The Recent Science, Chemistry & Ethics of Water Fluoridation

∞

En Vino Veritas, En Aqua Sanitas; In Wine, there is Truth, In Water, Health.
One may notice the word Sanitas, latin for Health, the etymological origin on the word Sanitary – that Health is intimately related to Clean Water.  As for “Truth” it is “there for anyone to see.”1 This paper is about the health effects of a chemical. This chemical has a long history of being used as a pesticide2-4 sprayed on grapes, so pesticide residues are found in the Wine5-6 we drink. It is also regulated as an air pollutant,7-11 a water contaminant,12-3 banned by international treaty as a greenhouse gas;14 this chemical is also classified as “toxic,”15-6 “corrosive”17 hazardous industrial waste by the United Nations International Programme on Chemical Safety.15-7 What if I told you that this chemical is intentionally added into the public drinking water of 200 million Americans?18-23 When you drink this chemical, it is known to bioaccumulate in your body – your teeth and your bones,24-5 and your brain,26 yet public health authorities do not classify this chemical as an essential nutrient;27-9 rather, it is regulated as a drug for topical use, to be used on the surface of teeth30-2 yet it is not approved for systemic ingestion, to be swallowed.33-6 What if I told you the Center for Disease Control (CDC) has found 41%37 of youth have what the World Health Organization defines as a “water related disease”38 caused by ingesting too much of this chemical? It was at this point that I asked myself, having grown up in a community where the water was fluoridated; having grown up drinking fluoride in every single glass of water I drink – what are the public health implications of adding this chemical into our public drinking water?

“If we are to live so intimately with these chemicals – eating and drinking them, taking them into the very marrow our bones – we had better know something of their power and nature.”39 Today, we know health risks exist; a disease41 called fluorosis affects the teeth, our skeleton and increases bone fracture risk when we drink water with less than 4 parts per million of fluoride.42 This is the official conclusion of the 2006 National Research Council (NRC) of the National Academies of Sciences’ systematic review entitled, “Fluoride in Drinking Water.”42 Data published in this report also revealed the vast majority of infants43 exceed minimum adverse dosages of fluoride when drinking fluoridated water at the fluoride concentration recommended as “optimal” by the CDC.44 These findings catalyzed the parent of the CDC, the Department of Health & Human Services (DHHS) to reduce the “optimal” concentration by 42%.45 For decades, up to 1.2ppm was “safe and effective,”46 but now “safe and effective” is said to be 0.7ppm.47

Public Water, Public Right to Know

Since “it is the public that is being asked to assume the risks, the obligation to endure gives us the right to know.”48 This paper was written for the 200 million Americans who live downstream from fluoridation chemicals; the public has the right to know the health effects documented by recent science, and the public certainly ought to know what the 2006 NRC has concluded regarding such health effects.49

“Questions Unsettled”

The purpose of this essay is to allow the science to speak for itself; thus it is written de facto so as to allow the reader to determine whether recent science supports health risks because you have this authority as a rational being. As recent science will demonstrate, there is much epistemic uncertainty with safety; as the “whole situation is beset with questions for which there are at present no satisfactory answers.”50

What we do know is: “many of these questions are unsettled,” and “now we need to take a fresh look,” according to the Chairman of the 2006 NRC, Dr. John Doull, MD:

“What the committee found is that we’ve gone with the status quo regarding fluoride for many years – for too long really, and now we need to take a fresh look… In the scientific community, people tend to think this is settled, but when we looked at the studies, we found many questions are unsettled, and we have much less information than we should, considering how long this has gone on.”51

“We Need To Take A Fresh Look”

Beginning with the Chemical Itself, topical use of pharmaceutical grade fluoride in toothpaste is distinguished from water fluoridation, which is the systemic ingestion of fluoride industrial by-products,52 with known contaminants like lead and arsenic.53-5 Further discerned is that these by-products are otherwise fluorine air pollution56-61 known to cause human illness.62-7 Hence, this chemical is regulated as hazardous by the UN, US and EU.68 This is followed secondly by Dosage versus Concentration as it relates to Margin of Safety. This highlights the nuance between safe for all or adverse for some.

Thirdly, the Health Effects Documented by Recent Science are presented, with the 2006 NRC69 used as the arbiter of the Science Itself. First, bioaccumulation causes dental and skeletal fluorosis, increasing bone fracture. Second, since the NRC reported: “fluoride appears to initiate or promote cancers”70 and “fluorides have the ability to interfere with brain function,”71 we then go over its carcinogenicity and neurotoxicity in children.

Then, we postulate over the Ethics of Water Fluoridation: What if recent science supports the possibility of health risks? With 41% of youth diagnosed with fluorosis,72 a disease73 caused by ingesting too much fluoride, perhaps the issue lies in overexposure? Keep in mind this is a drug we otherwise have a choice to use with toothpaste or consume with a prescription; there is no choice when its in the public water. This leads to the principle of individual medical consent.74 Then, considering the WHO states on its website that “the toxicity of fluorides is due to the toxicity of the fluoride ion, a direct cellular poison,”75 we explore whether dose makes the poison? Or, is toxicity an inherent property?
Naturally, this transitions to the lack of scientific consensus: three out of 12 members of the 2006 NRC have signed a “Professional Statement to End Water Fluorid-ation.”76 Citing a “legitimate scientific controversy,”77 the Chairman of another systematic review from the UK has also signed. Perhaps epistemic uncertainty about risk warrants the precautionary principle? The Ethics section is then consummated with a question: Is it logically consistent to balance risk with reverence of life? Or, does this beg the question?

The Power and Nature of The Chemical Itself: Fluoride, Fluorine & Fluoridation
FDA Approved Topical Use vs. Non-Approved Systemic Ingestion

For most of us, when we hear fluoride, we think of toothpaste. This fluoride is distinct from water fluoridation in three respects: Food & Drug Administration (FDA) approval, purity of product, and means of consumption. Toothpaste and dentistry use FDA approved pharmaceutical grade sodium or stannous fluoride, which is regulated as a drug for topical use, on the surface of the teeth.1-3 On the back of all fluoride toothpaste, one will see words mandated by a federal drug labeling law: “Warning… if accidentally swallowed, call a poison control center right away.”4 Simple arithmetic proves the recommended “pea-size” amount of toothpaste and a glass of “optimally” fluoridated water both contain a dose of approximately 0.25mg of fluoride.5

Drinking a glass of fluoridated water and swallowing toothpaste are similar, in that both are systemic ingestion, however, systemic ingestion of fluoride is not FDA approved.6-8 When one uses fluoride toothpaste or when a dentist applies it to the surface of teeth, one is instructed to spit it out after use. This is FDA approved. On the other hand, fluoride intended for ingestion in the form of tablets prescribed by that dentist and those often distributed to children in public schools – this is not FDA approved.6-8 Nor have fluoridation chemicals – silicofluorides, ever been submitted for approval.9

• Fluoridation with Industrial By-Products

The fluoride added to the public drinking water is an unpurified industrial by-product of the phosphate fertilizer industry.10-13 All of the fluorides used in water fluoridation: Sodium Fluoride as well as Silicofluorides like Fluorosilicic Acid or Sodium Fluorosilicate – all industrial by-products, however predominately Silicofluorides are added to our water, as only 9% of fluoridated communities ingest sodium fluoride.14

Air Pollution Known to Cause Human Illness

Fluorides are otherwise fluorine air pollution.15 Specifically, fluorine gases emitted from smokestacks, captured via water spray.16 Federal law requires mandatory reclamation17 as fluorine is known to harm ecosystems,18 farmers’ crops,19 the health of animals,20-1 and the health of humans22 “in low ambient concentrations.”23 During the Cold War, fluorine emissions were responsible for more litigation claims against uranium, phosphate, aluminum and other metal industries24 than all other regulated air pollutants combined.25-6 In 1955, a US district court in Oregon ruled for the first time that fluorine emissions from an aluminum plant caused illness to a farmer’s family, their animals and their farm.27

Regulated as Hazardous Waste

Fluorine-emitting industrial plants are also identified by published case studies as the cause of hundreds of cases of illness and dozens of deaths during “temperature inversions” in two valleys: Donora, Pennsylvania, 1948,29 and Meuse Valley, Belgium, 1930.30 Common dictionaries define fluorine as a “highly corrosive poisonous gas, the most reactive of all elements.”31 Hence, fluoride is regulated as air pollution. When this air pollution is captured in an aqueous solution, it is then regulated as hazardous materials by the UN’s International Programme on Chemical Safety,32-4 the European Union,35-7 and the US Environmental Protection Agency (EPA).38 Sodium Fluoride and Sodium Fluorosilicate are classified as “Toxic,” while Fluorosilicic Acid, “Corrosive.”32-34

Contaminated Fluoridation Chemicals & Fluoride as a Water Contaminant

Fluoride hazardous waste is also known to contain contaminants.39-41 Fluoride is thus more appropriately termed fluoridation chemicals. The CDC,39 National Sanitation Foundation40 and EPA41 cite traces of Arsenic and Lead as the primary contaminants. It should be noted that EPA has determined zero lead and arsenic as the maximum safe level in drinking water.42 This arsenic we intentionally add to our drinking water from fluoridation chemicals could potentially cause up to 4,100 cases of cancer per year.43 Moreover, there are a plethora44 of other contaminants like mercury, and radioactive chromium-6. In fact, fluoride itself is regulated by EPA as a water contaminant.45

Violation of the Safe Drinking Water Act

Community Water Fluoridation is therefore the addition of a chemical that is classified as toxic, corrosive, contaminated hazardous industrial waste to our public drinking water. Technically, this is what CDC’s Oral Health Division recommends as a “safe and effective” preventative health policy to reduce tooth decay.46 In addition, with fluoride technically a drug, we can clearly see water fluoridation violates the spirit of the Safe Drinking Water Act: “No national primary drinking water regulation may require the addition of any substance for preventative health care purposes.”47 For this reason, water fluoridation may be appropriately termed mass medication.

Through a Narrow Window:
Concentration versus Dosage & Margin of Safety

The Safe Drinking Water Act prohibits the addition of drugs to our public drinking water for two reasons. First, we do not know how an individual will respond to and therefore be affected as DHHS reports “subsets of the population may be unusually susceptible to the toxic effects of fluoride.”[i] Second, since we all drink different quantities of water, we cannot control dosage.[ii] Even if we all drink one concentration, at say 1ppm, we will nevertheless consume different dosages, since we all drink different quantities of water, for example. Consider 0.05mg/kg/day, the dosage “meant to protect against” a probable risk[iii] of dental fluorosis,4 or 0.06mg/kg/day for bone fracture,5 or 0.114mg/kg/day for crippling skeletal fluorosis. 6 These are minimum adverse dosages determined to cause health risks.

Vast Majority of Infants Exceed Minimum Adverse Dosage
at “Recommended” Concentration

This is precisely what the 2006 NRC found when infants drink water between 0.7ppm and 1.2ppm F.7 At 1.2ppm, infants consume fluoride up to 273 fold that of human breast milk and at 0.7ppm, it is 70 to 160 times greater.8 This is why the CDC issued a warning urging parents against using fluoridated water to reconstitute baby formula.9 In fact, the American Academy of Pediatrics10 and the National Institute of Health11 recommend zero fluoride, “none” for infants, as fluoride is not classified an essential nutrient.12-5
Out of the whole population, it is the infant who receives the highest dosage; compared to adults, infants consume more water per unit body weight and process i.e., excrete fluoride less efficiently and therefore absorb more than adults.16-7 There are many factors affecting dosage, namely body weight, water consumption and excretion ability,18 and if you factor sensitivity like health or nutrition into the equation; this can compound the response,19 e.g. fluoride can “exacerbate the effects of low iodine.”20 Thus, natural variation means humans drinking one concentration = many dosages, many responses.

Uncontrollable Dosage & Unknown Effect on the Individual

When a drug is in the public drinking water, we cannot control the dosage, and even if we could, we still cannot control the effect on the individual. A WHO report notes: “the principal health concern is the uncontrollable exposure to fluoride.”22 Water fluoridation inherently precludes controlling dosage, and since dosage determines the safety of a medication, we cannot control the safety of water fluoridation as a form of mass medication. Safety, therefore, is about dosage; dosage determines safety, not the concentration in water per se.

Inadequate Margin of Safety: Too Close for Comfort?

The fact that infants are consuming adverse dosages22 means the maximum dosage (infant) exceeds the minimum adverse dosage – there is no margin or “buffer zone” to protect safety. No space for comfort. This is a logical proof: the margin of safety is not only inadequate,23 but nonexistent at approximately 1ppm, the concentration recommended as “optimal” since 1945.24 Therefore, with 1ppm “adverse” for infants, DHHS reduced the “optimal” concentration by 42% in 2011, down to 0.7ppm.25 From the “adverse” 1ppm to 0.7ppm – this is a very narrow window of safety, given the issue is the risk of an adverse, i.e. a toxic dosage consumed by infants from simply drinking water. The point being: if the concentration we drink, 0.7ppm, is too close in proximity to a concentration associated with adverse risk, such as 0.9ppm for children with iodine deficiency,26 this leaves us with a logical possibility: the margin of safety may still be insufficient to protect individuals from risk.

The Science Itself: Recently Documented Health Effects
2006 National Research Council Systematic Review “Fluoride in Drinking Water”

What follows are the most significant peer-reviewed studies published on the health effects of drinking fluoride in water as well as the associated conclusions of the 2006 NRC’s systematic review of 1,100 “toxicologic, epidemiologic, and clinical data on fluoride, published since 1993.”1 Ultimately, three health risks were explicitly confirmed for water with less than 4ppm: severe dental fluorosis, bone fracture and stage II skeletal fluorosis.2

Bio-Accumulation & Fluoride’s Affinity to Calcium:
Dental Fluorosis, Bone Fracture & Skeletal Fluorosis

Fluorosis is “an abnormal condition”3 caused by excessive fluoride intake,4-6 taking three forms: Dental, Skeletal and Clinical.7 The CDC8 estimates that 41% of all adolescents in the US have dental fluorosis, predominately in its mild form, which appears as permanent opaque white spots on the teeth. 3% of all people have a moderate to severe form, marked by full discoloration to orange-brown mottling and pitting.

Given the teeth and bone are the principal sites of fluoride bioaccumulation,9 nineteen studies since 1990 have examined fluoride in water and hip fracture among the elderly, eleven of which found a positive correlation.10 The American Journal of Epidemiology11 and American Medical Journal12 recently published studies finding increased hip fracture risk, e.g. >1.5ppm.11 The WHO13 cited Li et al., 200114 as evidence of fluoride’s ability to increase bone fracture risk, and a 2001 published study reported a positive linear correlation between bone fracture and severity of dental fluorosis in both children and adults.15

Therefore, “dental fluorosis often occurs with skeletal fluorosis.”16 Skeletal fluorosis is defined as a “musculoskeletal disease”17 “characterized by pathological bone changes.”18 This disease is documented as endemic among two groups of people. First, industrial workers19-28 with occupational exposure to airborne fluoride emissions exhibit high prevalence of this disease, e.g. the United Steelworkers Union has called for an industry-wide ban on the use of hydrogen fluoride.29 Skeletal fluorosis is also endemic with high levels of naturally occurring calcium fluoride in water, studied mostly in Indian and Chinese communities.30-5 There are also recent studies published in US and EU journals.^36-8 The Mayo Clinic³⁶ for example, describes onset as “insidious” and highly susceptible to misdiagnosis because fluorosis “mimics”37 arthritis; as they are both musculoskeletal diseases with clinically identical symptoms. Fifty million Americans are diagnosed with arthritis, two-thirds of which are under age 65. Water fluoridation commenced exactly 64 years ago.

Many studies including four out of five common dictionaries I found at my local library39-47 define fluorosis as “chronic fluorine poisoning,” with dental fluorosis “the first visible sign of chronic fluoride toxicity.”48 What is more, is the fact that the WHO defines fluorosis as a disease,49 not simply a condition, and reports: “the toxicity of fluorides is due to the toxicity of the fluoride ion, a direct cellular poison that binds calcium.”⁵⁰

Osteosarcoma in Children:

“Fluoride Appears to Initiate or Promote Cancers, Particularly of Bone”51

• Although several studies52-4 have found null effect between water fluoridation and osteosarcoma across the whole population, several US studies55-9 found a correlation in young males. Of these four, Bassin et al, 200659 is the only one to examine prevalence in an age, sex, and exposure-specific research design. Bassin et al “quantified total fluoride intake at various stages of life preceding the onset of cancer.”60 From private wells vs. municipal water vs. bottled water, to tap water used to cook food, fluoride intake from water was quantified for each year of a boy’s life preceding his diagnosis. Results yielded a statistically significant correlation: male children who drank fluoride, during ages six to eight, were 550% more likely to develop osteosarcoma by age twenty.

The study was conducted at Harvard’s Dental School, the product of Elise Bassin’s doctoral dissertation work. When it was published, it catalyzed the EPA National Union of Scientists to publicly reaffirm their opposition to water fluoridation,61 as stated in an open letter sent to all members of Congress.62 This was seven years after the first call for an “immediate” “national moratorium,” still viewable on the EPA Union’s website, entitled “Why EPA Union of Scientists Oppose Water Fluoridation.”63

Conclusively, the 2006 NRC “was not able to rule out a carcinogenic effect of fluoride;”64 although “principles of cell biology indicate” support of carcinogenic plausibility,65 the “evidence to date is” nevertheless “tentative and mixed.”66

Intelligence Quotient in Children:
“Fluoride’s Apparent Ability to Interfere with Brain Function”67

In 2012, Harvard University researchers “found strong indications fluoride may adversely affect cognitive development in children,”68 based on a review of 27 studies that examined fluoride in water and children’s intelligence.69 Out of a total of 43 studies in this domain, 37 have found an inverse relationship, and in 31 of these studies, the predominant source of fluoride was water, with the other six from coal emissions.70 Thus, to date, 31 studies conducted in China,71-91 Mexico92 India93-7 and Iran98-100 associate fluoride in water to measurably lowered IQ among children.

There are also several studies on brain function recently published in US and EU journals. Two studies in the US journal Neurotoxicology link silicofluorides in water to increased uptake of lead into children’s blood assays, suggesting fluoride’s corrosive properties may leach lead from pipes.101-2 Another study found fluoride bioaccumulation in the brain, in the calcifying tissues of the human pineal gland.103 In addition, neurotoxic effects are documented in rats at levels equivalent to humans drinking 5 to 10ppm104 and 2.5ppm,105 both of which appear in the US journal, Neurotoxicology & Teratology. The former104 of which, also found fluoride in the hippocampus, the section associated with memory while another study, published in the US journal Brain Research reported fluoride increased aluminum uptake into the brains of rats, forming deposits linked to Alzheimer’s.106 Such results are replicated in many studies, the majority published outside the US.107-18

Lastly, to end on two reviews. “Chronic exposure to fluoride may be associated with cerebral impairment affecting particularly concentration and memory,” concluded a review in the US journal International Clinical Psychopharmacology.119 In 2014, fluoride was named among several newly confirmed “developmental neurotoxins” in a review conducted by Harvard researchers, published in the Lancet,120 the oldest, most prestigious medical journal in the UK.

Risk, Reverence of Life & The Ethics of Water Fluoridation

Over-Exposure, Individual Medical Consent & Dose Makes the Poison?

“Life,” Rachel Carson focused Silent Spring, “is a miracle beyond comprehension; we should reverence it.”1 What Reverence of Life is reflected in the fact that the CDC – the federal agency which promotes fluoridation, has found 41% of youth2 have what the WHO has defined as a disease3 caused by ingesting too much fluoride in the water? Two out of every five adolescents are diagnosed with fluorosis. The paramount issue is: we know “the first visible sign of chronic toxicity” is dental fluorosis.4 Therefore, public health implications are not about dosage, concentration, or science; it is the fact that our children are overexposed to a drug we otherwise would have a choice to use with toothpaste or consume with a prescription. Where is individual medical consent with fluoridation?

Fluoride medication in the form of tablets, are behind the counter at the pharmacy.5 The Greek origin of pharmacy – pharmacon – has a dual meaning: one substance, at the right dose, a medicine, at too high a dose, a poison. “As Paracelsus once wrote, ‘the right dose differentiates a remedy from a poison.’”6 This is true of essential nutrients, for instance but undoubtedly, it is false for “chemicals totally outside the limits of biologic life;”7 no dose of lead or arsenic is benign, nonetheless a remedy.8-9 Thus, for poisons per se, “toxicity is an inherent quality of the chemical itself.”10

“The toxicity of fluorides is due to the toxicity of the fluoride ion, a direct cellular poison” – this sentence appears on the WHO’s website.11 Whether lethal or non-lethal, too high a dose at one time causes acute poisoning, like swallowing toothpaste. On the other hand, chronic poisoning is non-lethal doses over a period of time. Ponder the mathematical proof mentioned earlier: pea-size toothpaste, a glass of fluoridated water – both, 0.25mg F.12 A federal law13 based in toxicology recommends you call poison control if you systemically ingest that toothpaste. Another federal policy14 based in dentistry, which treats oral health primarily on a topical basis, recommends you systemically ingest, in every glass of water you drink, for your entire lifetime, precisely the dose of fluoride the federal health law explicitly implies causes acute poisoning. How is water fluoridation not chronic poisoning? How can a Toxic Poison be Safe & Healthy? For everyone? For a lifetime?

Probably Safer & Healthier to Simply Drink Just Water:

Calculated Risk & The Lack of Scientific Consensus

Three out of twelve members of the 2006 NRC have signed Fluoride Action Network’s “Professional Statement to End Water Fluoridation.”15 One member of the NRC, Dr. Kathleen Thiessen, a Senior Risk Analysis Scientist, joins Dr. William Marcus, former Chief Risk Assessment Toxicologist at EPA’s Office of Water.16 To date, the most avidly and publicly outspoken scientists against water fluoridation have been the Toxicologists, Biochemists, and Risk Assessment Statisticians at the Environmental Protection Agency.17
Scientific opposition also extends to the dental profession. A second member of the NRC, Dr. Hardy Limeback, past president of the Canadian Association for Dental Research joins Dr. John Colquhoun, a former Chief Dental Officer in New Zealand – two former proponents who have since reversed their position.18 In addition, a Dr. David Kennedy of the International Academy of Oral Medicine & Toxicology has also signed.19
Lastly, Dr. Robert Isaacson, the third member of the NRC, is a Neuroscientist.20 Perhaps the most preeminent name on the list is a Pharmacologist, Dr. Arvid Carlsson, the 2000 Nobel Laureate in Physiology & Medicine.21 Logically, it is dissent from scientists in precisely these fields, which makes one question any claim about scientific “consensus.”

These are the ones Who Walk Away From Omelas,22 an allegory representing the inherent conflict between the utilitarian ideal of the greatest good for the greatest number and the deontological right of the individual, which in this case, is the principle of medical consent, freedom of choice, and freedom from an obligation to endure risk.

Those Who Walk Away: Epistemic Uncertainty & Bioethics

Omelas is the quintessential Utopia, albeit, with one caveat: it depends on the eternal suffering of a young boy, locked in a broom closet, with nothing beyond a paucity of food with fluoride pesticides residues and fluoridated water for subsistence. Everyone knows of the compromise; if the boy is loved or freed, the Utopia ceases. Those who walk away choose to do so as they are unable to justify sacrificing an Individual’s Health – their access to the Good Life, in exchange for their own. Fluoridation would be utopic if it effectively cured our cavities, but is it safe?
Dr. Colquhoun posed the ethical dilemma succinctly: “How many cavities would have to be prevented to justify the death of one man from osteosarcoma?” What reverence of life is posited in the justification of uncertain, perhaps seemingly small risks? One in a million? 200 million people + 550% possibility = 200 boys.23 If the Chair of the 2006 NRC says “questions are unsettled”24 after 69 years of water fluoridation, is anyone in a position to make truth claims about the magnitude of risk?

“The nature of uncertainties in the existing data could also be viewed as supporting a greater precaution regarding the potential risk to humans.”25 This was the conclusion of the NRC regarding fluoride and its statistically significant link to bone cancer in young boys.

“Legitimate Scientific Controversy”26

Three members of the 2006 NRC along with the Chair of another systematic review, Dr. Trevor Sheldon from the UK National Health Centre for Reviews and Dissemination all signed the “Professional Statement to End Water Fluoridation.”27 Why? Simply, because they are uncertain whether fluoride is safe for public health. Dr. Sheldon clarifies in an open letter: “until high quality studies are undertaken providing more definite evidence, there will continue to be a legitimate scientific controversy over the likely effects and costs of water fluoridation.”26 These scientists choose public opposition because they are unable to justify the possible risk to individual life, even if it may be for the greater good.

The Other Road: Risk, Reverence of Life & The Precautionary Principle

If the National Research Council of the National Academies of Sciences is “uncertain” about the “potential risk” of fluoride as a carcinogen to children, why should the public give fluoride the benefit of the doubt? We therefore find ourselves at an ethical juncture as it relates to Risk & Reverence of Life. One Road is to presume safety until we are certain studies have proven risk through finding harm. This is tantamount to the assumption that chemicals are innocent until proven guilty. Hence, we must wait for the public – us, to be harmed? At this point, is it reasonable to simply turn the knob off at the water treatment plant, to drink just water until we are 100% certain of safety?
This is the Other Road: to abide by the Precautionary Principle; in the presence of a preponderance of evidence to support the notion that water fluoridation may cause a risk of harm to public health, and in the absence of counter-evidence to warrant safety, the action to be taken is therefore twofold: we walk down the only road we know is safe: just drink water – clean water, then concomitantly ask for further research. Precaution is proactive; the public shouldn’t have to wait to be harmed, to prove fluoride guilty.

The Notion of Balance

“The conventional view that the ethical dilemmas posed by water fluoridation can be solved by balancing the benefits and harms actually begs the question, for it presumes such a balance can be achieved.”28 Is it logically consistent to view safety as an issue of concentration? Doesn’t this presume we can balance risk with reverence of life? This is akin to the policy of “tolerance” with pesticide residues. Even if fluoride is safe for most people, evidence supports fluoride may be harmful to infants and children, in particular. What about the possibility of risking an Individual’s Health – their access to the Good Life?

Reiterated, “How can it be ethical to be putting industrial waste in our drinking water?”29 Is it right to dose an infant with a chemical we know is not an essential nutrient,30 for a lifetime, through the public water, without consent? Can we justify this, knowing the vast majority will likely consume too much from drinking fluoridated water?31 Then, children brush with F toothpaste, twice a day, every day…32 and then eat insecticide on foods.33-9 6.8ppm in grape juice.36 A kiwi – 15ppm.40 No wonder two in five kids show the visible sign of over-exposure on their teeth.41 Why shouldn’t we add fluoride to the water? That is the question.

The Conclusion Speaks for Itself: Res Ipsa Loquitur
Clean Water Essential for Health; En Aqua Sanitas

After taking a fresh look at the recent science, chemistry and ethics of water fluoridation, would you consider fluoridated water, clean water? What of the public health implications? If we ask the Chairmen of recent systematic reviews, combined they say “questions are unsettled”1 due to a “legitimate scientific controversy…”2 after 69 years of water fluoridation.

The Lack of Scientific Consensus: EPA Toxicologists versus CDC Dentists

Consider both sides. The toxicologists, biochemists and statisticians at EPA report health risks are imminent: “Our opposition to drinking water fluoridation has grown, based on the scientific literature documenting… chronic toxic hazards of cancer… We looked at the cancer data with alarm… other incriminating cancer data.”3 This position statement is derived from expertise is the field of toxic chemical public health risk assessment. Notably, these scientists who publicly oppose water fluoridation – their job is to analyze the public health implications of science, to protect the public from the industries and entities who pollute our environment at our peril. On the other hand, dentists from the CDC, whose expertise pertains to the oral health of teeth and gums, who have publicly promoted this policy for half a century, report: “No credible evidence”4 links fluoride to cancer.
We find this sort of discrepancy between authorities from two vastly different domains, is akin to the case of DDT, as reported in Silent Spring:

“The citizen who wishes to make a fair judgment of the question
of wildlife loss is today confronted with a dilemma.
On the one hand, conservationists and many wildlife biologists assert that the losses have been severe and in some cases catastrophic.
On the other hand, the control agencies tend to deny flatly and categorically that such losses have occurred, or that they are of any importance if they have.
Which view are we to accept?”5
“The professional wildlife biologist on the scene is certainly best qualified
to discover and interpret wildlife loss.
The entomologists, whose specialty is insects, is not so qualified by training
and is not psychologically disposed to look for undesirable side effects
of his control programs.”6
“In spite of the assurances of the insecticide people
that their sprays were ‘harmless to birds,’
the robins were really dying of insecticidal poisoning.”7
“From all over the world come echoes of the peril facing birds.
The reports differ in detail, but always repeat the theme of death to wildlife
in the wake of pesticides.”8
“Yet it is the control men in state and federal governments
and of course the chemical manufacturers
who steadfastly deny the facts reported by the biologists
and declare they see little evidence of harm to wildlife.”9

The Paradigm Shift

At one point in time, the Principal Dental Officer of New Zealand, Dr. John Colquhoun, a self proclaimed former “fierce advocate” of fluoridation was asked to conduct a systematic review of fluoridation studies worldwide. The result, his essay: “Why I Changed My Mind on Water Fluoridation,”10 notes his PhD dissertation11 about water fluoridation was based on Thomas Kuhn’s The Structure of Scientific Revolutions,12 the book that coined the term “paradigm shift.” He found the history of science has a structure: “Normal Science” is bound by loyalty to a certain paradigm, a “worldview” inherited ideologically as a tradition by the previous generation, but “when the profession can no longer evade anomalies that subvert the existing tradition of scientific practice then begin the extraordinary investigations”13 that lead to the paradigm shift and ultimately “a scientific revolution, together with the controversies that almost always accompany them.”14

“Science has included bodies of belief quite incompatible with the ones we hold today.”15 This attests to a core tenet of science, according to Sir Karl Popper: that it is tentative, not absolute. At one point in history, “scientific” empirical observation reinforced the Ptolemaic geocentric model as the Truth, until Copernicus’ heliocentric model proved the Sun, the center of the universe. Galileo, who publicly embraced the Sun, rather than the Earth, as our center, was persecuted as a heretic by a trial of the educated elite. Today, we know that Truth does not revolve around our paradigms.

Historically, “Truth,” according to Schopenhauer, “goes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as self-evident.” Any novel claim, whether truthful or otherwise, if contrary to the worldview of the consensus, will be resisted. Einstein said: “Consensus is abhorred by the genius because when it is reached, thinking stops.” “Historically, the claim of consensus is the first refuge to avoid debate by claiming the matter is already settled… The greatest scientists in history are great precisely because they broke with the consensus.”16

Breaking Away from Consensus: Why Portland, Oregon Voted No

Like Copernicus and Galileo, Silent Spring broke the consensus, causing a revolution. When it was published in 1962, Time magazine wrote a book review, entitled “Pesticides: The Price for Progress.”17 Rachel Carson’s “emotional and inaccurate outburst” was regarded as “hysterically over-empathetic.” DDT, then “so universally used [it took] on the harmless aspect of the familiar”18 was banned ten years later.19 Likewise, the last major city with fluoride-free drinking water broke with the consensus in 2013. Six months after Portland voted No,20 Harvard researchers published a review in The Lancet confirming fluoride a neurotoxin.21

As a whole, the No vote likely reflects a preference for choice, i.e. to use fluoride topically with toothpaste or consume systemically with a prescription. Thus, the principle of individual consent is fundamental to the debate22 because fluoride is a drug.23 Adding contaminated24-8 industrial waste,29-30 regulated as hazardous31-4 for its corrosive31 and toxic properties32-3 into the public drinking water to treat dental decay is mass medication, technically. Moreover, when we drink this drug, this is not FDA approved35-8 because, when its in the water, dosage is uncontrollable, so safety is uncontrollable. This is why the Safe Drinking Water Act prohibits adding drugs to the public drinking water.39

With 41% of youth diagnosed with fluorosis,40 it is evident from all the sources of fluoride how children consume too much. The vast majority of infants exceed safe dosages of fluoride from water alone,41 and then go on to ingest fluoride from toothpaste42 twice a day, every day, after eating all sorts of foods laced with fluoride pesticide residues.43 When authorities reduced the “optimal” concentration, recommended for over half a century, by 42% in 2011,44 this tacitly acknowledged an inadequate margin of safety with water fluoridation.
Portland also could “not evade the anomalies” in the science itself. The 2006 NRC explicitly confirmed fluorosis as a real health risk – this is a disease affecting the teeth and skeleton, and it makes the bones more susceptible to fracture.45 Implicitly confirmed is a possible risk of cancer,46 neurotoxicity,47 endocrine,48 thyroid49 and immune system50 disruption, Down’s syndrome,51 compounded risks to people with diabetes52 and kidney dysfunction.53 Perhaps the lack of scientific consensus about safety54 is due to epistemic uncertainty about risk, which may warrant precaution? The ethics of water fluoridation therefore beckons many questions about whether we can balance risk with reverence of life by simply adjusting the concentration.
“The balance of nature is not a status quo”55 – this is the conclusion put forth by Rachel Carson after presenting the recent science on DDT, in Silent Spring.
“We have gone with the status quo for too long”56 – this is the conclusion of the Chair of the 2006 NRC’s review of the recent science on “Fluoride in Drinking Water.”
Fluorosis is typical, but is it natural for 41% of children57 to have a disease58 caused by ingesting too much of a chemical we intentionally add to the public drinking water? Water fluoridation may be effective for the teeth, but is it safe for the body?

“The Solution is Biological, Not Chemical”59

Although “many people believe [fluoride] is harmless since so many do not feel any immediate effect,”60 the conclusion of Silent Spring is cautionary: the “consequence” of ingesting non-essential61 chemicals that permanently bio-accumulate within our body,62 for a lifetime, “may be remote in time and place.”63 “That there are no immediate symptoms [therefore] is of little consequence, for the toxins may sleep long in the body, to become manifest years later in an obscure disorder impossible to trace to its origins.”64
Conclusively, this essay was an attempt to reconcile the following points in the water fluoridation debate. Firstly, the presence of lead, arsenic and other contaminants inherently precludes safety. Regarding fluoride itself, the pattern of results indicates health risks to the greater population, so this possibility invalidates the notion that the greater good justifies violating individual medical consent, a principle based unambiguously in deontological, universal reasoning. The most significant conclusion however is: one can justify ending water fluoridation on utilitarian grounds, and there is consequentialist reasoning behind the uncertainty of risk – the premise of the precautionary principle.

BIBLIOGRAPHY

⌘

INTRODUCTION

1.) Rachel Carson, Silent Spring, 1962. Boston, MA: Houghton Mifflin. Pg. 25.

2.) Environmental Protection Agency Pesticide Registration Review, ‘EPA Proposes to Withdraw Sulfuryl Fluoride Tolerances.’ http://www.epa.gov/pesticides/sulfuryl-fluoride/evaluations.html

3.) Pesticides on All Sorts of Foods. U.S. Department of Agriculture, “USDA National Fluoride Database of Selected Beverages and Foods,” 2004. Prepared by Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA; in collaboration with University of Minnesota, Nutrition Coordinating Center; University of Iowa, College of Dentistry; Virginia Polytechnic Institute and State University, Food Analysis Laboratory Control Center; National Agricultural Statistics Service, CSREES, USDA; and Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service. See: https://library.villanova.edu/Find/Record/817953/Details
See also: Federal Register Volume 67, Number 79 (Wednesday, April 24, 2002), Environmental Protection Agency, “Notice of Filing a Pesticide Petition to Establish a Tolerance for a Certain Pesticide Chemical in or on Food.” E.g., Fluoride Pesticide Residue Tolerance: 10ppm on Apricots, 15ppm on Kiwi, Up to 35ppm on Kale. http://www.gpo.gov/fdsys/pkg/FR-2002-04-24/html/02-9655.htm

4.) Fluorine in Agriculture, 1995. Edited by R. Banks, University of Manchester. Pg. 3, Shell trademarked a fluoride based insecticide and rodenticide. Dow has trademarked a fluoride based herbicide, and DuPont, fluoride fungicide. Google eBook.
5.) A. Burghstahler, “Fluoride in California Wines and Raisins,” Fluoride Vol. 30, No.3 (1997): 142-46. “Water-extractable F content of five brands of California raisins varied from 0.83 to 5.2 ppm (mean 2.71ppm). Elevated F levels in these wines and raisins appear to result from the pesticide use of cryolite (Na3AfF6) in the vineyards.”

6.) G. Ostrom, “Cryolite on Grapes/Fluoride in Wines—A Guide for Growers and Vintners to Determine Optimum Cryolite Applications on Grapevines,” CATI Viticulture and Enology Research Center, California State University, Fresno, published by the California Agricultural Technology Institute, CATI Publication #960601, June, 1996.

7.) D.F. Walters, “Regulatory, Economic, and Legal Aspects of Fluoride” presented at a conference, held at Utah State University in 1982, published in Fluorides: Effects on Vegetation, Animals and Humans (Salt Lake City, UT: Paragon Press, 1983). Authors: H.B. Peterson, N.C. Leone, Edited by: J.L. Shupe. Pg. 351-358, Fluoride is classified as a “welfare pollutant” under the Clean Air Act.
8.) U.S. Agency for Toxic Substances and Disease Registry, ‘Fluorides, Hydrogen Fluoride and Fluorine,’ Section 8: Regulations and Advisories. ‘Acute duration inhalation MRL of 0.01ppm has been derived for fluorine.’ http://www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf
9.) National Service Center for Environmental Publications. EPA document from December 1976: ‘Fluorine, Its Compounds and Air Pollution: Bibliography with Abstracts.’ Online. Go to Google.com, type in ‘fluorine EPA air pollutant,’ click on nepis.epa.gov link.
10.) EPA, National Research Council, Committee on Acute Exposure Guideline Levels, Committee on Toxicology, Environmental Criteria and Assessment Office. ‘Summary Review of Health Effects Associated with Hydrogen Fluoride and Related Compounds,’ Google eBook.
11.) EPA, ‘Fluorine, Its Compounds and Air Pollution: Bibliography and Abstracts,’ from the Office of Air Quality Planning and Standards, 1976. Google eBook.

12.) Environmental Protection Agency, List of Maximum Contaminant Levels in drinking water. http://water.epa.gov/drink/contaminants/upload/mcl-2.pdf

13.) United States Government Printing Office. Federal Register Volume 62, Number 234, Friday, December 5, 1997. 40 CFR Part 180. Environmental Protection Agency: ‘Fluorine Compounds; Time Limited Pesticide Tolerance.’ Pg. 64297, C. Exposures and Risks, Section 2, Part ii: ‘Fluoride levels in public drinking water are regulated under the Safe Drinking Water Act. EPA has established a Maximum Concentration Limit (MCL) at 4.0 mg/L 0.114 mg/ kg/day to protect against crippling skeletal fluorosis (April 2, 1986) (51 FR 11396).’ http://www.gpo.gov/fdsys/pkg/FR-1997-12-05/html/97-31920.htm

14.) United Nations Environment Program, Ozone Secretariat. Montreal Protocol. http://ozone.unep.org/new_site/en/montreal_protocol.php

15.) U.N. International Programme on Chemical Safety and European Commission classify Sodium Fluoride as Hazardous Waste: UN Hazard Class: 6.1 – Toxic substance. EC Classification: Symbol: T – Toxic substance. http://www.inchem.org/documents/icsc/icsc/eics0951.htm

16.) Ibid., Sodium Fluorosilicate as Hazardous Waste: UN Hazard Class: 6.1 – Toxic substance. EC Classification: Symbol: T – Toxic substance. Labeling: “Signal: Danger, Toxic if swallowed [skull and crossbones symbol].” http://www.inchem.org/documents/icsc/icsc/eics1243.htm

17.) Ibid. Fluorosilicic Acid as Hazardous Waste: UN Class 8 – Corrosive substance. EC Classification: Symbol: C – Corrosive substance Disposal: “Do NOT let this chemical enter the environment.” http://www.inchem.org/documents/icsc/icsc/eics1233.htm
See also: Environmental Protection Agency, Classifications of Hydrofluorosilicic Acid, Sodium Fluorosilicate, Sodium Fluoride: all fluorides are CERCLA Waste Substances from Superfund Sites: ‘severely harmful to human health and the environment.’ www.epa.gov/osweroe1/docs/er/302table01.pdf.
18.) National Research Council of the National Academy of Sciences, ‘Fluoride in Drinking Water,’ 2006. Washington DC, National Academies Press. Pg. 15, “The most commonly used [drinking water] additives are silicofluorides, not the fluoride salts used in dental products (such as sodium fluoride and stannous fluoride). Silicofluorides are one of the by-products from the manufacture of phosphate fertilizers.” http://www.nap.edu/catalog.php?record_id=11571

19.) Thomas G. Reeves, P.E., National Fluoridation Engineer, Program Services Branch Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention. Refer: FL-143, September 2000. “All of the fluoride chemicals used in the U.S. for water fluoridation, sodium fluoride, sodium fluorosilicate, and fluorosilicic acid, are useful byproducts of the phosphate fertilizer industry… These gases are captured by product recovery units (scrubbers) and condensed into 23% fluorosilicic acid. Sodium fluoride and sodium fluorosilicate are made from this acid.”

20.) Center for Disease Control. “Engineering Fact Sheet.” Click on ‘Types and Sources of Fluoride Additives.’ http://www.cdc.gov/fluoridation/fact_sheets/engineering/wfadditives.htm#2

21.) Petition to Environmental Protection Agency Administer Robert Perciasepe, from Dr. William Hirzy, on behalf of co-petitioners. Request for EPA to prohibit silicofluorides and unpurified sodium fluoride as fluoridating agents due to arsenic contamination; Request to mandate pharmaceutical grade sodium fluoride. April 22, 2013. Pg. 2, and 17. http://www2.epa.gov/aboutepa/hfsa-section-21-petition

22.) Department of Health and Human Services, PHS, CDC, ‘ National Center of Prevention Services, Division of Oral Health, 1993. Fluoridation Census (1992). Table VI, page xviii.
23.) Center for Disease Control, 200million, 74% http://www.cdc.gov/fluoridation/basics/

24.) H. Hodge, “Safety Factors in Water Fluoridation Based on the Toxicology of Fluorides,” The Proceedings of the Nutrition Society American Academy of Pediatrics Policy Statement American Academy of Pediatrics Policy Statement Vol. 22 (1963): 111-7http://journals.cambridge.org/action/displayFulltext?type=1&fid=784060&jid=PNS&volumeId=22&issueId=01&aid=784052

25.) Handbook of Nutritionally Essential Mineral Elements, 1997. Edited by B. O’Dell, R. Sunde. New York: Marcel Dekker Inc. Pg., 587, ‘At least 95% of total fluoride is found in bones and teeth.’ Note: Pg. 593, ‘Fluoride can only be classified as an essential nutrient if a broad definition is used.’ Google eBook.

26.) J. Luke, “Fluoride Deposition in the Aged Human Pineal Gland,” Caries Research Vol.35, No. 2 (2001): 125–28.
27.) European Union Panel on Dietetic Products, Nutrients and Allergies, Affiliated with the European Food Safety Authority, Scientific Committee on the Status of Dietary Reference Values for Fluoride. Requested by European Commission. EFSA Journal. Issue 11, No. 8 (Aug 2013). Pg. 3332. ‘Fluoride is not an essential nutrient.’ This sentence is viewable online: http://www.efsa.europa.eu/en/efsajournal/pub/3332.htm

28.) U.S. Federal Register, Volume 60, Number 249. Rules and Regulations, 21 CFR, Part 101. Docket NO. 90N-0134, RIN 0910-AA19. Department of Health and Human Services, Food and Drug Administration, “FDA Food Labeling: Reference Daily Intakes.” December 28, 1995. Last sentence of Section II: “Consistent with the vast majority of comments, FDA is adopting these values [Daily Values, i.e. Dietary Reference Intakes, for essential nutrients] except the value for fluoride, as explained below.”

See also: National Institute of Health’s “MedlinePlus Medical Encyclopedia.” Note: “Recommended Daily Dietary Intake of fluoride” is a distinct term from “Recommended Daily Allowance,” used with essential nutrients like calcium.   http://www.nlm.nih.gov/medlineplus/ency/article/002420.htm
29.) Letter by Dr. Bruce Albert, president of the National Academy of Sciences, and Dr. Kenneth Shine, president of the Institute of Medicine, to Dr. Albert W. Burgstahler and other scientists, November 20, 1998. “Contradictory results do not justify a classification of fluoride as an essential element, according to accepted standards. Nonetheless, because of its valuable effect on dental health, fluoride is a beneficial element for humans.’
See also: B.A. Burt, ‘The Changing Patterns of Systemic Fluoride Intake.’ Journal of Dental Research, Vol. 71, No. 5 (May 1992). Pg. 1228-1237. ‘Fluoride is not an essential nutrient due to a lack of studies.’

30.) Food and Drug Administration, “FDA Approved Drug Products Database.” http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm Colgate total fluoride toothpaste was approved July 1997. Injectable sodium fluoride “fluorine f-18” was approved in 1972 – discontinued. Injectable “sodium fluoride f-18” was approved January, 2011 – discontinued. Then again, injectable “sodium fluoride f-18” was approved for two manufacturers, one in December 2012, the other June 2013.
31.) Canadian National Association of Pharmacy Regulatory Authorities. Search the National Drug Schedules for “sodium fluoride” or “fluoride and its salts.” http://www.napra.org/

32.) Letter to Honorable Ken Calvert, Chairman, Subcommittee on Energy and Environment, Committee on Science, US House of Representatives, regarding FDA’s response to a Congressional Investigation about fluoride and fluoridation, from Melinda K. Plaisier, FDA Associate Commissioner for Legislation. December 21, 2000. “Fluoride, when used in the diagnosis, cure, mitigation, or prevention, of disease in man or animal, is a drug that is subject to FDA regulation […] Several NDAs [New Drug Applications] have been approved for fluoride topical products such as dentrifices and gels.” http://www.keepersofthewell.org/gov_resp_pdfs/fda_response.pdf

33.) Letter to Commissioner Jane Henry, Food and Drug Administration, from John Kelly, New Jersey Assemblyman, 36^th district, October 26, 2000. “I am petitioning the FDA to remove unapproved children’s fluoride supplements from the market… I filed a Freedom of Information Act request with the FDA to obtain copies of the studies the FDA had used in evaluating the safety and effectiveness of these products. I was shocked when the FDA informed me that the FDA had no such studies and that children’s fluoride supplements were not approved…. The last time the FDA reviewed an NDA for fluoride supplements was in 1975 and that NDA was rejected.”

34.) Citation #32: Letter to Honorable Ken Calvert, from Melinda K. Plaisier, Food & Drug Administration. “No New Drug Applications have been approved for fluoride drugs meant for ingestion… Fluoride products meant for ingestion were in use prior to the enactment [of the Kefauver-Harris Amendments (Drug Amendments of 1962) to the Food, Drug and Cosmetic Act [of 1938], in which efficacy in addition to safety became a requirement for drugs marketed in the U.S.”
See also: Approved Drug Products and Legal Requirements, Volume III of USP Dispensing Information, US Pharmacopeial Convention, 2004. 24^th Edition. Tauton, MA: Quebecor World. ISBN 1-56363-465-1. Pg. III/1, “The Federal Food, Drug and Cosmetic Act of 1938 require that drugs be shown to meet certain safety requirements prior to their being marketed. Drugs that were already being marketed at that time were ‘grandfathered,’ and were allowed to remain on the market without further regulatory approval… The following listing identifies drug products that we believe were considered ‘pre-1938’ or ‘grandfathered’… Sodium Fluoride (Solution, Oral + Tablets).”

35.) Food and Drug Administration, “FDA Approved Drug Products Database.” Online. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm One will note there are no systemic approvals. See also: National Institute of Health’s “DailyMed Current Medication Information” Database of Currently Marketed Drugs, including whether or not a drug is FDA approved. http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=fluoride&x=0&y=0

36.) D.W. Cross, R.J. Carton, “Fluoridation: A Violation of Medical Ethics and Human Rights,” International Journal of Occupational Environmental Health Vol.9, No. 1 (Jan-March 2003): 24-9. “Silicofluorides have never been submitted to the US FDA for approval as medications.”

37.) Center for Disease Control, “Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004.” http://www.cdc.gov/nchs/data/databriefs/db53.htm#summary

38.) World Health Organization, ‘Water-related diseases: Fluorosis.’ Online. ‘Ingestion of excess fluoride, most commonly in drinking-water, can cause fluorosis which affects the teeth and bones.’ http://www.who.int/water_sanitation_health/diseases/fluorosis/en/

39.) Rachel Carson, Silent Spring, 1962. Boston, MA: Houghton Mifflin. Pg. 25.

40.) Ibid. Silent Spring, Pg. 28.

41.) National Academy of Sciences, National Research Council, ‘Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.’ Washington, DC: National Academies Press, 2006. Pg. 170-71: “excessive intake of fluoride will manifest itself in a musculoskeletal disease with a high morbidity” i.e. skeletal fluorosis. http://www.nap.edu/openbook.php?record_id=11571 *This citation referred to herein, as NRC, ‘Fluoride in Drinking Water,’ 2006.
See also: World Health Organization, ‘Water-related diseases: Fluorosis.’ ‘Ingestion of excess fluoride, most commonly in drinking-water, can cause fluorosis which affects the teeth and bones.’ http://www.who.int/water_sanitation_health/diseases/fluorosis/en/

42.) Ibid. NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 2-3, “After reviewing the collective evidence, including studies conducted since the early 1990s, the committee concluded unanimously that the present MCLG of 4mg/L for fluoride should be lowered. Exposure at the MCLG clearly puts children at risk of developing severe enamel fluorosis, a condition that is associated with enamel loss and pitting. In addition, the majority of the committee concluded that the MCLG is not likely to be protective against bone fractures.” See also: Pg. 10, “Lowering the MCL will prevent children from developing severe dental fluorosis and will reduce the lifelong accumulation of fluoride into bone that the majority of the committee believes is likely to put individuals at increased risk of bone fracture and possibly skeletal fluorosis.”

43.) Ibid. NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 29, Infants with average water consumption: range of dosage is 0.042 to 0.072mg/kg/day. Infants with above average water consumption: range of dosage is 0.084 to 0.14mg/kg/day. http://www.nap.edu/openbook.php?record_id=11571 *This citation referred to herein, as NRC, ‘Fluoride in Drinking Water,’ 2006.

44.) Agency for Toxic Substances & Disease Registry, ‘Toxicological Profiles of Fluoride.’ Reference Dosage (RfD): Dental Fluorosis: 0.06mg/kg/day
Maximum Residue Limit (MRL): Bone Fracture: 0.05/mg/kg/day

www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf

Also viewable at EPA’s Integrated Risk Information System: http://www.epa.gov/iris/subst/0053.htm

45.) Department of Health and Human Services and Environmental Protection Agency, ‘News Release: EPA & DHHS Announce New Scientific Assessments and Actions on Fluoride.’ January 7, 2011. http://yosemite.epa.gov/opa/admpress.nsf/3881d73f4d4aaa0b85257

359003f5348/86964af577c37ab285257811005a8417!OpenDocument

46.) Center for Disease Control. ‘Community water fluoridation prevents tooth decay safely and effectively.’ http://www.cdc.gov/healthywater/drinking/public/water_treatment.html
See also: Center for Disease Control, ‘Fluoridation FAQ Sheet.’ ‘In 1962, based on scientific studies showing that fluoride reduces tooth decay, the U.S. Public Health Service recommended the amount of fluoride in drinking water range from 0.7 to 1.2 milligrams per liter.’ http://www.cdc.gov/fluoridation/faqs/#overview7
See also: NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 1, ‘Guidelines for that purpose (0.7 to 1.2 mg/L) were established by the U.S. Public Health Service more than 40 years ago.’

47.) Citation #45. See also: Center for Disease Control & Prevention, See under: ‘How is HHS developing new recommendations?’ ‘HHS has proposed changing the recommended level for community water fluoridation.’ ‘New proposed optimal fluoridation level.’ http://www.cdc.gov/fluoridation/faqs/#overview6
48.) Rachel Carson, Silent Spring, 1962. Pg. 23.

49.) NRC. “Fluoride in Drinking Water,” 2006.
Dental Fluorosis, Bone Fracture & Skeletal Fluorosis, Citation #42.

Bone Cancer: “Fluoride appears to have the potential to initiate or promote cancer, particularly of the bone,” Pg. 336. “Osteosarcoma is of particular concern as a potential effect of fluoride…” Pg. 336. “Bone is the most plausible site for cancer associated with fluoride,” Pg. 9.

Down’s Syndrome: “Down’s syndrome is a biologically plausible outcome of exposure,” Pg. 197.

Thyroid: “Several lines of information indicate an effect of fluoride exposure on thyroid function,” Pg. 234.

Endocrine Disruptor: “Fluoride is therefore an endocrine disruptor,” Pg. 266.

Neurotoxin: “It is apparent fluorides have the ability to interfere with the functions of the brain,” Pg. 222.

Diabetes: “Sufficient fluoride exposure appears to bring about increases in blood glucose or impaired glucose intolerance in some individuals and to increase the severity of some types of diabetes,” Pg. 260.

Kidney Dysfunction: “Portions of the renal system may therefore be at higher risk of fluoride toxicity than most soft tissues… The effect of low doses of fluoride on kidney… functions in humans needs to be carefully documented…” Pg. 303.

Immune System: “There is no question that fluoride can affect the cells involved in providing immune responses,” Pg. 295.

50.) Rachel Carson, Silent Spring, 1962. Pg. 139.
51.) J. Doull, interviewed by D. Fagin, “Second Thoughts on Fluoride,” Scientific American, 298, no. 1 (January 2008): 74-81. Pg. 80-1.View Preview: http://www.scientificamerican.com/article/second-thoughts-on-fluoride/

52.) Citation #15-22.
53.) National Sanitary Foundation International on documented impurities in fluoridation chemicals, as linked to by Center for Disease Control, “Fluoridation Fact Sheet.” “Fluoride additives are analyzed for impurities that have been identified as having the potential to occur. Those impurities include arsenic, lead and radionuclides.”   http://www.cdc.gov/fluoridation/factsheets/engineering/wfadditives.htm
54.) EPA Report: ‘1990 Report to Congress on Special Waste Mining.’ Office of Solid Waste to US Congress, July 23, 1990. www.epa.gov/compliance/resources/reports/…/1990rpttocongress.pdf
Petition to Environmental Protection Agency Administer Robert Perciasepe, from Dr. 54.) William Hirzy, on behalf of co-petitioners. Request for EPA to prohibit silicofluorides and unpurified sodium fluoride as fluoridating agents due to arsenic contamination; Request to mandate pharmaceutical grade sodium fluoride. April 22, 2013. Pg. 2, and 17. http://www2.epa.gov/aboutepa/hfsa-section-21-petition
55.) Center for Disease Control. “Engineering Fact Sheet.” Click on ‘Types and Sources of Fluoride Additives.’ http://www.cdc.gov/fluoridation/fact_sheets/engineering/wfadditives.htm#2
56.) U.S. Agency for Toxic Substances and Disease Registry, ‘Fluorides, Hydrogen Fluoride and Fluorine,’ Section 8: Regulations and Advisories. ‘Acute duration inhalation MRL of 0.01ppm has been derived for fluorine.’ http://www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf
57.) National Service Center for Environmental Publications. EPA document from December 1976: ‘Fluorine, Its Compounds and Air Pollution: Bibliography with Abstracts.’ Online. Go to Google.com, type in ‘fluorine EPA air pollutant,’ click on nepis.epa.gov link.
58.) EPA, National Research Council, Committee on Acute Exposure Guideline Levels, Committee on Toxicology, Environmental Criteria and Assessment Office. ‘Summary Review of Health Effects Associated with Hydrogen Fluoride and Related Compounds,’ Google eBook.
59.) EPA, ‘Fluorine, Its Compounds and Air Pollution: Bibliography and Abstracts,’ from the Office of Air Quality Planning and Standards, 1976. Google eBook.
60.) Environmental Protection Agency, ‘Summary of Mineral Processing: Fluorspar and Hydrofluoric Acid Wastewater.’ www.epg.gov, type in “fluorosilic acid mining,”
http://www.epa.gov/wastes/nonhaz/industrial/special/mining/minedock/id..
61.) Fluoride Industrial and Phosphate Research Institute. http://www.fipr.state.fl.us/research-area-public-health.htm

62.) D.F. Walters, “Regulatory, Economic, and Legal Aspects of Fluoride” presented at a conference, held at Utah State University in 1982, published in Fluorides: Effects on Vegetation, Animals and Humans (Salt Lake City, UT: Paragon Press, 1983). Authors: H.B. Peterson, N.C. Leone, Edited by: J.L. Shupe. Pg. 351-358, Fluoride is classified as a “welfare pollutant” under the Clean Air Act, which harms the welfare of people, plants, animals.
63.) Report of the Secretary of Health, Education, and Welfare to the 91^st US Congress, March 1970, cited in a letter from Donald R. van der Vaart, P.E., Chief of Permits Section, North Carolina Department of Environment and Natural Resources, to Michael E. Johnson, Environmental Engineer, DuPont Fluoroproducts, July 17, 2008. “This report concluded that ‘inorganic fluorides are highly irritant and toxic gases’ which, in low ambient concentrations, damage plants and animals.” daq.state.nc.us/permits/psd/docs/NSR_Fluorides.pdf
64.) Martin versus Reynolds Metals Company, 1964. United States Court of Appeals Ninth Circuit, No. 19219. 336 F.2d 876 (1964). Judge’s verdict in favor of defendant for damage to crops, his farm animals and the health of his family. http://www.osbar.org/publications/bulletin/05augsep/martin.html
65.) EPA’s classifications of Hydrofluorosilicic acid, Sodium Fluorosilicate, Sodium Fluoride: all fluorides are CERCLA Waste Substances from Superfund Sites: ‘severely harmful to human health and the environment.’ www.epa.gov/osweroe1/docs/er/302table01.pdf. *Hydrofluoric acid is the aqueous form of hydrogen fluoride, which is the gaseous form; both are classified under the same CASRN number, 7664393.
66.) Philip Sadtler, Chemical and Engineering News (December 18, 1948). See American Society for Engineering Education, ‘Familiarizing the Unknown: Three Unusual Engineering Cases,’ Marilyn Dyrud, Oregon Institute of Technology. http://www.asee.org/public/conferences/1/papers/32/view

67.) K. Roholm, “The Fog Disaster in the Meuse Valley, 1930: A Fluorine Intoxication,” Journal of Hygiene & Toxicology (March 1936). Pg. 126.

68.) Citation #14-16.
69.) National Academy of Sciences, National Research Council, ‘Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.’ Washington, DC: National Academies Press, 2006.
70.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 336.

71.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 222.
72.) Citation #24.

73.) Citation #25.
74.) D.W. Cross, R.J. Carton, “Fluoridation: A Violation of Medical Ethics and Human Rights,” International Journal of Occupational Environmental Health Vol.9, No. 1 (Jan-March 2003): 24-9.
See also: P. Clein, “How Can It Be Ethical To Be Putting Industrial Waste In Our Drinking Water?” Pharmaceutical Journal Vol. 271 (August 2003). Pg. 234.
75.) World Health Organization, ‘Air Quality Guidelines for Europe,’ 2000. Second Edition, WHO Regional Publications, No. 91. Pg. 4, “The toxicity of fluorides…”
http://www.euro.who.int/__data/assets/pdf_file/0018/123075/AQG2ndEd_6_5Fluorides.PDF
76.) Fluoride Action Network, “Professional Statement to End Water Fluoridation,” http://fluoridealert.org/researchers/professionals-statement/

77.) Open letter from Professor Trevor Sheldon, chair of the Advisory Group for the York Review, and founding director of the UK National Health Service’s Centre for Reviews and Dissemination at the University of York, Heslington, York, UK, January 3, 2001. http://www.appgaf.org.uk/archive/archive_letter_shel/

⌘
THE CHEMICAL ITSELF

1.) Food and Drug Administration, “FDA Approved Drug Products Database.” http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm Colgate total fluoride toothpaste was approved July 1997. Injectable sodium fluoride “fluorine f-18” was approved in 1972 – discontinued. Injectable “sodium fluoride f-18” was approved January, 2011 – discontinued. Then again, injectable “sodium fluoride f-18” was approved for two manufacturers, one in December 2012, the other June 2013.
2.) Canadian National Association of Pharmacy Regulatory Authorities. Search the National Drug Schedules for “sodium fluoride” or “fluoride and its salts.” http://www.napra.org/

3.) Letter to Honorable Ken Calvert, Chairman, Subcommittee on Energy and Environment, Committee on Science, US House of Representatives, regarding FDA’s response to a Congressional Investigation about fluoride and fluoridation, from Melinda K. Plaisier, FDA Associate Commissioner for Legislation. December 21, 2000. “Fluoride, when used in the diagnosis, cure, mitigation, or prevention, of disease in man or animal, is a drug that is subject to FDA regulation […] Several NDAs [New Drug Applications] have been approved for fluoride topical products such as dentrifices and gels.” http://www.keepersofthewell.org/gov_resp_pdfs/fda_response.pdf

4.) U.S. Code of Federal Regulations, Title 21, Volume 5, Part 355, Subpart C: Warning Labeling. Online. Accessed September, 2013. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=355.50

5.) An 11.5 fl. oz. glass of fluoridated water at the “optimal” level of 0.7ppm contains the exact same quantity of fluoride as the recommended “pea size” amount of fluoride toothpaste. FLUORIDATED WATER ratio — 0.7 units fluoride : 1,000,000 units water, or 0.7 parts per million, 0.7ppm

glass of water = about 11.5 fluid ounces (fl oz)

1 fl oz = about 30 milliliters (mL)

Distilled water at 40 degrees Fahrenheit: density of water is 1 gram/mL or 1 g/mL

\ 11.5 fl oz glass of fluoridated water x 30mL/fl oz x 1g/mL =
mass of glass of fluoridated water = about 345 grams = 345,000 milligrams (mg)

fluoridated water ratio is 0.7 units : 1,000,000 units

0.7/1,000,000 = x/345,000

x= ~0.25 mg fluoride

FLUORIDE TOOTHPASTE ratio — 1,000 units fluoride : 1,000,000 other toothpaste ingredients =1,000:1,000,000, which is 1,000ppm or, 1:1,000

Pea size amount of toothpaste is about 0.25 grams (g)

http://www.washington.edu/earlychildhood/faqs/childrens-oral-health-faqs

\ mass of pea size toothpaste = 0.25 g

1/1,000 = x/0.25

x= ~0.00025 g of fluoride

1,000 milligrams (mg) for every gram (g)

0.00025g x 1,000mg/g

x= ~0.25 mg fluoride

6.) Letter to Commissioner Jane Henry, Food and Drug Administration, from John Kelly, New Jersey Assemblyman, 36^th district, October 26, 2000. “I am petitioning the FDA to remove unapproved children’s fluoride supplements from the market… I filed a Freedom of Information Act request with the FDA to obtain copies of the studies the FDA had used in evaluating the safety and effectiveness of these products. I was shocked when the FDA informed me that the FDA had no such studies and that children’s fluoride supplements were not approved…. The last time the FDA reviewed an NDA for fluoride supplements was in 1975 and that NDA was rejected.”

7.) Citation #3: Letter to Honorable Ken Calvert, from Melinda K. Plaisier, FDA. “No New Drug Applications have been approved for fluoride drugs meant for ingestion… Fluoride products meant for ingestion were in use prior to the enactment [of the Kefauver-Harris Amendments (Drug Amendments of 1962) to the Food, Drug and Cosmetic Act [of 1938], in which efficacy in addition to safety became a requirement for drugs marketed in the U.S.”
See also: Approved Drug Products and Legal Requirements, Volume III of USP Dispensing Information, US Pharmacopeial Convention, 2004. 24^th Edition. Tauton, MA: Quebecor World. ISBN 1-56363-465-1. Pg. III/1, “The Federal Food, Drug and Cosmetic Act of 1938 require that drugs be shown to meet certain safety requirements prior to their being marketed. Drugs that were already being marketed at that time were ‘grandfathered,’ and were allowed to remain on the market without further regulatory approval… The following listing identifies drug products that we believe were considered ‘pre-1938’ or ‘grandfathered’… Sodium Fluoride (Solution, Oral + Tablets).”

8.) Food and Drug Administration, “FDA Approved Drug Products Database.” Online. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm One will note there are no systemic approvals. See also: National Institute of Health’s “DailyMed Current Medication Information” Database of Currently Marketed Drugs, including whether or not a drug is FDA approved. http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=fluoride&x=0&y=0

9.) D.W. Cross, R.J. Carton, “Fluoridation: A Violation of Medical Ethics and Human Rights,” International Journal of Occupational Environmental Health Vol.9, No. 1 (Jan-March 2003): 24-9. “Silicofluorides have never been submitted to the US FDA for approval as medications,” in abstract.

10.) National Research Council of the National Academy of Sciences, ‘Fluoride in Drinking Water,’ 2006. Washington DC, National Academies Press. Pg. 15, “The most commonly used [drinking water] additives are silicofluorides, not the fluoride salts used in dental products (such as sodium fluoride and stannous fluoride). Silicofluorides are one of the by-products from the manufacture of phosphate fertilizers.” http://www.nap.edu/catalog.php?record_id=11571

11.) Thomas G. Reeves, P.E., National Fluoridation Engineer, Program Services Branch Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention. Refer: FL-143, September 2000. “All of the fluoride chemicals used in the U.S. for water fluoridation, sodium fluoride, sodium fluorosilicate, and fluorosilicic acid, are useful byproducts of the phosphate fertilizer industry… These gases are captured by product recovery units (scrubbers) and condensed into 23% fluorosilicic acid. Sodium fluoride and sodium fluorosilicate are made from this acid.”

12.) Center for Disease Control. “Engineering Fact Sheet.” http://www.cdc.gov/fluoridation/fact_sheets/engineering/wfadditives.htm#2

13.) Petition to Environmental Protection Agency Administer Robert Perciasepe, from Dr. William Hirzy, on behalf of co-petitioners. Request for EPA to prohibit silicofluorides and unpurified sodium fluoride as fluoridating agents due to arsenic contamination; Request to mandate pharmaceutical grade sodium fluoride. April 22, 2013. Pg. 2, and 17. http://www2.epa.gov/aboutepa/hfsa-section-21-petition

14.) Department of Health and Human Services, PHS, CDC, ‘ National Center of Prevention Services, Division of Oral Health, 1993. Fluoridation Census (1992). Table VI, page xviii. See also: Citation #10.

15.) D.F. Walters, “Regulatory, Economic, and Legal Aspects of Fluoride” presented at a conference, held at Utah State University in 1982, published in Fluorides: Effects on Vegetation, Animals and Humans (Salt Lake City, UT: Paragon Press, 1983). Authors: H.B. Peterson, N.C. Leone, Edited by: J.L. Shupe. Pg. 351-358, Fluoride is classified as a “welfare pollutant” under the Clean Air Act.
See also: U.S. Agency for Toxic Substances and Disease Registry, ‘Fluorides, Hydrogen Fluoride and Fluorine,’ Section 8: Regulations and Advisories. ‘Acute duration inhalation MRL of 0.01ppm has been derived for fluorine.’ http://www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf
See also: National Service Center for Environmental Publications. EPA document from December 1976: ‘Fluorine, Its Compounds and Air Pollution: Bibliography with Abstracts.’ Online. Go to Google.com, type in ‘fluorine EPA air pollutant,’ click on nepis.epa.gov link.
See also: EPA, National Research Council, Committee on Acute Exposure Guideline Levels, Committee on Toxicology, Environmental Criteria and Assessment Office. ‘Summary Review of Health Effects Associated with Hydrogen Fluoride and Related Compounds,’ Google eBook.
Also: EPA, ‘Fluorine, Its Compounds and Air Pollution: Bibliography and Abstracts,’ from the Office of Air Quality Planning and Standards, 1976. Google eBook.

16.) Environmental Protection Agency, ‘Summary of Mineral Processing: Fluorspar and Hydrofluoric Acid Wastewater.’ www.epg.gov, type in “fluorosilic acid mining,”
http://www.epa.gov/wastes/nonhaz/industrial/special/mining/minedock/id..

See also: Citation #11: ‘gases recovered from scrubbers.’

17.) Fluoride Industrial and Phosphate Research Institute. http://www.fipr.state.fl.us/research-area-public-health.htm

18.) Ibid. Citation #17. See also: #21.

19.) Ibid. Citation #17. See also: #22.

20.) Ibid. Citation #17. See also: #22.

21.) Report of the Secretary of Health, Education, and Welfare to the 91^st US Congress, March 1970, cited in a letter from Donald R. van der Vaart, P.E., Chief of Permits Section, North Carolina Department of Environment and Natural Resources, to Michael E. Johnson, Environmental Engineer, DuPont Fluoroproducts, July 17, 2008. “This report concluded that ‘inorganic fluorides are highly irritant and toxic gases’ which, in low ambient concentrations, damage plants and animals.” daq.state.nc.us/permits/psd/docs/NSR_Fluorides.pdf

22.) Martin versus Reynolds Metals Company, 1964. United States Court of Appeals Ninth Circuit, No. 19219. 336 F.2d 876 (1964). Judge’s verdict in favor of defendant for damage to crops, his farm animals and the health of his family. http://www.osbar.org/publications/bulletin/05augsep/martin.html
See also: EPA’s classifications of Hydrofluorosilicic acid, Sodium Fluorosilicate, Sodium Fluoride: all fluorides are CERCLA Waste Substances from Superfund Sites: ‘severely harmful to human health and the environment.’ www.epa.gov/osweroe1/docs/er/302table01.pdf. *Hydrofluoric acid is the aqueous form of hydrogen fluoride, which is the gaseous form; both are classified under the same CASRN number, 7664393.

23.) Citation #21, Report of the Secretary of Health, Education, and Welfare.

24.) EPA Report: ‘1990 Report to Congress on Special Waste Mining.’ Office of Solid Waste to the US Congress, July 23, 1990. www.epa.gov/compliance/resources/reports/…/1990rpttocongress.pdf

25.) U.S. National Academy of Sciences Member, Edward Groth, “Air is Fluoridated,” Peninsula Observer, January 27-February 3, 1969. See also: Scott Dewey, “The Fickle Finger of Phosphate: Central Fluoride Air Pollution and the Failure of Environmental Policy, 1957-70.” Pg. 574. “Fluorine emissions were determined by Florida and Georgia University researchers, to be the cause of Fluoride’s Polk and Hillsborough counties depleted citrus yields and cattle sickened with symptoms typical of fluorosis.” Pg. 567, “The industries emissions produced air pollution severe and damaging enough to make the local atmosphere one of the most noxious and notorious in the US.”

26.) Former Professor at Cornell University’s Boyce Thompson Institute, L. H. Weinstein, “Effects of Fluorides on Plants and Plant Communities: An Overview,” presented at a conference, held at Utah State University in 1982, published in Fluorides: Effects on Vegetation, Animals and Humans (Salt Lake City, UT: Paragon Press, 1983). Editors: J.L. Shupe, H.B. Peterson, N.C. Leone. Pg. 54.
Also See: L. Weinstein, Fluoride in the Environment: Effects on Plants and Animals. 2004. Google eBook.

27.) Citation #22, Martin versus Reynolds Metals Company, 1964.

28.) “Intel will pay $143,000 penalty for fluoride violations,” The Oregonian, April 24, 2014. http://www.oregonlive.com/silicon-forest/index.ssf/2014/04/intel_will_pay_143000_penalty.html

29.) Philip Sadtler, Chemical and Engineering News (December 18, 1948). See American Society for Engineering Education, ‘Familiarizing the Unknown: Three Unusual Engineering Cases,’ Marilyn Dyrud, Oregon Institute of Technology. http://www.asee.org/public/conferences/1/papers/32/view

30.) K. Roholm, “The Fog Disaster in the Meuse Valley, 1930: A Fluorine Intoxication,” Journal of Hygiene & Toxicology (March 1936). Pg. 126.

31.) A.) The American Heritage College Dictionary, 2002. 4^th edition, New York: Houghton Mifflin Company. Pg. 534. See also: The Reader’s Digest Great Encyclopedia Dictionary, Standard College Dictionary, 1966. Pleasantville, New York: Funk & Wagnalls. Pg. 513, Fluorine is ‘A corrosive and extremely reactive gaseous element.”
B.) Encyclopedia of Ecology and Environmental Management, 1998. Edited by Peter Calow. Osney Mead, Oxford: Blackwell Science Ltd. Pg. 284, Fluorine is ‘a poisonous gaseous halogen element.’

C.) Concise Encyclopedia Chemistry, 1993. Edited by H. Jakubke, H. Jeschkeit. Berlin, Germany: Walter de Gruyter. Pg. 418, ‘Fluorine is extremely poisonous and, among other things, burns the skin… highly caustic.’ Google eBook.

32.) U.N. International Programme on Chemical Safety and European Commission classify Fluorosilicic acid as Hazardous Waste: UN Class 8 – Corrosive substance. EC Classification: Symbol: C – Corrosive substance Disposal: “Do NOT let this chemical enter the environment.” http://www.inchem.org/documents/icsc/icsc/eics1233.htm

33.) Ibid., Sodium Fluorosilicate as Hazardous Waste: UN Hazard Class: 6.1 – Toxic substance. EC Classification: Symbol: T – Toxic substance. Labeling: “Signal: Danger, Toxic if swallowed [skull and crossbones symbol].” http://www.inchem.org/documents/icsc/icsc/eics1243.htm

34.) Ibid. Sodium Fluoride as Hazardous Waste: UN Hazard Class: 6.1 – Toxic substance. EC Classification: Symbol: T – Toxic substance. http://www.inchem.org/documents/icsc/icsc/eics0951.htm

35.) Citation #32.

36.) Citation #33.

37.) Citation #34.

38.) EPA’s classifications of Hydrofluorosilicic acid, Sodium Fluorosilicate, Sodium Fluoride: all fluorides are CERCLA Waste Substances from Superfund Sites: ‘severely harmful to human health and the environment.’ www.epa.gov/osweroe1/docs/er/302table01.pdf. *Hydrofluoric acid is the aqueous form of hydrogen fluoride, which is the gaseous form; both are classified under the same CASRN number, 7664393. EPA does not list Sodium Fluorosilicate as hazardous waste, however it is the salt form of fluorosilicic acid, see: nepis.epa.gov/Adobe/PDF/2000EDA9.PDF.

39.) National Sanitary Foundation International on documented impurities in fluoridation chemicals, as linked to by Center for Disease Control, “Fluoridation Fact Sheet.” “Fluoride additives are analyzed for impurities that have been identified as having the potential to occur. Those impurities include arsenic, lead and radionuclides.”   http://www.cdc.gov/fluoridation/factsheets/engineering/wfadditives.htm

40.) Ibid, Citation #39, NSF.

41.) EPA Report: ‘1990 Report to Congress on Special Waste Mining.’ Office of Solid Waste to US Congress, July 23, 1990. www.epa.gov/compliance/resources/reports/…/1990rpttocongress.pdf

42.) Environmental Protection Agency, List of Maximum Contaminant Levels in drinking water. http://water.epa.gov/drink/contaminants/upload/mcl-2.pdf

43.) J. Hirzy, R. Carton, C. Bonnani, C. Montanero, M. Nagle, “Comparison of hydrofluorosilic acid and sodium fluoride as fluoridating agents – A cost-benefit analysis,” Environmental Science & Policy, Vol. 29 (May, 2013): 81-6. Pg. 12. http://www2.epa.gov/aboutepa/hfsa-section-21-petition

44.) Citation #41, EPA Report on Special Waste Mining Processing.

45.) Citation #42, EPA List of MCL in drinking water.

46.) Center for Disease Control & Prevention, See under: ‘How is HHS developing new recommendations?’ ‘HHS has proposed changing the recommended level for community water fluoridation.’ ‘New proposed optimal fluoridation level.’ http://www.cdc.gov/fluoridation/faqs/#overview6 See also: ‘Community water fluoridation is a safe and effective method for reducing tooth decay.’ http://www.cdc.gov/fluoridation/safety/systematic.htm

47.) Safe Drinking Water Act, 42 US Code § 300g-1. Section 11. http://www.law.cornell.edu/uscode/text/42/300g-1
See also: D. Cross, R. Carton, “Fluoridation: A Violation of Medical Ethics and Human Rights,” International Journal of Occupational Environmental Health, Vol.9, No.1 (Jan-Mar 2003):24-9.

See also: Nuremberg Code of Medical Ethics: http://www.ushmm.org/information/exhibitions/online-features/special-focus/doctors-trial/nuremberg-code

See also: United Nation’s Council of Europe’s Biomedical Convention of 1999, http://conventions.coe.int/Treaty/en/Treaties/Html/164.htm

⌘

DOSAGE versus CONCENTRATION & MARGIN OF SAFETY

1.) US Department of Health and Human Services, Public Health Service and Agency for Toxic Substances and Disease Registry,‘Toxicological Profile for Fluorides, Hydrogen Fluoride and Fluorine.’ April 1993. TP-91/17, 4/93. Section 2.7 (Health Impacts), Pg. 112, ‘Existing data indicate subsets of the population may be unusually susceptible to the toxic effects of fluoride and its compounds. These populations include the elderly, people with deficiencies of calcium, magnesium, and/or vitamin C, and people with cardiovascular and kidney problems… Impaired renal clearance of fluoride has also been found in people with diabetes mellitus and cardiac insufficiency… People over the age of 50 often have decreased renal fluoride clearance.’ This is also cited on the EPA Union of Scientist’s website: nteu280.org, “Fluoridation: Recent History.”
Infants: Citation #16 & #17.
Kidney Dysfunction: NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 292, ‘Several investigators have shown that patients with impaired renal function, or on hemodialysis, tend to accumulate fluoride much more quickly than normal.’ Pg. 101, ‘severe renal insufficiency appears to increase bone fluoride concentrations, perhaps as much as twofold.’ See also: National Kidney Foundation, Official Position Statement Rescinding NKF’s 1981 Endorsement of Water Fluoridation, April 15, 2008. https://www.kidney.org/atoz/pdf/Fluoride_Intake_in_CKD.pdf
Iodine Deficiency: NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 88, regarding dietary iodine effect on dosage, and Pg. 234, ‘In animal studies, high fluoride intake appears to exacerbate the effects of low iodine concentrations.’
Thyroid: Pg. 262-3, “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.”
See also: NAS, ‘Fluoride in Drinking Water,’ 2006. Pg. 23, “review acknowledged that ‘substantially’ higher intakes of fluoride from consumption of fluoridated water would result for individuals such as outdoor laborers in warm climates or people with high-urine-output disorders, but these intakes were not quantified.”

2.) World Health Organization Expert Committee on Oral Health Status and Fluoride Use “Fluorides and Oral Health,” WHO Technical Report Series 846, 1994. Pg. 34, “it is the uncontrollable exposure to fluoride that is the principal health concern.”
See also: Testimony Statement of Dr. J. William Hirzy, National Treasury Employees Union Chapter 280 aka ‘EPA Union of Scientists,’ Subcommittee on Wildlife, Fisheries and Drinking Water, U.S. Senate, June 29, 2000. Pg. 2, Section: ‘Fluoride Exposures Are Excessive and Un-controlled.’ Available on Union’s website: http://www.nteu280.org/Issues/Fluoride/629FINAL.htm or http://www.epw.senate.gov/107th/hir_0629.htm
See also: Citation #8: ‘Environmental Health Lecture: Principles of Exposure, Dose, and Response.’

3.) Agency for Toxic Substances & Disease Registry, ‘Minimum Risk Levels for Hazardous Substances.’ ‘Minimum Risk Limit (MRL): An MRL is an estimate of the daily human exposure to a hazardous substance that is likely to be without appreciable risk of adverse non-cancer health effects over a specified duration of exposure.’ http://www.atsdr.cdc.gov/mrls/index.asp

4.) Agency for Toxic Substances & Disease Registry, ‘Toxicological Profiles of Fluoride.’ Reference Dosage (RfD): Dental Fluorosis: 0.06mg/kg/day
Maximum Residue Limit (MRL): Bone Fracture: 0.05/mg/kg/day

www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf

Also viewable at EPA’s Integrated Risk Information System: http://www.epa.gov/iris/subst/0053.htm

5.) Ibid. Citation #4.

6.) United States Government Printing Office. Federal Register Volume 62, Number 234, Friday, December 5, 1997. 40 CFR Part 180. Environmental Protection Agency: ‘Fluorine Compounds; Time Limited Pesticide Tolerance.’ Pg. 64297, C. Exposures and Risks, Section 2, Part ii: ‘Fluoride levels in public drinking water are regulated under the Safe Drinking Water Act. EPA has established a Maximum Concentration Limit (MCL) at 4.0 mg/L 0.114 mg/ kg/day to protect against crippling skeletal fluorosis (April 2, 1986) (51 FR 11396).’ http://www.gpo.gov/fdsys/pkg/FR-1997-12-05/html/97-31920.htm

7.) National Academy of Sciences, National Research Council, ‘Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.’ Washington, DC: National Academies Press, 2006. Pg. 29, Infants with average water consumption: range of dosage is 0.042 to 0.072mg/kg/day. Infants with above average water consumption: range of dosage is 0.084 to 0.14mg/kg/day. http://www.nap.edu/openbook.php?record_id=11571

8.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 33, ‘Mean concentration of fluoride in milk from mothers in fluoridated…’ [Tables on pg.34-5] Pg. 36, ‘communities (1mg/L in the water) was 0.0098mg/L; in nonfluoridated communities, the mean was 0.0044 mg/L.’ Summary in Table 2-6, pg. 40: “Summary of Typical Fluoride Concentrations of Selected Food and Beverages in the United States.”
1.2/ 0.0044 = 273.   1.2/ 0.0098 = 122.   0.7/0.0044 = 160.   0.7/0.01 = 70.

9.) American Dental Association e Gram, ‘Interim Guidance on Reconstituted Infant Formula,’ November 9, 2006.

10.) American Academy of Pediatrics, “Fluoride Supplementation for Children: Interim Policy Recommendations from Dietary Fluoride Workshop Committee on Nutrition, January, 1994.’ Pediatrics, Vol. 95, No. 5 (May 1998). Also published by Journal of the American Dental Association, Vol. 126, June 1995. See also: American Dental Association, “Fluoride Supplement Dosage Schedule.” http://www.ada.org/en/member-center/oral-health-topics/fluoride-supplements#dosage

11.) US National Institute of Health’s Online Library of Medicine: “Toxnet Toxicity Data Network: Fluorosilicic Acid.” http://toxnet.nlm.nih.gov/cgi-bin/sis/search/a?dbs+hsdb:@term+@DOCNO+2018

12.) E.U. Panel on Dietetic Products, Nutrients and Allergies, Affiliated with the European Food Safety Authority, Scientific Committee on the Status of Dietary Reference Values for Fluoride. Requested by European Commission. EFSA Journal. Issue 11, No. 8 (Aug 2013). Pg. 3332. ‘Fluoride is not an essential nutrient.’ This sentence is viewable online: http://www.efsa.europa.eu/en/efsajournal/pub/3332.htm

13.) U.S. Federal Register, Volume 60, Number 249. Rules and Regulations, 21 CFR, Part 101. Docket NO. 90N-0134, RIN 0910-AA19. Department of Health and Human Services, Food and Drug Administration, “FDA Food Labeling: Reference Daily Intakes.” December 28, 1995. Last sentence of Section II.: “Consistent with the vast majority of comments, FDA is adopting these values [Daily Values, i.e. Dietary Reference Intakes, for essential nutrients] except the value for fluoride, as explained below.” See also: National Institute of Health’s “MedlinePlus Medical Encyclopedia.” Note: “Recommended Daily Dietary Intake of fluoride” is a distinct term from “Recommended Daily Allowance,” used with essential nutrients like calcium.   http://www.nlm.nih.gov/medlineplus/ency/article/002420.htm
14.) Letter by Dr. Bruce Albert, president of the National Academy of Sciences, and Dr. Kenneth Shine, president of the Institute of Medicine, to Dr. Albert W. Burgstahler and other scientists, November 20, 1998. “Contradictory results do not justify a classification of fluoride as an essential element, according to accepted standards. Nonetheless, because of its valuable effect on dental health, fluoride is a beneficial element for humans.’
15.) B. Burt, ‘The Changing Patterns of Systemic Fluoride Intake.’ Journal of Dental Research, Vol. 71, No. 5 (May 1992). Pg. 1228-1237. ‘Fluoride is not an essential nutrient due to a lack of studies.’

16.) Agency for Toxic Substances & Disease Registry, ‘Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine,’ 2003. Atlanta, GA: U.S. Department of Health and Human Service. Pg. 157, ‘Fluoride retention appears to be higher in children than adults. Approximately 80% of an absorbed dose of fluoride is retained in young children compared to 50% in adults. This is supported by the finding that renal fluoride excretion rate is lower in children than adults.  This difference in fluoride retention is due to high fluoride uptake in developing bones.’ Viewable on Google eBooks.
17.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 3, ‘On per-body-weight basis, infants and young children have approximately three to four times greater exposure than do adults… Among individuals with an average water-intake rate, infants and children have the greatest total exposure to fluoride.’ See also: Pg. 29: One will note infants consume the highest dosages.

18.) See Citation #1: Kidney Dysfunction, “accumulate fluoride much more quickly than normal.”
19.) Environmental Protection Agency, ‘Dose-Response Assessment.’ ‘Both the dose at which response begin to appear and the rate at which it increases given increasing dose can be variable between different pollutants, individuals, exposure routes, etc.’

http://www.epa.gov/risk_assessment/dose-response.htm.

20.) See Citation #1: Iodine.
21.) Citation #2.
22.) Citation #4 + Citation #7

23.) Food and Nutrition Encyclopedia, 1994. 2^nd edition: Vol. 1. Edited by M & A Ensminger. CRC Press. Pg.779, ‘Fluorine has a small safety range.’ Viewable on Amazon Books. See also: K. Thiessen, “Comments on: Prioritization of Chemicals for Carcinogen Identification Committee Review. Proposed Chemicals for Committee Consideration and Consultation. Proposition 65 Implementation, Office of Environmental Health Hazard Assessment, California Environmental Protection Agency,” May 5, 2009. http://www.oehha.org/prop65/public_meetings/052909coms/fluoride/SENESFluoride.pdf

“Water intake for a given age group varies substantially – around a factor of 100 between the highest and lowest consumption rates (discussed in the NRC report). The result of this is that for water fluoride at 1mg/L vs. water fluoride at 4 mg/L, there will be a huge overlap between the respective populations, with apparent differences only at the very highest water intakes. In other words, any effect seen at 4 mg/L is probably going to occur in some people at 1 mg/L (e.g., in the people with the highest water consumption or in people with impaired fluoride excretion), but this might easily be missed in the sample sizes typically used in studies.” See also: http://fluoridealert.org/content/kathleen-thiessen-phd/

24.) Center for Disease Control, ‘Recommendations for Using Fluoride to Prevent & Control Caries,’ 2001. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm ‘1 ppm fluoride was the optimal concentration in community drinking.’ [original emphasis]

See also: NRC, Fluoride in Drinking Water, 2006. Pg. 15. Artificial fluoridation began in 1945.
25.) Department of Health and Human Services and Environmental Protection Agency, ‘News Release: EPA & DHHS Announce New Scientific Assessments and Actions on Fluoride.’ January 7, 2011. http://yosemite.epa.gov/opa/admpress.nsf/3881d73f4d4aaa0b85257

359003f5348/86964af577c37ab285257811005a8417!OpenDocument

26.) F. Lin, Aihaiti, H. Zhao, et al., “The Relationship of a Low-Iodine and High-Fluoride Environment to Subclinical Cretinism in Xinjiang,” Iodine Deficiency Disorder Newsletter Vol. 7 (1991): 3. Xinjiang Institute for Endemic Disease Control and Research; Office of Leading Group for Endemic Disease Control of Hetian Prefectural; and County Health and Epidemic Prevention Station, Yutian, Xinjiang. See also: P. Connett, J. Beck, H. Micklem, The Case Against Fluoride, 2010. White River Junction, VT: Chelsea Green Publishing. Pg. 138, Pg. 202, this study was reviewed by the 2006 NRC.

⌘

THE SCIENCE ITSELF

1.) National Academy of Sciences, National Research Council, ‘Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.’ 2006. Washington, DC: National Academies Press. Pg. 18.

2.) Ibid. NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 2, “After reviewing the collective evidence, including studies conducted since the early 1990s, the committee concluded unanimously that the present MCLG of 4mg/L for fluoride should be lowered.” See also: Pg. 10, “Lowering the MCL will prevent children from developing severe dental fluorosis and will reduce the lifelong accumulation of fluoride into bone that the majority of the committee believes is likely to put individuals at increased risk of bone fracture and possibly skeletal fluorosis.”

3.) The American Heritage College Dictionary, 2002. 4^th edition. New York: Houghton Mifflin Company. Pg. 534, ‘abnormal condition caused by excessive intake of fluorine, characterized chiefly by mottling of the teeth.”
4.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 103, “Excessive intake of fluoride during enamel development can lead to enamel fluorosis.”

5.) “Fluoride Supplementation for Children: Interim Policy Recommendation,” American Academy of Pediatrics Policy Statement. Pediatrics Vol. 95, No.5 (May 1998).

6.) K. Heller, S. Eklund, B. Burt, “Dental Caries and Dental Fluorosis at Varying Water Fluoride Concentrations,” Journal of Public Health Dentistry Vol. 57, No. 3 (1997): 136-43.
7.) Environmental and Occupational Health, 2007. 4^th Edition. Edited by William Rom, Steven Markowitz. Philadelphia, PA: Lippincott Williams & Wilkins. Pg. 1086-7, “Chronic fluorine poisoning results in a condition called fluorosis, and the toxic manifestations can take three forms: clinical, skeletal and dental (38).”
8.) Center for Disease Control, “Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004.” http://www.cdc.gov/nchs/data/databriefs/db53.htm#summary
9.) H. Hodge, “Safety Factors in Water Fluoridation Based on the Toxicology of Fluorides,” The Proceedings of the Nutrition Society American Academy of Pediatrics Policy Statement American Academy of Pediatrics Policy Statement Vol. 22 (1963): 111-7http://journals.cambridge.org/action/displayFulltext?type=1&fid=784060&jid=PNS&volumeId=22&issueId=01&aid=784052

10.) P. Connett, J. Beck, H. Micklem, The Case Against Fluoride, 2010. White River Junction, VT: Chelsea Green Publishing. Pg. 172. Pg. 175. Appendix 2.
See also: Testimony of William Hirzy, National Treasury Employees Union Chapter 280, aka EPA Union of Scientists, before the Subcommittee on Wildlife, Fisheries and Drinking Water, US Senate, June 29, 2000. Pg., 2, “Few researchers, if any, are looking for the effects of excessive fluoride exposure on bone and other tissues in American children. What has been reported so far in this connection is disturbing…”

11.) P. Kurttio, N. Gustavsson, T. Vartiainen, and J. Pekkanen, “Exposure to Natural Fluoride in Well Water and Hip Fracture: A Cohort Analysis in Finland,” American Journal of Epidemiology Vol. 150, No. 8 (1999): 817–24.
12.) C. Danielson et al., “Hip Fractures and Fluoridation in Utah’s Elderly Population,” Journal of the American Medical Association, Vol. 268, No.6 (Aug 1992):746-8.

13.) World Health Organization, Fluorides, Environmental Health Criteria 227, International Programme on Chemical Safety, Geneva, Switzerland, 2002. http://www.inchem.org/documents/ehc/ehc/ehc227.htm
See also: J. Fawell, K. Bailey, J. Chilton, et al., World Health Organization, ‘Fluoride in Drinking-Water,’ 2006. London and Seattle: IWA Publishing, 2006.

14.) Y. Li, C. Liang, C. Slemenda, et al., “Effect of Long-Term Exposure to Fluoride in Drinking Water on Risks of Bone Fractures,” Journal of Bone and Mineral Research Vol. 16, No. 5 (2001): 932–39.

15.) M. Alarcón-Herrera, I. Martín-Domínguez, R. Trejo-Vázquez, et al., “Well Water Fluoride, Dental Fluorosis, Bone Fractures in the Guadiana Valley of Mexico,” Fluoride 34, no. 2 (2001): 139–49, http://www.fluoride-journal.com/01-34-2/342-139.pdf

16.) Environmental and Occupational Health, 2007. 4^th Edition. Edited by William Rom, Steven Markowitz. Philadelphia, PA: Lippincott Williams & Wilkins. Pg. 1086-7, “Chronic fluorine poisoning results in a condition called fluorosis, and the toxic manifestations can take three forms: clinical, skeletal and dental (38).”

17.) Ibid. NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 170-71: “excessive intake of fluoride will manifest itself in a musculoskeletal disease with a high morbidity” i.e. skeletal fluorosis. See also: World Health Organization, ‘Water-related diseases: Fluorosis.’ Online. ‘Ingestion of excess fluoride, most commonly in drinking-water, can cause fluorosis which affects the teeth and bones.’ http://www.who.int/water_sanitation_health/diseases/fluorosis/en/

18.) Random House Webster’s Unabridged Dictionary, 1998. 2^nd edition. New York: Random House. Pg. 739-40.

19.) K. Roholm, Fluorine Intoxication, 1937. London: H.K. Lewis Co., Ltd.

20.) D. Greenwood, “Fluorine Intoxication,” 1940. Physiological Review Vol. 20, No. 582. See also: B. Hileman, “Fluoridation of Water. Questions about Health Risks and Benefits Remain After More than 40 Years,” Chemical & Engineering News (August 1, 1988): 26–42.

21.) H. Hodge and F. Smith, “Occupational Fluoride Exposure,” Journal of Occupational Medicine Vol. 19, No. 1 (1977): 12–39.

22.) E. Czerwinski and W. Lankosz, “Fluoride-induced Changes in 60 Retired Aluminum Workers,” Fluoride Vol. 10, No. 3 (1977): 125–36
23.) E. Czerwinski, J. Nowak, D. Dabrowska, et al., “Bone and Joint Pathology in Fluoride-Exposed Workers,” Archives of Environmental Health Vol. 43, No. 5 (1988): 340–43.

24.) B. Carnow and S. Conibear, “Industrial Fluorosis,” Fluoride Vol. 14, No. 4 (1981): 172–81, http://fluoridealert.org/re/carnow.1981.pdf
25.) J. Shupe, “Fluorine Toxicosis and Industry,” American Industrial Hygiene Association Journal Vol. 31, No. 2 (1970): 240–47.
26.) M. Boillat, J. Garcia and L. Velebit, “Radiological Criteria of Industrial Fluorosis,” Skeletal Radiology Vol. 5, No. 3 (1980): 161–65.

27.) B. Carnow and S. Conibear, “Industrial Fluorosis,” Fluoride Vol. 14, No. 4 (1981): 172–81, http://fluoridealert.org/re/carnow.1981.pdf
28.) J. Franke, F. Rath, H. Runge, et al., “Industrial Fluorosis,” Fluoride Vol.8, No. 2 (1975): 61–83, http://www.fluoridealert.org/re/franke-1975.pdf
29.) United Steelworkers Union, The Oil Worker, Issue 12. http://www.usw.org/news/publications/oilworker/the-oil-worker-issue-12

See also: Environmental Protection Agency, Hydrogen Fluoride Information, ‘One of the strongest acids known,’ http://www.epa.gov/ttn/atw/hlthef/hydrogen.html#N_1_
See also: EPA’s CASRN number, 7664393 refers to both Hydrofluorosilicic acid, as is the aqueous form of Hydrogen Fluoride. Both are CERCLA Waste Substances from Superfund Sites: ‘severely harmful to human health and the environment.’ www.epa.gov/osweroe1/docs/er/302table01.pdf. *Hydrofluoric acid is the aqueous form of hydrogen fluoride, which is the gaseous form; both are classified under the same Chemical #.

30.) S. Bang, G. Boivin, J. Gerster, and C. Baud, “Distribution of Fluoride in Calcified Cartilage of a Fluoride-treated Osteoporotic Patient,” Bone Vol.6, No.4 (1985): 207–10.

31.) B. Bhavsar, V. Desai, N. Mehta, R. Vashi, K. Krishnamachari, “Neighborhood Fluorosis in Western India Part II: Population Study,” Fluoride Vol.18, No. 2 (1985): 86–92.
32.) J. Shupe, “Fluorine Toxicosis and Industry,” American Industrial Hygiene Association Journal Vol. 31, No. 2 (1970): 240–47.

33.) S. Singh, S. Jolly, and B. Bansal, “Skeletal Fluorosis and Its Neurological Complications,” The Lancet Vol. 1 (1961): 197–200.
34.) S. Teotia, M. Teotia, and N. Teotia, “Symposium on the Non-Skeletal Phase of Chronic Fluorosis: The Joints,” Fluoride Vol. 9, No. 1 (1976): 19–24, http://www.fluoridealert.org/re/teotia-1976.pdf

35.) A. Singh, S. Jolly, B. Bansal, and C. Mathur, “Endemic Fluorosis: Epidemiological, Clinical and Biochemical Study of Chronic Fluoride Intoxication in Punjab (India),” Medicine Vol. 42 (1963): 229–46.
36.) J. Hallanger Johnson, A. Kearns, P. Doran, et al., “Fluoride-Related Bone Disease Associated with Habitual Tea Consumption,” Mayo Clinic Proceedings 82, no. 6 (2007): 719–24. Note: Erratum on dosage error in article text in: Mayo Clinic Proceedings 82, no. 8 (2007): 1017, http://www.mayoclinicproceedings.com/content/82/6/719.full
37.) A. Gupta, N. Kumar, S. Bandhu, and S. Gupta, “Skeletal Fluorosis Mimicking Seronegative Arthritis,” Scandinavian Journal of Rheumatology Vol. 36, No. 2 (2007): 154–5.

38.) M. Whyte, W. Totty, V. Lim, and G. Whitford, “Skeletal Fluorosis from Instant Tea,” Journal of Bone and Mineral Research Vol.23, No. 5 (2008): 759–69.

39.) Taber’s Cyclopedic Medical Encyclopedia. Online. Accessed 2001. “Fluorosis is chronic fluorine poisoning.”

40.) Oxford English Dictionary, 2^nd Edition, Vol. 5, 1989. Oxford: Clarendon Press. Pg. 1105, “Fluorosis: Path. Poisoning by fluorine or a fluorine compound; any condition caused by poisoning.”

41.) Testimony of William Hirzy, National Treasury Employees Union Chapter 280, aka EPA Union of Scientists, before the Subcommittee on Wildlife, Fisheries and Drinking Water, US Senate, June 29, 2000. Pg. 2, “According to a study by the National Institute of Dental Research, 66 percent of American children in fluoridated communities show the visible sign of over-exposure and fluoride toxicity, dental fluorosis. That result is from a survey done in the mid-1980’s and the figure today is undoubtedly much higher.” 42.) See also: Environmental and Occupational Health, 2007. 4^th Edition. Edited by William Rom, Steven Markowitz. Philadelphia, PA: Lippincott Williams & Wilkins. Pg. 1086-7, “Chronic fluorine poisoning results in a condition called fluorosis, and the toxic manifestations can take three forms: clinical, skeletal and dental (38).”

43.) International Association of Oral Medicine & Toxicology, “Position on Fluoridation.” Online. Pg. 37. http://iaomt.org/iaomt-position-fluoridation/

44.) B. Bibby, “Effects of Topical Application of Fluorides on Dental Caries,” In Fluorine in Dental Public Health (New York Institute of Clinical Oral Pathology Inc., A Symposium, 1944). “Beyond certain limits, fluorides are toxic and the first evidence of toxicity manifests itself in the form of mottled enamel.”

45.) The Reader’s Digest Great Encyclopedia Dictionary, Standard College Dictionary, 1966. Pleasantville, New York: Funk & Wagnalls. Pg. 513, ‘Path., chronic poisoning with fluorine.’

46.) P. Denbesten, W. Li, “Chronic Fluoride Toxicity: Dental Fluorosis,’ Monographs in Oral Medicine, Vol. 22 (2011):81-96. http://www.ncbi.nlm.nih.gov/pubmed/21701193

47.) F. DeEds, “Fluorine in Relation to Bone and Tooth Development.” Journal of American Dental Association, Vol. 23, 1936. Pg. 574, “Fluorine is a general protoplasmic poison, but the most important symptoms of chronic fluorine poisoning known at present are mottling of the teeth and interference with bone formation.”
48.) National Treasury Employee’s Union 280, Coalition of Environmental Protection Agency Unions, ‘EPA Union of Scientists.’ “Why EPA Union of Scientists Oppose Water Fluoridation.”
49.) World Health Organization, ‘Water-related diseases: Fluorosis.’ Online. ‘Ingestion of excess fluoride, most commonly in drinking-water, can cause fluorosis which affects the teeth and bones.’ http://www.who.int/water_sanitation_health/diseases/fluorosis/en/
50.) World Health Organization, ‘Air Quality Guidelines for Europe,’ 2000. Second Edition, WHO Regional Publications, No. 91. Pg. 4, “The toxicity of fluorides…”
http://www.euro.who.int/__data/assets/pdf_file/0018/123075/AQG2ndEd_6_5Fluorides.PDF

51.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 336.

52.) National Cancer Institute, Fluoridation Fact Sheet, See under: Can fluoridated water cause cancer? http://www.cancer.gov/cancertopics/factsheet/Risk/fluoridated-water
“A possible relationship between fluoridated water and cancer risk has been debated for years. The debate resurfaced in 1990 when a study by the National Toxicology Program, part of the National Institute of Environmental Health Sciences, showed an increased number of osteosarcomas (bone tumors) in male rats given water high in fluoride for 2 years (4) [Citation #56, below]. However, other studies in humans and in animals have not shown an association between fluoridated water and cancer (5–7).”
See: E. Operskalski, S. Preston-Martin, B. Henderson, B. Visscher, ‘A case-control study of osteosarcoma in young persons.’ American Journal of Epidemiology, Vol.126, No.1 (July 1987):118-26.

53.) S. McGuire, E. Vanable, M. McGuire, J. Buckwalter, C. Douglass, ‘Is there a link between fluoridated water and osteosarcoma?’ Journal of the American Dental Association, Vol. 122, No.4 (April 1991):38-45.

54.) K. Gelberg, E. Fitzgerald, S. Hwang, R. Dubrow, ‘Fluoride exposure and childhood osteosarcoma: a case-control study.’ American Journal of Public Health, Vol. 85, No.12 (Dec 1995):1678-83.
55.) R. Hoover, S. Devsa, K. Cantor, J. Lubin, J. Fraumani; National Cancer Institute. ‘DHHS Review of Fluoride Benefits and Risks.’ US Public Health Service; 1990. Time trends for bone and joint cancers and osteosarcomas in the surveillance, epidemiology and end results (SEER) program; pp. F1–7. Unpublished; found in: Review of Fluoride: Benefits and Risks, U.S. Department of Health & Human Services, Public Health Service, Washington DC, February 1991. Appendix E. Cited in Connett, Case Against Fluoride, 2010, Pg. 185.

56.) P. Cohn, An Epidemiological Report on Drinking Water and Fluoridation, New Jersey Department of Health, Environmental Health Service, November 8, 1992. Note: The original title of this report was A Brief Report on the Association of Drinking Water Fluoridation and the Incidence of Osteosarcoma Among Young Males. Cited in Connett, Case Against Fluoride, 2010, Pg. 185.

57.) J. Yiamouyiannis, ‘Fluoridation and Cancer: The biology and epidemiology of bone and oral cancer related to fluoridation.’ Fluoride. Vol.26 (1993):83–96.
See also: K. Takahashi, K. Akiniwa, K. Narita, “Regression Analysis of Cancer Incidence Rates and Water Fluoride in the U.S.A. based in IACRI/IARC (WHO) data (1978-1992),” Journal of Epidemiology Vol.11, No.4 (July 2001):170-9. 63.9% of the sites of the body were “positively significant” associated with WF, including bone cancer among males. http://www.ncbi.nlm.nih.gov/pubmed/11512573
58.) Bucher JR, Hejtmancik MR, Toft JD, et al. Results and conclusions of the National Toxicology Program’s rodent carcinogenicity studies with sodium fluoride. International Journal of Cancer 1991; 48(5):733–737.
59.) E. Bassin, D. Wypij, R. Davis, M. Mittleman, “Age-Specific Fluoride Exposure in Drinking Water and Osteosarcoma (United States),” Cancer Causes and Control Vol.17, No.4 (May 2006): 281-82.

60.) Ibid. Pg. 6
61.) National Treasury Employee’s Union 280, Coalition of Environmental Protection Agency Unions, ‘EPA Union of Scientists.’ “Why EPA Union of Scientists Oppose Fluoridation,” 1998.http://www.nteu280.org/Issues/Fluoride/NTEU280-Fluoride.htm Pg. 4, “The implication for the general public of these calculations is clear. Recent, peer-reviewed toxicity data when applied to EPA’s standard method for controlling risks from toxic chemicals, require an immediate halt to the use of the nation’s drinking water reservoirs as disposal sites for the toxic waste of the phosphate fertilizer industry.”
See also: Testimony Statement of Dr. J. William Hirzy, before Subcommittee on Wildlife, Fisheries and Drinking Water, U.S. Senate, June 29, 2000. Pg. 3, ‘we believe that a national moratorium on water fluoridation should be instituted.’ Available on Union’s website: http://www.nteu280.org/Issues/Fluoride/629FINAL.htm or http://www.epw.senate.gov/107th/hir_0629.htm
62.) Ibid. Letter to members of U.S. Congress on Fluoride Regulation, “RE: Bone Cancer-Fluoridation Cover-Up,” August 5, 2005. http://www.nteu280.org/Issues/Fluoride/fluroride%20.unions.congress.htm
See also: NRC, “Fluoride in Drinking Water,” 2006.
Pg. 9, “Bone is the most plausible site for cancer associated with fluoride because of its deposition into bone and its mitogenic effects on bone cells in culture.” A mitogen is a cell divider, and bone cancer is caused by uncontrolled proliferation of osteoblasts, i.e., an abnormal rate of bone cell multiplication.
Pg. 222, “fluoride appears to have the potential to initiate or promote cancer, particularly of the bone,”
Pg. 336, ‘Osteosarcoma is of particular concern as a potential effect of fluoride…”
See: Rachel Carson, Silent Spring, Pg. 207, “Many of the most distinguished research men in this field look with suspicion on any agent that damages the chromosomes, interferes in cell division, or causes mutations. In the view of these men, any mutation is a potential cause of cancer.”

See: Google Scholar: 88,990 results for ‘fluoride mitogen.’
K. Farley, N. Tarbaux, S. Hall, D. Baylink, “Mitogenic Actions of Fluoride on Osteoblast line cells,” Journal of Bone Mineral Research, Vol.5, Suppl. 1: (March 1990): S107-13. http://www.ncbi.nlm.nih.gov/pubmed/2339619

See: Google Scholar: 36,000 results for ‘fluoride mutagenic.’
E. Zeigler, M. Shelby, K. Witt, “Genetic Toxicity of Fluoride.” Environmental & Molecular Mutagenesis, Vol. 21, No.4 (1993): 309-18. “Fluoride produces chromosome aberrations and gene mutations in cultured mammalian cells.”
http://www.ncbi.nlm.nih.gov/pubmed/8491210

63.) Citation #61.
64.) NRC, ‘Fluoride in Drinking Water,’ 2006 Panel member, K. Thiessen, Suggested Issues for Consideration: Water Fluoridation,’ December 13, 2006. http://fluoridealert.org/content/kathleen-thiessen-phd/

65.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 322 “principles of cell biology indicate that stimuli for rapid cell division increase the risks for some of the dividing cells to become malignant, either by inducing random transforming events or by unmasking malignant cells that previously were in non-dividing states (190).”
66.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 222. See also: Pg. 336, “Osteosarcoma is of particular concern as a potential effect of fluoride…”

67.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 222.

68.) “Impact of fluoride on neurological development in children,” Harvard School of Public Health Press Release, July 25, 2012. http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/

69.) A. Choi, G. Sun, Y. Zhang, P. Grandjean, “Development Fluoride Neurotoxicology: A Systematic Review and Meta-Analysis.” Environmental Health Perspective, Vol.120, No.10 (Oct 2012): 1361-1368. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/

70.) Fluoride Action Network, “Fluoride & Intelligence: the 37 studies.” Online. http://www.fluoridealert.org/studies/brain01/
71.) G. Wang et al., “Total intake of fluorine content and children’s IQ,” Southeast University Medical Sciences. Available at: http://www.cnki.com.cn/Article/CJFDTOTAL-NJTD201206020.htm

72.) S. Wang, Z. Wang, X. Cheng, et al., “Arsenic and Fluoride Exposure in Drinking Water: Children’s IQ and Growth in Shanyin County, Shanxi Province, China,” Environmental Health Perspectives Vol.115, No. 4 (2007): 643–47, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1852689/

73.) L. Zhao, G. Liang, D. Zhang, and X. Wu, “Effect of High-Fluoride Water Supply on Children’s Intelligence,” Fluoride Vol.29, No. 4 (1996): 190–92, http://fluoridealert.org/scher/zhao-1996.pdf

74.) G. Wang, D. Yang, F. Jia, and H. Wang, “A Study of the IQ Levels of Four- to Seven-Year-Old Children in High Fluoride Areas,” Fluoride Vol.41, No. 4 (2008): 340–43 (originally published in 1996 in Endemic Diseases Bulletin [China]), http://www.fluorideresearch.org/414/files/FJ2008_v41_n4_p340-343.pdf

320. Ren, K. Li, and D. Liu, “A Study of the Intellectual Ability of 8–14 Year-Old Children in High Fluoride, Low Iodine Areas,” Fluoride Vol.41, No. 4 (2008): 319–20 (originally published in 1989 in Chinese Journal of Control of Endemic Diseases), http://www.fluorideresearch.org/414/files/FJ2008_v41_n4_p319-320.pdf
     75.) L. Qin, S. Huo, R. Chen, et al., “Using the Raven’s Standard Progressive Matrices to Determine the Effects of the Level of Fluoride in Drinking Water on the Intellectual Ability of School-Age Children,” Fluoride Vol.41, No. 2 (2008): 115–19 (originally published in 1990 in Chinese Journal of the Control of Endemic Disease), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p115-119.pdf

76.) Y. Lu, Z. Sun, L. Wu, et al., “Effect of High-Fluoride Water on Intelligence in Children,” Fluoride Vol.33, No. 2 (2000): 74–78, http://www.fluorideresearch.org/332/files/FJ2000_v33_n2_p74-78.pdf

77.) S. Liu, Y. Lu, Z. Sun, et al., “Report on the Intellectual Ability of Children Living in High-Fluoride Water Areas,” Fluoride Vol.41, No. 2 (2008): 144–47 (originally published in 2000 in Chinese Journal of Control of Endemic Diseases), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p144-147.pdf

78.) F. Lin, F. Aihaiti, H. Zhao, et al., “The Relationship of a Low-Iodine and High-Fluoride Environment to Subclinical Cretinism in Xinjiang,” Xinjiang Institute for Endemic Disease Control and Research; Office of Leading Group for Endemic Disease Control of Hetian Prefectural Committee of the Communist Party of China; and County Health and Epidemic Prevention Station, Yutian, Xinjiang, Iodine Deficiency Disorder Newsletter Vol.7, (1991): 3, http://fluoridealert.org/scher/lin-1991.pdf -also see http://www.fluoridealert.org/IDD.htm

79.) X. Li, J. Zhi, and R. Gao, “Effect of Fluoride Exposure on Intelligence in Children,” Fluoride Vol. 28, No. 4 (1995): 189–92, http://fluoridealert.org/scher/li-1995.pdf

80.) Y. Ding et al., “The relationships between low levels of urine fluoride on children’s intelligence, dental fluorosis in endemic fluorosis areas in Hulunbuir, Inner Mongolia, China,” Journal of Hazardous Materials Vol.186, No.2-3 (2011):1942-46.

81.) Y. Li, X. Jing, D. Chen, L. Lin, and Z. Wang, “Effects of Endemic Fluoride Poisoning on the Intellectual Development of Children in Baotou,” Fluoride Vol.41, No. 2 (2008): 161–64 (origi­nally published in 2003 in Chinese Journal of Public Health Management), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p161-164.pdf

82.) F. Hong, Y. Cao, D. Yang, and H. Wang, “Research on the Effects of Fluoride on Child Intellectual Development Under Different Environmental Conditions,” Fluoride Vol.41, No. 2 (2008): 156–60 (originally published in 2001 in Chinese Primary Health Care), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p156-160.pdf

83.) Y. Chen, F. Han, Z. Zhou, et al., “Research on the Intellectual Development of Children in High Fluoride Areas,” Fluoride Vol.41, No. 2 (2008): 120–24, (originally published in 1991 in Chinese Journal of Control of Endemic Diseases), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p120-124.pdf

84.) Q. Xiang, Y. Liang, L. Chen, et al., “Effect of Fluoride in Drinking Water on Children’s Intelligence,” Fluoride Vol.36, No. 2 (2003): 84–94, http://www.fluorideresearch.org/362/files/FJ2003_v36_n2_p84-94.pdf – Also see Q. Xiang, Y. Liang, M. Zhou, and H. Zang, “Blood Lead of Children in Wamiao -Xinhuai Intelligence Study” (letter), Fluoride Vol. 36, No. 3 (2003): 198–99, http://www.fluorideresearch.org/363/files/FJ2003_v36_n3_p198-199.pdf
85.) M. Sun, et al., “Measurement of intelligence by drawing test among the children in the endemic area of Al-F combined toxicosis,” Journal of Guiyang Medical College Vol.16, No. 3 (1991): 204-06.

86.) Q. Shao, et al., “Study of Cognitive Function Impairment Caused by Chronis Fluorosis,” Chinese Journal of Endemiology Vol. 22, No.4 (2003): 336-8.
87.) J. An, S. Mei, A. Liu, et al., “Effect of High Level of Fluoride on Children’s Intelligence” (article in Chinese), Zhong Guo Di Fang Bing Fang Zhi Za Zhi (Chinese Journal of Control of Endemic Diseases) Vol.7, No. 2 (1992): 93–94.
88.) Z. Fan, H. Dai, A. Bai, et al., “Effect of High Fluoride Exposure on Children’s Intelligence” (article in Chinese), Huan Jing Yu Jian Kang Za Zhi Vol.24, No. 10 (2007): 802–3.
89.) Y. Xu, C. Lu, and X. Zhang, “Effect of Fluoride on Children’s Intelligence” (article in Chinese), Di Fang Bing Tong Bao Vol.9 (1994): 83–84.

90.) L. Yao, Y. Deng, S. Yang, et al., “Comparison of Children’s Health and Intelligence Between the Fluorosis Area with Altering Water Source and Those without Altering Water Source” (article in Chinese), Yu Fang Yi Xue Wen Xian Xin Xi Vol.3, No. 1 (1997): 42–43.
91.) J. Zhang, H. Yao, and Y. Chen, “Effect of High Level of Fluoride and Arsenium on Children’s Intelligence” (article in Chinese), Zhong Guo Gong Gong Wei Sheng Xue Bao Vol.17, No. 2 (1998): 119.

92.) M. Rocha-Amador, M. Navarro, L. Carrizales, et al., “Decreased Intelligence in Children and Exposure to Fluoride and Arsenic in Drinking Water,” Cadernos de Saúde Pública Vol.23, Suppl. 4 (2007): S579–87.

93.) P. Shivaprakash et al., “Relation between dental fluorosis and intelligence quotient in school children of Bagalkot district,” Journal of Indian Society Pedodontics & Preventative Dentistry Vol.29, No.2 (2011): 117-20.

94.) P. Eswar et al., “Intelligent quotients of 12-14 year old school children in a high and low fluoride village in India,” Fluoride Vol.44 (2011): 168-72.

95.) M. H. Trivedi, R. J. Verma, N. J. Chinoy, et al., “Effect of High Fluoride Water on Intelligence of School Children in India,” Fluoride Vol.40, No. 3 (2007): 178–83. http://www.fluorideresearch.org/403/files/FJ2007_v40_n3_p178-183.pdf

96.) M. Trivedi et al., “Assessment of groundwater quality with special reference to fluoride and its impact on IQ of schoolchildren in six villages of the Mundra Region, Kachchh, Gujurat, India,” Fluoride Vol.45, No.4 (2012): 377-83.

97.) S. Saxena, et al., “Effect of fluoride exposure on the intelligence of school children in Madhya Pradesh, India,” Journal of Neurosciences in Rural Practice Vol.3, No.2 (2012): 144-49.

98.) H. Poureslami et al, “Intelligence quotient of 7 to 9 year-old children from an area with high fluoride in drinking water,” Journal of Dentistry and Oral Hygiene Vol.3, No.4 (2011): 61-64.

99.) B. Seraj et al., “Effect of high water fluoride concentration on the intellectual development of children in Makoo/Iran,” Journal of Dentistry, Tehran University of Medical Sciences Vol.9, No.3 (2012): 221-29.

100.) B. Seraj, M. Shahrabi, M. Falahzade, et al., “Effect of High Fluoride Concentration in Drinking Water on Children’s Intelligence,” Journal of Dental Medicine 19, no. 2 (2007): 80–86. Note: English translation forwarded by lead author (B. Seraj, department of pediatric dentistry, faculty of dentistry, Tehran University of Medical Sciences), http://fluoridealert.org/scher/seraj-2007.trans.pdf
101.) R. Masters, M. Coplan, B. Hone, and J. Dykes, “Association of Silicofluoride Treated Water with Elevated Blood Lead,” Neurotoxicology Vol.21, No. 6 (2000): 1091-99.

102.) ‘M. Coplan, S. Patch, R. Masters, M. Bachman, “Confirmation of and Explanations for Elevated Blood Lead and Other Disorders in Children Exposed to Water Disinfection and Fluoridation Chemical.” Neurotoxicology Vol. 28, No. 5 (2007): 1032-42.
103.) J. Luke, “Fluoride Deposition in the Aged Human Pineal Gland,” Caries Research Vol.35, No. 2 (2001): 125–28.

104.) P. Mullenix, P. Denbesten, A. Schunior, and W. Kernan, “Neurotoxicity of Sodium Fluoride in Rats,” Neurotoxicology and Teratology Vol.17, No. 2 (1995): 169–77.

See also: Fluoride Action Network, “Fluoride & the Brain: An Interview with Dr. Phyllis Mullenix; http://www.fluoridealert.org/content/mullenix-interview/

105.) Z. Guan, Y. Wang, K. Xiao, et al., “Influence of Chronic Fluorosis on Membrane Lipids in Rat Brain,” Neurotoxicology and Teratology Vol.20, No. 5 (1998): 537–42.
See also: Q. Gao, Y. Liu, and Z. Guan, “Decreased Learning and Memory Ability in Rats with Fluorosis: Increased Oxidative Stress and Reduced Cholinesterase Activity,” Fluoride Vol.42, No. 4 (2009): 277–85, http://www.fluorideresearch.org/424/files/FJ2009_v42_n4_p277-285.pdf.
See also: Y. Liu, Q. Gao, C. Wu, and Z. Guan, “Alterations of nAChRs and ERK1/2 in the Brains of Rats with Chronic Fluorosis and Their Connections with the Decreased Capacity of Learning and Memory,” Toxicology Letters Vol.192, No. 3 (2010): 324–29.

106.) J. Varner, K. Jensen, W. Horvath, and R. Isaacson, “Chronic Administration of Aluminum-Fluoride or Sodium-Fluoride to Rats in Drinking Water: Alterations in Neuronal and Cerebrovascular Integrity,” Brain Research Vol.784, No. 1–2 (1998): 284–98. Excerpts at http://www.fluoride-journal.com/98-31-2/31291-95.htm

107.) J. Zhai, Z. Guo, C. Hu, et al., “Studies on Fluoride Concentration and Cholinesterase Activity in Rat Hippocampus” (article in Chinese), Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi Vol.21, No. 2 (2003): 102–4.

108.) I. Inkielewicz and J. Krechniak, “Fluoride Content in Soft Tissues and Urine of Rats Exposed to Sodium Fluoride in Drinking Water,” Fluoride Vol.36, No. 4 (2003): 263–66, http://www.fluoride-journal.com/03-36-4/364-263.pdf

109.) A. R. Kay, R. Miles, and R. K. Wong, “Intracellular Fluoride Alters the Kinetic Properties of Calcium Currents Facilitating the Investigation of Synaptic Events in Hippocampal Neurons,” The Journal of Neuroscience Vol.6, No. 10 (1986): 2915–20, http://www.jneurosci.org/cgi/reprint/6/10/2915

110.) M. Bhatnagar, P. Rao, J. Sushma, and R. Bhatnagar, “Neurotoxicity of Fluoride: Neurodegeneration in Hippocampus of Female Mice,” Indian Journal of Experimental Biology Vol.40, No. 5 (2002): 546–54.

11.) Z. Zhang, X. Shen, and X. Xu, “Effects of Selenium on the Damage of Learning-Memory Ability of Mice Induced by Fluoride” (article in Chinese), Wei Sheng Yan Jiu Vol.30, No. 3 (2001): 144-46.

112.) G. van der Voet, O. Schijns, and F. de Wolff, “Fluoride Enhances the Effect of Aluminium Chloride on Interconnections Between Aggregates of Hippocampal Neurons,” Archives of Physiology and Biochemistry Vol.107, No. 1 (1999): 15–21.

113.) Z. Zhang, X. Xu, X. Shen, and X. Xu, “Effect of Fluoride Exposure on Synaptic Structure of Brain Areas Related to Learning-memory in Mice,” Fluoride Vol.41, No. 2 (2008): 139–43 (originally published in 1999 in Journal of Hygiene Research [China]), http://www.fluorideresearch.org/412/files/FJ2008_v41_n2_p139-143.pdf

114.) W. Zhu, J. Zhang, and Z. Zhang, “Effects of Fluoride on Synaptic Membrane Fluidity and PSD-95 Expression Level in Rat Hippocampus,” Biological Trace Element Research, March 2010.

115.) M. Pereira, P. Dombrowski, E. Losso, et al., “Memory Impairment Induced by Sodium Fluoride Is Associated with Changes in Brain Monoamine Levels,” Neurotoxicity Research, December 2009.

116.) M. Zhang, A. Wang, T. Xia, and P. He, “Effects of Fluoride on DNA Damage, S-phase Cell-cycle Arrest and the Expression of NF-KappaB in Primary Cultured Rat Hippocampal Neurons,” Toxicology Letters Vol.179, No. 1 (2008): 1–5.

117.) T. Xia, M. Zhang, W. He, et al., “Effects of Fluoride on Neural Cell Adhesion Molecules mRNA and Protein Expression Levels in Primary Rat Hippocampal Neurons” (article in Chinese), Zhonghua Yu Fang Yi Xue Za Zhi Vol.41, No. 6 (2007): 475–78.

118.) M. Zhang, A. Wang, W. He, et al., “Effects of Fluoride on the Expression of NCAM, Oxidative Stress, and Apoptosis in Primary Cultured Hippocampal Neurons,” Toxicology Vol.236, No. 3 (2007): 208–16.

119.) B. Spittle, “Psychopharmacology of Fluoride: A Review,” International Clinical Psychopharmacology Vol.9, No. 2 (1994): 79–82.

120.) P. Grandjean, P. Landrigan, ‘Neurobehavioural Effects of Developmental Toxicity,’ The Lancet Neurology Vol. 13, No. 3 (March 2014):330-8.
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2813%2970278-3/abstract

See also: P. Grandjean and P. Landrigan, “Developmental Neurotoxicity of Industrial Chemicals,” The Lancet Vol.368, No. 9553 (2006): 2167–78.

⌘

RISK, REVERENCE OF LIFE & ETHICS

1.) Rachel Carson, Silent Spring, 1962. Pg. 243.
2.) Center for Disease Control, “Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004.” http://www.cdc.gov/nchs/data/databriefs/db53.htm#summary

3.) World Health Organization, ‘Water-related diseases: Fluorosis.’ Online. ‘Ingestion of excess fluoride, most commonly in drinking-water, can cause fluorosis which affects the teeth and bones.’ http://www.who.int/water_sanitation_health/diseases/fluorosis/en/
4.) National Treasury Employee’s Union 280, Coalition of Environmental Protection Agency Unions, ‘EPA Union of Scientists.’ “Why EPA Union of Scientists Oppose Water Fluoridation.”
5.) Approved Drug Products and Legal Requirements, Volume III of USP Dispensing Information, US Pharmacopeial Convention, 2004. 24^th Edition. Tauton, MA: Quebecor World. ISBN 1-56363-465-1. Pg. III/1, “The Federal Food, Drug and Cosmetic Act of 1938 require that drugs be shown to meet certain safety requirements prior to their being marketed. Drugs that were already being marketed at that time were ‘grandfathered,’ and were allowed to remain on the market without further regulatory approval… The following listing identifies drug products that we believe were considered ‘pre-1938’ or ‘grandfathered’… Sodium Fluoride (Solution, Oral + Tablets).”
6.) “Dose-Response Relationships in Toxicology,” Pesticide Information Project, Extension Toxicology Network. http://pmep.cce.cornell.edu/profiles/extoxnet/TIB/dose-response.html

7.) Rachel Carson, Silent Spring, 1962. Pg. 18
8.) EPA Report: ‘1990 Report to Congress on Special Waste Mining.’ Office of Solid Waste to US Congress, July 23, 1990. www.epa.gov/compliance/resources/reports/…/1990rpttocongress.pdf

9.) National Sanitary Foundation International on documented impurities in fluoridation chemicals, as linked to by Center for Disease Control, “Fluoridation Fact Sheet.” “Fluoride additives are analyzed for impurities that have been identified as having the potential to occur. Those impurities include arsenic, lead and radionuclides.”   http://www.cdc.gov/fluoridation/factsheets/engineering/wfadditives.htm
10.) Citation #6

11.) World Health Organization, ‘Air Quality Guidelines for Europe,’ 2000. Second Edition, WHO Regional Publications, No. 91. Pg. 4, “The toxicity of fluorides…”
http://www.euro.who.int/__data/assets/pdf_file/0018/123075/AQG2ndEd_6_5Fluorides.PDF
12.) An 11.5 fl. oz. glass of fluoridated water at the “optimal” level of 0.7ppm contains the exact same quantity of fluoride as the recommended “pea size” amount of fluoride toothpaste. FLUORIDATED WATER ratio — 0.7 units fluoride : 1,000,000 units water, or 0.7 parts per million, 0.7ppm

glass of water = about 11.5 fluid ounces (fl oz)

1 fl oz = about 30 milliliters (mL)

Distilled water at 40 degrees Fahrenheit: density of water is 1 gram/mL or 1 g/mL

\ 11.5 fl oz glass of fluoridated water x 30mL/fl oz x 1g/mL =
mass of glass of fluoridated water = about 345 grams = 345,000 milligrams (mg)

fluoridated water ratio is 0.7 units : 1,000,000 units

0.7/1,000,000 = x/345,000

x= ~0.25 mg fluoride

FLUORIDE TOOTHPASTE ratio — 1,000 units fluoride : 1,000,000 other toothpaste ingredients =1,000:1,000,000, which is 1,000ppm or, 1:1,000

Pea size amount of toothpaste is about 0.25 grams (g)

http://www.washington.edu/earlychildhood/faqs/childrens-oral-health-faqs

\ mass of pea size toothpaste = 0.25 g

1/1,000 = x/0.25

x= ~0.00025 g of fluoride

1,000 milligrams (mg) for every gram (g)

0.00025g x 1,000mg/g

x= ~0.25 mg fluoride
13.) U.S. Code of Federal Regulations, Title 21, Volume 5, Part 355, Subpart C: Warning Labeling. Online. Accessed September, 2013. http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?fr=355.50
14.) Center for Disease Control, see “Fluoridation Policy Tool.” http://www.cdc.gov/fluoridation/index.htm
15.) Fluoride Action Network, “Professional Statement to End Water Fluoridation,” http://fluoridealert.org/researchers/professionals-statement/
16.) Ibid. Citation #15.
17.) National Treasury Employee’s Union 280, Coalition of Environmental Protection Agency Unions, ‘EPA Union of Scientists.’ “Why EPA Union of Scientists Oppose Water Fluoridation.” www.nteu280.org

18.) Citation #15.
19.) International Academy of Oral Medicine & Toxicology, http://iaomt.org/wp-content/uploads/article_IAOMT-Fluoridation-Position.pdf

20.) Citation #15.
21.) Citation #15.
22.) Ursula K. LeGuin, “Those Who Walk Away From Omelas,” Short Story, 1973.
23.) E. Bassin, D. Wypij, R. Davis, M. Mittleman, “Age-Specific Fluoride Exposure in Drinking Water and Osteosarcoma (United States),” Cancer Causes and Control Vol.17, No.4 (May 2006): 281-82.
24.) J. Doull, interviewed by D. Fagin, “Second Thoughts on Fluoride,” Scientific American, 298, no. 1 (January 2008): 74-81. Pg. 80-1.View Preview: http://www.scientificamerican.com/article/second-thoughts-on-fluoride/
See also: NRC, “Fluoride in Drinking Water,” 2006. Pg. 336, ‘Osteosarcoma is of particular concern as a potential effect of fluoride…”
25.) NRC, “Fluoride in Drinking Water,” 2006. Pg. 317.

26.) Open letter from Professor Trevor Sheldon, chair of the Advisory Group for the York Review, and founding director of the UK National Health Service’s Centre for Reviews and Dissemination at the University of York, Heslington, York, UK, January 3, 2001, [bold in original] http://www.appgaf.org.uk/archive/archive_letter_shel/.
See also: “What the ‘York Review’ on the Fluoridation of Drinking Water Really Found,” University of York Centre for Reviews & Dissemination, October 28, 2003. http://www.york.ac.uk/inst/crd/fluoridnew.htm
27.) Citation #15.
28.) D. Locker, M. McNally, J. Downie, H. Cohen, “The Science and Ethics of Water Fluoridation,” Journal of the Canadian Dental Association, Vol.67, No.10 (2001):578-80. http://cof-cof.ca/wp-content/uploads/2012/02/Cohen-and-Locker-The-Science-And-Ethics-Of-Water-Fluoridation-Journal-Canadian-Dental-Association-2001-6710578-80.pdf
29.) P. Clein, “How Can It Be Ethical To Be Putting Industrial Waste In Our Drinking Water?” Pharmaceutical Journal Vol. 271 (August 2003). Pg. 234.

30.) European Union Panel on Dietetic Products, Nutrients and Allergies, Affiliated with the European Food Safety Authority, Scientific Committee on the Status of Dietary Reference Values for Fluoride. Requested by European Commission. EFSA Journal. Issue 11, No. 8 (Aug 2013). Pg. 3332. ‘Fluoride is not an essential nutrient.’ This sentence is viewable online: http://www.efsa.europa.eu/en/efsajournal/pub/3332.htm

See also: U.S. Federal Register, Volume 60, Number 249. Rules and Regulations, 21 CFR, Part 101. Docket NO. 90N-0134, RIN 0910-AA19. Department of Health and Human Services, Food and Drug Administration, “FDA Food Labeling: Reference Daily Intakes.” December 28, 1995. Last sentence of Section II: “Consistent with the vast majority of comments, FDA is adopting these values [Daily Values, i.e. Dietary Reference Intakes, for essential nutrients] except the value for fluoride, as explained below.”
31.) Agency for Toxic Substances & Disease Registry, ‘Toxicological Profiles of Fluoride.’ Reference Dosage (RfD): Dental Fluorosis: 0.06mg/kg/day
Maximum Residue Limit (MRL): Bone Fracture: 0.05/mg/kg/day

www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf

Also viewable at EPA’s Integrated Risk Information System: http://www.epa.gov/iris/subst/0053.htm

See also: National Academy of Sciences, National Research Council, ‘Fluoride in Drinking Water: A Scientific Review of EPA’s Standards.’ Washington, DC: National Academies Press, 2006. Pg. 29, Infants with average water consumption: range of dosage is 0.042 to 0.072mg/kg/day. Infants with above average water consumption: range of dosage is 0.084 to 0.14mg/kg/day. http://www.nap.edu/openbook.php?record_id=11571

32.) NRC, “Fluoride in Drinking Water,” 2006. Pg. 23, “The National Research Council’s (NRC’s) 1993 review of the health effects of ingested fluoride reported estimates of average daily fluoride intake from the diet of 0.04-0.07 milligrams per kilogram (mg/kg) of body weight for young children in an area with fluoridated water (fluoride concentration in drinking water, 0.7-1.2 mg per liter [L]; NRC 1993)…. The fluoride intake from toothpaste or mouth rinse by children with good control of swallowing, assuming twice-a-day use, was estimated to equal the intake from food, water, and beverages.”
33.) Environmental Protection Agency Pesticide Registration Review, ‘EPA Proposes to Withdraw Sulfuryl Fluoride Tolerances.’ http://www.epa.gov/pesticides/sulfuryl-fluoride/evaluations.html

34.) U.S. Department of Agriculture, “USDA National Fluoride Database of Selected Beverages and Foods,” 2004. Prepared by Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA; in collaboration with University of Minnesota, Nutrition Coordinating Center; University of Iowa, College of Dentistry; Virginia Polytechnic Institute and State University, Food Analysis Laboratory Control Center; National Agricultural Statistics Service, CSREES, USDA; and Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service. See: https://library.villanova.edu/Find/Record/817953/Details

35.) Fluorine in Agriculture, 1995. Edited by R. Banks, University of Manchester. Pg. 3, Shell trademarked a fluoride based insecticide and rodenticide. Dow has trademarked a fluoride based herbicide, and DuPont, fluoride fungicide. Google eBook.
36.) Carbonated Beverages and Fruit Juices, especially Grape

A.) J. Heilman, M. Kiritsy, S.M. Levy, J.S. Wefel, “Assessing Fluoride Levels of Carbonated Soft Drinks,” Journal of the American Dental Association, Vol. 130, No.11 (Nov 1999): 1593-95. 332 soft drinks, ranged from 0.02ppm to 1.28, with mean of 0.72. “Fluoride levels exceeded 0.6ppm for 71% of the products.”
B.) J. Shannard, Y. Shim, M. Kritsineli, P. Labropoulou, A. Tsamtsouris, “Fluoride Levels and Fluorides Contamination of Fruit Juices,” Journal of Clinical Pediatric Dentistry, Vol. 16, No.1 (Fall 1991): 38-40. 42% of 43 samples had more than 1ppm fluoride. “Since it is a common practice to use fluoride-containing insecticide in growing grapes, it is believed that contamination of these juices is occurring.” Abstract. Range from 0.15 to 6.8ppm. Top three highest fluoride juices: Welch’s brand 100% grape juice 2.6ppm, Minute Maid brand white grape, 3, Gerber brand white grape, 6.8.

37.) Teas, for some reason, take in and store more fluoride than other plants.

A.) M. Whyte, “Fluoride Levels in Bottled Teas,” The American Journal of Medicine Vol. 119, No. 2 (2006): 189–90.

B.) M. Whyte, W. Totty, V. Lim, and G. Whitford, “Skeletal Fluorosis from Instant Tea,” Journal of Bone and Mineral Research Vol. 23, No. 5 (2008): 759–69.

C.) J. Hallanger Johnson, A. Kearns, P. Doran, et al., “Fluoride-Related Bone Disease Associated with Habitual Tea Consumption,” Mayo Clinic Proceedings Vol. 82, No. 6 (2007): 719–24. Note: Erratum on dosage error in article text in: Mayo Clinic Proceedings 82, no. 8 (2007): 1017 http://www.mayoclinicproceedings.com/content/82/6/719.full

38.) Chicken: N. Fein, F. Cerklewski, “Fluoride Content of Foods Made with Mechanically Separated Chicken,” Journal of Agricultural Food Chemistry Vol. 49, No.9 (Sept 2001): 4284. “A single serving of chicken sticks alone would provide about half of a child’s upper limit of safety for fluoride.”

39.) Infant Food

863. Heilman, M. Kiritsy, S. Levy, J. Wefel, “Fluoride Concentrations of Infant Foods,” Journal of the American Dental Association, Vol. 128 (July 1, 1997): 857-863. 0.01 to 8.38 micrograms per gram, with highest fluoride concentrations found in infant foods containing chicken.

40.) Federal Register Volume 67, Number 79 (Wednesday, April 24, 2002), Environmental Protection Agency, “Notice of Filing a Pesticide Petition to Establish a Tolerance for a Certain Pesticide Chemical in or on Food.” E.g., Fluoride Pesticide Residue Tolerance: 10ppm on Apricots, 15ppm on Kiwi, Up to 35ppm on Kale. http://www.gpo.gov/fdsys/pkg/FR-2002-04-24/html/02-9655.htm

41.) Center for Disease Control, “Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004.” http://www.cdc.gov/nchs/data/databriefs/db53.htm#summary

⌘
CONCLUSION

1.) J. Doull, interviewed by D. Fagin, “Second Thoughts on Fluoride,” Scientific American, 298, no. 1 (January 2008): 74-81. Pg. 80-1.View Preview: http://www.scientificamerican.com/article/second-thoughts-on-fluoride/
2.) Open letter from Professor Trevor Sheldon, chair of the Advisory Group for the York Review, and founding director of the UK National Health Service’s Centre for Reviews and Dissemination at the University of York, Heslington, York, UK, January 3, 2001, [bold in original] http://www.appgaf.org.uk/archive/archive_letter_shel/.

3.) National Treasury Employee’s Union 280, Coalition of Environmental Protection Agency Unions, ‘EPA Union of Scientists.’ “Why EPA Union of Scientists Oppose Water Fluoridation.” www.nteu280.org

4.) National Cancer Institute, http://www.cancer.gov/cancertopics/factsheet/Risk/fluoridated-water [emphasis added]
5.) Rachel Carson, Silent Spring, 1963. Pg. 83.
6.) Pg. 84.

7.) Pg. 100.
8.) Pg. 114.

9.) Pg. 86.

10.) J. Colquhoun, “Why I Changed My Mind About Water Fluoridation,” Perspectives on Biological Medicine, Vol.41, No.1 (Autumn 1997):29-44. Available at: http://www.fluoridation.com/colquhoun.htm
11.) J. Colquhoun, “Education and Fluoridation in New Zealand: An Historical Study,” Ph.D. Dissertation, University of Auckland, New Zealand, 1987.
12.) Thomas Kuhn, “Structure of Scientific Revolutions,” 1962. Second Edition. Chicago, IL: University of Chicago Press.
13.) Ibid. Pg. 6.
14.) Ibid. Pg. 6.

15.) Ibid. Pg. 2.
16.) Michael Crichton, https://www.cfa.harvard.edu/~scranmer/SPD/crichton.html

17.) “How Silent Spring Ignited the Environmental Movement,” Bryan Walsh, Time Magazine, September 25, 2012. http://science.time.com/2012/09/25/how-silent-spring-became-the-first-shot-in-the-war-over-the-environment/

18.) Rachel Carson, Silent Spring, 1962. Pg. 29.

19.) Environmental Defense Fund, “25 Years After DDT, Bald Eagles, Osprey Numbers Soar; Ban Credited with Resurgence in Nation’s Symbol,” June 13, 1997. http://www.edf.org/news/25-years-after-ddt-ban-bald-eagles-osprey-numbers-soar

20.) Scientific American, May 2013. http://blogs.scientificamerican.com/but-not-simpler/2013/05/22/why-portland-is-wrong-about-water-fluoridation/

21.) P. Grandjean, P. Landrigan, ‘Neurobehavioural Effects of Developmental Toxicity,’ The Lancet Neurology Vol. 13, No. 3 (March 2014):330-8.
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422%2813%2970278-3/abstract

See also: P. Grandjean and P. Landrigan, “Developmental Neurotoxicity of Industrial Chemicals,” The Lancet Vol.368, No. 9553 (2006): 2167–78.

See also: Fluoride Action Network, “IQ: The 39 Studies.” http://fluoridealert.org/studies/brain01/

22.) D.W. Cross, R.J. Carton, “Fluoridation: A violation of Medical Ethics and Human Rights,” International Journal of Occupational Environmental Health 9, no. 1 (Jan-March 2003): 24-9.
23.) Letter to Honorable Ken Calvert, Chairman, Subcommittee on Energy and Environment, Committee on Science, US House of Representatives, regarding FDA’s response to a Congressional Investigation about fluoride and fluoridation, from Melinda K. Plaisier, FDA Associate Commissioner for Legislation. December 21, 2000. “Fluoride, when used in the diagnosis, cure, mitigation, or prevention, of disease in man or animal, is a drug that is subject to FDA regulation […] Several NDAs [New Drug Applications] have been approved for fluoride topical products such as dentrifices and gels.” http://www.keepersofthewell.org/gov_resp_pdfs/fda_response.pdf

24.) Petition to Environmental Protection Agency Administer Robert Perciasepe, from Dr. William Hirzy, on behalf of co-petitioners. Request for EPA to prohibit silicofluorides and unpurified sodium fluoride as fluoridating agents due to arsenic contamination; Request to mandate pharmaceutical grade sodium fluoride. April 22, 2013. Pg. 2, and 17. http://www2.epa.gov/aboutepa/hfsa-section-21-petition

25.) National Sanitary Foundation International on documented impurities in fluoridation chemicals, as linked to by Center for Disease Control, “Fluoridation Fact Sheet.” “Fluoride additives are analyzed for impurities that have been identified as having the potential to occur. Those impurities include arsenic, lead and radionuclides.”   http://www.cdc.gov/fluoridation/factsheets/engineering/wfadditives.htm

26.) EPA Report: ‘1990 Report to Congress on Special Waste Mining.’ Office of Solid Waste to US Congress, July 23, 1990. www.epa.gov/compliance/resources/reports/…/1990rpttocongress.pdf

27.) Center for Disease Control. “Engineering Fact Sheet.” http://www.cdc.gov/fluoridation/fact_sheets/engineering/wfadditives.htm#2

28.) Petition to Environmental Protection Agency Administer Robert Perciasepe, from Dr. William Hirzy, on behalf of co-petitioners. Request for EPA to prohibit silicofluorides and unpurified sodium fluoride as fluoridating agents due to arsenic contamination; Request to mandate pharmaceutical grade sodium fluoride. April 22, 2013. Pg. 2, and 17. http://www2.epa.gov/aboutepa/hfsa-section-21-petition

29.) National Research Council of the National Academy of Sciences, ‘Fluoride in Drinking Water,’ 2006. Washington DC, National Academies Press. Pg. 15, “The most commonly used [drinking water] additives are silicofluorides, not the fluoride salts used in dental products (such as sodium fluoride and stannous fluoride). Silicofluorides are one of the by-products from the manufacture of phosphate fertilizers.” http://www.nap.edu/catalog.php?record_id=11571

30.) Thomas G. Reeves, P.E., National Fluoridation Engineer, Program Services Branch Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, Center for Disease Control and Prevention. Refer: FL-143, September 2000. “All of the fluoride chemicals used in the U.S. for water fluoridation, sodium fluoride, sodium fluorosilicate, and fluorosilicic acid, are useful byproducts of the phosphate fertilizer industry… These gases are captured by product recovery units (scrubbers) and condensed into 23% fluorosilicic acid. Sodium fluoride and sodium fluorosilicate are made from this acid.”

31.) U.N. International Programme on Chemical Safety and European Commission classify Fluorosilicic acid as Hazardous Waste: UN Class 8 – Corrosive substance. EC Classification: Symbol: C – Corrosive substance Disposal: “Do NOT let this chemical enter the environment.” http://www.inchem.org/documents/icsc/icsc/eics1233.htm

32.) Ibid., Sodium Fluorosilicate as Hazardous Waste: UN Hazard Class: 6.1 – Toxic substance. EC Classification: Symbol: T – Toxic substance. Labeling: “Signal: Danger, Toxic if swallowed [skull and crossbones symbol].” http://www.inchem.org/documents/icsc/icsc/eics1243.htm

33.) Ibid. Sodium Fluoride as Hazardous Waste: UN Hazard Class: 6.1 – Toxic substance. EC Classification: Symbol: T – Toxic substance. http://www.inchem.org/documents/icsc/icsc/eics0951.htm

34.) EPA’s classifications of Hydrofluorosilicic acid, Sodium Fluorosilicate, Sodium Fluoride: all fluorides are CERCLA Waste Substances from Superfund Sites: ‘severely harmful to human health and the environment.’ www.epa.gov/osweroe1/docs/er/302table01.pdf. *Hydrofluoric acid is the aqueous form of hydrogen fluoride, which is the gaseous form; both are classified under the same CASRN number, 7664393.

35.) Letter to Commissioner Jane Henry, Food and Drug Administration, from John Kelly, New Jersey Assemblyman, 36^th district, October 26, 2000. “I am petitioning the FDA to remove unapproved children’s fluoride supplements from the market… I filed a Freedom of Information Act request with the FDA to obtain copies of the studies the FDA had used in evaluating the safety and effectiveness of these products. I was shocked when the FDA informed me that the FDA had no such studies and that children’s fluoride supplements were not approved…. The last time the FDA reviewed an NDA for fluoride supplements was in 1975 and that NDA was rejected.”

36.) Letter to Honorable Ken Calvert, from Melinda K. Plaisier, FDA. “No New Drug Applications have been approved for fluoride drugs meant for ingestion… Fluoride products meant for ingestion were in use prior to the enactment [of the Kefauver-Harris Amendments (Drug Amendments of 1962) to the Food, Drug and Cosmetic Act [of 1938], in which efficacy in addition to safety became a requirement for drugs marketed in the U.S.”
See also: Approved Drug Products and Legal Requirements, Volume III of USP Dispensing Information, US Pharmacopeial Convention, 2004. 24^th Edition. Tauton, MA: Quebecor World. ISBN 1-56363-465-1. Pg. III/1, “The Federal Food, Drug and Cosmetic Act of 1938 require that drugs be shown to meet certain safety requirements prior to their being marketed. Drugs that were already being marketed at that time were ‘grandfathered,’ and were allowed to remain on the market without further regulatory approval… The following listing identifies drug products that we believe were considered ‘pre-1938’ or ‘grandfathered’… Sodium Fluoride (Solution, Oral + Tablets).”

37.) Food and Drug Administration, “FDA Approved Drug Products Database.” Online. http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm One will note there are no systemic approvals. See also: National Institute of Health’s “DailyMed Current Medication Information” Database of Currently Marketed Drugs, including whether or not a drug is FDA approved. http://dailymed.nlm.nih.gov/dailymed/search.cfm?startswith=fluoride&x=0&y=0

38.) D.W. Cross, R.J. Carton, “Fluoridation: A Violation of Medical Ethics and Human Rights,” International Journal of Occupational Environmental Health Vol.9, No. 1 (Jan-March 2003): 24-9. “Silicofluorides have never been submitted to the US FDA for approval as medications.”

39.) Safe Drinking Water Act, 42 US Code § 300g-1. Section 11. http://www.law.cornell.edu/uscode/text/42/300g-1
See also: D. Cross, R. Carton, “Fluoridation: A Violation of Medical Ethics and Human Rights,” International Journal of Occupational Environmental Health, Vol.9, No.1 (Jan-Mar 2003):24-9.

See also: Nuremberg Code of Medical Ethics: http://www.ushmm.org/information/exhibitions/online-features/special-focus/doctors-trial/nuremberg-code

See also: United Nation’s Council of Europe’s Biomedical Convention of 1999, http://conventions.coe.int/Treaty/en/Treaties/Html/164.htm

40.) Center for Disease Control, “Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004.” http://www.cdc.gov/nchs/data/databriefs/db53.htm#summary

41.) NRC, “Fluoride in Drinking Water,” 2006. Pg. 29, Infants with average water consumption: range of dosage is 0.042 to 0.072mg/kg/day. Infants with above average water consumption: range of dosage is 0.084 to 0.14mg/kg/day. http://www.nap.edu/openbook.php?record_id=11571

See also: Agency for Toxic Substances & Disease Registry, ‘Toxicological Profiles of Fluoride.’ Reference Dosage (RfD): Dental Fluorosis: 0.06mg/kg/day
Maximum Residue Limit (MRL): Bone Fracture: 0.05/mg/kg/day

www.atsdr.cdc.gov/toxprofiles/tp11-c8.pdf

Also viewable at EPA’s Integrated Risk Information System: http://www.epa.gov/iris/subst/0053.htm

42.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 23, ‘The fluoride intake from toothpaste or mouth rinse by children with good control of swallowing, assuming twice-a-day use, was estimated to equal the intake from food, water, and beverages.’ [emphasis added]. See also: Dental Products E. Bentley, R. Ellwood, and R. Davies, “Fluoride Ingestion from Toothpaste by Young Children,” British Dental Journal 186, no. 9 (1999): 460–62.

43.) Pesticides on All Sorts of Foods. U.S. Department of Agriculture, “USDA National Fluoride Database of Selected Beverages and Foods,” 2004. Prepared by Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, USDA; in collaboration with University of Minnesota, Nutrition Coordinating Center; University of Iowa, College of Dentistry; Virginia Polytechnic Institute and State University, Food Analysis Laboratory Control Center; National Agricultural Statistics Service, CSREES, USDA; and Food Composition Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service. See: https://library.villanova.edu/Find/Record/817953/Details

44.) Department of Health and Human Services and Environmental Protection Agency, ‘News Release: EPA & DHHS Announce New Scientific Assessments and Actions on Fluoride.’ January 7, 2011. http://yosemite.epa.gov/opa/admpress.nsf/3881d73f4d4aaa0b85257

359003f5348/86964af577c37ab285257811005a8417!OpenDocument

45.) NRC, ‘Fluoride in Drinking Water,’ 2006. Pg. 2, “After reviewing the collective evidence, including studies conducted since the early 1990s, the committee concluded unanimously that the present MCLG of 4mg/L for fluoride should be lowered.” See also: Pg. 10, “Lowering the MCL will prevent children from developing severe dental fluorosis and will reduce the lifelong accumulation of fluoride into bone that the majority of the committee believes is likely to put individuals at increased risk of bone fracture and possibly skeletal fluorosis.”
46.) NRC. “Fluoride in Drinking Water,” 2006.

Bone Cancer: “Fluoride appears to have the potential to initiate or promote cancer, particularly of the bone,” Pg. 336. “Osteosarcoma is of particular concern as a potential effect of fluoride…” Pg. 336. “Bone is the most plausible site for cancer associated with fluoride,” Pg. 9.

47.) Ibid. Neurotoxin: “It is apparent fluorides have the ability to interfere with the functions of the brain,” Pg. 222.
48.) Endocrine Disruptor: “Fluoride is therefore an endocrine disruptor,” Pg. 266.

49.) Thyroid: “Several lines of information indicate an effect of fluoride exposure on thyroid function,” Pg. 234.
50.) Immune System: “There is no question that fluoride can affect the cells involved in providing immune responses,” Pg. 295.

51.) Down’s Syndrome: “Down’s syndrome is a biologically plausible outcome of exposure,” Pg. 197.

52.) Diabetes: “Sufficient fluoride exposure appears to bring about increases in blood glucose or impaired glucose intolerance in some individuals and to increase the severity of some types of diabetes,” Pg. 260.

53.) Kidney Dysfunction: “Portions of the renal system may therefore be at higher risk of fluoride toxicity than most soft tissues… The effect of low doses of fluoride on kidney… functions in humans needs to be carefully documented…” Pg. 303.

54.) Fluoride Action Network, “Professional Statement to End Water Fluoridation,” http://fluoridealert.org/researchers/professionals-statement/

55.) Silent Spring, 1962. Pg. 246.

56.) J. Doull, interviewed by D. Fagin, “Second Thoughts on Fluoride,” Scientific American, 298, no. 1 (January 2008): 74-81. Pg. 80-1.View Preview: http://www.scientificamerican.com/article/second-thoughts-on-fluoride/

57.) Center for Disease Control, “Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004.”

58.) World Health Organization, ‘Water-related diseases: Fluorosis.’ Online. ‘Ingestion of excess fluoride, most commonly in drinking-water, can cause fluorosis which affects the teeth and bones.’ http://www.who.int/water_sanitation_health/diseases/fluorosis/en/
59.) Silent Spring, 1962. Pg. 278.
60.) Ibid. Pg. 29.
61.) European Union Panel on Dietetic Products, Nutrients and Allergies, Affiliated with the European Food Safety Authority, Scientific Committee on the Status of Dietary Reference Values for Fluoride. Requested by European Commission. EFSA Journal. Issue 11, No. 8 (Aug 2013). Pg. 3332. ‘Fluoride is not an essential nutrient.’ This sentence is viewable online: http://www.efsa.europa.eu/en/efsajournal/pub/3332.htm
62. J. Luke, “Fluoride Deposition in the Aged Human Pineal Gland,” Caries Research Vol.35, No. 2 (2001): 125–28.

Ibid. Pg. 32.
63.) Ibid. Pg. 4.

64.) Ibid. Pg. 278.

65.) CDC, Morbidity & Mortality Weekly Report, 1999. Vol. 48: 933-40. “Fluoride’s caries-preventative properties initially were attributed to changes in enamel during tooth development… However, laboratory and epidemiological research suggests fluoride prevents dental caries predominately after eruption of the tooth, and its action primarily are topical for both adults and children.”
See also: http://www.cdc.gov/Mmwr/preview/mmwrhtml/rr5014a1.htm

66.) Bryson, Christopher, “Fluoride Deception,” 2004. New York, NY: Seven Stories Press.

67.) U.N. International Programme on Chemical Safety classify Sodium Fluoride as Hazardous Waste: UN Hazard Class: 6.1 – Toxic substance. EC Classification: Symbol: T – Toxic substance. Labeling: “Signal: Danger, Toxic if swallowed [skull and crossbones symbol].” http://www.inchem.org/documents/icsc/icsc/eics1243.htm

68.) Ibid. Disposal: “Do NOT let this chemical enter the environment.”
69.) Silent Spring, 1962. Pg. 278.