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Fluoride, a longtime blessing, now a curse?

A debate follows a warning by the ADA about giving babies fluoridated water.

Published June 4, 2007

Few noticed in November when the American Dental Association alerted its
members via e-mail of a possible problem with giving babies fluoridated

The ADA, long among fluoride's biggest advocates, wrote that parents of
infants younger than a year old "should consider using water that has no
or low levels of fluoride" when mixing baby formula.

Public health agencies in some states, like Vermont and New Hampshire,
responded by issuing warnings through the media based on the ADA e-mail.

But it would be four months before Florida's Department of Health would
relay the ADA's message on its Web site along with its own seemingly
contradictory footnote: "Mixing formula with fluoridated water poses no
known health risks."

Neither Hillsborough nor Pinellas counties' water utilities - both of
which use fluoride additive - passed along the warning.

So is fluoridated water safe for infants? It depends on whom you ask.

* * *

The issue for the ADA and for babies is fluorosis, a condition caused by
too much fluoride that damages the enamel of teeth. In its milder forms,
fluorosis causes white specks or streaks to appear. More severe cases
involve dark staining and pitting of tooth enamel, which can increase the
likelihood of decay and infection.

Both sides in the fluoride debate agree severe cases are rarely seen in
those whose water is fluoridated at recommended levels. Mild fluorosis is
more common and fluoride backers have argued for years that such cases are
cosmetic and not harmful.

Yet some scientists warn even mild to moderate cases may lead to more
significant problems.

Two things led the ADA to issue its e-mail, said Daniel Meyer, the group's
senior vice president of science and professional affairs. One was an
October announcement by the Food and Drug Administration allowing health
claims on bottled fluoridated water - except when marketed to infants.

The other was a report released in March 2006 by the National Research
Council, which had been asked by the Environmental Protection Agency to
evaluate the federal safety limits for fluoride that naturally occurs in
drinking water. The safety limit: 4 parts per million.

The report found that the EPA limit is too high and associated with
harmful dental effects and an increased risk of bone fractures. Not
addressed in the report was the safety of treated water supplies - which
have much lower concentrations. Pinellas and Hillsborough counties average
around 0.8 parts per million.

The report also concluded that additional research was warranted because
of previous work that had suggested links between fluoride and lowered IQs
in children and bone cancer. And it raised questions about the connection
between baby formula reconstituted with fluoridated water and fluorosis.

In light of the report and the FDA's new rule, the ADA's Meyer said a
decision was made to send the e-mail, but he made clear that his group's
overall position supporting fluoridating water supplies was unchanged.

"The overwhelming evidence, " Meyer said, "is that at the proper levels,
fluoride is very effective and very safe."

That some should treat the ADA e-mail with more gravity than others is not
surprising. Adding fluoride to drinking water to prevent tooth decay has
been a public health staple for 60 years. Yet skeptics have claimed the
practice does more harm than good.

The rhetoric can be extreme. Supporters have been slammed as lapdogs for
the chemical fertilizer industry that benefits by selling its waste to
water suppliers as a fluoridation agent. And critics are often derided as
deluded fearmongers blind to the support fluoridation has from the
scientific community.

With a 6-1 vote of the Pinellas County Commission in 2004, about 600, 000
residents joined the estimated 170-million people nationwide whose water
is fluoridated.

St. Petersburg, Dunedin, Gulfport and Belleair were already adding
fluoride to their water. Pinellas supplies water to all other county
residents. Hillsborough County, Tampa and Temple Terrace also fluoridate.

After learning of the ADA e-mail last year, Pinellas Utilities Department
director Pick Talley said he contacted the state Health Department and the
Centers for Disease Control and Prevention to gauge the seriousness of the
threat. No public outreach was warranted, Talley said he was told, so his
department was silent.

"We kind of follow the mainstream medical advice on fluoridation, " Talley
said. "There are a lot more serious issues that mothers need to know about
when it comes to their infants."

Similarly, Hillsborough County utility officials stayed mum, doubting the
significance of the ADA e-mail.

That attitude infuriates Tom Nocera, a Clearwater resident who has blasted
Pinellas County for its decision to fluoridate.

"They are trying to protect policies that have been in place for a number
of years, " said Nocera, 58, a federal government employee who works in
disaster relief. "They don't want to be proven wrong."

Kathleen Thiessen, one of the NRC report's 12 authors, is sympathetic to
Nocera's view. A scientist who specializes in assessing toxic risks,
Thiessen said studies done overseas have associated mild to moderate
fluorosis with lower IQs, endocrine system problems and skeletal damage.

Thiessen, who along with two other authors of the report have gained
reputations as fluoride skeptics, said the ADA's e-mail should be of
particular concern to poor parents enrolled in the federal government's
Women, Infant and Children Nutrition Program.

For the most part, parents can use WIC checks to buy only powdered or
condensed formula, which must be mixed with water.

Neither the ADA e-mail nor the NRC report has led to a groundswell of
skepticism about fluoridation. But they have been affirmation for former
Pinellas County Commissioner Barbara Sheen Todd, who cast the lone vote
against adding fluoride to the water supply.

"The very things that I feared are now the things that are showing up, "
Todd said.

Fast Facts:

What goes in your water?

Like much about the fluoride debate, fluorosilic acid can be made to
appear better or worse simply by how it's described. The acid is what's
added to water supplies to fight tooth decay.

Critics of the process call the acid an industrial waste product.
Supporters prefer industry byproduct.

Whatever it's called, the major portion of the fluorosilic acid added to
the nation's water supply comes from Florida's phosphate fertilizer
industry. Here's how:

Florida's phosphate rock is about 3.5 percent fluorine. To make phosphoric
acid for fertilizer, the rock is mixed with sulfuric acid. The mixture
produces a gas called silicon tetrafluoride. The gas is sent through
ductwork and a water scrubber to create fluorosilic acid, a clear liquid
that in high concentrations is toxic. The acid is what fertilizer
companies sell as a fluoride additive. It's diluted to what's considered a
safe level when pumped into water supplies.

Source: Florida Institute of Phosphate Research
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