoride to a fair trial, Hewat had doubts. In private memoranda he pointed out to his colleagues that an earlier survey had shown that children residing in natural fluoride areas of New Zealand (0.2 or more parts per million) did not have significantly less dental decay, and sometimes had significantly more. He stated: ''In spite of the fact that there is a steady increase in the number of communities in USA which are adopting fluoridation (over 400 recently), there is still doubt in my mind whether the benefit claimed to result from this measure is fully supported by scientific evidence. In New Zealand, we have found that many factors are interrelated with the caries rate, and I am not aware that any consideration has been given to such influences in the published data on caries and fluorine'' (Memo., Mar. 14, 1953 on file 125/299). Professional Behaviour The obvious possibility jumped at by opponents, that fluoride had actually damaged teeth of younger children, seems never to have been entertained by those conducting the experiment. They had faith in their theory that fluoridation would provide an immense benefit, based on their acceptance of evidence from the United States. The experiment was conducted in an atmosphere of intense public debate. Sir Dove Myer Robinson, for many years Mayor of Auckland and a prominent opponent of fluoridation, described the Hastings experiment as a 'swindle'. That view is understandable. But there is no doubt about the good intentions and sincere 66

67 commitment of the professionals who conducted the experiment. Their ways of thinking and behaving are shared with other professions and have been the subject of sociological inquiry in other contexts (eg. "Professional Networks and the Institutionalisation of a Single Mind Set'', American Sociological Review, vol.50, p.639). There was no conscious effort to deceive, because the first deception was of themselves. Some of their actions are difficult to explain or condone. One was the calling in of the police to investigate secretly the backgrounds and political affiliations of persons organising opposition to fluoridation. Apparently the professionals on the Fluoridation Committee were unable to understand that their opponents could have other than sinister motives. The result of their inquiry, in a letter from Head Office, no doubt left them mystified When the 1963 Hastings results were announced they drew comment from Hewat, then living in retirement (File 124/30/33, Apr. 27, 1965). He agreed, with the retired High School principal who had vigorously opposed Hastings fluoridation, that the results as presented could be interpreted differently, to show only a temporary delay in the onset of decay, with no reduction in the progress of the disease. Fuller and Ludwig, supported by the Government Statistician, rejected such an explanation (same File, May 19, 1965). The information now available, presented in this study, reinforces Hewat's assessment, which could explain why by 1962 Hastings children, as Dr Leslie had discovered, were receiving as many fillings as in other places where overall prevalence of the disease was also declining. At the time Fuller commented: "I think we all realise this is largely a question of point of view and unfortunately Dr Hewat does not see it from the viewpoint of a fluoridationist (same file, Apr. 30, l965). Those who are committed to strong belief in a theory can interpret data and arrive at conclusions quite opposite to the conclusions of those who are not so committed. The history of science has repeatedly demonstrated that more than one theoretical construction can usually he placed upon a given collection of data. It is apparent that belief in, and commitment to the fluoridation paradigm, strongly influenced New Zealand health professionals in their interpretation or the Hastings data. Many of the participants in the above events are still living. They have been invited to comment on this new information. 67

68 "The obvious possibility jumped at by opponents, that fluoride had actually damaged teeth of younger children, seems never to have been entertained by those conducting the experiment." Conclusion From the above considerations, it seems clear that the Hastings fluoridation study did not, as it was purported to do, demonstrate the effectiveness of water fluoridation in reducing dental decay in a typical New Zealand population. The reported reductions were at least partly, if not wholly, the result of factors other than fluoridation. Today, proponents or fluoridation will concede that there were other factors operating to cause the reductions, over and above any fluoridation effect. But that fact, although known to those responsible for the study, was never mentioned in official and scientific published reports on it. The study was, it seems, more a public relations exercise than a scientific one. Nonetheless, it is still cited in dental scientific literature, and in textbooks like Professor Murray's, as being the latter. We suggest closer examination of past fluoridation studies in other countries, as begun by Diesendorf (Nature, vol. 322, 125-l29, 10 July, 1986). 68

69 Why I Changed My Mind About Water Fluoridation John Colquhoun To explain how I came to change my opinion about water fluoridation, I must go back to when I was an ardent advocate of the procedure. I now realize that I had learned, in my training in dentistry, only one side of the scientific controversy over fluoridation. I had been taught, and believed, that there was really no scientific case against fluoridation, and that only misinformed lay people and a few crackpot professionals were foolish enough to oppose it I recall how, after I had been elected to a local government in Auckland (New Zealand s largest city, where I practised dentistry for many years and where I eventually became the Principal Dental Officer) I had fiercely and, I now regret, rather arrogantly poured scorn on another Council member (a lay person who had heard and accepted the case against fluoridation) and persuaded the Mayor and majority of my fellow councillors to agree to fluoridation of our water supply. A few years later, when I had become the city s Principal Dental Officer, I published a paper in the New Zealand Dental Journal that reported how children s tooth decay had declined in the city following fluoridation of its water, to which I attributed the decline, pointing out that the greatest benefit appeared to be in low-income areas [1]. My duties as a public servant included supervision of the city s school dental clinics, which were part of a national School Dental Service which provided regular sixmonthly dental treatment, with strictly enforced uniform diagnostic standards, to almost all (98 percent) school children up to the age of 12 or 13 years. I thus had access to treatment records, and therefore tooth decay rates, of virtually all the city s children. In the study I claimed that such treatment statistics provide a valid measure of the dental health of our child population [1]. That claim was accepted by my professional colleagues, and the study is cited in the official history of the New Zealand Dental Association [2]. INFORMATION CONFIDED I was so articulate and successful in my support of water fluoridation that my public service superiors in our capital city, Wellington, approached me and asked me to make fluoridation the subject of a world study tour in 1980 after which I would become their expert on fluoridation and lead a campaign to promote fluoridation in those parts of New Zealand which had resisted having fluoride put into their drinking water. Before I left on the tour my superiors confided to me that they were worried about some new evidence which had become available: information they had collected on the amount of treatment children were receiving in our school dental clinics seemed 69

70 to show that tooth decay was declining just as much in places in New Zealand where fluoride had not been added to the water supply. But they felt sure that, when they had collected more detailed information, on all children (especially the oldest treated, year age group) from all fluoridated and allnonfluoridated places [3] information which they would start to collect while was I away on my tour it would reveal that the teeth were better in the fluoridated places: not the 50 to 60 percent difference which we had always claimed resulted from fluoridation, but a significant difference nonetheless. They thought that the decline in tooth decay in the nonfluoridated places must have resulted from the use of fluoride toothpastes and fluoride supplements, and from fluoride applications to the children s teeth in dental clinics, which we had started at the same time as fluoridation. Being a keen fluoridationist, I readily accepted their explanation. Previously, of course, we had assured the public that the only really effective way to reduce tooth decay was to add fluoride to the water supply. WORLD STUDY TOUR My world study tour took me to North America, Britain, Europe, Asia, and Australia [4]. In the United States I discussed fluoridation with Ernest Newbrun in San Francisco, Brian Burt in Ann Arbor, dental scientists and officials like John Small in Bethesda near Washington, DC, and others at the Centers for Disease Control in Atlanta. I then proceeded to Britain, where I met Michael Lennon, John Beale, Andrew Rugg-Gunn, and Neil Jenkins, as well as many other scientists and public health officials in Britain and Europe. Although I visited only pro-fluoridation research centers and scientists, I came across the same situation which concerned my superiors in New Zealand. Tooth decay was declining without water fluoridation. Again I was assured, however, that more extensive and thorough surveys would show that fluoridation was the most effective and efficient way to reduce tooth decay. Such large-scale surveys, on very large numbers of children, were nearing completion in the United States, and the authorities conducting them promised to send me the results. LESSON FROM HISTORY I now realize that what my colleagues and I were doing was what the history of science shows all professionals do when their pet theory is confronted by disconcerting new evidence: they bend over backwards to explain away the new evidence. They try very hard to keep their theory intact especially so if their own professional reputations depend on maintaining that theory. (Some time after I graduated in dentistry almost half a century ago, I also graduated in history studies, my special interest being the history of science which may partly explain my reexamination of the fluoridation theory ahead of many of my fellow dentists.) So I returned from my study tour reinforced in my pro-fluoridation beliefs by these reassurances from fluoridationists around the world. I expounded these beliefs to my superiors, and was duly appointed chairman of a national Fluoridation Promotion Committee. I was instructed to inform the public, and my fellow professionals, that water fluoridation resulted in better children s teeth, when compared with places with no fluoridation. 70

71 Surprise: Teeth Better Without Fluoridation? Before complying, I looked at the new dental statistics that had been collected while I was away for my own Health District, Auckland. These were for all children attending school dental clinics virtually the entire child population of Auckland. To my surprise, they showed that fewer fillings had been required in the nonfluoridated part of my district than in the fluoridated part. When I obtained the same statistics from the districts to the north and south of mine that is, from Greater Auckland, which contains a quarter of New Zealand s population the picture was the same: tooth decay had declined, but there was virtually no difference in tooth decay rates between the fluoridated and non fluoridated places. In fact, teeth were slightly better in the nonfluoridated areas. I wondered why I had not been sent the statistics for the rest of New Zealand. When I requested them, they were sent to me with a warning that they were not to be made public. Those for 1981 showed that in most Health Districts the percentage of 12- and 13-year-old children who were free of tooth decay that is, had perfect teeth was greater in the non-fluoridated part of the district. Eventually the information was published [4]. Over the next few years these treatment statistics, collected for all children, showed that, when similar fluoridated and non-fluoridated areas were compared, child dental health continued to be slightly better in the non-fluoridated areas [5,6]. My professional colleagues, still strongly defensive of fluoridation, now claimed that treatment statistics did not provide a valid measure of child dental health, thus reversing their previous acceptance of such a measure when it had appeared to support fluoridation. I did not carry out the instruction to tell people that teeth were better in the fluoridated areas. Instead, I wrote to my American colleagues and asked them for the results of the large-scale surveys they had carried out there. I did not receive an answer. Some years later, Dr John Yiamouyiannis obtained the results by then collected by resorting to the U.S. Freedom of Information Act, which compelled the authorities to release them. The surveys showed that there is little or no differences in tooth decay rates between fluoridated and nonfluoridated places throughout America [7]. Another publication using the same database, apparently intended to counter that finding, reported that when a more precise measurement of decay was used, a small benefit from fluoridation was shown (20 percent fewer decayed tooth surfaces, which is really less than one cavity per child) [8]. Serious errors in that report, acknowledged but not corrected, have been pointed out, including a lack of statistical analysis and a failure to report the percentages of decay-free children in the fluoridated and nonfluoridated areas [7]. Other large-scale surveys from United States, from Missouri and Arizona, have since revealed the same picture: no real benefit to teeth from fluoride in drinking water [9, 10]. For example, Professor Steelink in Tucson, AZ, obtained information on the dental status of all schoolchildren 26,000 of them as well as information on the fluoride content of Tucson water [10]. He found: When we plotted the incidence of 71

72 tooth decay versus fluoride content in a child s neighborhood drinking water, a positive correlation was revealed. In other words, the more fluoride a child drank, the more cavities appeared in the teeth [11]. From other lands Australia, Britain, Canada, Sri Lanka, Greece, Malta, Spain, Hungary, and India a similar situation has been revealed: either little or no relation between water fluoride and tooth decay, or a positive one (more fluoride, more decay) [12-17]. For example, over 30 years Professor Teotia and his team in India have examined the teeth of some 400,000 children. They found that tooth decay increases as fluoride intake increases. Tooth decay, they decided, results from a deficiency of calcium and an excess of fluoride [17]. CAUSE OF DECLINE IN TOOTH DECAY At first I thought, with my colleagues, that other uses of fluoride must have been the main cause of the decline in tooth decay throughout the western world. But what came to worry me about that argument was the fact that, in the nonfluoridated part of my city, where decay had also declined dramatically, very few children used fluoride toothpaste, many had not received fluoride applications to their teeth, and hardly any had been given fluoride tablets. So I obtained the national figures on tooth decay rates of five-year-olds from our dental clinics which had served large numbers of these children from the 1930s on [18]. They show that tooth decay had started to decline well before we had started to use fluorides (Fig. 1). Also, the decline has continued after all children had received fluoride all their lives, so the continuing decline could not be because of fluoride. The fewer figures available for older children are consistent with the above pattern of decline [18]. So fluorides, while possibly contributing, could not be the main cause of the reduction in tooth decay. Figure 1 72

73 (reproduced by Fluoride Action Network) So what did cause this decline, which we find in most industrialized countries? I do not know the answer for sure, but we do know that after the second world war there was a rise in the standard of living of many people. In my country there has been a tremendous increase in the consumption of fresh fruit and vegetables since the 1930s, assisted by the introduction of household refrigerators [19]. There has also been an eightfold increase in the consumption per head of cheese, which we now know has anti-decay properties [19, 20]. These nutritional changes, accompanied by a continuing decline in tooth decay, started before the introduction of fluorides. The influence of general nutrition in protection against tooth decay has been well described in the past [21], but is largely ignored by the fluoride enthusiasts, who insist that fluorides have been the main contributor to improved dental health. The increase in tooth decay in third-world countries, much of which has been attributed to worsening nutrition [22], lends support to the argument that improved nutrition in developed countries contributed to improved dental health. FLAWED STUDIES The studies showing little if any benefit from fluoridation have been published since Are there contrary findings? Yes: many more studies, published in dental professional journals, claim that there is a benefit to teeth from water fluoride. An example is a recent study from New Zealand [23], carried out in the southernmost area of the country [23]. Throughout New Zealand there is a range of tooth decay 73

74 rates, from very high to very low, occurring in both fluoridated and nonfluoridated areas. The same situation exists in other countries. What the pro-fluoride academics at our dental school did was to select from that southern area four communities: one nonfluoridated, two fluoridated, and another which had stopped fluoridation a few years earlier. Although information on decay rates in all these areas was available to them, from the school dental service, they chose for their study the one non-fluoridated community with the highest decay rate and two fluoridated ones with low decay rates, and compared these with the recently stopped fluoridated one, which happened to have medium decay rates (both before and after it had stopped fluoridation). The teeth of randomly selected samples of children from each community were examined. The chosen communities, of course, had not been randomly selected. The results, first published with much publicity in the news media, showed over 50 percent less tooth decay in the fluoridated communities, with the recently defluoridated town in a middle position (see left side of Fig. 2). When I obtained the decay rates for all children in all the fluoridated and all the nonfluoridated areas in that part of New Zealand, as well as the decay rates for all children in the recently defluoridated town, they revealed that there are virtually no differences in tooth decay rates related to fluoridation (see right side of Fig. 2). When I confronted the authors with this information, they retorted that the results of their study were consistent with other studies. And of course it is true that many similar studies have been published in the dental professional literature. It is easy to see how the consistent results are obtained: an appropriate selection of the communities being compared. There is another factor: most pro-fluoridation studies (including this New Zealand one) were not blind that is, the examiners knew which children received fluoride and which did not. Diagnosis of tooth decay is a very subjective exercise, and most of the examiners were keen fluoridationists, so it is easy to see how their bias could affect their results. It is just not possible to find a blind fluoridation study in which the fluoridated and nonfluoridated populations were similar and chosen randomly. EARLY FLAWED STUDIES One of the early fluoridation studies listed in the textbooks is a New Zealand one, the Hastings Fluoridation Experiment (the term experiment was later dropped because the locals objected to being experimented on) [24]. I obtained the Health Department s fluoridation files under my own country s Official Information legislation. They revealed how a fluoridation trial can, in effect, be rigged [25]. The school dentists in the area of the experiment were instructed to change their method of diagnosing tooth decay, so that they recorded much less decay after fluoridation began. Before the experiment they had filled (and classified as decayed ) teeth with any small catch on the surface, before it had penetrated the outer enamel layer.after the experiment began, they filled (and classified as decayed ) only teeth with cavities which penetrated the outer enamel layer. It is easy to see why a sudden drop in the numbers of decayed and filled teeth occurred. This change in method of diagnosis was not reported in any of the published accounts of the experiment. Another city, Napier, which was not fluoridated but had otherwise identical drinking water, was at first included in the experiment as an ideal control to show how 74

75 tooth decay did not decline the same as in fluoridated Hastings. But when tooth decay actually declined more in the non-fluoridated control city than in the fluoridated one, in spite of the instructions to find fewer cavities in the fluoridated one, the control was dropped and the experiment proceeded with no control. (The claimed excuse was that a previously unknown trace element, molybdenum, had been discovered in some of the soil of the control city, making tooth decay levels there unusually low [26], but this excuse is not supported by available information, from the files or elsewhere, on decay levels throughout New Zealand). The initial sudden decline in tooth decay in the fluoridated city, plus the continuing decline which we now know was occurring everywhere else in New Zealand, were claimed to prove the success of fluoridation. These revelations from government files were published in the international environmental journal, The Ecologist, and presented in 1987 at the 56th Congress of the Australian and New Zealand Association for the Advancement of Science [27]. When I re-examined the classic fluoridation studies, which had been presented to me in the text books during my training, I found, as others had before me, that they also contained serious flaws [28-30]. The earliest set, which purported to show an inverse relationship between tooth decay prevalence and naturally occurring water fluoride concentrations, are flawed mainly by their nonrandom methods of selecting data. The later set, the fluoridation trials at Newburgh, Grand Rapids, Evanston, and Brantford, display inadequate baselines, negligible statistical analysis, and especially a failure to recognize large variations in tooth decay prevalence in the control communities. We really cannot know whether or not some of the tooth decay reductions reported in those early studies were due to water fluoride. I do not believe that the selection and bias that apparently occurred was necessarily deliberate. Enthusiasts for a theory can fool themselves very often, and persuade themselves and others that their activities are genuinely scientific. I am also aware that, after 50 years of widespread acceptance and endorsement of fluoridation, many scholars (including the reviewers of this essay) may find it difficult to accept the claim that the original fluoridation studies were invalid. That is why some of us, who have reached that conclusion, have submitted an invitation to examine and discuss new and old evidence in the hope that at least some kind of scholarly debate will ensue [31]. However, whether or not the early studies were valid, new evidence strongly indicates that water fluoridation today is of little if any value. Moreover, it is now widely conceded that the main action of fluoride on teeth is a topical one (at the surface of the teeth), not a systemic one as previously thought, so that there is negligible benefit from swallowing fluoride [32]. Harm from Fluoridation The other kind of evidence which changed my mind was that of harm from fluoridation. We had always assured the public that there was absolutely no possibility of any harm. We admitted that a small percentage of children would have a slight mottling of their teeth, caused by the fluoride, but this disturbance in the formation of tooth enamel would, we asserted, be very mild and was nothing to worry 75

76 about. It was, we asserted, not really a sign of toxicity (which was how the early literature on clinical effects of fluoride had described it) but was only at most a slight, purely cosmetic change, and no threat to health. In fact, we claimed that only an expert could ever detect it. HARM TO TEETH So it came as a shock to me when I discovered that in my own fluoridated city some children had teeth like those in Fig. 3. This kind of mottling answered the description of dental fluorosis (bilateral diffuse opacities along the growth lines of the enamel). Some of the children with these teeth had used fluoride toothpaste and swallowed much of it. But I could not find children with this kind of fluorosis in the nonfluoridated parts of my Health District, except in children who had been given fluoride tablets at the recommended dose of that time. I published my findings: 25 percent of children had dental fluorosis in fluoridated Auckland and around 3 percent had the severer (discolored or pitted) degree of the condition [33]. At first the authorities vigorously denied that fluoride was causing this unsightly mottling. However, the following year another Auckland study, intended to discount my finding, reported almost identical prevalences and severity, and recommended lowering the water fluoride level to below 1 ppm [34]. Others in New Zealand and the United States have reported similar findings. All these studies were reviewed in the journal of the International Society for Fluoride Research [35]. The same unhappy result of systemic administration of fluoride has been reported in children who received fluoride supplements [36]. As a result, in New Zealand as elsewhere, the doses of fluoride tablets were drastically reduced, and parents were warned to reduce the amount of fluoride toothpaste used by their children, and to caution them not swallow any. Fluoridationists would not at first admit that fluoridated water contributed to the unsightly mottling though later, in some countries including New Zealand, they also recommended lowering the level of fluoride in the water. They still insist that the benefit to teeth outweighs any harm. WEAKENED BONES Common sense should tell us that if a poison circulating in a child s body can damage the tooth-forming cells, then other harm also is likely. We had always admitted that fluoride in excess can damage bones, as well as teeth. By 1983 I was thoroughly convinced that fluoridation caused more harm than good. I expressed the opinion that some of these children with dental fluorosis could, just possibly, have also suffered harm to their bones [Letter to Auckland Regional Authority, January 1984]. This opinion brought scorn and derision: there was absolutely no evidence, my dental colleagues asserted, of any other harm from low levels of fluoride intake, other than mottling of the teeth. Six years later, the first study reporting an association between fluoridated water and hip fractures in the elderly was published [37]. It was a large-scale one. Computerization has made possible the accumulation of vast data banks of information on various diseases. Hip fracture rates have increased dramatically, independently of the increasing age of populations. Seven other studies have now 76

77 reported this association between low water fluoride levels and hip fractures [38-44]. Have there been contrary findings? Yes; but most of the studies claiming no association are of small numbers of cases, over short periods of time, which one would not expect to show any association [45, 46]. Another, comparing a fluoridated and a nonfluoridated Canadian community, also found an association in males but not in females, which hardly proves there is no difference in all cases [47]. Our fluoridationists claim that the studies which do show such an association are only epidemiological ones, not clinical ones, and so are not conclusive evidence. But in addition to these epidemiological studies, clinical trials have demonstrated that when fluoride was used in an attempt to treat osteoporosis (in the belief it strengthened bones), it actually caused more hip fractures [48-52]. That is, when fluoride accumulates in bones, it weakens them. We have always known that only around half of any fluoride we swallow is excreted in our urine; the rest accumulates in our bones [53, 54]. But we believed that the accumulation would be insignificant at the low fluoride levels of fluoridated water. However, researchers in Finland during the 1980s reported that people who lived 10 years or more in that country s one fluoridated city, Kuopio, had accumulated extremely high levels of fluoride in their bones thousands of parts per million especially osteoporosis sufferers and people with impaired kidney function [55, 56]. After this research was published, Finland stopped fluoridation altogether. But that information has been ignored by our fluoridationists. BONE CANCER? An association with hip fracture is not the only evidence of harm to bones from fluoridation. Five years ago, animal experiments were reported of a fluoride-related incidence of a rare bone cancer, called osteosarcoma, in young male rats [57]. Why only the male animals got the bone cancer is not certain, but another study has reported that fluoride at very low levels can interfere with the male hormone, testosterone [58]. That hormone is involved in bone growth in males but not in females. This finding was dismissed by fluoridation promoters as only equivocal evidence, unlikely to be important for humans. But it has now been found that the same rare bone cancer has increased dramatically in young human males teenage boys aged 9 to 19 in the fluoridated areas of America but not in the nonfluoridated areas [59]. The New Jersey Department of Health reported osteosarcoma rates were three to seven times higher in its fluoridated areas than in its nonfluoridated areas [60]. Once again, our fluoridationists are claiming that this evidence does not conclusively demonstrate that fluoride caused the cancers, and they cite smallscale studies indicating no association. One study claimed that fluoride might even be protective against osteosarcoma [61]; yet it included only 42 males in its 130 cases, which meant the cases were not typical of the disease, because osteosarcoma is routinely found to be more common in males. Also, the case-control method used was quite inappropriate, being based on an assumption that if ingested fluoride was the cause, osteosarcoma victims would require higher fluoride exposure than those without the disease. The possibility that such victims might be more 77

78 susceptible to equal fluoride exposures was ignored. All these counter-claims have been subjected to critical scrutiny which suggests they are flawed [62, 63]. Nonetheless, the pro-fluoride lobbyists continue to insist that water fluoridation should continue because, in their view, the benefits to teeth outweigh the possibility of harm. Many dispute that assessment. OTHER EVIDENCE OF HARM There is much more evidence that tooth mottling is not the only harm caused by fluoridated water. Polish researchers, using a new computerized method of X-ray diagnosis, reported that boys with dental fluorosis also exhibit bone structure disturbances [64]. Even more chilling is the evidence from China that children with dental fluorosis have on average lower intelligence scores [65, 66]. This finding is supported by a recently published animal experiment in America, which showed that fluoride also accumulated in certain areas of the brain, affecting behavior and the ability to learn [67]. Endorsements Not Universal Concerning the oft-repeated observation that fluoridation has enjoyed overwhelming scientific endorsement, one should remember that even strongly supported theories have eventually been revised or replaced. From the outset, distinguished and reputable scientists opposed fluoridation, in spite of considerable intimidation and pressure [68, 69]. Most of the world has rejected fluoridation. Only America where it originated, and countries under strong American influence persist in the practice. Denmark banned fluoridation when its National Agency for Environmental Protection, after consulting the widest possible range of scientific sources, pointed out that the long-term effects of low fluoride intakes on certain groups in the population (for example, persons with reduced kidney function), were insufficiently known [70]. Sweden also rejected fluoridation on the recommendation of a special Fluoride Commission, which included among its reasons that: The combined and long-term environmental effects of fluoride are insufficiently known [71]. Holland banned fluoridation after a group of medical practitioners presented evidence that it caused reversible neuromuscular and gastrointestinal harm to some individuals in the population [72]. Environmental scientists, as well as many others, tend to doubt fluoridation. In the United States, scientists employed by the Environmental Protection Agency have publicly disavowed support for their employer s pro-fluoridation policies [73]. The orthodox medical establishment, rather weak or even ignorant on environmental issues, persist in their support, as do most dentists, who tend to be almost fanatical about the subject. In English- speaking countries, unfortunately, the medical profession and its allied pharmaceutical lobby (the people who sell fluoride) seem to have more political influence than environmentalists. 78

79 REFERENCES 1. Colquhoun J. The influence of social rank and fluoridation on dental treatment requirements. New Zealand Dental Journal Brooking TWH. A History of Dentistry in New Zealand. Dunedin. New Zealand Dental Association 1980 pp Hollis MJ, Hunter PB. Official Instructions: Dental health statistics, Form II children. School Dental Service Gazette 41 (3) Colquhoun J. New evidence on fluoridation. Social Science and Medicine Colquhoun J. Influence of social class and fluoridation on child dental health. Community Dentistry and Oral Epidemiology Colquhoun J. Child dental health differences in New Zealand. Community Health Studies Yiamouyiannis JA. Water fluoridation and tooth decay: Results from the national survey of U.S. schoolchildren. Fluoride Brunelle JA, Carlos JP Recent trends in dental caries in U. S. children and the effect of water fluoridation. Journal of Dental Research 69 (Special Issue) Hildebolt CF, Elvin-Lewis M, Molnar S et al. Caries prevalences among geochemical regions of Missouri. American Journal of Physical Anthropology Jones T, Steelink C, Sierka J. Analysis of the causes of tooth decay in children in Tucson, Arizona. Paper presented at Annual Meeting of the American Association for the Advancement of Science, San Francisco, USA, February Abstract in Fluoride 27 (4) Steelink C. Letter. Chemical and Engineering News 27 July 1992 pp Diesendorf M A re-examination of Australian fluoridation trials. Search Diesendorf M. Have the benefits of water fluoridation been overestimated? International Clinical Nutrition Review Diesendorf M. The mystery of declining tooth decay. Nature Gray A S. Fluoridation: Time for a new base line? Journal of the Canadian Dental Association Ziegelbecker RC, Ziegelbecker R. WHO data on dental caries and natural water fluoride levels. Fluoride Teotia SPS, Teotia M. Dental caries: a disorder of high fluoride and low dietary calcium interactions (30 years of personal research). Fluoride Colquhoun J. Fluorides and the decline in tooth decay in New Zealand. Fluoride Hamilton V, Birkbeck JA. The Home Style Survey of New Zealand s Changing Diet. Quality Bakers, Palmerston North Herod EL. The effect of cheese on dental caries: A review of the literature. Australian Dental Journal 36 (2) Price WA. Nutrition and Physical Degeneration. Heuber, New York Smith G. Tooth decay in the developing world: could a vaccine help prevent cavities? Perspectives in Biology and Medicine

80 23. Treasure ET, Dever JG. The prevalence of caries in 5-year-old children living in fluoridated and non-fluoridated communities in New Zealand. New Zealand Dental Journal Ludwig TG. The Hastings fluoridation project. New Zealand Dental Journal (co-author EIF Pearce) Department of Health files on fluoridation in National Archives, Wellington, New Zealand. Copies in possession of author and described in: Colquhoun J. Education and Fluoridation in New Zealand: An historical study (PhD dissertation, University of Auckland). University Microfilms International, Ann Arbor MI Ludwig TG. Recent marine soils and resistance to dental caries. Australian Dental Journal Colquhoun J, Mann R. The Hastings fluoridation experiment: Science or swindle? Ecologist 16 (6) (2) Colquhoun J. Flawed foundation: A re-examination of the scientific basis for a dental benefit from fluoridation. Community Health Studies Klerer M. The fluoridation experiment. Contemporary Issues Sutton PRN. Fluoridation: Errors and Omissions in Experimental Trials. Melbourne University Press, Melbourne Diesendorf M, Colquhoun J, Spittle B J et al. New evidence on fluoridation. Australian and New Zealand Journal of Public Health Journal of Dental Research 69 (Special Issue) Colquhoun J. Disfiguring dental fluorosis in Auckland, New Zealand. Fluoride Cutress TW, Suckling GW, Pearce EIF, Ball ME. Defects in tooth enamel in children in fluoridated and non-fluoridated water areas of the Auckland Region. New Zealand Dental Journal Colquhoun J. Disfiguring or white and strong? Fluoride Aasenden R, Peebles TC. Effects of fluoride supplementation from birth on human deciduous and permanent teeth. Archives of Oral Biology Jacobsen SJ, Goldberg J, Miles TP et al. Regional variation in the incidence of hip fracture among white women aged 65 years and older. Journal of the American Medical Association Cooper C, Wickham CAC, Barker DJR, Jacobsen SJ. Letter. Journal of the American Medical Association Jacobsen SJ, Goldberg J, Cooper C, Lockwood SA. The association between water fluoridation and hip fracture among white women and men aged 65 years and older. A national ecologic study. Annals of Epidemiology Sowers MFR, Clark MK, Jannausch ML, Wallace RB. A prospective study of bone mineral content and fracture in communities with differential fluoride exposure. American Journal of Epidemiology Jacqmin-Gadda H, Commenges D, Dartigues J-F. Fluorine concentration in drinking water and fractures in the elderly. Journal of the American Medical Association Danielson C, Lyon JL, Egger M, Goodenough GK. Hip fractures and fluoridation in Utah s elderly population. Journal of the American Medical Association

81 43. Keller C. Fluorides in drinking water. Paper presented at Workshop on Drinking Water Fluoride Influence on Hip Fractures and Bone Health. Bethesda MD, April May DS., Wilson MG. Hip fractures in relation to water fluoridation: an ecologic analysis. Paper presented at Workshop on Drinking Water Fluoride Influence on Hip Fractures and Bone Health. Bethesda MD, April 10, Cauley JA, Murphy PA, Riley T, Black D. Public health bonus of water fluoridation: Does fluoridation prevent osteoporosis and its related fractures? American Journal of Epidemiology Abstract. 46. Jacobsen SJ, O Fallon WM, Melton III IJ. Hip fracture incidence before and after fluoridation of the public water supply, Rochester, Minnesota. American Journal of Public Health Suarez-Almazor ME, Flowerdew G, Saunders LD et al. The fluoridation of drinking water and hip fracture hospitalization rates in 2 Canadian communities. American Journal of Public Health Riggs BL, Hodgson SF, O Fallon WM et al. Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. New England Journal of Medicine Kleerekoper M, Peterson E, Philips E et al. Continuous sodium fluoride therapy does not reduce vertebral fracture rate in postmenopausal osteoporosis. Journal of Bone and Mineral Research 4 (Suppl 1) S Abstract. 50. Hedlund LR, Gallagher JC. Increased incidence of hip fracture in osteoporotic women treated with sodium fluoride. Journal of Bone and Mineral Research Lindsay R. Fluoride and bone quantity versus quality. New England Journal of Medicine Melton LJ. Fluoride in the prevention of osteoporosis and fractures. Journal of Bone and Mineral Research 5 (Suppl 1) S163-S Fluorides and Human Health. World Health Organization, Geneva 1970 pp Fluorine and Fluorides. World Health Organization, Geneva 1984 pp Alhava EM, Olkkomen H, Kauranen P, Kari T. The effect of drinking water fluoridation on the fluoride content, strength and mineral density of human bone. Acta Orthopædica Scandinavica Arnala I, Alhava EM, Kauranen EM. Effects of fluoride on bone in Finland. histomorphometry of cadaver bone from low and high fluoride areas. Acta Orthopædica Scandinavica Maurer JK, Cheng MC, Boysen BG, Anderson RL. Two-year carcinogenicity study of sodium fluoride in rats. Journal, National Cancer Institute Kanwar KC, Parminderjit SV, Kalla NR. In vitro inhibition of testosterone synthesis in the presence of fluoride ions. IRCS Medical Science Hoover RN, Devesa S, Cantor K, Fraumeni Jr JF. Time trends for bone and joint cancers and osteosarcomas in the Surveillance, Epidemiology and End Results (SEER) Program, National Cancer Institute. In: Review of Fluoride: Benefits and Risks, Report of the Ad Hoc Committee on Fluoride of the Committee to Coordinate Environmental Health and Related Programs. US Public Health Service, F1-F7. 81

82 60. Cohn PD. A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males. New Jersey Department of Health, November Gelberg KH, Fitzgerald EF, Hwang S, Dubrow R. Fluoride exposure and childhood osteosarcoma: a case-control study. American Journal of Public Health Lee JR. Review of report by K H Gelberg et al. Fluoride Yiamouyiannis JA. Fluoridation and cancer. Fluoride Chlebna-Sokol D, Czerwinski E. Bone structure assessment on radiographs of distal radial metaphysis in children with dental fluorosis. Fluoride Li XS, Zhi JL, Gao RO. Effect of fluoride exposure on intelligence of children. Fluoride Zhao LB, Liang GH, Zhang DN, Wu XR. Effect of a high fluoride water supply on children s intelligence. Fluoride Mullenix PJ, Denbesten PK, Schunior A, Kernan WJ. Neurotoxicity of sodium fluoride in rats. Neurotoxicology and Teratology (Cf. Editorial: Neurotoxicity of Fluoride. Fluoride ). 68. Martin B. Scientific Knowledge in Controversy: The Social Dynamics of the Fluoridation Debate. State University of New York Press, Albany NY Waldbott GL, Burgstahler AW, McKinney HL. Fluoridation: The Great Dilemma. Coronado Press, Lawrence KS Chapter Nyt fra miljøstyrelsen (Newsletter of National Agency of Environmental Protection, Denmark). Special issue (in English), February, Fluor i karies- förebyggande syfte (Report of Swedish Fluoride Commission). Statens Offentliga Utredningar, Stockholm English-language summary pp Grimbergen GW. A double blind test for determination of intolerance to fluoridated water (preliminary report). Fluoride Hirzy W. Press releases. Fluoride ; Fluoride * John Colquhoun School of Education, University of Auckland, Private Bag 92019, Auckland, New Zealand by The University of Chicago Press. All rights reserved. First published in Perspectives in Biology and Medicine Reprinted with permission in Fluoride, Journal of the International Society for Fluoride Research. Editorial Office: 81A Landscape Road, Mount Eden, Auckland 1004, New Zealand PERSPECTIVES IN BIOLOGY AND MEDICINE The purpose of this quarterly journal is to serve as a vehicle for articles which convey new ideas or stimulate original thought in the biological and medical sciences. Subscription information is available from the publisher: the University of Chicago Press, Journals Division, PO Box 37005, Chicago, IL 60637, USA. 82

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84 Fluoride & Intelligence: The 36 Studies Fluoride Action Network By Michael Connett & Tara Blank, PhD UPDATED December 9, 2012 As of December 2012, a total of 42 studies have investigated the relationship between fluoride and human intelligence, and a total of 17 studies have investigated the relationship fluoride and learning/memory in animals. Of these investigations, 36 of the 42 human studies have found that elevated fluoride exposure is associated with reduced IQ, while 16 of the 17 animal studies have found that fluoride exposure impairs the learning and memory capacity of animals. The human studies, which are based on IQ examinations of over 11,000 children, provide compelling evidence that fluoride exposure during the early years of life can damage a child s developing brain. After reviewing 27 of these studies, a team of Harvard scientists concluded that fluoride s effect on the young brain should now be a high research priority. (Choi, et al 2012). Other reviewers have reached similar conclusions, including the prestigious National Research Council (NRC), and scientists in the Neurotoxicology Divisionof the Environmental Protection Agency (Mundy, et al). In the table below, we summarize the results from the 36 studies that have found associations between fluoride and reduced IQ and provide links to full-text copies of the studies. For a discussion of the 6 studies that did not find an association between fluoride and IQ, click here. Quick Facts About the 36 Studies: Location of Studies: China (28), India (4), Iran (3), and Mexico (1). Sources of Fluoride Exposure: Thirty of the thirty-six IQ studies involved communities where the predominant source of fluoride exposure was water; six studies investigated fluoride exposure from coal burning. Fluoride Levels in Water: IQ reductions have been significantly associated with fluoride levels of just 0.88 mg/l among children with iodine deficiency. (Lin 1991) Other studies have found IQ reductions at 1.8 ppm (Xu 1994); 1.9 ppm (Xiang 84