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Fluoride – the Danger that we must Avoid H. BĂLAN “Carol Davila”University of Medicine and Pharmacy, Bucharest Medical Clinic Clinical Emergency Ilfov County Hospital, Bucharest, Romania One of the sad stories about what was considered to be a successful prevention of tooth decay is represented by fluoride supplementation of water and toothpastes. But even today, without knowing all the scientific reliable proofs, all the pieces of a very large puzzle, this action has many (especially in developing countries) promoters. That’s why we considered that a well-documented review in this domain would be of large interest, especially because the deleterious effects are many, accompanied by a large number of threats for the health, and the benefits are lacking. Key words: fluoride, toxic effects, oncologic impact, tooth decay. WATER FLUORIDATION & TOOTH DECAY We can say that’s another story about… better is the enemy of good. The addition of fluoride to water for the purpose of preventing tooth decay began in the 1940s with the belief that fluoride’s primary benefit came from ingestion of fluoride during the tooth- forming years; it is now acknowledged by the dental research community that fluoride’s primary benefit comes from topical contact, not from ingestion. Dr. Arvid Carlson – Pharmacologist, Nobel Laureate in Medicine/Physiology (2000): “In pharmacology, if the effect is local, it’s of course absolutely illogical to use it in any other way than as a local treatment.” “Since the current scientific thought is that the cariostatic activity of fluoride is mainly due to its topical effects, the need to provide systemic fluoride supplementation for caries prevention is questionable”. But the truth about fluoridation and how much of medical benefits were expected is pretty sad: “Some fifty years after the United States began adding fluoride to public water supplies to reduce cavities in children’s teeth, declassified government documents are shedding new light on the roots of that still controversial public health measure, revealing a surprising connection between fluoride and the dawning of the nuclear age” [1]. “Much of the original proofs that fluoride is “safe” for humans in low doses was generated by A-bomb program scientists, who had been secretly ordered to provide “evidence useful in litigation” against defense contractors for fluoride injury to citizens. The first lawsuits against the U.S. A-bomb program were not over radiation, but over fluoride damage, the documents reveal. Human studies were required. Bomb program researchers played a leading role in the design and implementation of the most extensive U.S. study of the health effects of fluoridating public drinking water – conducted in Newburgh, New York from 1945 to 1956. Then, in a classified operation code-named “Program F”, they secretely gathered and analysed blood and tissue samples from Newburgh citizens, with the cooperation of the State Health Department personnel. The original “secret” version – obtained by these reporters – of a 1948 study published by Program F scientists in the Journal of the American Dental Association shows that evidence of the adverse health effects from fluoride was censored by the U.S. Atomic Energy Commission (AEC) – considered the most powerful of Cold War agencies – for reasons of national security” [1]. Instead of a very costly process of decon- tamination of industrial fluoride by-products, it was much easier and much cheaper to use these toxic products in what was considered a vast sanitary operation in the benefit of large populations: prevention of tooth decay. Fluoride compounds which are put: in water (fluoridation), in toothpastes, in supplemental tablets were never tested for safety before approval. Not only the lack of benefits must be a permanent preoccupation, but also the permanent statement: studies as early the 1930s showed extreme hazards to man and environment, due to fluoride dumping and exposure. ROM. J. INTERN. MED., 2012, 50, 1, 61–69 H. Bălan 2 62 Independent researches made by scientists without any connection with dental trade organi- zations made clear the following conclusions: – it is worth mentioning that the toxic effects were confirmed by previously-classified government research [2]; – in animals (rats) drinking only 1 part per million fluoride (NaF) in water were found histologic lesions similar to Alzheimer’s disease and dementia and also damage of the blood-brain barrier, after extended fluorid exposure [3][4]; – and, most important, it is also acknowledged that fluoride is ineffective at preventing tooth decay in the pits and fissures of teeth (where the majority of decays appears) [5–8]. In all western countries (whether it is a country using water fluoridation or not), in the latter half of the 20th century, tooth decay declined quite drama- tically. But recent large-scale studies, using modern scientific methods showed “a strong positive correlation between the presence of fluorosis and the occurrence of dental caries” – The WHO/ FAO/UNICEF study (Bohdal, Gibbs, Simmons, 1968) [9–27]. FLUORIDE TOXICITY Historically, most cases of fluoride toxicity have followed accidental ingestion of sodium fluoride based insecticides or rodenticides. In advanced countries, most cases are due to ingestion of fluoride products. Other sources are represented by: glass- etching or chrome-cleaning agents (ammonium bifluoride or hydrofluoric acid), industrial exposure to fluxes to promote the flow of a molten metal on a solid surface, volcanic ejecta, metal cleaners, mal- function of water fluoridation equipment [28–36]. Acute toxicity (poisoning being defined as the ingestion of a large amount of fluoride, in a very short period of time) is characterized by: abdominal pain, diarrhea, dysphagia, hypersalivation, mucosal injury, nausea, vomiting, accompanied by electrolytic abnormalities: hyperkalemia, hypocal- cemia, hypoglycemia, hypomagnesemia. There are also impressive neurological symptoms, such as: headache, muscle weakness, hyperactive reflexes, muscular spasms, paresthesia, tetanic contractions, tremours. The most severe cases can be characterized by multiorgan failure. Death can result from: cardiac arrest, shock, large QRS and different kinds of arrhythmias [38– 40]. The Food and Nutrition Board recommends that public water supplies be fluoridated when natural fluoride levels are significantly below 0.7 mg per liter. FLUORIDATION – PROVEN INEFFECTIVE All the recent large-scale studies of water fluoridation have shown that there are no positive effects. A supplementary confirmation is given by the fact that countries without fluoridation have shown an equal improvement in dental health than those with fluoridation. And there are also proofs regarding the fact that excessive fluoride exposure leads to increased levels of caries [41–64]. N.B. Even pro-fluoridation scientists admit that there is not any properly-conducted research showing that fluoride supplements help prevent cavities. Independent Experts oppose dumping fluoride into water Over 1500 professionals at the USEPA voted unanimously to oppose the fluoridation initiative in California because of the health risks involved. We must warn our patients to avoid fluoridated water and fluoridated toothpaste (with a special consideration for children, which are more sus- ceptible for the neurological toxicity of fluoride). We must also warn them that: carbon filters do not significantly remove fluoride compounds; many kinds of non-organic juices have large amounts of fluoride (from pesticide residues); they must avoid those toothpasteswith fluoride claimed “natural”; definitely do not give children any fluoride since they appear to be more susceptible to the neurological toxicity from fluoride (Level of fluoride in infant-formula made with fluoridated water is 100–200 times higher than fluoride level found in women’s breast milk); avoid toothpastes that have fluoride (it is impossible to avoid swallowing some fluoride from fluoridated toothpaste); avoid putting fluoridated water in humidifiers; many kinds of non-organic juice have large amounts of fluoride from pesticides residues. CDA Board of Directors: approved: March 2003; reaffirmed: February 2008; revised: April 2010 – reaffirmed the Canadian Dental Association (CDA) Position on use of fluorides in caries prevention: November 1997 [65]: “The availability of fluorides from a variety of sources must be taken into account before embarking on a specific course of fluoride delivery to either population or in- dividual patient. 3 Fluoride – the danger that we must avoid 63 The CDA abrogated its legal responsibility for fluoridation support to the Federal Provincial- Territorial Committee on Drinking Water. This is particularly important for children under the age of six, where exposure to more fluoride than is required to simply prevent dental caries can cause dental fluorosis. Because young children tend to swallow toothpaste when they are brushing, the following guidelines must be followed: children from birth to 3 years of age should have their teeth and gums brushed by an adult; parents should consult a health professional to determine whether a child up to 3 years of age is at risk of developing tooth decay; if the risk exists, a minimal amount of fluoridated toothpaste should be used; children from 3 to 6 years of age should be assisted by an adult in brushing their teeth; all children should be super- vised or assisted until they develop appropriate manual dexterity; CDA recognize and support the professional topical applications of fluoride gels, foams and varnishes in the prevention of dental caries for individuals at risk; before prescribing fluoride supplements, a thorough clinical examination, dental caries risk assessment and informed consent with patients/caregivers are required; the use of fluoride supplements before the eruption of the first permanent tooth is generally not recommended: the total daily fluoride intake from all sources should not exceed 0.05–0.07 mgF/kg body weight (in order to minimize the risk of dental fluorosis). The Canadian Dental Association Consultant and Researcher urged people to avoid drinking fluoridated water. “Fluoridated water does not prevent tooth decay” – concluded Mark D. Gold (66) and he accused: “Dental Trade Organization have used flawed studies to convince dentists that fluoridation was useful”. “The original studies by H. Trendly on fluoridation (which led to the decision to allow fluoridation of municipal water supplies): were worthless (using his own criteria); did not considered other minerals in the water; didn’t considered the differences between “natural fluoride” (e.g. CaF) and fluoride waste products (e.g. NaF); only a subsection of the data were reported; had no/or little statistical analysis; only for dental fluorosis was included for observations regarding safety experiments [26]; showed that fluoridation of the U.S. water supply was worthless, at best (data from 39.207 U.S. schoolchildren in 84 different areas in USA, the data being confirmed by another study of Steelink et al. [67] on 26.000 elementary school children”. Another reliable data sustained that: “…a positive correlation was revealed. In other words, the more fluoride a child drank, the more cavities appeared in the teeth” [27]. Large reduction in tooth decay, in time, can be considered to an increased (wealthier) standard of life and cannot be attributed to fluoridation (it was noticed in both unfluoridated and fluoridated areas of at least eight developed countries) in the past forty years. 24 studies of unfluoridated areas proved this conclusion [41–64]. A 20-year study (1973–1993) of 400.000 children in India, the largest ever made about tooth decay [24] showed that the higher was the fluoride concentration in water, the more caries occurred. And if a reduced intake of calcium is associated, the adolescents had extremely high rates of fluorosis and dental decay [68]. That’s why, many regions and countries rejected fluoridation. “Fluoridation will be banned in this country. It is in its death throes now. It just hasn’t stopped kicking! Like a snake, it keeps twitching for awhile!” (Virginia Rosenbaum). And the danger is even greater: “it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion” – Hardy Limeback, 2000 (Head of Preventive Dentistry, University of Toronto). “Common sense should tell us that if a poison circulating in a child’s body can damage the tooth- forming cells, then other harm is also likely” [5]. FLUORIDE CAUSES ACUTE ADVERSE REACTIONS A list of the acute adverse effects observed is composed by: gastro-intestinal symptoms, stomatitis, painful joints, headaches, visual disturbances, muscular weakness, extreme tiredness, but it is important to always remember that fluoride is a cumulative poison. And one must note, also, that health care practitioners are not trained to test or recognize the effects of chronic poisoning from fluoride. So that, after ingestion, they have initially a local action, generating hydroxyfluoric acid inside the stomach, that afterwards are binding calcium, interfering different enzymes, generating the following symptoms: abdominal pain, diarrhea, dysphagia, hypersalivation, nausea, vomiting, associated with: mucosal injury. In order of their frequency these are repre- sented by: abdominal pain, diarrhea, dysphagia, hypersalivation, nausea, vomiting, headache, muscle H. Bălan 4 64 weakness, hyperactive reflexes, muscular spasms, paresthesia, seizures, tetanic contractures, tremors. As signs, it is mandatory to quote: mucosal injury, hyperkaliemia, hypocalcemia, hypoglycemia, hypomagnesemia. In severe cases: multiorgan failure and death that can result from: cardiac arrest, shock, large QT syndromes, different arrhythmias. In high concentrations, fluoride soluble salts are toxic, the contact of the skin or of the eyes being dangerous. For sodium fluoride, the median lethal dose varies between 1–10 grams, that means around 28 mg/kg body weight. That’s why in the USA is now required a poison warning on fluoride toothpastes. Regarding the chronic toxicity, the most significant event happened in India, where 60 million people have been poisoned by well water contaminated (the origin of fluoride being granite rocks) by excessive fluoridation. The different deleterious effects can be summarized as follows: 1) dental fluorosis; 2) skeletal fluorosis, with changes in bone structure and strength; 3) osteoarthritis; 4) neurotoxic effects, even IQ lowering; 5) oncologic impact; 6) birth defects and perinatal deaths; 7) impairment of the immune system; 8) inhibition of key enzymes; 9) suppression of the thyroid function; 10) the increase to lead and arsenic exposure; 11) contri- bution to the development of repetitive stress injury. 1. DENTAL FLUOROSIS Permanent disfigurement of the teeth in children is due to dental fluorosis (a permanent adverse structural change of teeth) A linear correlation between the Dean index of dental fluorosis and the frequency of bone fractures was observed among both children and adults [69]. “Dental fluorosis is defined as a permanenthypomineralization of enamel, characterized by a greater surface and subsurface porosity than in normal enamel, that results from excess fluoride reaching the developing tooth during developmental stages” [70]. “Fluoride affects the forming enamel by causing porosity, e.g., widening gaps between the enamel rods and enlarging intercrystalline spaces in parts of the rod. With increasing severity, the subsurface enamel all along the tooth becomes increasingly porous… The more severe forms are subject to extensive mechanical breakdown of the surface [71]. “Dental fluorosis is characterized by an increased porosity (hypomineralization) of the subsurface enamel, causing the enamel to appear opaque… In advanced stages, the enamel may become so porous that the outer layers breakdown and the exposed porous subsurface becomes dis- colored” [72]. Another problem that was confirmed (see skeletal fluorosis) is that a similar damage can be generated in the bones [73]. The structural damage of the hardest tooth layer compromises the health-protective function (the too mineralized zone is very fragile to mechanical stress) [74][75]. 2. SKELETAL FLUOROSIS, WITH CHANGES IN BONE STRUCTURE AND STRENGTH Skeletal fibrosis is expressed by: pains in bones and joints, burning sensations, pricking and tingling in the limbs, muscle weakness, chronic fatigue, gastro-intestinal disorders, reduced appetite, backache, osteoarthritis. Skeletal fluorosis produces a wide variety of radiological manifestations, including osteosclerosis, osteomalacia, osteoporosis and secondary hyperpara- thyroidism, thus a potential for misdiagnosis exists between skeletal fluorosis and these disorders. “In areas where fluorosis is endemic, skeletal fluorosis is a common mimic of seronegative arthritis and should be pursued with investigations for diagnosis of fluorosis with measurement of fluoride levels, wherever applicable [76]. Fluoride-induced bone fractures in clinical trials Due to its ability to increase bone mass, fluoride has been used as a treatment for osteo- porosis, but the observed effect after 40 years of experimentation, a well-documented side-effect of fluoride therapy (in dosages of 20–34 mg/day) is increased bone fracture (arms, legs, hips): several clinical trials have reported a particularly high rate of spontaneous fracture in the femoral neck among fluoride-treated patients [77–84]. The high rate of spontaneous fracture among fluoride-treated patients may be related to the increase in incomplete fractures (“stress fractures”) among fluoride-treated patients. An increased number of microfractures was found frequently in fluorotic bone; because there are “pockets” of mineralization disorders (because fluoride can cause both hypomineralization and hypermineralization – the resulting inhomo- geneity of the bone structure can decrease its strength, increasing the probability that a fracture is produced. The osteocyte is a bone cell very active in the bone resorption process, that can be impacted by high levels of fluoride accumulation in the bone. 5 Fluoride – the danger that we must avoid 65 So, fluoride-induced damage to osteocytes may be a particularly important factor in the pathogenesis of fluoride-induced microfractures. Fluoride’s impact on bone density tends to differ depending on the type of bone being studied: increases in density frequently noted in trabecular bone and decreases frequently noted in cortical bone [85–114.] “The weight of evidence indicates that, although fluoride might increase bone volume, there is less strength per unit volume” [115]. 3. CAUSES OSTEOARTHRITIS It has been proven (Rheumatology International, 2001 – quoted by [116]) that the level of exposure that water fluoridation in USA creates can generate osteoarthritis, that is clinically characterized as follows: clinical phase 1 fluorosis: sporadic pain; stiffness of joints; osteosclerosis of the pelvis and of the vertebral column; clinical phase 2 fluorosis: chronic joint pain; arthritic symptoms; slight calcification of ligaments…” [116] in more severe cases: vague and diffuse aches, stiffness of joints with decreased range of motion, followed by kyphosis with limited spinal mobility, flexion in contracture of the lower extremities, restricted chest wall expansion. 4. NEUROTOXIC EFFECTS, EVEN IQ LOWERING The neurotoxicity of fluoride is one of the most active directions of research, a fact that made that even EPA considered necessary to change its standards [117]: “it is apparent that fluorides have the ability to interfere with the functions of the brain”. Many human studies (from China, India, Iran, Mexico) [118–138] demonstrated that high levels of fluoride exposure are associated with IQ deficits in chidren (even after controlling for different types of exposure: lead, iodine, parenteral education, income status). Other studies [139–140] demonstrated that fluoride accumulates in the fetal brain, damaging neural cells and neurotransmitters, generating behavioral deficits among neonates. But also, other recent studies showed that brain adult exposure to fluoride induced central nervous system disturbances, explained by the different neuro-toxical effects (demonstrated on animal studies): reduction in nicotinic acetylcholine receptors, in lipid content, impairment of the anti- oxidant defense systems, damage of the hippo- campus and of the Purkinje cells, appearance of the beta-amyloid plaques, enhancement of the iodine deficiency-induced lesions, accumulation of fluoride in the pineal gland. The blood-brain barrier is relatively imper- meable to fluoride, but that means that, despite this fact, fluoride has the capability to penetrate the brain: difficulties with concentration and memory; general malaise; fatigue, explained by different effects: alteration of calcium currents, alteration of enzymatic configuration (by generating strong hydrogen bonds with amide groups), inhibition of the cortical adenylyl cyclase activity, the increase of the phophoinositide hydrolysis [134–138][140–144]. Many municipal water supplies are treated with both alum (aluminium sulphate) and fluoride (their combination in the blood, aluminum fluoride is very poorly excreted in the urine, being toxic for the kidneys). The National Research Council speculates that effects on the thyroid could lead to poor test results. The NRC stated that “many of the untoward effects of fluoride are due to the formation of AlFx (aluminium fluoride complexes) [145–148]. It has been demonstrated that aluminum salts in the brain are generating Alzheimer’s disease: “Fluoride also increases the production of free radicals in the brain through several different biological pathways. These changes have a bearing on the possibility that fluorides act to increase the risk of developing Alzheimer’s disease” [117]. Rats drinking only 1/1.000.000 fluoride (NaF) in water had histologic lesions in their brain similar to Alzheimer’s disease and dementia [149]. 5. ONCOLOGIC IMPACT: FLUORIDE COMPOUNDS ARE CAUSING CANCER According to the National Toxicology Program – “the preponderance of evidence” from laboratory “in vitro” studies indicates that fluoride is a mutagen (= a compound that causes genetic damage)”. The Department of Health of New Jersey: bone cancer in male children was 2–7 times greater in areas with fluoridated water [150]. U.S. Environmental Protection Agency (EPA) confirmed the bone cancer – causing effects of fluoride at low levels in an animal model. Another study (see later) has shown the existence of a link to uterine cancer deaths. A series of studies indicate that fluoridecan cause osteosarcoma (bone cancer) in fluoride- treated male rats and boys under the age of 20, living in fluoridated areas. Relative recent studies [151–153] confirmed these data. H. Bălan 6 66 A recent national case control study conducted by scientists at Harvard University found a sig- nificant relationship between fluoride exposure and osteosarcoma among boys, particularly if exposed to fluoridated water between the age of 6 and 8 years (the mid-childhood growth spurt)[154]; the data of this study are concordant with the U.S. National Toxicology Program’s Congressionally- mandated fluoride/cancer study – National Research Council, 2006 [155]. Dr. Takeki Tsutsui et al. of the Nippon Dental College in Japan showed that fluoride not only caused genetic damage, but it was also capable of transforming normal cells into cancer cells [156]. “In cultured human and rodent cells, the weight of evidence leads to the conclusion that fluoride exposure results in increased chromosome aberrations (genetic damage) – National Institute of Environmental Health Sciences, 1993. It is easy to understand that bone is the principal site of fluoride accumulation, particularly during the growth spurts of children, and, due to the fact that fluoride is a mutagen when present in sufficient concentrations, its mechanism of muta- genity being artificially stimulation of the proliferation of bone cells (osteoblasts). “When fluoride exposure increases, the following bone responses generally occur: 1) an increase in the number of fibroblasts, 2) an increase in the rate of bone formation, 3) an increase in the serum activity of alkaline phosphatase, and 4) an inhibition of osteoblastic acid phosphatase… The increase in osteoblast proliferation and activity may increase the probability that these cells undergo malignant transformation” [157]. “Osteosarcoma presents the greatest a priori plausibility as a potential cancer target site because of fluoride’s deposition in bone. It is biologically plausible that fluoride affects the incidence rate of osteosarcoma, and these effects would be the strongest during periods of growth, particularly in males” [158]. Approximately 99% of fluoride in the human body is contained in the skeleton, with about 59% of the daily ingested fluoride being deposited directly into calcified tissue (bone or dentition). “We observed that for males diagnosed before the age of 20 years, fluoride level in drinking water during growth was associated with an increased risk of osteosarcoma, demonstrating a peak in the odds ratios from 6 to 8 years of age. All of our models were remarkably robust in showing this effect, which coincides with the mid-childhood growth spurt. For females, no clear association between fluoride in drinking water during growth and osteosarcoma emerged” [159]. “Age-specific and age-standardized rates (ASR) of registered cancers for nine communities in the USA (21.8 million inhabitants, mainly white) were obtained from IARC data (1978–1982, 1983– 1987, 1988–1992)… The incidence rate of bone cancer as the mean of three five-years ASRs was significantly correlated with FD (fluoridated water) only in males, with CIR-100 of 1.22, whereas in 1978-82 it showed a high CIR-100 of 2.53” [160]. By investigating 156 cancer deaths U.S. Government concluded that fluoride accumulates in body tissues and may eventually cause cancer and/or fatal diseases. Since 1990, the National Cancer Institute, the New Jersey Department of Health, and the Safe Water Foundation all found that the incidence of osteosarcoma was substantially higher in young men exposed to fluoridated water as compared to those who were not. All these reasons of concern were confirmed by relatively recent data (161–175). A study [176] has shown the existence of a link to uterine cancer deaths. 6. GASTROINTESTINAL SIDE-EFFECTS [177] summarized with great concision the gastrointestinal effects of fluoride: “It is concluded: 1) ingested fluoride damages gastroduodenal mucosa; 2) gastrointestinal discomfort can be an early warning sign of fluorosis; 3) fluoride toxicity should be considered a possible reason for non-ulcer dyspepsia, especially in fluorosis endemic areas; 4) gastrointestinal discomfort during sodium fluoride therapy calls for extreme caution and close monitoring; 5) gastrointestinal discomfort in the form of dyspeptic symptoms should be an important diagnostic feature when identifying fluorosis patients and should not be dismissed as non-specific”. Children may experience gastrointestinal distress upon ingesting sufficient amounts of fluoridated toothpaste: in 4 years (1990–1994) 628 subjects, mostly children, needed treatment after such toxi- cologic effects [2]. 7. CAUSES BIRTH DEFECTS AND PERINATAL DEATHS Regarding the possible correlation between birth defects and perinatal deaths, the following data have been gathered: in the United Kingdom the perinatal deaths in a fluoridated area was 15% higher than in proximal areas non-fluoridated. The fluoridated area had also a 30% higher rate of Down’s syndrome (178–184). In Chile fluoridation was banned after a link was demonstrated between infant deaths and fluoridation. 7 Fluoride – the danger that we must avoid 67 8. IMPAIRS IMMUNE SYSTEM In the United States where toxic fluoride compounds are regularly added to water and given to children since the 1960s and 1970s, it is now becoming evident an overwhelming number of people of that generation who are developing chronic immune system disorders. Many studies confirmed the data concerning the complex disturbances of the immune system [185–195]. 9. INHIBITS KEY ENZYMES The general toxic effect, as neurotoxicity, the effect on birth events and the before mentioned gastro- intestinal effects and birth defects are explained by the capacity of fluoride to inhibit key enzymes, explained by the characteristic of fluoride: a cumulative toxic. 10. SUPPRESSES THE THYROID FUNCTION At the beginning of the 20th century fluoride administration was used as an effective way of suppressing thyroid function, in treating hyper- thyroidism [196–198], fluoride’s suppressive effect on the thyroid being more severe when iodine is deficient (thyroid effects in humans were associated with fluoride levels 0.05–0.13 mg/kg/day when iodine intake was adequate and 0.01–0.03 mg/ kg/day when iodine was inadequate). The neurotoxicity and the decrease of IQ are considered also other side-effects mediated by hypothyroidism [199–205]. 11. INCREASES LEAD AND ARSENIC EXPOSURE There is often a simultaneous contamination with: lead, arsenic and radionuclides because fluoride compounds are toxic waste byproducts that largely come from polluting scrubbers of fertilizer plants. Water fluoridation was demonstrated to increase blood lead levels in children [206–208]. All the fluoride products used in the artificial fluoridation of water are contaminated with lead and arsenic (toxic waste products that otherwise would be prone to mandatory decontamination). The EPA estimates that 10–20% of the lead in children comes from water. But it was considered that the amount is too small to be of regulatory concern. But EPA has overlooked the fact that it concentrates in the body tissues, and over time, would add up to quite a lot. In addition, it becomes concentrated in products processed with water. The 10–20% that came directly from water can easily become three or four times as much. At the end, some recent thoughts, informed opinions: “Over the past ten years a large body of peer-reviewed science has raised concerns that fluoride may present unreasonable health risks, particularlyamong children, at levels routinely added to tap water in American cities”. ENVIRONMENTAL WORKING GROUP, July 2005. “In summary, we hold that fluoridation is an unreasonable risk.” – US ENVIRONMENTAL PROTECTION AGENCY HEADQUARTERS’ UNION, 2001. “Carefully conducted studies of exposure to fluoride and emerging health parameters of interest (e.g., endocrine effects and brain function) should be performed in populations in the United States exposed to various concentrations of fluoride.” – US NATIONAL RESEARCH COUNCIL, 2006. “I am quite convinced that water fluoridation, in a not-too-distant future, will be consigned to medical history.” – Dr. ARVID CARLSSON, Pharmacologist, Nobel Laureate in Physiology and Medicine, 2000. Una dintre istoriile a ceea ce fusese considerată a fi o modalitate de succes de prevenţie a cariilor dentare este reprezentată de fluorizarea apei şi a pastelor de dinţi. Chiar în zilele noastre, fără a fi la curent cu toate dovezile ştiinţifice fiabile acumulate în timp (în special în ţările în curs de dezvoltare) acţiunea are în prezent susţinători care o promovează. Iată de ce am considerat că o documentată actualizare a acestei probleme poate prezenta interes, în special deoarece efectele nocive sunt numeroase, asociate cu un mare număr de ameninţări pentru sănătate, în timp ce beneficiile sale nu au fost dovedite. Corresponding author: H. Bălan, Assoc. Professor Medical Clinic, Clinical Emergency Ilfov County Hospital, Basarabia Blv. 49–51, Bucharest, Romania Email: drhoriabalan@yahoo.com H. Bălan 8 68 REFERENCES 1. GRIFFITHS J., BRYSON C., Fluoride, Teeth, and the Atomic Bomb. Copyright 1997. 2. European Commission. The safety of Fluorine Compunds in Oral Hygiene Products for Chidren Under the Age of 6 Years. European Commission, Health & Consumer Protection Directorate-General, Scientific Committee on Consumer Products, 2005, September 20. 3. 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