Fluoride: The Facts, the Controversy & the Science

30 Aug

Being the dental issue with undoubtedly the most controversy, I knew I would have to write my first post on the issue of fluoride.  So where do I, as a Registered Dental Hygienist, yet advocate for holistic health and the Paleo diet, stand on the issue of fluoride?  Well…that’s a loaded question…with a loaded answer…


Recently, I saw the above picture making the rounds on Facebook, and boy did it stir up some comments!  However, nobody presented any solid evidence or explanations.  I didn’t know what was true and what was false because, in school, we don’t cover this stuff; in fact, we really don’t cover much at all when it comes to fluoride during our dental education.  I wanted to investigate all the claims made in that picture because, frankly, I was curious.  So for this post, I have made it my mission to hopefully provide some education, information, and easy to understand answers to the whole misunderstood fluoride issue.  (Or I could just be setting myself up for an endless stream of rants, ha!)  I think it’s safe to say that this will be the most complete and comprehensive coverage of fluoride you have ever seen or read.  I will warn you now, this is a bit lengthy, but I wanted to make sure I covered all my bases and made this information as complete and as easy to understand as possible.  With that said, let’s dive in…

To begin covering this issue, it requires understanding some very basic chemistry.  Don’t worry, if chemistry was not your favorite subject in school, I will attempt to make this as painless as possible.  First off, let’s clarify the difference between fluorine and fluoride.  Fluorine is the element listed within the periodic table of elements with the atomic symbol, F.  It is a pale yellow-green, irritating gas with a sharp odor.   It is so reactive that it rarely occurs naturally in an isolated elemental state.  However, French chemist, Henri Moisson, won the 1906 Nobel Prize for isolating fluorine in its elemental form [1].

As I stated above, fluorine does not tend to occur on its own naturally; it is typically bonded with another element or elements to make a compound.  It is when fluorine is bonded with another element or elements that it becomes a fluoride compound.  There are seemingly endless fluoride compounds that can be constructed depending on what elements you bond with fluorine, and all of these different combinations of compounds can be called fluorides.  This is where the anti-fluoride activists and conspiracy theorists take advantage of the definition of fluoride to support their claims that fluoride is a toxic poison.  The answer is that some fluorides are indeed highly toxic and some are not; it all depends on the compound and what exactly is in that compound.  To easily understand this, let’s look at the element chlorine.  By itself, chlorine is a poisonous, yellowish-green gas.  When bonded to another element or elements, we will get a chloride compound.  When we bond it with sodium (Na), creating Sodium chloride (NaCl), we no longer have a poison, we have table salt.  Chlorine bleach, used around the house or when you launder your whites, is NaOCl.  Now, I will sprinkle table salt on my meal, but wouldn’t think of doing that with bleach.  Despite chlorine on its own being highly toxic, this shows that the product you end up with and its toxicity are dependent on what the compound is.  Some compounds will be toxic and some non-toxic, or some may only be toxic in very high quantities.  With this first chemistry review completed, let’s get back to fluoride.

Within our dental hygiene curriculum, we were sung the praises of water fluoridation, fluoride supplements, fluoride toothpastes/rinses and in-office fluoride treatments.  We’re told that The US Centers for Disease Control and Prevention (CDC) considers water fluoridation one of the 10 great public health achievements of the 20th century.  We even had a day of lecture dedicated to snuffing out “quackery” when it comes to misinformation regarding fluoride and that all the “propaganda” from those anti-fluoride websites just cannot be trusted.  We were taught that fluoride is a naturally occurring element in the earth’s crust, rocks, coal, clay, and soil.  What we were NOT taught was how to intelligently respond to a patient that proclaims, “Fluoride is toxic! I don’t want any fluoride! Don’t you know that fluoride is toxic waste that the government put in our water?!”  If you are a concerned patient, a dental professional, or are somewhere in the middle and don’t know who to believe, I hope the following information clears some things up for you.

I think the best way to go about this is to tackle each claim on the above picture one by one.  But first, let’s list which fluorides are most commonly used in dentistry, dental products and in public water fluoridation.

  • Sodium fluoride (NaF) is predominantly used in dental office fluoride treatments, toothpastes and mouthwashes.  Some toothpastes will instead use sodium monofluorophosphate (Na2PFO3), often abbreviated MFP on toothpaste packaging.  This is most often used in toothpastes that contain calcium because calcium will bind with the fluoride in NaF2 during storage, rendering calcium fluoride (CaF2), which is less effective at preventing tooth decay [2].  (Remember this point; we’ll discuss more on CaF2 later…)
  • Sodium fluoride can be added to drinking water supplies, but most often it is another fluoride compound, fluorosilicic acid (H2SiF6), that is predominantly used.  Fluorosilicic acid is also often called Fluosilicic acid, Hexafluorosilicic acid, Hydrofluorosilic acid, or Silicofluoric acid, among other names [3].

1)    Fluoride is a toxic chemical waste

Yes, this is true.  But before we end this whole discussion and give merit to the anti-fluoride groups, we should understand the process and we’ll realize that this is really a matter of word selection to deliver a strongly biased message.  The anti-fluoride groups will tell you that fluorosilicic acid is a toxic waste product of the fertilizer industry (the phosphorus fertilizer industry to be exact).  Now, this does sound frightening, and I’ll admit that when I was in the early stages of researching for this post and found this to be correct, my first thought was “oh #@*t!  It’s true?!”  But, if we look at what the phosphorus fertilizer production process actually entails, well, you’ll find yourself telling them “Duh…of course it does!”

Fluorosilicic acid is only deemed a “waste product” of the fertilizer industry because they do not have a need for it; it is the phosphorus they are after.  So we can call fluorosilicic acid a “waste product” or we can call it a “useful byproduct” of the fertilizer industry (see how one sounds scarier than the other?).  The following is a very simplified explanation of what the phosphate fertilizer industry does:

As mentioned earlier, natural fluoride can be found in rocks.  This natural form of fluoride is Calcium fluoride (CaF2), or it is also referred to as fluorspar [4].  Apatite rock is ground up and treated with sulfuric acid, producing phosphoric acid and the following byproducts: Calcium sulfate (sheetrock, CaSo4), hydrofluoric acid (HF) and Silicon tetrafluoride (SiF4) [5].  (So it appears the fertilizer industry is doing the same thing an independent fluoride manufacturing company would do if they existed.  Only then, fluoride would likely cost a lot more.)  Both the hydrofluoric acid and the Silicon tetrafluoride are in gas form.  These two gases are captured in recovery units, called scrubbers (scrubbing is a purification process), and condensed into a concentrated fluorosilicic acid solution [4] [5].  For those chemistry buffs, the process looks like this:

2HF + SiF4 —> H2SiF6

Sodium fluoride (NaF) can also be produced with the use of isolated hydrofluoric acid, but this is not done at the fertilizer plant.  It is produced by neutralizing hydrofluoric acid with Sodium hydroxide [6]. The process looks like this:

HF + NaOH —> NaF + H2O

Now that we have some background on the role of the fertilizer industry in fluoride production, the next issue is safety.  Many have questions and concerns regarding the toxicity, purity and risk to humans from the addition of fluoride compounds into our drinking water.  Nearly all of the over 40 (yes, 40!) water treatment chemicals that may be used at a water treatment facility are toxic to humans in their concentrated form [5].  Concentrated fluorosilicic acid solutions are corrosive and contact can severely irritate and burn the skin and eyes causing permanent eye damage [3].  Breathing concentrated fluorosilicic acid solutions can severely irritate and burn the nose, throat and lungs, causing nosebleeds, cough, wheezing and shortness of breath [3].  Inhalation or ingestion of large amounts of concentrated fluorosilicic acid solution can cause nausea, vomiting and loss of appetite.  Exposure to high concentrations or long term exposures to lower concentrations can cause fluoride poisoning with symptoms of stomach pain, weakness, convulsions and death.  It can also cause excessive deposits of fluorides in bones and teeth, known as fluorosis.  Excessive deposits in the bones may cause pain and disability; fluorosis deposits in the teeth cause discoloration.  However, the above health effects DO NOT occur with the low part per million levels of fluorosilicic acid solution used in drinking water [3].

The US Department of Health and Human Services (HHS) along with the Environmental Protection Agency (EPA) currently recommend that public drinking water in communities that fluoridate do so at a level of 0.7 ppm (parts per million) [7].  The previous recommendation was 0.7ppm – 1.2ppm, but the new recommendation comes after re-evaluation from taking into account that compared to the 1940’s, when water fluoridation started, we are now exposed to fluoride through various other products such as toothpaste, mouthrinses and dental fluoride treatments [7].  At levels below 1ppm, there is no evidence of adverse effects, short term or long term [8].  Fluoride toxicity does not occur from drinking fluoridated public water at less than 1ppm, but rather from drinking well water that has a moderate-high fluoride content or from acute high fluoride exposures in children that ingest a large dose of fluoride.  With the wide array of flavored toothpastes and rinses, it is not uncommon for young children to eat/drink them thinking they taste like candy.  If you have small children, either use a non-fluoridated toothpaste (which is recommended for children under age 2 because they tend to swallow it during brushing rather than holding it in their mouth and waiting to spit it out after brushing) and keep fluoridated toothpastes and rinses out of their reach.  If you have well water, have the fluoride content checked.

As you can see, the answer to the fluoride issue comes in understanding the concept of therapeutic dose vs. toxic dose.  This is vital for any drug or supplement we take.  For instance, anemic individuals are often given an iron supplement.  Taking the appropriate dose of iron will help the condition of iron deficiency.  However, take the whole bottle of iron pills and you can suffer from a wide range of symptoms including nausea, diarrhea, vomiting blood, fluid buildup in the lungs, liver damage, shock, convulsions, coma and even death, just to name a few.

2)   Mass medication without consent

The confusion here is that the word “medication” typically means “drug”.  Some will also proclaim that fluoride is not FDA approved (again, makes me want to say “Duh…of course it’s not!”).  The FDA tests foods and drugs.  Fluoride is not a drug, it is a supplement.  No supplement on the market requires FDA approval.  The statement above sounds much less scary when corrected to “mass supplementation”.

3)   Vital to creating nuclear weapons

Uranium hexafluoride is the fluoride compound associated with the preparation of nuclear reactor fuel and atomic bombs.  Fluorides of uranium are highly volatile.  Obviously, this type of fluoride is not used in dentistry or in water fluoridation.

4)   Nazis, Soviets, US Prisons use it to sterilize & make people subservient

The argument here is stated often by anti-fluoride groups.  They claim fluoride was used in concentration camps/prisons to sterilize people and make them docile.  One story goes that at the end of WWII, the US sent Charles E. Perkins (whom some credit as a chemical engineer while others state he was a research worker in chemistry/biochemistry/physiology/pathology) to Germany to oversee the IG Farben chemical plants.  While there, it is said that Perkins discovered IG Farben had developed plans during the war to fluoridate the occupied countries because it had been found fluoride caused slight damage to part of the brain that made the inflicted more docile to authority and thus made it more difficult for the person to defend their freedom.  Sources that recite this story go on to say that they are unaware of any actual research or studies that show fluoride to have these effects, but then will discuss a Dutch medical reference book that has a section titled “major tranquilizers” and that 7 of the 27 compounds listed are fluoride compounds, which just leads us back to the rationale that it depends on the compound, as pointed out above in the table salt vs. chlorine bleach example.

You can also find the story of USAF Major George R. Jordan, who apparently testified before Un-American Activity committees of Congress in the 1950’s that during his post as a USA-Soviet liason officer in the 1930’s, the Soviets openly admitted to “using fluoride in the water supplies in their concentration camps to make the prisoners stupid, docile and subservient.”  This is all that is said.  Again, we do not have information such as the fluoride compound used (although some sites say Sodium fluoride) and how much.  We’ll touch on this again later.

Animal studies have been performed to observe the effect of Sodium fluoride on fertility, however these studies have been at extremely high doses, more than 100 times higher than levels found in fluoridated water [9].  One such study I reviewed was performed on male rabbits that were given Sodium fluoride doses at 20mg/kg body weight.  This is a very high dosage.  In humans, a toxic dose that may lead to adverse health effects is estimated to begin at 3-5mg/kg [10].  At the given dosage, male rabbits exhibited significant decreases in sperm count, motility, and progressive motility.  The even more interesting part of this study was that one of the rabbit test groups was given the high dosage of Sodium fluoride along with Vitamin D and E supplementation.  The group given both Vitamin D and E supplementation with the toxic dosage of Sodium fluoride had significant improvement in sperm count and motility to near normal levels.  This begs the question, can proper nutrition protect us from the adverse effects of “toxins” we are exposed to?  In many cases, I believe so.

5)   Cancer causing, cancer promoting

A number of studies have been done to assess whether there is an association between fluoride and cancer in people who live in areas with fluoridated water (whether it be added fluoride or naturally occurring fluoride), or among those who work in jobs where they may be exposed to concentrated fluorides [9].  A study by the US National Toxicology Program (NTP) conducted toxicology and carcinogenicity studies with Sodium fluoride administered in the drinking water of rats and mice over a two year period [11].  Test groups included those given fluoridated water at 0ppm, 11ppm, 45ppm and 79ppm (all much greater amounts than 1ppm or under in public drinking water).  Researchers found that animals receiving Sodium fluoride developed dental fluorosis (not surprising at those fluoridation levels), and that female rats in the highest dosage group had increased rates of osteosclerosis, which is an increase in bone density.  There were no increases in tumors in female rats or in either male or female mice.  There was evidence of carcinogenic activity in male rats based on a small number of osteosarcomas present in that group that were administered Sodium fluoride [11].  The International Agency for Research of Cancer (IARC) has determined that the carcinogenicity of fluoride to humans is not classifiable [9].  In my opinion, the ones who are truly at risk of developing cancer from fluoride exposure are those working in chemical plants and industries that deal with the highly concentrated forms of fluoride, however, this kind of occupational exposure holds true for numerous other substances in various other industries as well, not just those that deal with fluoride compounds.

6)   Primary ingredient in anesthetic, hypnotic and phychiatric drugs like Prozac, rat/cockroach poison and in military/Department of Defense (DoD) sarin nerve gas

The type of anesthetic referenced here is an inhalational general anesthetic, such as Halothane (C2HBrClF3), trademarked as Fluothane.  Prozac is the brand name for the drug Fluoxetine (C17H18F3NO).  Sodium fluoroacetate (FCH2CO2Na) is a pesticide and can be found in rat/cockroach poison.  Lastly, sarin nerve gas (C4H10FO2P) is also, by definition, a fluoride compound.  Again, none of these compounds are used in dental products or water fluoridation.  And just to throw it out there, Warfarin (a popular blood thinning medication), is also used in rat poison, proving again that it comes down to dosage.

7)    Causes decay

Conduct any research on this issue and it will always lead you to studies comparing groups who were consuming fluoridated water at much higher levels than currently recommended by HHS and the EPA.  As stated earlier, the current recommendation is 0.7ppm or 0.7mg fluoride/liter of water.  Perform an internet search of “fluoride causes cavities” and you’ll find people citing a study involving two groups of children, aged 10-14, from different parts of Uganda.  The study concludes that the children from the area with a higher fluoride level in their drinking water had higher rates of decay than the children from the area that had less fluoride in the water [12].  Therefore, anti-fluoride groups conclude that fluoride actually causes decay.  However, if we look at the details of the study, we easily see some problems.  First, the level of fluoride in the low-fluoride area was 0.5mg/liter (much closer to recommended amounts) vs. 2.5mg/liter in the high-fluoride area [12].  They also state that no teeth were lost due to cavities in the low-fluoride area among the children in their sample, but in the high-fluoride area, 6 teeth out of 135 were missing, a 4% rate of tooth loss due to decay [12].  I find this faulty because, on average, a child aged 10-14 will have 28 teeth.  If there were only 135 teeth in their sample of children, they only surveyed 4-5 children.  This is a rather small sample size for any study to be taken seriously.

8)   Study proves it reduces IQ in children

Again, with a simple internet search, you’ll discover headlines that state, “Harvard Study finds Fluoride Lowers IQ”.  (A study from Harvard?!  Who can dispute that?!)  Let’s investigate… First off, when just skipping ahead to the “conclusions” of the study, the researchers state, “The results support the possibility of an adverse effect of high fluoride exposure on children’s neurodevelopment.”  The first thing I notice is possibility, and the second thing I notice is high fluoride.  The study looked at children in various parts of China, Mexico and India.  This was not a study of controlled public water fluoridation, but rather a study among children whose drinking water was from wells with water high in fluoride.  The real meat of this study is in the supplemental information, in which they provided data they collected that was excluded in their study.  This data shows they saw lower IQ scores among children from Tianjin, China in 2000 with a fluoride level that ranged from 0.37mg/L-3.15mg/L in their drinking water.  However, among children in Ningxia, China in 1991 that lived in an area with a fluoride level that ranged from 0.73mg/L- 3.99mg/L in their water, their results stated, “No effect of high fluoride levels on IQ”.  Frankly, this study is inconclusive and does not take into account other possible factors for their results, which I will cover later.

9)  Hydrochloric acid is safer than fluoride

Hydrochloric acid is a clear, colorless solution of Hydrogen chloride in water.  It is a highly corrosive, strong mineral acid with many industrial uses.  Hydrochloric acid is found naturally in our stomach acid, so this may be the reason they proclaim it is safe.  However, concentrated hydrochloric acid has a corrosive effect on human tissue, with the potential to damage respiratory organs (if acidic mist fumes are inhaled), eyes, skin and intestines.  Hydrochloric acid is not safer than dental fluoride products or the water that comes out of the tap in a fluoridated community in the US.  The fluoride compound they are comparing here is Hydrofluoric acid.  Hydrofluoric acid, like hydrochloric acid, is dangerous to humans.  It can burn the eyes and skin.  When hydrofluoric acid exposure is not treated properly, serious skin damage and tissue loss can occur.  In the worst cases, exposure to a large amount of hydrofluoric acid can affect the lungs or heart, causing death [9].

I will also note that hydrofluoric acid can form in the stomach when fluoride is ingested, which can cause irritation and have corrosive effects on the GI tract [10].  However, this is only of concern when high, toxic doses of fluoride are ingested.  The table [1] below shows various acids listed in order of increasing strength from bottom to top.  We can clearly see that hydrochloric acid is listed as having higher acid strength than hydrofluoric acid.  In fact, look two spots up from hydrofluoric acid and you’ll see citric acid is a stronger acid.  Hmmmm…guess we can conclude that fluoride is safer than oranges.


10)  Caused 1st US environmental disaster and started the environmental movement

Some say the “dirty thirties” dustbowl was the first US environmental disaster, however, I believe anti-fluoride groups are referring to the story of the Donora smog that occurred in the mill town of Donora, Pennsylvania in 1948, allegedly killing 20 people and injuring over 7,000.  It is reported that Hydrogen fluoride and Sulfur dioxide emissions (from US Steel’s Donora Zinc Works and its American Steel & Wire plant) were common in Donora.  However, on October 27, 1948 a temperature inversion occurred in which a mass of warm stagnant air was trapped in the valley.  The emissions in the air mixed with fog to form a yellowish pungent smog that hung over Donora for five days.  The sulfuric acid, Nitrogen dioxide, fluorine and other gases typically dispersed into the atmosphere were instead caught in the inversion and accumulated until the rain ended the weather pattern on October 31st.

It is no secret that Hydrogen fluoride and fluorine gases are highly irritating and toxic; I covered this earlier.  People breathing Hydrogen fluoride have complained of eye, nose and skin irritation [9].  Breathing in a large amount of Hydrogen fluoride in air can also harm the lungs and heart, leading to death.  Fluorine gas is also very harmful to the eyes, skin and lungs.  Even at low concentrations, fluorine gas makes your eyes and nose burn.  At higher concentrations, it becomes hard to breathe.  Exposure to high concentrations of fluorine gas can cause death due to lung damage [9].

11) Creates weak/brittle bones

I’m sure you are starting to see a pattern here, but this issue, again, relates to dosage.  Surprisingly, the same can be said for bisphosphonates, which are the drugs often prescribed for osteoporosis.  At proper dosage levels, bisphosphonates can help prevent future fractures in osteoporotic patients who have already suffered a bone fracture.  However, bisphosphonates have also been administered via IV in high doses to treat cancer.  In these patients, the high dosage has actually been associated with osteonecrosis of the jaw bone.  Fluorides are also commonly prescribed for osteoporosis, but again, the proper dosage is the key to being therapeutic vs. toxic.

Getting back to fluoride…

At levels 5 times greater than levels typically found in fluoridated water, fluoride can result in denser bones [9].  However, these bones are often more brittle or fragile than normal bone and have an increased risk of breakage or fractures among older men and women.  Skeletal fluorosis can occur in those eating, drinking or breathing such large amounts of fluorides.  This disease only occurs after long-term exposures and can cause denser bones, joint pain and limited range of movement.  In the most severe cases, the spine is completely rigid.  Skeletal fluorosis is extremely rare in the United States; it has occurred in people consuming greater than 30 times the amount of fluoride typically found in fluoridated water and is more common among people who do not get proper nutrition [9].  Some may read this and assert that fluoride must be the reason for osteoporosis rates in the US, especially since we are a country obsessed with calcium intake.  (Hold that thought!  We’ll come back to this issue later.)  We are also learning more about other vital nutrients needed for bone health, such as Vitamin D and magnesium, along with other factors.  I will be addressing this issue in a future post.

12) Deadly toxic to touch/inhale

Refer back to 9 and 10 above where Hydrogen fluoride, hydrofluoric acid, and fluorine gas are discussed.

13) Gaseous form strips flesh from bone on contact

Again, refer back to 9 and 10 where Hydrogen fluoride, hydrofluoric acid and fluorine gas are discussed.

14) DoD and Edward Bernays forced it into water supply by falsifying Manhattan Project Data fearing lawsuits/end of nuclear projects

This is classified as conspiracy theory, but again, conduct a simple internet search and you’ll find this story is rampant.  Here is a brief synopsis:

Edward Bernays is regarded by many, including himself, as the father of public relations, or as some may call it, “spin”.  The Manhattan Project was the name of the ultra-secret US military program to build the first atomic bomb during the height of WWII.  Dr. Harold Hogde, the chief toxicologist of the Manhattan Project, became involved in “Project F” because large amounts of fluoride (Uranium hexafluoride, as we discussed earlier) are used in the construction of an atomic bomb.  The Atomic Energy Commission was concerned about preventing a flood of lawsuits from Manhattan Project scientists who had potential exposure to highly concentrated fluoride doses while working on the project.  Thus, Edward Bernays was given the task of convincing the public that fluoride was safe.  It is stated that he taught industry leaders how to convince government agencies that fluoride is beneficial to our health and should therefore be added to municipal water supplies.

I’m going to divert for a moment and discuss the aluminum industry since ALCOA, a US aluminum manufacturer, is often tied to this story.  Proponents of this story claim that ALCOA was a large producer of Sodium fluoride during aluminum smelting, and that this produced a large amount of fluoride waste that needed a place to go, thus into our water supply.  The story continues that rather than encouraging ALCOA to institute pollution controls, an ALCOA researcher by the name of Francis Frary decided a better solution was to alter the public perception of fluoride by convincing Americans it improved dental health.  Frary then approached researcher, Gerald J. Cox, for help.  Cox allegedly performed a single study in rats in 1937 that “proved” fluoride strengthened teeth and the American Medical Association (AMA) thus declared the “case for fluoride” was proven.  At the time, the concept of peer reviewed research was unknown, so the AMA declared this rather quickly.  This story continues with a couple more companies becoming involved.  Frary and Cox were then joined by Charles Kettering, research director for General Motors (GM was involved because they owned a patent on fluoride-based Freon that DuPont manufactured, a common refrigerant which has since been banned.).  Kettering approached the American Dental Association (ADA) and began funding many of their activities and then got appointed to their three-member Advisory Committee on Research in Dental Caries, thus gaining support from both the AMA and ADA.  Bernays is credited with starting a campaign to persuade public opinion on fluoride.  Anti-fluoride groups quote him as saying, “You can get practically any idea accepted if doctors are in favor.  The public is willing to accept it because a doctor is an authority to most people, regardless of how much he knows or doesn’t know.”

Now all of this sounds pretty convincing; aluminum manufacturing, fertilizer and nuclear industries needed researchers to perform a basic fluoride study to show fluoride was safe and beneficial so they could convince the public that we needed it in the water to prevent tooth decay, thus giving industries an easy solution to their pollution problem.  But we need to take a step back here and we’ll find some definite flaws, especially with the claims on the aluminum industry (I covered the fertilizer industry and nuclear weapons issues earlier).

They claim ALCOA was a large producer of toxic Sodium fluoride waste and rather than develop pollution controls, they could instead make money by selling their fluoride waste to be used for water fluoridation.  Sounds plausible, right?  A little research into the aluminum smelting process reveals some interesting opposition to this claim.  The Hall-Heroult aluminum smelting process was discovered in the 1880’s, by Charles Hall and Paul Heroult, and is still used to this day [13].  The following is an explanation of the process.  It is a bit technical, but hang in there for the surprise ending.

Smelting is the process of extracting a metal from its oxide.  Bauxite, a rock composed of hydrated Aluminum oxides, is the main ore of Aluminum oxide commonly known as alumina, which is used to make aluminum (Al).  Mined bauxite is refined into alumina (Al2O3).  Powdered alumina is fed into a large, carbon-lined container called a cell.  The cell contains an electrolytic bath of molten salt called cryolite (Na3AlF6).  The alumina (Aluminum oxide powder) dissolves to form a solution.  Aluminum fluoride (AlF3) is added to maintain the proper chemical composition.  Large carbon blocks are suspended in the solution to serve as a positive electrode, or anode.  An electrical current passes from the carbon block anodes to the carbon cathode cell lining.  As the electrical current passes through the solution, the Aluminum oxide (Al2O3) is broken down/dissociated into molten aluminum (Al) and oxygen (O2).  The oxygen consumes the carbon (C) in the anode blocks to form Carbon dioxide (CO2), which is released. The reaction looks like this:

2 Al2O3 + 3 C —> 4 Al + 3 CO2

The hot, molten aluminum sinks to the bottom of the cell while the gaseous by-products collect at the top.  In addition to Carbon dioxide, the smelting process also emits the toxic gas Hydrogen fluoride (HF), discussed earlier.  Fume treatment plants are used to capture the Hydrogen fluoride and recycle it into Aluminum fluoride for use in the smelting process [13] [14].

(Wait!  What?!  They recycle their fluoride waste to use again in the smelting process?!  Where is all the waste they are looking to put in our water?  Hmmm…)  Currently, the aluminum industry is the largest user of fluoride compounds; therefore they have no vested interest in promoting water fluoridation whatsoever [15].

So how did water fluoridation begin?  Well, conspiracy theorists and anti-fluoride groups would have you believe that a use for fluoride was sought after in the 1940’s as an answer to disposing of industrial “toxic waste”.  However, according to the report, Fluorine and Dental Caries, by Professor of Dental Research at the University of Pittsburgh School of Dentistry, Gerald J. Cox (yes, the same Gerald J. Cox!) the relationship between fluoride and teeth actually dates back to the early 1800’s [16].  By 1850, it had been established that fluoride occurs in varying concentrations in teeth, bone and drinking water.  By 1900, it had been speculated that fluoride would protect against tooth decay and the notion of supplementing the diet with fluoride had been proposed [16].

Water fluoridation in the US is due in large part to the research of dentists Frederick McKay and Norman Ainsworth.  McKay spent 30 years investigating the cause of what was known in the early 1900’s as Colorado brown stain, which produced mottled, but cavity-free teeth [17].  With the help of other researchers, McKay determined the cause to be fluoride.  The first report of a statistical association between the stain and a lack of tooth decay was made by Norman Ainsworth, of the UK, in 1925 [18].

Anti-fluoride groups also often fail to mention the work H. Trendley Dean, whose research also predates their conspiracy theories.  In the 1930’s and early 1940’s, Dean and other colleagues at the US National Institutes of Health (NIH) published several epidemiological studies suggesting that a fluoride concentration level of 1mg/L was associated with substantially fewer cavities in areas of temperate climates, and that it increased fluorosis, but only to a level that was of no medical or aesthetic concern [19].  Other studies found no other significant adverse effects, even in areas with fluoride levels as high as 8mg/L [19].  To test the hypothesis that a proper dosage of fluoride would prevent cavities, Dean and his colleagues conducted a controlled experiment by fluoridating the drinking water in Grand Rapids, Michigan starting on January 25, 1945 [20][21].  He published the results in 1950, which showed a significant reduction in tooth decay [20][21].  Significant reductions in tooth decay from fluoridated drinking water were also reported in studies conducted outside the US, including the Bratford/Sarnia/Stratford study in Canada (1945-1962), the Tiel-Culemborg study in the Netherlands (1953-1969), the Hastings study in New Zealand (1954-1970) and the Department of Health study in the UK (1955-1960) [18].  By present-day standards, conducting such studies on the general public would not be tolerated well, to say the least.  However, it was the large reduction in tooth decay shown in these studies that convinced public health professionals of the benefits of fluoridation [22].  Fluoridation became an official policy of the US Public Health Service in 1951, and by 1960 water fluoridation was widely used in the US [19].

15) Decimated New   Jersey’s agriculture/farming, killing the former “GardenState

The story here is that in 1945, a group of orchard owners and farmers in Salem County filed suit against DuPont due to the toxic emissions of Hydrogen fluoride and hydrofluoric acid from a chemical plant in Deepwater, NJ.  They claimed their peach orchards were destroyed and animals were made sick or died from the pollutants.  We have already covered earlier that Hydrogen fluoride and hydrofluoric acid are highly toxic, as well as the fact that these compounds are different than Sodium fluoride and fluorosilicic acid used in dental products and in water fluoridation.

16) Degenerative and shortens lifespan

I think by this point we can say this is again due to dosage/high exposures and dependent on the fluoride compound one was exposed to.  This is of more concern for those working in the industrial plants where concentrated fluoride compounds are produced.

17) Banned in most European Nations

It is true that there is no wide-scale water fluoridation in Europe [23], but this statement is misleading.  Europe has not banned fluoride outright.  Instead, they use other measures such as fluoridating the salt, much like our iodized salt enriched with iodine [24].  Some European countries have also offered school-based dental care and fluoride programs for children [25], which most American children do not receive in our public schools.  Many American children have no dental care whatsoever.

(Wow!  Are you still with me?  That was a lot of information, but it was necessary.  Now that we got all those misconceptions cleared up, let’s continue…)

If they so choose, people can easily avoid fluoride products by choosing non-fluoridated toothpastes and mouthrinses, and by opting out of dental office fluoride treatments.  So the real issue is public water fluoridation.  Let’s take an in-depth look at this issue.

Decay & Water Fluoridation

When we eat sugary foods or fermentable carbohydrates (e.g. crackers, potato chips, pretzels, cereal and some fruits), specific oral bacteria (Streptococcus mutans and Lactobacillus) metabolize these carbohydrates, causing them to produce acid.  Enamel’s primary mineral content is hydroxyapatite crystals.  When enough acid is produced that lowers the oral pH to a level below 5.5, the acid begins to dissolve the hydroxyapatite crystals (known as demineralization).  After the carbohydrate is gone (eaten), some of the mineral loss can be recovered, or re-mineralized, from our saliva.  Cavities occur when the rate of demineralization exceeds the rate of re-mineralization.  This is a process that can take months or even years to actually develop a cavity.

Ingesting systemic fluoride (via fluoridated water or fluoride tablets/drops) is most beneficial for children up to 12 years of age; typically by age 12 all adult teeth have erupted, except for the wisdom teeth.  When a child ingests systemic fluoride, while the adult teeth are still developing underneath the gums, fluoride will incorporate into the developing enamel, producing fluorapaptite crystals.  Fluorapaptite is more resistant to acids than hydroxyapatite, thus making the teeth more resistant to demineralization.

After the age of 12, the benefits of fluoridated water are more topical rather than systemic.  Ingested fluoride is secreted in the saliva, which topically washes over the teeth aiding the re-mineralization process.  The fluoridated water itself, washing over the teeth, has this same effect.  Topical fluoride (both from fluoridated water and fluoride products) also has an effect on oral plaque bacteria.  Fluoride enters the bacterial cell and inhibits its acid-producing ability, thus reducing potential enamel demineralization.  Therefore people of all ages benefit from fluoridated water.

Fluoride in the Body

Next, let’s review the process of absorption and excretion of ingested fluoride.  When low doses of soluble forms of fluoride (like those in fluoridated drinking water) are ingested, the fluoride compound dissociates into ions (for example, NaF would break down into sodium ions and fluoride ions).  Fluoride ions enter the bloodstream via the gastrointestinal tract, where most is then filtered through the kidneys and excreted in the urine [26].  To a much lesser extent, fluoride is also excreted in the feces, sweat and saliva.  Fluoride does not accumulate in most soft tissue, and studies in rats and ewes suggest that the blood-brain barrier is effective in preventing fluoride migration into the central nervous system.   The largest concentration of fluoride in the body is found in calcified tissues.  Approximately 99% of the fluoride in the body is found in bones and teeth; the pineal gland also accumulates fluoride (you’ll see this everywhere on anti-fluoride websites).  This is because the pineal gland contains hydroxyapatite [26], and we’ve already covered how fluoride reacts with hydroxyapatite.

The pineal gland is an endocrine gland located between the two hemispheres of the brain that produces melatonin, a hormone that influences sexual development and sleep-wake cycles.  When reading information online about fluoride and the pineal gland, you’ll see claims on anti-fluoride websites that fluoride accumulation disrupts melatonin production and causes early puberty in children.  They report that a study showed fluoride in the pineal gland, but this is not surprising seeing as the pineal gland contains hydroxyapatite.  They will then even discuss the Newburgh-Kingston study conducted by the New York State Department of Health, a 10-year study that began in 1944 to observe the effects of fluoride.  The city of Newburgh had public water fluoridation at levels of 1.0-1.2mg/L, while Kingston was not fluoridated.  One part of the study sought to discover if fluoride had any effect on timing of puberty in humans.  At the end of the 10 year study, average ages of first menstruation among girls in the fluoridated city was 12 years; average age of first menstruation among girls in the non-fluoridated city was 12 years, 5 months.  (This is clearly not significant.  I had friends that had their first period 1, 2 and even 3 years before me, and we all grew up in the same city that did not have fluoridated water in our area.)  At the end of the 10-year study, the researchers reported no adverse systemic effects from drinking fluoridated water because no significant differences were found between the two groups in the two cities.

(Note: You can perform an internet search on “pineal gland and fluoride” and find anti-fluoride websites that report the information above regarding this study.  I chose not to provide a link in this post because I do not want to endorse those sites by providing a link on my website.  They would be notified of the fact that I provided such a link to their site.)

The Chemistry of Water Fluoridation

Earlier, I asked you to remember Calcium fluoride (CaF2) and how it was less effective at preventing tooth decay, the argument that fluoride was used in concentration camps to make people more docile, and the claim that fluoride causes weak/brittle bones/osteoporosis.  These issues have to do with calcium.  I’ll explain…

Some claim that the fluoride from natural sources, typically Calcium fluoride (CaF2), is better than “artificially” or “synthetically” manufactured fluorides that are added to drinking water, and would thus be a more preferred/less toxic fluoride source.  Chemistry provides the answer to this issue.  Calcium fluoride is highly insoluble, meaning the ions do not dissociate in water like those in the soluble fluoride compounds used in water fluoridation.  Low doses of insoluble sources of fluoride, such as Calcium fluoride, are much less well absorbed and therefore do not have as great of an effect on the teeth and saliva.  The insolubility of Calcium fluoride shows just how strong the attraction and bond of calcium and fluoride ions are.  This leads us back to the claims of fluoride use in concentration camps and its ability to cause weak/brittle bones.  We’ve just reviewed that when the soluble forms of fluoride in drinking water are ingested, dissociation occurs and fluoride ions enter the bloodstream and are deposited in the body or excreted.  But what happens when high, toxic doses of soluble fluorides are ingested?  Here is the answer:  The body moves calcium out of the bones and into the blood as needed to maintain a steady level of calcium in the blood [27].  When a toxic dose of fluoride is ingested, the fluoride ions that enter the bloodstream bond with the free calcium ions to form the stable and non-toxic compound, Calcium fluoride.  When there are not enough free calcium ions in the bloodstream, the body will speed up the process of moving calcium from the bones into the blood, but often the body cannot perform this fast enough to fully handle the toxic dose of fluoride that has been ingested.  When there is not enough calcium in the blood, the condition is known as hypocalcemia.  Hypocalcemia can cause problems with the parathyroid glands (thyroid issues are often blamed on fluoride by anti-fluoride groups).  As hypocalcemia progresses, people may become confused, depressed and forgetful.  Over time, hypocalcemia can affect the brain and cause neurologic or psychologic symptoms such as memory loss, delirium, and hallucinations.  These symptoms disappear if calcium levels in the blood are restored.  This can be achieved simply through calcium supplements [27].  This explains away so many of the claims of anti-fluoride groups from the docile individuals in concentration camps to even the lower IQ scores of the children drinking water with high fluoride concentrations (even though I don’t think that study holds much weight).  This also explains how high doses of fluoride can cause weak/brittle bones, due to the calcium being pulled out of the bones and sent into the bloodstream.  We reviewed earlier that skeletal fluorosis occurred in people consuming greater than 30 times the amount of fluoride typically found in fluoridated water AND it is more common among people who do not get proper nutrition, hence low calcium intake.  The issue is not low-dose fluoride; the issue is hypocalcemia induced by exposure to high/toxic doses of fluoride compounds either acutely or long-term.

Some may still worry about the believed effects of ingesting a small amount of fluoride on a daily basis.  You can find a lot of discussion online from those opposed to fluoride about how to “detox” fluoride from the body, and I bet you can guess what they recommend…you got it, calcium!  But is a calcium regimen for detoxing fluoride we ingest from our drinking water even necessary?  Just how much calcium would we need?   To explain this one, I dug out the ole chemistry book so you don’t have to.  (You’re welcome.)  A couple simple mathematical and chemistry calculations will give us the answer…and you may be surprised.

Let’s create the example of a person (we’ll call him Fred) living in a community with water fluoridated at a level of 1mg/L.  The current EPA recommendation is lower at 0.7mg/L, but we want to keep the math a bit simpler.  If Fred drinks 8 cups (1 cup = 8oz) of fluoridated water per day, this would equal 64 oz of water ingested.  We now need to covert this into liters.  One liter = 33.8oz, so if we divide 64oz/33.8oz, we would calculate that 1.89L of fluoridated water was ingested per day.  Since our fluoride concentration is 1mg/L, it is easily seen that Fred would be ingesting 1.89mg of fluoride per day.

Now for the real chemistry review…we’ll determine how much calcium would be needed to bind with, and thus, counteract this amount of ingested fluoride.  I’ll start with a short preview of the numbers we’ll be using in this calculation.

  • 1 mol = the weight in grams of an element or compound.  The weight for each element can be found listed on the periodic table of elements underneath the letter that represents each element.  For our equation, we will be using the element Fluorine (F-) and Calcium (Ca2+).  The weight in grams of of 1 mol F- is 19g, and Ca2+ is 40.08g, Therefore, we’ll be using (1 mol F-/19g F-) and (1 mol Ca2+/40.08g Ca2+).
  • Since Fluorine has a -1 charge, and Calcium a +2 charge, it will require two fluoride ions to bond with 1 calcium ion, hence CaF2.  So our equation will also include (1 mol Ca2+/2 mol F-).
  • We calculated above that Fred ingests 1.89mg of fluoride per day.  We need to convert this into grams.  There are 1000mg/g, so 1.89mg/1000 = .00189g of fluoride ingested per day.

To determine the amount of calcium needed to bind with this much fluoride, our equation looks like this:

(.00189g F-)(1mol F-/19g F-)(1mol Ca2+/2mol F-)(40.08g Ca2+/1mol Ca2+) = ?

Complete the necessary “cross-canceling” (is it coming back to ya a little bit?) and calculating this equation will look like this:

.00189g ÷ 19g ÷ 2 x 40.08g = .002g Ca2

When we then multiply the .002g by 1000 to covert grams back to milligrams, we will have determined that only 2mg of calcium are needed to counteract this daily ingested fluoride.

The RDA (Recommended Daily Allowance) of calcium for an adult under the age of 50 is 1000mg/day.  So if Fred is taking in the recommended 1000mg of calcium per day, only 2mg will be lost to binding with fluoride.  I think it is safe to say that likely all Americans living in areas with fluoridated drinking water are ingesting at least 2mg of calcium per day, therefore there is no need to be following some “fluoride detox” regimen if you are concerned about ingesting fluoride.  Treatment is only necessary in cases of toxic dose exposure.  For example, if a child is caught eating toothpaste, the recommendation is to have the child drink milk because the calcium will bond with the fluoride in the digestive tract, preventing the fluoride from entering the bloodstream where the large dose can be absorbed and deposited into the teeth and bones.

The Take Away

As we have seen, fluoride-containing compounds are so diverse that it is not possible to generalize on their toxicity, which is exactly what that photo at the beginning of this post is doing.  So, after all we’ve reviewed and learned, where do I stand?  Do we need water fluoridation?  In my opinion…and this may surprise you…I don’t believe so.  Reviews of the literature show it is now accepted that systemic fluoride actually plays a limited role in preventing decay, and that the major anti-caries effect of fluoride is topical rather than systemic.  Nevertheless, water fluoridation may still be of benefit for those more prone to decay due to socioeconomic status, limited or no access to preventative dental care/education, or lifestyle factors.  This gets into the issue of ethics; is it fair to impose water fluoridation on all in order to help some?  Now, after everything we’ve covered, I personally do not believe that dental fluoride (in the recommended dosages) causes any detrimental health effects.  Frankly, when it comes to issues regarding our health, I think we have bigger concerns than fluoride.  But is it possible that even small doses of fluoride, like those in fluoridated drinking water, could cause adverse effects to some individuals?…You bet.  Each person is unique and may have sensitivities or allergies that another may not.  Therefore, I do believe people should have a choice about what they put in their bodies.  When I have patients that prefer to avoid fluoride, I respect that decision and will not try to persuade them otherwise; I will instead find out what steps they are taking to reduce their risk for decay and educate them further when needed.  So what is the answer?  Should the money spent on public water fluoridation instead be put towards providing more public access to free fluoride treatments for those that decide they want them?…Maybe.  My local health department does provide this service on a regular basis free to children, but we could also implement school fluoride programs that parents could opt-in or opt-out of for their children, bringing back people’s choice on this issue.

There are ways to reduce your risk/prevent decay naturally.  However, these are not actions that all will be willing, or possibly even able, to take.  In my opinion, tooth decay is not a disease caused by not brushing or flossing enough, or even a disease caused by either lack of fluoride or lack of dental care; tooth decay is a disease of DIET.  In school we review diet as a small portion of our curriculum, and the rest of the focus is on more brushing/flossing, dental cleanings, fluoride treatments and restoring decay with fillings and crowns.  Our society, along with the dental society, is all about the “quick fix” to the problem rather than learning how and taking action to prevent the problem in the first place.  From cavities to periodontal disease, dental offices provide people with that “quick fix”; that is just what we have been trained to do.  While it would be wonderful if everyone took the necessary steps to reduce/prevent decay, it’s just not realistic.  We live in a society of people consuming high quantities of cariogenic foods, some by choice and some by necessity, because these same foods are often a cheap source of calories.  When money is tight and you’re hungry, these foods will likely make up the bulk of your diet.  So for many in America, there is no arguing that fluoride is of great benefit, but fluoridated toothpastes/mouthrinses and dental office fluoride treatments are more effective than fluoridated water.  For those interested in more natural, fluoride free approaches to reducing/preventing decay, stay tuned… I will be covering this topic in a future post.

Thoughts?  Opinions?  Scroll past the sources below to leave a comment and join the discussion!

Final Note

I could not possibly review every study or claim out there that exists pertaining to fluoride (although it probably feels like I did, huh?), but I hope that I have given you a more critical eye and mind so that when you read headlines or claims on websites, you will dig a little deeper.  You can’t believe headlines; you must get your hands on the actual study and read the details.  Only then can you make an informed decision.

Additional facts for those curious/interested:

  • I grew up in a fluoridated community from the ages of 0-4.
  • I lived in a non-fluoridated community from the ages of 4-29.
  • I again lived in a fluoridated community from the ages of 29-33.
  • At age 33, we moved outside city limits and are currently on well water.
  • I had dental sealants placed in all molars and premolars as a child.
  • The only decay I have had was mild pit/fissure decay in my partially erupted (thus hard to clean and sealants could not be placed) wisdom teeth, which have been extracted, and underneath 3 sealants that had chipped/worn after nearly 20 years; this decay was discovered by my dentist when I was having these worn sealants removed and replaced.
  • I have only had my wisdom teeth extracted.
  • I have had no other decay, thus I have no fillings or crowns.
  • I have always used fluoridated toothpaste and had dental office fluoride treatments up to age 18.
  • I had regular dental care throughout childhood.
  • I consider myself to have a pretty high IQ… 😉

Sources Cited

 1)  Brady, J., Holum, J.  1988.  Fundamentals of Chemistry 3E.  USA: John Wiley & Sons, Inc.

2)  (n.d.)  Tri-Calcium Phosphate (TCP): A Calcium Technology Exclusively from 3M ESPE.  From URL: http://multimedia.3m.com/mws/mediawebserver?mwsId=bbbbbdE37nQCWg1DZgjPXgq4PFE0PnE36FcbPFcbPbbbbbb–

3)  Solvay America, Inc.  2010-2012.  Product Safety Summary: Fluorosilicic Acid.  From URL: http://www.solvaynorthamerica.com/SiteCollectionDocuments/PDF/PS_Fluorosilicic_Acid.pdf

4)  US Envrionmental Protection Agency (EPA).  (n.d.)  Fluorspar and Hydrofluoric Acid.  From URL:  http://www.epa.gov/wastes/nonhaz/industrial/special/mining/minedock/id/id4-hfa.pdf

5)  NationalCenter for Chronic Disease Prevention and Health Promotion-Centers for Disease Control and Prevention.  Reeves, T.  2000.  The Manufacture of the Fluoride Chemicals.  From URL:  http://www.cdphe.state.co.us/pp/oralhealth/fluoridation/fl-143.pdf

6)  Aigueperse, J. et al.  2000.  Fluorine Compounds, Inorganic.  Ullman’s Encyclopedia of Industrial Chemistry.

7)  US Department of Health and Human Services (HHS).  2011.  HHS and EPA Announce New Scientific Assesments and Actions on Fluoride.  From URL: http://www.hhs.gov/news/press/2011pres/01/20110107a.html

8)  Greenwood, N., Earnshaw, A.  1997.  Chemistry of the Elements Second Edition.  Burlington, MA: Butterworth-Heinemann.

9)  Agency for Toxic Substances and Disease Registry (ATSDR).  2001.  Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine.  Atlanta, GA: Department of Health and Human Services, Public Health Service.  From URL: http://www.atsdr.cdc.gov/phs/phs.asp?id=210&tid=38

10)  Nochimson, G.  2011.  Fluoride Toxicity.  From URL:  http://emedicine.medscape.com/article/814774-overview#a0199

11)  Bucher, J.R.  et al.  Results and Conclusions of the National Toxicology Program’s Rodent Carcinogenicity Studies with Sodium Fluoride.  Int J Cancer.  1991 Jul 9;48(5):733-7.

12)  Rwenyonyi, C.M. et al.  Age as a Determinant of the Severity of Dental Fluorosis in Children Residing in Areas with 0.5 and 2.5 mg Fluoride per Liter in Drinking Water.  Clin Oral Inves.  2000.  4: 157-161.

13)  ALCOA.  (n.d.)  Aluminum Smelting.  From URL: http://www.alcoa.com/global/en/about_alcoa/pdf/Smeltingpaper.pdf

14)  Dubal Dubai Aluminum.  2012.  Aluminum Smelting.  From URL: http://www.dubal.ae/who-we-are/our-production-process/aluminium-smelting.aspx

15)  British Fluoridation Society.  (n.d.)  Technical Aspects of Water Fluoridation.  From URL: http://www.bfsweb.org/facts/tech_aspects/chemsmanufac.htm

16)  Cox, G.J.  1952.  Fluorine and Dental Caries.  A Survey of the Literature of Dental Caries.  Washington, D.C.: National Academy of Sciences-National Research Council.

17)  Peterson, J.  Solving the Mystery of the Colorado Brown Stain.  J Hist Dent.  1997;45(2):57-61.

18)  Mullen, J.  History of Water Fluoridation.  Br Dent J.  2005;199(7s):1-4.

19)  Lennon, M.A.  One in a Million: The First Community Trial of Water Fluoridation.  Bull World Health Organ.  2006;84(9):759-60.

20)  National Institute of Dental and Craniofacial Research.  2011.  The Story of Fluoridation.  From URL: http://www.nidcr.nih.gov/OralHealth/Topics/Fluoride/TheStoryofFluoridation.htm

21)  Dean, H.T. et al.  Studies on Mass Control of Dental Caries Through Flouridation of the Public Water Supply.  Public Health Rep.  1950;65(43):1403-8.

22)  Burt, B.A., Tomar, S.L.  2007.  Changing the Face of America: Water Fluoridation and Oral Health.  Silent Victories: The History and Practice of Public Health in Twentieth-Century America.  OxfordUniversity Press.

23)  Martin, B.  The Sociology of the Fluoridation Controversy: A Reexamination.  Sociological Quarterly.  1989;30(1):59-76.

24)  European Commission-Scientific Committee on Health and Environmental Risks.  2010.  Critical Review of Any New Evidence on the Hazard Profile, Health, Effects, and Human Exposure to Fluoride and the Fluoridating Agents of Drinking Water.  From URL: http://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_122.pdf

25)  Petersen, P.E. (n.d.)  World Health Organization.  Changing Oral Health Profiles of Children in Central and Eastern Europe-Challenges for the 21st Century.  From URL: http://www.who.int/oral_health/media/en/orh_eastern_europe.pdf

26)  Agency for Toxic Substances and Disease Registry (ATSDR).  2003.  Toxicological Profile for Flourides, Hydrogen Fluoride, and Fluorine.  , GA: Department of Health and Human Services, Public Health Service.  From URL: http://www.atsdr.cdc.gov/toxprofiles/TP.asp?id=212&tid=38

27)  Merck, Sharp and Dohme Co.  2010-2011.  Calcium.  From URL: http://www.merckmanuals.com/home/hormonal_and_metabolic_disorders/electrolyte_balance/calcium.html

13 Responses to “Fluoride: The Facts, the Controversy & the Science”

  1. Mike Ludwig August 31, 2012 at 3:38 pm #

    Absolutely great article! You gave me a couple of new things to consider as well as quality rebuttle to those with blinders on!

  2. Flossi September 12, 2012 at 11:19 am #

    Thanks for your time writing that article!
    It is quite informative, but I didn’t always resonate with what you were saying, perhaps because you were implying that those folks that understand the science of this situation, and whom you negatively labeled anti-fluoride or conspiracy theorists are getting their information from unreliable sources. Many scholarly journals are cited by these people who resonate with truth and social justice.
    Getting down to the end of it and seeing that you are actually against water fluoridation was a shock…
    and stating that it is caused by diet is right on. Sugar and soda are the main offenders.
    We need to provide better nutrition to our kiddos to prevent dental decay!

    Paleo Hygienist, with all due respect ma’am, I’d like to make some corrections and comments to your article:

    1) scrubbing is not a “purification process”, it is a method of controlling for air pollution, by turning the toxic fluoride gas into the Fluorosilicic Acid by adding water.

    2)the part where you claim fluoride is “not a drug” but a “supplement” is incorrect. It is a drug and that is why patients need a prescription and consent to ingest it. On Aug 15 1963 the FDA stated” Sodium Fluoride used for therapeutic effect would be a DRUG, NOT A MINERAL NUTRIENT,Fluoride HAS NOT BEEN DETERMINED ESSENTIAL TO HUMAN HEALTH.” However it still is an unapproved drug! It is not an effective way of administering a drug. Nobel Prize winner Arvid Carlsson states “Fluoridation is against all principles of modern pharmacology”. No one can control the dose or monitor anyone and there are plenty of consumer goods (food and beverages made in fluoridated areas) that are sources for fluoride.

    3)…furthermore, we aren’t talking about the pharmaceutical grade stuff here, the water bureau intends to add industrial grade “fluoride” that has not been tested comprehensively. (Section 104 (I) (5) of the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA) directs the Toxic Substances and Disease Registry, the EPA, the Public Health Service and the National Toxicology Program to initiate a program of research on fluoride safety. However, after almost 30 years of using fluorosilicic acid and sodium fluorosilicate to fluoridate the drinking water, not one study has been commissioned.)

    4)and Fluorosilicic Acid is contaminated with Arsenic, Cadmium, Mercury, Lead, Sulfates, Iron and Phosphorous, plus radionuclides Radium, Uranium, Polonium ( H.F. Denzinger, H. J. König and G.E. Krüger in the fertilizer industry journal, Phosphorus & Potassium (No. 103, Sept./Oct. 1979) discussed how radionuclides are carried into the fluorosilicic acid.In written communications EPA Office of Drinking Water official Joseph A. Cotruvo and Public Health Service fluoridation engineer Thomas Reeves have acknowledged the presence of radionuclides in fluorosilicic acid.) ….you left that part out….

    5) There are people that may be more sensitive to Fluoride ingestion, including those with thyroid dysfunction, kidney issues, infants etc….[the CDC warns against using Fluoridated water to make baby formula, plus the amount of fluoride provided by mother’s milk is notably low!]

    6)regarding bones:
    Although fluorine may thicken bones, the bones are not any stronger. The new bone is weaker.
    [New England Journal of Medicine, 32, #12, (1990):802-09]

    In four separate studies, increased hip fracture rates is linked to fluoride in the water. The latest study calculated an 86% increased risk for people over 65 who have been drinking fluorinated water.
    [JAMA, 1990-1995]

    Mayo Clinic researchers reported that fluoride treatment of osteoporosis increased bone fracture rate and bone fragility.
    [New England Journal of Medicine, March 22, 1990]

    7) we DO HAVE programs in our schools to provide topical application or supplements to children already….
    so its unnecessary to add it to our water supply, especially since only about 1% is actually drank and the rest goes down the drain….

    8)Quotes directly from your article I did resonate with: “After the age of 12, the benefits of fluoridated water are more topical rather than systemic.”…so i believe people should be asking “why put in the water supply at all?”
    At the end of your article you say that we don’t need water fluoridation and follow it up by saying ” Reviews of the literature show it is now accepted that systemic fluoride actually plays a limited role in preventing decay, and that the major anti-caries effect of fluoride is topical rather than systemic. “….so why subject anyone to health risks by fluoridating water supplies if it has been stated by the CDC that the predominate benefit is “TOPICAL, NOT SYSTEMIC”???
    Research on low dose long term effects needed to be conducted before water fluoridation practices spread~but that never happened.
    41% of children ages 12-15 already have fluorosis…does that number need to rise?

    9) look at Luke /Kunz Pineal Gland studies! I personally choose to detoxify my pineal gland and avoid fluoride whenever possible to do so, among other things. If there is even a bit of a chance that the accumulation in my pineal gland could cause adverse effects I’d like to avoid it. It is hard to avoid something when it is added to our water….people who want fluoride can seek it out!

    10) socioeconomic reasoning is flawed. Sure, everyone would have access to fluoride if it is in the water but Fluoride increases lead absorption and that effects minority groups more.
    Fluoridation is found ineffective in preventing early childhood caries in poor children
    (Barnes 1992, Shiboski 2003)

    11) I rather appreciate this line “Our society, along with the dental society, is all about the “quick fix” to the problem rather than learning how and taking action to prevent the problem in the first place”
    Perhaps a nutritional education program would be better than this water fluoridation idea…
    ~Again, thanks for writing this to clear up many misconceptions. Most people don’t know there is a difference between types of fluorides….Most people that are claiming that it is safe and effective are referring to flawed studies on pharmaceutical grade fluoride and not what is intended to be added to the water, and this is misleading to the public.
    The quote that has been grossly misquoted by the Everyone Deserves Healthy Teeth Coalition about fluoridation being one of the achievements of the century was taken out of context and was not made bt the CDC as a whole, it was made by 2 members of the CDC and does not reflect the CDC as a whole entity. It is a campaign tactic to make Portlanders,and the world,  think it is safe and effective, when in reality it is anything but. Please look into where that quote really came from.

    12) Here is a quote about situation here in Portland:
    “The situation in Portland is highly distressing and the machinations of three politicians is an insult to the citizens and to the spirit of democracy. What we are seeing here is the outcome of a slick PR campaign and much backroom dealing. It is certainly not the outcome of a dispassionate analysis of the science of fluoridation’s effectiveness (or lack of it), its mode of action or the potential dangers it poses. The Harvard review of IQ studies should rule this practice out. Who in their right mind would put a small benefit (if any) to teeth ahead of a possible threat to the mental development of children. It is preposterous. If a threat to the brain is not enough to make these politicians blink then how about the threat to the bone of adults summarized in this short review http://www.fluoridealert.org/articles/arthritis-risk/ ?. The promoters of this practice certainly have power on their side but they don’t have the science. That is why they run a mile when they are challenged to defend this foolish practice in open public debate.”

    Paul Connett, PhD, lead author of “The Case Against Fluoride” and Director of the Fluoride Action Network.

    13) Plus I’d like to point out that nearly 4,200 professionals have signed a statement calling for an end to water fluoridation (see http://www.fluoridealert.org/professionals-stateme… ).  
    Among these professionals: 
     –Arvid Carlsson (Nobel Laureate for Physiology or Medicine, 2000) 
    –Three members of the National Research Council committee who wrote the landmark 2006 report: Fluoride in Drinking Water: A Scientific Review of EPA’s Standards (Hardy Limeback, PhD, DDS; Robert L. Isaacson, PhD; Kathleen M. Thiessen, PhD) 
    –The current President and six past Presidents of the International Academy of Oral Medicine and Toxicology
    — Three scientists from the Environmental Protection Agency (EPA) Headquarters Union in Washington D.C. 
    — The Board of Directors, American Academy of Environmental Medicine 
    –Two advisory board members of the UK government sponsored “York Review” 
    –Five Goldman Prize winners (2006, 2003, 1997,1995, 1990) 
    –William Marcus, PhD, Former chief toxicologist of the EPA Water Division, Boyds, MD 
    –Vyvyan Howard, MD, PhD (Past President, International Society of Doctors for the Environment) 
    — Ken Cook and Richard Wiles, President and Executive Director, Environmental Working Group (EWG) 
    –Ron Cummins, Director, Organic Consumers Association  
    –Lynn Margulis, PhD, a recipient of the National Medal of Science  
    –Theo Colborn, PhD, co-author, Our Stolen Future 
    –Andy Harris, MD, former national president, Physicians for Social Responsibility, Salem, OR 
    14)  http://www.nationalwatercenter.org/50_reasons.htm
    50 reasons not to Fluoridate water by the National Water Center:
    Reason 38 illustrates a point I made earlier about flawed studies: “The early studies conducted in 1945 -1955 in the US, which helped to launch fluoridation, have been heavily criticized for their poor methodology and poor choice of control communities (De Stefano, 1954; Sutton 1959, 1960 and 1996). According to Dr. Hubert Arnold, a statistician from the University of California at Davis, the early fluoridation trials “are especially rich in fallacies, improper design, invalid use of statistical methods, omissions of contrary data, and just plain muddleheadedness and hebetude”
    ….also, we must look at who funded the research and what their agenda would be to create data to support their stance on fluoride use….Do a search on Aliss Terpstra, fluoride poisoning survivor who was one of the residents in the first community to be fluoridated. Discovering her personal testimony may make people think more deeply about this practice.

    Just wanted to add those comments to this forum.

    • ThePaleoHygienist September 12, 2012 at 8:18 pm #


      Thank you for taking the time to respond, and doing so respectfully. I appreciate the information you provided and I am completely open to learning more about this issue, because, as I stated in my post, we do not cover much during our dental education. My post is the result of my personal research that I embarked on to answer the questions I had from arguments against fluoride. I am completely open to being presented studies that are not biased in regards to who funded the study. (I made it a point to not use the ADA as a source of my post for a reason; I wanted to hopefully eliminate percieved bias.) I also want to note that in your rebuttal #4 (where you state that fluorosilicic acid is “contaminated” and that I left this part out), I did not intentionally leave information out of my report, merely, my report was nearing 17 pages and I had to cut myself off at some point as all the arguments around this issue can really go on forever. I figured when points like this were made from reader’s comments, I could address them then.

      In most aspects of the medical side of health and nutrition, I greatly disagree with what is mainstream. Thus, I feel I should be just as open to exploring health issues in the dental arena as well. I am never one to persuade my patients into any treatment they are uncomfortable with or do not want. Just because I work in the dental field does not mean that I agree with the ADA on every issue. I don’t believe the treatment methodologies and protocols I learned in school are the right choice for everyone. I am all for personal choice, especially when it comes to what we put in our bodies, which is why I personally don’t advocate for water fluoridation.

      Now I would like to address each of your comments:

      1) Yes, you are correct in your statement on fluorosilicic acid, however the word “purification” is not mine. I cited two sources at the end of that section that you can click on the link to read the description of the process. One source clearly calls it a purification process while the other states “purified by scrubbing”. Here is the exact quote: “The crude product gas is handled differently by the various manufacturers, but cooling and scrubbing are always involved. Exhibit 2 shows the gas being cooled, PURIFIED by scrubbing, and condensed.” I in no way meandered around the fact that the scrubbers are recovery units that trap the waste gases; I stated this.

      2) Next the “drug” vs. “supplement” issue: Let me first point out that you mention Sodium fluoride, not fluorosilicic acid used in water fluoridation; two different compounds. Second, just because something requires a prescription does not automatically mean it is a “drug”. For instance, Vit D2 50,000iu is only available by prescription, as is Folic Acid 1mg (a B vitamin). Does this mean these supplements are drugs? No, it simply means that due to the dosage, you should first be advised by your physician and pharmacist on how to properly ingest such a dosage and to verify that you in fact need that dosage, which your physician determines. Same with prescription fluoride products. Water fluoridation fluoridates the water at a concentration of 1ppm. OTC fluoride toothpaste is around 225ppm, while prescription fluoride toothpaste has a fluoride concentration of 5000ppm, quite a difference, thus is it provided as a prescription by a doctor and pharmacist whom have both reviewed with the patient the proper use in order to avoid ingesting a toxic dose. But honestly, this really just comes down to semantics and how you choose to define “drug” vs. “supplement”. Honestly, I don’t mind if people want to view fluoride as a “drug” as long as they view vitamins in that same category since they can both require a prescription, and that seems to be your argument here.

      3) No, we are not talking pharmaceutical grade fluoride, because again, these are different compounds. Pharmaceutical grade compounds are used to make prescription drugs, not fluoridate drinking water or be used in dental products. The fluoride compound you use for water fluoridation must be water soluble, so a water soluble form must be made. But let me still address your statement on the fluoride added to water not being tested. What I am going to present here is straight from my provided source, “The Manufacture of the Fluoride Chemicals” with link provided so you can review. This source states:

      Concern has been raised about the impurities in the fluoride chemicals. The American Water Works Association (AWWA), a well-respected water supply industry association, sets standards for all chemicals used in the water treatment plant, including fluoride chemicals. The AWWA standards are ANSI/AWWA B701-99 (Sodium fluoride), ANSI/AWWA B702-99 (Sodium fluorosilicate) and ANSI/AWWA B703-00 (fluorosilicic acid). The National Sanitation Foundation (NSF) also sets standards and does product certification for products used in the water industry, including fluoride chemicals. ANSI/NSF Standard 60 sets standards for purity and provides testing and certification for the fluoride chemicals. Standard 60 was developed by NSF and a consortium of associations, including the AWWA and the American National Standards Institute (ANSI). This standard provides for product quality and safety assurance to prevent the addition of harmful levels of contaminants from water treatment chemicals. More than 40 states have laws or regulations requiring product compliance with Standard 60. NSF tests the fluoride chemicals for the 11 regulated metal compounds that have an EPA MCL (maximum contaminant level). In order for a product [for example, fluorosilicic acid] to be certified to meet the NSF Standard 60, the regulated metal contaminants must be present at the tap [in the home] at a concentration of less than 10 percent of the EPA MCL when added to drinking water at the recommended maximum use level. This NSF Standard 60 level [10% of the EPA MCL] is called Maximum Allowable Level (MAL).

      In tests by the NSF, the majority of samples of fluorosilicic acid showed no detectable level of arsenic in the finished water. Of those that did have a detectable level, the average arsenic concentratin in the finished water was 0.43 ug/L [parts per billion]. Opflow, a monthly magazine from the AWWA, has found the arsenic level in the finished water from the fluorosilicic acid to be 0.245 ug/L [Opflow, Vol 26, No. 10, October 2000]. The NSF Standard 60 for arsenic has a Maximum Allowable Level (MAL) of 2.5 ug/L and EPA has a MCL for arsenic of 50 ug/L, although it will be lowered to 10 ug/L by 2004.

      Tests by NSF and other independent testing laboratories have shown no detectable levels of radionuclides in product samples of fluoride chemicals. There is no evidence that any of the known impurities in the fluoride chemicals have failed to meet any of these standards.

      Opponents of water fluoridation have sometimes charged that “industrial grade fluoride” chemicals are used at the water plant instead of pharmaceutical grade chemicals. All the standards of the AWWA, ANSI, and NSF apply to these industrial grade fluoride chemicals to endure they are safe.”

      I listed this source at the end of my original post for your review, and it is written by the same man you cite in your rebuttal, Fluoridation Engineer Thomas G. Reeves. Although I do notice that the source you cite is from 1979, and my source is from 2000. I would expect that in 21 years there have been many improvements in standards, testing and safety of our drinking water.

      4) I belive the above addressed your #4 point as well.

      5) You state “There are people that may be more sensitive to fluoride ingestion, including those with thyroid dysfunction, kidney issues, infants, etc”…key word “MAY”. Show me a study! I can provide for you a study that tested urinary excretion of ingested fluoride on those without kidney issues and those with chronic renal failure. The study reported that yes, there was less fluoride in the urine of those with chronic renal failure, however they had more fluoride excreted in the feces than those with no kidney issues. Interesting to note, those with chronic kidney failure were supplemented with a small dosage of Aluminum hydroxide [30ml three times daily] and the result: “…intake of the aluminum hydroxide resulted in a fluoride balance that was the same as the fluoride balance of patients with normal renal function in the control study.” What is Aluminum hydroxide? An antacid. [Spencer, H., Kramer, L. et al. 1980. Effect of Calcium, Phosphorus, Magnesium, and Aluminum on Fluoride Metabolism in Man.]

      As for infants, the CDC reports that infants fed exclusively formula made with fluoridated tap water may have the result of mild fluorosis. This is not harmful to the child. Actually, teeth with fluorosis are very decay resistant (hence my info above regarding the people with “Colorado brown stain” that had cavity-free teeth). Any fluorosis caused from drinking water is typically unnoticealbe. Noticeable fluorosis in teeth is usually due to a larger dose of ingested fluoride from overdosing on fluoride supplements or children eating toothpaste, drinking fluoridated rinses, etc.

      As for thyroid issues, I’ve been trying to find a valid study here so if you have one, feel free to post it.

      6) Regarding bones: I covered this issue in my post and this related to dosage. Proper dosage is therapeutic, too much causes weaker bones. Same for the bisphosphonates I mentioned which are also used to treat osteoporosis.

      7) I agree with you! I stated that I would favor school fluoride programs (that give parents choice) over water fluoridation.

      8) Glad you appreciated what I stated there. It is my opinion that many dental professionals that advocate for water fluoridation may not be aware that it is no longer seen as the best defense against decay over topical fluoride. This notion changed in roughly 2000, so if dental professionals are not keeping up with the literature, they missed this one.

      9) Again, I agree with you that if there is a chance something can harm us, then why not try to avoid it. I will indeed take a look at the pineal gland study you mentioned and will post a comment if I have a response to it. I do feel that if I have a response or question regarding that study that you should be prepared to defend it since you presented it.

      10) Yes, the argument is always stated about it helping those of lower socioeconomic status, but again I stated that this does not mean that, ethically, we should give something to ALL to help SOME. I will read the lead link you provided, but I did cover above how the water is tested for levels of lead, arsenic, etc.

      11) Thank you. And as for the CDC quote about water fluoridation being one of the greatest achievements in health in the last century, I did not state that I endorsed that quote; I stated that in school, we are taught that.

      12) I agree that Portlanders should definitely have the right to vote on this issue rather than lawmakers making the decision. They are supposed to be working for the people of their city and it is clear that the people want a voice in this issue and should have it. As for the part about the Harvard IQ study, I covered that in my original post and reviewed why that study was faulty.

      13) Thanks for posting on the petition for anyone that may want to add their signature to it.

      14) I would think that many studies conducted 50-60 years ago could be seen as having faulty methodologies by today’s standards. I wholeheartedly agree that the issue of water fluoridation should be studied, especially the issue of long-term/low-dose fluoride ingestion, since most studies are a couple years long with very large doses. And I will indeed look up the story of Aliss Terpstra.

      Thanks again for your comments! My goal is to provide an open forum here so we can get a dialogue going and learn from each other. I thank you again for presenting your views and information in a postive and respectful manner. I hope others that choose to comment will do the same.


  3. prunesaregood November 28, 2012 at 6:27 pm #

    Wow!! I think this could be (and has been) a book. Unfortunately, i am one of those sensitive to fluotide. Anchovies, chicken, salmon with bones, wine, any tea drink, nonorganic vegetables -especially grapes, lettuces-these all contain fluorides, which give me fluoroderma.

    I found out about this skin condition via the cellulite investigation blog. Also I received fluoride pills because I lived abroad in France at a young age, used too much toothpaste! (apparently one tube should last years, not months) and i also took cipro, a fluoridated antibiotic. Many antidepressants -which I am not taking-also have fluoride.

    Finally, a chronic tap water drinker, and very regular dentist goer.

    I would be for fluoride if the sources were controlled but its not. It took me months to piece this together, and I only realized it when I went to a restaurant, drank only water for a day and woke up with huge painful lumps in my chin. I would not wish this on anyone. I don’t think anyone anticipated the levels of fluoride we would be exposed to today be side of pesticides like cryolite, lower levels of iodine in our diet, and the overuse of antibiotics and other fluoride containing drugs. I wonder how uncommon my situation is and I pray to God that no one would ever have to go through what I have been through. Thanks for a balanced article, and perhaps check out the ebook from thecelluliteinvestigation.com on fluoroderma. It may be more common than we think.

  4. Ben June 4, 2013 at 11:53 pm #

    Great article. Similar to the vaccine debate, the moral error is imposing something on all people. Both fluoride and vaccines are demonstrated to be safe in general. But those studies tend to measure/track the status of all people in the study and more/less average them out. Like the previous commenter, some people have genetic (or environmental) factors that could make them an outlier to the safety data. If 1 in 1,000 has an adverse reaction, the decision to do it anyway (similar for vaccines) is acknowledging that 1 in 10,000 will be sacrificed for the others. That is not a decision for the government to make. Everyone is fine with it as long as it isn’t them or their kid who is sacrificed,

    And as you know being paleo, the government has been feeding us phony-bologna data to support BS nutrition advice for decades. I am not going to trust their safety data for fluoride either. And if it increased cancer or AI diseases or heart disease by 25% if all other factors were constant, you would lose this in the noise of the data since the other factors are not constant. The medical study statisticians are prone to errors of assuming that they can control for just about any factor. But the truth is they cannot do that unless they understand the impact of those factors….which they don’t.

    If you haven’t, it is interesting to hear what jackkruse.com says about fluoridated water. He provides a theoretical reason it damages your health. I am not convinced that his theory is correct at this point. But I do agree that I should be ingesting natural foods and water. The water out of my tap is not natural.

    Thanks again for the article.


  5. dentalstudentdds July 8, 2013 at 12:32 pm #

    Great article! I am beginning dental school this fall and have been asked by several people about this topic as well as the mercury controversy. I am glad to finally have a good source of information to refute the misinformation.

  6. Paige Seaborg July 3, 2014 at 10:21 am #

    “I didn’t know what was true and what was false because, in school, we don’t cover this stuff; in fact, we really don’t cover much at all when it comes to fluoride during our dental education.”

    I enjoyed reading your very thorough overview; just wanted to comment on this statement…….I am so sorry that you did not cover this in your education. It was extensively covered in mine at University of Washington, class of 1978……. through the years I have followed the new research and ideas surrounding fl , methods, levels, effectiveness etc. So perhaps, “At the school I attended, we didn’t cover fluoride….etc.” may be more accurate; I wouldn’t want the general public to think this is not a covered topic in all schools and that we are just sheep following ADA dental doctrine.

    I will look forward to reading your other posts.

    • ThePaleoHygienist August 10, 2014 at 1:37 pm #

      What I meant was that yes, we cover fluoride during our education, but we simply learn what fluoride is and how it benefits the teeth, but we do not cover the controversy or how to respond to the negative information out there. If that aspect was covered during your education then I’d say you were fortunate to have received a very thorough and progressive curriculum.

  7. reasonable income online September 4, 2014 at 12:42 pm #

    I’m not sure where you’re getting your info, but great topic.
    I needs to spend some time learning more or understanding more.

    Thanks for wonderful information I was looking for this info for my mission.


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