HomeMy WebLinkAboutEloise Kailin (3) mm M
i
1i W
SEP 2 8 C,15
September 28, 2015 F F,�,
For City Council consideration OctoberJirst, 2015
From: Yes4cleanwater Committee of Protect the Peninsula's Future, Eloise Kailin M.D. Chair, Dr. Bill
Osmunson DDS, MPH Vice Chair
TEN QUESTIONS TO ASK FLUORIDATION PROPONENTS
1. What is the range of fluoride ingested per day from non water sources in Port Angeles by
infants, adolescents, adults; and their estimated fluoride serum and urine concentrations
compared to serum and urine concentrations reporting harm?
2. Please provide one prospective randomized controlled trial of fluoridation's efficacy. What
modern peer reviewed, published study, controlled for socio-economic, racial and age factors
reports statistical significance supportive of claims of a 30% reduction in tooth decay?
3. What accounts for the fact that incidence of tooth decay in developed countries, like Western
Europe, has decreased at the same rate as in fluoridated cities in the United States?
4. Please provide the best 5 published research studies of MEASURED cost savings from
fluoridation. (Not estimates of cost savings but actual measured cost savings.) How much does
fluorosis cost (1) for dental treatment, and (2) in reduced life earnings for a disfigured person?
S. Please furnish a copy of tests made to disclose all contaminants, their chemical identities, the
quantities and radioactivity in the crude mix of fluorosilicic acid as delivered to Port Angeles for
addition to drinking water. If unobtainable please give the reason and explain how non-disclosure
serves the public interest.
6. Explain how you can be sure the fluoride mix being put into our drinking water is safe when
multiple toxicologic and even radioactive contaminants, are unknown.
7. What are the initial country(s) and the industry(ies) of origin(s) of Port Angeles' latest lot of
fluorosilicic acid ?
8. If a person wants to ingest fluoride, what other sources of fluoride are available?
9. What happens to dental caries when fluoridation is stopped?
10. How much fluoride does it take to cause brain damage, lower IQ?
i
uuunmm w wn imumlmirumrmliuuMlNiiiimmimmiil�mllmlllmlmlllllllllllllllllmllmlllllllmlllmlYmllllmlllllllll1011llYllI00IIlIIImIOIIIIOIImIIImIIIIIIIIIIIIIIIIIIIIIIImIIIIIIIIIUlA/IIIAUAUIri'7fittIIIIIIIIIIIIIIIIIIIIIIIIIIIIIiImI
REFERENCES
. Our best reference for compiling data on non-water sources of fluoride iS " Fluoride:
Exposure and Relative Source Contribution Analysis"' EPA pub|ivation82O-R-1O'O15, December,
2O1U. Key pages are on file with City. Figure 7-1 from page 99, a color graph, is appended
here.
NRC 2086, FLUORIDE IN DRINKING WATER: AScientific Review of EPA's Standards Chapter 2,
pages 19-72 is a good reference for estimates of fluoride exposure from several sources. For
references also see supplements ernoi|ed by Bill Osrnunson [}OB, MPH There is no detectable
,
fluoride in most samples ofMother's Milk. Infants on formula made with PA water are ingesting
175 times more than the "rnean" fluoride concentration in Mother's Milk.
guestion 2. Since 1980 the effect mfincreased fluoride from non water sources has greatly
decreased ability to discriminate between dental caries in people living with from those living
without water fluoridation, Our best reference is "Water Fluoridation &Tooth Decay: Results from
the 1986-1987 National Survey of US Schoolchildren." John Yiarnouyiannis/ PhD, Fluoride Vol 23,
No.2, April, 1990 pp55-67. Submitted herewith. After about 70 years of fluoridation, we should
have quality studies and there is not one double blind study.
Chemical and Engineering Nevvsvo|67 #18 May 8,1989, "New studies cast doubt on fluoridation
benefits" Bette Hi|8rnan. NOTE: "The American Dental Association said that ADA believes that
water fluoridation can reduce tooth decay 18 to 25%. But as recently as 1988 the association
claimed UUO[idOtiDD reduces decay 4Ot0 6096."
QuesJon 3. Graph herewith, from W.H.O. data, testing in 12 year O\dS world wide. All developed
countries, US states and counties, have decreased dental caries to similar low levels, Artificial
fluoridation has not played a significant public health role in caries reduction. No one knows for
sure what caused the significant decline in caries prior to fluoridation.
~
Ko L, Thiessen KM.A critique of recent economic evaluations of community water fluoridation.
Int ] O[cupEnvironHealth. 2015Mer;37(1):91-130. doi: 10.1179/2049396714\(0000000093.
Epub2O14 Dec 3.
PMID: 25471729
nonfluoridated areas.
Mauporn6 (3, Gu||ionCM, Peters D, Litt|eB].
] Public Health Dent. 2007 Fall;67(4):224-33
-QugsClon 6, Letter from Washington State Department ofHealth Assistant Secretary Gregg
(5ruenfe|der.
Oct. 28,2008: "...we do not have the resources that would a||ovv us to do independent evaluations
of water treatment products...Since the fluoridation product being used by the City of Pod
Angeles is certified under NSF Standard 60, the city's use of this product is in compliance with
state law." In City files: The latest Certificate of Analysis notes presence of fluoride, lead, arsenic
and reveals little else. The content is largely proprietary. Multiple toxic contaminants are not
reported to the certifying agency according to National Sanitation Foundation (NSF) official Stan
Hazen in sworn testimony copy of which was previously supplied to the City.. The City supplier
Material Safety Data Sheets note that toxicological contents and effects are unknown.
~
Question 7. E Mail to city from supplier tells us our latest supply came from Israel (which has
terminated its fluoridation program), and in SeaML|e "a small amount" ofnn unidentified
ingredient was added.
QueaLionjL For other sources of fluoride sea NRC Report of 2006. SvvaUovv a pea size of tooth
paste. Eat more grape products/ bone meal, orRxfluoride pills.
�
---------. caries after cessation of fluoridation.
|
1. CANADA:
"The prevalence of caries decreased over time in the fluoridation-ended community while
remaining unchanged in the fluoridated community."
SOURCE: Mauporne (5, Clark DC, Levy SM, Berkowitz ]. (2001). Patterns of dental caries following
the cessation of water fluoridation. Community Dentistry and Oral Epidemiology 29: 37-47.
2. FINLAND
"The fact that no increase in caries was found in Kuopio despite discontinuation of water
fluoridation and decrease in preventive procedures suggests that not all of these measures were
|
necessary for each child."
| SOURCE: Seppa L, KD[kha|DeD S, H3USeD H. (2000). Caries Trends 1992-1998 in Two Low-
Fluoride Finnish Towns Formerly with and without Fluoridation. Caries Research 34: 462-468.
~ 3. GERMANY
"In contrast to the anticipated increase in dental caries following the cessation of water
fluoridation in the cities Chernnitz and P|auen, a significant fall in caries prevalence was observed."
SOURCE: Kunze| VV., Fischer T, Lorenz K. Bruhrnann S, (2000). Decline ofcaries prevalence after
the cessation of water fluoridation in the former East Gernnany, Community Dentistry and [)na|
Epidemiology 28:382-9.
4. CUBA
"In 1997, following the cessation of drinking water fluoridation, in contrast to an expected rise in
caries prevalence, UMFTand DMFS values remained at |ovv level for the 6- to 9-year-olds and
appeared to decrease for the 10/11 year olds. In the 12/13 y8ar'o|dS, there was a significant
decrease, vvhi|8 the percentage of caries free children of this age group had increased..."
SOURCE;Kunze| W, Fischer T. (2000). Caries prevalence after cessation of water fluoridation in La
Sa|ud, Cuba. Caries Research 34: 20-5.
Q . 45 human studies and over 100 animal studies report lower IQ, cognitive reasoning,
brain damage from fluoride. The question is not "whether" fluoride causes bn]|D damage but at
what dosage and age the brain damage occurs.
16 human studies report significant IO loss below the EPA's Maximum Contaminant Level and
Maximum Contaminant Level Goal.
`
^ 1. ChlOiAL1' SUn G, Zha[
Developmental fluoride neurotoxidty: a systematic review and meta-analysis.
�O12 (JCt;12O(1O):1362-8. doi: 1O.1Z89/ehp.11O4912. EpUb 2U12 ]u|
20,
2. Choi A, et al. (2014). Association nf lifetime expOSunetofluoride and oogniUvefunctions in
Chinese children: A Pilot Study, Neun3toxico|*gy & Terato|ogy.
1 Zhang S/ e[ o|. (2015). Modifying Effect ofCQMTGene Po|ynnorphisrn and a Predictive Role
for PrOteVrniCS Analysis in Children's Intelligence in Endernic F|u0roSiS Area in Tianjin, China.
Toxicological Sciences
4. KarirnzadeS, et al. (2014). Investigation of intelligence quotient in 9-12-year-D|d children
exposed to high- and low-drinking water- fluoride in West Azerbaijan province, Iran. Fluoride
47(1):9-1.4.
Water Fluoridation&ToothDecay:Restdts ftom the 1986-1987
National Survey of US Schookbildren
Fluoride
Volume 23, No. 2,-April, 1990;pp SS-67
by John A. Yiamouyiannis, Ph.D.
SUMMARY: Data from dental examinations of 39,207 schoolchildren, aged 5-17,
in 84 areas throughout the United States are analyzed. Of these areas, 27 had been
fluoridated for 17 years or more (F), 30 had never been fluoridated(NF), and 27 had
been only partially fluoridated or fluoridated for less than 17 years(PF). No
statistically significant differences were found in the decay rates of permanent teeth
or the percentages of decay-free children in the F, NF, and PF areas. However,
among 5-year olds, the decay rates of deciduous teeth were significantly lower in F
than in NF areas.
KEY WORDS: Dental caries; Fluoridation; Schoolchildren; Tooth decay.
Introduction
It has become widely accepted among dental and public health professionals that
fluoridation reduces tooth decay by one-half to two-thirds (1,2). However, recent studies by
public health dentists in New Zealand, Canada, and the United States have reported similar
or lower tooth decay rates in nonfluoridated areas as compared to fluoridated areas(3-6).
Moreover, findings in the United States and worldwide show that, over the last 25 years,
reductions in tooth decay rates in nonfluoridated areas are comparable to those in
fluoridated areas (7-9).
From 1986 to 1987, dentists trained by the US National Institute of Dental Research
(NIDR) performed dental examinations on 39,207 schoolchildren, aged 5-17, in 84 areas
throughout the United States. This sllrv,!xy allowed a comparison of tooth decay of large
numbers of people from a large number of areas, some of which have been fluoridated and
some of which have not.
Materials and Methods
Through the United States Freedom of Information Act, we obtained a printout of the
dental records and a fist of the 84 areas used in this survey. From these data, we calculated
the number of decayed and filled deciduous teeth(dft) and the number of decayed, missing,
and filled permanent teeth(DMFT)for each record and entered the resulting data into a
..................... ....m....................m ................. ............ ................................... .............
computer. All calculations were triple-checked before being entered into the computer and
all computer entries were double-checked.
By computer, each record(including the dft and DMFT scores of each student) was placed
in the appropriate age group. For each of the 13 age groups, average dft and DMFT rates
per child were determined for each of the 84 areas. Age-adjusted DMFT rates for 5-to 17-
year olds were calculated by adding the DMFT rates for each of the 13 age groups and
dividing by 13 (10).
We obtained the data regarding the fluoridation status of the areas surveyed from Natural
Fluoride Content of Community Water Supplies, Fluoridation Census 1969, Fluoridation
Census 1975, and Fluoridation Census 1985, all published by the US Public Health Service.
In some cases, local authorities were also contacted to determine the fluoridation status of
an•area.
Average DMFT(and dft)rates for F, NF, and PF groups were calculated for each age.
Average-age-adjusted DMFT (and dft) rates for the F, NF, and PF groups were calculated
by taking the average of age-adjusted rates for the respective groups (10).
The percentage of"caries-free" children was calculated for each age group for each area.
Age-adjusted "caries-free" rates were also calculated. A student was considered to be "caries-
free" so long as they had no DMFT or dft. For example, a child who had lost all their teeth
and no longer had any left to be decayed or filled would not be recorded as a "caries-free"
student.
Through the United States Freedom of Information Act, we also obtained residence data for
each of the above schoolchildren which allowed us to calculate tooth decay rates for those
in F, NF, and PF areas who had lived at the same residence for their entire life.
The two-tailed t-test was used to determine 95% confidence intervals and to determine
statistical significance (at the 95% confidence level). A two-sided Wilcoxon rank sum test
(11)was used to determine whether there was a statistically significant difference (at the
95% confidence level) in the rank order of DMFT rates of F and NF areas.
Results
Table 1 presents the number of students examined and the age-adjusted DMFT rate for each
of the 84 areas in the order of increasing tooth decay rate. There is no statistically significant
difference in the rank order of the age-adjusted DMFT rates of F and NIT areas. As can be
seen by examination of column 1, there is no clustering of fluoridated areas at the top of the
table. In the quartile with the lowest age-adjusted DMFT rates, 9 are non-fluoridated, 3 are
partially fluoridated, and 9 are fluoridated. In the quartile with the highest DMFT rates, 5
are nonfluoridated, 10 are partially fluoridated, and 6 are fluoridated. Table I also indicates
that there is no biased geographical distribution of F and NF areas that is hiding some
potential decay preventive effect of water fluoridation.
2
Table I
The number of children examined and the average-age-adjusted DMFT dfl, and"caries free"
rates for 5-to 17 year olds in each of the 84 areas in the order of increasing age-adjusted DMFT
rate. F refers to areas fluoridated before 1970;PF refers to areas which are only partially
fluoridated;PF(x) refers to areas fluoridated in the year"x";NF refers to areas that are not
fluoridated.
Water Area No. DNIFT dft Caries-free
NF Buhler,KS 543 1.229 0,810 443%
F El Paso,TX 451 1.321 0.777 43.5%
NF Brooklyn,CT 410 1.420 0.693 47.6%
F Richmond,VA 475 1,435 0.715 45.6%
F Ft. Scott,KS 491 1.442 0.774 38.2%
F Prince George,MD 443 1.491 0.539 48.0%
NF Cloverdale,OR 354 1.494 0.872 40,4%
PF(7 1) Alliance,OH 467 1.584 0.549 44.6%
NF Martin,Co.,FL 440 1,587 0.677 41.0%
F Andrews,TX 455 1.588 0.893 35.8%
NF Coldspring,TX 406 1,589 1.144 33.8%
F Tulsa,OK 504 1.602 1.075 35.5%
NF Palm Beach,FL 476 1,613 0.896 34.5%
PF Hocomb,MO 558 1.628 0.883 403%
NF Kitsap,WA 564 1.635 0.769 42.9%
F St. Louis,MO 491 1.638 0.711 39.1%
(82)
PF Houston,TX 488 1.662 0119 41.8%
F Clarksville,IN 428 1.678 0.747 40.4%
NF Grand Island,NE 535 1.719 0.789 40.7%
F Ft. Stock-ton,TX 415 1.722 0.891 33.4%
NF San Antonio,TX 422 1.736 0.895 393%
F Cherry Creek,CO 441 1,757 0.727 36.5%
F Tuscaloosa,AL 475 1.809 0.963 32.0%
PF Marlon Co.,FL 545 1.817 0.944 28.8%
F Cleveland,OH 486 1.819 0.715 39.9%
NF Allegany,MID 458 1.834 0.735 38.3%
(7 8) Norwood,MA 434 1,841 0.640 39.9%
F Alton,IL 511 1.859 0.843 37.6%
NF Shamokin,PA 462 1.861 1,023 32,2%
NF Lodi,CA 573 1.878 1.197 33.0%
PF Bullock Creek,MI 472 1.879 0.766 36.7%
PF Marlboro,MA 386 1,885 0.613 40.8%
(82)
(8
PF Allen,TX 445 1.905 0.674 38.7%
1)
F San Francisco,CA 456 1,908 1.031 36.3%
NF E. Orange,NJ 401 1.909 0.796 38.0%
3
(71/60)PF Lincoln/Sudbury,MA 436 1.923 0.758 37.8%
NF Conejo,CA 620 1.930 0.811 41.7%
NF Lakewood,NJ 450 1.933 0.698 38.0%
F New York City-2 336 1.953 0.812 34.9%
PF Bethel,WA 540 1.958 1.072 34.3%
F Beach Park,IL 518 1.970 0.878 35.2%
PF Rising Star,TX 370 1.971 0.909 28.7%
F Philipsburg,PA 499 1.983 0.982 33.2%
F Lanett,AL 503 1.994 0.978 31.9%
(8
PF Plainville,CT 436 2.006 0,795 39.3%
2)
NF Wichita,KS 496 2.036 0.878 315%
NF Newark,NJ 494 2.038 0.869 35.9%
PF Knox Co.,TN 530 2.056 1.152 31.3%
NF Los Angeles,CA 540 2.063 1.039 310%
F Pittsburgh,PA 415 2.064 0.781 34.1%
(70)PF Lincoln,NE 476 2,076 0.825 31.5%
NF Newton,KS 464 2.083 1.225 31.1%
PF Lakeshore,MI 486 2.088 0.781 32.6%
NF New Paltz,NY 350 2.110 0.751 34.8%
F Bemidgl,MN 485 2.124 1.001 293%
NF Alpine,OR 397 2.133 0.974 34.7%
NF Canon City,CO 463 2.160 1.118 33.1%
NF Wyandank,NY 396 2.161 0.828 34.7%
NF Milbrook,NY 332 2,179 0.716 32.2%
NF Chowchilla,CA 551 2.181 1.073 33.0%
F New York City-1 503 2,190 0.627 37.9%
(82)PF Baltic, SD 487 2.193 0.974 27.8%
(71/74)
PF Blue Hill,NE 480 2.218 0.855 29.6%
NF Crawford,PA 492 2.222 0.996 28,5%
(74)PF New Orleans,LA 459 2.251 0.953 27.4%
(70
Pill Memphis,TN 464 2.253 0.763 33.1%
)
PF Madison Co.,MS 493 2.259 1.455 26.4%
F Milwaukee,WI 478 2.349 0.909 32.1%
NF Tooele,UT 519 2.372 1.458 24.3%
NF Chicopee,MA 453 2.389 0.862 34,2%
PF Cambria,PA 532 2.460 1.039 27.1%
(75)
PF Springfield,VT 444 2.489 0.838 32.1%
F Dearborne,MI 491 2.496 1,167 26.3%
4
F Maryville,TN 466 2.512 1.287 22.9%
(81
PF Taunton,MA 445 2.515 0.903 31.0%
)
F Greenville,MI 556 2.558 1.191 25.3%
PF Hart/Pentwater,Nfl 455 2.584 1.344 24.1%
F Philadelphia,PA 463 2.649 0.824 26.0%
PF Sup.Union#47,VT 487 2.710 0.907 28.1%
NF Cutler/Oroal,CA 528 2.796 1.742 19.2%
F Brown City,MI 512 2.972 1.229 22.5%
(83)
PF Lawrence,MA 339 3.012 1.262 17,6%
NF State of Hawaii 293 3.294 1.375 23.9%
PF Concordia,Co.,LA 424 3.767 1.508 12.4%
There is no statistically significant difference between the average DMFT rates for the F and
NF groups at any age (Figure 1). The average DMFT rates of the PF groups are higher than
those of the F and NF groups at every age with the exception of 14-year olds.
There is no statistically significant difference in the average-age-adjusted DMFT rates
among the F, PIT, and NF groups (Table 2). The average-age-adjusted DMFT rates in F and
NF areas are 1.96 and 1.99, respectively. The 95%confidence interval for the DMFT rate in
F areas minus the DMFT rate in NF areas is (-0.19, 0.25); thus we can rule out, with a
certainty of 95%, the possibility that the DMFT rate in F areas is more than one-fourth of a
tooth less than in the NF areas. We can also rule out,with a certainty of 95%, the possibility
that the DMFT rate in NF areas is more than one-fifth of a tooth less than in the F areas.
Table 2
Average-age adjusted DMFT rates for 39,207 U.S. schoolchildren and 17,336 life-long resident
schoolchildren in 84 areas throughout the United States. Standard deviations are given in
parentheses.
Total Life-long
No. of No. of Students DMFT No. of Students DMFT
Areas
Fluoridated 27 12,747 1.96(0.415) 6,272 1.97(0.465)
Partially Fluoridated 27 12,578 2.18 (0.465) 5,642 2.25(0,470)
Nonfluoridated 30 13,882 1.99(0.408) 5,422 105(0.517)
To make certain that the absence of a statistically significant difference between the DMFT
rates of schoolchildren living in F and NF areas was not the result of the mobility of
schoolchildren, or their sex and racial compositions, DMFT rates were determined for 1.1
those who spent their entire lives in one household and 2.1 for white males and white
females. The results in Table 2 show that for life-long residents, there is no statistically
significant difference in average-age-adjusted DMFT rates in F and NF areas, In addition,
there are no statistically significant differences in tooth decay rates between permanent
residents of F and NF areas at any age (Figure 2A), If water fluoridation were to have
5
reduced tooth decay as measured by DMFT, tooth decay rates for lifelong residents living in
fluoridated areas should be lower than residents who had not spent their entire lives in these
areas. This was not found to be the case. Figures 2B and 2C show that among white males
and white females (which make up about 70% of all the children studied), there is no
significant difference in DMFT rates in the F and NF areas at any age group.
fig Rre 2A
.4x I—A IT'411
6 rc
Of) IN S'
MV.)r f 1,,r,D AND PULP> 4
(.2 PF
't"Mr"Pf I
44�
UO
a lei.1,1;il l� I-
4 15 16 17
W.E
(Qj k to enlam��image
Fi ore 2B
1"'Alt 'A wM I tV,41-
arA Mod "s?1 Y4,
PwmWell A an
OPF
CUM ------ ra' M PF
'0,U
7 a 5+911 121314 15 Ir 17
Ago
flu e
GLI 1�1,_L�)_en IL
Figure 3 Kk!Lre 4
h in f4w oew� ��ri Cvlw J6l t.
JJ)'
T
Nr
MC Mct'15 '13 01*
P7,P 11'
Ell
Dt a%
AiF
to cnlal-ge it a, 'k JOC_nl'artixj
In contrast, notably lower tooth decay rates were observed in the deciduous teeth of young
children living in F areas. The 5-, 6-, and 7-year-olds in the F group have dft rates 22%, 9%
and 6% lower than those of the NF group, respectively(Figure 3). Although the average-age
6
adjusted dft rates for F, NF, and PF groups were not significantly different statistically, they
were higher for the NF groups (0.96, +0.25) for the PF groups (0-93, +0.24), which in turn
is slightly higher than the F group (0.89, +0.19).
To focus in on dft rates among children 5-8, the eight areas which commenced water
fluoridation between 1970 and 1978 were removed from the PF group and added to the F
group. The 5-, 6-, and 7-year-olds in the new F (F*) group have dft rates 24%, 10%, and 10%
lower than those of the NF group, respectively, and the dft rate of 5-year-olds in the F*
group is significantly lower(p < 0.05) than that of the NF group.
Moreover, among 5-, 6-, and 7-year-old lifelong residents in the F* group, dft rates were
42%, 18% and 11%lower than those of the NF group, respectively, and the dft rate of 5-
year-olds in the F* group was significantly lower(p < 0.002) than that of the NF group
(Table 3). If water fluoridation were to have reduced tooth decay as measured by dft:among
5-year-olds, tooth decay rates for lifelong 5-year-old residents living in fluoridated areas
should hav been lower than those of residents who had not spent their entire lives in these
areas. This was found to be the case. From Table 3, it can also be seen that this large and
significant reduction disappears after a couple of years.
Table 3
Percentage change in dft rates in all residents and life-long residents of F and F*
life-long
areas in comparison to NF areas.
Total Life-long
Age (NF-F)/NF (NF-F*)/NF (NF-F)/NF (NF-F*)/NF
5 22% 24%(p<0.05) 36%(p<0.02) 42%(p<0.002)
6 9% 10% 14% 18%
7 6% 10% 5% 11%
8 4% 1% -5% 1%
Fluoride may have caused a reduction in dft:by delaying deciduous tooth eruption. This is
consistent with the fact that the dft rate in the F and F* groups reaches a maximum later
than in the NF group. Fluoride-induced delays in tooth eruption have been reviewed
elsewhere (12, 13)with contradictory conclusions,but more recent studies examining 5-
year-olds have indicated delayed eruption that could account for such a difference in tooth
decay rates (14).
The percentage of decay-free children in F, PF, and NF areas is 34.5%, 31.9%, and 35.1%
respectively. There is no statistically significant difference between the average "caries-free"
rates for the F and NF groups at any age (Figure 4).
Discussion
The data presented here are consistent with data reported elsewhere in large US surveys. In
1977, the Rand Corporation examined the tooth decay rate of 25,000 children in(5F and
5NF) nourandomly selected areas (15). In the three areas in their study that were included
in the present study, we compared the tooth decay rates of 12-year-olds. There was good
7
agreement between this study and theirs with regard to tooth decay rate, after converting
DMFS (decayed, missing and filled permanent tooth surfaces)to DMFT (16) and
considering the acknowledged 36% decrease in DMFS from 1979-1980 to 1986-1987 (17).
In 1983-84, Hildebolt et al. (4) examined the tooth decay rates of over 6500 Missouri rural
schoolchildren from grades 2 (average age 7.5) and 6 (average age 11.5). Among 6th graders
living in the most intensively studied regions, the average DMFT + dft rate was 2.07 for
those drinking nonfluoridated water and 2.17 for those drinking fluoridated water,
compared to the DMFT + dft rate of 2.00 reported for 11-year-olds living in Holcomb,
Missouri in our study.
In 1986, Kumar et al. examined 1446 schoolchildren aged 7-14 from Newburgh, New York
(fluoridated in 1945) and cohorts from nonfluoridated Kingston, New York(18). The
sample selection was non-random and had a response rate of only 50-65%. Nonetheless, the
age-adjusted DMFT rates observed(1.5 for fluoridated Newburgh and 2.0 for
nonfluoridated Kingston)were in line with the corresponding values obtained in this study
for communities in the area (1.5 for nonfluoridated New Paltz, New York and 1.7 for
fluoridated New York City).
Conclusions
Does water fluoridation reduce tooth decay? il This study and other recent studies (3-8)
show that there is currently no significant difference in tooth decay rates in F and NF areas
and that decreases in tooth decay rates over the last 25 years have been comparable
regardless of fluoridation status; if this is true, there was no significant-difference in the
tooth decay rates between these areas 25 years ago. fil From 1970 to the present, total
fluoride intake studies indicate an average intake of 1-2 mg per day in nonfluoridated areas
and 3-5 mg per day in fluoridated areas (19,20); thus, it is difficult to claim that the reason
tooth decay differentials between fluoridated and nonfluoridated areas have disappeared is
because the fluoride intakes in these areas are now similar. Furthermore, the substantially
higher incidence of dental fluorosis in fluoridated areas confirms that residents in these areas
are consuming substantially higher levels of fluoride than those living in non-fluoridated
areas(21-23). ifil Dramatic reductions in tooth decay have occurred in developing countries
where there is no water fluoridation Hezilth 0 Iliz ation da-tq' and there is little
reason to suspect that there would be elevated levels of fluoride in the food chain
(7,9,24,25). iv] In addition to recent studies, a number of early studies have also shown no
significant reduction in tooth decay as a result of water fluoridation(7, 26-28). v] Serious
questions have been raised regarding the reliability of earlier studies claiming that
fluoridation causes a reduction in tooth decay(29).
Acknowltdgments
I thank Kimberly Close-Hittle, Jerry Putnam, Margot Yiamouyiannis, and Opal Kuhn for
their help in the calculation and verification of summary data as well as Jill Pitts and Chris
Hiatt for their lightning fast speed in entering data into our computer. Without the
generosity of Dr. Leo Roy, Dr. Reuben Benner, Dr. H. Charles Kaplan, Dr. Gerald Judd,
8
Richard Barmakian, John C. Justice,. Len Greenall, Mr. and Mrs. Andrew Yimoyines, Wini
Silko, AIM International, Inc., and other patrons of the Center for Health Action and the
Safe Water Foundation, the preparation and publication of this article would not have been
possible. Finally, I thank Ray Fahey for correcting an error we had made in assigning the
fluoridation status of E. Orange, NJ.
Addendum
Recently Brunelle (30), using the same database that we used, reported 26% fewer Us
(decayed and filled deciduous tooth surfaces) in children who had always resided in F
communities than those who never lived in F communities. This finding agrees reasonably
well with the data outlined in our Table 3, which shows a statistically significantly lower dft
rate in lifelong 5-year-old residents of fluoridated areas. However, by omission of age-
specific data, the Brunelle study covers up the fact that this difference in tooth decay is no
longer significant in 6-year-olds and disappears entirely among 8-year-olds.
Another recent study by_Brurielte a�.qd_Q.a.r1o_s (31), which also uses the same database that
we used, reports a 17% lower DMFS rate in the F areas. This study has a number of major
deficiencies which render the study of little or no value.
1. It contains extremely serious errors. For example,by a cursory inspection, we found two
values that are off by 100% or more. In their Table 9, the DMFS figure for lifelong F
exposure residents of Region VII should be about 3, not 1.46 as reported. From their Table
3, the percent of 5-year-olds who have caries is 1.0%, not the 2.7%that can be calculated
from the Table (100%-97.3%). When I pointed out this error to Dr. Carlos, he admitted that
only 19 out of the 1851 5-year-olds had caries: 19/1851 = 1%, but refused to make the
correction (32).
2. It fails to report the tooth decay rates for each of the'84 geographical areas surveyed. This
covers up the fact that there is no difference in the tooth decay rates of the fluoridated and
nonfluoridated areas surveyed. The Brunelle/Carlos study even fails to list the area studied.
As a result, they produce misleading illustrations; for example, their Figure 3 implies that
Arizona and New Mexico have the lowest tooth decay rates, when, in fact, not a single area
was surveyed in either of the two states.
3. It fails to control for geographical differences in tooth decay rates by indiscriminately and
disproportionately bunching children from all parts of the country into 2 groups, F and NY
4. It fails to do the statistical analysis (or even provide the data, i.e. the standard deviation
and sample number)necessary to determine whether the values found for F and NF areas
are significantly different. Our calculations show that even if their data were accurate, the
17.7%figure does not reflect a statistically significant difference between the F and NF
groups.
5. It fails to report the data for approximately 23,000 schoolchildren who were not life-time
residents of either the F or NF areas (the PF group). If fluoridation reduced tooth decay, the
9
111M,
D rate of the PF group should have been greater than that of the F group and less than
that of the NF group. Our data indicate that the PF group would have had a DMFS rate
higher(although not significantly higher)than either the F or NF groups.
6. It fails to report the data for the percentages of decay-free children in F and NF areas. Our
data indicate that had these calculations been done by Brunelle and Carlos, the results may
have actually indicated better(although not significantly better) dental health in the NF
areas.
Brunelle and Carlos, as well as their employer, the NIDR, have recently come under attack
for presenting erroneous data and designing poor experiments which promoted the fluoride
mouthrinse program(33). The apparent poor quality of their research regarding the 1986-87
survey (30, 3 1) is not an isolated case.
............ ..................
Read the Chemical and Engineering News(1989)article "New Studies Cast Doubt on
Fluoridation Benefits.." which discusses this study.
References and Notes
1. Green, J.C., Louie, R. and Wycoff, S.J.: Preventive Dentistry I. Dental Caries. J. Amer.
Med. Assn., 262:3456-3463, 1989.
2. Szpunar, S.M. and Burt, B.A.: Dental Caries, Fluorosis and Fluoride Exposure in
Michigan Schoolchildren. J. Dent. Res., 67:802, 1988.
3. Colquhoun, J.: Influence of Social Class and Fluoridation on Child Dental Health.
Community Dent. Oral Epidemiol., 13:37-41, 1985.
4. Colquhoun, J.: Child Dental Health Differences in New Zealand. Community Health
Studies, 11:85-90, 1987.
5. Gray, A.S.: Fluoridation: Time for a New Baseline? J. Canadian Dent. Assoc., 53:763-
765, 1987.
6. Hildebolt, C.F., Elvin-Lewis, M.,Molnar, S., McKee, J.K., Perkins, M.D. and Young,
K.L.: Caries Prevalences Among Geochernical Regions of Missouri. Amer. J. Physical
Anthropol., 78:79-92, 1989.
7. Diesendorf, M.: The Mystery Nature, 322:125-129, 1986.
8. Johnston, D.W., Grainger, R.M. and Ryan, R.K.: The Decline of Dental Caries in
Ontario School Children. J. Canadian Dent. Assoc., 52:411-417, 1986.
10
9. Luoma, A-R. and Ronnberg, K.: Twelve-Year Follow-up of Caries Prevalence and
Incidence in Children and Young Adults in Espoo, Finland. Community Dent. Oral
Epidemiol., 15: 29-32, 1987.
10. Hill, A.B.: Medical Statistics. Hodder and Stoughton, London, 1977, p. 183. While the
numerous age-specific comparisons of dental health of children at different ages provide the
best evidence, it is occasionally desirable to have a summary rate to enable an overall
comparison of different populations. For this purpose, we have used the age-standardized or
age-adjusted rates, in order to avoid giving disproportionate weighting to larger numbers of
children from one particular age-group that would tend to distort the summary figure. In
using these rates, a standard population must be chosen. The one most commonly used is
the hypothetical population with equal populations at each age group, which merely results
from taking an arithmetic mean of the age-specific tooth decay rates measured. In the above
reference, Austin Bradford Hill addresses this method in a discussion of the handling of
mortality rates under a section titled"The Equivalent Average Death-Rate." Analogously,
equal weights were given to each of the 84 geographical areas to prevent a distortion which
might be induced by the variation of the area sample sizes, since certain geographical areas
have characteristically higher(or lower) tooth decay rates than others.
11. Wilcoxon, F., Katti, S.K. and Wilcox, R.A.: Critical Values and Probability Levels for
the Wisconsin Rank Sum Test and the Wilcoxon Signed Rank Test. Selected Tables in
Mathematical Statistics, Markham Publishing Co., Chicago, 1:197, 201, 1970.
12. Waldbott, G.L., Burgstahler, A.W. and McKinney, H.L.: Fluoridation, the Great
Dilemma. Coronado Press, Lawrence, Kansas, 1978, 423 pp.
13. El-Badrawy, H.E.: Dental Development in Optimal and Suboptimal Fluoride
Communities. J. Canadian Dent. Assoc., 50:761-764, 1984.
14. Krylov, S.S. and Pemrolyd, K.: Deciduous Tooth Eruption and Fluorosis in the Case of
Increased Fluorine Content in the Drinking Water. Stomatologiia (Mock), 61: 75-77, 1982.
15. Bell, R.M., Klein, S.P., Boharman, H.M., Graves, R.C. and Disney, J.A.: Results of
Baseline Dental Exams in the National Preventive Dentistry Demonstration Program. R-
2862-RWJ. Rand Corporation, Santa Monica, CA, 1982.
16. Jarvinen, S.: Epiderniologic Characteristics of Dental Caries: Relation of DMFS to
DMFT. Community Dent. Oral Epidemiol., 11: 363-366, 1983.
17. Johnson, S. HHS News (U.S. Department of Health and Human Services: National
Institutes of Health) June 21, 1988.
18. Kumar, J.V., Green, E.L., Wallace, W. and Carnahan, T.: Trends in Dental Fluorosis
and Dental Caries Prevalences in Newburgh and Kingston, NY. Amer. J. Pub. Health,
79:565-569, 1989.
19. Rose, D. and Maver, JR.: Environmental Fluoride, 1977. NRCC No. 16081. National
Research Council of Canada, Ottawa, Ontario, 1977, pp. 75-83.
20. Featherstone, J.D.B. and Shields, C.P.: A Study of Fluoride Intake in New York State
Residents. 01 14Ucl288-1, Eastman Dental Center, Rochester, NY, 1988.
21. Segreto, A.S., Collins, E.M., Camann, D. and Smith, C.T.: A Current Study of Mottled
Enamel in Texas. J. Amer. Dent. Assoc., 108:56-59, 1984.
22. Leveret, D.: Prevalence of Dental Fluorosis in Fluoridated and Nonfluoridated
Communities -A Preliminary Investigation. J. Pub. Health Dent., 46:184-187, 1986.
23. Colquhoun, J.: Disfiguring Dental Fluorosis in Auckland, New Zealand. Fluoride, 17:
234242, 1984.
24. Poulsen, S., Amaratunge, A. and Risager, J.: Changes in the Epidemiological Pattern of
Dental Caries in a Danish Rural Community over a 10-year Period. Community Dent. Oral
Epiderniol., 10:345-351, 1982.
25. Backman, B., Crossner, C-G. and Holm, A-K.: Reduction of Caries in 8-Year-Old
Swedish Children between 1967 and 1979. Community Dent. Oral Epiden:dol., 10:178-181,
1983.
26. Scrivener, C.: Unfavorable Report from Kansas Community Using Artificial
Fluoridation of City Water Supply for Three-Year Period. J. Dent. Res.., 30:465, 1951.
27. Galagan, D.J.: Climate and Controlled Fluoridation. J. Amer, Dent. Assoc., 47:159-
170, 1953.
28. Schroeder, P.: Dental Health in Children in Rural Regions without School Clinics. J.
Dent. Res., 50(Supplement Part 1):1231, 1971.
29. Yiamouyiannis, J.: Fluoride, the Aging Factor. Health Action Press, Delaware, Ohio,
1986m pp. 94-110.
Referenco for Addendum
30. Brunelle, J.A.: Caries Attack in the Primary Dentition of U.S. Children. J. Dent. Res.,
69(Special Issue):180 [Abstr. No. 575], 1990.
31. Brunelle, J.A. and Carlos, J.P.: Recent Trends in Dental Caries in U.S. Children and the
Effect of Water Fluoridation. J. Dent. Res., 69(Special Issue):723-728, 1990.
32. Carlos, J.P.: Personal communication, 1989.
12
33. Disney, J.A., Bohannan, H.M., Klein, S.P., and Bell, R..M.: A Case Study in
Contesting the Conventional Wisdom.: School Based Mouthrinse Programs in the USA.
Community Dent. Oral Epidemiol., 18:46-56, 1990.
Visit Fluoride: The International Journal for Muoride Research on the web at:4lv:a .flu(?:_�:t{�.
L)L,Lm ('L)Lr-'
f
13
-�y��� MUCH FLUORIDE
/ ���� r/��^�/ / m
100% mom
80%
70%
60%
40%
30%
20%
m%
0%
uaw^, `m�4 ^tov rm~x ',mw ,14
Years
Figure 7-1. Percentage Media Contribution to 90th Percentile
Drinking Water Intakes for Consumers Only and a Fluoride Concentration"Y0.87vvWx
This graph hnmER4Pub|icationO2O'R-l0'Dl5. December2OlO<p. 99>' shmwsthepmportionoffluohde
received from drinking water vs. fluoride from foods, beverages, sulfuryl fluoride( fumigant), toothpaste and soi|s
for people of different ages. Fluoride from water' for infants is 70Y6. for ages l to lI years is 40%. for ages lI to 14
is 50%, over 14 years is 60%. Increasingly amounts of fluoridecontaining pesticides are applied to growing crops
and stored foods are fumigated
Overdosing with fluoride has reached epidemic pmportions: 4l96mfteenager showed abnormal tooth enamel
(fluomsis) ine major national study rt din2OD7. ApmposeddecneaseoffluohdeinwatertoO.7partsper
million is expected to still a||ovv ug|y, tooth destructive' severe dental flunouistodevelop in 0.596 (one in 200
people. Ref. pplU3'l04>.
Protect the Peninsula's Future PO.Box 1677, 5equim, WA 98382
wwW �
uo_ «. .
f
.....w....
WO
fit
�o
0
wed
oww ,
Oo v y a
i
1 r wvM, f
tq 4poiL Pollij *, l
,,
..................
a
i
5TATE, GI! a✓[Jf S H, N U ON
D'slr00N OF ENVIRONMENTAL HEALTH
PO Box 478,20 Ofympia, 70,lashingkm, 98504-7820
October 28, 2008
Dr. Eloise Kailin, MD
P.O. Box 1677
Sequirn, WA 98382
Dear Dr. Kailin:
At the October 21, 2008 meeting of the Clallam County Board of Health you raised the
question of whether or not the product used by the city of Port Angeles to fluoridate the
city's water supply meets the regulatory requirements of the Washington State
Department of Health. In follow-up we have confirmed that the city uses fluorosilicic
acid provided from J. R. Simplot Company in Rock Springs, Wyoming. The product is
NSF Standard 60 certified and does meet the requirements of our regulations.
At the Department of Health we do not have the resources that would allow us to do
independent evaluations of water treatment products. As such we rely on national
certification protocols to ensure the safety of water additives. Specifically, Washington
Administrative Code 246-290-220 (3), requires that: "Any treatment chemicals, with the
exception of commercially retailed hypochlorite compounds such as unscented Clorox,
Purex, etc., added to water intended for potable use must comply with ANSI/NSF
Standard 60. The maximum application dosage recommendation for the product certified
by the ANSI/NSF Standard 60 shall not be exceeded in practice. Since the fluoridation
product being used by the city of Port Angeles is certified under NSF Standard 60, the
city's use of this product is in compliance with state law.
Attached is a July 2000 letter from Stan Hazan, general manager of the NSF Additives
Certification Program, to US Representative Ken Calvert providing information on the
NSF program. I hope you find this additional information useful_
Sincerely,
Greg%( Grunenfelder, Assistant Secretary
Cc: Mary Selecky, Secretary of Health
Tom Locke, Clallam County Health Officer
Denise Clifford, Director Office of Drinking Water
k;HL:MlGAL& ENGINEERING
Volume 67, Number 19 ,
CENEAR 67(19) 1-60
ISSN 0009-2947 MAY 8, 1989 News of the Week
both permanent and deciduous rates give a more complete picture
t
New stu(Hes cmt doub (baby) teeth. NIDR's claim that 50% of the extent of decay, she adds,
on fluonklation benefits of the children in the U.S.are decay- and the decay rate for teeth"is rath-
free,headlined in newspapers across er low so that there is very little
An analysis of national survey data the country last summer,was based difference in most anything."When
collected by the National Institute largely on the fact that NIDR ana- asked to comment on Yiamouyian-
of Dental Research (NIDR) con- lyzed only permanent teeth in chil- nis'results,Brunelle said she didn't
cludes that children who live in dren aged five to 17, and a large know whether they are valid.
areas of the U.S. where the water fraction of these children were not In reaction to Yiamouyiannis new
supplies are fluoridated have tooth old enough to have many, perma- study,the union of professional em-
decay rates nearly identical with nent teeth,Yiamouyiannis says. ployees at the Environmental Pro-
those who live in nonfluoridated When analyzing the survey data, tection Agency has written a letter
to EPA Administrator William K.
areas.
The analysis was done by John A. Reilly. The letter asks him to "im-
Yiamouviannis,a biochemist.mist and ex- Tooth decay rates appear mediately suspend (not revoke)
I unrelated to fluoridation EPA's unqualified support for fluor-
pert on the biological effects of flu-
"
oride, who has been an ardent op- Average decayed,missing,and idation until the agency conducts
ponent of fluoridation for 20 years. filled permanent teeth per child its own assessment'of the risks and
His results are not widely different 6 M Fluoridated benefits of fluoride exposure. The
from those recently found—but as 5 0 Nonfluoridated-_ union, Local 2050 of the National
y Federation of Federal Employees,
et unpublished—by NIDR in ana-
has been concerned for some time
lyzing the same data. 4
In the 1986-87 school year, NIDR that EPA evaluated fluoride politi-
examiners looked for dental caries 3 cally, rather than scientifically.The
in 39,207 schoolchildren aged five union also believes the safe level of
2 fluoride in drinking water should
to 17 from 84 different geographi-
have been lowered rather than
cal areas. Yiamouyiannis obtained 1 raised in 1986,when EPA increased
the survey data from NIDR under the maximum allowable contami-
the Freedom of Information Act. 0
Yiamouyiannis compared decay 5 6 7 8 9 10 1112 1314 1516 17 nant level to 4 ppm from a range of
rates in terms of decayed, missing, Years of so 1.4 to 2.4 ppm.
and filled permanent teeth. The av- Noft:Averages are for the'U.&o*."as wtwe Uw hu- Another analysis of decay rates is
ondabon stoA was nuxed or chary firne suve
1970 have been orriftled.Spume:Natmal ktsfflute of the American Journal of Public Health.
erage decay rates for all the chil led,at sorne published in the current issue of
dren aged five to 17 were 2.0 teeth Dental Research data analyzed by John Yiarnouyiarm Jayanth V. Kumar of the New York
for both fluoridated and nonfluori- State Department of Health exam-
dated areas. When he omitted those NIDR compared decay rates in two
children who had ever changed ways: in terms of the number of fined decay rates in seven to 14 year
addresses, and thus confined the decayed,missing,and filled perma- olds in Newburgh,N.Y.,which has
study to children with an unchang-
vent teeth;and in terms of derayed, been fluoridated since 1945, and in
ing fluoridation status, the results missing,and filled surfaces of teeth. nearby Kingston, which has never
were nearly the same—a decay rate Both of these methods are widely been fluoridated.He found that the
of 2.0 for fluoridated areas, and 2.1 used today. NIDR found that chil- caries prevalence in Newburgh-1.5
for nonfluoridated areas. Decay rates dren who have always lived in fluor- decayed, missing,and filled perma-
in the individual age groups were fluor-
idated areas have 18%fewer decayed nent.teeth—is somewhat lower than
sometimes lower in fluoridated surfaces than those who have never it is in Kingston (2.0). However,
areas,sometimes lower in nonfluor- lived in fluoridated areas. But when since the 1954-55 school year, the
idated areas. The differences were NIDR analyzed the data in terms of decay .rate has actually declined
never greater than 0.5 teeth. He has teeth, the differences were smaller. more in nonfluoridated Kingston
submitted his study for publication Janet A. Brunelle,statistician in the than in Newburgh.
in the Danish journal Community epidemiology program at NIDR, When asked by C&EN, a spokes-
Dentistry&Oral Epidemiology. tells C&EN the results for teeth are man for the American Dental Asso-
He also found that the percent- in a box somewhere" and she does ciation said that ADA believes that
ages of decay-free children were vir- not remember exactly what they are. water fluoridation can reduce tooth
tually the same in fluoridated and Briinelle says NIDR is publishing decay 18 to 25%. But as recently as
nonfluoridated areas, and averaged only the results for surfaces because 1988 the association claimed fluori-
about 34%. This analysis included th.ey are more meaningful. Surface dation reduces decay 40 to 60%.
Bette Hileman
EU � [l �I
SEP;z I
2 82015
i � CITY QF PORT ANGELES
` s CITY CLERK
3 3q
7 �
s
i $3'xs'„^ ,i t "$ni, 5� ,4 :-T� �i f F,�,q, i S. .s✓ ;�«F%� 3'`y `
r xz i
f
s
}
4 �
q
yy- '
t
141 111 o
O by a; o3 O w
cC O y v � n�
cd
p a" o a�i 3 d .v as bvn d v O co
. v O O E aobi �? y p «s vW n y tom,
?a avi id ¢ v A w 'ZS x m a, " s r. ° *;— cd y >' p v p p
V
.0 y - v
y a i cz U p
v ° p A o U ,, +x° �"� p y W ti 'U" y as as � �, 03 v w w p
vy °' o " o v ° `° 3 w -q. t o c'"i 3 v o v o '� aoi c v
x� c p V nVi v o b a`li .� b o p. d •tS b 'A Q, cd a d tw
co C's
'A 141 cz
n Q. cl,
r. cd O i ° Cd w a a � b v o cd v v as
u w "� "d +�- cd" t],c++
ai .� s U w by'i, p O O
id O n v a rT y p v y } Cd
c O
O
4 ..G .t3 v b4 v as .. p .-., ° .� W a, v as -� � •° O oA � D. rn V �
as v w .� V C1 ++ i i. y bA A v w 'C v s,
X 06
cd 3
rte..
t
O v Q+ v s�
ca ca as cl rr An CJ ..� cv •r! rrp .. F�1 v ..`ro, �vI r-tlyi,
U ~ O v S-1 ill O 3 •V V ftY F-/ V•6q �i
CJ
co
.Co p p O v y w O O Iz
V) crj cl N "y b�A.� x bvA ?C 3 C1 y ,� O q .cq �.
cl
co 0
" cvv v � X 'C7 C W C's i v v O + O v s O
C .s.' .. w y N '� ,-�i V V L, . v 'ir v cV + O p
'Cf
co TJ Gti7 v t1 h Qy ;z jL v +.� py CO 'n t O ✓ O �" .y, bA u
aim--., •--, a7 .�+ v ��• c'"C ° O ' q rn ''�-' to
v v $ v n Q Q 0 a � sL a i Cl ca Co � r0 C Q,;'(n "U O C� 3 '�� w
s O 0 w y f1 V t3 O " v CO v 'n cn " >, v u v,( p!
cl v � i r-.+ O rte-, O cz .Vi v N v v '� v c� � "t"" V 0 W cct l O
"3 v 0i co
ai v v + i O O «t
v v v x 's O v p + �" V N r" V >` v 3 v o v v
a '^ C
c6 i.� Q �• +.. p v v .-�" c� .�+ Ll. .� ,•,Q s-. C". s., u v V
CA ai N b v O s v v O h 9 c/) o O Z7 b v O v
cd
w w w > ro c'OC cn
w
`— ----