Fluoride Action Network

At last the American Dental Association gives sound advice!
By Paul Connett

In an announcement that should spell trouble for fluoridation, the ADA has advised parents not to make up milk formula with fluoridated water. Their actual words in yesterday’s ADA e-gram (Nov 9, 2006) referring to baby formula were: “If using a product that needs to be reconstituted, parents and caregivers should consider using water that has no or low levels of fluoride.” Of course, this is very sensible advice – and should have been made years ago - as soon as scientists had found out how low fluoride was in mothers’ breast milk.

According to table 2-6 on page 23 of the NRC (2006) review, the level of fluoride in mothers milk in a non-fluoridated community is 0.004 ppm. This means a baby bottle fed with formula made up with fluoridated tap water (at 1 ppm) will get 250 times more fluoride than a breast fed baby. Unless one is prepared to say (like the Chief Health Officer in Victoria, Australia) that nature screwed up on these matters, it is abundantly clear that a new born baby does not NEED fluoride, and it is quite likely that such levels could be dangerous at these very early days in its life. One of the reasons that Nobel Laureate Arvid Carlsson gave for opposing fluoridation in Sweden in the 1970’s was his concern with what such excessive levels would do to the baby’s developing brain. The baby’s blood brain barrier is not fully developed at birth.

In yesterday’s announcement, the ADA still sticks to phrases like “exceeding optimal levels” thus blindly ignoring that as far as “optimal levels” are concerned nature has said that there are NONE. Fluoride is not a nutrient period. Even the CDC (1999, 2001) has conceded what most dental researchers have found, namely that whatever slight benefit fluoride might have on teeth is TOPICAL not SYSTEMIC, so it is very hard to see what an “optimal level” means to a new born baby before its teeth have erupted! Giving tap water to a baby, or to an infant before its teeth have erupted, gives no TOPICAL benefit, only SYSTEMIC risks.

For the ADA the concern is largely focused on the one SYSTEMIC toxic effect that they cannot hide  - or deny – dental fluorosis. With 32% of kids in the US now afflicted with this damaged enamel (CDC 2005) - it is abundantly clear that kids are being grossly over-exposed to fluoride in this country (as well as other fluoridated countries like Australia, New Zealand and Ireland). One contributing factor to this is bottle feeding with fluoridated water and correctly the ADA now advises against it.

When a few years ago the Food and Safety Authority of Ireland (FSAI) recommended to the Fluoridation Forum that women should not bottle-feed their babies using tap water (73% of the people in Ireland drink fluoridated water) it caused great consternation among the pro-fluoridation panel members. The result was a great deal of pressure behind the scenes and another FSAI committee recommendation (organized by phone!) came back with a watered down version – the second time round the FSAI merely made a positive recommendation for breast feeding, without advising against using bottle feeding with fluoridated tap water. It was widely recognized by Irish politicians, at the time, that if the FSAI had stuck to its guns it would have spelt the end of water fluoridation in Ireland. They knew that it would have been impossible to educate all the mothers in Ireland to follow these directions without a commitment to a massive education campaign. (For more info on the Irish controversy, see:

 http://www.fluoridealert.org/health/news/09.html )

So the key question now is this. Is the ADA statement a “paper tiger” warning - merely some  “liability limiting” action? Or is the ADA going to commit time, effort and resources to educating the public, the media and local officials to make sure that a large majority of parents (if not ALL) get this information? Giving this information only to dentists is not sufficient.

My gut feeling is that the ADA won’t reach out to the masses of people who need to hear and heed this warning; that it will simply limit its effort to statements like this. After all, the last thing any promoter of fluoridation wants to do is to warn parents about any dangers – small or large – accruing from their “perfectly safe” practice. Better to hide the warnings in very small print.

However, for all of those who are unfortunate enough to live in a fluoridated community please contact your village, town or city councilors and tell them about this statement and ask them how they intend to give parents this important information. Also, take the ADA’s statement with you to your local supermarket and warn the manager if they sell fluoridated bottle water aimed at kids and infants.

Please also go to our homepage <http://www.FluorideAlert.Org> for a lot more background information on this issue – currently, it is the top item. Note in particular the crucial question: how likely is it that when fluoride has caused dental fluorosis, it has caused no harm to any other tissue? I have printed this section after the ADA statements below.

ADA E-Gram
 
November 9, 2006
A forum for breaking news and
timely information from the ADA
 
 Interim Guidance on Reconstituted Infant Formula

Have any of your patients ever asked what type of water should be used when mixing powdered or liquid concentrate infant formula? Information about fluoride intake for infants and young children, which includes interim guidance on reconstituted infant formula, is posted on ADA.org.

The appropriate amount of fluoride is essential to prevent tooth decay, but fluoride intake above the recommended level for a child’s age creates a risk for enamel fluorosis in teeth during their development before eruption through the gums. According to fluoride intake guidelines set by the Institute of Medicine, the amount of fluoride recommended for babies under a year old is less than that for older children and adults. Infants less than one year old may be getting more than the optimal amount of fluoride (which may increase their risk of enamel fluorosis) if their primary source of nutrition is powdered or liquid concentrate infant formula mixed with water containing fluoride.

Recent developments led the ADA to develop the interim guidance. Last spring, the National Research Council released a report on naturally occurring fluoride in drinking water. While not the major focus of the report, research was cited that raised the possibility that infants could receive a greater than optimal amount of fluoride from reconstituted baby formula. Then, on Oct. 14, the FDA said bottlers could claim that fluoridated water can reduce the risk of dental cavities or tooth decay, but that this claim could not be used on water marketed to infants.

More research is needed before definitive recommendations can be made, but, in the meantime, if parents and caregivers are concerned, the ADA’s interim guidance provides steps to simply and effectively reduce fluoride intake during a baby’s first year of life. Essentially, the ADA supports the pediatricians’ recommendations on the benefits of breast feeding and notes that using ready-to-feed formula for bottle-fed babies will keep their fluoride intake under IOM limits. If using a product that needs to be reconstituted, parents and caregivers should consider using water that has no or low levels of fluoride.

Visit ADA.org for additional information on fluoride. If you have questions about products containing fluoride, contact John Malone (2878, malonej@ada.org). With questions about community water fluoridation, contact Jane McGinley (2862, mcginleyj@ada.org).
 
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A fuller statement was also released by the ADA:

ADA offers interim guidance on infant formula and fluoride
Posted 11/09/2006

By Stacie Crozier

The ADA has developed interim guidance on fluoride intake for infants and young children with advice for parents, caregivers and health care professionals of infants who consume infant formula.

Recent developments led the Association to offer interim guidance on infant formula and fluoride while more research is conducted, said Dr. Daniel M. Meyer, associate executive director, ADA Division of Science.

Those developments include the U.S. Food and Drug Administration's health claim notification Oct. 14 allowing bottlers to claim that fluoridated water may reduce the risk of dental cavities or tooth decay (but not make the claim for bottled water products specifically marketed for use by infants), and the March 22 release of the National Research Council report: "Fluoride in Drinking Water: A Scientific Review of EPA's Standards."

"We understand that parents and other caregivers need to make informed choices, with the help of their family physician and dentist, about what is best for their children," Dr. Meyer said. "We want to help ensure that infants receive an optimal amount of fluoride. In some cases, infants may be getting a greater than optimal amount of fluoride through liquid or powder baby formula mixed with water containing fluoride."

The ADA interim guidance, Dr. Meyer added, notes that fluoride intake above recommended levels creates a risk for enamel fluorosis in teeth during their development before eruption through the gums.

Enamel fluorosis, a disruption in tooth enamel formation, occurs only during tooth development in early childhood. In its milder form, fluorosis appears as faint white lines or streaks on tooth enamel visible only to dental experts under controlled examination conditions. Noticeable white lines or streaks that often consolidate into larger opaque areas, which may become a cosmetic concern, characterize mild to moderate fluorosis.

"While more research is needed before definitive recommendations can be made on fluoride intake by bottle-fed infants," reads the guidance, "the American Dental Association issues this guidance because we know that parents and other caregivers are understandably cautious about what is best for their children.

"Parents, caregivers and health professionals who are concerned have some simple and effective ways to reduce fluoride intake from infant formula": feeding infants breast milk, widely acknowledged as the most complete form of nutrition for infants; for infants who get most of their nutrition from formula during the first 12 months, choosing ready-to-feed formula over formula mixed with fluoridated water to help ensure that infants do not exceed the optimal amount of fluoride intake; if liquid or powdered concentrate infant formulas is the primary source of nutrition, it should be mixed with water that is fluoride free (or contains low levels of fluoride) to decrease the risk of fluorosis, including water that is labeled purified, demineralized, deionized, distilled or reverse osmosis filtered water to reduce the risk of fluorosis.

Parents or caregivers should consult with their pediatrician or family physician on the most appropriate water for infants that is available in each area and whether that water should be sterilized when mixed with the type of infant formula that is used.

Additional guidance is offered on other sources of fluoride for young children, including fluoride toothpaste, fluoride mouthrinse and dietary fluoride supplements.

"We all agree that the appropriate amount of fluoride is essential to prevent tooth decay, but at the same time we want to reduce the risk of enamel fluorosis as much as possible," said Dr. John Luther, associate executive director, ADA Division of Dental Practice.

The ADA guidance encourages parents/caregivers "to ensure that young children use an appropriate size toothbrush with a small brushing surface and only a pea-sized amount of fluoride toothpaste at each brushing. Young children should always be supervised while brushing and taught to spit out rather than swallow toothpaste. Many children under the age of six have not fully developed their swallowing reflex and may be more likely to inadvertently swallow fluoride toothpaste. Unless advised to do so by a dentist or other health professional, parents should not use fluoride toothpaste for children less than two years of age."

The guidance also notes that fluoride mouthrinses and dietary fluoride supplements should not be used for young children unless recommended by a dentist or other health professional.

The ADA continues to endorse fluoridation of community water supplies as safe and effective for preventing tooth decay. The CDC also endorses water fluoridation and has called it one of 10 great public health achievements of the 20th century. Water fluoridation protects individuals of all ages and is more cost-effective than other forms of fluoride treatments or applications.

Some 170 million people in the U.S. are served by public water systems that are fluoridated. The ADA, along with state and local dental societies, continues to work with federal, state and local agencies to increase the number of communities benefiting from water fluoridation.

Last month's decision by the FDA to allow bottlers to use health claims on fluoridated water was welcomed by the ADA. It allows manufacturers to promote the benefits of optimally fluoridated water, improve consumer understanding of its benefits and enable consumers to better identify bottled-water products with optimal fluoride levels.

"Whether you drink fluoridated water from the tap or buy it in a bottle, you're doing the right thing for your oral health," said Dr. James B. Bramson, ADA executive director. "Thanks to the FDA's decision, bottlers can now claim what dentists have long known—that optimally fluoridated water helps prevent tooth decay."

The FDA cited scientific statements form the CDC, the U.S. Public Health Service and the 2000 Surgeon General's Oral Health in America report supporting water fluoridation for caries prevention. The agency also said the claim is not intended for use on bottled water marketed to infants.

You can read the ADA's Interim Guidance: Information on Fluoride Intake for Infants and Young Children in the A-Z Professional Topic: Fluoride & Fluoridation.

ADA.org also offers more information on the FDA decision on bottled water; information on bottled water, home water treatment systems and fluoride exposure; fluoride and fluoridation; fluorosis, patient information and more.

 

Fluoride Exposure During Infancy - Is dental fluorosis just a 'cosmetic effect’?

"Like bones, a child's teeth are alive and growing. Fluorosis is the result of fluoride rearranging the crystalline structure of a tooth's enamel as it is still growing. It is evidence of fluoride's potency and ability to cause physiologic changes within the body, and raises concerns about similar damage that may be occurring in the bones."
    
SOURCE: Environmental Working Group, "National Academy Calls for Lowering Fluoride Limits in Tap Water", March 22, 2006.
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 "A linear correlation between the Dean index of dental fluorosis and the frequency of bone fractures was observed among both children and adults."
    
SOURCE: Alarcon-Herrera MT, et al. (2001). Well Water Fluoride, Dental fluorosis, Bone Fractures in the Guadiana Valley of Mexico. Fluoride 34(2): 139-149.
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"it is illogical to assume that tooth enamel is the only tissue affected by low daily doses of fluoride ingestion."
    
SOURCE: Dr. Hardy Limeback, Head of Preventive Dentistry, University of Toronto. (2000). Why I am now Officially Opposed to Adding Fluoride to Drinking Water.
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"The safety of the use of fluorides ultimately rests on the assumption that the developing enamel organ is most sensitive to the toxic effects of fluoride. The results from this study suggest that the pinealocytes may be as susceptible to fluoride as the developing enamel organ."
    
SOURCE: Luke J. (1997). The Effect of Fluoride on the Physiology of the Pineal Gland. Ph.D. Thesis. University of Surrey, Guildford. p. 176
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"It seems prudent at present to assume that the ameloblasts are not the only cells in the body whose function may be disturbed by the physiological concentrations of fluoride which result from drinking water containing 1 ppm."
   
SOURCE: Groth, E. (1973), Two Issues of Science and Public Policy: Air Pollution Control in the San Francisco Bay Area, and Fluoridation of Community Water Supplies. Ph.D. Dissertation, Department of Biological Sciences, Stanford University, May 1973.