The following attendees of the XXVth conference of the International Society for Fluoride Research held in Dunedin, New Zealand in January of 2003, resolved to call upon our colleagues in the scientific, academic and professional communities, and all others actively promoting sound public health policies worldwide, to help bring scientific integrity to the issue of water fluoridation. (Please note that the ISFR organization itself does not take a position on the fluoridation debate.)

Our primary focus with this initiative is to encourage more scientists, academics and professionals to examine this controversial issue with an open mind and ensure that it is resolved scientifically and ethically. From the viewpoint of good scientific method and scholarship, it is unacceptable that spokespersons for several governments practicing fluoridation repeatedly claim that the practice is 'safe and effective', while refusing to subject the issue to open public debate. This refusal allows them to wrongly claim that the arguments mobilized by opponents of fluoridation are ‘junk science’ when in fact most of the opponents’ evidence is based upon peer-reviewed literature, including important articles written by advocates of fluoridation themselves.

The signatories to this Appeal take the position that biased reviews; misrepresentation and censorship of results; a failure to collect the basic data; intimidation and harassment of opponents, as has happened in the case of Dr William Marcus, Dr John Colquhoun, Dr Bruce Spittle, Dr Phyllis Mullenix, Dr Mark Diesendorf and Dr Hardy Limeback, to name a few, have no place in science. In this appeal we first list 13 principal scientific findings that concern us. Then we present the petition, which spells out the steps we believe have to be taken to ensure that this issue is resolved properly. These findings are:

1. Topical not systemic mechanism

The mechanisms of action of fluoride in reducing tooth decay are now widely accepted to be predominantly topical, i.e. acting directly on the surface of teeth, not systemic (CDC, 1999, 2001). In other words, there is no credible justification for requiring people to swallow fluoride.

2. No deficiency

No-one has ever been identified as having a genuine deficiency of fluoride. Fluoride, in the mg/day doses recommended by proponents of fluoridation, is not an essential nutrient.

3. Negligible benefits

A major cross-sectional survey of 84 cities in the USA by the National Institute of Dental Research found that children (aged 5 to 17) who had lived their whole lives in fluoridated cities had on average only 0.6 fewer decayed, missing and filled tooth surfaces (DMFS) per child than those in unfluoridated cities (Brunelle & Carlos, 1990). In Australia a survey by pro-fluoridationists found an average reduction of only 0.12 to 0.3 DMFS per child (Spencer, Slade & Davies, 1996). Since the total number of permanent tooth surfaces in a child's mouth is 128, the US and Australian reductions are less than one half and one quarter of one percent of tooth surfaces, respectively. Both are negligible.

4. Excellent teeth in unfluoridated areas

Since the 1960s tooth decay has declined dramatically in both fluoridated and non-fluoridated regions of the vast majority of developed countries. Indeed, WHO figures, available online, show that in non-fluoridated countries, including most of Europe, tooth decay in 12 year-olds is just as good, if not better than in fluoridated ones. In several cases this decline also commenced in fluoridated places before fluoridation and the uses of any other fluorides were implemented. Clearly, factors other than fluoridation and fluorides must be playing a major role (Diesendorf, 1986; Colquhoun, 1988; De Liefde, 1998). In five recent studies it has been shown that when fluoridation was discontinued in communities in Finland, Cuba, former East Germany and British Columbia, tooth decay did not go up, but continued to go down (Maupome et al, 2001; Kunzel and Fischer,1997, 2000; Kunzel et al, 2000, and Seppa et al, 2000).

5. Medication with uncontrolled dose

Fluoridation is medication with uncontrolled dose (Diesendorf, 1995). The daily fluoride dose received by people ingesting drinking water fluoridated at a concentration of 1 ppm varies widely with water intake (Ershow & Cantor, 1989), diet, and kidney function. Those with high fluoride intake include athletes, outdoor laborers, people with diabetes, people with kidney damage and bottle-fed infants.

6. High dose to bottle-fed infants

In particular, bottle-fed infants, who ingest milk formula reconstituted with fluoridated water, receive a daily fluoride dose that is 100 times that of breast-fed infants and at least 4-6 times that recommended by medical authorities for fluoride supplementation in unfluoridated areas (Diesendorf & Diesendorf, 1997).

7. Dental fluorosis is rampant

When fluoridation was originally proposed, proponents claimed that it would only cause ‘mild’ or even milder types of dental fluorosis (fluoride-induced mottling of teeth) in 10% of the community and no ‘moderate’ or ‘severe’ types. However, in practice, because of the combined exposure to both fluoridated water and other sources, the prevalence and severity of dental fluorosis has increased far beyond initial expectations. The York Review (McDonagh et al, 2000) estimates that up to 48% of children in fluoridated areas have some form of dental fluorosis. Even children in unfluoridated areas have dental fluorosis rates exceeding those thought to be associated with the ‘optimal dose’ originally proposed to prevent dental decay (Heller, et al. (1997).

8. Skeletal fluorosis and arthritis

Over a lifetime fluoride accumulates in bones, adding mass but gradually destroying bone structure. The disease of bones and joints, skeletal fluorosis, has been reported in the medical literature to be observed in naturally fluoridated areas of several countries where fluoride concentrations in drinking water are less than 4 ppm and in several cases where they are less than or equal to 1 ppm (Singh et al, 1961; Singh et al, 1963; Siddiqui, 1970; Jolly et al, 1973). Of particular concern is the fact that the early symptoms of skeletal fluorosis are identical to arthritis, and the incidence of arthritis is increasing rapidly in several fluoridated countries. In America, one in three Americans have arthritis (CDC, 2002). Incredibly, there has been no attempt to check the fluoride levels in the bones of those inflicted by this disease. There have been no scientifically adequate studies of the prevalence of skeletal fluorosis in developed countries.

9. Hip and other bone fractures are a hazard

Many people in fluoridated communities will receive a cumulative dose of fluoride during their lifetimes that exceeds the cumulative dose which in clinical trials of large daily fluoride doses over a short period of time clearly increases hip fracture rates (Riggs et al, 1990). Furthermore, in the majority of epidemiological studies conducted since 1990, a higher rate of hip fractures has been found in artificially fluoridated areas compared with unfluoridated areas (www.SLweb.org/fluoride-bone.html). In particular, a recent epidemiological study, which examined the elderly in six naturally fluoridated Chinese villages, hip fracture rates doubled at 1.5 ppm, and tripled at 4.3 ppm, when compared to the fracture rates at 1 ppm fluoride (Li et al., 2001). This finding again suggests a very small (if any) safety margin for such a serious outcome. In Mexico, Alarcon-Herrera et al (2001) have shown a linear correlation between the severity of dental fluorosis and the incidence of bone fractures in children.

10. Inadequate safety factor

In order to protect members of the population at greatest risk, toxicology generally requires a safety factor of 100 between ingested and unsafe concentrations of environmental chemicals. This allows for variations in individual exposures and individual sensitivities, which each receive a factor of 10. However, in the USA the maximum contaminant (i.e. unsafe) level for fluoride in drinking water was unscientifically set at 4 ppm providing a safety factor of only 4 for water fluoridated at 1 ppm. This is based on the fluoride concentration at which it is officially accepted that some people will suffer from skeletal fluorosis in the USA, despite the fact that in some other countries this disease is occasionally seen at 1 ppm or less. Based on evidence mentioned in this Appeal, the safety factor for hip fractures is a factor or 4 (or possibly as low as 1.5, see Li et al, 2001); less than 3 for lowered fertility (Freni, 1994), possibly 1 for the uptake of aluminum into the brain (Varner et al, 1998) and definitely 1 for dental fluorosis. In practice, even with a safety factor of 4, some people with high intakes of water fluoridated at 1 ppm could consume the same daily fluoride dose as people with average intakes of water containing 4 ppm fluoride. So, in reality, in terms of the fluoride doses that they ingest, there is no safety margin for these people for any of the above diseases.

11. Hypersensitivity/intolerance reactions

There is large body of clinical reports that some people suffer from hypersensitivity or intolerance reactions to fluoride in drinking water, tablets and toothpaste. These symptoms (which include excessive fatigue, excessive thirst, gastric distress, muscular weakness, etc) are reversed when the source of fluoride is removed and have been observed under double blind conditions (Waldbott, Burgstahler & McKinney, 1978; Grimbergen, 1974). Inexplicably, these studies have been dismissed out of hand by government agencies which have never followed them up in any systematic fashion.

12. Numerous biological effects

Laboratory and animal experiments show that fluoride is highly active biologically. Emsley et al (1981) have shown that fluoride forms a strong hydrogen bond with the groups found in proteins and nucleic acids. In vitro experiments demonstrate that fluoride inhibits enzymes; induces chromosome aberrations (Susuki and Tsutsui, 1989); genetic mutations (Caspary et al, 1987) and in the presence of aluminum disrupts G-proteins (Strunecka and Patocka, 2002). Animal experiments reveal that fluoride increases the uptake of aluminum into the brain at 1 ppm in the drinking water (Varner et al, 1998). At higher doses fluoride causes reproductive problems (Chinoy and Narayana,1994) and could be a weak promoter (Taylor and Taylor, 1965) and inducer of cancer (NTP, 1990). In US counties with 3 ppm fluoride in the water there is a significant decrease in human fertility (Freni, 1994). Also, in humans, fluoride accumulates in the pineal gland (Luke, 2001) and in animals it lowers melatonin production (Luke, 1997).

13. Industrial waste as a medication

The agents which are used to fluoridate over 90% of the water treated in the US (hexafluorosilicic acid and its sodium salt) are waste materials obtained from the pollution scrubbers of the phosphate fertilizer industry and contain trace amounts of arsenic, lead and other toxic chemicals. Even in their pure state the US EPA confirms that the silicofluorides have never been subjected to chronic testing in animals. However, in two epidemiological studies they have been shown to be associated with a greater uptake of lead into children's blood and increased violent behavior (Masters & Coplan, 1999, 2000).

On the following page is the petition we hope that you will wish to sign.

SIGNED:

Dr. Miklos Bely,
National Institute of Rheumatology,
Budapest, Hungary.

Dr. Albert Burgstahler,
Professor Emeritus in Organic Chemistry,
University of Kansas,
Lawrence, Kansas, USA.

Dr. N. J.Chinoy,
Zoology Department,
Gujarat University,
Ahmedabad, Gujarat, India.

Dr. Paul Connett,
Professor of Chemistry,
St. Lawrence University,
Canton, NY, USA.

Dr. Mark Diesendorf,
Director, Sustainability Centre Pty Ltd,
Sydney, Australia.

Dr.William J. Hirzy,
Vice-President,
National Treasury Employees Union, Chapter 280,
US EPA, Washington, DC, USA.

Dr. Hardy Limeback,
Head of Preventive Dentistry,
University of Toronto,
Toronto, Canada.

Dr. Bruce Spittle,
Senior Lecturer,
Department of Psychological Medicine,
University of Otago,
Dunedin, New Zealand.

Dr. Anna Strunecka,
Professor of Physiology,
King Charles University,
Prague, Czech Republic.

* * *

We cannot hope in the space available to present all our concerns (that would take a book) or both sides of the issue. Hopefully we have said enough to spark your interest and you will find out more for yourselves. The pro-fluoridation position is articulated at the American Dental Association web page www.ada.org; the anti-position is further elaborated at www.fluoridealert.org and a comprehensive and annotated bibliography can be found a www.SLweb.org/bibliography.html, where all the references noted above can be found.

THE PETITION

A Petition to all Governments Practicing, and all Organizations Supporting, Water Fluoridation

We, the undersigned members of the scientific, academic and professional communities, and others promoting sound public health policy worldwide, call upon professional associations and government agencies in Australia, Brazil, Canada, Ireland, Israel, Malaysia, New Zealand, Singapore, South Africa, the UK and the US, to bring scientific integrity to the issue of water fluoridation. To this end, we urge them:

1) To examine carefully all the literature which pertains to fluoridation's dangers and benefits, in an open, honest and transparent manner. We urge them to hear from experts on both sides of this issue who are prepared to give their testimony under oath before a truly independent scientific panel, the membership of which is approved by both sides.

2) To collect fundamental data such as fluoride levels in the bones and pineal glands, measured during autopsy, and the prevalence of skeletal fluorosis and hypersensitivity/intolerance to fluoride, of those who have lived for various lengths of times in fluoridated areas, as well as using dental fluorosis (tooth mottling) as a bio-marker to investigate the possible dangers to children of being exposed to excessive levels of fluoride at an early age.

3) To halt immediately the practice of using untested and industrial grade waste materials (such as hexafluorosilicic acid from the phosphate fertilizer industry) in water fluoridation programs.

4) To renounce the use of any intimidatory pressures on those professionals whose research or review has led them to adopt an anti-fluoridation position.

5) To renounce the widespread practice of misrepresenting scientific results in order to achieve the fluoridation of more water supplies.

6) Either to defend water fluoridation in open public debate or to halt the practice forthwith.

Click here to see the list of Signatories