Intended for healthcare professionals

Rapid response to:


Fluoridation of water supplies

BMJ 1999; 319 doi: (Published 31 July 1999) Cite this as: BMJ 1999;319:269

Rapid Response:

Sound Science?

With both amazement and sad disbelief I read the editorial
"Fluoridation of water supplies" in the July 31 edition of the British
Medical Journal.(1) Subtitled "Debate on the ethics must be informed by
sound science", the authors David Coggon and Cyrus Cooper report on the
recent decision by the British government to conduct a new expert review,
which apparently is designed with a view to strengthen legislation to
fluoridate public water supplies should the findings be supportive. In
direct contradiction to their call for "sound science" the authors quote
highly questionable data and make rather ill-informed statements. This
article will address a few of the issues raised.

A)Coggon and Cooper state that "the epidemiological evidence that
protects against dental caries is overwhelming."

Several studies have clearly shown that fluoridation does NOT prevent
tooth decay. The most comprehensive of those was done by the National
Institute of Dental Research on 39,000 schoolchildren aged 5-17 years(2).
It showed no significant differences in terms of DMF (decayed, missing and
filled teeth). What it did show was that high decay cities (66.5 -87.5%)
have 9.34% more decay in the children who drink fluoridated water.
Furthermore, a 5.4% increase in students with decay was observed when 1
ppm fluoride was added to the water supply. Nine fluoridated cities with
high decay had 10% more decay than 9 equivalent non-fluoridated cities.
Similar effects have been reported in at least three different

B)In support of their statements the authors quote the work by Dean

Dean's data has been shown erroneous several times. Dean himself
admitted in several court proceedings and hearings that his data were not
valid (5,6). Dean used data from 21 cities while completely disregarding
data from 272 other locations which show an almost complete lack of
correlation when plotted.

C) The authors state that "recent research suggests that the benefits
are still important, particularly among the poorer sections of society."

This statement regarding "benefits" is quite remarkable, for recent
research reports that any perceived benefit is not due to the systemic
ingestion, but by the direct topical effects of fluoride, a thesis which
is now supported even by long standing fluoride supporters. (7,8,9)

Regarding the "benefits" to the poorer sections of society the
authors cite a study by Jones et al (10) which was done on 5-year-old
schoolchildren in Britain, documenting a decay decrease.

There are two points to be made on this: Firstly, it has been shown
numerous times that this "reduction" disappears by the time the child
turns six. The cause for the one-year, temporary "benefit" is delayed
tooth eruption in fluoridated areas (11,12,13).
Secondly, it is well known that socioeconomics can play an important role
in caries prevention.(14,15) However, it has nothing to do with fluoride.
If a non-fluoridated area with lack of dental facilities, poverty, poor
diet and hygiene is compared against a nearby, yet more well-to-do
fluoridated area, it becomes very easy to "prove" that fluoridation is
beneficial. [Another British study guilty of this "misguided" science is
one done by Jackson et al.(16)]

D) Coggan and Cooper state that the effects of dental fluorosis are
cosmetic and cause problems only when the disorder is severe. They further
state that such cases would not normally be expected from fluoridation of
water alone.

Dental fluorosis is not just a mere cosmetic effect. Dental fluorosis
is the first _visible_ sign that damage has occurred and is regarded
universally as such. Regarding the statement that such cases would not
normally be expected from fluoridated water alone, it should be noted that
Dean himself was forced to admit in AMA hearings that fluorosis occurred
even at water concentrations of 0.1ppm.(17)

E) The authors state that "careful epidemiological studies have
failed to support associations with either cancer or osteoarthritis".

This is outright wrong information, for the cancer-fluoride
association has been documented countless times in medical journals, court
proceedings, and congressional hearings.(18,19,20,21,22,23,24,25,26,27,28)

Regarding osteoarthritis the authors show ignorance on the subject
matter by completely disregarding any and all occupational regulations in
existence ever since Kaj Roholm published his research on cryolite workers
in the 1930's.(29)
Osteoarthritis is a recognized symptom of Chronic Skeletal Fluorosis (CSF)
as stated in the Toxicological Profile for Fluorides, Hydrogen Fluoride
and Fluorine, ATSDR/U.S. Public Health Service, 1993, page 46. The very
"real" threat of CSF is the reson why a Maximum Contaminant Level (MCL)
for fluoride in water is required by law.

F) Coggon and Cooper state that "concerns about fluoride and fracture
have a stronger basis", but are calling the results from ecological
studies of hip fracture inconsistent.

At least five epidemiology studies have clearly shown a higher rate
of hip fractures in fluoridated vs. non-fluoridated

The authors write in their final paragraph that "before lay people
can make a meaningful contribution to the debate they need an
understanding of the science."

This is highly ironic, for the above contribution by Coggon and
Cooper is obviously lacking in proper scientific knowledge. It is indeed a
sad state of affairs when laypeople such as myself who happen to be
parents of fluoride-poisoned children obviously know more than the
"scientific experts". As the ever increasing toxicity findings of fluoride
will lead more and more parents such as myself to conduct their own
research, such articles as the one reviewed here will stand as one of the
more embarrasing moments in the medical literature. The authors are
encouraged to familiarize themselves more thoroughly with the many adverse
health effects of fluoride and fluoride compounds, particular the
fluorometallic compounds. Regarding the latter, two excellent reviews have
been published this year and are recommended highly. (35,36)

To further disregard the mounting evidence against fluorides is
highly irresponsible. If anything, fluoride use should be discouraged. The
public must become informed about the high fluoride content in food and
beverages, dental products, and the environment and overall intake must be

Andreas Schuld
Parents of Fluoride Poisoned Children
Vancouver, BC, Canada


1)Coggon D, Cooper C - "Fluoridation of Water Supplies - Debate on
the Ethics Must Be Informed By Sound Science" BMJ 319:269-270 (1999)

2)Yiamouyannis, J - "Water fluoridation and tooth decay: Results from
the 1986-1987 national survey of U.S. school children" Fluoride 23:55-67

3)Dean HT, Arnold FA, Elvove E - "Domestic water and dental caries,
V, additional studies of the relation of fluoride domestic waters to
dental caries experience in 4425 white children aged 12 to 14 years of
13 cities in 4 states." Publ Health Rep 57: 1155-1179 (1942)

4)Arnold FA, Dean HT, Knutson JW - " Effect of fluoridated public
water supplies on dental caries prevalence." Publ Health Rep 68: 141-148

5)Dean, HT - Proceedings, City of Orville vs. Public Utilities
Commission of the State of California, Orville, CA, October 20-21 (1955)

6)Dean HT - Hearings before Am Med Assoc Councils on Pharmacy and
Chemistry and on Foods and Nutrition, Chicago, Ill., August 7, 1957

7)Limeback H - "A re-examination of the pre-eruptive and post-
eruptive mechanism of the anti-caries effects of fluoride: is there any
anti-caries benefit from swallowing fluoride?" Community Dent Oral
Epidemiol 27(1):62-71(1999)

8)Riordan, PJ "Fluoride Supplements For Young Children: An Analysis
Of The Literature Focussing on Benefits and Risks" Community Dent Oral
Epidemiol 27(1):72-83 (1999)

9)Featherstone, JD -"Prevention And Reversal Of Dental Caries:Role Of
Low Level Fluoride" Community Dent Oral Epidemiol 27(1):31-40(1999)

10)Jones, CM et al -"Water fluoridation, tooth decay in five year
olds, and social deprivation measured by the Jarman score:analysis of data
from British dental surveys" BMJ 315:514-517 (1997)

11)Kunzel VW - "Cross-sectional comparison of the median eruption
time for permanent teeth in children from fluoride poor and optimally
fluoridated areas" Stomatol DDR 5:310-21 (1976)

12)Jonas I, et al - "Changes in tooth morphology as affected by
fluoridated drinking water" Schweiz Monatsschr Zahnmed 94(5):399-4089

13)Schatz, A -"Low-level fluoridation and low-level radiation --Two
case histories of mis-conduct in science" by Albert Schatz, Ph.D,1996,
Philadelphia, Pennsylvania

14)"Influence of social class and fluoridation on child dental
health" Community Dentistry and Oral Epidemiology 13:37-41 (1985)

15)Colquohoun J - "Child dental health differences in New Zealand"
Community Health Studies 11:85-90 (1987)

16)Jackson, D., et al. "Fluoridation in Anglesey 1983: a Clinical
Study of Dental Caries" British Dental Journal 158: 45(1985)

17)Dean HT - Hearings before Am Med Assoc Councils on Pharmacy and
Chemistry and on Foods and Nutrition, Chicago, Ill., August 7, 1957

18)Tohyama, E. - "Relationship between fluoride concentration in
drinking water
mortality rate from uterine cancer in Okinawa prefecture" Japan. J
Epidemiol (CL8); 6 (4): 184-91 (1996)

19)Cohn, P.D. "A brief report on the association of drinking water
fluoridation and the incidence of osteosarcoma among young males" New
Jersey Department of Health (1992)

20)Burk, D.: Statement Regarding Fluoridation Facts. Hearings before
subcommittee of the Committee on Appropriations, House of Representatives,

97th Congress, 1st session, Part 8, Washington, D.C. (1981)

21)Yiamouyiannis, J. - "Fluoride - The Aging Factor", 3rd. Edition,
Action Press, 6439 Taggart Road, Delaware, Ohio (1993)

22)Takeki Tsutui, et al. - Sodium Fluoride-induced Morphological and
Transformation, Chromosome Aberrations, Sister Chromatid Exchanges, and
Unscheduled DNA Synthesis in Cultured Syrian Hamster Embryo Cells", Cancer

Research 44:938-941 (1984)

23)C.A. Jones, et al. - "Sodium Fluoride Promotes Morphological
of Syrian Hamster Embryo Cells" Carcinogenesis 9:2279-2284 (1988)

24)Yiamouyiannis, J; Burk, D.: Public Water Fluoridation Hearings
before a
subcommittee of the Committee on Appropriations, House of Representatives,
94th Congress, 1st session, Washington, D.C. (1976)

25)Pennsylvania Judge Rules: Fluoride Is Carcinogenic. National
Federation Bulletin 25 (1979)

26)Meiers, P. - "Zur Toxizität von Fluorverbindungen, mit besonderer
Berücksichtigung der Onkogenese", Verlag für Medizin Dr. Ewald Fischer,

Heidelberg (1984)

27)Surveillance, epidemiology and end results (SEER) program.
Cancer Institute in: Review of Fluoride Benefits And Risks. Department of
Health and Human Services. F1-F7 (1991)

28) NTP Technical Report Series No. 393; NIH Publication No.
91-2848; "Toxicology and carcinogenesis studies of sodium fluoride (CAS
No. 7681-49-4) in F344/N rats and B6C3F1 mice", December 1990) National
Toxicology Program P.O. Box 12233 Research Triangle Park, NC 27709

29)Roholm, K - "Fluoride intoxication: a clinical-hygienic study with
a review of the literature and some experimental investigations" H.K.
Lewis Ltd
(London) (1937).

30)Jacobsen SJ, Goldberg J, Miles TP et al.-"Regional variation in
the incidence of hip fracture: U.S. white women aged 65 years and older"
JAMA 264:500-502 (1990)

31)Danielson C, Lyon JL, Egger M, Goodenough GK -"Hip fracture and
fluoridation in Utah's elderly population" JAMA 268:746-748 (1992).

32)Jacobsen, S.J., Goldberg, J., Cooper, C. and Lockwood, S.A. -"The
association between water fluoridation and hip fracture among white women
and men aged 65 years and older: a national ecological study" Ann
Epidemiol 2:617-626 (1992).

33) Jacqmin-Gadda H, Commenges D, Dartigues JF - "Fluorine
concentration is drinking water and fractures in the elderly"[letter] JAMA
273:775-776 (1995).

34) Cooper C, Wickham CAC, Barker, DJR, Jacobson SJ -"Water
fluoridation and hip fracture" [letter] JAMA 266:513-514 (1991).

35)Susa M - "Heterotrimeric G proteins as fluoride targets in bone
Int J Mol Med 3(2):115-126 (1999)

36)Strunecká, Anna; Patocka, Jiri - "Aluminofluoride complexes: new
phosphate analogues for laboratory investigations and potential danger for
living organisms"

Competing interests: No competing interests

02 August 1999
Andreas Schuld
Head, Parents of Fluoride Poisoned Children
Vancouver, BC, Canada