Written by Dr Sarah Lantz I Photography by Nadia Harrison @photocollective.co

Whether you agree with water fluoridation or not, it is added to many water supplies in Australia. Some consider this mass medication, against citizens will and others consider it a required step in oral protection. Dr Sarah Lantz reviews the current research in relation to its effects on our health.

Fluoride is one of those issues that runs deep with people – like vaccination, religion and money. Those in favour argue that its addition to public water supplies and toothpastes has been a boon to dental health, providing a cost-effective and equitable way to prevent tooth decay. Opponents argue that evidence for its safety and efficacy is dubious at best and that dosing the public water supply with a chemical amounts to mass medication.

And there is evidence to support both sides of the debate.

WHERE DO I SIT?
If I listened to everything the doctors, obstetricians, and my fellow public health colleagues said I would have taken the epidural, stopped breastfeeding after 6 months and resisted our desires for co-sleeping. But I didn’t. And it’s usually when we’re co-sleeping—with one child buried under the crook of my armpit, the other with a leg thrown across my belly—that my intellectual wonderings as a public health researcher and natural parenting mama converge. And this is what I have discovered about fluoride and caring for our oral health.

WHAT IS FLUORIDE?
Fluoride ions (Calcium Fluoride CaF2) are naturally occurring and come from the element fluorine, found in rocks, soil, plants, air and water. Proponents are quick to sell the ‘natural’ aspect of fluoridation, arguing that its addition to water is akin to fortifying or enriching foods such as adding zinc, iron or calcium to breakfast cereals; iodine to salt; or folic acid to flour. They say it’s not adding a ‘medicine’, just tweaking the natural level of fluoride found in water. The problem with this argument is threefold. Firstly, the majority of what we see on food packaging is simply a distortion by the food marketers and manufacturers. Lollies that are laced with vitamin C, or oven fries fortified with Omega 3 fatty acids with the promise of boosting the brain functions of consumers are simply a distortion of science and examples of misleading nutritional value marketed as healthy food choices. Secondly, fluoride, unlike calcium or magnesium, is not an essential nutrient for your body. If you were to consume zero fluoride your entire life, you wouldn’t suffer for it. There’s no such thing as fluoride deficiency. And thirdly, while fluoride ions can be naturally occurring, these are not the ones added to drinking water and oral hygiene products. Queensland Health Water Fluoridation: Questions and Answers booklet states that the fluoride in our water is in fact sourced from scrubbers used in the manufacturing of fertilizers and that these scrubbers ‘convert fluoride into a liquid or powder form (hydrofluoroslicic acid) that can be collected and safely added to water supplies’.

‘Fluoride sourced from scrubbers [which is in many water supplies in Australia] does not undergo purification procedures and has been found to contain various contaminants, including arsenic, lead, and mercury. ’

Despite reassurances from regulators that contaminant levels are ‘extremely low’ and conform to Australian Drinking Water Guidelines, fluoride sourced from scrubbers does not undergo purification procedures and has been found to contain various contaminants, including arsenic, lead, and mercury. Along with fluoride, these contaminants bio-accumulate in our cells, bones, blood and organs—even in the pineal gland in our brains.

And overexposed to fluoride we are! Virtually all foodstuffs contain at least trace amounts of fluoride. When water is fluoridated, it is not just the water that is fluoridated, but all foods and beverages that are made with the water. As a general rule, the more processed a food is, the more fluoride it has. The highest dietary concentration of fluoride occurs in animal and processed foods, especially fish. Fluoride builds up in the tissues of animals, and whenever fluoridated water is used in food production, fluoride will be concentrated in the final product. The same goes for cooking with fluoridated water. Adults only excrete 50-60% of the fluoride we ingest, children only about 20%, and babies and the elderly excrete even less. Fluoride even crosses the placenta in pregnancy.

BUT ISN’ IT GOOD FOR OUR TEETH?
Fluoride remains the cornerstone of modern dental caries management. Fluoride acts as an enzyme inhibitor and is said to work by strengthening teeth, inhibiting demineralisation, remineralising damaged enamel, and destroying the enzymes in the oral bacteria that produce the acids that erode the teeth. And there are some studies to support this. Researchers comparing topical and systemic fluoride action concluded that it was the topical application of fluoride in toothpaste and mouthwash products that is most beneficial.

Even so, there are currently no labelling nor legal requirements to specify the type of fluoride being added to topical applications, and there is currently no scientific evidence of a safe fluoride dosage per person given that fluoride consumption varies from person to person depending on their level of exposure.

Research also reveals that when fluoridation has been discontinued in communities in Canada, the former East Germany, Cuba and Finland, dental decay has not increased but has generally continued to decrease.3 At a supermarket outing on a recent trip to the United States, we also noted that the US Food and Drug Administration (FDA) requires a poison warning on every tube of fluoride toothpaste sold in the US. The warning reads:

‘If you accidentally swallow more than used for brushing, seek medical help or contact a poison control center immediately.’

Children swallowing too much fluoride toothpaste can suffer acute poisoning at doses as low as 0.1 to 0.3mg per kg of bodyweight. This generally presents in the form of gastric pain, nausea, vomiting, headache, dizziness, and flu-like symptoms. A child weighing 10kg need only ingest 1 to 3 grams of paste (less than 3% of a tube of fluoridated toothpaste) to experience one or more of these symptoms.

As my partner and I passed each other different brands of children’s toothpaste we were struck by the irony of marketing. The manufacturers of children’s toothpastes create products just begging to be eaten by children. They generally tend to be sweet, glossy, glittery, luminescent and smell ofbubblegum, strawberries and sherbet. While I was examining the toothpastes, a mother leaned over my shoulder and told me she had recently taken to putting all the toothpaste in a safety cupboard out of her children’s reach.

Manufacturers in Australia are not legislated to put a warning label on our fluorinated toothpastes.

THE TOXICITY OF FLUORIDE
Fluorine compounds are listed by the US Agency for Toxic Substances and Disease Registry (ATSDR) as among the top 20 of 275 substances that pose the most significant threat to human health. The Australian National Pollutant Inventory (NPI) recently considered 400 substances for inclusion on the NPI reporting list. A risk ranking was given based on health and environmental hazard identification and human and environmental exposure to the substance. Some substances were grouped together at the same rank to give a total of 208 ranks. Fluoride compounds were ranked 27th out of the 208 ranks.

HEALTH EFFECTS
The evidence of health effects are far reaching. A review of scientific literature by the Independent National Academy of Sciences found many gaps in the data about long-term health risks associated with exposure to systemically-ingested fluoride. The authors found evidence of increases in dental fluorosis and called for more research on potential links with skeletal fluorosis, bone fractures, bone cancer, joint pain, thyroid damage, mental and physiological changes and dementia.5 According to the National Research Council (2006), ‘it is apparent that fluorides have the ability to interfere with the functions of the brain’.

In 2012, researchers at Harvard University published the results of a long-term analysis that links fluoridated water to lower IQ scores in children.7 The researchers examined data on water fluoridation levels from a variety of medical databases and compared them to IQ scores of children who lived in the associated neighbourhoods. In total, 27 separate studies were examined which found a direct link between IQ scores and the levels of fluoride in the public water supply. Children in high-fluoride areas had significantly lower IQ scores than those who lived in low-fluoride areas. The children studied were up to 14 years of age, but the investigators speculate that any toxic effect on brain development may have happened earlier, and that the brain may not be fully capable of compensating for the toxicity.

‘Fluoride seems to fit in with lead, mercury, and other poisons that cause chemical brain drain,’ says Phillipe Grandjean, adjunct professor of environmental health, Harvard School of Public Health. ‘The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us.’

HOW TO REDUCE YOUR DAILY EXPOSURE TO FLUORIDE AND BUILD RESILIENCY
1. Stop drinking fluoridated water.
Tap water consumption is the largest daily source of fluoride exposure for people who live in areas that add fluoride to the water. Avoiding consumption of fluoridated water is especially critical for babies and children. If you live in area which fluoridates its water (like 87% of the communities in Australia) you can avoid drinking the fluoride in one of three ways:
Water Filters: Purchase a water filter. However not all water filters remove fluoride. The three types of filters that can remove fluoride are reverse osmosis, deionizers (which use ion-exchange resins), and activated alumina. Each of these filters can remove over 95-100% of the fluoride. By contrast, ‘activated carbon’ filters (e.g. Brita) do not remove fluoride. Harvesting and filtering rainwater is also an option and our preferred choice.

Spring Water: Purchase spring water. Most brands of spring water contain very low levels of fluoride. Some brands, however, contain high levels, so ask your supplier. Many suppliers also provide large reusable containers so you are not contributing to plastic consumption.
Water Distillation: A third way to avoid fluoride from the tap is to purchase a distillation unit. Water distillation will remove most, if not all, of the fluoride. The price for a distillation unit varies widely depending on the size.

2. Eat a diet of whole foods
A comparison of native and primitive societies have shown a high immunity to dental caries and freedom from degenerative processes compared with the diets of modernised groups who have forsaken their native diets for the foods of commerce: white flour products, sugar, polished rice, canned goods and vegetable fats.
Dental caries and gum disease are usually a sign of nutritional deficiencies and a toxic overload. Building resiliency means increasing nutrient dense foods in your diet. These include:

Raw or cultured grass-fed dairy including, milk, cheese, cream, ghee, and butter;

Clean sources of fat such as coconut oil, cod liver oil, butter and olive oil;

Protein such as eggs and grass-fed animal protein;

Fermented or lacto-fermented condiments and beverages such as pickled vegetables, kefir and kombucha;

Organically-sourced vegetables and fruits.

3. Breastfeed your baby
Fluoridated water, which contains up to 300 times more fluoride than breast milk, is by far the single largest source of fluoride for babies and infants. So without question, the single most important way to protect a baby from fluoride exposure is to breastfeed. Breast milk almost completely excludes fluoride and thus an exclusively breast-fed baby will receive virtually no fluoride exposure and will provide your baby with all the delicious and beneficial immuno-properties of breast milk.
If you’re not breastfeeding, use clean, non-fluoridated water with organic cow or goat milk formula.

4. Say NO to dental fluoride gel treatments
Although dental researchers recommend that fluoride gel treatment should only be used for patients at highest risk of cavities, many dentists continue to apply fluoride gels irrespective of the patient’s cavity risk. The fluoride gel procedure uses a concentrated acidic fluoride gel (12,300 ppm). Because of the fluoride gel’s high acidity, the saliva glands produce a large amount of saliva during the treatment, which makes it extremely difficult (both for children and adults) to avoid swallowing the gel.
Even when dentists use precautionary suction devices, children and adults will still ingest some quantities of the paste, which can cause spikes of fluoride in the blood. The next time your dentist asks you whether you want a fluoride gel treatment, say no. Alternatively, seek out a holistic dentist who does not use nor recommend fluoride in their practice.

5. Xylitol benefits
Xylitol are sweet ‘tooth-friendly’ non-fermentable, sugar alcohols found in the fibers of many fruits and vegetables and can be extracted from various berries, corn husks, and birch trees. Unlike other sweeteners, xylitol has been found to be actively beneficial for dental health, including reducing dental caries9 by inhibiting the Streptococcus bacteria that are significant contributors to tooth decay.10 For dental use, you can find xylitol gums, toothpastes, lozenges, and rinses.
WHAT FLUORIDE-FREE BRANDS TO BUY?
Oral health impacts the whole body. When you have gum disease or plaque, inflammation of the whole body can occur. So getting your dental regime right is important. There are some really good gums, pastes and rinses on the market. Our ‘adult’ favourites include: Ganozhi, Mukti Tooth Powder, and Oral Wellness. Our children love Spry Fluoride Free toothpaste or gel (with Xylitol), gums and mints and Dr Tung’s Floss.

References
1.NRC (2006). National Research Council of the National Academies, Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. Washington, DC: National Academies Press
2.Hellwig, E. & Lennon, A. Systemic versus Topical Fluoride’, Caries Research, 2004, 38: 258–262
3.Seppa L, et al. (2000). Caries trends 1992-98 in two low-fluoride Finnish towns formerly with and without fluoride. Caries Research.34: 462-8; Maupome G, et al. (2001). Patterns of dental caries following the cessation of water fluoridation. Community Dentistry and Oral Epidemiology. 29: 37-47.
4.Government of Australia, National Pollutant Inventory, http://www.environment.gov.au/epg/npi/contextual_info/context/fluoride.html
5.Dr. Paul Connett, 50 Reasons to Oppose Fluoridation, Accessed online at http://www.slweb.org/50reasons.html
6.Fluoride in Drinking Water: A Scientific Review of EPA’s Standards, National Academy of Sciences, 2006
7.Choi, A. DSun, G. Zhang, Y & Grandjean, P, Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environ Health Perspect. 2012 October; 120(10): 1362–1368
8.See Harvard School of Public Health: http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/
9.Milgrom P, Ly KA, Roberts M, Rothen M, Mueller G, Yamaguchi DK (2006). Mutans streptococci dose response to xylitol chewing gum. Journal of Dental Research 85 (2): 177–181.
10.Maguire, A; Rugg-Gunn, A J (2003). Xylitol and caries prevention — is it a magic bullet?”. British Dental Journal 194 (8): 429–436.

Dr Sarah Lantz is a mama, writer, and researcher from Queensland University of Technology with a background in public and population health and author of the bestselling book Chemical Free Kids; Raising healthy Children in a Toxic World. http://www.chemicalfreeparenting.com.au or http://www.nontoxsoapbox.com.

As published in nurtureparentingmagazine.com.au