Waikato University Science and Engineering Department Google Hang Out Monday 14 October 2013 12pm
In October 2013, some Waikato University faculty got together and held a live streamed Google Hangout. They were attempting to show the science on fluoridation but what they showed was that they were ignorant of the science. The fact that they thought they were going to share the “real” science with the public is quite typical of fluoridation promoters who think they know about fluoridation but in fact they do not.
Speakers
Dr Alison Campbell – Senior Lecturer (Biological sciences) AC Chairperson
Dr Carrie Barker – Clinical Psychology Graduate Programme Director CB
Dr Graham Saunders – Senior Lecturer (Inorganic Chemistry) GS
Dr Joseph Lane – Senior Lecturer (Physical and Theoretical chemistry) JL
Dr Merrilyn Manley-Harris – Associate Professor (Organic and Analytical Chemistry) MMH
Dr Michael Mucalo Senior Lecturer (physical chemistry) MM
Questions and Times:
Q1 1m40s The 2000 York review of Fluoride studies. It concluded a reduction in decay of 15% in fluoridated areas which translates to on average about a quarter of a filling in a 12 year old. Is that enough to justify treating water for everybody?
Panel Answer MMH: What the York review found on dental care was that the difference in the number of children found to be caries free in fluoridated and non-fluoridated areas range from -5 – 64% with a median of 14.6%. So that is not the number, I guess it’s the number of children, not the number of fillings. The mean difference of Decayed Missing or Filled Teeth was from 0.5 to 4.4 teeth with the median of 2 ¼ teeth. That is all that I can find about it but the thing about the York review was that in 1997 it concluded that most of the data either for and against was not particularly good but of course we’ve had another 16 years of research since then.
Fluoride Free NZ Answer: The York Review was unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. The chair of the Review, Prof Trevor Sheldon, presented a paper to the UK parliament stating that “Whilst there is evidence that water fluoridation is effective at reducing caries, the quality of the studies was generally moderate and the size of the estimated benefit, only of the order of 15%, is far from massive” and that “The review found water fluoridation to be significantly associated with high levels of dental fluorosis which was not characterised as “just a cosmetic issue”. Read Prof Trevor Sheldon’s letter on the York Review.
2 3m48s If Fluoride is perfectly safe as stated by Dr Jonathan Broadbent and others then why does the American Dental Association recommend the use of unfluoridated water when making up infant bottled formula?
Panel Answer GS: I wouldn’t know why they’re advising that. I suspect they are erring on the side of ah caution. With regard to that. No it maybe that there are areas of the USA that are naturally high in Fluoride. That have over 3.5ppm Fluoride. If you are making up infant formula with high levels of Fluoride that may cause some problems. So I suspect they’re erring on the side of caution for those people living in the naturally high areas. But I mean without knowing the reasons behind the thinking then presumably they wrote a report where they gave the reason I couldn’t answer that question really.
AC: Okay, I do notice that the CDC, that’s the Centers for Disease Control, in the United States do say that you can use fluoridated water for preparing infant formula however if the child is exclusively consuming infant formula reconstituted with fluoridated water there may be an increased chance of mild dental fluorosis. And they advise that if that is a chance the parents could use low Fluoride bottled water some of the time.
GS: I guess there is no guarantee that bottled water is going to be low Fluoride either I mean.
AC: No, this is true.
GS: Most of the water I’m familiar with comes from the volcanic springs and so on. And I suspect the levels of Fluoride in the bottled water may actually be higher than in fluoridated tap water.
AC: So you think bottled water has probably got it in here as well here in New Zealand because of our water sources?
GS: It depends where it’s from.
Fluoride Free NZ Answer ADA issued an advisory in 2006 saying “If liquid concentrate or powdered infant formula is the primary source of nutrition, it can be mixed with water that is fluoride-free or contains low levels of fluoride to reduce the risk of fluorosis. These include water labeled as purified, demineralized, deionized or distilled, as well as reverseosmosis filtered water.
They therefore considered “low levels” to be “purified, demineralised, deionized or distilled” and therefore not fluoridated water.
The CDC say “Recent evidence suggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of a child developing the faint, white markings of very mild or mild enamel fluorosis.”
Jonathan Broadbent continues to say that making up infant formual with fluoridated water is safe, because he denies that dental fluorosis is a problem. However, we concur with Trevor Sheldon, chair of the York Review, that dental fluorosis, no matter how minor, is NOT cosmetic, but the first outward sign of fluoride poisoining. If it has affected the teeth then it is likely to have affected the bones, and possibly interfered with other functions in the body.
3 5m49s What is the safe value of Fluoride ingestion for an individual and does this vary with body weight?
Panel Answer MM : Yeah, I think. I mean I can’t answer that one but I think 1ppm. Actually hang on. Here’s some figures here. The US institute of medicine established dietary reference intakes of Fluoride, from .01mg per day for infants aged 6 months or less to 4mg per day for men aged 19 years and up. And the tolerable upper intake level was 0.1mg per kg per day for infants and children. Through the age of 8 years and 10mg per day thereafter. These are things that I’m reading off a source.
AC: So it does vary due to body weight and children were taken in and out.
MM: Yes that is right.
GS: I think it’s important to remember that Fluoride is also excreted from the body. So it’s not bio accumulated. So it’s the concentration that’s important, rather than necessarily the total dose. Total dose is important for acute poisoning. A single dose at a relatively high level. When it comes to small doses over a long period of time then it’s the concentration that is the important.
AC: You’re saying the amount of Fluoride will vary according to dose only but the other thing to be aware of is that it is excreted through the body as well.
GS: That’s right. The concentration is the important bit.
M: And the values will differ greatly amongst the World’s regions. Like in China they have a high (unaudible) some parts of China the level of Fluoride is quite high naturally so, it will depend on where you are obviously.
AC: I think there a fairly large spread of the world where there are witnessed high levels (unaudible).
GS: Sorry. Yeah.
Fluoride Free NZ answer There is never a “one size fits all” in medicine or even supplementation. Millions of people in India and China have developed Stage III skeletal fluorosis from chronic exposure to fluoride, not from a single high dose. These doses may be higher than what we are experiening in New Zealand but the chronic dose New Zealanders are receiving may be enough to cause stage I or 11 skeletal fluorosis. According to National Academy of Science/National Reasearch Council in 1993 the dosage rate for skeletal fluorosis as 10-25 mg/day of fluoride for 10-20 years. (See http://www.fluoridation.com/skeletal.htm #ISFR for more detail)
A Report by Cressey et al for ESR, ESTIMATED DIETARY FLUORIDE INTAKE FOR NEW ZEALANDERS, quotes figures from the US Agency for Toxic Substance and Disease Registry (ATSDR) and the US Environmental Protection Agency (EPA) which for safe levels of chronic low dose poisoning. They base their recommendations of a safe limit solely on weight but without reference to other factors such as nutrition and individual sensitivity.
4 8m24s The Veterinary Association expresses concern about Fluoride build ups in soil as a result of long term fertiliser application. Given that less than 1% of water is consumed and the other 99% released into the environment. Is there concern that it could be contributing to toxic bio accumulation?
Panel Answer AC: Jo I’m just going to summarise that because I don’t know about the others but the sound was a bit funny there. Your feeling is the contribution from fluoridated water to any Fluoride build up is going to be minimal compared to the amount coming through the fertiliser, and that because the Fluoride anion is extremely mobile it is not likely to hang around the top soil for terribly long. Is that a fair summary?
JL: Ah, that is correct.
FLUORIDE FREE NZ answer coming soon
5 12m20s Is Fluoride a mineral?
Panel Answer MM: Fluoride, when we talk about Fluoride on its own as an ion. It’s an ion. If it forms part of a compound then it’s, like for example, as Graham was saying like Fl, Calcium Fluoride for instance then it would be classed as a mineral. You would class it as a mineral when it forms part of a compound with some other ion.
AC: So something like ‘unaudible’ Fluorite mineral.
MM: Yes, yes that’s right. Exactly.
AC: But it’s not a term that we apply to the ion in isolation
MM: No
AC: Okay so the ion is always going to form a compound with something else when dissolved in water?
MM: Yeah, that’s right. If it’s dissolved in water as an ion, it’s Fluoride ion.
FLUORIDE FREE NZ answer coming soon
6 13m37sRegular Ministry of Health data on 90,000 school children and the World Health Organisation data show no difference between fluoridated and non-fluoridated communities. Does this not prove that water fluoridation has minimal or no effect on tooth decay?
Panel Answer MMH: I’ve just flicked to the MOH works website and they list some reports here, a study which analysed 8,375 five year olds and 7,158 twelve year olds from Canterbury and Wellington. Even after taking most things into account Maori and Pacific children had worst oral health than other children. Analysis showed that water fluoridation had a significant effect on improving oral health and that this improvement was greater for groups with poorer oral health such as Maori and Pacific children, and children attending low decile school. Overall decay rates were 30% lower among five year old children receiving fluoridated water and 40% lower among twelve year olds.
AC: Okay, can you give us the reference for that Merrilyn?
MMH: Yes, water fluoridation and dental caries in five and twelve year old children from Canterbury and Wellington, New Zealand Dental Journal. Authors are Lee and Dennison.
AC: And the publication date?
MMH: 2004.
AC: Okay so it’s a fairly recent one then.
MMH: Yeah.
AC: From memory with some of the WHO data the reason that would show no difference between fluoridated and un-fluoridated because it hasn’t always been collected in that format but certainly what you’ve just read out from the publications suggests that there is quite a difference between fluoridated and un-fluoridated in terms of dental decay.
FLUORIDE FREE NZ answer This is the much touted Wellington-Canterbury study that fluoridationists like to use to justify fluoridation in New Zealand. They use this study because it considers the decile rating of the schools that were selected for the study, to estimate the socio-economic status of the children. However, as you will see here, these schools were only a handful of schools from each area and the decile ratings of some of the schools changed dramatically the following year making the ratings unreliable.
Ministry of Health data shows no discernible difference in decay rates from fluoridated and non-fluoridated areas. In fact a recent Official Information Act request (OIA) regarding the effect of ending fluoridation in Ashburton has shown that there have been no detrimental effects on dental health, in fact, the opposite is true. Since Ashburton stopped fluoridation in 2002 there has been a small, steady improvement in dental decay rates, a far cry from dire consequences proclaimed by the Ministry of Health (MOH) and district health boards in the lead up to last year’s referenda in Hamilton, Hastings and Whakatane. The misleading 40% tooth reduction figure used by the MOH and DHB in their referendum advertisements has been discussed here.
717m13s What is the LD50 of the Fluoride ion not the salt?
Panel Answer GS: You can’t get that because you can’t have the Fluoride ion on its own.
AC: Okay.
GS: I guess Sodium is fairly innocuous so you could take the LD50 of Sodium Fluoride. Which is 52mg/kg of body mass.
AC: But what’s, what organism is that? Is that just a general statement?
GS: That’s for the rat.
AC: That’s for the Rat.
MMH: Sodium Hexafluorosilicate is 125mg/kg. So it’s administered as Sodium Hexafluorosilicate but that would be because solubility is less so it’s not so readily absorbed.
AC: So you’ve got to.
MMH: This question of how much you absorb it as well.
AC: So that’s why there’s such a big difference between Sodium Fluoride and Sodium Hexafluorosilicate?
MMH: If you’d like it placed in perspective Alison. The LD50 for Caffeine for rats is 192mg/kg so caffeine is only slightly less toxic than Fluoride (laughs).
AC: I think I’m going off coffee even more.
MMH: Yeah
FLUORIDE FREE NZ answer coming soon
818m42s Is it possible to be allergenic or allergic or hypersensitive to Fluoride? if so how should those individuals avoid contact with fluoridated water?
Panel Answer GS: From what I’ve read, and I take my information mainly from a review by Paul Harrison in the Journal of Fluorine Chemistry 2005 ah Vol 126- 1448 which, reviews literature on this. The evidence for an allergic or hypersensitive reaction is non-existent. The studies that have been done do not support claims that Fluoride is allergenic. These studies would have looked at the antibody response rather than just rashes and things like that. Some people claim to have observed when they’ve touched fluoridated water and so on. These would actually look at antibodies and the body’s immune response. And so these were much better indicators of any allergic response than a symptom that could be caused by other factors. So these are real data rather than anecdote or just a minimal study.
AC: Okay, so they basically looked at antibody levels in the bloodstream for people who have reported an allergic response and if there is no significant antibody tighter then that was being taken then as evidence that the response was probably not to Fluoride?
GS: Well it wasn’t looking at individual humans. It was mainly looking at rats as far as I’m concerned. As far as I’m aware but there have been a number of reports. I’ll try and find one here. Yeah, the NRC. The published a report in 1993 on this there’s another paper by ‘unaudible’ in Community Dental Health 1996. Then there is a National Health and Medical Research Council of Canberra, 1991. So those are the reports that I have access to at the moment. But they all concluded that there was no allergenic reaction to the Fluoride ion itself.
FLUORIDE FREE NZ In the Netherlands in 1972, a double blind study by 10 physicians, biologists, a pharmacologist, an allergy specialist, a dermatologist, and a notary (to ensure objectivity). Demonstrated the same adverse symptoms as already described in the literature. Water was supplied from drinking bottles with secret codes, changed every 2 weeks, known only to the notary. After 16 weeks the reports were delivered, sealed, to the notary. They were opened with two witnesses. It was found that 1-5% showed adverse symptoms. The validity of the study was subsequently upheld in court. (On 31 August 1976, by Royal decree, fluoridation was banned in the Netherlands.) See examples of individual cases here.
9 21m36s Considering the natural involvement of Fluoride in bio appetites and the fact that it is ubiquitous in the environment could the panel clarify the question of whether Fluoride is beneficial or essential? I ask because some reviews describe Fluoride as an essential nutrient while others call it an essential microelement because of the role it plays in bones and teeth.
Panel Answer MM: The benefit of it is that in teeth obviously the compound that compromises teeth is the hydroxyapatite. Which has got a formula of Ca10PO446OH2 and that OH2 which is Hydroxyl groups is what gets attacked by acid and the theory is that this is meant the Fluoride is meant to replace those and produce a compound called Fluorapatite which, is very insoluble and is more resistant to attack and I think it’s been shown that even if it is ingested it has got a very small improvement for bone strength but I mean that that’s the general view about the beneficial benefits of it anyway. Yep.
AC:Does anyone want to add?
JL: I think the decision about whether something is considered to be an essential element or nutrient or whether it’s a medication a lot of those decisions get ended up being made by courts and not necessarily by scientists so just because a certain decision has been made in a particular country doesn’t necessarily mean it’s the best descriptor for a word. I think this idea that Fluoride is a medication that is commonly used is a decision from a high court in Holland. Why we are necessarily considering something to be a medication or not a medication based on the decision of one foreign country I’m not quite sure about. With regards to specifically whether it’s an essential element or nutrient, it depends on whether you think having strong healthy teeth is an essential component of a healthy lifestyle. If you think it’s not you are happy to have your teeth fall out, and rot etc then you’d happily put it in the category of not being essential. But if you know if you want to live a long life that allows you to eat food the whole time um then maybe you would make it that consideration that it is an essential element or nutrient.
AC: Thanks Jo. Does anyone want to add to that one?
GS: I think it would be very hard to prove one way or the other because Fluoride is ubiquitous. It’s in sea water to 1.2ppm. It’s hard to avoid it. Every creature will have grown up and evolved in an environment containing Fluoride, whether that is actually necessary I mean one could perhaps think that since fluorapatite is more or less soluble than hydroxyapatite that when bones are first formed they’re seeded on fluorapatite. I could make an argument that it is essential if that mechanism applies. So I think it’s going to be very hard to prove one way or the other of whether it is essential or not. Its benefit comes from fluorapatite being much more resistant to acid than Hydroxyapatite in terms of the teeth. It also has perhaps more controversial benefit in terms of bone health in that it slows down loss of Calcium in older age. So it can be used or has been used as a treatment for Osteoporosis but I think that is a much higher doses of Fluoride and problems can arise because of that. Some patients have developed a dental, sorry not dental, skeletal fluorosis as a result of treatment for Osteoporosis but to conclude with I think it is going to be very hard to prove one way or the other whether it is an essential element or not. It is quite possibly that it could be but its benefits certainly from a scientific point of view, chemical point of view are sort of incontrovertible.
AC: Great, ah, Michael?
MM: Okay yes, you’d need to do, you’d need to design very careful experiments to specifically exclude Fluoride from the diet before you could categorically prove whether it was not an essential element. And I think they’ve done that for things like Silicon where they’re trying to prove that it’s essential for the diet but you’d have to do very very excruciatingly careful experiments to do that so at this stage I don’t know whether anyone has done that yet?
MMH: I think that there are many substances which, people regard as essential which haven’t actually been scientifically proven to be essential.
AC: Okay, hopefully that will give our questioner a reasonably solid answer then.
FLUORIDE FREE NZ answer There is little or no evidence that fluoride is an essential nutrient. To prove that a fluoride is an essential nutrient it has to be demonstrated that some disease results from depriving an animal or human of fluoride. This has never been done. Taken from Dr Connett’s book The Case Against Fluoride:
In a 1998 letter by Bruce Alberts, president of the Institute of Medicine, to Professor Albert Burgstahler, editor of the journal Fluoride and several other scientists, in response to there complaint to the National Academy about the Institute of Medicine’s inclusion of fluoride in the list of nutrients in its report ‘Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride, the following quote appeared:
First, let us reassure you with regard to one concern. Nowhere in the report is it stated that fluoride is an essential nutrient. If any speaker or panel member at the September 23rd workshop referred to fluoride as such, they misspoke. As was stated in Recommended Dietary Allowances 10th Edition, which we published in 1989: “These contradictory results do not justify a classification of fluoride as an essential element, according to accepted standards.”
1027m02s Can you give a rational and sensible explanation as to why different Fluoride compounds have significantly different levels of toxicity yet you claim they all revert back to exactly the same Fluoride ion and are all directly equivalent? All different Fluoride compounds should have exactly the same LD50 but the fact that they are very different seems a little paradoxical.
Panel Answer JL: Yeah so, that’s a good question. There are two parts to that. One is to think whether a molecule contains the atom of Fluorine? Okay so and whether that when you take that compound it’s likely to disassociate to produce Fluoride, the anion. Just to deal with the first part of the question so the concept or idea that a molecule is necessarily good or bad for you based on it because it contains certain elements is one you have got to be very careful with. You could make an argument that say something like Sarin which, is a known nasty compound which, is often used to explain or commented about in the fact that it contains a Fluorine atom you could say that is nasty and it contains fluorine and it’s evil and bad etc. But it also includes Carbon and if you are going to make that sort of connection then you’d then say okay Sarin I know is bad for me it contains fluorine and it contains Carbon therefore every molecule with other molecules that contain Carbon I’m not going to try and consume or I’m going to try and avoid. Which is a little bit of a silly statement in that the fact you know humans are made quite a large proportion of us are made of Carbon and things like Glucose and anything we might want to eat has carbon in it as well. So we need to be careful distinguishing about whether the product that breaks down is going to be Fluoride or not. Okay, so that’s I think the first part of it. If we’re considering compounds that are salts, these are things that will, when we put them into water to disassociate to form Fluoride then I think we can start to make some more similar comparisons. We need to first be certain that they are totally disassociating and then of course the other metal that is involved in the salt is going to be important. Okay so if you have Sodium Fluoride or Calcium Fluoride, Calcium and Fluoride, sorry Calcium and Sodium themselves have different LD50 values as well. So whether something is going to be toxic is going to depend not just on the Fluoride that’s going to be in the compound that you are consuming or that is the disassociated product but also the other metals that are going to be contained as well. Graham perhaps you’ve got something more to say?
GS: Yeah, there are two factors that are very important in LD50 that Jo hasn’t covered yet. One is the solubility of the compound. Compounds that are insoluble or only slightly soluble have much higher LD50s than compounds that are soluble. For example, Cadmium Sulphide is a much less toxic than Cadmium Oxide. And that’s all to do, they’ve both got Cadmium and it’s the Cadmium that’s giving rise to the toxicity. But it’s that Cadmium Sulphide is much less soluble than Cadmium Oxide and that’s the reason. The second thing is the masses of the compounds are different. LD50 is based on the mass of a compound required. It’s not based on the number of atoms or ions at a, at a toxin that are required. So comparing Sodium Fluoride with say Caesium Fluoride is very different because Caesium is very heavy. So Caesium Fluoride has a much higher mass than Sodium Fluoride. So we’d expect the LD 50 for Caesium Fluoride to be a lot higher than that of Sodium Fluoride. So there’s two factors in there. I don’t think things are, LD50 are directly comparable. Ah they’re a useful guide for indicating the toxicity or the acute toxicity of a compound but we can’t make a direct comparison between them.
FLUORIDE FREE NZ answer coming soon
1131m35s How can we encourage more critical thought when it comes to sources of information most of the evidence I’ve seen used by the Anti-Fluoride supporters is either misrepresented or not applicable to the situation. How can science make it’s own research more accessible and easier to understand?
Panel Answer CB: Yeah, well. I mean I think again there are two aspects to that. One is how can scientists communicate their information clearly and in the places that people read. That’s something you know that science writers and science education people are working on. I’m sure that people are trying to work on to communicate that in a variety of different venues but you know the thing that interests me is how we can, how people who have very different positions for probably a variety of different reasons can communicate about this, how do we communicate about this kind of really controversial issue because that’s what really struck me about the issue. It’s about how polarised people get and therefore the more polarised they are the less they actually can hear and think critically about their own, other people on their side and also the people that are on the other side. And so I mean my, I think, that probably the thing that’s most likely to be helpful is for people to talk and people to talk not just to the people who agree with them but to talk openly with people who disagree with them and try to understand what it is that they are trying to say. Now that’s a big ask because it’s difficult to talk with somebody who and especially in this particular topic where the sides are sometimes so so hostile really to each other that it is hard to not feel dismissed. If you are on one side or the other. I think both. It comes from both sides. So I don’t know, that’s my interest is how can we actually have some dialogue between people who don’t agree and see if they can understand what, cause there are variety of different you know pieces to the puzzle. To the question. Some of them are scientific and some of them are more social, ethical and political really. Sort of how do people share those views without just sort of yelling at each other?
AC: Guys do you want to add to that? Do you have some comment to make too?
MMH: I the point that I made fairly early on in correspondence to the newspaper was that if people want to make statements about science they really need to supply where the information has come from because otherwise you could make any statement without backing it up. If you supply where the information has come from then people will be able to look at that themselves and make their own judgement but at the same time, we shouldn’t confuse science and ethics. What I feel about whether water fluoridation should occur is quite separate to how I feel about something which is been scientifically reported in the literature. That is the difference between fact and opinion.
AC: So, I’m guessing we’ve got quite a bit of work to do on issues like this in terms of getting that dialogue really going?
CB: Yeah, I think, sorry just to say one thing. I think the difficult thing is that there is so much information out there from all different sides and even as for example me coming to this six months ago thinking well what is there? I assume that there must be some good evidence out there? I found it really hard to find. You know so I think it’s trying to figure out how does a reasonably intelligent person who is not a chemist or a biologist go to this and sort through and think okay well there are these people screaming this and these people screaming this how do I know, who do I trust? And that’s the issue that people have, I think.
AC: That does appear to be an issue that is coming through a bit. Looking at the facebook feed but also from a lot of the discussions that I’ve had online that for whatever reason there is a significant amount of distrust of scientists and a trust, more of a trust in what’s been said by the group with whom that thinker might associate most closely.
I don’t know. Personally I don’t know why there is this underlying reason for that is and I certainly don’t know how to overcome it?
CB: Right
JL: I have a couple of comments. I’ve heard Peter Gluckman talk on a totally separate issue that is science and I guess ethics based and it has got nothing to do with fluoride and it was his opinion that New Zealand society is particularly immature when comes to having rational discussions about what might be best for us as a nation or us as a people group or words to that effect and it’s something that he’s grappled with throughout his tenure as Chief Science advisor as how we can have a better more educated discussion amongst the public. How we can get scientists to better engage with the public and how we can get the public to be more trusting of scientists. Because one of the most dangerous things is you hear of some sort of idea or something sounds interesting or new. The first thing that most of us do is jump on the web and do a quick Google search. Unfortunately the top ten hits on Google aren’t necessarily going to be the most reliable sources of information apart from anything you can more or less buy your way up the Google rankings with sufficient money or a sufficient investment in a good website developer who knows about search engine optimisation so we need to be very careful what what’s on the top ten you know pages of Google isn’t necessarily going to be the highest quality information. I’ve heard actually from both sides of the fluoride argument. People saying to do more Google Scholar and less Google which, I think is interesting and I have heard it from both pro and anti Fluoridationists.
FLUORIDE FREE NZ has continually called for an independently chaired open public discussion on fluoridation. Most recently in response to the secret review approved by Prime Minister John Key and led by admitted pro fluoridationists Prof Peter Gluckman and Prof Skegg. Given that the Deputy Director of the National Poisons Centre admits that the ‘jury is still out regarding fluoride’s safety’ it is time that independence is brought to fluoridation.
1238m10s To what extent does using fluoride tooth paste provide protection? Is it a sufficient replacement for fluoride in water?
Panel Answer GS: The difference between water and toothpaste is that fluoride toothpaste is very much topical. It’s on the surface. Now if your teeth are okay that’s going to provide a good protection you’ll get some fluorapitate incorporated into the surface layer of the tooth. Problems come if you do get decay because the enamel is very slow at decaying in acid but the dentine beneath that is much more rapid. Just in the acid so you end up with a small hole in the enamel and then a big sort of cavern underneath. That’s got no protection. If you are using toothpaste the fluoride doesn’t get down into the dentine. It’s not all the way through the enamel. Water fluoridation provides protection throughout the tooth. Whereas fluorapitate because of the way the tooth develops because of the blood supply provides fluoride to the tooth. There is fluoride right the way through. Now it’s slowing down decay in the enamel but not just at the surface but all the way through. Then there is also some protection for the dentine. This occurs even before the teeth have erupted. So the teeth have Fluoride in them so if you are you know a youngster. Maybe you are not terribly good at cleaning your teeth which kids don’t generally don’t like following dental instructions and so on. The water fluoridation provides from protection from the inside. Whereas just toothpaste provides just topical protection just on the surface. So water fluoridation does provide a benefit in that respect as well.
AC: Okay.
MMH: Alison, can I add something else?
AC: Yes
MMH: Yeah, I looked up the work of professor Colin Robinson at Leeds Dental Institute as a result of a letter that was in today’s Times and a lot of his work centres around looking at the efficacy of topically applied fluoride and he was amongst other things pointed out that in areas where plaque is difficult to remove by brushing the even penetration of a thousand parts per million fluoride was unable to get through the plaque. So Graham’s comment that systemically applied is better would appear to be supported by that research.
AC: Thanks Merrilyn. So it does make a lot of sense.
FLUORIDE FREE NZ answer This makes no sense and is completely inconsistent with how Dr Robin Whyman, Consortium partner of NFIS, Director of Dental Health Services at Hawke’s Bay and Whanganui Health Board. Dr Whyman explains how fluoridation works here. Importantly he acknowledges that fluoride works topically. ‘Do we have anycommon ground between the people who are proponents and people saying we shouldn’t have community water fluoridation – we are agreeing that this is a topical effect, this is largely occurring by a topical benefit.’
Dr Whyman states ‘You then swallow the fluoride and it comes down into the blood supply. Some of it actually moves across to bone, we don’t disagree with that at all, and some of it will go to soft tissue. A proportion of it you will excrete in the urine and some of it will come back again in your salivary glands and then come back in the saliva and continue to keep a constant level sitting in the mouth’. Given that we are told that 1,000ppm fluoride tooth paste is what should be using to brush our teeth with it is implausible that 0.0017ppm fluoride via the saliva is going to provide the topical benefit that Dr Whyman agrees with us on. We critique the saliva theory here.
13 41m21s How do New Zealand fluoridated and non-fluoridated water supplies compare, (AC comment: I’m presuming in terms of fluoride concentration), with a range of natural levels of fluoride in water worldwide?
Panel Answer GS: Okay. My understanding is that fluoridation of water is carried out to up to 1ppm. Sea water is 1.2ppm. There are lots of areas of the world that have significantly more than 1.5ppm. These are volcanic areas. Some in South America. The Rockies, China and India in particular. Those areas can have really high levels of Fluoride and they cause some really quite horrible health effects. There is no getting away from it. Fluoride at high Concentration is quite nasty. In particular the Unicef estimate that there are millions of people in India and China suffering from skeletal fluorosis. Leading to bad deformities and is really really quite a significant problem. Of course removing fluoride from water is not trivial, it’s important to remember though that these areas are naturally fluoridated. These are significantly higher than what is in, what is put into a water supply so yeah some areas, particularly away from volcanic areas, you might expect the amount of fluoride to be very low perhaps less than .1ppm and areas that that are near volcanic regions, we might expect it to be over 20ppm and even about up to 50ppm. The levels we get unnaturally in New Zealand are really quite small compared with what can occur naturally.
AC: Okay. So in other words there’s a significant amount of variation in water fluoridation, or sorry not water fluoridation, concentrations of fluoride globally. Some parts of New Zealand would be quite high because of the volcanic water source of a particular area. The one reason we fluoridate in New Zealand is because the overall the level is lower than that recognised than that providing a benefit.
GS: That’s right. The Waikato river has .2 parts per million naturally and when water is fluoridated here it was brought up to I think .8 parts per million. So it would just increase the concentration by four times.
FLUORIDE FREE NZ answer Fluoride concentrations vary across the world as answered above. This is based on the geology of the rocks that the water passes through. What we are concerned with is the dose of fluoride that individuals are receiving. As Dr Michael Beasley, Deputy Director of the National Poisons Centre pointed out on Radio New Zealand, “The question really is the safety of fluoride at what level?” “The dose determines a lot of what happens”, he confirms. Therefore to imply that a certain concentration of fluoride is safe completely ignores the issue of dose.
Simply put, if a person drinks 1L of water they will receive approx. 0.75ppm – 1.0ppm of fluoride, if a person drinks 3L of water they will receive 2.25ppm – 3.0ppm of fluoride. We are concerned with the Chronic affects of individuals consuming this dose of fluoride.
14 44m 20s Can Dr Manley-Harris please discuss the difference between Canterbury and Auckland, Hamilton and Dunedin on the Ministry of Health of 2001 statistics? The questioner feels that the Wellington – Canterbury comparison is invalid.
Panel Answer MMH: Okay, I’ve turned up a study on the enamel defects of the dental caries in 9 year old children living in fluoridated and non-fluoridated areas of Auckland. Completed in 2009. What it found was that the children who lived continuously in fluoridated areas were .42 times as likely to have dental caries as children who lived in continuously in non-fluoridated areas. So therefore, it’s greater than 50% reduction in dental caries. Now the medical, I couldn’t quite find. You commented about a 2001 review or something by the Ministry of Health?
AC: There is a 2000 review that I’ve got hold of now through one of the commenter’s on the Facebook page.
MMH: Fluoridation of water supplies is an evaluation of the …
AC: Epidemiological evidence. That’s the one.
MMH: Right, ok. And they’re saying it contradicts what was published in 2004? Well the process of science is that it generally advances as time goes by and in fact. I’m not quite sure what it is that they want me to talk about? Is it hip fractures or tooth decay?
AC: It appears to be tooth caries. Dental caries.
MMH: Right ah, wait a minute.
FLUORIDE FREE NZ answer Review the New Zealand Dental Studies here.
15 44m52s Are there any papers that look at IQ and low levels of fluoride where that level is defined as .7 to 1 parts per million? That is the level of Fluoride received in our water supply.
Panel Answer GS: I’m not aware of any studies looking at that level of Fluoride. I do know there have been some studies, particularly in China on IQ but those were comparing high Fluoride concentrations and low Fluoride concentrations. And we are talking about 5ppm. 3.5ppm that sort of thing is very high but I don’t know, I don’t have to hand, the values of the low fluoride concentrations there. I do know they’ve been. There’s been a meta analysis done in the past few years, again I don’t have that to hand. I’ll try and look it up.
FLUORIDE FREE NZ answer coming soon
16 46m26s Please explain how this pharmacologically active substance when ingested supposedly only interferes, which is perhaps not quite the right word but, with the chemical structure of the teeth when it has access to chemical structures in every cell of the body?
Panel Answer MM: Yes I imagine it’s ingested I mean access to every cell in the body I’m not sure but I mean I guess it would harmlessly pass through your stomach wall and go into your bloodstream and it may have beneficial influence in strengthening bone which, they’ve shown to be a marginal effect but apart from that I can’t really answer that question. It sounds like it’s more biochemical to me.
AC; We’ll have to come back.
GS: If I could answer that one.
AC: Yep
GC: When Fluoride is dissolved in water. The Fluoride ion is surrounded by a sphere of water molecules and it is quite tightly held on by the Fluoride because the Fluoride ion is very small. So for any biological molecule to get to the Fluoride it needs to remove all those water molecules and that takes over 500Kj which, is a significant energy loss. So incorporating Fluoride into organic molecules is something that that nature finds very very hard indeed. There are about 40 plants and some microbe’s that can make Fluoride organic molecules from Fluoride but the mechanisms for incorporating Fluoride into organic molecules that exist for Fluoride& Bromide and Iodide don’t exist for Fluoride. So it’s very unlikely that it has an effect it’s forming organic molecules. The other thing that Fluoride can do is mimic Hydroxide. It’s about the same size and has the same charge as OH-. There’s a lot of OH-in the body and of cause enzymes are continually interacting with OH- so Fluoride can inhibit some enzymes to a certain extent and certainly in oral bacteria. But these are minor affects and the acute toxicity of Fluoride comes from its affinity for Calcium. Essentially the biology of Fluoride is dominated by the affinity for Calcium. The reason why its toxic at high concentrations or high doses is because it takes Calcium out of the blood. It precipitates Calcium out of the blood. We need Calcium to signal between nerves. There are studies that people attribute Fluoride to inhibit and activate certain enzymes. It’s not actually the Fluoride in those cases that’s doing the work. It’s Aluminium Fluorides that are doing that. Now the levels of Aluminium Fluoride in the body I haven’t had the chance to look those up but the people who do the studies usually use levels of Fluoride that are 100 times higher than those that are found in the body so they are significantly higher to form the Aluminium Fluoride. Also Aluminium Fluoride in order to form these species are at quite a low PH. So I think in terms of the enzyme and the biology, the organic biology in the body because we are multi celled animals because we are large ah the effect is going to be minimal. There is an affect but it’s minimal.
FLUORIDE FREE NZ answer coming soon
17 55m18s Is Fluoride considered to be a drug or a medicine when added to the water?
Panel Answer JL: I believe Medsafe don’t consider it to be a medication.
AC: Okay, at what, in general or at the concentration in water?
JL: When it’s added to water. It’s not considered to be a medicine. It’s worth noting that may differ, you know different countries may have different opinions about whether it is considered a medicine or not but my understanding is that medsafe do not consider it to be a medicine.
JL: I think the decision about whether something is considered to be an essential element or nutrient or whether it’s a medication a lot of those decisions get ended up being made by courts and not necessarily by scientists so just because a certain decision has been made in a particular country doesn’t necessarily mean it’s the best descriptor for a word. I think this idea that Fluoride is a medication that is commonly used is a decision from a high court in Holland. Why we are necessarily considering something to be a medication or not a medication based on the decision of one foreign country I’m not quite sure about. With regards to specifically whether it’s an essential element or nutrient, it depends on whether you think having strong healthy teeth is an essential component of a healthy lifestyle. If you think it’s not you are happy to have your teeth fall out, and rot etc then you’d happily put it in the category of not being essential. But if you know if you want to live a long life that allows you to eat food the whole time um then maybe you would make it that consideration that it is an essential element or nutrient.
FLUORIDE FREE NZ answer coming soon
18 57m20s Every time I hear the ethical argument it gets diverted into claims about the science which, maybe unsupported at times. We keep saying fluoridation is an ethical question not a scientific one but informed by the science. Is it possible to have that ethical debate if the participants don’t accept the science?
Panel Answer CB: No, I think one of the problems that you have to have. You have to work from the same assumptions. You could discuss the ethical. I think one could discuss the sort of social and ethical questions but some of that depends on whether you assume, whether you believe that for example Fluoride has a beneficial effect. Because it changes the answer if you know. If you don’t believe that it has a beneficial effect then that would change the answer. If you guys didn’t believe that it wouldn’t have a beneficial effect I’d suspect you wouldn’t be arguing to do it.
So it is sort of founded first on belief on a certain on the having the same a assumptions about what’s helpful and whether there is a harmful effect. So you can’t really disentangle them completely it’s like a step ladder you have to. Maybe that’s why the discussion isn’t about the science because that’s the foundation but then if people agree on the science then you can discuss the ethical, social, political you know individual rights versus collective health benefits and that sort of thing but the problem is if people are arguing about the science and the facts.
AC: About the science. Which says something about what Peter Gluckman said prior to the tribunal in Hamilton was that the science was effectively settled. I think the word effectively, has sort of slipped under the radar but I think it’s also important to bring in Merrilyn’s point addressed at that you made as well that science is actually quite a dynamic process and we do re-evaluate our positions all the time in the light of the evidence that comes to hand.
CB: Is science ever settled?
AC: Well, no science is never firmly settled that’s probably one of the reasons that people may find it actually really frustrating thing to talk about because we don’t agree all the time or we change our minds but I think it’s really important that and it might be a good time to finish cause we are pretty much out of time. That you know if you are doing science properly it isn’t a matter of belief it is a matter of looking at all of the available evidence weighing it up and coming to a decision in light of that evidence. As soon as we start bringing belief into it then we are really into a whole other ball game entirely.
FLUORIDE FREE NZ agrees with the statement that ‘as soon as we start bringing belief into it then we are really into a whole other ball game entirely’. Fluoridation is based on a belief system that is designed to protect the status quo and the status of the health professionals who have staked their reputations and careers on it. Fluoridation should end because it doesn’t work, is not safe and robs you of choice.