Fluoride toxixity and anti fluoridation lobby

Dr. Bijivin Raj. V
10/14/2019 1ANTI FLUORIDATION LOBBY - BIJIVIN

• MULTIPLE FLUORIDE THERAPY
o Recommendations
• FLUORIDE TOXICITY
o History
o Toxic doses
o Types
o Action of fluoride in various organs
o Antidotes for fluoride poisoning

• ANTI FLUORIDATION LOBBY
o History
o Techniques used by fluoride opponents
o Reasons for anti fluoridation
o Fluoridation status worldwide.
o Conclusion
o References

• Multiple fluoride therapy is a term that has been used to describe fluoride
combination programs.
• As originally developed, this program included the application of fluoride in the
dental office in the form of both a fluoride-containing prophylactic paste and a
topically applied fluoride solution and the home use of an approved fluoride
dentifrice.
• In addition, some form of systemic fluoride ingestion, preferably communal-water
fluoridation, was included.
Norman.O.Harris. Textbook of Primary preventive dentistry.3rd edition.10/14/2019 4ANTI FLUORIDATION LOBBY - BIJIVIN

• The topical fluoride treatments were administered semiannually
• The results of these investigations indicate that the combination of topical fluoride
applications and home use of a fluoride dentifrice resulted in about 59% fewer
carious lesions.
Norman.O.Harris. Textbook of Primary preventive dentistry.3rd edition.10/14/2019 5
CLINICAL
IVESTIGATION
STUDY
POPULATION
FLUORIDE IN
WATER
STUDY DURATION CARIES
REDUCTION
GISH & MUHLER CHILDREN YES 3 YEARS 55%
BIXLER & MUHLER CHILDREN NO 3 YEARS 58%
MUHLER et al ADULT YES 30 MONTHS 64%
SCOLA & OSTROM ADULT NO 2 YEARS 58%
SCOLA ADULT NO 2 YEARS 56%
OBERSZTYN et al ADULT NO 1 YEAR 60%
ANTI FLUORIDATION LOBBY - BIJIVIN

• Beiswanger and coworkers reported that additive benefits were observed with topical
applications of acidulated phosphate fluoride and the home use of a stannous fluoride
dentifrice.
• Downer and associates were able to demonstrate additive benefits from the combined
use of a sodium Monofluorophosphate dentifrice and topical application of
acidulated phosphate fluoride.

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• The only other statistically significant result was in favour of the combined use of
fluoride gel and mouthrinse in comparison to gel alone.
• No other combinations of TFT were consistently superior to a single TFT.
• Topical fluorides (mouthrinses, gels, or varnishes) used in addition to fluoride toothpaste
achieve a modest reduction in caries compared to toothpaste used alone

Manatu et al ; Guidelines for the Use of Fluorides; Ministry of Health 2009 ,Published by: Ministry of Health, Wellington.

• Prior to introduction of water fluoridation, fluoride was known to layman as pesticide.
• Extraordinary case of mass poisoning due to ingestion of NaF was due to mistaking roach
powder for powdered milk.
Ole fejerskov, brion A.Burt fluoride in dentistry, 2nd edition10/14/2019 11ANTI FLUORIDATION LOBBY - BIJIVIN

• On November 18, 1942, approximately 17 pounds of NaF was added to 10 gallon
mixture of scrambled eggs at the Oregon State Hospital.
• 263 poisoning cases, 47 terminated fatally.

• NaF was added to pancakes at a Salvation Army Centre.
• 40 were affected and 12 died.
• Hodge and Smith noted that there were more than 600 fluoride induced deaths in the
US since 1933, and that approximately 1% of all fatal poisonings were due to
fluoride.
• However, this might be an over estimation, as there was no uniform procedure for
reporting poisonings to a central facility during those years.

• Commercial dental fluoride products and professional practices can be toxic and
even lethal when used inappropriately.
• The lethal dose for an adult is somewhere between 2.5 and 10 g, with the average
lethal dose being 4 to 5 g.
• A review of the literature reveals a wide range of estimates for the acute lethal dose
in humans. They range from 6-9 mgF/kg (Driesbach, 1980) to over 100 mg F/kg
(Lidbeck et al., 1943).
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Whitford G M. The Physiological and Toxicological Characteristics of Fluoride. J Dent Res 1990; 69:539-549.

• Hodge and Smith in 1965, concluded that the Certainly Lethal Dose of Sodium
Fluoride for a 70kg adult is 5-10 g.
• This corresponds to a fluoride dose range of from 32 to 64 mg F/kg.
• Although considerable amounts of data about the acute lethal dose are available from
animal studies (Hodge and Smith, 1965), direct extrapolation to humans is not
warranted.
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• The use of the "average lethal dose" is a very imprecise designation that makes it
difficult to predict the outcome of an accidental swallowing of an excess of fluoride.
• To correct this problem, a body-weight based, probable toxic dose (PTD) standard
has been recommended as a more practical approach to making treatment decisions.
• The PTD approach, first reported by Bayless and Tinanoff, bases the level and
urgency of treatment on the number of multiples of 5 mg/kg of fluoride ingested
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• The PTD has been defined as, “the minimum dose that could cause toxic signs and
symptoms, including death, and that should trigger immediate therapeutic intervention and
hospitalization” (Whitford, 1987).
• Based on previous reports, it is concluded that the PTD is approximately 5 mg F/kg.
• This does not imply that this dose must result in death nor that a somewhat smaller dose
would be innocuous.
• It does mean that even if it is only suspected that 5 mg F/kg has been ingested, it should be
assumed that an emergency exists and that immediate treatment and hospitalization are
required.

• Largest container of tooth paste = 9 ounce (270 gms)
• 1 x 270 = 270 mg of F
• Less than the Certainly lethal dose for a two year kid.(320 mg)
• Over the counter anticaries toothpaste limited to 260 mg.

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AGE
Younger animals-
more resistance
ROUTE OF
ADMINISTRATION
RATE OF
ABSORPTION
ACID BASE
STATUS

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• Like every chemical, there are safe limits for fluoride ingestion beyond which
harmful effects occur.
• These effects can be classified as:
1. Acute: due to a single ingestion of a large amount of fluoride
2. Chronic: due to long-term ingestion of smaller amounts.

• Fluoride acts in four general ways:
(1) when a concentrated fluoride salt contacts moist skin or mucous membrane,
hydrofluoric acid forms, causing a chemical burn;
(2) it is a general protoplasmic poison that acts to inhibit enzyme systems
(3) it binds calcium needed for nerve action;
(4) hyperkalemia occurs, contributing to cardiotoxicity.
Norman.O.Harris. Textbook of Primary preventive dentistry.3rd edition.10/14/2019 22ANTI FLUORIDATION LOBBY - BIJIVIN

• When dry fluoride powder contacts the mucous membrane or the moist skin, a
reddened lesion occurs, and later the area becomes swollen and pale; still later,
ulceration and necrosis may occur.
• In past years, skin burns of this type were common for many water engineers who
emptied drums of fluoride agents into the hoppers feeding water supplies.
• Federal and state occupational safety acts have greatly reduced this danger.
Norman.O.Harris. Textbook of Primary preventive dentistry.3rd edition.

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• Ingested fluoride initially acts locally on the intestinal mucosa.
• Following ingestion, the GI tract is the earliest and most commonly affected organ
system.
• Forms hydrofluoric acid in the stomach, which leads to GI irritation or corrosive
effects.
• Once absorbed, fluoride binds calcium ions and may lead to hypocalcemia.
25Ole fejerskov, brion A.Burt fluoride in dentistry, 2nd edition10/14/2019 25ANTI FLUORIDATION LOBBY - BIJIVIN

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• Fluoride has direct cytotoxic effects and interferes with a number of enzyme systems
• Disrupts oxidative phosphorylation, glycolysis, coagulation, and neurotransmission
(by binding calcium).
• Fluoride inhibits Na+/K+ -ATPase, which may lead to hyperkalemia by extracellular
release of potassium.

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• Fluoride inhibits acetylcholinesterase, which may be partly responsible for
hypersalivation, vomiting, and diarrhea (cholinergic signs).
• Seizures may result from both hypomagnesemia & hypocalcemia.
• Severe fluoride toxicity will result in multi-organ failure.
• Central vasomotor depression as well as direct cardiotoxicity also may occur.
• Death usually results from respiratory paralysis, dysrhythmia, or cardiac failure.

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• Gastrointestinal signs predominate
– Hypersalivation
– Nausea
– Vomiting
– Diarrhea
– Abdominal pain
– Dysphagia
– Mucosal injury
• Electrolyte abnormalities
– Hypocalcemia
– Hypomagnesemia
– Hyperkalemia
– Hypoglycemia

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• Neurologic effects
– Headache
– Tremors
– Muscular spasm
– Tetanic contractions
– Hyperactive reflexes
– Seizures
– Muscle weakness
• Cardiovascular
– Widening of QRS complex
– Various arrhythmias
– Shock
– Cardiac arrest

(1) Immediate treatment,
(2) Induced vomiting,
(3) Protection of the stomach by binding fluoride with orally administered calcium or
aluminum preparations,
(4) Maintenance of blood calcium levels with intravenous calcium.

If an excessive amount of sodium fluoride is ingested, first aid treatment can be
initiated. Milk, or better yet, milk and eggs should be given, for two reasons:
(1) As demulcents, they help protect the mucous membrane of the upper-GI tract
from chemical burns;
(2) they provide the calcium that acts as a binder for the fluoride. Lime water
(calcium hydroxide) or Maalox (an aluminum preparation), can be drunk to
accomplish the same purpose.

• If the amount ingested is less than 5 mg/kg, the office use of available calcium,
aluminum, or magnesium products as first aid antidotes should suffice.
• If the amount is over 5 mg/kg, first aid measures should be expeditiously applied,
followed by hospital observation for possible further care.
• If the amount of fluoride ingested approaches or exceeds 15 mg/kg, the immediate
first aid treatment should be followed by a most urgent action to move the patient
swiftly into a hospital emergency room where cardiac monitoring, electrolyte
evaluation, and shock support is available.

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Enamel fluorosis can occur following either an acute or chronic exposure to fluoride
during tooth formation.
• Fluorosed enamel is characterized by a retention of amelogenins in the early-
maturation stage, and by the formation of a more porous enamel with a subsurface
hypomineralization.
• The transition/early-maturation stage of enamel formation is most susceptible to the
effects of chronic fluoride ingestion at above optimal levels of fluoride in drinking
water.
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• Fluoride may influence the maturational stage of ameloblasts by two means:
• It may reduce the quantity of the proteinases by interfering with the synthetic or the
secretory pathway of ameloblasts.
(DenBesten and Heffernan, 1989).

• The prevalence and severity of fluorosis was high in children consuming water
containing as low as 0.2mg F/ litre.
• The authors suggested that the location, fluoride in diet, malnutrition and altitude
could be contributing factors for the severity of dental fluorosis.
(Yoder et al 1998, Ibrahim et al 1995)

10/14/2019 ANTI FLUORIDATION LOBBY - BIJIVIN 37

• The normal turn over of bone during remodelling brings about a change in the
fluoride content.
• The rate of increase in bone F levels is greater in young individuals than older
people.
• Bone F levels reflect a life time cumulative history of exposure to the element.

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• Signs of skeletal fluorosis may appear with higher levels of fluoride intake (8-10
ppm or more in the drinking water) for approximately 10 years or more.
• Severe cases are normally found only in warm climates where the drinking water
contains very high levels of fluoride or where industrial workers are unnecessarily
exposed to materials, such as cryolite, containing large amounts of fluoride.
• The results of epidemiological studies, have suggested a positive relationship
between water fluoridation and the incidence of bone fractures.

• Early stages of skeletal fluorosis start with pain in bones and joints, muscle
weakness, sporadic pain, stiffness of joints and chronic fatigue.
• During later stages, calcification of the bones takes place, osteoporosis in long bones,
and symptoms of osteosclerosis where the bones become denser and develop
abnormal crystalline structure.
• In the advanced stage the bones and joints become completely weak and moving
them is difficult
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Arlappa N et al., Fluorosis in India www.ijrdh.com Int J Res Dev Health. April 2013; Vol 1(2) 99

• Phase 1: sporadic pain; stiffness of joints; osteosclerosis of pelvis and vertebral
column (6,000-7,000 ppm F in bone ash).
• Phase 2: chronic joint pain; arthritic symptoms; slight calcification of ligaments;
increased osteosclerosis / cancellous bones; with/without osteoporosis of long bones
(7,500-9,000 ppm F in bone ash).
• Phase 3: Crippling Skeletal Fluorosis: limitation of joint movement; calcification of
ligaments/neck and vertebral column; crippling deformities of spine and major joints;
muscle wasting; neurological defects/ compression of spinal cord (more than 8,400
ppm F in bone ash).10/14/2019 46ANTI FLUORIDATION LOBBY - BIJIVIN

• Rheumatoid arthritis,
• Osteoarthritis or seronegative spondyloarthropathy
• Cervical spondylosis.

• Joint pain and stiffness – signs of excessive fluoride intake.
• people diagnosed with arthritis are suffering from low grade fluoride poisoning.
• The U.S Department of Health and Human Services (DHHS, 1991) - fluoride causes
arthritic symptoms in patients with advanced skeletal fluorosis.
• Modern research shows that fluoride can induce joint pains in absence of skeletal
fluorosis.
• Research has found that fluoride can be a direct cause of osteoarthritis, with or
without the presence of classic skeletal fluorosis.
(Bao 2003; Savas 2001; Tartatovskaya 1995; Czerwinski 1988; Chen 1988).
http://fluoridealert.org/issues/health/arthritis10/14/2019 49ANTI FLUORIDATION LOBBY - BIJIVIN

• A daily dose of 10mg f for 10 years – Skeletal fluorosis (NRC 1993).
• A dose lower than 10mg can cause early stages of skeletal fluorosis.
• A case study published in The Lancet found that daily doses of 6 to 9 mg per day
were sufficient to cause arthritis in an avid tea-drinker. (Cook 1971).
• Research from China confirms that doses lower than 10 mg/day can cause early
stages of fluorosis as well as osteoarthritis.
• They found that doses of just 6.2 to 6.6 mg/day consistently produced x-ray
evidence of skeletal fluorosis. It stands to reason, therefore, that doses less than 6
mg/day may cause arthritic symptoms, as fluoride can cause chronic joint pain prior
to the development of x-ray changes.
http://fluoridealert.org/issues/health/arthritis

• Several human epidemiological studies have found an association between fluoride
in drinking water and the occurrence of osteosarcoma in young males. (Bassin
2006; Cohn 1992; Hoover 1991).
• Ecological studies found no relationship between F levels in drinking water and
osteosarcoma.
• Individual exposures were examined only in 2 small studies.
• Therefore, a case-control study was carried out wherein all sources of fluoride
exposure were examined except dietary sources.

• The association between fluoride and risk for osteosarcoma is controversial.
• To determine if bone fluoride levels are higher in individuals with osteosarcoma.
• Incident cases of osteosarcoma (N = 137) and tumor controls (N = 51) were identified by
orthopedic physicians, and segments of tumor-adjacent bone and iliac crest bone were
analyzed for fluoride content.
• There was no significant difference in bone fluoride levels between cases and controls.
F.M. Kim, C. Hayes, P.L. Williams,G.M. Whitford. An Assessment of Bone Fluoride and Osteosarcoma. Dent Res 2011;90(10):1171-1176

10/14/2019 53
DAVID W. BANTING AN UPDATE ONE YEAR AFTER THE NATIONAL TOXICOLOGY PROGRAM STUDY,

• The major breakthrough in the understanding of soft tissue involvement in fluorosis
led on to a third entity, "nonskeletal fluorosis“.
• "Non-skeletal fluorosis" and its clinical manifestations led to diagnosis of fluorosis at
very early onset and complete recovery from fluorosis became a reality.
• Unfortunately, the early manifestations are still non-specific.

• Kidney cells are exposed to relatively high concentrations of fluoride.
• Shows an increasing concentration from cortex to medulla.
• Thus the portion of nephron responsible for concentrating urine and conserving
water is exposed to high concentrations of F.

• The gastric mucosa is exposed to higher concentrations of fluoride.
• The hydrofluoric acid molecule readily penetrates the cell membrane and epithelium.
• Once, it enters the mucosa, it dissociates into fluoride and protons.
• The fluxes of water, sodium, potassium, protons and other ions increase sharply.
• Mucus secretion decreases followed by patchy or widespread los of mucous layer.
• Hyperemia, oedema and haemorrhage occur.
• Surface mucous cells are shed.
Pratusha NG, Banji OJF, Banji D. Fluoride Toxicity- A Harsh Reality. Int Res J of Pharmacy.2011;2(4):79-85

Susheela AK. Fluorosis and associated health issues. Ind J of Pract Pediatrics.2015; 17(2):138-146.

• Fluoride affects oxygen metabolism and produces free radicals which affect cognitive ability
such as learning and memory.
• Absence of compensatory antioxidant system with the presence of oxidative stress and free
radicals play a role in damage of nerve cell membrane.
• Chronic exposure to F – reduction in protein content and phospholipids.
• Animal studies – disturbance in brain development in off springs.
• Demyelination, decrease in number of Purkinje cells, thickening and disappearance of
dendrites, swelling of mitochondria and dilation of ER.

•
• A study showed that there were decrease in IQ in children between 8-13 years old in
China due to too much intake of fluoride (Huff, 2010).
• Average IQ loss had a mean of 0.45 which was about 7 points of IQ.
• Studies have been conducted on animals to see the effects of fluoride on the brain.
Most of the adverse effects are displayed in the brain.

• There are numerous accounts of neuronal damage and protein production and
expression (Connet 2012). Results also showed that fluoride directly effects the
pineal glands ability to efficiently excrete hormones, especially during the puberty
stages of animals tested (Luke, 1997).
• There was alterations in neurotransmitter activity. Fluoride also has effects on
oxidative processes, perhaps due to its reactivity, and also reduces antioxidant levels
in response to these oxidative processes (Connet 2012).

• F induces free radical generation and lipid per oxidation.
• F enhances Aluminium absorption from the gastric mucosa and across Blood Brain
Barrier.
• F forms a complex with Al which is toxic at lower concentrations and can activate G
– proteins, a membrane link to second messenger activation.
• Central mechanism – EXCITOTOXICITY.

• FEMALE REPRODUCTIVE SYSTEM - exposure to 200,400 and 600ppm F resulted in
reduction of viable foetuses and increased number of resorptions.
• Increased oxidative stress and lipid per oxidation was found in endometrium.
• MALE REPRODUCTIVE SYSTEM – Functional and structural alteration of sperm due
disturbances in homeostasis of testis and epididymis.
• Reduction in count and motility of sperms.
• Reduced testosterone levels.

• The thyroid gland has the capacity to accumulate fluoride.
• F can directly injure the structure of thyroid follicle, cytoplasm reduction,
karyopycnosis of follicular epithelial cells, reduction of microvilli on the cristae of
epithelial cells and swelling of vacuoles.
• Disturbs synthesis and secretion of thyroid hormone.
• Interferes with the function of enzymes that catalyze the conversion of T4 to T3.
• Stresses the hypothalamo-pituitary system – affecting synthesis of RNA and DNA in
thyroid cells.

• In humans, effects on thyroid function were associated with fluoride exposures of
0.05–0.13 mg/kg/day when iodine intake was adequate and 0.01–0.03 mg/kg/day
when iodine intake was inadequate (NRC 2006).
• There is evidence that
1. fluoride can exacerbate the anti-thyroid effects of iodine deficiency,
2. can cause goitre in some individuals, and
3. can alter thyroid hormone levels in a manner consistent with a general thyroid
suppressant.
Burgi H, et al. Fluorine and the Thyroid Gland: A Review of the Literature. Klin Wochenschr. 1984 ;62(12):564-9.

• Fluoride has been shown to increase blood glucose levels and impair glucose tolerance, likely by
inhibiting insulin production or secretion.
• Has been found to occur in humans with fluoride intakes of only 0.07-0.4 mg/kg/day—a dose that
can be reached in areas of “optimally” fluoridated water.
• Primary mechanism for fluoride induced impairment in glucose tolerance – inhibition of insulin
production.
http://fluoridealert.org/issues/health/diabetes10/14/2019 65ANTI FLUORIDATION LOBBY - BIJIVIN

• Two groups of rats received 0 (C) or 10 ppm (F10) fluoride via drinking water for
three weeks. Two other groups were treated with a single dose of streptozotocin to
induce diabetes, and also received 0 (D) or 10 ppm fluoride (DF10). The quantity of
fluoride consumed via water by the DF10 animals was calculated daily and an equal
amount was added to the drinking water of another group of non-diabetic animals
(FF). In the diabetic group (DF10) the intake of fluoride gradually increased,
hyperglycemia was more severe, and renal hypertrophy was expressed.

• F destroys the microvilli of the gastric mucosa, which is important for absorption of iron and
folic acid given to pregnant women.
• Also destroys the probiotics of the intestine, B12 synthesis is affected which is an essential
ingredient for Hb biosynthesis.
Susheela AK. Fluorosis and associated health issues. Ind J of Pract Pediatrics.2015; 17(2):138-146.

• Erythrocytes produced in a fluoride environment are abnormal with crenations known as
echinocytes.
• Do not survive the normal life span of RBCs.
• Get phagocytosed and eliminated from blood stream.
• Reduction in Hb level.
A. K. Susheela and Suresh K. JAIN. Fluoride toxicity : erythrocyte membrane abnormality and "echinocyte" formation.
Fluoride Research, Studies in Environmental Science 1985; 27: 231-239

Anurag Tewari, Ashutosh Dubey. Defluoridation of Drinking Water : Efficacy and Need. Journal of Chemical and Pharmaceutical
Research.2009; 1 (1):31-37.

• Edematous swellings have been reported in rare instances after application to
extensive surfaces.
• Dyspnea (difficulty or labored breathing) associated with asthmatic children, has been
reported in unique situations.
• Patients having sensitive digestive systems may experience nausea, usually after
prolonged treatment. If needed, the varnish can easily be removed by toothbrushing and
rinsing.
• Developing teeth of children under age 6 may become permanently discolored if
excessive amounts are repeatedly swallowed.
• The following adverse reactions are possible in individuals hypersensitive to fluoride:
eczema, atopic dermatitis, urticaria, gastric distress, headache, and weakness.

• While fluoridation is generally not considered controversial among the scientific
community, it persists as a political lightening rod, an issue to be avoided at all costs
by the political community.
• Since Grand Rapids, Michigan, began fluoridating its public-water supply in January
1945, there has been a relentless effort by a small but determined opposition to
undermine the efforts of health professionals and civic leaders to implement
fluoridation around the world.

• "pure-water committees" seem to spring up wherever there appears to be a
fluoridation measure on the public agenda.
• Such committees define pure water as fluoride-free; forty-eight other chemicals
frequently used in water treatment are excluded from their definition of pure water.
Invoking "the pure water/fluoride-free zone" is a clever tactic designed to push
emotional buttons against fluoridation.

• Fluoridation proponents assume that the misinformation disseminated by the
opponents will be easily refuted and/or readily dismissed since the facts favoring
fluoridation are mistakenly thought to be clear and convincing.
• However, such a miscalculation may be the basis for underestimating the power of
the highly motivated opposition who believe that fluoridation is a prime example of
government intrusion.

• The controversy over fluoridation of drinking water supply began as early as the nineteen
sixties, approximately a decade after the American Public Health Service officially launched
the National Fluoridation Program.
• The controversy has gained momentum over the years as more research is released to
support the stance of the anti-fluoride lobby.
• The irreversible, debilitating effects of fluoride toxicity, the transient effects and hence the
continuous need of exposure to fluoride to maintain caries resistance and the fact that
benefits of topical use of fluoride are as good as ingested fluoride are some of the leading
contributing factors.

• The first large fluoridation controversy occurred in Wisconsin in 1950. Fluoridation
opponents questioned the ethics, safety, and efficacy of fluoridation.
• New Zealand was the second country to fluoridate, and similar controversies arose there.
• water fluoridation was adopted in some European countries, but in the late 1970s and early
1980s, Denmark and Sweden banned fluoridation when government panels found
insufficient evidence of safety, and the Netherlands banned water fluoridation when "a group
of medical practitioners presented evidence" that it caused negative effects in a percentage of
the population.

• During the "Red Scare" in the United States during the late 1940s and 1950s, and to
a lesser extent in the 1960s, activists on the far right of American politics routinely
asserted that fluoridation was part of a far-reaching plot to impose a socialist or
communist regime.
• They also opposed other public health programs, notably mass vaccination and
mental health services. Their views were influenced by opposition to a number of
major social and political changes that had happened in recent years: the growth of
internationalism, particularly the UN and its programs

• Dr. Charles Bett, a prominent anti-fluoridationist, charged that fluoridation was
"better than using the atom bomb because the atom bomb has to be made, has to be
transported to the place it is to be set off while poisonous fluorine has been placed
right beside the water supplies by the Americans themselves ready to be dumped into
the water mains whenever a Communist desires
• This controversy had a direct impact on local program during the 1950s and 1960s,
where referendums on introducing fluoridation were defeated in over a thousand
Florida communities.
• The communist conspiracy argument declined in influence by the mid-1960s,
becoming associated in the public mind with irrational fear and paranoia.

• In 1987, Ian E. Stephens authored a self-published booklet, an extract of which was
published in the Australian New Age publication Nexus Magazine in 1995.
• "Charles Elliot Perkins" : "Repeated doses of infinitesimal amounts of fluoride will
in time reduce an individual's power to resist domination by slowly poisoning and
narcotizing a certain area of the brain and will thus make him submissive to the will
of those who wish to govern him.
• Both the Germans and the Russians added sodium fluoride to the drinking water of
prisoners of war to make them stupid and docile."

• In 2004, on the U.S. television program Democracy Now, investigative journalist and
author of the book The Fluoride Deception, Christopher Bryson claimed that, "the
post-war campaign to fluoridate drinking water was less a public health innovation
than a public relations ploy sponsored by industrial users of fluoride—including the
government's nuclear weapons program."

1. Neutralizing Politicians
• Once the fluoridation legislation/ordinance has been introduced, opponents attempt
to convince state and local elected officials to remain neutral, rather than make the
appropriate health policy decision to fluoridate the water supply.
• Opponents often attempt to give the impression that there is "scientific" legitimacy
for their positions by quoting "alternative medicine" websites or using pseudo-
scientific spokespersons in hearings, correspondence, and distributed propaganda.
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Norman.O.Harris. Textbook of Primary preventive dentistry.3rd edition.ANTI FLUORIDATION LOBBY - BIJIVIN

NEUTRALIZING POLITICIANS
• Anti-fluoridationists try to convince the elected officials to refer the issue to public
vote, usually, a special election where there is inadequate time for proponents to
organize effectively, rather than to decide the issue through the normal
legislative/administrative process.
• This strategy is favorable to fluoridation opponents who are often more adept at
running a scare campaign focused on negative claims about fluoridation than they are
at convincing skeptical legislators/city/county officials to agree with their views
without verification.
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Norman.O.Harris. Textbook of Primary preventive dentistry.3rd edition.ANTI FLUORIDATION LOBBY - BIJIVIN

USE OF THE BIG LIE
• Anti-fluoridationists repeatedly allege that fluoride causes cancer, kidney disease,
heart disease, genetic damage, osteoporosis, Down's syndrome, AIDS, Alzheimer's
disease, nymphomania, violent behavior, crime,
• Nonetheless, these laundry lists are repeated so frequently in anti-fluoride pamphlets,
letters-to-the-editor, and phone calls to talk-radio shows, that the public may actually
begin to believe the unsubstantiated claims.
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USE OF THE BIG LIE
• The appearance of an allegation in print (such as in the letters to the editor section of
local newspapers) is often believed by the public to be evidence of the allegation's
validity. The public incorrectly assumes that the "authorities" (in this case print
media editors) would not allow allegations to be printed if they were untrue.
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USE OF HALF-TRUTHS
• The use of Half-Truths, where an out-of-context statement is used to imply a cause-
and-effect relationship with some negative result alleged to have been caused by
fluoridation
• Fluoridation opponents claim that "fluoride is poison, so don't let them put it in our
water." This statement ignores the principle that toxicity is related to dose of a
substance and not to mere exposure to the substance itself.
• Chlorine, vitamin D, table salt, iodine, antibiotics, even water, serve as excellent
examples of substances that are harmful in the wrong amounts but beneficial in the
correct amounts.10/14/2019 85ANTI FLUORIDATION LOBBY - BIJIVIN

USE OF HALF-TRUTHS
• "fluoride causes dental fluorosis or mottling." By itself, this claim fails to take into
account either the source of the fluoride, the amount of fluoride, the mechanism of
fluoride exposure, or the time of exposure as related to the dental age of the person
exposed.
• When this claim is made, opponents disingenuously equate fluoridation with the
severe form of fluorosis, not the milder forms, even though they know their
information is a misrepresentation of the facts.
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USE OF HALF-TRUTHS
• The majority of AIDS victims come from fluoridated cities." This half-truth was frequently
made in misguided attempts to persuade San Francisco's public into stopping fluoridation in
that city.
• This claim continued to be made, even after the discovery of the virus that causes AIDS.
While most AIDS patients coincidentally reside in major metropolitan areas and most major
metropolitan areas are fluoridated (47 of the 50 largest cities in the United States), the anti-
fluoridationists logic never did explain the high incidence of AIDS in Los Angeles, San
Diego, or Newark (New Jersey), all not fluoridated at the time of the claim.
10/14/2019 87

USE OF HALF-TRUTHS
• A frequently used fluorophobic tome is, that "while one glass of fluoridated water
will not kill anyone, it is the glass after glass of fluoridated water, as with cigarette
after cigarette, that takes its toll in human health and life."
• This technique uses a guilt-by-association ploy, attempting to link the known health
risks of cigarette smoking (for which there is substantial scientific evidence) to
alleged risks from drinking fluoridated water (for which there is no scientific
evidence).
10/14/2019 88

USE OF HALF-TRUTHS
• Another used claim by fluoridation opponents is that "insufficient research has been
carried out to prove absolute safety, and therefore consumers and government
officials are urged to wait until all doubt about the safety of fluoridation has been
'scientifically' resolved."
• This argument could be used indefinitely in that it is impossible to ever prove
absolute safety for all time for anything.
10/14/2019 89

QUOTING OF INACCURATE STATEMENTS AND THE USE
OF STATEMENTS TAKEN OUT OF CONTEXT
• The best way to illustrate this common technique of anti-fluoridationists is to refer to
two frequently used anti-fluoridation publications,
• The Lifesavers (Sic) Guide to Fluoridation (a pamphlet) and Fluoride: the Aging
Factor. (a book).
• Both use essentially the same "scientific references," both are distributed frequently
in campaigns, opposing fluoridation, and both documents were marketed by their
author as "scientific documents." The one-sheet pamphlet claimed over 250
references.
• Subsequently, a group of 20 scientists and public health officials from around the
United States did a systematic review, tracking down the original references in order
to evaluate their validity as used by the author.
10/14/2019 90

QUOTING OF EXPERTS
• Some of the quoted experts have legitimate academic or professional credentials,
although not necessarily in disciplines qualified to serve as experts in health research
specific to fluorides.
• Moreover, anti-fluoridationists occasionally find a credentialed individual to speak
against mainstream science. The statements by these marginalized individuals, while
of questionable authority, are often exploited by the opposition.
10/14/2019 91

THE CONSPIRACY GAMBIT
• Because alleged conspiracies are difficult to disprove, they are a favorite of the
health-conspiracy theorists.
• The alleged "conspirators" often include the American Medical Association, the
American Dental Association, the American Council on Science and Health, the
equipment and chemical supply companies, the Communist Party, both the aluminum
and phosphate fertilizer industries, toothpaste manufacturers, or any other
organization appearing to be threatening to the anti-fluoridationists.
• Highest on their list of conspirators is the "government"
• Conspiracies generate a tremendous amount of anger among those susceptible to
conspiracy propaganda, a factor that negatively impacts fluoridation efforts.
10/14/2019 92

THE USE OF SCARE WORDS
• Anti-fluoridationists frequently play on the current phobias and concerns of the
public by describing fluoridation in ecologically-linked or environmentally-loaded
terms or phrases such as, "pollutant, toxic waste product, chemical by-product,
dumped in the water, or forced down our throats."
• Fluoride is also frequently linked by fluorophobics with words like "poison, genetic
damage, cancer, AIDS, or artificial“ words that certainly conjure up fear by the
public when linked to something to which they think they will be unwittingly
exposed. Fear is a major factor that negatively impacts fluoridation efforts.
10/14/2019 93

THE USE OF CONTRIVED ORGANIZATIONS
• The opponents often form their own pseudo-scientific organizations having names
that sound like legitimate scientific entities, but which are in reality, front
organizations for the anti-fluoridationist movement.
10/14/2019 94

Subversion of the media
• The job of the media is to present all sides of an issue.
• Often the media appear to be more interested in publicizing a controversy than in
accurately representing an issue.
10/14/2019 95

1) Fluoride is the only chemical added to water for the purpose of medical treatment.
2) Fluoridation is unethical
3) The dose cannot be controlled.
4) The fluoride goes to everyone regardless of age, health or vulnerability.
5) People now receive fluoride from many other sources besides water.
6) Fluoride is not an essential nutrient.
7) The level in mothers’ milk is very low.
8 ) Fluoride accumulates in the body.
9) No health agency in fluoridated countries is monitoring fluoride

10) There has never been a single randomized clinical trial to demonstrate fluoridation’s
effectiveness or safety. Swallowing fluoride provides no (or very little) benefit
11) Benefit is topical not systemic. The centers for disease control and prevention
(cdc, 1999, 2001) has now acknowledged that the mechanism of fluoride’s benefits are
mainly topical, not systemic.
12) Fluoridation is not necessary.
13) Fluoridation’s role in the decline of tooth decay is in serious doubt.

14) NIH-funded study on individual fluoride ingestion and tooth decay found no
significant correlation.
15) Tooth decay is high in low-income communities that have been fluoridated for
years.
16) Tooth decay does not go up when fluoridation is stopped.
17) tooth decay was coming down before fluoridation started.
18) The studies that launched fluoridation were methodologically flawed.

19) Children are being over-exposed to fluoride.
20) The highest doses of fluoride are going to bottle-fed babies.

21) Dental fluorosis may be an indicator of wider systemic damage.
22) Fluoride may damage the brain.
23) Fluoride may lower IQ.
24) Fluoride may cause non-IQ neurotoxic effects.
25) Fluoride affects the pineal gland.
26) Fluoride affects thyroid function.
27) Fluoride causes arthritic symptoms.
28) Fluoride damages bone.
29) Fluoride may increase hip fractures in the elderly.
30) People with impaired kidney function are particularly

31) Fluoride may cause bone cancer (osteosarcoma).
32) Proponents have failed to refute the bassin-osteosarcoma study.
33) Fluoride may cause reproductive problems.
34) Some individuals are highly sensitive to low levels of fluoride as shown by case
studies and double blind studies.
35) Other subsets of population are more vulnerable to fluoride’s toxicity.

36) There is no margin of safety for several health effects. Environmental justice
37) Low-income families penalized by fluoridation.
38) black and hispanic children are more vulnerable to fluoride’s toxicity.
39) Minorities are not being warned about their vulnerabilities to fluoride. 40) tooth
decay reflects low-income not low-fluoride intake.

41) The chemicals used to fluoridate water are not pharmaceutical grade.
42) The silicon fluorides have not been tested comprehensively.
43) The silicon fluorides may increase lead uptake into children’s blood.
44) Fluoride may leach lead from pipes, brass fittings and soldered joints.

48) many scientists oppose fluoridation.
49) proponents usually refuse to defend fluoridation in open debate.
50) proponents use very dubious tactics to promote fluoridation.

• Technology Mission on Safe Drinking Water’ during 1986 for providing ‘potable water
for people of rural India.
• The ‘Water Mission’ took cognizance of the problems of drinking water in rural areas
• As drinking water is collected from bore-wells, open wells, ponds, rivers and lakes, the
contamination with chemicals, living organisms (bacteria, worms, and micro-organisms) and
• Total unawareness of the health problems associated with drinking polluted/contaminated
water was wide spread.

GOALS
To provide safe water ( with less than
1.5 ppm of Fluoride/or lesser)
as excess causes health problems
To control and prevent Fluorosis and
fluoride toxicity manifestations and
promote health in
endemic areas for Fluorosis
Water quality is impacted due to
ground water table falling due to
excessive drawals. The levels of
natural contaminants such as
fluoride and arsenic and man-made
chemical pollutants such as
pesticides and insecticides are high
in many areas.

10/14/2019 119
Preventing
dental caries
Dental and
skeletal
fluorosis
Fluoride is a double-edge
sword

Fluoride toxixity and anti fluoridation lobby

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