The Very Best of 101 Fluoride Questions

Why is public health promoting water fluoridation?

Community water fluoridation serves as an example of an excellent public health program. Because the benefits can be readily provided to everyone served by a fluoridated public water system, large groups of people can benefit in a manner that does not discriminate against any group, regardless of age, race, gender, ethnicity, religion, educational status and socioeconomic level. The protection of fluoridation reaches community members in their homes, at work and at school -- simply by drinking the water.

Therefore like milk pasteurization, immunization and the chlorination of water, fluoridation is a classic public health initiative.

Is water fluoridation the most cost-effective means of preventing tooth decay?

Yes. Data from scientific studies continue to confirm that fluoridation has substantial lifelong tooth decay preventing effects (up to 60% for children with baby teeth and up to 30% in adults). Therefore the need for restorative dentistry is lower in fluoridated communities.  The annual average cost of water fluori-dation in SaltLakeCounty is $1 per person per year. The cost to restore one permanent molar with a silver filling is about $70, or the cost of providing fluoridation to one individual for 70 years!

Is there a difference between natural fluoride and the fluoride used in "artificial fluoridation"?

No. There is no such thing as artificial fluoride. Fluoride is found in a natural mineral form and cannot be artificially created.  The appropriate term "adjusted" fluoridation more accurately describes the process. In the fluoridation process, natural fluoride from the environment is used to adjust the existing natural level of fluoride to the recommended level of 1 ppm for preventing tooth decay.

Is fluoride a fertilizer?

No. Fluoride is not a fertilizer. Fluoride is a mineral that is obtained from rocks and minerals in the environment.  Phosphate, which is a fertilizer, is often found in the same rocks and minerals as fluoride. During the phosphate fertilizer manufacturing process, fluoride is collected separately from the phosphate.

Is fluoride a poison or toxic substance?

No. Fluoride is not toxic at the level of 1 ppm. Fluoridated water at 1 ppm is considered to be safe and effective to reduce tooth decay. However, like many common substances important to life and good health, such as iron, vitamins A and D and even water, fluoride can be toxic in excessive quantities.

Serious toxic effects are possible from massive doses of extremely high levels of fluoride (e.g. 2500-5000 mgs of fluoride would have to be consumed at one sitting to achieve this). In comparison, only 1 mg of fluoride is found in 1 liter (4 cups) of fluoridated water at 1 ppm. You would have to drink 3,125 liters of fluoridated water at1 ppm at one sitting, to obtain a toxic dose of fluoride.

Does water fluoridation cause cancer?

No. More than 50 epidemiological studies have been conducted to evaluate the relationship between fluoride concentrations in drinking water and cancer. The U.S. Public Health Service reviewed the results of these studies and concluded there was no credible evidence for an association between fluoride in drinking water and the risk of cancer.  

The fluoridation/cancer controversy began in the 1970's with a publication by well-known anti-fluoridationists. Their report analyzed cancer deaths in 20 American cities and concluded that cancer mortality in fluoridated cities was greater than in cities without fluoridated drinking.

The National Cancer Institute reviewed this report and found the investigations had failed to take into account widely accepted risk factors known to affect the death rate for specific types of cancers. Ethnic composition of the population, geographic location, socioeconomic status, ages and sex differences all had been ignored.

When the data was reanalyzed using standard procedures to account for these factors, the differences in cancer death rates were found to be due entirely to the age and racial makeup of the respective popula-tions. Thus the study failed to show any relationship between water fluoridation at 1 ppm and cancer.

Does water fluoridation harm people when they are undergoing dialysis?

No. As required by Federal regulation, individuals undergoing dialysis do not use fluoridated water during the dialysis process.  However, people receiving dialysis treatment can drink fluoridated water with no danger.

People with severe kidney failure have limited ability to remove absorbed minerals. If kidney function has decreased to such an extent that dialysis is necessary, it is important that the water utilized during dialysis treatments be de-ionized. This is because the individual's blood is exposed to very large amounts of water each week during these treatments (280 - 560 quarts). The de-ionizing process removes excess minerals such as iron, magnesium, aluminum, calcium and other minerals as well as fluoride from the water.

Is the fluoride from the drinking water accumulating in my body and eventually will it harm me?

No. The fluoride that you consume, if not utilized by your teeth and bones is efficiently excreted by your kidneys within 24 hours. To obtain a fluoride level that could harm your bones, an individual would have to drink 10 - 25 liters (equivalent to 50-125 cups) of fluoridated water at 1 ppm per day for 10 to 20 years. The average fluid intake for an adult is 1.5 liters (6 cups) a day.

Are certain populations (elderly, people with deficiencies of calcium, magnesium and vitamin C, and people with cardiovascular and kidney problems) susceptible to the toxic effects of fluoride?     I read that the U.S. Agency for Toxic Substances and Disease Registry stated this in a report.

No. This claim has been made by antifluoridationists to scare the public and persuade community leaders to discontinue water fluoridation. The Agency for Toxic Substances and Disease Registry (ATSDR) prepared the document, Toxicology Profile on Fluorides, to address high level of exposure to fluorides for persons living or working near hazardous waste sites. The hazardous levels of exposure discussed in this document far exceed those levels of fluoride used for the fluoridation of community water systems. This information was taken out of context by antifluoridationists.

The CDC has responded by stating "To date, there is no scientific evidence that exposure to fluoride at the levels found in optimally fluoridated water present any risk for the development of any disease processes. Neither is there any evidence that certain individuals or subgroups of individuals such as the elderly or those with renal disease, suffer any adverse effects from drinking fluoridated water. The preponderance of scientific evidence indicates that fluoridation of community water supplies is both safe and effective."

How is the water fluoridated?

Water fluoridation is the adjustment of the existing natural fluoride level to the recommended level of 1 ppm for healthy teeth.

The fluoridation process occurs at the water treatment facility, under the careful supervision of the water treatment personnel. The fluoride control system was designed with numerous safeguards. The fluoride system has a computerized control system that provides precise control of fluoride dosage. If there are any deviations from the desired flow rate an alarm will sound. If the computerized control system fails, the fluoride feed pumps will shut down automatically.

To operate a fluoride system, SaltLakeCounty systems must obtain an operating permit from the State Department of Environmental Quality as outlined in the drinking water regulations.  The Salt Lake Valley Health Regulation #33 requires monitoring and reporting on the systems as well.

The fluoride that is used in the adjustment is obtained from the environment. The water treatment plant receives it in the form of a liquid (containing fluoride, hydrogen and silica - all of which are natural components of our water).

Is it possible for a fluoride spill to occur at the water treatment plant and cause the water supply to receive a toxic dose of fluoride?

No. It is virtually impossible for the community to receive a toxic dose of fluoride from a spill of fluoride at the water treatment plant.

For an adult, fatal poisoning from fluoride would require consuming 2500-5000 milligrams of fluoride all at once. To acquire this much fluoride from appropriately adjusted fluoridated water, one would have to drink at least 3,125 liters (688 gallons) of water in one day. It is a mechanical impossibility for the water treatment plant to deliver this high toxic concentration of fluoride in the water to the community because of the equipment's design and safety features.

The fluoride system controls deliver a regulated fluoride dosage. An analyzer is used to measure the actual fluoride concentration in the finished water. The chemical feed system is attached to a limited supply of the chemical and an alarm is sounded if the chemical level drops too suddenly. The fluoride feed pumps will also shut down automatically if this occurs, or there is no water flow. At the treatment plants, finished water is monitored with an on line device providing finished concentration measurements every 5 minutes. Manual checks of the fluoride can be performed by the operators at the treatment facilities and at tap system sampling is performed and verified on a routine basis.

Is it wasteful to fluoridate the entire water system?

No. It is technically difficult and certainly more costly to fluoridate only the water used for drinking. Our entire water supply is chlorinated, and it is also used for watering lawns and washing cars.  Compared to alternative methods of preventing tooth decay, fluoridating the entire water supply is most cost effective.

I think water fluoridation adds taste, color and an odor to the water supply.

Taste, color and odor are not affected by the addition of fluoride at a concentration of 1 ppm. This has been demonstrated in taste tests with and without fluoride at concentrations up to 133 ppm fluoride.

Water supplies normally vary in their taste, color and odor. Dissolved solids such as calcium, magnesium, iron and organic materials such as decaying vegetation are primarily responsible for causing the tastes, colors, or odors in a water supply.

Does water fluoridation interfere with my freedom of choice?

No. The courts have rejected the contention that fluoridation ordinances are a deprivation of religious or individual rights and ruled that:

• Fluoride is a nutrient, not a medication and is present naturally in the environment.
• No one is forced to drink fluoridated water as fluoride-free sources are available.
• In cases where a person believes that fluoridation interferes with religious beliefs, there is a difference between the freedom to believe, which is absolute, and the freedom to practice beliefs, which may be restricted in the public's interest.

Have the courts upheld the legality of water fluoridation?

Yes. During the last 50 years, the legality of fluoridation has been thoroughly tested in the North American courts. No court of last resort has ever rendered an opinion against fluoridation. The courts have reasoned that safe public health measures such as vaccination, chlorination, pasteurization and fluoridation can take precedence over the wishes of the individual in order to benefit society as a whole.

Is water fluoridation a form of mass medication?

No. Fluoride is the 13th most abundant element in the earth's crust and also in the human body. It is present in small and varying amounts in all soils, plants, animals, air and water supplies. Fluoride occurs naturally in varying amounts in surface water (oceans and lakes) and in groundwater. Because of this, our diet contains fluoride and it is then deposited in our teeth and bones. Fluoride is considered a beneficial nutrient based on its proven effects ondental health.