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HomeMy WebLinkAboutAgenda Packet 10/29/2015 For fluoride and receiving on to d water Print 1Narn Clearly Address oc/ 6,C)"S's (c ;u-� 141441- ,� �.� y ; V-1A Z-bC PA J V b r0i�ot,t 41v *-7-01 1 140 He -ov r"* At r` N Q�-4 V-�)-- 1��,. � c , �f r ) For fluoride and receiving rl to ter Print Name Clearly press LADk 2 fluoride n reeeiv* ri ate ate Print Name dearly A c res 3 For fluoride and receiving on to ter 'Tint Name dearly A ddre s s 4 r or fluoride but not reeeivi 2 fluoridated water Fin lTairie earns f CGS Le� �. C- r4,�o" C E C wA or fluoride but not receivin2 fluoridated water Pant lame C earl + res ztr v-- (,a, Ve- 2o Av� Ao O-A c) ' tk) At, 1 2 Against fluoride and receiving fluoridated water print M e ea ddess A �� �cc.�- �dr.. ��� �•�,��� w� �����, �� �.,� , of;' � IV OC 4 t� C 0 A Y) 0-F -1-s C', TIZ�\ LID p h 1� 1 a Against fluoride and receiving fluoridated water Print dame + earlyres 152-2- N, � 9, 2 6 W 'o w r m 0 n 1 t�T A 'n t Y� \Je j'L 2-4011 Ilt E _A2ai*nst fluoride and receiving fluoridated water E+h FA Print l�Ta ►e +gar . : cues C LGjG� i L G i e i L ' U /.2-3 P A A cx. p C 11dZe Ij 3 Against fluoride but not receiving fluoridated water Pr%nt a� .e lean r ss iL I J F s 1 1 c-,o G� � � �"'ice✓ Mrs C,� fob -Ay Against fluoride but not receiving on ate ater 1'r nt Name fear dress Jo' 421 Gkk e 6e �V OSi6e vc _lets ck,A \km% 2 �E City Council Meeting 10-29-2015 Think Before You Drink! ! Port Angeles has an abundance of chemical toxics that alters our water supply. Logically, why would the city continue to add the artificially synthetic chemical known as hydro fluorosilicate Acid, FSA, or HFS? Over the course of your life, ask yourself can this artificial chemical and all the other trace pollutants affect my health and that of my family? Do you consider, what it means if, over the course of your life, you drink approximately 13,000 gallons of water. There could be accumulative, undetected contaminants, lead, arsenic and mercury along with synthetic additives like artificial fluoride from your pipe lines in each glass you drink having accumulative effect on your health for the worse. Who's benefitting more, consumer health regarding prevention of caries or industrial economy? All the studies show that our drinking water with the artificial synthetic fluoride does not reduce caries. Just brush your teeth and stay away from excessive sugar intake along with eating a proper diet. Over an arrange of time the human body becomes a cesspool of artificial and neurotoxic poisons. In science it's not a sin to change your mind when the evidence demands it. VOTE NO because its's our choice not yours. Comments October 29 2015 1 am Glenn Cutler, Former Director of Public Works and Utilities from June 1999 to September 2013 for the City of Port Angeles. I am a professional engineer registered in Georgia and Washington. I am a water customer of the PUD receiving City fluoridated water. When I was the Director I would not offer my personal opinion but now that I am no longer in that position I want you and others to know I am a supporter of fluoridated water and desire that the City continue to fluoridate its water supply. I am not _going to talk about the beneficial health effects of fluoridated water. The community medical and dental doctors and other health_ professionals have spoken to you last week. I want to talk about the qualified water treatment plant operators and some facts on water fluoridation additives. The City has state of the art municipal water facilities. I have the highest confidence in the exceptionally trained, educated and dedicated City staff that ensure outstanding drinking water quality. Washington State has very structured and rigorous certification standards that once achieved must be maintained by these individuals. They run a sophisticated laboratory and constantly take water samples for analysis all under the authority of the Washington State Department of Health. I have provided the City Clerk with a Water Fluoridation Additives Fact Sheet obtained from the US Department of Health and Human Services, Centers for Disease Control and Prevention to be provided to Y ou for reading. I have highlighted some sections that I consider i important for you to read before you make your final decision. I want to make a few points before my time runs out. Centers for Disease Control and Prevention United States Department of Health and Human Services http://www.cdc.gov/TemplatePackage/3.0/images/masthead_subpage.svg Water Fluoridation Additives Fact Sheet Types of Fluoride Additives Community water systems in the United States use one of three additives for water fluoridation. Decisions on which additive to use are based on cost of product,product-handling requirements,space availability,and equipment. The three additives are: The City uses Fluorosilicic acid: a water-based solution used by most water systems in the United States. Fluorosilicic acid is also referred to as hydrofluorosilicate, FSA, or HFS. • Sodium fluorosilicate:a dry additive,dissolved into a solution before being added to water. • Sodium fluoride:a dry additive,typically used in small water systems,dissolved into a solution before being added to water. Sources of Fluoride Additives Most fluoride additives used in the United States are produced from phosphorite rock. Phosphorite is mainly used for manufacturing phosphate fertilizer. Phosphorite contains calcium phosphate mixed with limestone(calcium carbonates)minerals and apatite—a mineral with high phosphate and fluoride content. It is refluxed(heated)with sulfuric acid to produce a phosphoric acid-gypsum(calcium sulfate-CaSO4)slurry. The heating process releases hydrogen fluoride(HF)and silicon tetrafluoride(SiF4)gases,which are captured by vacuum evaporators.These gases are then condensed to a water-based solution of approximately 23%FSA. Approximately 95%of FSA used for water fluoridation comes from this process.The remaining 5%of FSA is produced in manufacturing hydrogen fluoride or from the use of hydrogen fluoride to etch silicates and glasses when manufacturing solar panels and electronics. Since the early 1950s,FSA has been the main additive used for water fluoridation in the United States.The favorable cost and high purity of FSA make it a popular additive.Sodium fluorosilicate and sodium fluoride are dry additives that come from FSA. FSA can be partially neutralized by either table salt(sodium chloride)or caustic soda to get sodium fluorosilicate. If enough caustic soda is added to completely neutralize the fluorosilicate,the result is sodium fluoride.About 90%of the sodium fluoride used in the United States comes from FSA.Sodium fluoride is also produced by mixing caustic soda with hydrogen fluoride. Regulatory Scope on Additives The U.S. Environmental Protection Agency (EPA) has authority over safe community drinking water, as specified in the Safe Drinking Water Act. On the basis of the scientific study of potential harmful health effects from contaminated water,the EPA sets a Maximum Contaminant Level(MCL)concentration allowed for various organisms or substances. Although the EPA does not specifically regulate levels of"direct additives,"which are additives added to water in the course of treatment,it does specify that the addition of chemicals as part of the treatment process should not be more than the MCL concentration for regulated substances. This MCL limit includes the levels naturally occurring in the source water,plus the contribution from direct additives. In 1979, EPA executed a Memorandum of Understanding with the U.S. Food and Drug Administration FDA to establish and clarify areas of authority in controlling additives in drinking water. FDA has regulatory oversight for food additives,which includes bottled water,and EPA has regulatory oversight of direct additives in public drinking water supplies. Because of the decision to transfer the additives program to the private sector, E PA declared a moratorium in 1980 on issuing new advisory opinions on additives. EPA awarded a cooperative agreement to a group of nonprofit, nongovernmental organizations led by the National Sanitation Foundation (NSF) in 1985 (now NSF International) to develop a new additives program. Three years later, EPA announced that the new National Sanitation Foundation/American National Standards Institute (NSF/ANSI) Standard 60 was in operation. Information on drinking water treatment quality assurance practices of governmental authorities in various countries can be found in the Overview of National and International Guidelines and Recommendations on the Assessment and Approval of Chemicals Used in the Treatment of Drinking WateifPDF--476K1.This document discusses the American Water Works Association(AWWA)and NSF/ANSI standards and practices,which apply to water fluoridation in the United States. EPA Regulatory Criteria for Fluoride Additives All additives used by water treatment plants, including fluoride additives, must meet strict quality standards that assure the public's safety. These additives are subject to a stringent system of standards, testing, and certificates by AWWA and NSF International. Both of these organizations are nonprofit, nongovernmental organizations. Fluoridated community water systems adjust fluoride to approximately 0.7 milligrams per Liter(mg/L).Because in some rare locations fluoride is naturally present in water at much higher levels,the EPA established a Maximum Contaminant Level(MCL)for fluoride of 4.0 mg/L(parts per million). The EPA has not established an MCL for silicates,the second most prevalent substance in FSA,because there are no known health concerns. NSF/ANSI Standard 60, however, has a Maximum Allowable Level of 16 mg/L for sodium silicates as corrosion control agents.This is mainly to control turbidity—a measure of water clarity or how much the material suspended in water decreases light passing through the water. Studies have shown that silicofluorides achieve virtually complete dissolution and ionic disassociation at the concentrations used when they are added to the drinking water.The equilibrium reached at the pH,temperature,and fluoride concentration used in water fluoridation account for this.One study reported that no intermediates or other products were observed at pH levels as low as 3.5.(Finney WF,Wilson E,Callender A, Morris MD, Beck LW.Reexamination of hexafluorosilicate hydrolysis by fluoride NMR and pH measurement.Environ Sci Technol 2006;40:8:2572). The studies that examined potential health effects from sodium fluoride additives in drinking water should also apply to FSA because they have the same results for ionic disassociation. AWWA Standards The AWWA sets the minimum requirements for the design,installation, performance,and manufacturing of fluoride products used for adjusting water content.The AWWA standards for fluoride additives are ANSI/AWWA B701 (sodium fluoride),ANSI/AWWA 8702(sodium fluorosilicate), and ANSI/AWWA 8703(FSA).AWWA's standards are prepared by its Fluoride Standards Committee,with oversight by the Standards Council, concurrence by the AWWA Board of Directors,and concurrence by ANSI.AWWA standards are reviewed and updated at least every 5 years. AWWA standards stipulate product quality testing requirements and verification. NSF/ANSI Standards for Drinking Water Additives The NSF/ANSI Standard 60 limits a chemical or product's contribution of contaminants to drinking water applications.Standard 60 provides for product purity and safety assurance that aim to prevent adding harmful levels of contaminants from chemicals and water treatment additives. It includes a detailed audit of the production of the additive products,validation testing of quality, and auditing of all locations for logistic handling. There are also specific criteria for imported products from other countries,and in conjunction with NSF/ANSI Standard 223,there is conformity in quality controls regardless of where certification occurs or which entity performs the certification. Forty-seven states have laws or regulations requiring product compliance with Standard 60. NSF/ANSI standards 60 and 61 (a related standard that applies to products that come in contact with water)were developed by a consortium of associations, including NSF,AWWA,ANSI,the Association of State Drinking Water Administrators,and the Conference of State Health and Environmental Managers.Standards 60 and 61 are accepted by the EPA as the requirements for controlling potential harmful effects from products added to water for its treatment.These standards replaced the former EPA Additives Advisory Program.More information on Standard 60 is posted on NSF's website. Independent organizations, including NSF International and Underwriters Laboratories,verify that fluoride additives meet the NSF/ANSI standards.These organizations test fluoride additives for regulated metal compounds and other substances that have an EPA MCL. For a fluoride additive product to meet certification standards, regulated metal compounds added by the water treatment process must have a concentration less than 10%of the MCL. A comprehensive assessment of the ANSI/NSF Standard 60 for more than 50 additives was published in 2004.This peer-reviewed assessment concluded that the process successfully met the stated goals of preventing problems with trace contaminants in U.S.water treatment additives. More information is available in the following article:Brown,Cornwell,MacPhee.Trace contaminants in water treatment chemicals.(Journal of the American Water Works Association 2004;96:12:111-125.) Measured Levels of Impurities Fluoride additives are analyzed for potential impurities including arsenic,lead,and radionuclides.Verification of compliance with NSF/ANSI Standard 60 must also be certified. NSF hosts a detailed fact sheet on the documented quality of fluoride additives including impuritiesjPDF- 142KB).The fact sheet is based on separate product samples analyzed from 2000 to 2011. Consumers may raise concerns about arsenic in drinking water and that fluoride additives may contain some arsenic.The EPA allowable amount for arsenic in drinking water is 10 parts per billion. NSF guality testing has found that most fluoride additive samples do not have detectable levels of arsenic. For those samples that do have some amount of arsenic,the arsenic level that an average consumer would experience over an entire year of drinking water at a concentration of 1.2 mg/L fluoride is extremely small--only about 1.2%of the EPA allowable amount. Other impurities in the NSF International-certified fluoride product testing were found to be even lower than the arsenic levels,with only 1%-3% of fluoride products containing detectable levels of metals.The average exposure to a typical consumer would be less than 0.1%of the EPA allowable levels. FDA Regulatory Criteria for Fluoride The U.S. Food and Drug Administration (FDA) does not regulate additives used for community drinking water (i.e., tap water), because its regulatory reach concerns the safety and efficacy of food, drugs, or cosmetic-related products. However,because the FDA has authority over bottled water as a consumer beverage (Federal Register,Volume 44, No. 141,July 20, 1979),they do regulate the intentional addition of fluoride to bottled water and require labeling identifying the additive used.Bottlers typically use NSF/ANSI Standard 60-certified fluoride product. I I In 2006,FDA announced that bottled water with fluoride levels greater than 0.6 and up to 1.0 mg/L could be labeled with the following statement: "Drinking fluoridated water may reduce the risk of tooth decay."CDC's fact sheet, Bottled Water and Fluoride,provides additional information on FDA requirements FDA also regulates fluoride in over-the-counter drug products,such as toothpaste and mouthwash,and in prescription items,such as pediatric fluoride tablets and professional-strength gels and foams. FDA does not have criteria on allowable impurities in sodium fluoride or fluorosilicate products. United States Pharmacopeia (USP) Grade Fluoride Products Some have suggested that pharmaceutical grade fluoride additives should be used for water fluoridation. Pharmaceutical harmaceutical grading standards used in formulating prescription drugs are not appropriate for water fluoridation additives. If applied, those standards could actually exceed the amount of impurities allowed by AWWA and NSF/ANSI in drinking water. The U.S. Pharmacopeia-National Formulary(USP-NF)publishes monographs on tests and acceptance criteria for substances and ingredients by manufacturers for pharmaceuticals.The USP 29 NF-24 monograph on sodium fluoride provides no independent monitoring or quality assurance testing. The USP does not include acceptance criteria for fluorosilicic acid or sodium fluorosilicate.As a result,the manufacturer is responsible for quality assurance and reporting.The USP does not provide specific protection levels for individual contaminants, but establishes a relative maximum exposure level for a group of related contaminants.Some potential impurities have no restrictions by the USP, including arsenic,some heavy metals regulated by the U.S. EPA,and radionuclides.Given the volumes of chemicals used in water fluoridation,a pharmaceutical grade of sodium fluoride for fluoridation could potentially contain much higher levels of arsenic, radionuclides,and regulated heavy metals than an NSF/ANSI Standard 60-certified product.The USP does not provide specific protection levels for individual contaminants, but tries to establish a relative maximum exposure level of a group of related contaminants.The USP does not include acceptance criteria for fluorosilicic acid or sodium fluorosilicate. In addition,AWWA-grade sodium fluoride is preferred over USP-grade sodium fluoride for use in water treatment facilities because the granular AWWA product is less likely to result in exposure to fluoride dust by water plant operators than the more powder-like USP-grade sodium fluoride. Fluoride Additives Are Not Different From Natural Fluoride Some consumers have questioned whether fluoride from natural groundwater sources,such as calcium fluoride, is better than fluorides added "artificially,"such as FSA or sodium fluoride.Two recent scientific studies,listed below,demonstrate that the same fluoride ion is present in naturally occurring fluoride or in fluoride drinking water additives and that no intermediates or other products were observed at pH levels as low as 3.5. In addition,the metabolism of fluoride does not differ depending on the chemical compound used or whether the fluoride is present naturally or added to the water supply. • Finney WF,Wilson E,Callender A,Morris MD,Beck LW. Re-examination of hexafluorosilicate hydrolysis by fluoride NMR and pH measurement.Environ Sci Technol 2006;40:8:2572. • G.M.Whitford,F.C.Sampaio,C.S. Pinto,A.G.Maria,V.E.S.Cardoso,M.A.R. Buzalaf. Pharmacokinetics of ingested fluoride:Lack of effect of chemical compound.,Archives of Oral Biology,53(2008) 1037-1041. Thank you for the opportunity to speak on this important subject concerning our community. Norm,w E 7 rn,er 3928 MtAn#e1"1Zoa& PortAn#eta, WA 98362 To: Port Angeles City Council members From:Norma Turner,R.N.,MPH Re: Fluoridation hearing—October 29,2015 I cannot attend this evening and would like to submit the following comments for the record. At the panel discussion of Oct 22, 2015 1 was struck by the difference in the two approaches. The pro fluoride panel were professionals involved in caring for our children. All either lived or worked in Port Angeles. At least three of the opponents neither lived nor worked in Port Angeles. One is the west coast spokesman for the anti-fluoride group and only a temporary resident of the county. The proponents simply stated what the public health studies have shown. The opponents showed videos, presented charts that were difficult to read and/or understand, quotes with dots preceding and following the highlighted words(which made me suspect they were out of context) . It felt more like a show than a serious scientific presentation. The issue of who you trust is the most important element in this discussion,because as elected officials your role is to set policy. In setting policy you must rely on experts, in whom you trust,to help make the best possible decision. Dr. Irwin said it best—when making your decision it comes down to who do you trust? Do you trust those who have made Port Angeles their home and work in fields that help our children be healthier? Just as chlorine is added to the water as an accepted public health measure as a Public Health Nurse I believe that fluoridation is also an accepted public health measure. I hope the professionals who live and work and care for our children in Port Angeles have earned your trust on this issue. Sincerely r Norma E. Turner,RN,MPH I Eugene F.Turner 3928 Mt Angeles Road Port Angeles,WA 98262 October 29, 20115 To: Port Angeles City Council Members and City Manager Dan McKeen From: Eugene F.Turner, MD Re: Fluoride Community meeting set for Oct 29th 1 will be unable to attend the meeting regarding Fluoridation of the Port Angeles water supply. I endorse the public health measure of fluoridation and would like to submit,for the record,my letter to the editor printed in the Peninsula Daily News. As a Pediatrician with 45 years of experience, 1 can attest to the fact that water fluoridation is highly effective. First of all,fluoride is NOT a medication. It is a naturally-occurring substance found in many water supplies around the world. Secondly, since fluoride was introduced into the municipal water supply of Grand Rapids, Michigan 70 years ago(that's almost 3 generations!) it has been studied extensively as to its safety and effectiveness. Thirdly, The American Dental Association, among other organizations, endorses its use in public water supplies, despite the intuitive fact that they stand to lose business for so-doing. Fluoride is effective for reducing or eliminating tooth decay, and it is safe. As a lifetime advocate for childrens'health, i urge the city to continue fluoridation of the water supply. Thank you for this opportunity to share my support of fluoridation as a positive public measure for the children of our community. Signed: Eugene F.Turner, Mb` information re:Grand Rapids can be found at http://nidcr.nih.gov/OralHealth/Topics/Fluoride/The5toryofFluoridation.htm http://www.grcity.us/enterprise-services/Water-System/Pages/Fluoride-i n-Drinking-Water.aspx FISH STUDIES AND FLUORIDE The North American Journal of Fisheries Mgt. state that rather than biodegrading,fluoride accumulates in the environment and is toxic to plants and animals especially salmon. Numerous studies indicate that fluoride is toxic to our already threatened salmon and trout species. One major field study,conducted on the Columbia River demonstrated that relatively low levels of fluoride, just one-fifth of what is found within fluoridation programs can negatively affect the salmon's ability to migrate upstream.Water treated with half the dose that fluoridation provides(0.5mg/L) resulted in 55% loss of migrating salmon within a six day period. The Sierra Club has grave concerns about even small amounts of Fluoride entering our waterways which act as an anesthetic making trout and salmon lethargic which affects spawning. W6 Washington State Pharmacy Board Inspector,Stan Jeppesen stated that none of the t�treatment plants in the world can effectively treat water for pharmaceuticals. The Wastewater Treatment Plant in Port Angeles is releasing 2 .5 million gallons of fluoridated water per day into the harbor. ' I I i I 1. North American Journal of Fisheries Management 9:154-162, 1989 2. Damkaer DM, Dey DB. Evidence for fluoride effects on salmon passage at John Day Dam, Columbia River, 1982-1986. North American Journal of Fisheries Management 9:154-162 1989 3. Brent Foster,State Conservative Chair Oregon Sierra Club, Environmental Attorney, Professional Perspectives on Water Fluoridation, 2009 4. Washington State Pharmacy Board Inspector,Stan Jeppsen, 5-09-07 verified news article with phone conversation 5. Craig Fulton, Director of Public Works, City of Port Angeles, phone conversation 10-26-15 GL > A LA C) 693 62- I am Virginia O'Neil I live in Sequim. I am a member of the county's Developmental Disability Advisory council. I grew up in a city with fluoridated water. I had my first cavity at 28 years old. I am 54 and have never had a root canal and have no crowns. When a dentist looks into my mouth he or she always smiles and says,"Ahh you grew up with fluoride." In stark contrast my three daughters grew up in a beautiful rural area, the Olympic Peninsula. And they grew up on well water. They had fluoride toothpaste and they had annual fluoride treatments at every dental appointment. But topical fluoride only provides a temporary benefit it doesn't do the job like drinking fluoridated water. Our girls all have had cavities. However, our oldest is developmentally disabled she has had over 20 cavities. Her gross and fine motor skills have affected her ability to brush and floss and I believe, as do her dentists and doctors, that fluoride would have made an immense difference in her dental health. I am a former school board director and I know that Good government should be about taking care of those who are more at risk. The science behind fluoridation is clear. Local and national health care leaders have spoken and cited scores of data that confirm that fluoride reduces cavities. Maintaining an optimal amount of fluoride in water is based on the principle that decisions about public health should be based on what is healthy for the entire community. Children in poverty and the developmentally disabled are those populations who need society's help. That's why we insist that kids get vaccinated. We make sure they have one hot meal a day at school and we, as a society should help them take care of their teeth. I am in PA at least twice a week and I pass an anti-fluoride billboard on the highway. pie W C7 Fluoride is misspelled. It appears that the leaders of this anti-fluoridation campaign haven't done their homework enough to even spell check their billboard. If you can't spell the cornerstone of your campaign how detailed oriented are you about checking your science facts? Something to think about. Please continue to do the job that you were elected to do, and to protect the youngest and most vulnerable citizens. They are often the quietest voices with the greatest of need. And Thank you for taking the time and listening to all of us. My name is Susan Sorensen and I live at 21.4 Roberson Road in Sequim. I am a registered nurse and have been doing diabetes education in the community since 1999. Additionally, I wrote a monthly diabetes article for the Sequim Gazette from 1999 to 2013, a total of 14 years. I am here tonight to encourage you to support continued fluoridation in Port Angeles. Good oral hygiene promotes overall good health for everyone but especially people who have diabetes. In the situation when a person with diabetes does not have the best preventive dental care possible, decay and gum infections are common and can be deadly. Just like any infection, a dental infection results in an elevated blood sugar level. That higher than normal blood glucose level results in damage to every blood vessel in the body, especially the essential blood vessels in the heart and kidneys. Saliva normally washes away sticky foods that are the precursor to plaque. Often, a person with diabetes develops what is commonly referred to as "dry mouth" and their body does not produce enough saliva to help control the growth of germs that cause tooth decay and other oral infections. Fluoridated drinking water is extremely beneficial to people with diabetes because the fluoride is consistently present in their saliva. Many people with dry mouth chew on ice all day to keep their mouths from drying out — ice made with fluoridated water will give their teeth protection just like saliva! Fluoride in the City's drinking water is the best way to help prevent future problems because the community water system is providing added fluoride at an optimal and safe rate, to protect these vulnerable individuals. I was present last week and heard the pseudo-science testimony by the Fluoride Action Network. Fluoridation has been proven by credible organizations to be one of the safest and cost effective methods to protect children and more vulnerable populations from extensive dental disease. I strongly urge you to support continued fluoridation of the community water system for the benefit of all community members. Thank you for this opportunity to speak with you. 10/29,2015 Oral Health:The Silent Epidemic joistj rroi l& I Public Health Rep.2010 Mar-Apr;125(2):158-159. PMCID:PMC2821841 Oral Health: The Silent Epidemic Regina M. Benjamin, MD, MBA VADM,USPHS Surgeon General Copyright©2010 Association of Schools of Public Health This article has been cited by other articles in PMC. We are taught from an early age that proper oral health is maintaining healthy teeth. The simple acts of brushing and flossing are instilled in us so that we maintain our"pearly whites;"yet, oral health is much more than clean teeth. It involves the gums and their supporting tissues, the palate, the lining of the mouth and throat,the tongue, the lips, the salivary glands, the chewing muscles,the nerves, and the bones of the upper and lower jaws. Recent research has indicated possible associations between chronic oral infections and diabetes,heart and lung disease, stroke, and low birthweight or premature births.!In other words, oral health refers to the health of our mouth and, ultimately, supports and reflects the health of the entire body. Since the 20th century,numerous advances in research and technology have improved the status of oral health in America for most populations. With the development of fluoridated drinking water and dental sealants, Americans are less likely to experience tooth loss and gingivitis by middle age,which commonly plagued Americans prior to the turn of the last century.1 In addition,the development of dental implants and the refinement of dental materials and treatment techniques have improved our ability to restore function due to tooth loss. Strides toward achieving the Healthy People 2010 objectives for oral health have highlighted the progress made in recent decades. Between 1988-1994 and 1999-2002, the proportion of 15-year-olds with dental caries(tooth decay)declined from 61%to 57%. Similarly, 15-year-olds with untreated dental caries dropped from 20%to 18%. Between 1992 and 2002, the proportion of the U.S.population served by community water fluoridation increased from 62%to 67%,moving toward the target of 75%.2 Community water fluoridation continues to be a vital,cost- effective method of preventing dental caries. Although largely preventable, dental caries and periodontal disease are the two biggest threats to oral health,and are among the most common chronic diseases in the United States. Dental caries is the most common chronic disease in children: it is about five times as common as asthma and seven times as common as hay fever. The most common cause of tooth loss among adults is untreated periodontal disease. Fifty-three million people live with untreated tooth decay in their permanent teeth.3 Strikingly, one-quarter of adults aged 65 years and older have lost all of their teeth due to untreated oral disease.3 4 Despite these statistics, the majority of Americans often take oral health for granted.2 Unknown to many are the complications associated with untreated dental caries and periodontal disease. If left untreated,they may cause pain, dysfunction,poor appearance,loss of self-esteem, absence from school or work, and difficulty concentrating on daily tasks.3 10/29/21015 Oral Health:The Silent Epidemic The health disparities surrounding access to proper dental care add another layer of complexity. The silent epidemic of oral diseases disproportionately affects disadvantaged communities, especially children,the elderly, and racial/ethnic minority groups. Oral health disparities are exacerbated by the fact that a cavity continues to enlarge and become more difficult to repair the longer it remains untreated. Only one in five school-aged children from low-income families receives dental sealants to prevent dental caries. Furthermore,40%of Mexican American children aged 6-8 years have untreated tooth decay, compared with 25%of non-Hispanic white children.3 More astonishing is the 87%of American Indian and Alaska Native children aged 6-14 years and 91%of the 15-to 19- year-olds who have a history of tooth decay.5 In 2000, former Surgeon General David Satcher released Oral Health in America:A Report of the Surgeon General,i which highlighted the importance of oral health as the gateway to general health and well-being. The report revealed how oral disease is a silent problem, especially in underserved populations. In 2003, former Surgeon General Richard H. Carmona released a National Call to Action to Promote Oral Health, which built upon Satcher's report and underscored the many disparities related to oral health. It charged individuals,whether as community leaders,volunteers,health-care professionals,researchers, or policy makers,to collaborate to promote oral health and reduce disparities. The interest in oral health and related disparities has contributed to expanding the language in the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA). Under CHIPRA, states are allocated funding to help strengthen existing programs and provide additional services to low-income uninsured children.The funding provided by CHIPRA allows states to expand coverage of dental services necessary to prevent disease,promote oral health, restore health and function, and treat emergency conditions.7 An important fast step in combating the two leading causes of poor oral health—dental caries and periodontal disease—is understanding that tooth loss is often the result of disease or injury,rather than an inevitable consequence of aging. Educational programs emphasizing the importance of oral health promotion/disease prevention are also necessary to raise awareness and discourage the lack of concern regarding oral health. Proper oral health is vital to a productive and healthy life. Messages that encourage lowering sucrose intake,reducing acidic beverage consumption,and routinely brushing and flossing teeth should continue to be disseminated through all sources of media, including dental literature,television,newspapers, magazines,radio, and the Internet, and should be incorporated into the education curriculum targeting children, caregivers, and communities. Together,we will be able to promote good oral health and encourage our children to be vigilant of their oral health status. Over the years,research,technological advances,and public involvement have improved oral health to the point that most Americans take their oral health for granted.Yet, as most of us benefit from these advances,profound disparities in oral health still exist. To decrease the disparities that exist among different groups,all stakeholders at the federal, state, and community levels must be engaged in the issues surrounding oral health promotion/disease prevention. Additionally,raising the country's understanding of the linkage between good oral health and good overall health will help to reduce the disparities associated with oral health and will lead to a healthier nation. VADM Regina M. Benjamin, Surgeon General I 10/20'2015' Oral Health:The Silent Epidemic e00 Acknowledgments Go to: The author thanks Michael J. Strong,MS, MPH,an MD candidate at Tulane University School of Medicine and a summer 2009 intern at the Office of the Surgeon General, for his contributions to this article. REFERENCES Go to: 1. Department of Health and Human Services(US)Oral health in America: a report of the Surgeon General. Rockville(MD):HHS, Office of the Surgeon General(US);2000. [cited 2009 Jun 3]. Also available from:URL: hM2://www.surgeongeneral.gov/library/oralhealth. 2. Department of Health and Human Services(US)Healthy People 2010:midcourse review on oral health. Washington: U.S. Government Printing Office;2006. Dec, 3. Centers for Disease Control and Prevention,Division of Oral Health(US)Oral health:preventing cavities, gum disease, and tooth loss. [cited 2009 Jun 3].Available from: URL: http://www.cdc.gov/ncedphn/publications/aag/doh.htin. 4.National Institute of Dental and Craniofacial Research,National Institutes of Health (US)Data and statistics. [cited 2009 Jun 6]. Available from:URL: hM2://www.nider.nih.gov/DataStatisties. 5. Department of Health and Human Services(US)Rockville(MD):HHS, Indian Health Service(US); 1999. The 1999 oral health survey of American Indian and Alaska Native dental patients: findings,regional differences and national comparisons. 6. Department of Health and Human Services(US)National call to action to promote oral health. Rockville(MD): HHS, Public Health Service,National Institutes of Health,National Institute of Dental and Craniofacial Research (US); Spring 2003.NIH Publication No. 03-5303. 7. Children's Health Insurance Program Reauthorization Act of 2009. Title V, Sec. 501. Articles from Public Health Reports are provided here courtesy of Association of Schools of Public Health I To Special Hearing of Port Angeles City Council October 29, • 2015 From: Eloise Kailin, M.D. Our governmental health protection system is not working as it should. The rules for assuring quality of fluoride require listing all ingredients. An official of the certifying organization admitted that this is not being done. No one knows what is added to our drinking water aside from fluoride, lead and arsenic. The Port Angeles supplier's Materials Safety Data Sheets disclose this lack of toxicity information. Since no one knows what is in the mix, claims of safety are obviously untrustworthy. As to political influence on Smile Surveys. You may recall a contract I gave you a copy of a few weeks ago between the Washington Dental Services Foundation and State Dept of Health. The Foundation paid $48,779 to "partner" with the Department of Health to produce Smile Survey 2010 . In exchange the Department of Health pledged to control release of survey results in a manner not adverse to Foundation interests. The Foundation promotes water fluoridation. Confidential information which must not be disclosed includes data and technical information or material. It is now apparent why my public disclosure requests for facts and figures of smile surveys were blocked for so long.Your right to know is in jeopardy, as is your right to control your personal medication. This power of the Dental Foundation to manipulate information was abused in 2011 when the Foundation published false claims of benefit from fluoridation in public media and in their Fact Sheet. The State Oral Health Program Manager protested as untrue published Foundation statements that tooth decay in preschoolers declined between 2005 and 2010 . The same false allegations are being repeated during this campaign. This time however we have managed to obtain the County raw data and read it. That data shows that community water fluoridation does not decrease tooth decay in Clallam County children even when economic and racial differences are considered. Community water fluoridation is not shown to decrease cavities in this community. Water fluoridation is not safe, not effective. Vote NO to continued water fluoridation. Take back your right to choose or deny medication. RESTORE CLEAN WATER: VOTE:NO!r ON FLUORIDATION . OCT a 2015 * Fluoride use should be an individual choice. CITY OF PORT ANGELES This or any future City Council may add to drinking water any medicati Y P.A. citizens in 1970s voted down fluoridation. In 2003 City Council disallowed a vote on two initiatives. To regain your right to refuse forced medication VOTE NO!. * P.A.'s fluoridation product is polluted. The label shows hydrofluorosilicic acid arsenic and lead. The certifying official admits required toxicology reports are missing. The vendor admits toxic contents are unknown. The state will not test it. The Health Officer calls it safe! * Mother's milk tells us what is safe for our-infants. By this standard we have over 200 times too much fluoride in our water. * Additional fluoride is harmful. Fluoride exposure from non-water sources has skyrocketed thanks to fluoride containing pesticides, ° dental products, medications,.Abnormal tooth enamel (dental fluorosis)results from too much fluoride consumed in childhood..As of 2007 over 41% of teenagers nationwide are affected. Fluorosis is the visible sign of poisoning which over time harms teeth, bones, brains, and more: hip fractures in later years, painful j oints, thyroid and kidney disorders. Lowered I.Q. is now linked to fluoridation in 36 studies. Poor children are particularly vulnerable . * No dental benefit in today's world. 2005 Clallam County Smile Survey data revealed no decrease in cavities in fluoridated Forks compared to children in non-fluoridated Sequim and P.A. MORE INFO: yes4cleanwater.org Eloise W. Kailin, M.D. 45.00% w No camities in children'8=9 years old in 2005:All caucasian, none on free lunch program. 40.00% 35.00% _ ° 30.00% .,......_....... ._....... .. .. ......_ ...._...... 25.00% .................. 3 i 20.00%....:............_.....__......_. _......................_.... ................. 15.00%....;......_..................__. _......__.._...........__................... 10.00%... ........................ ............_...._......................._. _...... -... . .......... 5.00% 0.00% Forks (fluoridated) Port Angeles (not fluoridated) Sequim (not fluoridated) 29% 41.9% 39:6% G�- J. R. SIMPLOT COMPANY s SEMPf._OT PE-{OSPE-IATES (_t.._C Certi,fxeate of.Analysis (COA) SIMPLOT PHOSPHATES LLC 515 South Hwy 430 Rock Springs, WY 82901 DATE: Wednesday, September 144, 2011 TO: Cascade Columbia c/a BHS Marketing Product: F'luorosiLicic Acid (FSA) Bill:of Lading Number: 012959RS Rail Car Number: JRSX 20007 Date Analyzed; September 14, 2011 Omer Information: Release # 7053606.1 Analysis Name specification Analysis Marc Min % Assay(H2SiF6) 28% 23% 24.55_ % HF 1.0% 0.51 0 % 1'295 Specific vl 60°F 40.04a Lead (Pb) ppm 9100 Arsenic Ppm 5 Color (APHA) 200 0 Visible Suspended Matter By: Brian R. Thomas NSFTitle: Laboratory.iVSctr ager Certified to Max.use, NSF/ANSI 60 6 m li_ Arsenic affects many body functions and promotes cancer even Meets ANSI IAWWAs7o'at extremely high dilutions. It carries a (nonenforceable) Maximum Contaminant Level Goal of ZERO, meaning there is no completely safe level. For practical reasons (cost) the enforceable Maximum level MCL for arsenic in water i5 0.01 arts per milli�n Contaminant 1 ( ) h (or 10 parts per billion). The MCL for fluoride is 400 times greater at 4 parts per million. 'For more information see websites yes4cleanwater.org And flunridi, a1Prf.nr9 J. R. SIMPLOT COMPANY SANiF7LOT P"C� SPI-iA`T"ES t_LC Certificate of Analysis (COA) SIMPLOT PHOSPHATES LLC 515 South Hwy 430 Rock Springs, WY 82901 DATE; Wednesday, September 14, 2011 TO: Cascade Columbia c/o SHS Marketing Product: Fluorosillcic Acid (FSA) Dill of Lading Number: 012959RS Rail Car Number: JRSX 20007 _ Date Analyzed: September 14, 2011 Other Information: Release # 7053606.1 Artalysis Name Specification Analysis Max Min Assay (H2SiF6) 25% 23% :24.55 % HF 1.0% 0.51 P2r� 0 p % 05 1.228 SP ecific aavjtLr Cad 600E 0,40 Lead (Pb) ppm 9.00 Arsenic ppm 5 Color (APIA) 200 0 Visible Suspended Matter NSE $y: Srzarc R. Thomas Title; Laboratory.tY,fartager CeIlirtedto Max,use: NSFIANSI 60 6 m li_ Arsenic affects many body functions and promotes cancer even Meets ANSI IAWWA B70 at extremely high dilutions. it carries a (noaenforceable) Maximum Contaminant Level Goal of ZERO, meaning there is no completely safe level. For practical reasons (cost) the enforceable Maximum Contaminant level (MCL) for arsenic in water is 0.01 parts per million (or 10 parts per billion). The MCL for fluoride is 400 times greater at 4 parts per million. For more information see websites yes4cleanwater.org and, fluoride alert.org RESTORE CLEAN WATER: VOTE NO! ON FLUORIDATION ACT �(}� * Fluoride use should be an individual choice. CITY OF PORT ANGELES This or any future City Council may add to drinking water any medicati Y P.A. citizens in 1970s voted down fluoridation. In 2003 City Council disallowed a vote on two initiatives. To regain your right to refuse forced medication VOTE NO!. * P.A.'s fluoridation product is polluted. The label shows hydrofluorosilicic acid, arsenic and lead. The certifying official admits required toxicology reports are missing. The vendor admits toxic contents are unknown. The state will not test it. The Health Officer calls it safe! * Mother's milk tells us what is safe for our infants. By this standard we have over 200 times too much fluoride in our water. * Additional fluoride is harmful. Fluoride exposure from non-water sources has skyrocketed thanks to fluoride containing pesticides, dental products, medications,.Abnormal tooth enamel (dental fuorosis) results from too much fluoride consumed in childhood..As of 2007 over 41% of teenagers nationwide are affected. Fluorosis is the visible sign of poisoning which over time harms teeth, bones, brains, and more: hip fractures in later years, painful joints, thyroid and kidney disorders. Lowered I.Q. is now linked to fluoridation in 36 studies. Poor children are particularly vulnerable . * No dental benefit in today's world. 2005 Clallam County Smile Survey data revealed no decrease in cavities in fluoridated Forks compared to children in non-fluoridated Sequim and P.A. MORE INFO: yes4cleanwater.org Eloise W. Kailin, M.D. i L` To: Port Angeles City Council for October 29, 2015 From Janet Kailin, 2902 S. Regent Street, Port Angeles, WA I attended the debate last week, and was concerned that the pro-fluoridation group has once again misrepresented scientific studies. Regarding the Smile Survey: We know that the Smile Survey did not show a local improvement for preschool children due to fluoridation between 2005 and 2010. No preschool children from Port Angeles were even included in the 2005 study, so no comparison could possibly have been made for our city. The State's Smile Survey 2010 did not show an improvement for preschool children. You have received a copy of the 2011 email from the Washington State Oral Health Program Manager, chastising the Dental Foundation for inaccurate press releases on this topic. She clearly stated, "The Smile Survey 2010 shows that the amount of decay was as high in 2010 and in 2005." Regarding IQ: Forty-five human studies report harm to the brain from fluoride. Dr. Locke used one study that did not find harm from fluoride. However,the study by Broadbent essentially compared those with water fluoridation and those taking fluoride pills. Dr. Locke did not understand, both groups had fluoride,just a different source. No surprise fluoridation showed no difference in IQ because.the study compared sources of fluoride, not amounts of fluoride. In the end,the real issue goes beyond trust or distrust of this study or that,this expert or that. "Experts" on all kinds of issues have proved fallible in the past. The critical issue at hand today is the individual's right of informed consent.We are each responsible for our own bodies and what we choose to put in them. Doctors cannot force medication on an individual. Dentists cannot force medication on an individual. It is worse than inappropriate for a City Council to force medication not only on an individual, but on an entire population. What helps one person may harm another. Under the principle of informed consent, it is up to the individual to decide what medications to take. Please do not medicate everyone. Safer dental health options-ones that respect individual choice- are widely available. If in doubt, leave it out. Thank you. Considerations WHY TO VOTE N O TO FLUORIDE (please read and hand it on to someone who might not know!) The following subgroups of our population are vulnerable to being overexposed to fluoride -who would EVER consider adding to their toxic burden by forcing them to live with fluoridated water? -Babies (CDC says risk of fluorosis) -Children under 6 (get more than safe levels from toothpaste) - Elderly (accumulates for life, crates brittle bones, arthritic symptoms and gut issues). -40% children with fluorosis (what else being damaged? Brain, thyroid etc.) -People with compromised Kidneys - People who have, or are developing hypothyroidism -Nursing moms, athletes, diabetics - other people who drink a -lot of water - -Black or green tea drinkers -People that are getting fluoridated on their prescription meds- -People who are over fluoridated because they eat pesticide laden foods/drink pop/etc. -People eating organic food from out of country(fumigated with fluoride) -People that are taking fluoride pills or other fluoride treatments 1)Port Townsend and Sequim chose to not have fluoride in their water and many people in Port Angeles also would like the chose. 2)Families have been forced to move from Port Angles to have Fluoride free water. Many more families have been forced to get reverse osmosis or distilling systems which is the only way to remove fluoride from water. Families that have limited funds to spend on water purification buy bottled water to drink and cook with comes with its own risks and an environmental burden. These families are forced to bath and shower in fluoridated water which is absorbed thru the skin and inhaled into the lungs. What a violation of people rights to feel distressed by the local government forcing a toxic chemical in their homes on the many for the few. 3) 95% of processed foods are processed on fluoridated water. Fluoride concentrates in dehydrated foods like dried cereals 4) Fluoridation is becoming a thing of the past The world is waking up to the dangers of Fluoride Now 97% of Europe has removed Fluoride from their water. Canada was 2/3 fluoridated, and is now is 1/3 fluoridated. Israel recently stopped fluoridation (Now PA is buying fluoride from them) Since 2010, over 50 North American communities, with approximately 2 million residents, have rejected water fluoridation. 5) Fertilizer companies make phosphorus for fertilizer from fluoride rich Phosphorite rock. Sulfuric acid is used to break down the rock. Originally the factories released the fluorine gas byproduct into the atmosphere. The gases burned crops and killed cattle around the mills destroying thousands of acres of farmland. Then then needed to start capturing it. That is how fluorocilicate, one of the forms of fluoride used in water fluoridation is created. IT comes from the stacks to us, there is no refining and thus comes with contaminants. 6) Lucier- a fluoride chemical supplier out of Florida was our supplier. Quirky little fact -Lucier is Lucifer without the F and all they supply is the element F (fluoride) 8) A growing number of studies 3(7-45) studies indicate fluoride exposure lowers IQ. Some studies up to 7 points in a fluoridated community. 9) Hypothyroid is 2x higher in Fluoridated communities and often goes undiagnosed. Symptoms of untreated Hypothyroidism, include fatigue, weight gain, concentration problems, poor memory, deceased ability to detoxify due to sluggish liver and increased potential of cancer. 10) Fluoride competes with Iodine and iodine deficiency and has been associated with breast, ovarian, uterine, and prostate cancer. 11) There are thousands of studies done world wide showing the dangers of fluoride. And thousands of organizations that are fighting fluoridation in their communities. 12) Elderly have had years to accumulate fluoride. It causes brittle bones which are more apt to shatter when broken. Accumulated fluoride also increase arthritic like aches and pains and disrupts normal digestion. 14) Fluoridated water doesn't taste good (it tastes like something you should not be drinking) 15) Sodium fluoride was first patented (in 1800's as an insecticide) long before it was used for fluoridating water. 16) Saying Fluoride is natural" is misleading. Fluoride comes in many forms, like sodium can be sodium fluoride, sodium chloride (table salt), or sodium bicarbonate (baking soda) for instance and all have very different effects on the body and different levels of safety. The form of fluoride in Port Angeles water is Fluorosilicic Acid and is NOT the form found in nature (calcium fluoride also called fluorspar) which is considered less toxic, however STILL toxic enough to cause severe skeletal fluorosis which is painful and can be crippling.(An estimated 30 million Chinese are suffering from it) 17) U.S. Center for Disease Control says babies drinking 1ppm fluoride water are at risk of fluorosis and that children under 6 should be supervised when brushing their teeth so they make sure to spit it out.(Children under 6 have not developed a spit mechanism yet so are still apt to swallow their toothpaste and even when attempting to spit still swallow much of it.) Yet, the CDC still endorses it...why??? And how many parents know how important it is to supervise spitting out the toothpaste? 18) Approximately Half of Fluoride is excreted (if the kidneys are at full capacity) and half deposits in the body somewhere, potentially the kidney, bones, brain, and teeth and pineal gland. Fluoride accumulates with age and has been found at thousands part/ million. When in the joints it is painful. 19) Fluoride is in many of the pesticides and is toxic enough to be the primary toxic ingredient in cryolite (sodium aluminum fluoride) 20) Pets (dog drinks 2x the amount/body weight and a cow or horse 4-5x more) are exposed to increased toxic levels of fluoride. 21) People are encouraged to drink higher doses of water but in fluoridated communities that is toxic. Nursing mothers, Diabetics and athletes are at higher risk. 22) People feel forced to drink bottled water to avoid the fluoride the burden of plastic waste goes up markedly to the environment (and local dumps). Bottled water quality is questionable as well, including contaminants from the plastic and sources of water may contain fluoride. 23) Weston Price DDC in the 1940s studies teeth in local people all over the world and found one thing in common. They all had great teeth UNTIL they collided with diets of sugar, wheat etc. 24) Fluoride poisons the enzymes in the body including the enzymes that repair damaged DNA and with fluoridated water at 1ppm can be decreased up to 50% 25) FDA has jurisdiction over the toothpaste but not the water thus the FDA warning DO NOT SWALLOW on the toothpaste. 26) Many (if not most) people that are forced to have their waters fluoridated are already fluoride toxic from the multitude of exposures both naturally and artificially 27) There are a number of food that are high in the form of fluoride that is found in nature. For instance Black tea and Green tea so "tea tootlers" may be at risk for excess fluoride 28) Fluoride is in over 20 percent of our prescription medications, including Prozac, Cipro, Paxil, and a number of antibiotics. 29) Nonorganic food are many times higher in fluoride than 1ppm because the crops and soils with pesticides used are laden with fluoride. 30) Fresh produce from out of country, even if organic, is required by the US Government to be fumigated with fluoride gas yet Europe refuses this procedure on their imports from us. Again just one more unmonitored dose of fluoride Questions we should be asking- Are dentists monitoring potential over exposure to fluoride? What is, and who is monitoring the accumulated amount of fluoride in the body from using- fluoridated mouthwash, fluoride pills, fluoride rinses (much higher than toothpaste), fluoride varnishes, gels, washes, all highly concentrated and yes it is absorbed through the skin. Why are we not educating the public about the true cause of cavities and how to eat in a manner that will support healthy teeth but also increase healthy mind and body. There was a world of great teeth before fluoride (again see the Weston Price DDC studies)? Where are the environmental impact studies? Why are so many organizations endorsing fluoridated water without doing due diligence research for impact on the individual as a whole or on the environment as a whole? We are a whole lot more than teeth? What organizations are accepting grant money that influences there endorsements? Which of those organizations would make a statement that fluoride is safe, and that they would be accountable to that statement? Why is fluoride free toothpaste so hard to find in our main supermarkets? (Except in health food stores) Fluoridated toothpaste 1000 -1500 ppm (pea size equals 1 glass of 1ppm fluoridated water) Who evaluates the toxic burden of each resident before the added dosing in a ""the more the merrier fashion" in spite of the fact it is approximately the same toxicity of arsenic (which by the way our fluoride source has as a contaminant as well). Quality control? Its measured only at one train car per manufacturer per year. No testing is done on the state level. The local radio commercial says that " there is 70 years of proven safety". How do they determine that? Read -Tender Harvest by Duffy Watch-Daily Dose When fluoride is removed from the city water system not one person will be forcing anyone to stop taking fluoride, while it forces many, very much against their will, to feel unsafe in their own homes unable to comfortably use their own water to bathe their own children. It is not your right to force me to drink a substance in the water that is being prescribed for a problem I don't have.