Posts Tagged ‘dental fluorosis’

Association of vascular fluoride uptake with… [Nucl Med Commun. 2012] – PubMed – NCBI

This article was posted just last month (Jan, 2012) on

OBJECTIVE: The feasibility of a fluoride positron emission tomography/computed tomography (PET/CT) scan for imaging atherosclerosis has not been well documented. The purpose of this study was to assess fluoride uptake of vascular calcification in various major arteries, including coronary arteries.

METHODS: We retrospectively reviewed the imaging data and cardiovascular history of 61 patients who received whole-body sodium [¹⁸F]fluoride PET/CT studies at our institution from 2009 to 2010. Fluoride uptake and calcification in major arteries, including coronary arteries, were analyzed by both visual assessment and standardized uptake value measurement.

RESULTS: Fluoride uptake in vascular walls was demonstrated in 361 sites of 54 (96%) patients, whereas calcification was observed in 317 sites of 49 (88%) patients. Significant correlation between fluoride uptake and calcification was observed in most of the arterial walls, except in those of the abdominal aorta. Fluoride uptake in coronary arteries was demonstrated in 28 (46%) patients and coronary calcifications were observed in 34 (56%) patients. There was significant correlation between history of cardiovascular events and presence of fluoride uptake in coronary arteries. The coronary fluoride uptake value in patients with cardiovascular events was significantly higher than in patients without cardiovascular events.

CONCLUSION: sodium [¹⁸F]fluoride PET/CT might be useful in the evaluation of the atherosclerotic process in major arteries, including coronary arteries. An increased fluoride uptake in coronary arteries may be associated with an increased cardiovascular risk.

It will be interesting to see where this goes. If it is accurate then here is one more item of concern. – Jeff

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Community Water Fluoridation (CWF) is having a significant impact on my work as of late. It all started when a local resident spoke before our board. He, his family and friends presented concerns about our district adding fluoride to the drinking water. Their concerns for the most part was from recent studies that calls into question not only the safety of fluoride, but the effectiveness of a CWF program that the Centers for Disease Control (CDC) has praised as one of the top 10 public health advances in the nation.

With the heavy government promotion of CWF programs, it would seem incongruous that our government would allow something unsafe in our water supply. After finding myself falling into the trap of assuming the black helicopter gang had just visited us. I took a step back and decided to take a closer look this issue.

In researching fluoride and the CWF program I came across many reports, studies, opinions and articles. Out of all of the information that I compiled from the internet. I identified certain documents that I have relied upon for my research. They are;

  1. United States National Research Council Report of 2006 on Fluoride in Drinking Water
  2. City of Palmer passes ordinance ceasing adding fluoride to water supply.
  3. Fairbanks Alaska Fluoride Task Force Report
  4. January 2008 Issue of Scientific American – “Second Thoughts about Fluoride” page 79
  5. A Quantitative Look at Fluorosis, Fluoride Exposure, and Intake in Children Using a Health Risk Assessment Approach
  6. Community water fluoridation and caries prevention: a critical review
  7. Considerations on Optimal Fluoride Intake Using Dental Fluorosis and Dental Caries Outcomes – A Longitudinal Study

In the coming days I will be involved in a vote to either cease/modify or continue adding Sodium Fluoride (HaF) into our communities water supply. So in order to make that decision I came up with some basic questions to seek answers to. Those questions invariably led to more questions which involved many sleepless nights and reading numerous research papers and articles from both sides of the issue. So here is what I have come up with so far.

  1. What is Fluoride and where does it come from?
  2. What is the history of water fluoridation?
  3. Is Fluoride safe for human consumption?
  4. Does fluoride provide a significant benefit to the community?
  5. Is it appropriate to mass medicate a community without individual consent?

Hopefully, taking a close look at these questions will help me to decide after balancing the risks vs rewards if water fluoridation is appropriate for our community. That is a heavy weight on my shoulders given the issues and emotions involved with that decision.

So, first off; What is Fluoride and where does it come from? Fluorine is one of the most reactive elements in nature. Fluoride is  found within a variety of naturally formed minerals. It is highly toxic and of concern to many parts of the world were exposure to the high levels of naturally formed fluoride in the environment is a major health concern. Some of these minerals have commercial applications. Two of those applications are aluminum and fertilizer production. Rock phosphates are converted into phosphate fertilizers by the removal of up to 4.2 per cent fluoride; the removed and purified fluoride (as fluorosilicates) is a source of fluoride that in some countries is added to drinking-water in order to protect against dental caries.

Sodium Fluoride (NaF) is prepared by neutralizing hydrofluoric acid or hexafluorosilicic acid (H2SiF6), byproducts of the production of super-phosphate fertilizer. This is the form of fluoride that is currently added to the water supply in my community.

Hydrofluoric acid (HF) is a solution of hydrogen fluoride in water. It is a valued source of fluorine and is the precursor to numerous pharmaceuticals such as fluoxetine (Prozac) and diverse materials such as PTFE (Teflon). Cooking with Teflon is considered one of the ways that a person is exposed to Fluoride. I find this interesting in that Prozac is a medication that is designed to cross the blood brain barrier and have an impact on a persons mental processes.

Hexafluorosilicic acid is the inorganic compound with the formula H2SiF6. It is a product of the production of hydrogen fluoride and the production of phosphate fertilizers. The majority of the hexafluorosilicic acid is used for the production of aluminum metal.

Hexafluorosilicic acid is also commonly used for water fluoridation in several countries including the United States, Great Britain, and Ireland. In the U.S., about 40,000 tons of fluorosilic acid is recovered from phosphoric acid plants, and then used primarily in water fluoridation, sometimes after being processed into sodium silicofluoride.

Hexafluorosilicic acid is also used as an electrolyte in the Betts Electrowinning process for refining Lead.

In a nut shell, the hydrofluoric and hexafluorosilicic acids, which are highly reactive is converted into a more stable and highly toxic chemical. That chemical is then used to fluoridate our drinking water.

What is the History of Water Fluoridation? Prior to 1945, fluoride left over from manufacturing processes was considered a highly toxic waste product requiring safe disposal. Now it is sold throughout the world and added to the drinking water supply as a means of preventing tooth decay, particularly in children who have not erupted their adult teeth.

The controversy surrounding water fluoridation has been prevalent ever since the practice first began. The primary reason driving this practice is to reduce childhood tooth decay, particularly for those citizens on the lower end of the socioeconomic scale. The idea being that those with little resources are more likely to not have good oral hygiene and dental care available to them. Therefore the mass application of fluoride to a community through the water supply is considered a major accomplishment in public health particularly for the poor.

Is Fluoride Safe for Human Consumption? The answer from proponents is that it is safe for human consumption in small quantities and that the levels maintained in the public water system as expressed in parts per million is not high enough to cause significant health impacts to the public. They also believe that the insignificant health impacts such as mild dental fluorisis, do not outweigh the overall benefits to the community. Some have even said that if it prevents one childhood cavity then it is worth it.

It is significant to note that Fluoride accumulates in the  body. It is estimated that for a healthy person, half of all fluoride consumed remains in their body.

So what about it, is it safe? To try and understand this issue it helps to have some basic medical knowledge. This helps to sort through the myriad of papers and articles discussing effects on the human body from fluoride exposure. I relied on several sources a listed above, but felt that the National Research Councils report from 2006 had the most complete and recent analysis and review of fluoride exposure.

First off, the most prevalent and visible symptom off fluoride exposure is dental fluorisis. Researchers in the early 30’s studying the causes of severe dental fluorisis in the mid-west discovered that naturally occurring calcium fluoride in the local water supply caused teeth to become black and pitted with striations. They also found that there was a lower incidence of tooth decay caused by bacteria infecting the surface of the tooth. Because of the affinity of fluorine to bond to bony structures in the human body exposure to fluoride also resulted in skeletal fluorisis. Which is a condition in its most severe forms causes pain and stiffness in the joints along with a propensity to make bones not only harder but more brittle and easily broken. From a base level of understanding it is apparent that dental fluorisis and the increased resistance to tooth decay are early symptoms of fluoride exposure.

The 2006 NRC report also specifically addressed fluorides influence on different body systems. These include, Musculoskeletal, Reproductive and Developmental, Neurotoxicity and Neurobehavioral, Endocrine System, Gastrointestinal, Renal, Hepatic and Immune Systems, Genotoxicity and Carcinogenicity.

What the NRC Review concluded was that fluoride does have impacts to a persons health depending on a variety of factors. Some of the factors identified sub-population groups that because of genetics, age or disease processes made them more susceptible to exceeding recommended daily exposure limits of fluoride. A majority of those studies determined that physiological influences occurred when water fluoride levels exceeded 4 mg/L which is considered by the EPA as the maximum daily exposure limit.

The one body system that is of particular interest to me is the conclusions regarding the Endocrine System. My interest is based on my wife and children’s ongoing endocrine disorders. Instead of paraphrasing the conclusion I will quote it for you from Page 7 of the report.

The chief endocrine effects of fluoride exposures in experimental animals and in humans include decreased thyroid function, increased calcitonin activity, increased parathyroid hormone activity, secondary hyperparathyroidism, impaired glucose tolerance, and possible effects on timing of sexual maturity. Some of these effects are associated with fluoride intake that is achievable at fluoride concentrations in drinking water of 4 mg/L or less, especially for young children or for individuals with high water intake. Many of the effects could be considered sub-clinical effects, meaning that they are not adverse health effects. However, recent work on borderline hormonal imbalances and endocrine-disrupting chemicals indicated that adverse health effects, or increased risks for developing adverse effects, might be associated with seemingly mild imbalances or perturbations in hormone concentrations. Further research is needed to explore these possibilities.

Some studies have also concluded that fluoride is able to pass the blood/brain barrier and have negative effect on the persons mental and cognitive abilities. Some scientists have also theorized that fluoride may have a hand in increasing the risk of developing Alzheimer Disease.

So given all that I have read, it is apparent to me that high exposure levels of fluoride is not good for human consumption. It is also apparent that persons whom have been exposed over a long period of time have a higher risk of developing health related issues attributable to fluoride. The report also identified areas of study to further clarify the effects upon the human body from fluoride.

Too answer the question of whether or not fluoride is safe for human consumption, particularly at the lower levels artificially added to the water supply. I would have to say the jury is still out. Although evidence appears to be mounting that it may not be as safe as first advertised.

Does fluoride provide a significant benefit to the community? From what I have found out, the answer is “It Depends”. There is evidence that communities on the lower socioeconomic scale may benefit from a CWF program. The communities that gain the greatest benefit from fluoride are ones without access to regular dental care, dental care products with fluoride and education in oral hygiene. These communities tend to be in third world countries, not industrialized societies.

In evaluating the level of benefit to the community, I need to understand how effective fluoride is in reducing the number of caries a person develops. I have heard from a few pro-fluoridation medical professionals at one of our meetings. Recently, I had the occasion to visit my family dentist. This dentist has been treating my family and I for over 25 years. He has been in practice for 35 years and at the same location ever since I first went to him. While I was in the chair, and without discussing any information that I had developed so far, I asked him what his take was on CWF. His answer was quite surprising. He was not for it, he told me that he has seen increases of dental fluorisis. He also shared with me something I was not aware of. Caries develop for the most part within the pits and fissures of the teeth where food and bacteria collect. His experience is that fluoride does not provide any greater protection in these areas. This is something that I had not heard before. Coincidentally, I received an email a couple of days later from a Maureen Jones with the Citizens for Safe Drinking Water. In her email, she listed several subject headings with quotes from various studies on oral health and CWF. On section was titled “Pits and Fissure Tooth Decay”. The information she had sent to me helped to validate what my family dentist shared.

Fluoride primarily protects the smooth surfaces of teeth, and sealants protect the pits and fissures (grooves), mainly on the chewing surfaces of the back teeth.  Although pit and fissure tooth surfaces only comprise about 15% of all permanent tooth surfaces, they were the site of 83% of tooth decay in U.S. children in 1986-87.
Selected Findings and Recommendations from the 1993/94 California Oral Health Needs Assessment.

Because the surface-specific analysis was used, we learned that almost 90 percent of the remaining decay is found in the pits and fissures (chewing surfaces) of children’s teeth; those surfaces that are not as affected by the protective benefit of fluoride.
Letter, August 8, 2000, from Jeffrey P. Koplan, M.D., M.P.H., CDC Atlanta GA.

Nearly 90 percent of cavities in school children occur in the surfaces of teeth with vulnerable pits and grooves, where fluoride is least effective.”
Facts From National Institute of Dental Research. Marshall Independent Marshall, MN, 5/92.

I found this information surprising. The totality of the quotes provides a strong argument against CWF. Of particular note is the second quote from a letter written by the Director of the Centers for Disease Control admitting that fluoride is not as effective in the areas of the teeth most susceptible to tooth decay. The National Institute of Dental Research also confirms that 90 percent of cavities occur in the pits and fissures of a persons tooth.

I find this little tidbit to be significant in that these statements may contradict statements made from these same organizations supporting CWF. In order to verify the above quotes, I have requested from Miss Maureen Jones copies or links for these quotes.

In the referenced article titled “Community water fluoridation and caries prevention:
a critical review
” the conclusion was;

For the past 50 years, CWF has been considered the most cost-effective measure for the control of caries at the community level. However, it is now accepted that systemic fluoride plays a limited role in caries prevention. Several epidemiologic studies conducted in fluoridated and nonfluoridated communities clearly indicated that CWF may be unnecessary for caries prevention, particularly in the industrialized countries where the caries level has became low. Moreover, the evidence of an increased prevalence of fluorosis, particularly in fluoridated areas, needs to be considered. Nevertheless, water fluoridation may still be a relevant public health measure in populations where oral hygiene  conditions are poor, lifestyle results in a high caries incidence, and access to a well-functioning oral health care system is limited. Instead, topical fluoride offers an optimal opportunity to prevent dental caries among people living in both industrialized and developing countries, and the use of fluoride-containing products, particularly the toothpaste, needs to be maintained and expanded.

In order to answer this question you would need to critically evaluate the socioeconomic status of the community being served.

Now for the last question, Is it appropriate to mass medicate a community without individual consent? This question is one that can only be answered by each of us. Some feel, that the benefits to community members who do not have access to oral health care greatly outweighs the rights of those that do. Others believe that in a free society, people have the right to choose what, if any medical intervention happens to them and their families.

So, where do I stand? My political beliefs are generally a little right of center. Almost a libertarian but not exactly. That belief tells me that we do not have the right to impose medications on a populace without their individual consent. No matter how safe they may be.

I am gonna step back right now and see what the readers think. I will followup as I develop more information.

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