News Coverage
Fluoride fine in advised amounts
Published June 25, 2005
During the past week, another coincidence occurred in my life that resulted in this column. While visiting a relative, I noticed a bottle of water with fluoride added in an effort to get us to buy their bottled water. A couple of days later, I read an article titled "Fluoride in water linked to cancer."
These things caused me to think of the days of my childhood when there were people saying (loudly) that the practice of putting fluoride in the water supply was a "communist plot" rather than a plan to help strengthen teeth.
I also thought of my days as a family doctor when we would test the water in homes with newborn babies. This was used to decide whether to add fluoride to the vitamins of the baby and how much to use.
Many of the tests done in northeastern Indiana showed that fluoride occurs naturally in the water. In the city water supply where I live, fluoride testing is done regularly and the fluoride level is adjusted to about one part per million (ppm). Similarly, many North American cities also fluoridate their water supplies, citing effectiveness in reducing tooth decay, safety of fluoridation and the low cost to do so. As of 2002, the Centers for Disease Control and Prevention (CDC) statistics showed that almost 66 percent of the U.S. population received fluoridated water through the taps in their homes.
The American Dental Association (ADA), World Health Organization (WHO), and some other health organizations recommend fluoridation of municipal water supplies to a level between 0.7 and 1.2 ppm. On the other hand, UNICEF warns against water fluoridation, as does the Sierra Club. So, water fluoridation is still a highly controversial practice and is banned in most countries in Europe, China, India and Japan.
Much of the controversy dates back to 1951, when Joseph C. Muhler and Harry G. Day of Indiana University, Bloomington, reported their research results on stannous fluoride as a tooth decay preventive and the university sold the technology to Procter & Gamble to use in Crest toothpaste.
The main concern has been the possibility of the development of fluorosis. This is a condition caused by "excessive" intake of fluorine compounds over an extended period of time, which can cause yellowing of teeth, hypothyroidism or brittling of bones and teeth. However, the definition of "excessive" is generally accepted to mean significantly higher than the 0.7 to 1.2 ppm amounts recommended for fluoridated water. The amount that is problematic will depend on the amount of fluoride drank, how much is absorbed, and the weight of the person drinking it. For this reason, many doctors have advised against using fluoridated water to make up formula for infants. People with kidney problems, or those on dialysis, are also advised not to drink fluoridated water.
Babies over 6 months old get sufficient levels of fluoride from breast milk or formula mixed with tap water if they live in fluoridated areas. Only children living in nonfluoridated areas or children who drink only nonfluoridated bottled water might need to receive supplements.
Because children under the age of 3 can't spit effectively, they may swallow too much toothpaste while brushing. Talk to your child's dentist about the type of toothpaste your child under 3 should use and how often. Children should use only a pea-sized amount of toothpaste and spit out as much as possible after brushing. Even a small amount of toothpaste supplies enough fluoride for tooth protection but minimizes the chances of side effects from too much fluoride.
Most cases of fluorosis occur in children who take unnecessary daily fluoride supplements even though they brush regularly with fluoridated toothpaste and their home's tap water already contains good levels of fluoride. Misuse of fluoride products, including rinses and toothpaste, can also contribute to fluorosis, but this is less common.
Very rarely, fluoride toxicity can occur when large amounts of fluoride are ingested during a short period of time. Children under age 6 account for more than 80 percent of reports of suspected overingestion. Although outcomes are generally not serious, several hundred children turn up in emergency rooms each year.
Symptoms of fluoride toxicity may include nausea, diarrhea, vomiting, abdominal pain, increased salivation, or increased thirst. Symptoms begin 30 minutes after ingestion and can last up to 24 hours. If you suspect your child may have eaten a substantial amount of a fluoridated product or supplement, call the poison control center or 911. Be sure to keep toothpaste, supplements, mouth rinses, and other fluoride-containing products out of children's reach or in a locked cabinet.
Adding to the concern about fluoride, new research by scientists at the Harvard School of Dental Medicine has suggested that adding fluoride to tap water can increase the risk of boys developing bone cancer. The Environmental Working Group is even calling for fluoride in tap water to be formally added to a U.S. government list of substances known or feared to be cancer-causing to humans. The study found that fluoride does not pose the same risk to young girls, but scientists say that they have not worked out why this is.
After reading all of this, I feel that I should share my opinion about fluoride. So, here it is. I would recommend that we use tap water for cooking and drinking whenever possible. If there is a problem with your tap water, you may choose to drink bottled water. But I would not pay extra for the fluoridated variety. If you have no other source of fluoride, a supplement can be prescribed. But most of us can get all of the fluoride we need by brushing our teeth regularly with a small amount of fluoride-containing toothpaste. Since tooth decay is much more common than boyhood bone cancer, I still feel that wise use of fluoride is worth the risk.
Dr. Terry Gaff practiced family medicine in Albion for 17 years and is now medical director of the emergency department at Parkview Noble Hospital in Kendallville and the Noble County EMS. He welcomes your questions. He can be reached at terrygaff@pol.net
