THAMES 5 SEPT 2015

PART 2: SAFETY

Is fluoridation safe?

Chemico-Biological Interactions5 November 2010, Vol.188(2):319–333,

doi:10.1016/j.cbi.2010.07.011

Molecular mechanisms of fluoride toxicityOlivier Barbier, Laura Arreola-Mendoza, Luz María Del

Razo

Until the 1990s, the toxicity of fluoride was largely ignored due to its “good reputation” for preventing caries

via topical application and in dental toothpastes. However, in the last decade, interest in its undesirable effects has resurfaced due to the awareness that this element interacts with cellular systems even at low

doses. In recent years, several investigations demonstrated that fluoride can induce oxidative stress

and modulate intracellular redox homeostasis, lipid peroxidation and protein carbonyl content, as well as alter gene expression and cause apoptosis. Genes modulated by fluoride include those related to the stress response,

metabolic enzymes, the cell cycle, cell–cell communications and signal transduction.

ISRN Cell BiologyVolume 2012, Article ID 403835, 16 pages

doi:10.5402/2012/403835Review Article

MolecularMechanisms of Cytotoxicity and Apoptosis Induced byInorganic Fluoride

Natalia Ivanovna Agalakova and Gennadii Petrovich Gusev

“.an exposure to high fluoridedoses has been reported to induce apoptotic cell death in

ameloblasts , odontoblasts , and osteoblasts. In the cells of other tissues, fluoride has been shown

to negatively influence many metabolic, structural, andfunctional cellular functions in experimental animal models

in vivo and in cultured cells in vitro. The toxic fluoride effectsinclude an induction of inflammatory reactions, cell contrac-tile responses, inhibition of protein synthesis and cell cycle

progression, oxidative stress, and DNA damage. Manyof these cellular events ultimately lead to cell death. NaF-

induced apoptosis was demonstrated in the cells from differ-ent organs and tissues including lungs , kidneys

liver, brain, pancreas, thymus, endometrium , bone marrow , hair follicles, erythrocytes, as well as leukemic cells”

Dental fluorosis = fluoride overdose during tooth development

40%

Fluoride is an endocrine disruptor, affecting cell processes by causing receptor malfunction.

Phyllis Mullinex , IAOMT conference, Las Vegas, 2009. Sauerheber, R. "Physiologic conditions affect toxicity of ingested industrial fluoride"

JEnvPubHealth, 2013Chen BMJ 2007

Brain

Bone and joints

Endocrine system

Diabetes

Could not assure safety: more research needed

National Research Council, 2006Fluoride in Drinking Water: A Scientific Review of EPA's

Standards

• Pineal gland

• Immune system

• Cancer

Iodine deficiency & thyroid

"Fluoride's suppressive effect on the thyroid is more severe when iodine is

deficient, and fluoride is associated with lower levels of iodine.

Thyroid effects in humans were associated with fluoride levels 0.05–0.13

mg/kg/day when iodine intake was adequate and 0.01–0.03 mg/kg/day when iodine intake was inadequate."

NRC 2006

New research Are fluoride levels in drinking water associated

with hypothyroidism prevalence in England?A large observational study of GP practice data

and fluoride levels in drinking water

Peckham S, et al. J Epidemiol Community Health 2015;0:1–6. doi:10.1136/jech-2014-2049711

"We found that higher levels of fluoride in

drinking water provide a useful contribution for

predicting prevalence of hypothyroidism.

We found thatpractices located in the West Midlands

(a whollyfluoridated area) are nearly twice as

likely to report highhypothyroidism prevalence in

comparison to GreaterManchester (non-fluoridated area)."

Fluoride is a developmental neurotoxin

Dr. Philippe Grandjean et al, The Lancet Neurology, March 2014

Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-AnalysisAnna Choi et.al.

VOLUME 120 | NUMBER 10 |pp1362-1368 October 2012 • Environmental Health Perspectives

www.thelancet.com/neurology Vol 13 March 2014Pp 330-338

Neurobehavioural eff ects of developmental toxicity

ADHD study

Declan Waugh B.Sc. C.Env. MCIWEM. MIEMA. MCIWM. Chartered Environmental ManagerChartered EnvironmentalistChartered Waste ManagerEnvironmental AuditorEnvironmental Scientist

Report to Irish parliament, 2013

DOSE

is not how much fluoride is in the water, it is the amount a person swallows

Safe at these "levels"?

Dose is not concentration

WHO measures dose?

1.2 now 0.7

Limits are inadequate to reassure safety

what are the safety margins?

DEATH 5mg/kg

DAMAGE 0.05 mg/kg/day

• Minimal Risk Level, MRL, set by the US Agency for Toxic Substances and Disease Registry: “an estimate of daily human exposure to a hazardous substance that is likely to be without an appreciable risk of adverse non-cancer health effects over a specified route and duration of exposure”

Some Sources of Fluoride

0.65mg 3.75mg

The US Agency for Toxic Substance and Disease Registry (ATSDR)

2003 chronic duration oral Minimal Risk Level (MRL) for fluoride

0.05 mg/kg/day

In a healthy person, Toxic effects are likely to occur above:

http://www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf

Estimated Fluoride ingestion (mg/day) ESR 2009

AgeDiet (no CWF)

Diet (with CWF)

FlourideToothpaste

Total UFTOTAL (with CWF)

MRL MAX DOSEAGE

3 months 0.003 1.0 0 0.003 1.0 0.3

9 months 0.18 0.71 0.35 0.53 1.06 0.45

2 years 0.25 0.57 0.3 0.55 0.87 0.65

5 years 0.36 0.86 0.41 0.77 1.27 1

12 years 0.5 1 0.3 0.8 1.3 2.7

Adult 0.98 2.07 0.3 1.28 2.37 3.5

3yo toddler

• weighs 13kg

• MRL = 0.65 mg/day

• TOTAL FLUORIDE INTAKE = 1.8mg

FTP 0.6

(smear)

FLUORIDE0

0.45

0.9

1.35

1.8

2.25

WATER 0.7

FOOD 0.5

MRL 0.65

• EXCEEDS TOXIC LIMIT BY 177%

FTP 0.6

0.44mg x twice a day x 70% swallowed = 0.6mg/day

ESR fluoride intake calculated on a smear up to age 6

Smear Pea

Estimated Fluoride ingestion (mg/day) for high intake adults

Age KgTOTAL (with CWF)

MRL MAX DOSEAGE

Adult 75 2.37 3.75

High intake adult

75 10.65 3.75

1. Dietary fluoride intake is about five times higher for adults in the high fluoride intake group, eg high beer or tea drinkers.

2. Maori are twice as likely as the average to be in the high fluoride group.

3. Most deprived groups are about 25% more likely than average to be in the high fluoride diet group. (Ref. ESR report,

page 39)

WHO 1984

"in the assessment of the safety of a water supply with respect to the fluoride concentration, the total

daily fluoride intake by the individual must be considered."

WHO 2006

“at a minimum, the fluoride level in local water supplies should be monitored and the population

examined for signs of excessive fluoride exposure”.

At risk citizensInfants

In utero

Maori

Old

Athletes

Diabetics

Kidney patients

Everyone

Making an informed decision for your family and community

Efficacy is doubtful

Better and cheaper ways to reduce decay in at risk groups.

F is toxic in low doses

Safety margins are inadequate

Maori and low SES are more at risk of toxic effects

Total F ingested is unknown and unmonitored

Public must have balanced information to make decision.

Conclusion

These diseases include bone and hip fracture, cancer, reduced IQ, thyroid disease, chronic

fatigue syndrome, irritable bowel,ADHD, depression, dementia, asthma, Diabetes

cardiovascular disease, etc.

While adding fluoride to community water supplies offers no significant benefit to the vast majority of New Zealanders forced to drink it, it

puts large numbers of New Zealanders of all ages at greater risk of chronic health disorders, with

those most at risk being Maori and the underprivileged.

Is it worth the risk ?