Frequently Asked Questions
What is a safe level of fluoride in drinking water?
There is no quick answer to this.
Firstly, you need to understand the difference between the level in drinking water (concentration) and dose – the total daily intake. It is the latter that is relevant to safety. The “authorities” still do not grasp this essential point.
When fluoridation began in the 1940s, the daily intake was 0 to 0.5 mg/day.
Trendley Dean and others considered 1 mg/day to be a balance between dental protection and increased dental fluorosis (fluoride poisoning). Dean actually considered this too high (he found dental fluorosis at much lower levels) and was opposed to fluoridation, even though he was persuaded to go along with it and became known as ‘the father of fluoridation”.
In temperate climates (like NZ) people typically drank 1 litre of water a day. At 1 mg/l (or 1ppm) this added 1 mg/day to intake, for a maximum of 1.5 mg/day from all sources. In hotter climates eg Queensland Australia the level was set at 0.6 ppm. In cold climates it was set at 1.2 – 1.5 ppm.
To take peanuts as an example, some individuals go into anophylactic shock with the merest trace of peanut intake. Personally I (the author) can tolerate a taste or two of peanut satay, but a meal of it would make me vomit. For most people, there probably is no upper limit (unlike fluoride).
Similarly, some people are allergic to fluoride and have medical certificates to that effect. There was a young girl in Wellington who was so allergic she had to have her water DOUBLE distilled, as the first distillation still had traces of fluoride in it (comes over as HF).
Once the ambient intake of fluoride is known, however, the level in water roughly equates to a known additional fluoride burden.
The National Research Council’s 2006 report identified adverse effects at levels as low as 0.1 ppm in the water, especially for children with iodine deficiency. Interestingly, 0.1 ppm was the proposed upper limit for drinking water in the USA in the 1930s/40s before vested interests decided to get it in the public water supply to avoid litigation (see “The Fluoride Deception” by Chris Bryson). The NRC concluded that they could find no lower limit of fluoride intake that was protective of health, hence could not recommend a safe level for drinking water.
In NZ, the Public Health Commission in 1995 identified that ambient fluoride intake had increased, that people were being overdosed by the additional fluoride burden of 1ppm in the water, and recommended lowering to 0.7 ppm. The NZMA and NZDA continued to quote the “magic number” of 1ppm until recently, and refused to address this inconsistency. The Ministry of Health, since I made that enquiry, slowly acknowledged a “range” of 0.7 to 1 ppm, with a target of 0.8 ppm.
If it were not for the increase in ambient exposure, it seems generally agreed that normal healthy people can tolerate 0.3ppm (or roughly 0.3 mg/day). This seems the upper limit for those with impaired kidney function (leaving aside the ever-increasing ambient exposure).
Most NZ water is naturally 0.1 ppm or less, which is not going to add a significant fluoride burden to ambient exposure. Some places are up to 0.3 ppm.
The situation is different for infants, however. Breast milk contains between 0.006 ppm (unfluoridated mother) and 0.16 ppm (fluoridated mother). This must be assumed the upper safe limit for infants. The NZ Food Safety standard for fluoride in infant formula specified fluoride-free water for reconstituting formula powder.
Heightened risk of dental fluorosis, the first sign of chronic fluoride poisoning, is greatest at 0-6 months but continues until age 4 according to international studies.
The commonly stated 0.05-0.07 mg per kg body weight/day is now outdated, and was never assessed for young children. It is considered too high by informed scientists.
“Authorities” used to quote 1 mg/day as an “adequate dose” and 3 mg/day as the upper limit for toxicity. With no scientific justification (but politically directed) they now say 3 mg/day is an “adequate dose” and 10 mg/day is the upper limit. In fact 5 mg/day will cause skeletal fluorosis and even Hodge identified 10 mg/day as toxic. In this context “adequate dose” is a technical term. It means “there is no scientific evidence, but this is what most people are ingesting and they don’t seem to suffer ill-effects” (but authorities never look for ill-effects in the short term, let alone the long term).
So overall, our exposure to fluoride today is up to 3 mg/day (NZ) or 6 mg/day (USA) without fluoridated water – more than a safe exposure. Consequently no addition of fluoride to water is safe.
Is there a difference between “natural” fluoride and “artificial” fluoride?
This is a complex question which proponents answer in a naively simplistic way: that all fluoride ions are the same no matter where they come from. In fact, this involves four separate questions:
1. Do all fluoridation substances dissociate to form fluoride ions?
2. If so, do the ions behave the same way when in solution with different cations?
3. If so, do they stay the same way once they have entered the body’s digestive system?
4. If not, do the different forms behave the same way once it enters the body’s digestive system?
1. “Natural” fluoride is calcium fluoride which, at 1 ppm, dissociates to form free calcium and fluoride ions. The same is true of sodium fluoride, on which all research was done. The substances used to today are silicofluorides. The only scientific reference the Ministry of health cites, claiming silicofluorides dissociate completely by a 2-stage process to form free fluoride ions, in fact says they do not. One of the two methods of analysis showed only an 87% dissociation.
2. It is well established that the presence of calcium or magnesium “buffers” the effect of fluoride, safeguarding the human body to some extent. In fact calcium is given as an antidote to acute fluoride poisoning. Waters with “natural” fluoride levels usually have high calcium and or magnesium levels also, whereas artificially fluoridated water generally does not. Consequently this natural protection is unavailable in artificially fluoridated water.
3. We are aware of no studies to show directly whether the dissociation equilibrium of silicofluorides changes in the acidic stomach conditions, or the enzymatic conditions in the intestines. There is evidence that any fluoride ion will form both hydrofluoric acid (HF) and the equally toxic HF2– in acid solutions such as the stomach. This would be expected to cause stomach ulcers, as evidenced in some early research.
4. The US EPA acknowledges that no human safety testing has been done on silicofluorides. However Masters and Coplan demonstrated in 1999 that silicofluorides cause a higher uptake of dietary lead than sodium fluoride, proving that there is a different effect between different forms of fluoride, contrary to proponents’ claims.
Hence although all fluoride ions are chemically the same, that is essentially irrelevant to the issue.
It is also worth noting that early fluoride toothpastes used stannous fluoride, but this was stopped as it caused brown staining of the teeth. Toothpaste manufacturers changed to, primarily, sodium monofluorophosphate which did not cause such staining. If all fluoride is the same, why did one fluoride compound cause staining and not the other? This simple fact proves the lie promulgated by proponents.
Don’t health authorities like WHO support fluoridation?
Firstly, WHO only endorsed fluoridation by proxy: it was part of a bulk bill pion, or even a quorum, at the ned of a session when the Assembly had run out of time and the 45 members remaining just passed everything that was left.
Further, WHO’s “support” for fluoridation carries the explicit waiver that if anyone’s health is harmed by fluoridation WHO refuse to accept responsibility.
WHO’s position is, further, that it supports fluoridation up to a maximum intake of 1.5 mg per day from all sources: it does not support a blanket fluoridation policy of 1ppm regardless of total intake as currently promoted in NZ.
Also we must look at how WHO came to adopt a pro-fluoridation stance. WHO originally resisted US pressure to endorse fluoridation as it had more important health matters to deal with, such as 30 year life expectancy in 3rd world countries. For 2 years it turned away approaches. Then in 1950 the US delegation promoted a general resolution that WHO concern itself with dental health. Leonard Scheele Surgeon General of the US PHS , and promoter of fluoridation, was elected president of WHO. By 1958 5 of the 7 man special committee reporting on fluoridation were known fluoridation promoters who then committed WHO to supporting it. (Expert Committee on Fluoridation, Technical Report 146, WHO, Geneva, 1958).
That this subversion was not well received by many countries was noted by E. Krieps, Minister of Public Health Luxembourg 1976:
|Re the last WHO resolution: ” the vote on this resolution had been preceded by dramatic discussions, at times extremely violent, between followers and the adversaries of fluoridation of drinking water, which proves to society that the last word has certainly not been said in this complex and complicated domain.”
Meanwhile, Sweden discontinued fluoridation in 1969, after 10 years of study. The Swedish government asked WHO to provide evidence of WHO’s claim that fluoridation was safe. No evidence was ever produced, and the Swedish parliament declared fluordation illegal in 1971.
In fact, outside the U.S., a number of scientific groups and individuals have decided fluoridation is not safe:
In France, the Chief Council of Public Health rejected fluoridation in 1980 because of doubts about whether it harms human health.
The minister for the environment in Denmark recommended in 1977 that fluoridation not be allowed primarily because no adequate studies had been carried out on its long-term effects on human organ systems other than teeth and because not enough studies had been done on the effects of fluoride discharges on freshwater ecosystems.
In 1978, the West German Association of Gas & Water Experts rejected fluoridation for legal reasons and because “the so-called optimal fluoride concentration of 1 mg per L is close to the dose at which long-term damage [to the human body] is to be expected.”
In countries with political ties to the US many “authorities” have endorsed fluoridation based on endorsements by other “authorities” but without ever studying the relevant research. This is called “bootstrapping”: first some “authorities” accepted the word of the US PHS and ADA, and then quote simply each other as support for their own position.
For example the US National Cancer Institute endorsed fluoridation as safe for 25 years, until they had to admit before a Congressional Inquiry that they had never conducted a single piece of research to support that endorsement. The AMA in 1965 refused to support fluoridation as safe as it had conducted no research. Those who support fluoridation, like the CDC, ADA, USPHS, have never supported their view in public when challenged by opponents. The US EPA which has been a main supporter of fluoridation admitted in 2002 that no human health studies had ever been completed on the Silicofluorides used in water fluoridation, and in 2003 called for promoters such as the CDC and ADA to present their evidence at its scientific forum: all federal agency supporters of fluoridation declined to appear –the very organisations quoted as endorsing fluoridation.
The bottom line is that whenever promoters are asked to support their position with scientific research, they quote endorsements from each other instead. It must be remembered that the York Review, after studying every published epidemiological study since the beginnings of fluoridation found no evidence of safety and no evidence of significant benefits and, most importantly, all such research was of such poor scientific standard as to be unreliable as to results.
So what do these “authorities” base their “recommendations” on?
What is Dental Fluorosis – is it just cosmetic?
Dental fluorosis is a defect in tooth enamel resulting only from fluoride taken into the bloodstream such as by drinking fluoridated water. It is not caused by brushing with fluoride toothpaste (unless the toothpaste is swallowed). In mild forms it looks like tiny white spots on the enamel – hardly visible. In more severe cases the spots become brown or even black. This latter type actually results in tooth decay.
It is not merely cosmetic. Those who promote fluoridation claim it is but is was acknowledged as far back as 1949 that fluorosis is the first outward sign of skeletal fluorosis and chronic fluoride poisoning:
“Dental fluorosis, or ‘mottled’ enamel, is the first outward symptom of chronic fluoride poisoning.”
– Medical Research Council UK, 1949.
“Dental fluorosis is the first detectable sign of chronic fluoride poisoning.”
– US National Research Council, 1951.
“Fluorosis results from the ingestion of toxic amounts of fluoride present in water during the period of calcification of the teeth.”
– H Trendley Dean – “the father of fluoridation.”
“We may therefore speak of very mild fluorosis as first evidence of disease.”
– Quebec Committee of Inquiry 1979.
Those who first promoted fluoridation accepted a 10% level of fluorosis, claiming it was only cosmetic. Recent studies have shown up to 60% fluorosis in fluoridated communities with significant numbers of individuals rated as “severe”. No tests for chronic fluoride poisoning are conducted on such victims, and even remedial dental work is at the individual’s cost, in spite of resulting from State policy. Today the cost of repairing dental fluorosis in the US and Canada is greater than the cost of treating tooth decay.
Examples of Dental Fluorosis
Doesn’t fluoridation help the underprivileged?
This is the claim of Governments who do not want to incur the cost of actually looking after the underprivileged. In fact the York Review found “no evidence to support the social equity theory.”
This is supported by the latest dental statistics from Napier and Hastings: after 50 years of fluoridation of Hastings there is no benefit for either Maori or Pacific people:
More importantly, it is the underprivileged who will be most at risk from fluoride’s adverse health effects, as poor nutrition, especially low levels of calcium and magnesium which are natural buffers against fluoride, exacerbates fluoride’s inherent toxicity. It is for this very reason that Chile abandoned fluoridation in 1977, after research conducted by Dr Albert Schatz, discoverer of the antibiotic streptomycin, showed higher death rates amongst the poor drinking fluoridated water.
How is fluoride supposed to work?
Those who originally promoted fluoridation claimed that it worked by being taken into the bloodstream and hardening the enamel as it was forming, even before birth. Hence fluoride tablets were given to pregnant women to give their children better teeth. There was absolutely no research evidence to support this view. Firstly, prenatal fluoride was found to be teratogenic (causing birth deformities, like thalidomide) and was banned for use by pregnant women by the US FDA in 1966. New Zealand never imposed such a ban. The systemic effect (through the bloodstream) was promoted with the “authority” of medical and dental associations for 50 years, while opponents claimed it could only be topical (by surface contact such as toothpaste). Opponents were proven right and in 1998 the CDC and in 2000 the ADA admitted that the effect was topical not systemic.
Featherstone J.D.B. (2000). The Science and Practice of Caries Prevention. Journal of the American Dental Association 131(7):887-899:
Fluoride, the key agent in battling caries, works primarily via topical mechanisms. Fluoride incorporated during tooth development is insufficient to play a significant role in caries protection.
Centers for Disease Control (1999). Achievements in Public Health,
1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries.
Mortality and Morbidity Weekly Review 48(41): 933-940:
Fluoride’s caries-preventive properties initially were attributed to changes in enamel during tooth development. However, laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children.
It follows from this of course that the teeth must have erupted before such effect can occur.
This should have ended fluoridation, but promoters came up with a new theory to continue this unscientific practice: they claimed that ingested fluoride was re-emitted through the saliva which bathed the surface of the teeth causing an all-day topical effect. The fact that saliva contains only 0.016ppm fluoride compared with 1ppm in the water (and 0.006ppm in unfluoridated communities) should have alerted promoters to the unlikelihood of this explanation, which again was made without any research basis. This fiction was rapidly disproven:
Center for Disease Control. (2001). Recommendations for Using
Fluoride to Prevent and Control Dental Caries in the United States.
Mortality and Morbidity Weekly Review 50(RR14):1-42.
The concentration of fluoride in ductal saliva, as it is secreted from the salivary glands, is low — approximately 0.016 ppm in areas where drinking water is fluoridated. This concentration of fluoride is not likely to affect cariogenic activity.
A later attempt at straw-clutching was the claim that it is small quantities of water passing over the teeth throughout the day which provides the topical effect and hence benefit, and therefore that water fluoridation should continue. The New Zealand Ministry of Health even claims that this is more effective than brushing with fluoride toothpaste (at 1000ppm). The self-defeating nature of this argument should be obvious: since nobody sipped water throughout the day until the advent of sipper bottles in the 1990’s, if this speculation had not already been disproven, it follows that the improvement in dental health from the 1950’s until the 1990’s must have been from something other than fluoridation. As Dr Frank Bull, one of the first spin doctors promoting fluoridation in the US before the trials at Newburgh and Grand rapids were completed, said at the infamous 1951 Conference: “when they (opponents) take us at our own word they make awful liars our of us.”
In fact remineralisation of the enamel is shown not to occur below 2 ppm concentration:
Wilding, R.J.C. A review of the repair potential of the pulp-dentine.
In vitro studies indicate that provided fluoride is in concentration above 2 ppm, substantial remineralisation occurs. The levels required by dentine are however much greater than enamel. Dentine requires over 100 ppm.
Didn’t the Hastings experiment prove a 60% improvement in tooth decay?
The Hastings experiment began with Napier as the scientific control city. It is vital to have a control in such scientific experiments to be sure that any difference is due to the agent being tested –fluoride in this case. Health statistics had shown a steady improvement in tooth decay since 1930, so the inclusion of Napier was essential to see if there was any difference from this background improvement. The first thing that happened was that dental nurses were told to stop filling surface imperfections. This resulted in an immediate 20% reduction in reported statistics. After 2 years it was founds that Napier continued to have lower rates of tooth decay than Hastings, and was improving at the same rate. This embarrassment was avoided just as it was in the US Grand Rapids experiment, the overseer of which advised Ludwig, the overseer of the Hasting experiment: Napier was removed as the control city and the Hastings results were reported on a scientifically invalid “before and after” basis, hence falsely claiming a 60% improvement due to fluoridation, including the changed specification discussed above, but without mentioning it. The Ministry of Health touted the Hastings experiment for 20 years as showing 60% improvement until this deliberate fraud was exposed in 1986 by one of their own dental researchers, Dr John Colquhoun, who was forced into early retirement for this whistleblowing. The Ministry no longer claim the Hastings experiment to support their position – they just stopped mentioning it after exposure. Unfortunately the lie has become part of New Zealand “history” and many people still believe it, through no fault of their own.
In fact unfluoridated Napier today, as it did in 1954, has less tooth decay than fluoridated Hastings. Similraly, unfluoridated Kingston has less decay than fluoridated Newburgh – the only two trials in the world to run for 50 years – and they both show no benefit from fluoridation !
Is there something “magic” about 1ppm?
No. The original trials by Trendley Dean showed dental fluorosis above 1mg/day intake from fluoridated water. There was up to 0.5mg per day from food at the time. (McClure 1943). So 1 mg/day was set as the upper limit for fluoride intake. In temperate climates like NZ people drank about 1 litre of water a day, so 1ppm would give 1 mg. In hot climates like Queensland where people drank more the level was set at 0.5ppm; in cold climates it would be 1.2 -1.5ppm, all designed to deliver 1 mg.
But dietary intake of fluoride has increased and today our intake equals or exceeds 1 mg/day without fluoridated water. For this reason WHO states that health authorities must consider this when setting fluoride levels in the water. NZ’s level was “lowered” in the mid 1990’s to 0.7 – 1.0 ppm, but there is no recent information on dietary intake.
It should also be noted that any bacteriacidal effect from fluoride, which proponents claim as one of the ways fluoride protects teeth, only occurs above 2ppm.
Could I be harmed by 1ppm fluoride in the water?
According to the World Health Organisation – Yes ! when added to current dietary intake as found by the Public Health Commission in 1994:
“At higher levels of ingestion – from 2 to 8 mg daily, skeletal fluorosis may arise … Whereas dental fluorosis is easily recognised, the skeletal involvement is not clinically obvious until the advanced stage of crippling fluorosis … early cases may be misdiagnosed as rheumatoid or osteoarthritis.”
– Fluorides and Human Health, 1970. page 239-240
With 1 mg per day from diet, another 1 mg per day from fluoridated water = 2 mg per day: enough to cause skeletal fluorosis according to WHO. This is why WHO only recommend fluoridation where the total daily intake is taken into account.
Aside from long term accumulation in the bones and other tissues, and a range of adverse health effects demonstrated in the general population, there are some people who are particularly hypersensitive or allergic to fluoride. These people may suffer stomach or intestinal disturbances, skin problems, muscular twitching, or “chronic fatigue” type symptoms, all of which disappear once unfluoridated water is used and the body has ridden itself of accumulated fluoride.
Such symptoms appeared in every city where fluoridation was originally implemented, even when fluoridation was secretly begun, so there was no possibility of psychsomatic problems. (Windsor, Canada). Many such people from Hastings appeared before the 1956 Fluoridation Commission in NZ, and the 1980 Victorian Commission in Australia. One woman even wore a medical wrist band warning doctors not to give her fluoridated water, issued by a Melbourne public Hospital. There is also a recent report (San Antonio Express News (26 July 2002) of a family who were eventually given a free fluoride filter as all the children were found to be suffering symptoms at 1.5 mg/day intake (less than we currently get in NZ) and had unfluoridated water medically prescribed by their doctor.
It should also be remembered, as noted above, that outside U.S.political influence, a number of scientific groups and individuals have decided fluoridation is not safe. In France, the Chief Council of Public Health rejected fluoridation in 1980 because of doubts about whether it harms human health. The minister for the environment in Denmark recommended in 1977 that fluoridation not be allowed primarily because no adequate studies had been carried out on its long-term effects on human organ systems other than teeth and because not enough studies had been done on the effects of fluoride discharges on freshwater ecosystems. In 1978, the West German Association of Gas & Water Experts rejected fluoridation for legal reasons and because “the so-called optimal fluoride concentration of 1 mg per L is close to the dose at which long-term damage [to the human body] is to be expected.”
Is fluoridation “medication”?
There are two questions in one here:
Is fluoride medication?
Is fluoridation medical treatment or intervention?
Firstly, contrary to the claims of the Ministry of Health, the Privy Council, when considering the legality of fluoridating New Zealand water, did not rule that fluoridation was not medication. The report can be read at  NZLR 116.
Secondly fluoride clearly falls within the definition of “medicine” in the Ministry of Health proposal for a Trans-Tasman Therapeutics Agency discussion paper:
Medicine – a therapeutic product that is represented to achieve, or is likely to achieve, its principal intended action by pharmacological, chemical, immunological or metabolic means in or on the human body.
Fluoride is classified as a drug under the US FDA regulations and can only be obtained by prescription. (The water supply is outside FDA jurisdiction)
The more important issue is whether fluoridation is a medical intervention. The currently internationally accepted definition is:
“Intervention” includes any preventive health measure applied to a human being by any means.
– Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine 1997
It is consequently irrelevant whether added fluorides are “medication”
Under this fluoridation is a medical intervention and subject to medical ethics requirements of informed consent:
An intervention in the health field may only be carried out after the person concerned has given free and informed consent to it.
The person shall beforehand be given appropriate information as to the purpose and nature of the intervention as well as on its consequences and risks.
– Article 5, Convention for the Protection of Human Rights and Dignity of the Human Being with Regard to the Application of Biology and Medicine 1997