Coming to a tap near you: Fluoridated water

A healthcare debate that’s been simmering in the background for 70 years is once again about to boil over.

Last month, the government announced plans to add fluoride to every drop of drinking water across the UK. Under the proposal, the health secretary, Sajid Javid, will have the power to order water fluoridation throughout the country; centralising a key aspect of healthcare without public consent. “Good to see UK Chief Medical Officers examining how water fluoridation can improve oral health & prevent tooth decay,” Javid tweeted. “Reinforces why our health and care bill will make it simpler to expand water fluoridation schemes.”

While dismissing the ongoing safety concerns of mass water fluoridation as “exaggerated and unevidenced,” Britain’s Chief Medical Officers admitted that, “as with all things in medicine and public health, there is a balance of risk and benefit,” and said that fluoride levels must always be “closely monitored” by drinking water inspectors.

The question is, do the risks of water fluoridation outweigh the benefits?

First things first, what is fluoride?

Fluorides are compounds that combine the element fluorine (which, on its own, is a poisonous gas) with another substance, like a metal or a salt.

Some fluorides are found naturally in soil, air or water – although the concentration varies. Artificial fluorides added to water supplies include fluorosilicic acid, sodium fluoride and hexafluorosilicates. According to the official website of the European Commission, “the toxicology of these compounds is incompletely investigated,” and “concerns have been raised about several heavy metals present as low-concentration impurities in commercial hexafluorosilicic acid.”

What happens to fluoride in the body?

Fluoride enters the body through fluoridated water supplies, toothpaste, mouthwashes, processed food, some vitamin tablets and drinks like soda and tea.

Once ingested, fluoride is absorbed into the blood. It travels through the blood and collects in calcium-rich areas, with around 99% of total body fluoride contained in bones and teeth. According to a 2018 scientific review, the amount of fluoride in the body “steadily increases during life”.[1]

“The very same professionals and institutions who told us that fluoride was safe said much the same about lead, asbestos or DDT, or persuaded us to smoke cigarettes.”

Where did water fluoridation start and why?

The first water fluoridation schemes started in the US at the end of the second world war.

As journalist Bob Woffinden writes in The Guardian, “it was a time of scientific evangelism, when chemicals meant progress and the public trusted them to bring about a safer, cleaner future.”

With studies finding that people who consumed water with naturally occurring fluoride seemed to have healthier teeth, artificial fluoride was added to public water supplies across America throughout the 1950s.

“Finland, Cuba, Canada and East Germany have found that rates of dental decay did not rise (and, indeed, continued to decline) after fluoridation was abandoned.”

Something suspicious in the water…

According to Christopher Bryson, author of ‘The Fluoride Deception’, this ‘discovery’ that fluoride benefitted teeth coincided with research paid for by major US industries that needed to be able to defend “lawsuits from workers and communities poisoned by industrial fluoride emissions.”

Fluoridation is a triumph not of medical science, argues Bryson, but of US government spin. “The very same professionals and institutions who told us that fluoride was safe said much the same about lead, asbestos or DDT, or persuaded us to smoke cigarettes,” Bryson writes. Indeed, the ‘father of PR’ himself, Edward Bernays, was handed the task of boosting public approval of fluoride, saying “you can get practically any idea accepted if doctors are in favour.”

As dental cavities decreased during the 1950s and 60s, the benefits of fluoridation were said to be indisputable. The first UK scheme was established in Birmingham in 1964. Products containing fluoride soon followed, from toothpaste to mouth rinse. Adding fluoride to water was heralded as “one of the greatest public health achievements of the 20th century”.

Though, as Bob Woffinden points out, “with better diet and treatment, dental health was improving across the western world, irrespective of fluoridation.” Subsequent studies of communities in “Finland, Cuba, Canada and East Germany have found that rates of dental decay did not rise (and, indeed, continued to decline) after fluoridation was abandoned,” raising questions around the role fluoride really played in healthier smiles.

Which countries have fluoridated water?

Currently, about 372 million people (around 5.7% of the world population) receive fluoridated water in countries including America, Brazil, Australia, Chile, South Korea and Vietnam.

"Water fluoridation is rare in Europe, with 97–98% choosing not to fluoridate drinking water."

Which countries oppose water fluoridation?

Water fluoridation is rare in Europe, with 97–98% choosing not to fluoridate drinking water.

Austria, Belgium, Denmark, France, Finland, Luxembourg, Norway, Switzerland, West Germany, Netherlands and Italy have all rejected water fluoridation. A 2003 survey of European opinion concluded that “the vast majority of people opposed water fluoridation.”

Japan and India, where fluoride occurs naturally and skeletal fluorosis (thickening of bones) is widespread, have also banned the addition of artificial fluoride to their drinking water.

Does the UK water supply currently have fluoride in it?

Around 5.8 million Brits currently receive artificially fluoridated water, with the following UK water utility companies choosing to fluoridate their supply:

"Is trying to treat the symptoms of childhood dental decay with blanket fluoridation, without first addressing the causes – such as nutrition, lifestyle, lack of dental care, education, poor hygiene and low incomes – the most sensible way to solve the problem? That would be a resounding no, according to fluoride’s many opponents..."

Why does the UK government want to fluoridate the entire water supply?

Shockingly, tooth decay is the most common reason for hospitalisation in children aged 5 to 9 in the UK, costing the NHS £65 million a year. The government’s answer to this health crisis? To fluoridate the entire UK water supply.

Fluoride has been shown by some studies to reduce dental decay. Its anti-cariogenic and antimicrobial properties work to control dental caries, and it lowers the pH of the mouth – meaning bacteria have less energy to grow and generate acid.

But, says the Holistic Dental Institute, “the latest scientific evidence shows tooth decay is caused by low levels of calcium and other minerals in the teeth, and to remineralize them, vitamins D and K2, as well as higher intake of calcium, are required.” Tooth decay, therefore, is “all about diet; about correct nutrition.”

So, is trying to treat the symptoms of childhood dental decay with blanket fluoridation, without first addressing the causes – such as nutrition, lifestyle, lack of dental care, education, poor hygiene and low incomes – the most sensible way to solve the problem? That would be a resounding no, according to fluoride’s many opponents.

“Many believe that the effects of fluoride on teeth, beneficial or otherwise, are irrelevant,” says Bob Woffinden. “what matters is the accumulating research evidence that fluoride may have serious adverse health effects.”

What are the concerns around fluoridated water?

Despite the UK’s plans, concerns about excessive fluoride intake and associated toxicity persist.

“Many believe that the effects of fluoride on teeth, beneficial or otherwise, are irrelevant,” says Bob Woffinden. “what matters is the accumulating research evidence that fluoride may have serious adverse health effects.”

“Putting fluoride into the water supply […] would, according to opponents, appear to ignore some important considerations.”

Those considerations include:

  • Regular exposure from other sources, like toothpaste, tea and pharmaceuticals contributing to an increased overall intake.
  • Individual sensitivities to fluoride.
  • The dental benefits fluoride is said to bring are topical rather than systemic, making ingesting it pointless.
  • Tooth decay is widespread in fluoridated low-income countries where a lack of dental care and poor hygiene are the main issue.
  • Sick people are more vulnerable to fluoride’s toxic properties (e.g. patients with impaired kidney function).
  • The level of fluoride in a water supply is no indication of an individual’s actual exposure (with some people drinking more than others).
  • The fact that, while fluoridating water, contamination with toxic chemicals can occur.

Dr Arvid Carlsson of Sweden, a co-winner of the Nobel Prize for medicine in 2000, advises against fluoridation. He says: "Fluoridation of water supplies would also treat people who may not benefit from the treatment. Side effects cannot be excluded and thus some might only have negative effect without any benefit".

Independent scientific research looks at the link between fluoride and health issues like thyroid problems, infertility and neurological damage:

Fluoride and low IQ

Recent studies[2] link elevated fluoride intake during childhood with “considerable” IQ deficits.

A Canadian study[3] found that exposure to fluoridated water during pregnancy is linked with lower IQ scores in children aged 3 to 4 years, and can be associated with adverse effects on children’s intellectual development.

Fluoride and thyroid problems

Even when administered in small doses, studies show[4] fluoride can harm thyroid function. The concern is that fluoride displaces iodine in the human body, which is essential for the normal functioning of the thyroid gland.

Effects of fluoride exposure on the thyroid were first reported[5] as early as 1854, with subsequent studies[6] showing how excess fluoride intake can increase the incidence of thyroid diseases. One recent study found that people living in the West Midlands (a fluoridated area) are nearly twice as likely to report hypothyroidism in comparison with non-fluoridated areas. Also known as an underactive thyroid, hypothyroidism causes symptoms such as fatigue, weight gain, low mood, cold intolerance and dry skin.

"Research connects exposure to high fluoride concentrations in drinking water with decreased birth rates, disturbed reproductive endocrines and the disruption of reproductive hormones in men."

Fluoride and neurotoxic effects

Several animal and human studies on fluoride show neurotoxic[7] and nephrotoxic[8] effects.

Fluoride and fertility 

Research connects exposure to high fluoride concentrations in drinking water with decreased birth rates,[9] disturbed reproductive endocrines[10] and the disruption of reproductive hormones in men.[11]

Fluoride and pregnancy complications

Studies[12] show that women with elevated urinary fluoride levels were found to have a strong association with pregnancy complications and “adverse pregnancy outcomes”. 

Fluoride and bone damage

Research shows[13] that “excessive systemic exposure to fluorides can lead to disturbances of bone homeostasis”. Further studies[14] reveal that, while fluoride may increase bone mass, “the newly formed bone appears to lack normal structure and strength,” making them brittle and more easily fractured.

“As currently packaged, many dental products contain sufficient fluoride to exceed the 'Probably Toxic Dose' for young children.”

Is fluoride harmful to children?

According to the Journal of Dental Research,[15] there is enough fluoride in a tube of toothpaste to poison a young child.  

“The “probably toxic dose” or PTD of fluoride—the dose which should trigger therapeutic intervention and hospitalization—is 5 mg/kg of body weight,” said the researchers. “As currently packaged, many dental products contain sufficient fluoride to exceed the PTD for young children.”

Dr. Paul Connett, a former professor of Environmental Chemistry and Toxicology, is a prominent water fluoridation critic. Speaking at a conference in London, he said: "There are no benefits, only risks, for infants ingesting heightened levels of fluoride at such an early age, [when] susceptibility to toxins are particularly high."

Even the toothpaste manufacturers seem to agree, with Colgate adding the following warning to its US packaging: ''Keep out of the reach of children under 6 years of age. If you accidentally swallow more than used for brushing, seek professional assistance or contact a Poison Control Center immediately.'

With the ‘safe’ dose of fluoride so low for young children, worries persist that adding extra fluoride to water may lead to toxic overwhelm for vulnerable, growing bodies. 

Professor Hardy Limeback, a consultant to the Canadian Dental Association, warned that children under three years of age should never drink fluoridated water or use fluoride toothpaste or products, and that fluoridated water must never be used for making baby formula. He refutes the safety claims about fluoride, raising concern that no tests have been carried out to properly assess the effects of fluoride accumulation.

"A 2018 review of the evidence said “it is important to note that there are no randomised controlled trials to validate the effectiveness of fluoridation.""

What is dental fluorosis?

Dental fluorosis is a condition caused by excessive fluoride intake that leads to changes in tooth enamel. In mild cases, it appears as frosty edges, white spots or chalky lines on the tooth surface. In more severe forms, teeth have large white spots and rough, pitted surfaces.

Fluorosis affects nearly one in four Americans aged 6 to 49, and is most prevalent in children aged 12 to 15. Since the mid-1980s, the prevalence of fluorosis in American children has increased.

More investigation needed?

Interestingly, a 2018 review[16] of the evidence said “it is important to note that there are no randomised controlled trials to validate the effectiveness of fluoridation." 

In 2000, none of the studies on fluoridation received a Grade A classification by the British Government’s ‘York Review’ on the safety and effectiveness of water fluoridation. Correspondingly, fluoride is classified as an “unapproved new drug” by the US Food and Drug Administration. 

The York Review said that there was "surprisingly little research" into the harmful effects of fluoride and recommended "high quality research" into fluoride's possible links with infant mortality, IQ and congenital defects.

Now that you know all about fluoride and its effects, discover how to remove it from your drinking water and lower your intake with our helpful guide

 

Scientific Papers: References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6195894/

[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6923889/

[3] https://jamanetwork.com/journals/jamapediatrics/fullarticle/2748634

[4] https://pubmed.ncbi.nlm.nih.gov/26319807/

[5] https://www.nap.edu/read/11571/chapter/10

[6] https://journals.sagepub.com/doi/10.1177/2156587211414424

[7] https://pubmed.ncbi.nlm.nih.gov/9518651/

[8] https://pubmed.ncbi.nlm.nih.gov/7825191/

[9] https://pubmed.ncbi.nlm.nih.gov/8169995/

[10] https://pubmed.ncbi.nlm.nih.gov/20364589/

[11] https://pubmed.ncbi.nlm.nih.gov/12865044/

[12]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7491833/

[13] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144112/

[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3144112/

[15] https://journals.sagepub.com/doi/10.1177/00220345900690S108

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6195894/