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Teething Pains: the Fluoride Issue
In Oregon, they voted to ban it from the water supply. In Florida, they put it back in. What does the renewed national debate over fluoride mean for moms at brushing time?

Here are some things I expected to have to teach my 20-month-old daughter: how to say “please” and “thank you,” use a fork and knife, and share her toys. Nobody ever told me that I’d be teaching her how to spit, too. Somehow, I thought I would be teaching her not to do that.

Yet now when my sugar-starved child lunges for her toothbrush and its dollop of delicious orange-flavored toothpaste at bedtime, I find myself thinking about the day, coming very soon, when I’ll take her for her first visit to the dentist. I know from friends who have slightly older kids what’s going to happen: the dentist will advise us to start using something with fluoride in it. And that means that my daughter, in addition to kicking and screaming whenever I wrest control of her toothbrush and try to implement the proper brushing motion, will also have to learn to be vigilant about spitting out the toothpaste at the end of our nightly comedy of errors.

I know what you’re thinking: Isn’t fluoride good for us?

Sure it is ... in moderation. Don’t get me wrong: I’m not anti-fluoride, like some of the residents of Portland, Oregon, who earlier this year defeated—for the fourth time since 1956!—their city's attempts to add the enamel-enhancing mineral to its water supply. I don't doubt that the addition of modest amounts of fluoride into our drinking water has, overall, benefitted the dental health of millions of Americans.

But as with so many aspects of modern life—eating canned tuna (including its mercury), over-enthusiastically applying sunscreen (and depriving ourselves of Vitamin D in the process)—we’ve now reached the point where many Americans, especially relatively well-off Americans like my daughter, may actually be getting too much of a good thing.

There are, today, numerous ways that we take fluoride into our bodies. Toothpastes and mouthwashes contain it, of course. But so do the many beverages made with fluoridated water that line our grocery-store shelves. Crops that have been irrigated with treated water absorb the mineral. And staple grains and other commodities contain residual fluoride from the breakdown of the fluorine-based pesticides that have been applied to them. As a result, most people get more fluoride than public health officials could ever have imagined back in the 1950s, when the first public water-fluoridation campaigns began.

We’ve now reached the point where many Americans, especially relatively well-off Americans like my daughter, may actually be getting too much of a good thing.

Unsurprisingly, the rate of dental fluorosis, which appears most commonly as white markings on tooth enamel, has been on the rise. More than 40 percent of children aged 12 to 15 show signs of the condition, up from about 23 percent in the mid 1980s. Although most cases of fluorosis are mild enough to be considered merely cosmetic, more serious ones can lead to weakened enamel and tooth decay later in life. Somewhat troublingly, the rate of serious fluorosis among children 12 to 15 has tripled—from just over one percent to just under 4 percent—since the late 1980s.

Responding to the signs of potential overfluoridation, in 2011 the U.S. Department of Health and Human Services and the Environmental Protection Agency revised the federal recommendations for the amount of fluoride in tap water, advising municipal water systems to provide their customers with a maximum of 0.7 milligrams of fluoride per liter of water, down from the previously recommended range of 0.7 to 1.2 milligrams per liter. The most common (and mild) types of fluorosis can occur at levels as low as 2 milligrams per liter; but at much higher levels of exposure—more than 10 times what most of us typically ingest—fluoride can cause bone weakness and even skeletal deformity, according to the World Health Organization. Such cases are rare but not unheard of; the WHO’s website refers to the example of the Indian province of Assam, where some residents were crippled for life after drinking water that contained naturally occurring fluoride at levels of up to 23 milligrams per liter.

For American children, the greatest risk for overexposure occurs in infancy, specifically among babies who are exclusively fed powdered infant formula mixed with tap water. (Infants generally drink nothing but milk until about 6 months of age, and it remains a large part of their diet for many months to follow.) The CDC doesn’t put a figure on the increased risk to tap-and-formula-fed babies; it merely advises concerned parents to breastfeed (as I did), or to use liquid formula instead.

Portland has managed to keep fluoride out of its water for decades, but other local governments are now discovering just how complicated the politics surrounding the issue can be. Last year, officials in Pinellas County, Florida—influenced as much by small-government ideology as they were by health concerns—voted to remove the mineral from their water supply. A major backlash ensued when many residents who had previously been paying 29 cents of tax per year for fluoridated water felt the need to go to their family dentists for fluoride pills. According to the Tampa Bay Times (which won a Pulitzer Prize for its editorial coverage of the story), some families found themselves paying as much as $120 a year for the supplements. As a result, the county commission was shaken up in last November’s election—and the new commission voted to return fluoride to the water. As of March, it’s back.

A mouth free from toothaches is a luxury I’d like all kids to have. In our home, we’ll continue to drink our fluoridated tap water, and will eventually graduate to toothpaste fortified with the mineral. For my part, I’ll muster the time and the patience (well, on most nights) to wrestle my daughter for control of the toothbrush. And when the time comes, I’ll be the sentry at the bathroom door, eyeing her in the mirror as she brushes—and as she spits. Just to be on the safe side.

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Brooklyn-based journalist Laura Wright Treadway is a contributing editor to OnEarth and a former senior editor at the magazine. With degrees in environmental science and geology, as well as stints at Scientific American and Discover, she's also our favorite science geek. MORE STORIES ➔
Comments (13)
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It seems to me, if there are ANY adverse effects, at all, ever, for anyone, we should seriously want to reconsider putting it in the water. Seems kinda silly. If we put it in the water to prevent dental decay, it kinda sounds like medicine. And probably a doctor should be administering medicine, not government. Just my two cents.
People are having reactions to fluorides. I am one of them. I started the Fluoride Poisoning support group http://health.groups.yahoo.com/group/FluoridePoisoning/ All anyone can talk about is teeth. What about the rest of the body? Overcoming fluoridation fears is a no-brainer. Simply, all one has to do is assure that all the laws, rules and regulations are followed to the letter. The research must already exist and all they need to do is present it. In order to do so one must look to the National Sanitation Foundation International, because No federal agency has taken responsibility for fluoridation. The EPA set up the NSF International, a private, non-profit company, and in 1988 replaced its own drinking water additives program with NSF/ANSI Standards 60 and 61, which set public health standards for all chemicals used to treat water and products coming into contact with drinking water. The NSF was handed the job to approve water treatment chemicals and wrote the rules. NSF requires 20+ toxicological studies that must be provided by the manufacturers just to apply for certification. 1. Ask for the ANSI/NSF Standard 60 Health Effects document. 2. Locate the all the toxicological studies, in that document, that are required for certification of the product to be in compliance with said document. 3. Demand a list of the original studies and all the data collected for the product that will be used for fluoridation. Provide copies of the original, dated documents used to obtain and maintain NSF/ANSI Standard 60 certification 4. Present them. Publish them or provide a source where everyone can see for themselves that their product is "safe and Effective". The head toxicologist of the EPA called for more research on fluoride. http://www.fluoridegate.org/the-film/ FLUORIDEGATE An American Tragedy: How did the EPA respond? They committed FORGERY – fabricated timecards They committed DESTRUCTION OF EVEIDENCE – shredding documents They committed OBSTRUCTION OF JUSTICE – They conspired to cover-up the call for more research by terminating the senior toxicologist of the EPA He took the EPA to court and won on all counts – except one, that he used the wrong pronoun. He used the word “we’d” when referring to EPA’s activities instead of “EPA” The senior toxicologist then had to sue the EPA for HARRASSMENT – and won the case.
Absolutely, Ron. Check out NSF documentation on fluoridated water. As you know, full well, anyone who does so will find that all Standard 60 requirements for certification have been met. Were they not, the EPA would not allow drinking water to be fluoridated. For any who feel compelled to waste time watching the antifluoridationist Kennedy's nonsensical little video, "Fluoridegate" feel free, but that's all it will be......a total waste of time. Steven D. Slott, DDS
At a time when more than 100 million Americans lack dental insurance, fluoridation offers an easy, inexpensive preventive strategy that everyone benefits from simply by turning on their tap.
The CDC reports that 41% of all children have enamel damage, dental fluorosis. In fluoridated communities, this translates to 60%. Of these children, 5% to 10% are severe enough to cost $10,000 to $30,000 to repair, with veneers costing over $1000 each. Why is the family stuck with this bill when the government forces everyone to consume this toxic waste fluoride chemical? Why doesn't the government offer to pay? Why doesn't the dental community, which favors this outdated practice offer to pay for this damage on children?
jwillie6/James Reeves James, In the CDC report you reference here are some facts you omitted: That "41% of all children" is composed of 37.1% with mild to very mild dental fluorosis, both of which are barely detectable, benign conditions requiring no treatment, and which have no effect on cosmetics, form, function, or health of teeth. The other 3.8% are those with moderate dental fluorosis, a condition which manifests as white areas on teeth. Whether or not these moderately fluorosed teeth require any restoration depends on the preferences of the patients and their parents. Some may be concerned enough with the cosmetics to desire treatment, others may not. There was not enough evidence of severe dental fluorosis to even be quantifiable. The percentage of that 3.8% who may desire cosmetic treatment does not override the dental decay preventing benefit to the whole population. The cosmetics alone from dental decay are far worse than any from moderate dental fluorosis, and this not even take into account the amount of pain, debilitation, and life-threatening infection that is prevented by water fluoridation. The cost savings of preventing the need for restoration of decayed teeth completely dwarfs any expenses involved in cosmetic treatment of the very few with moderate fluorosis who may desire to have it. Steven D. Slott, DDS
"Facebook User" recently posted this. It cost her $2500 to repair this "mild" case of dental fluorosis, which was brown streaks. The more severe cases cost $10,000 to $30,000. Once again, why is the family stuck with this repair bill when the government forces fluoride on everyone. The government should pay. Maybe the dental community which promotes this toxic waste drug will volunteer to pay for the damage they cause. My daughter lived with brown streaks on her teeth all through elementary and high school due to the fluoridated water in the town where we lived. The forced fluoride pushers continue to say brown teeth are "just cosmetic", but my 13 year old daughter will disagree. And I can tell you how great fluoridated water is after spending $2500.00 to fix brown teeth caused by artificially fluoridated water. And...And... and she still got 2 cavities. What happened to the panacea called fluoride? Why, if fluoride is soo great, did my daughter have brown teeth and 2 cavities. And it wasn't because she didn't go to the dentist and didn't brush her teeth. It was fluoride. And do you think the city would pay for the repair? Of course not. You should be able to drink as much water as you want without worry of getting dental fluorosis and brown streaks on your teeth. Fluoridation doesn't work and is unethical to force medicine on anyone. No one will come to your rescue when your kids have brown teeth. I can tell you that for sure. You will pay for what the city did to your kids teeth. To all the forced fluoride pushers. Why do you feel it necessary to force medicine down the throat of MY children and then walk away and leave me holding the bill for the repairs when she ends up with brown teeth as a result.
Well, jwillie, anecdotal information is meaningless in considering a public health initiative with proven decay preventive benefits for the entire population. It is very unfortunate that your daughter had brown streaks on her teeth, but they did not come from water fluoridated at the optimal level. If the streaks were indeed dental fluorosis, then she was getting an abnormal excess of fluoride from another source than the public, fluoridated drinking water. As for her cavities, no fluoridation proponent I know has ever claimed that water fluoridation prevents ALL cavities. If your daughter grew up with fluoridated water, then you saved a fortune by not having to pay for all the cavities she would have had without it. As far as who pays, as i've said before, by your logic, you and other antifluoridationists should have to pay the dental bills of those in Portland where your lobbying against fluoridation contributed to 900,000 of those citizens being deprived of the benefits of water fluoridation. Steven D. Slott, DDS
After 65 years of fluoride use, with 99 1/2 % going directly down the drain, we now have it in most of our drinks and foods. It is used in pesticides as well, which contributes more for our consumption. It is in orange juice, beer, wine, vegetables and fruits, etc. So now everyone in fluoridated communities is over-dosed. That is why in the 1950's dental damage, fluorosis, was only 10%, but now it is 41% of all children (60% in fluoridated communities). I was quoting "Facebook User" in my post. Her daughter's $2500 cost is an example of the extreme cost of fluorosis, even for "mild cases." The more severe cases cost 4 to 10 times that amount. Once again, why doesn't the government which forces this toxic drug on everyone pay these bills? Why won't the dental community which promotes it volunteer to pay instead of sticking the family with the bill?
Well, jwillie/James Reeves At less than $1 per year per person for water fluoridation, which is more effective than all other, far more expensive modes of fluoride delivery to the teeth, it doesn't matter how much of it goes down the drain, provided it poses no problems for the environment, which peer-reviewed studies have shown that it does not. As far as who pays for dental bills, again I state that by your logic, you and other antifluridationists should be responsible for oaying the lifetime dental bills for the 900,000 Portlanders for whom your lobbying against fluoridation will cost them dearly in increased dental bills over their entire lives. As for your repeated question about the CDC fluorosis findings, maybe you are simply unable to comprehend what I have told you about that, in as simple terms as I can put it, but for the sake of those readers who will not have any problems with simple comprehension, I'll state it again. In the CDC report you reference here are some facts you omitted: That "41% of all children" is composed of 37.1% with mild to very mild dental fluorosis, both of which are barely detectable, benign conditions requiring no treatment, and which have no effect on cosmetics, form, function, or health of teeth. The other 3.8% are those with moderate dental fluorosis, a condition which manifests as white areas on teeth. Whether or not these moderately fluorosed teeth require any restoration depends on the preferences of the patients and their parents. Some may be concerned enough with the cosmetics to desire treatment, others may not. There was not enough evidence of severe dental fluorosis to even be quantifiable. The percentage of that 3.8% who may desire cosmetic treatment does not override the dental decay preventing benefit to the whole population. The cosmetics alone from dental decay are far worse than any from moderate dental fluorosis, and this not even take into account the amount of pain, debilitation, and life-threatening infection that is prevented by water fluoridation. The cost savings of preventing the need for restoration of decayed teeth completely dwarfs any expenses involved in cosmetic treatment of the very few with moderate fluorosis who may desire to have it. Steven D. Slott, DDS
Increasing numbers of dentists are responding to carefully documented proof of harm from fluorine compounds. While Steven D. Slott likes to dismiss damage, his dismissal of case studies (he dismisses these as anecdotes) is irresponsible. Providers of health services must be expected to respect the individuality of persons. As functional, integrative, personal, personalized, and N=1 medicines increase in influence, one-size-fits-all medicine decreases. Writing off collateral damage becomes less acceptable. Many health-care professionals are quite concerned about this. You can read about it on many medical list-serves. Steven D. Slott cannot control individual reactions. Some people clear this toxin better than others. For those who cannot clear it, the damage is cumulative, and as pointed out by others, dose cannot be controlled because fluorine-based toxins are ubiquitous in the U.S. environment and also in some other places. In addition to the damage to human organs, salmonids, as one example, can tolerate very little of this endocrine disruptor. Elephants also tolerate it poorly. Zoo animals have been harmed by fluoride at levels that Steven D. Slott likes. People calling out the real costs of this massive medication program have been called so many names, I could hardly count them all. The damages, however, are so serious and so lasting, that those of us who have been harmed will not stop calling out the dangers. It is unethical to medicate as if every imbiber weighs 150 pounds and has healthy kidneys. For reasons such as this, France never medicated, and Sweden ended it after the testimony of a Nobel winner. The obesity epidemic alone harms human kidneys at an alarming rate, and increases the number of individuals at risk. Athletes and diabetics are at greater risk because they drink more water and may ingest more fluorine compounds from other sources as well. Industrial waste promoters in Portland got slammed to a large extent because Portland is an extraordinarily geeky place. Thousands of voters did their own extensive research, finding out for example, that an EPA scientists' union sued to get fluoride removed from the water in their workplace. Individuals harmed posted their photos and the nature of their harm on Cleanwater websites. You can also do a search for reviews of Steven D. Slott's work on the net. This is not a dentist I would choose. My own dentist understands the fine details on the need for respect for an individual's health and history when considering the use of fluoride in a dental-health plan for an individual person. I was over-dosed as a child. Fluoride is inappropriate for an anecdote like me.
Sorry, what "case studies" did Dr. Slott "dismiss"? An unsubstantiated Facebook post? Treadway's article is wonderfully modulated and thoughtful. Most of the posts here are silly (and utterly predictable) diatribes with a slender grasp of how clinical studies actually work.
This article is soft on the many dangers of drinking flouride. You just need to do your research to see that it is a dangerous toxin made from other toxins. And ask yourself why our government wants to put it in your water? There are many studies and evidences of what it does to teeth and bones. Also since our bodies from the neck down are 75% percent water... and from the head up 85% water.... it goes to figure that someone wants "we the people" to stop using our brains.... and become unable to think. Flouride and Chloride are making you brain dead!