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HomeMy WebLinkAbout1999 04 05 Other COMMISSION AGENDA April 5, 1999 Meeting CONSENT INFORMATIONAL PUBLIC HEARING REGULAR MGR ~T J~ Authorization WORKSHOP REQUEST: Utility Department Scheduling a Public Forum to Discuss Fluoridating the Potable Water Supply PURPOSE: The purpose of this Board item is to gauge the public interest in fluoridating the potable water supply by conducting a public forum with a panel of experts. CONSIDERATIONS: The issue of why the City of Winter Springs does not fluoridate the potable water supply was raised at the June 8, 1998 City Commission meeting. At the June 22, 1998 City Commission meeting staffwas directed to schedule a workshop and invite a panel of experts to discuss the pros and cons of fluoridation. This issue was most previously voted on January 8, 1996 and the decision was to not fluoridate the water supply. The issue has never been put to a referendum in this City. Approximately two thirds of the population in this country served by a public water supply receive fluoridated water of which 10% are from naturally occurring fluoride. The amount of naturally occurring fluoride in the City of Winter Springs water supply is insignificant. The panel of experts invited to attend is: Timothy P. Broduer (Resident of Winter Springs) Senior Associate, Malcolm Pimie, Inc. Engineer with 26 years of water and wastewater process design experience AprilS, 1999 Fluoridation Workshop Page 2 Dr. James Taylor, Ph.D., P.E. (Resident of Winter Springs) Director Environmental Systems Engineering Institute University of Central Florida Richard Loti, P.E., P.G. Drinking Water Program Manager - Central District Florida Department of Environmental Protection Rhoda Lawrence, RDH Fluoridation Project Coordinator Florida Department of Health The panel will each a brief provide introduction and then a question and answer period for the Commission and residents. ATTACHMENTS: 1. Fluoride overview from Florida Faucet COMMISSION ACTION: Florida Faucet, Volume I, Number 6 ~ ......... _ I'i3l'L A TT ACHMENT NO. 1 -~ -- UNDER THE MICROSCOPE The section that highlights a particular contaminant or topic, FLUORIDE ~. t~ .,.tiIl, ~ This issue highlights: Fluoride is a natural trace element foundin small but widely varying amounts in practically all soils, water . supplies, plants and animals. Fluorine (F), the element: IS a pale yellow-green, extremelyreactive gas found only In nature as a compound of calcium, radium and other elements, Fluorine combines with hydrogen to make hydrogen fluoride, a colorless gas. Hydrogen flu?rid~ dissolves in water to form hydroflUOriC aCid. ( .' ......, /i~; -:'\\ ", }. ~ f".: ;",1\ ,(,'" ..".......1 -t" 'J' ,~,/.,. r . ~~..:i,' \\';:t. ( U': (:>j' rlu"rk'1:: 1:: ~r.t. D10rlpgradable. It gradually accumulates in the environment, the food chain and people's bodies, where it settles in bones and teeth. It is released into the air from volcanoes and industrial sources where wind and rain carry it to nearby water, soil and food sources. Fluorides erode from rocks into soil and water, and leach from phosphorus fertilizers into food and water. Some plants store fluorides in their leaves and stems, Fluoride is present to some extent in all foods and beverages, but the concentrations vary widely. All water contains some fluoride n4lturally. Water fluoridation is the process of adjusting the fluoride content of fluoride- deficient waterto the recommended level for optimal dental health. The optimum concentration for fluoride in the water for hot climates has been established as 0.7 mg/l, but in ;,x:'".r :,1 'nates it has be'en established c;,; : . "t;" According to the U.S. Public Health Service, fluorides, at very low levels, are not believed to be harmful; however, high levels are toxic, causing lung, skin and bone damage. In children, high fluoride exposure can cause dental fluorosis defined as chronic fluorine poisoning, sometimes marked by mottling of the tooth enamel. The Safe Drinking Water Act regulates the amount of fluoride in water supplies. The Florida DEP sets two levels for fluoride: a secondary, or aesthetic level, of 2 mg/I, and a primary, or toxic level, of 4 mg/1. Systems exceeding the 4 mg/I must take corrective action. As an industrial pollutant, fluoride emissions from iron and copper industries have caused concern since 1850. By the turn of the century, lawsuits threatened the existence of these industries in Germany and England. In this country, fluoride was seen as "an apparently worthless by-product" until scientists with the University of Cincinnati's Kettering Laboratory (funded by metal and other industries) began to generate reports that very low doses of fluoride might be beneficial in reducing cavities in children, The discovery of the role of waterborne fluoride in prevent- ing tooth decay started with a young dentist, Dr. Frederick S. McKay, who set up his practice in Colorado Springs, Colorado. He noticed that many of his patients' teeth had a condition he called "Colorado Brown Stain." In 1908, he initiated a study and found that the condition of mottled enamel (fluorosis), was prevalent throughout the county, Around the 1920, Dr. McKay, along with Dr. G.V. Black, concluded that something either in or missing from the drinking water was causing the mottled enamel. He also " discovered that the teeth with the mottled en,amel were basically free of dental caries (tooth decay). In,1931, fluoride was identified as the element in drinking water that caused mottled enamel and also inhibited tooth decay, In the 1930's, Dr. H. Trendley Dean and Dr. McKay conducted several classic studies to determine if fluoride could be added to the drinking water to prevent cavities, More studies were conducted, but the outbreak of World War II temporarily Interrupted studies on fluorides, In 1945, four classic studies were begun to finally prove the benefits of water fluoridation. These studiE"J firrrdy es:;:b!ished fluoridation as a practical and ~ffi_cFv", !-ub ic health measure that would prevent tooth tiP! :.1'" During the McCarthy era in the 1950's, extreme right-wing groups claimed that fluoridation was a plot by communists in the U.S. government to poison Americans' brain cells. It has been suggested that this '50s politicization muddied the scientific water for decades so that legitimate scientists, dentists or physicians opposing the use of fluoride were branded extremists. In 1975, John Yiamouyiannis, a biochemist and controver- sial fluoridation opponent, and Dean Burk: a retired National Cancer Institute (NCI) official, reported a 5-10 percent increase in total cancer rates in U.S, cities with fluoridated water supplies, The scientific validity of the study was questioned; however, it did trigger a congressional hearing in 1977, where it was revealed that the government had never cancer-tested fluoride in drinking water. Congress ordered the NCI to begin. In 1983 the Public Health Service convened a panel of "world-~Iass experts" to review safety data on fluoride in drinking water. The panel recommended caution, especially in regard to fluoride exposure for children. (continued on page 3.. Florida Faucet, Volume I, f'Jurnber 6 ~1S""~ --tar .\tCJZI --1[. .....-..-~- ~ r1F~'-"'" nors:~_ ..~..aI:IPP'.., ~.;m~)l(~ (Fluoride...continued from page 2) In 1989, the NCl's study found evidence that fluoride caused bone cancer in male rats, However, the Agency for Toxic Substances and Disease Registry reported that "studies in people have not shown fluorides tobe carcino- genic, and the studies in animals are mixed." There appears to be solid documentation on both sides of the fluoride debate. Supporters point to studies document- ing a reduction in dental cavities in children has resulted in both medical and financial savings. The EPA considers fluoride in drinking water, in the small amounts approved, an acceptable additive with dental health benefits. Opponents of liuorid0 (2'1';:: h:J~l tho::..'C ". ~,< don't want anything added to drinking water unless it is absolutely necessary in the disinfection process, to those who insists that children, in particular, are already exposed to excess fluoride in soft drinks, juices, fluoride treatments and toothpaste. In December 1991, the EPA asked the National Research Council of the National Academy of Sciences (NAS)to review toxicological arid exposure data on fluoride. On August 17, 1993, the NAS released its report. Following a review, the EPA announced on December 29, 1993 that it would not revise the MCLG , for fluoride. The EPA based the decision partly on the NAS report, stating; "At that [the current] level, a small percent- , age of the U.S. population will exhibit moderate or even severe dental fluorosis," but decided to consider dental fluorosis a cosmetic effect rather than an adverse health . :~"c,. ",; ~1);:- \:-LJmmended further research, ' ',',I: t ,;, ongoing and will be completed by 2001. For more informa- . tion, contact the: Public Health Dental Program Florida Department of Health 1317 Winewood Boulevard Tallahassee, Florida 32399-0700 telephone 850/487-1845 '''''' . ...-, . -' -<.~~~~~}- r.--:--<~ ~ }~~ ) (~r ,) _.~~ American Association of Public Health Dentistry 10619 Jousting Lane Richmond, VA 23235-3838 telephone 804/272-8344 American Dental Association 211 East Chicago Avenue Chicago, IL 60611-2678 Condensed from "What is Fluoride?", On Tap, Summer 1997, and "Fluoridation Facts" by the American Dental Association, 1993, ~ " €3 'go-:":.- f:J" (:J _ LQI:''''.a..~ ....~(!:':':.>'.\.j r-:' ,""" Ir"' ~~~9.J)lIIW ~-(~-, Page 3 1998 EPA PLANT EXCELLENCE AWARDS The 1998 EPA Region IV Plant Excellence Award nomination packets will be mailed out to the states in Region IV around late November. Copies of the nomination packets will be forwarded to each DEP district office. Several Florida plants have either won this award or been a close contender. Listed below are some helpful suggestions made by staff at the EPA involved in the award process: i;".., ,-:" '(~ :~ :=' ':?;.yt~ )% ~:::,:~:.:~ Avoid submittjng.TOO MUCH material. Just one sample copy of certain documents, such as an analysis sheet, a training certificate, etc., is enough. A copy of the Table of Contents page of training and safety manuals, not the entire manual, is sufficient. l~: Expand on innovative treatments, special training, interesting aspects of different treatment technolo- gies used: What are you doing special, out of the ordinary, etc.' How are you thinking ahead, plan- ning forthe future, Remember, be BRIEF. y.~t :;f~-{:" !:~~~ ~;:;:~:;: (,o......;,..,:. Show involvement in community events, especially with the u~'.; or pictures, Have people in the picture~, eSl')ar.iClliy if taken at the plant. Avoid ',.l'~9c;ar.p.s, th{.:y take tob much time to review, l. II~: . -~ . f in:7ot\n~-!tj v'Jitf"i'/,:n~~r ,=orn:nuni~y I associations, professional groups, and local govemment? iV't. ":~ftr &%. Include a few samples of brochures, door hangers, flyers, etc. Brag about your plant and the wonder- ful things you've accomplished. ~=:.~_:-::::::.::.:=:=----:=::::':=::-=.::::::::=-::::..:~::::::::-.:::::::::==::::.::':::.::::::::::, IMPORTANT ADDRESSES FOR ORGANIZATIONS '\~\ OFFERING INFORMATION ABOUT PUBLIC HEALTH II The World Health Organization I 525 23rd St., N.W, I Washington, DC 20037 I 202/861-3200 I wWw.who.ch/programmes/inf/pub-inf.htm I Centers for Disease Control and Prevention 1600 Clifton Road, N,E, Atlanta, GA 30333 404/639-3534 www.cdc.gov/cdc.htm ! ! , I i I !) \':.:.:-::,-=-=-.::-.-::.~- .~:...-:.: ~.::. .-. . THE FLUORIDE INFORMATION PACKET Compiled by LylU1 Landes, Founder of Zero Waste America (215) 493-1070/ lynnlandes@earthlink,net / www.ZeroWasteAmerica.org 1006 Harvard Drive, Yardley, P A 19067 *We strongly encourage you to share this information with your local dental and medical professionals. It has been our experience, that many health professionals have not been properly trained to diagnose fluorosis and are not aware of the harmful health effects due to the chronic fluoride exposure experienced by most Americans. Wall Street Journal Dee 21, 1998: Some Young Children Get Too Much Fluoride, by TARA PARKER-POPE SUMMAR Y: CDC Says 22% of All Children Now Have Fluorosis health researchers are questioning whether Americans, particularly children, may have too much fluoride in their diets," The article goes on to say that The U,S, Centers for Disease Control and Prevention (eDC) recently completed a study showing that 22% of all children now have fluorosis, which is the pitting, spotting, and decay of teeth. Bleaching is not effective, Expensive veneers are used to cover the teeth. ZW A notes that widespread fluorosis should not be news to the eDe or the American Dental Association (ADA). Health and Human Services (HHS) under which the eDC operates, has known since 1991 that Americans were being overexposed to fluoride, even in unfluoridated communities, and from multiple sources, The HHS published that data in the Review of Fluoride Benefits and Risks (1991), Table II, Summary-Daily fluoride intake of adults, However, the CDe continues to claim that dental fluorosis is the result of only using too much fluoridated toothpaste, In addition, the eDC erroneously characterizes fluorosis as just a cosmetic effect, rather than a symptom of the body reacting to the toxic effects of fluoride and an indication of potentially more serious harmful health consequences. Since at least 1995, the ADA has published studies in their Journal of the American Dental Association (JADA) about the widespread incidence of fluorosis in the U.S, population due to overexposure from multiple sources, AMERICA: OVERDOSED ON FLUORIDE by Lynn Landes 1 wwwZeroWasteArnerica.org 1 Iynnlandes@earthlink,net 1 (215) 493-1070, updated March 1999 Americans are suffering from overexposure to fluoride due to its widesllread and uncontrolled use. Fluoride can be found in any food or beverage made with fluoridated municipal water. The U,S, Centers for Disease Control and Prevention (CDC) completed a studv in 1998 showing that 22% of all children now have dental fluorosis, This is the discoloration and, in advanced cases, the pitting of teeth, Bleaching is not effective. Less than 2'};, of Western Europe drink fluoridated water compared to over 60% of the United States population, Federal and state public health agencies and health organizations continue to promote fluoride despite growing evidence that it is harmful to public health and the environment. This is also despite EPA's own union, which has taken a stand against fluoride, Fluoride has been linked in government and scientific reports to a wide range of hannful health effects, including: Alzheimer's, kidney damage, cancer, genetic damage, neurological impairnlent, and bone disease (brittle bones). Fluoride is not an essential nutrient. It has never received "FDA Approval" (U,S, Food and Drug Administration), It is listed as an "unapproved new drug" by the FDA, and as a "contaminant" by the EPA Although calcium fluoride can occur naturdlly, the type of fluoride (sodium) added to municipal water is a hazardous waste of the aluminum, phosphate fertilizer, and other industries. There is no margin of safety for fluoride exposure. In the 1940's, when fluoridation began, the "optimal" level of e:\.-posure for dental benefit was determined to be 1 milligram/day. Even at that level, 10% of the population were e:\.-pected to contract dental fluorosis. It was estimated that individuals drank 1 liter of water per day. At that time, other sources of fluoride were scarce. 1986: The Environmental Protection Agency (EPA) set new "ma.xi.mum contaminant levels (MCLs)" for fluoride in water. Above 2 mglliter "children are likely to develop objectionable dental fluorosis" and parents must be officially notified Above 4 mglliter, individuals are at risk of developing "crippling skeletal fluorosis." It is against federal law to fluoridate water above 4 mg/liter. 1991: The U.S. Dept. of Health and Human Services, in their Review of Fluoride Benefits and Risks, published an analysis of fluoride ex-posure levels from food, beverages, toothpaste, and mouthwash. This data indicates that the public is already overexposed to fluoride and that, at the very least, dentists should no longer prescribe fluoride supplements. FLUORIDE CONCENTRA nON IN" WATER % OVER I MG "OPTIMAL" DOSAGE Unfluoridated Communities < 0.3 m as much a~ 120 % timally" Fluoridated 0.7-1.2 m as much as 560 % Fluoridated communities > 2.0 m ssible ><505 % (Table does not include: Fluoride supplements, phannaceuticals, emissions, and workplace exposures to fluoride) 1993: The U.S. Dept. of Health and Human Services (HHS) stated in its Toxicological Profile on Fluoride, "Existing data indicate that 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 calciUIll, magnesiUIll, and/or vitamin C, and people with cardiovascular and kidney problems... Postmenopausal women and elderly men in fluoridated communities may also be at increased risk of fractures." 1994: The American Dental Association's (ADA) Council on Scientific Affairs approved a new Fluoride Supplementation Dosage Schedule with the following cautions, "All sources of fluoride must be evaluated with a thorough fluoride history. Patient exposure to multiple water sources can make proper prescribing complex." Due to multiple sources, it is impossible to know a patient's exposure. 1995-97: The Journal of the American Dental Association (lADA's Dec. 1995, July 1996, July 1997) has published a series of studies reporting on pervasive overexposure to fluoride due to "the widespread use of fluoridated water, fluoride dentifrice, dietary fluoride supplements and other forms of fluoride... {There is} an increased prevalencc of dental fluorosis, ranging from about 15% to 65% in fluoridated areas and 5% to 40% in non-fluoridated areas in North America." In February of 1997, The Academy of General Dentistry (AGD), representing 35,000 dentists, warned parents to limit their children's intake of juices due to fluoride content. RECOMMENDATION: The FDA should be required to put fluoride through the rigorous "controlled studies" necessary for standard "FDA Approval." If fluoride gains FDA approval, then it should be treated as a prescribed medication in order to prevent patient over-cxposure. AUA,I.luonde,&Ltabtl1ty rd!:SC; 1 VI L.. Zero Waste America Promotes the Elimination of W!lSte, Toxics, & Pollution. CON'TENTS . SE.ARCH . JOIN' E.-MAIl. . ~T YOU CAN DO' . ZWA REPORTS o For more infprmation on Fluoride ZW A REPORTS: The ADA and Liability For Fluoride Overexposure PHILADELPHIA, July 23 -- The American Dental Association (ADA) may be building a legal defense to shield itself from culpability in patient lawsuits for fluoride overexposure. Dentists and patients should take note. So says Lynn Landes, Director of Zero Waste America, a non-profit organization specializing in waste and toxic issues, and author of America: OverDosed On Fluoride. Since 1995, the Journal of American Dental Association (JADA) has published a series of scientific reports on the growing prevalence of fluorosis in the U.S. population. Fluorosis is caused by over- exposure to fluoride, resulting in tooth and bone decay. Fluoride is also linked to Alzheimer's, kidney damage, cancer, genetic damage, neurological impairment, and bone pathology. Fluoride is in most toothpaste products. It is also in an unknown number offood and drink products, due to the artificial fluoridation of over half of the U.S. municipal water systems. "The JADA reports and ADA's actions should raise a red flag for dentists and patients," says Landes. "At the same time that the ADA is promoting fluoridation of municipal water systems nationwide, they are warning of fluoride over-exposure. They seem to be working at cross purposes," adds Landes. She believes that there will be a growing movement by patients to sue over the harmful health effects of fluoride over-exposure, .' Dentists may be at significant risk of liability if they have prescribed fluoride supplements since 1994, In April of that year, the ADA's Council on Scientific Affairs approved a new Fluoride Supplementation Dosage Schedule with the following cautions, "All sources of fluoride must be evaluated with a thorough fluoride history ... Patient exposure to multiple sources can make proper prescribing complex... Caries reduction benefits must be balanced with risk for mild and very mild fluorosis. " The ADA directive to dentists, amounts to 'Mission Impossible,' according to Landes_ "How can a dentist take a 'thorough fluoride history?' " she asks. "Americans ingest fluoride from multiple sources. Any assessment of a patient's fluoride exposure would be highly speculative," she adds. Government data indicates that dentists should no longer prescribe supplements. In 1991, the U. S, Dept. of Health and Human Services, Review of Fluoride Benefits and Risks, published the estimated intake of fluoride for Americans, at as much as 120% over the assigned 'optimum dosage' of 1 milligram/day in unfluoridated areas and 605% in fluoridated areas. Reports of increased cases of fluorosis have caused concern within other dental organizations. The Academy of General Dentistry, which represents 34,000 dentists, issued a press release in February of 1997, warning parents to limit their children's intake of juices due to excessive fluoride content. Contact: http://www.zerowasteamerica.org!ADA.Fluoride.&Liability.htm 3/11/99 Citizens for Safe Drinking Water Monday, July 7, 1997 - NEWS RELEASE For immediate release Contact: Jeff Green Citizens For Safe Drinking Water Madrid Street 3243 San Diego, CA. 92110 (800)728-3833(v) (619)222- 6981 (f) Email: jgreen@abac.com Email: dkennedy@Ucsd.edu J. William Hirzy, Ph.D., Senior V.P. NFFE, Local 2050 P.O. Box 76082, Washington, D.C. 20013 (202)260-2383(v) (202)401-3139(f) EP A Scientists Take Stand Against Fluoridation The EP A scientists, engineers and attorneys who assess the scientific data for Safe Drinking Water Act standards and other EP A regulations have gone on record against the practice of adding fluoride to public drinking water. On Wednesday, July 2, 1997, National Federation of Federal Employees, Local 2050, which consists of professionals at EP A headquarters in Washington, D.C., voted unanimously to CO-sponsor the California Safe Drinking Water Initiative that would reverse the State Legislature's 1995 law mandating fluoridation, Both proponents of fluoridation and the sponsors of this initiative consider the result of the fluoridation battle in California to be crucial to. the federal governments plan to fluoridate the entire United States by the year 2000. Citizens for Safe Drinking Water and their sponsors are circulating petitions to gather 500,000 signatures by October to place the initiative prohibiting fluoridation in California on the June 1998 statewide ballot. In its endorsement of the initiative, the EPA professional's union states, "It is our hope that our co-sponsorship of the Safe Drinking Water Initiative to prohibit fluoridation will have a beneficial effect on the health and welfare of all Californians by helping to keep their water free of a chemical substance for which there is substantial evidence of adverse health effects and, contrary to public perception, virtually no evidence of significant benefits." The statement from NFFE Local 2050 continues, "Our members' review of the body of evidence over the last eleven years, including animal and human epidemiology studies, indicate a causal link between fluoride/fluoridation and cancer, genetic damaoe, neurological impainnent, and bone pathology. Of particular concern are recent epidemiology studies linking fluoride exposure to lowered IQ in children. "As the professionals who are charged with assessing the safety of drinking water, we conclude that the health and welfare of the public is not served by the addition of this su.bstance to the public water supply." After numerous attempts to correct EP A management conclusions that were not supported by the available facts, the union attempted to join a lawsuit against their own employer in 1986, citing "fraudulent alterations of data and negligent omission offact to anive at predetennined Agency political lof2 7/14.'97 10:41 AN --_OJ r.'O_.' . ";,,',, ..)ol...,cuuo>u positions regarding fluoride," Dr. Wm. L. Marcus, Senior Science Advisor in EPA's Office of Drinking Water, was fired for a 1990 whistle-blowing memo calling for a review of the cover-up of the National Toxicology Program study that shows fluoride is a "probable human carcinogen [cancer causing agent]". Under the Safe Drinking Water Act, that finding alone prohibits the addition of fluoride to the public water supply, Although Dr. Marcus won his whistle-blower lawsuit, with punitive damages, and returned to work at the EP A, the classifications were never reviewed. Historically, fluoridation is mandated by government and rejected by citizens, Communities allover the U.S. are currently fighting for their right to choose. Japan and nearly all of Europe have rejected fluoridation. The California Safe Drinking Water Initiative reads: The public water supply should be safe for all to drink, In order to protect the public health from increased risk of hip fracture, cancer, dental fluorosis and other hannful effects which have been linked to fluoride in the scientific literature, and whereas data from the U.S. Public Health Service and the State of California show no significant difference in decay rates of pennanent teeth and dental costs in fluoridated and non fluoridated areas in California. Section 116410 of the Health and Safety Code is amended to read: No fluoride or fluorine-containing substance may be added to public water systems, All laws to the contrary are hereby repealed. For more infonnation on the petition drive, contact Citizens for Safe Drinking Water at 1 (888) 704-3833, Or visit: http://www.sonic.netl-monty/fluoride.htm Reference June 19, 1997 News Release: FDA Requires New Poison Label for Fluoride Toothpaste and Other Fluoride Products. 20f2 7/14/97 10': I AM Comments on Drinking Water Standards Page 1 of3 Comments on Reevaluating the Fluoride in Drinking Water Standard by Robert 1. Canon, Ph. D., Vice-President, Local 2050 of the National Federation of Federal Employees (NFFE) before the Drinking Water Committee of the Science Advisory Board of the En0ronrnental Protection Agency, Arlington, VA., Nov. I, 1991. . My name is Dr. Bob Carton, I am Vice-President ofLoca12050 of the National Federation of Federal Employees, Our union represents the 1100 scientists, lawyers, and engineers at EP A Headquarters, Weare the professionals who are responsible for providing the scientific basis for EP A's regulations We have an obviously important stake in ensuring that the scientific process used in assessing risks from chemicals is sound and that those who conduct this assessment are not forced or coerced in any way into supporting predetermined conclusions, In this context, I am here today to alert you to the fraudulent nature of EP A's previous efforts on fluoride and to request that you take an active role in insisting that EP A conduct an unbiased, indepth investigation of the risks posed by exposure to fluoride, not a whitewash as occurred in 1985, Let me explain to you what happened in 1985. The fluoride in drinking water standard, or Recommended Maximum Contaminant Level (RMCL], published by EPA in the Federal Register on Nov. 14, 1985, is a classic case of political interference with science, The regulation is a fraudulent statement by the Federal Government that 4 milligrams per liter (mg/l) of fluoride in drinking water is safe with an adequate margin of safety, There is evidence that critical information in the scientific and technical support documents used to develop the standard was falsified by the Department of Health and Human Services and the Envirorunental Protection Agency to protect a long-standing public health policy. EPA professionals were never asked to conduct a thorough, independent analysis of the fluoride literature. Instead, their credentials were used to give the appearance of scientific credibility. They were used to support the predetermined conclusion that 4 mgll of fluoride in drinking water was safe. Ethical misconduct by EP A management included the following: they ignored the requirements of the law to protect sensitive individuals such as children, diabetics, or people with kidney impairment. Contrary to law, they made the criteria for considering health data so stringent that reasonable concerns for safety were eliminated. Data showing positive correlations between fluoride exposure and genetic effects in almost all laboratory tests were discounted. By selective use of data, they fit science to the desired outcome. They reponed to the Administrator data demonstrating that dental fluorosis was an adverse health effect, but then hid this information from the public when the Administrator decided to call dental fluorosis a "cosmetic" effect. The National Institute for Dental Research had warned EPA that admitting dental fluorosis was an adverse health effect would be contrary to the long-standing policy of the Public Health Service that fluoridation at I mgll is totally safe. EP A had already admitted in the Federal Register that objectionable dental fluorosis can occur at levels as low as 0.7 mgll Comments on Drinking Water Standards Page 2 of3 EP A management based its standard on only one health effect: crippling skeletal fluorosis, In sening the safe level at 4 mgll, however, they ignored data showing that-hea1thy individuals were at risk of developing crippling skeletal fluorosis if these individuals happened to drink large quantities of water at the "safe" level of 4 mgll. EPA's own data showed that some people drink as much as 5.5 liters/day, If these people ingested this amount of water containing 4 mgll of fluoride, they would receive a daily dose of22 mg, This exceeds the minimum dose necessary to cause crippling skeletal fluorosis, or "20 mglday for 20 years" as stated by EP A and the Public Health Service. This situation is made worse by the fact that there are additional sources of fluoride, spch as toothpaste, tea, mouthwash, etc, Even more unsenling is the fact that there is no sound s'cientific basis for the 20 mglday t~eshold. The threshold is probably lower. There is evidence, ignored by EP A, in a preliminary study by Dr. Geoffrey Smith, that exposure to fluoride at ] mgll in drinking water over a long period oftime may calcify ligaments and tendons causing arthritic pains, and may be partially responsible for the alarming increase in cases of repetitive stress injury. EP A management also relied upon a report from the Surgeon General which ~hey knew was false. This report claimed to represent the conclusions of an expert panel (on which EP A was present as an observer) when in fact the concerns of this panel for the effects of fluoride on the bones of children, for its effects on the heart, for dental fluorosis, and for the overall lack of scientific data on the effects of fluoride in U. S, drinking water were deleted. There is a report in the press that these changes were made without the knowledge or approval of the expert panel. EP A accepted the falsified report from the Surgeon General's office and asked a contractor to tum this into an "assessment." The contractor dutifully collected only literature that supported the report The report was submitted for public comment, but was never altered to incorporate the volumes of information sent in by world class experts, and by ordinary citizens who had taken the time to look for all of the appropriate literature, Any opinions contrary to the report were dismissed. It can truly be said that there is no final report, because the substance of the public comment was virtually ignored, What we have is actually a "Draft" stamped "Final"! After the regulation was published, NFFE Local 2050 spent a great deal of energy anempting to get this issue resolved. We did not want any part of such a charade. In 1986, after numerous letters to EP A management which were ignored. NFFE Local 2050 prepared an amicus brief in an unsuccessful suit by the Natural Resources Defense Council to overturn the fluoride regulation. Our message began to be heard in August of 1988. when Chemical & Engineering News. a weekly magazine of the American Chemical Society. published a 17 page feature story on the fluoride issue. focusing in part on our union's efforts. In 1989. with prodding from Mr. Reilly's staff, we had an exchange of leners and some productive meetings with Mr. Bill Whittington, Deputy Assistant Administrator for Water, who unfortunately has now left the Agency. In one of these letters. we detailed for Mr. Whinington, our recommendations for conducting an assessment of the risks from fluoride exposure. We grouped them into three categories: (1) focus on the scientific endpoints the law requires us to examine which the previous effort did not, (2) bring in scientific experts from around the world who have published extensively on various aspects of the risks from fluoride exposure, and (3) create an independent scientific assessment comminee with no conflict of interest to peer review the repon. We also recommended that all of this should be done under the direction ofEP A scientists with expertise in the various disciplines that an understanding of fluoride risks requires: carcinogenicity, mutagenicity, metabolism, etc. Comments on Drinking Water Standards Page J of J We would like you to take these recommendations seriously. We do not need another exercise in political expediency, And we do not need to see EP A scientist~.aKacked by their managers, as is now occurring. because they reveal unpleasant facts. A number of recent publications in prestigious journals show there is overwhelming evidence that the aged population of the US is experiencing a significant increase in hip fractures as a result of the reckless practice of fluoridation, The senior toxicologist who brought this and other negative infonnation on fluoride to the attention of EP A management is being threatened with dismissal, It is about time that science prevailed on this subject. and past errors were corrected This will not happen by using the so-called "Frank Young" repon or the National Academy of Sciences to review his repon This will only result in the same whitewash that emerged from the Surgeon General's office, The NAS has already indicated that they will produce the pany line, even if they can't substantiate it. In a recent series ofleners between the NAS, Ms. Darlene Sherrell, and Sen Graham of Florida, the NAS was forced to admit that it could not document the derivation of the chronic effect level for crippling skeletal fluorosis. As already mentioned. crippling skeletal fluorosis is the single health effect upon which the fluoride in drinking water standard is based EP A should reconsider their current plans to duck major responsibility for assessing Duoride risks and should let EP A professionals do tbe job that the American public who pays their salaries expects of them, The seriousness of the coverup on this issue requires that we go back to square one, evaluate the primary literature and let the chips fall where they may, A budget commensurate with the size of this task needs to be developed, even ifit means going to Congress for a special appropriation We ask Your suppon in ensuring that the above recommendations are taken seriously l\T'fFE Local 2050 Box 76082 Washington, D.C. 20013 FOR IMMEDIATE RELEASE: JAN 20, 1999/ CONTACT: BILL HIRZY 202-260-4683(V) 202-401-3139(F) EMAIL: Error! Bookmark not defined. SCIENTISTS ACCUSE NATIONAL ACADEMY OF SCIENCES OF UNSCIENTIFIC BEHAVIOR IN PROMOTING FLUORIDE Four scientists and an attorney today accused the National Academy of Sciences of unscientific behavior by promoting fluoride as a "beneficial element." Citing research on fluoride, some from NAS's own publications, Drs. Albert BurgstaWer, University of Kansas, Paul Connett, St. Lawrence University, Lennart Krook, Cornell University, and William Hirzy, National Treasury Employees Union at EP A, and New York attorney Paul Beeber said NAS was engaging in "linguistic de-toxification" of fluoride. Professor Krook linked fluoride with increased risk of hip fractures in the elderly, He said peer reviewed publications showed weaker bones result from drinking fluoridated water. He also discussed several studies showing fluoride causes bone cancer in animals and humans, studies NAS downplays. Professor BurgstaWer pointed out errors in NAS's publication that purports to establish a safe upper limit of exposure to fluoride and expressed concern over bias among the NAS panelists, BurgstaWer said NAS has previous}y cited 13 studies showing fluoride causes bone toxicity below the doses NAS now says are "tolerable," Dr. Hirzy said EP A treats fluoride as a "protected pollutant." He gave several examples including EP A's drinking water standard, set at a level known to cause adverse effects on teeth, its reliance on NAS rather than its own staff for advice on fluoride risks, and its firing of the senior drinking water toxicologist for refusing to keep quiet about fluoride's ability to cause cancer. He said the professionals' union voted to support citizens fighting fluoridation after union scientists reviewed recent research on fluoride. Paul Beeber discussed a new report that shows, after a fifty-year trial, no difference in the dental cavities rates in children in fluoridated Newburgh and un-fluoridated Kingston, NY. The report shows children in Newburgh to have about twice the rate of dental fluorosis, the earliest sign of fluoride toxicity, as children in Kingston. Professor Connett said, "If we add the new evidence of fluoride's damage to the brain and the pineal gland to its carcinogenicity and its known toxicity to teeth, bones, the reproductive and other systems, and consider the ineffectiveness of fluoride in drinking water in preventing dental cavities, it is insane for NAS to promote fluoride as a beneficial element. Fluoride is a very toxic substance, and the less our children get the better. " -~... ....... ...: ~.. .in,: eO StitiS ::-v,ronmenlal ?'Clect,on Agency Olliee 01 Watel '.tall Coo a. 4J().4 :?A,a22 ,;, i).J' 'J JiCemOe' '993 \ ~EPA FACT S'HEET FLUORIDE IN DRINKING WATER Fluoride occurs'nat'urally In water. 'It Is also added to drinking water to reduce tooth Oe<.:2y State agencies or local public 'waters.~pply authorities make the decision as to wnetner or not to a::::J fluoride to spoclllc drinking water supplies. Drinking Water Standards Fluoride in drinking water Is regulated under Section 1412 of tne Safe OrlnklQlfWater Act (SDWA), When regulating a contaminant under tr11s Act, EPA promulgates both a Maximum ContamInant Level. Goal (MCLG, a nonenforceable health goal), and a ~Maxlmum Contaminant Level (MCL, which Is afed9rally enforceable standard). The MCL Is. set' as close to tM MCLG as technically fea,slble I a kin g co S t san dot her, I act on In to' consideration. When establls'hlryg an MCLG, the ACI requires EPA to protect against aoverSE1 health eHects with a margin '01 safety. The SDWA leaves the question .of what constitutes an adverse health eHect to EPA. E P A may also promulgate nonenforceable secondary standards whIch are desIgned to protect the public welfariil. Secondary standards are usually based on aesthetic considerations such as taste or odor. Fluoride Standards -> romul ated' both the fluoride L at 4 mg/l. This level ~rotecls numans from crlODllrto skeletal fluorosis. an adverse health eH~, -/ dental fluorosis Is a cosmet Ic elfe<:t and nOI en advers.a he.alth elfect. Fluoride RevIew In '992, as pan of an ongOing review :1 t1uorld'e, ,EPA requested the National Acade:- f of Sctences (HAS) to review lluorlde toxiC ',y and exposure data, In addition, EPA slQne: a consent decree In '992 with Clttze:-,s Interested In Bull Run, Inc. concerning a reVle,." of the fluoride standard. The National Academy of Sciences comDle:~o the fluoride rivlew In AUQust , 993, Arne ~,Q other points, tMY concluCle<l IMI: . TIlll current 4 mg/l MCLG and MCL IS appr:. prlate as an Interim standard pending rKe :>\ of additional data, and . The question of whether dental fluorOSIs IS an adverse et1eC1 Is a decision for r~UlalC-., agencIes. Findings and Concluslon-s Based on the NAS review and other SlUe es, tflere are no data available at tnl~ lime 10 ,conclude that the fluoride drlnldno ....c:er standards should be revised. EPA has. requested that the U.S. Oepanmerd 01 Health .and Human S8rvlce~ aOClress ....ne\:ier dintal :tluorosls Should be conslaereo an ad....erse hgalth ellect or a cosmetIC ei'eCI 'whIch may Impact the MCLG anO /o.,l C L stan~ards. EPA has also askeO Ine L' S Oepanment of Health and Human Sef'r'lce, 10 ,explore ways 10 reduce tluorloe e 1 pc ~..;r e wngn II gXC~OS bgngllclal IgV81S, ,FLUORIDES, HYDROGEN FLUORIDE, AND FLUORINE A Toxicological Prome by the U.S. Dept. of Health aDd Human SerVices, Public Health Service, Agency for Toxic Substances and Disease Registry (ATSDR) TP-91/17, Page 112, Sec. 2.7 (Health Impacts), April 1993 POPULATIONS THAT ARE UNUSUALLY SUSCEPTmLE 'Existing data indicate that 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 cif calcium, magnesium, and/or vitamin C, and people with cardiovascular and kidney problems. Because fluoride is excreted through the kidney, people with renal insufficiency would have impaired renal clearance of fluoride (Juncos and Donadio 1972). Fluoride retention on a low-pro~ein, low-calcium, and low-phosphorus diet was 65% in patients with chronic renal failure, compared with 20% in normal subjects (Spencer et al. 1980a). Serum creatinine levels were weakly correlated (r=O.35-0.59) with serum fluoride levels (Rmhijarvi 1982). People on kidney dialysis are particularly susceptible to the use of fluoridated water in the dialysis machine (Anderson et al, 1980), This is due to the decreased fluoride clearance combined with the intravenous exposure to large amounts of fluoride during dialysis. Impaired renal clearance of fluoride has also been found in people with diabetes mellitus and cardiac insufficiency (Hanhijarvi 1974). People over the age of 50 often have decreased renal fluoride clearance (Hanhijarvi 1974). This may be because of the decreased rate of accumulation of fluoride in bones or decreased renal function. This decreased clearance of fluoride may indicate that elderly people are more susceptible to fluoride toxicity. Poor nutrition increases the incidence and severity of dental fluorosis (Murray and Wilson 1948; Pandit et al, 1940) and skeletal fluorosis (pandit et aI. 1940). Comparison of dietary adequacy, water fluoride levels, and the incidence of skeletal fluorosis in several villages in India suggested that vitamin C deficiency played a major role in the disease (pandit et al. 1940), Calcium intake met minimum standards, although the source was grains and vegetables, rather than milk, and bioavailability was not determined. Because of the role of calcium in bone formation, calcium deficiency would be expected to increase susceptibility to effects of fluoride. No studies in humans supporting this hypothesis were located. Calcium deticiency was found to increase bone fluoride levels in a two-week study in rats (Guggenheim et al. 1976) but not in a 10-day study in monkeys (Reddy and Srikantia 1971). Guinea pigs administered fluoride and low-protein diet had l~ger increases in bone fluoride than those ~ven fluoride and a control diet (parker et aI. 1979). Bone changes"in monkeys following fluoride treatment appear to be more marked if the diet is deficient in protein or vitamin C, but the conc1usionsare not definitive because of incomplete controls u:d small sample size (Reddy and Srikantia 1971). Inadequate dietary levels <?fmagnesium may affect the toxic effects of fluoride, Fluoride administered to magnesium-deficient dogs prevented soft-tissue calcification, but not muscle weakness and convulsions (Chiemchaisri and Philips 1963). In rats, fluoride aggravated the hypomagnesemia condition, which produced convulsive seizures. The symptoms of magnesium deficiency are similar to those produced by fluoride toxicity. This may be because ofa fluoride-mquced increase in the uptake of magnesium from plasma into bone. Some people with cardiovascular problems may be at increased risk of fluoride toxicity. Fluoride inhibits glycolysis by inhibiting enolase (Guminska and Sterkowicz 1975~ Peters et ai, 1964). It also inhibits energy metabolism through the tricarboxylic acid cycle by blocking the entry of pyruvate and fatty acids and by inhibiting succinic dehydrogenase (Slater and Bonner 1952). There is evidence that daily doses of34 mg fluoride (0.48 mg/kg/day) increases the risk of non vertebral fractures in women with postmenopausal osteoporosis (Riggs et al. 1990). Postmenopausal women (Danielson et al. 1992; Sowers et al. 1991) and elderly men (Danielson et al. 1992) in fluoridated communities may also be at increased risk of fractures, >smrJ '" "'.... c: (1 5' n 3::lr;:::.. n n - Q.J c.. ~ & 5' s~ c.:l ~ 0: ~. c:r n -.... ~~"< ~ 0;J~0. :1,5 0 c: ~OO ::1,"8 c..-.~:l ~ ~ 3' ~ =.::l - E.. ='-~- -'-.n ~fi-,~ ~Q.g€ Q. ::l ~ :. c: ::I ::I 30...~ o :1. C. VI c:c.c:o c:.n- 5.(5 c:r~ ~c:e:' o ~ 0 c:~c. '" ~ c: 2. "'8 :l C. Co> ~ ~ X ... n )oC c. ~ ~ "8 .... n c.. ~ < .... ::I, o c: '" '" o c: n n Vl n "8 :J. n 0. :l 5- o '" n o 2 :'l n C". n ;l c: ... p. ... .. ::l Q'O n '" Z# a c: ::l Co ~ 3 ~ ~ c. ... "< - V to..I o 3 ? 3 ~ c. .. "< - o o to.> N (5 c o -.J (5 \,0) ~ o b QO o '" (5 6 v o o -.J v \,0) VI ~ o !=' 8 1,.,.1 " n 8' 3z 3 0 o - :l C. n 0. - o ~ o v !=> A "LI" o ~ o to..I 3 -? 3 ~ ~ .. '< 3 ~ 0. .. "< o 8 co o ::.. (5 o p VI A t.J ~ ~o b - to.) ~ '" 5 o o ~ ~ N o o Q:l ~' ~ 6 6 !=l A VI o 8 \,.,I o 0 o v- a- t,J ~@ 5 S !=l - A VI ^ p \,oJ 3 ? 3 ~ ~ 0. r>> "< 3 ~ c. .. "< o N 6 p ClCl !=l o 00("") -'0 3 ~. :n g ~ E': c:. n r' :l' Cf :l OQE:5 ~ 0 =. .... _,0 _ :l :l n .. m '" - C,:l 3 - .. ~. n n w [ Vl o c: ~ .... o ~ o :1. ~ ~ < 5' S ~OQ ~ :: .... * ... o ~ (5 o o a- - !=' 8 /'oJ - o o o - A i o o 8 1,.,.1 - (3 !=' o "^ _ a- - o o !=l - QO '" ClCl 5 0 o b Q:l ??:n :l c: :.0 ~ :1. .... e. 'H n .. 6 !=' A VI ~ o:!] c: c: 5-0 :1. ::I. :l 0. .... n o . .., Om _t;;", :l - c. -:!l3 ~c:" n 0 - ::I. S- o. n p '" 0 t.J _ 0. ~ t.J ~ ~ ~ t '6 ':) I")~O ~ ;~ R~~-Y ?+~ ~ 'tl ~ .( 7 -P ( X ~ ~,- ~ ,.... V -.J b V\ .- :!l c: o ::I. e. o 2 .... 7<:' n Vl c: ::l 3 eo. ~ o ~, "< ::l c: o ::I, 0. o :l ~ ,.,. o o -, ... Co c: t; . ]~ ~ Vl ::I t'l ~ E". n 3 ~ :: ~~ 3 OC -0 3. o C ::l ::: C e-o :J. c. n n )( -0 o '" c ... n Cll - ...1 >= c:: r- en z o - n \ V c-on:;:o , c: 0 n CI'l 2: 3 '~, ~ :cn' g. ~ n - 0 .... ~ ~ -. :l _ .,., 3:roc nCl'lnO ;. n 0 :l. o~oc. ..... _.... n ~gc.tD n ::l n ~ "'::I n &, m- ::I ~ < ::I o C. ~ ~. n ;0;- 2. '" ~~ o -.J o -c Cll ::l 11\ -c n ... 2. o .':J cr Cll '" n c- o ::I Cll :r '" ::I C. :c C 3 '" ::I CI'l n ~ n' n '" :r\O n ~ ~- :r '" :l C. :;:0 !!." Cl n c. -0 ... o ~ go 3 '" O~'18,'9i n:r 16:45 FAX ~12 440 0559 AGD ~()(J~ . _ I ,..J .'. : . I I , ' ~l ' . Newstran th9~ - of~ ~ Fruit juices may foster fluorosis in children . Ites 5 )'c.atl to 7 )'e:a.ll drUii. J.es s th..&.n . qWJt of Cru i I j u ~ a Now even fruiljulce.s-tho$e -h~lby" &llmW.i~ day bea.\J~ these are the tOC'mlIive)Un of l.be development be~e.s (or your dillch-en-may QlJse I uOI.'lO-bcal1by of e:wncl. f't.3'POrue iri their lceUl. A ~I $ wd Y ~ws th.a1 too much The IWd Y t'I"CD dl rr ClUl tWcd which !1a vcrs of j u i 0: !ru it j ul ce could d:lm.a: e the c:rwneJ on you r ch ildrc:n '1 lee lb, bad the mw I fluoride. WbJ '" ~ j u.lc% twS t.be ~ I reporu lhe AWe:ny o( GenenJ Dentistry, an c:o~cntiOQ1 of fluoride, wilb I m.e:.n value of VCS pans inltmaUcxW Otlmiz.ation of 34,~ ~~ pet million. The high Oucr1de CCD~I of p-ape juicts was d.al tis ts r rom th e U nltt.d S~. llS t.e.rnLoneS auribu Led to the us e of an 1h.sectid.de tb:1\ con t.lins nuori.d.e. znd Cztnad1 dedi c:at.ed 10 c.onti 0 uio ~ den W l:1 con tras l. ~ j uic:es prepucd !rom ,rapes aft.er Lb e skin edua..tion 10 ensure Lbe best pouible deow ha.d beu removed cocu.a..i.c~ no d.et.clCable C~lratioos of cue for Lbe ~ L fluoride. Thus.. the a.u lhon coGCw ded that :ra::pe Wns An An4l)'S is 0 f 532 juices \Io7.S ~ to have CO?cen trat.e:d &moun ts of nooritk. rooililcted 10 de lamlne !be arnou n I of fluori de in T ca. pnm.e. Q"a.O ~, pear, red ~, CbClT)' a.o.d th~ drini:J. Manufr.ctl.lr'CrS of rudy.to-drink juice::, froten. apple'~ juice 111 ~ meaJ:l flooride a:>ncerHtaUons coocentnl.e juiCl:.$, and juicz:-!lavo~d drinks ""ere coolaCt.ed ~r than 0.60 patu per tollUoo. Onn~e juic:.3. lemorw:1es, to determine bow m.u.ch fluoride was in the ~ ~ ui~. The (roil oe....-..m and pin.::app~ : c:.& u.s.u c.ll y. bu l no I al wa y s. had $tuOy coocluderl ~ more Ih.an half of the JUICe.s bave more lower fluoridt coo.c:cntnU n u arid e than is rec.ocn.tneDde d. . Tbcrt were \Wide yuil.tioos in flu aride i'be problc:rn wi!b nvoride is that ~metime.s YOU conc:ncrWOD.1, nn:ln~ frem 0.02 to 2.80 pans per million. could have too mucb of A ~ood ~in~" u.plain~ Wi.l.LWn Tbe fll.lOride COOle1l1 of most jQl~.~ juice.f1avored drinks 7 Owe. DDS. FAGD. spooC~enusI or !be AC4dan>' of correlaLea with!be amounl be nlXlnde In Lbe ""Ua used to Ge:le~ Dc:nt.iury, ..-0:: cOU'eCt amounl of nuoride Q.!l manufactUre the produc1.. prevenl eviLies. bUI too CUJcb fluoride can Ie:4U 10 fiuoru~is. "?an of the problem 11 IAat the prodUCl W>el.s of ""bich causes d..am<1l:: to the enamel and even deQy, \he.sejuiC%S COIltAined no infomwion about the wbe Fluorosis is Iypic:ally ~ by either ~ chalXy while uirfcren~ in fluoride conc::tltntioos between \.he juict.$." stain or a dark bro\lw'tl sLain against a n~ ~1." SOlid Dr. Chase. -MllDu!a.a.urcn ~CXlld ubel produ~ with investigAton of this swdy looked Al the !.heir fluoride a:lO~L" ru:o~ded do~ o( supplc.mental fluoride :lnd This wou!.1 ~ A dauQt.in~ Wi.:. howevCl. ckt.e.:mlIled which jui~ WC"e above or below lhos.e ~e the same products u&u.a11y have vel")' amounts. The recommended Oos.e of supplemenW fluori<.Je c.linerent Ouoride cor.cencrauOlU bcQus.e lbey is baw~n 0.30 ~d 0.60 pms per mlllion. TIle rcsuhs of llu: \!tere manufac1Ured :u dirrcru1I1i~. :lUJdy, bowever, Ihow thaI aboUI 43 percent hw.J conc:enO"'auo:u Above 0.60 paN per million. and ] 9 percent had fluoride COflCUltn.lions above 1.00 part.\ per million. The good Dews is lhal .(8 percenl of the juic:c~ hacl concentrations below 0.30 pa.ru per cU1lion. Jbls is "cry revealin~" $aYS Dr. Cbase, who h:l.~ noticed an ~ in nuorosis !.mOO~ the children in his owo daJlA1 pn.ctice. - Althou:,b fluoride can wso be !ound ill drinkiog WJJ.U and I.OOl.bput.e, the (acl U10l1 there's so much Duoride in wm.e of !be~ juices u swtJint." Pucnu ~ve been comio!; 1.0 bu pnu:uce COOCl:moj &bout the c:hAlky whi~ marks on \heir l.:hihlrcn', Lcc~. t,pc.ci&lly lbe lWO (ront. upper Lb:th, BeQlu~ of!bu $wdy. Dr. Ch41c tn:ly be~n recoD'\lnendiot Ulill chilt1ren . ~ ) What a purr! If )'O'J $Cart smokinS at lIe 18 end smoke one ~ck a day. bow many I.e.e!b will you los.e by Ille time you are 35 Id' .,. (; , yr.an 0 . ~r ~ . ..~'.c . , ... .":';, Answer. Belween .c and ~ tuUl. The A~cm)' of Gencr.4l DenLisll)' rcporu l.ooililoss. due lO Lmokoinl: a1 ~e r.u..e of 2.Y IUl.h eve.ry 10 )'C<1n fur men AllY 1.5 teeth every ]0 yun (or women. o."wlA.u, . /'all I . o.,,,,,kr I tH Ol...~ _~..I;. 'h" Ar'Ademv of General Dentislrv ,cY~s~ RMlION:fLUOBI8E SUPPlEMENlAnON:::,';<, .; ...... . . ' . . . . . I I =t 'Child~n'~ ~o.n~ to 16 y~a~'or~ livini in a~u Jth le~. than' optimally fluoridated water, for uample, home or .primary- water supply is fluoride deficient. " -' . ADA Cow:cil on ~ientific A1Tain ~cotnme~cationa, new do,age schedule liPPrQved April 1994: INDICATIONal - , AOE PLUO"IDE.-IC?H,.L.vaL IN CAINKINQ W4T'" (pprn). i - <0.3 ppm . '. , O.3-0.6~pp.m . ., . .0.6 ppm I __.l.....:."' I Birth- None . None ~ ~ month I ! . - 6 monW- 0.25 None None I 3 yun ' m~dayt l 3-6 yean 0.50 tn~day .. 0.25 mglday I None - I -' I 6.16 years 1.0 mg/day L- 0.50 mg/dny \ None I I - ...1--- - . 1.0 l'l'm . I m~il.lr , :2.2 me ...d.um nwondt conl.&.1U I me n~ridt ion, 'Permill eiTly UpoIU~. which muimitu prot.e('tion. Fluord. lupplemenu are IOld in two fornu: drop. for lnfanu aEc 6 monthl and up. ~nd thewable ubleu for chi1d~n and ~doluanLa. Syatemie and ttlpiu\ beneliu whrn chewed. .wilhed Mnd Iwallowed. Cariet .proteCtion frum 6 munth. of aii:e whrn u~d &1 m:Qmmend~. LIMITATIONS: Allaourofl orOgoride mUlt be evaluated with I thorou~h O\Jolide hist.l:l .If nuoride level u unknown. drinkinE water mutt be te.l,.td or Ilolide C'Qnl,.tnt bero~ lupplemenu are pres.aibc-d. For teltini ~r nuoride C'OMent., c:onuet the local or .ute health' department. R.equi~sloni.urm compliA nce on a daily buis. In~estion or higher thin ~mmended levela of nuolide by children has ~n n.uociat.ed with an increU< in mild denl.Ul nl.loro.i, in .devrlupin&. unenJptl'd . t.eeth:Patient U su~ to multi Ie Wlur IOU~s Cln maKe ro r rucnbin complu. AO\lANTAOES: CONSIDEA.ATION8: TOOTHe ' CQlies ~uction.benefiU must be bllan~ with riSK for mild and veN mild Ouoro.il. J I \ L PATIENTl Home watediltntion l)'Iteml may remove Ouoride. \her,fon:. trut.ed water . .hould be t.ut.ed. Other louretl or n\loridc n~d ~ be detArmlnt.d. mcludmi Ou.oride prucribed by a pby.i~~. (Ra!cr s.o FlJu~'5.1 "...."aHc..1 .Am.ric:.an ~n~1 ""uodaUon. CO\lncll on Sci.nt.l!ic AJraiu. "'uoc:iation a.pol"L on Diet&J")' Fluoride Supplcmcnu. JADA 1;96 lIn pr....'. J..\UA \'...1 L!ti .luM \"~~ 1":1:) .\ I ~ ! I i ~ I 11 fJJ: ----.-...- \ Risk of Fluorosis in a Fluoridated Population . Implications for the Dentist and Hygienist ~~~"~-;~V;I~'~~~' if:',~?rJ.~~ :: :';~ :~':::: ~ ::. '~:;t~~;i~';;:'~~~~~~ t1:~;;,~;r:jf~~ nCllnt ye~rs. ThI~'hU ~.d t~ .ffort.io~~~~~~ the cau.e or cau..a and to make r.comrnen- ~ datlona that' ...k to ~aln~;n 'th. carlea.- ,:.:..:.~~. . ..' ( preventive lIffectlv.~.aa of fluorlde us. whU':';~ - '~,~~-:T-;:::~ .,', . :-,'---:,""'-'7'--:, .~:.~ minImizing the riak of f1uorollla. In thlll study,>. . . . . ~ . the author .atlmated the potential dlr.ct 1m- ,) pact that dental prllctltJone,-. could have on reducing the amount,of enam.l. f1uoroala In .". :~ U.S. chlldr.n. Theflndlnga auggut that d4ntal ; practltlon.r. couId hav."an Important Im~ct ;: on r.duclng the prevalenc. of .nam.1 fluoro- - al. by guIdIng the public toward the man ap- I proprlat. u.. of fluorlde producta. C....VIC Q. PE:NORYS. C.o.a.. PH.C. ! , ! he practicing dentist and hygie:c.ist are important sources of inform a con for patients regarding the use of fluoride- containing products, such as tooth- paste. It is vitally important t1:..at these health care professional..;; be kept fully informed about new information and rc-::om- mendations related to the most appropriate \l.5e of these products. In this way, the findings of the re- search community can best be transmitted to the public at large. The classic work of Dean I and subsequent commu. city trials established that a fluoride concentration of approximately 1 part per million in the dr...n.king water imparted a significant reduction in ca.:-:es, while the ocrorrence of enamel fluorosis remained low and limited to only very mild categories, unno- ticeable to all but the trained eye...., Since the::l. other efficacious fluoride produru have be€n introduced, including fluoride toothpaste and 5upplements.6-.I ' In recent years, however, there has been an in- crease in the DrevaJence Jf enamel fluorosis in both . optimally fluoridated an non-fluoridated communi- ties,"llleading to efforts to identify the underhmg cause or cause9, The goal of these investigations has been to define the most effective recommen~tions for preventing caries. while minimizing the occur- j . ) JADA. Vol. 126, De~lDlxr 1~5 1617 · Infants' Fluoride Ingestion from Water, Supplements and Dentifrice C~Z-1I'~5. ab~~ ~~ ~~~U 1.:11 fluorosis and the .... . . .. ... ''": '~. .:' .~:.~.. '."..: :: '5'~.'..{ ~~ i.~:..'., paucity of detailed nuoride Intake da~,:pr:o!"pt-, . . .' . ed this longItudinal awdy of fluoride Intake In' !;"\f;lr.~ from birth to 9 months 'of "g~:' O~ ';v"r- . ;.:' I.. ":'J:'-':"-;.,,:::,,,::f...} age, water fluo~de,lnt.ak~ greatly ex~!~~!r:s ~5!.:; . . that from dleary ftuoride aupplement.' or fluo;. . . .' ,_ J"P"~"" ". _:... . ride dentifrice. Ho_ver, fluoride aupplemanta and dentifrice contributad aubstantlal propor- . tlcn. of fluoride Intaka among children ualng' , .' . ttlem. Some children had a.tlmated fluoride In-' t..lIk. frtlm water, aupplemanta and dantlfrica that exceeded tha .-.commended "optlmal" I!; uke (a leval that ha. yet to be datannlned ac~ entlflcally). Practttione,... ahould a.tlmata flue- ride Inge.tlon from all the.e aoure.. tf conalderlng ayatemlc fluoride .upplementatlon. ,.. ~-- --.'-' ....-......-'......--.......... STEVEN M. L,AVV. 0.0.5.. t.1.P.H.; ,.RANK .I. KOHOUT. PH.O.. M.S.; MARY C. KIRITSY, M.SC.. R,C.; .JUOY R. HEIL-MAN, B.S.: .JAMES 6. wa,.EL. PH.O. y the mid-1980s, the prevalence of dental caries in children bad de- clined dramatically in the United States and other developed coun- tries. mainly due to the widespread use of fluoride in many forms.u More recently, concerns ben been raised about the in- creased prevalence and severity of dental fluoro'Sis in the United States~ due to the widespread mges- tion of fluoride from s. variety of sources. Local and regional studies in the united States and Canada bave found the pre\"alence of mostly mild dental fluorosis to range frO:D about 20 to 80 percent.~: In an effort to belp people achieve the "optimal" in- take of ingested fluoride to balance dental caries prevention and dental fluorosis, the recommended dietary fluoride supplementation dosage recently bas been reduced in both the United States~ll and Canada.u In addition, prudent use of small quanti. ties of fluoride dentifrice by preschool-aged children has been widely recommended.12'u <Author's note: The optimal level of fluoride intake has never been determined scientifically and has been used only 1I1 general terms. Lev';, and Guha-Chowdhuryl4 ad- dressed the limitations of current knowledge of "op- timal" fluoride intake levels.) JADA. Vo\. 126. December 1995 1625 e7/12/1997 11:eg 41282850% ELL I E RUDOLPH PAGE 133 JADA Preview. July 1!)971 Fluoride Concenlratlon. or InCant Foods 7110/'710135 rM t~'...~ ~ ~ ! ~ ' ADA Publishing Co. .__...-..._-...._-.~- --.-". T Jl E ,1 0 URN ^ L 0 F' T Ii E A MER [ CAN' DEN T A J. ASS () C , A T I () N ... IA D.' AI, July 1997 JADA contents Fluoride Concentrations of Infant Foods Prn'jOl!S ahstract Judy R. Heilman. B.S.; Mary C. Kirils)'. M.Sr... R.D.: Sleven M. foe v:',. , I),n.s.. M.P.H.: JameJ S. We/e!. Ph.D. Nt.\1 ;~bstmct Order this arti<:l.~ For the full text of this article, see the July JADA. page 857. _ 1 - -- Search .4D.4 O.A.'LINE I Contact the A DA I Help A\O)A~ Amerit:an ('l1n:03; A;5j,jCli:llll)n Copyright C 1997 American Dental ABsod~tJon. Reproduction or republication strictly prohibited without prior written permission. Last lTlod..ifitd: July 8. 1997 Dxumcnt addrcSll: htlp: l/www,aa..O/'g/Old.apcoljada!'7707'j-02.html 1 1fl~ ..~~. ~/-?:~ rr~ O? ~ . . ~ . " '" "' ~ '"A B S:T.R A,C T Few .tudle. ha...e In...e.tJgated fluoride e..po.ure. from Juice. and julc...fl....ored drink. manu- factured with water. In thl. .tudy, the authona analyzed 1532 Juice. and Juice drink. for nuo- ride. Fluoride Ion concontratlon. ranged from 0.02 to 2.80 part. per million, In part ~u.e of yariatlon. In fluoride conceno tnltlon. of water u.ed In pro- cu~lon. C:-'lldror\'a InQ'Ilatlon ot . " fluoride from Juice. and julc... fl....ored drink. can be .ub.t.a~ tlal and a factor In the develop:- ment ot tluoro.la. ~ t, .,. <. ~, ~: 4 j; , l , j- ~ ASSfS~ING flUORIUf CONCfNTRATfONS OF JUICES AND JUICE-FLAVORED DRINKS M....Ry C. KIRITSY. M.SC.. R.O.; STEVEN M. LEVY. 0.0.5.. M.P.H.: .JOHN .J. WARREN. 0.0.5.. M.S.: NUPUR aUH....-CHOWOHURY. M.O.S.. PH.D.; .JUDY R. HEIL.MAN. B.S.; TERESA M....RSHALl.. PH.O.. R.O. o dramatic decrease in dental caries among children in developed countries has been attributed to the widespread use of fluoridated water. fluoride dentifrice, dietary fluoride supplements and other forms of fluoride. I" This health benefit has be€n accompanied by an increased revalence of dental fluorosis. ran' from about 15 to 65 percent in fluoridated areas an to 4 percent 10 no uon- dated areas in North America:'" Water, beverages made with water, dietary fluoride supplements (drops and tablets) and unin- tentional ingestion of fluoridated dentifrice are thought to be impor- tant sources of ingested fluoride among young children.~u All indi~dual fluoride sources are important, although it is the total fluoride intake from all sources that is critical in the develop- ment offluorosis..~IO However, the amount of fluoride needed to cause fluorosis is not known precisely, U and variation among indi- viduals probably exists. STUDIES OF FLUORIDE INTAKE FROM BEVERAQES Recent dietary studies indicate that water intake among children has declined and consumption of soft drinks and juices has in. creased in recent years....U.I..I. National survey data indicate that children younger than age 1 year consume an average' of 3 ounces of juices and other beverages per day, children aged 1 to 2 years con- sume 9 0% and chiIdren aged 3 to 5 years consume 10.5 oz. I' (For each liter of juice, the number of milligrams of fluoride ingested equals the fluoride concentration in parts per million. so that an 8- oz glass [approximately 0.25 LJ of juice with a fluoride concentra- tion of 1 ppm would pro~de about 0.25 mg of fluoride.) Investigators have indicated that the increased consumption of soft drinks and juices prepared with fluoridated water may be a sig- nificant source of systemic fluoride for. children. and have implicated this source as a risk factor for dental fluorosis in young children. .,~ \1,'''",'. This phenomenon has been called the ~diffusion effect".or "halo effect" when those living in non11uoridated communities ingest fluoridated beverages that have been produced els~where. II Both the fluoride content of beverages and the quantity of beverages con- sumed by children have been the subject of several studies..'...2l).:J JADA. Vol. 127. Julv 1996 895 ADA News Releases: Can Your Child Be Getting Too tvluch FluorIde lhrOugn naoy ruuu: rabe I Vi.... ADADNUNt SC<lrch Contact Us About the ADA What's New ,,41))1 j\~vs Releas'es June/July 1997 Contact: ADA Department of Media Relations & Creative Services m~di arelat ion 5 f(j)9.~QIg 312/440-2806 Can Your Child Be Getting Too Much Fluoride Through Baby Food? CHICAGO - New research suggests young children may be getting more fluoride than they need through baby foods, according to a study published in the July issue of the The JOllrna! of the American Denfa! Association (.JADA) , "Our main concern is that these young children could be at increased risk for mild to moderate dental fluorosis by ingesting too much fluoride," says Steven M. Levy, D.D,S., one of the authors of the JADA study from the College of Dentistry at the University ofIowa, "It's important for parents to know how much fluoride their children are getting, whether it's through the water supply, fluoride supplements, fluoridated toothpaste or baby food." Fluorosis is a mild to moderate cosmetic defect that occurs when more than an optimal amount of fluoride is ingested, The result of mild fluorosis is light spots on permanent teeth that develop while the teeth are still forming. The researchers analyzed the fluoride concentration of238 commercially available infant foods. They took samples for analysis from 206 ready-to-eat infant foods and 32 dry infant cereals, which they prepared with water according to the manufacturer's directions. The results of the analysis reveal ready-to-eat foods with chicken had the highest fluoride concentrations, One of the reasons for the high fluoride concentrations in infant foods with chicken may be because of the processing method, according to the study. The mechanical deboning process may leave skin and residual bone particles in the food. Much of fluoride is stored in bone; therefore, the higher concentrations in the chicken-containing products. The researchers also found that dry infant cereals that are reconstituted with fluoridated water may noticeably increase the levels of fluoride in a child's daily intake. "What we found in this study is fluoride concentrations for the majority of all the products tested varied widely because of the different water sources used to process the foods," Dr. Levy explains, "The differences can be traced to the manufacturing sites that use a fluoridated municipal water supply as compared to a non-fluoridated city or well water." The American Dental Association reminds consumers that drinking water fluoridated at the http://www ,ada. org/newsre1l97067 1m -03 .html 11130/98 ADA News Releases: Can Your Child Be Getting Too Much fluoride Through tlaby tooa'l page L or L recommended level or eating foods prepared or processed with fluoridated water is safe and effective, Studies show that community water fluoridation is the single most effective public health measure,we have to prevent tooth decay and improve oral health for a lifetime. -. . --.-..-.--.......- .._._._.~._---_._-~._---_.__.._._-----.------------ ------.-. '..'n.'......._.._...'..nnn._.nn.._.n~ re \:~~~n_~.~~.~.~~_!.~.~~.~~:!. i c I ~.L~.~i. N:.~.~:~J!: :0..~:~~.:~:..s:.~.~~_~.~.~.~.,._m m._ .__ __n ,..nm..n....... "....." F~\f)' A\ /."",,:1, .I P ..__1.. .1 11 ~...~'..JIJIl ,,\ i. "'1l~ o:ar ['~.II" ~ 3 ~(..: ~ :b> '1 Copyright iQ 1997 American Dcntal Association. Rcproduction or rcpublication strictly prohibited without prior writtcn pcrmission. Last modified: June/July 1997 Document address: http://www.ada.orginewsrel/97067/nr-03.html http://www.ada,org/newsreI/9706 7/m-03, html 11/30/98 Orlando Utilities Commission Lake Highland Plant: Hydrofluosilicic Acid Storage/Feed Facilities Bulk Storage Day tank on scale; pumps for feeding on wall Truck loading station City of Daytona Beach, Brennan Water Treatment Plant Sodium silica fluoride storage/feed facility Dry chemical in paper bags in separate storage room Dry chemical, gravimetric feeder Community Water Fluoridation is the most efficient way to prevent dental decay, thereby preventing dental problems and leading to optimum oral health. Varying Degrees of Dental Problems Caries-Free Mouth Demonstrating Optimum Oral Health DEP 1996 PERMITTING AND CONSTRUCTION OF r USUC WATER SYSTEMS 62-555 Law Implemented 553.06, FS. History -- New 1-18-89, Formerly 17-555.322. 62-555.325 Fluoridation. (1) Conditions - Before the installation and placing into service of fluoridation equipment, a public water system shall apply for and receive a permit or permit modification from the Department. Fluoride compounds as used herein may include NaF, Na2SiF6 and H2SiF6. (2) Fluoride levels in drinking water shall not exceed the maximum contaminant levels in Rules 62-550.310 and .320, F.A.C. The optimum fluoride level should be maintained at approximately 0.8 milligrams per liter. (3) Equipment an'_! Installation, (a) Fluoridation equipment for use with hydrofluorosilic acid shall be housed in an adequately vented space with high-level ventilation. (b) A means k determine daily fluoride chemical dosage shall be provided. VVhen weighing scales are used to determine the amount of chemical fed, the scales shall be installed flush with the loading platform at floor level to avoid unnecess~~ry lifting of large containers. (c) Chemicals in powdered or granular form used for fluoridation shall be kept in color-coded containers to distinguish from other water treatment chemicals. (d) Analytical equipment is required to accurately determine the fluoride ion concentration in the treated water. Analysis of the treated water for fluoride content shall be performed daily and reported to the HRS State Dental Health Office monthly along with the daily fluoride dosage and the daily quantity of chemical fed. (4) Quality Assurance. (a) At monthly intervals, each plant practicing fluoridation shall collect a raw, an effluent, and four distribution system samples. The samples shall be "split" and sent to a laboratory of the Department of Health and Rehabilitative Services or another certified laboratory for analysis. The results of analysis by the plant and the other laboratory shall be submitted to the HRS State Dental Health Office. (b) If the Department finds that fluoridation is not being carried out in compliance with these rules, it may order corrective action. " (c) The HRS State Dental Health Office is authorized to conduct annual or more frequent inspections of fluoridation facilities at public water systems. Specific Authority 403.853(3), 403.861 (6), (9), 403.862(1), FS. Law Implemented 403.852(12), (13),403.853(3), (5), FS. History -- New 11-19-87; Formerly 17-22.625; Amended 1-18-89, 1-3-91, Formerly 17-555.325. Effective 12-10-96 13