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Fluorosis; The Downside to Fluoride

Fluorosis1There is one problem associated with fluoride.  This involves the appearance of the teeth if a child under the age of six receives too much fluoride while the teeth are forming.

By the time fluoride had finally become common in municipal water supplies, the experts were surprised to find a fair number of children whose teeth exhibited the white (and sometimes orange) spots typical of fluorosis.  All the studies done during the pioneering years of fluoride research suggested that this just should not happen at the doses recommended.  The problem of widespread fluorosis did not start showing up until about the mid 1950’s.  The experts were very puzzled until they realized that the fluorosis was not caused by the fluoride intentionally placed in the water supplies.

The problem was fluoride containing toothpastes (which–surprise–became widespread in the mid 1950’s).  When small children are encouraged to brush their teeth, the parents generally put toothpaste on the brush for them.  Being children, they do not know that this sweet stuff is not supposed to be swallowed.  Unfortunately, the typical toothpaste contains concentrated fluoride meant to be used topically only.  Adults spit it out when they are finished brushing, but to children, toothpaste tastes like candy, and the more you put on the brush, the better it tastes.  In addition, children under six have a difficult time controlling the swallowing reflex and find it difficult to avoid swallowing.  This extra high concentration of proprietary fluoride, when actually swallowed by a child goes into circulation and is deposited in the developing adult teeth causing fluorosis.

Fluorosis can happen only during the time that the enamel is forming on the teeth.   Since all the tooth enamel (except for the wisdom teeth) forms before the age of six, only children six and under are susceptible to getting fluorosis.  Fluorosis does not happen to any portion of the teeth that have already erupted.

It is recommended that children under the age of six use toothpaste only under adult supervision, and that only a “pea sized” dollop of toothpaste be placed on the brush.

Cases like the one shown in the image above are extreme and very unusual today.  The majority of modern cases appear like the ones below, with white parallel lines on the central and lateral incisors.  If the mottling is severe enough to cause embarrassment, bleaching the teeth generally reduces the prominence of the white spots by whitening the natural tooth enamel surrounding them.  Unfortunately, bleaching the teeth is not effective for removing the fluorosis discoloration itself.

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What about the pictures on the anti-fluoridation sites?

fluorosisInternet sites that preach the evils of fluoridation frequently exhibit  horrid images of dental fluorosis in order to scare the public.  The images above are quite graphic and occur all over the web.  A bit of history is in order here.  In the 1930s, the very first cases of fluorosis were noted in the American Southwest.  No one knew what the cause of the epidemic was until some local dentists did a lot of research and pinned the cause on very high concentrations of naturally occurring fluoride in the water supply of some isolated communities.  Dentists in areas where this type of deformity was endemic noted that these people never got decay in their teeth, unlike their neighbors who moved into the area form other parts of the country and who’s teeth were normally shaped, but had lots of decay.  It was this observation that caused these dentists to realize that whatever was causing the deformation of the teeth was also causing the resistance of the teeth to decay.  Careful research finally revealed that the very high concentration of  naturally occurring fluoride in the local water supply was the cause of both conditions.  Fluorosis of this severity rarely happens anymore since state public health services prohibit the use of drinking water with toxic levels of naturally occurring fluoride.  People who live in areas with water that could produce this type of deformity simply do not drink the local water.

The images you see above are from that era of research.  You will note that the quality of the images is quite poor, and this is the result of the state of the technology of color photography at that time.  These people grew up in areas where the concentration of Fluoride in the natural water was several hundred parts per million.  Further research in 1940s revealed that using a concentration of 0.7 to 1.2 parts per million in drinking water could confer the benefits of decay free teeth without the deformities seen above.

Thus the images above are typical of severe fluorosis, but cases like this are rarely seen today because people who live in areas with toxic concentrations of fluoride (indeed with toxic concentrations of anything) in the ground water generally drink municipal sources that are controlled for their purity.

Skeletal Fluorosis

An interesting anecdote demonstrates that a person can consume too much fluoride, but it also demonstrates just how much fluoride it takes to actually cause physical problems.

In 2013, a 47-year-old Michigan woman visited the doctor because she had been experiencing pain in her lower back, arms, legs and hips for five years. It turns out that she had developed skeletal fluorosis, a condition in which bone density increases due to extreme fluoride intake. Under normal circumstances, bone is constantly being remodeled as the body removes the hydroxyapatite (the hard material in bones) in areas in which it is not needed for support, and then replaces it in areas where the bone needs extra strength. Skeletal fluorosis causes the body to deposit fluoroapetite in bone instead of the normal hydroxyapatite, and since it is denser and harder than hydroxyapatite, the body has a harder time removing it from the areas where it is no longer needed. Even so, it keeps reinforcing the bone in other high stress areas anyway.

Our lady had acquired this problem because she had been drinking a large pitcher of tea every day of her life for the last 17 years. Furthermore, the tea had been made using 100 tea bags per pitcher. Recent analyses have revealed an average fluoride content of 17.25 mg per tea bag or cup in black tea and 22 mg per tea bag or cup in green tea. 100 tea bags comes up to around 2 full grams of fluoride ingested per day! (Compare that with the 0.7 to 1.2 mg of fluoride per liter in fluoridated municipal water supplies. In order to ingest 2 grams of fluoride by drinking fluoridated municipal water, a person would have to drink between 417 and 714 gallons of water!)

The lady’s treatment, however, consisted of simply stopping the intake of the tea. In countries like China and India where this problem is endemic, simply eliminating the source of the fluoride cures the problem because excess fluoride is typically eliminated from the body by the kidneys. Over the course of three to fiveyears, the fluoroapetite is eliminated from the body and the bone becomes normal again.

The other “evils” of fluoride

Anti-fluoridationists accuse fluoride of causing all sorts of diseases including cancer, bone fractures, thyroid and parathyroid disease, heart disease, kidney disease, pineal gland disease, Alzheimer’s disease, Downs syndrome and genetic diseases.  Believe me, municipal water fluoridation does not cause any of these problems.  I have debunked numerous claims on my “Dear Dr. Dumbass” page, but for the full scoop on them, please read this excellent 70 page long fact sheet (in pdf format) which not only debunks the antifluoridationist claims, but gives the correct scientific reference for each study that is referenced.

Fluorides in dental material

Regardless of how anyone feels about fluoride, it is apparent that the dental profession (not just in the US, but worldwide) feels that Fluoride is a tremendous benefit for their patients.  This attitude is borne out by the fact that fluoride is found not only in mouth rinses and tablet form, but it is included in the very materials used to fill your teeth.  Many tooth colored fillings placed in teeth today either contain fluoride, or are placed over a base or cement that does.  This is done intentionally.  Many composite fillings and cements are formulated in such a way as to leach small amounts of fluoride into the surrounding tooth structure to strengthen it against recurrent decay.  For more information on how these materials are formulated, please click on the dental materials button below.

Dental_Materials

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Fluoride pages 123