In this bulletin, we’ve compiled some of
the many research recommendations made by NRC to address their concerns
about fluoride toxicity (see below).
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“Fluoride should be included in nationwide
biomonitoring surveys and nutritional studies; in particular,
analysis of fluoride in blood and urine samples taken in these
surveys would be valuable.” p9
“To assist in estimating individual fluoride
exposure from ingestion, manufacturers and producers should provide
information on the fluoride content of commercial foods and beverages.“
p71
“The concentrations of fluoride in human
bone as a function of exposure concentration, exposure duration,
age, sex, and health status should be studied.” p9
“Information is particularly needed on
fluoride plasma and bone concentrations in people with small-to-moderate
changes in renal function as well as in those with serious renal
deficiency.” p9
“More research is needed on the relation
between fluoride exposure and dentin fluorosis and delayed tooth
eruption patterns.” p9
“A systematic study of clinical stage II
and stage III skeletal fluorosis should be conducted to clarify
the relationship between fluoride ingestion, fluoride concentration
in bone, and clinical symptoms. “ p10
“More studies of communities with drinking
water containing fluoride at 2 mg/L or more are needed to assess
potential bone fracture risk at these higher concentrations.”
p10
“Carefully conducted studies of exposure
to fluoride and emerging health parameters of interest (e.g.,
endocrine effects and brain function) should be performed in populations
in the United States exposed to various concentrations of fluoride.”
p10
“Better characterization of exposure to
fluoride is needed in epidemiology studies investigating potential
effects. Important exposure aspects of such studies would include
the following: collecting data on general dietary status and dietary
factors that could influence exposure or effects, such as calcium,
iodine, and aluminum intakes.” p72
“To permit better characterization of current
exposures from airborne fluorides, ambient concentrations of airborne
hydrogen fluoride and particulates should be reported on national
aregional scales, especially for areas of known air pollution
or known sources of airborne fluorides. Additional information
on fluoride concentrations in soils in residential and recreational
areas near industrial fluoride sources also should be obtained”
p71-72
“The possibility of biological effects
of SiF6 , as opposed to free fluoride ion, should be examined.”
p72
“The biological effects of aluminofluoride
complexes should be researched further, including the conditions
(exposure conditions and physiological conditions) under which
the complexes can be expected to occur and to have biological
effects.” p72
“Thus, more studies are needed on fluoride
concentrations in soft tissues (e.g., brain, thyroid, kidney)
following chronic exposure.” p83
“Research is needed on fluoride plasma
and bone concentrations in people with small to moderate changes
in renal function as well as patients with serious renal deficiency.
Other potentially sensitive populations should be evaluated, including
the elderly, postmenopausal women, and people with altered acid-base
balance.” p83
“More work is needed on the potential for
release of fluoride by the metabolism of organofluorines.”
p83
“More research is needed on bone concentrations
of fluoride in people with altered renal function, as well as
other potentially sensitive populations (e.g., the elderly, post-menopausal
women, people with altered acid-balance), to better understand
the risks of musculoskeletal effects in these populations.”
p147
“the relationship between fertility and
fluoride requires additional study.” p161
“Two small studies have raised the possibility
of an increased incidence of spina bifida occulta in fluorosis-prone
areas in India; larger, well-controlled studies are needed to
evaluate that possibility further.” p164
“More research is needed to clarify fluoride’s
biochemical effects on the brain.” p186
“The possibility has been raised by the
studies conducted in China that fluoride can lower intellectual
abilities. Thus, studies of populations exposed to different concentrations
of fluoride in drinking water should include measurements of reasoning
ability, problem solving, IQ, and short- and long-term memory.
p187
“Studies of populations exposed to different
concentrations of fluoride should be undertaken to evaluate neurochemical
changes that may be associated with dementia. Consideration should
be given to assessing effects from chronic exposure, effects that
might be delayed or occur late-in-life, and individual susceptibility.”
p187
“Further effort is necessary to characterize
the direct and indirect mechanisms of fluoride’s action
on the endocrine system and the factors that determine the response,
if any, in a given individual. Such studies would address the
following..
- identification of those factors, endogenous (e.g., age, sex,
genetic factors, or preexisting disease) or exogenous (e.g.,
dietary calcium or iodine concentrations, malnutrition), associated
with increased likelihood of effects of fluoride exposures in
individuals.
- consideration of the impact of multiple contaminants (e.g.,
fluoride and perchlorate) that affect the same endocrine system
or mechanism.” p223
“The effects of fluoride on various aspects of endocrine
function should be examined particularly with respect to a possible
role in the development of several diseases or mental states in
the United States. Major areas for investigation include the following:
- thyroid disease (especially in light of decreasing iodine
intake by the U.S. population);
- nutritional (calcium-deficiency) rickets;
- calcium metabolism (including measurements of both calcitonin
and PTH);
- pineal function (including, but not limited to, melatonin
production); and
- development of glucose intolerance and diabetes.” p224
“Studies are needed to evaluate gastric responses to fluoride
from natural sources at concentrations up to 4 mg/L and from artificial
sources.” p. 258
“Additional studies should be carried out to determine
the incidence, prevalence, and severity of renal osteodystrophy
in patients with renal impairments in areas where there is fluoride
at up to 4 mg/L in the drinking water.” p. 258
“The effect of low doses of fluoride on kidney and liver
enzyme functions in humans needs to be carefully documented in
communities exposed to different concentrations of fluoride in
drinking water.” p258
“In addition, studies could be conducted to determine what
percentage of immunocompromised subjects have adverse reactions
when exposed to fluoride in the range of 1-4 mg/L in drinking
water.” p259
“It is paramount that careful biochemical studies be conducted
to determine what fluoride concentrations occur in the bone and
surrounding interstitial fluids from exposure to fluoride in drinking
water at up to 4 mg/L, because bone marrow is the source of the
progenitors that produce the immune system cells.” p 259
“Further research on a possible effect of fluoride on bladder
cancer risk should be conducted.” p288
“in vivo human genotoxicity studies in U.S. populations
or other populations with nutritional and sociodemographic variables
similar to those in the United States should be conducted.”
p288
