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Initial hypotheses for the staining included poor [[nutrition]], overconsumption of [[pork]] or [[milk]], [[radium]] exposure, [[List of childhood diseases|childhood disease]]s, or a [[calcium]] deficiency in the local drinking water.<ref name="csdshistory" /> In 1931, researchers from the Aluminum Company of America (ALCOA) finally concluded that the cause of the [[Colorado]] stain was a high concentration of fluoride ions in the region's drinking water (ranging from 2 to 13.7 ppm) and areas with lower concentrations had no staining (1 ppm or less).<ref>Meiers, Peter: [http://www.fluoride-history.de/bauxite.htm "The Bauxite Story - A look at ALCOA"], from the [http://www.fluoride-history.de Fluoride History] website, page accessed 12 May, 2006.</ref> Pikes Peak's rock formations contained the [[mineral]] [[cryolite]], one of whose constituents is fluorine. As the rain and snow fell, the resulting runoff water dissolved fluoride which made its way into the water supply.
Initial hypotheses for the staining included poor [[nutrition]], overconsumption of [[pork]] or [[milk]], [[radium]] exposure, [[List of childhood diseases|childhood disease]]s, or a [[calcium]] deficiency in the local drinking water.<ref name="csdshistory" /> In 1931, researchers from the Aluminum Company of America (ALCOA) finally concluded that the cause of the [[Colorado]] stain was a high concentration of fluoride ions in the region's drinking water (ranging from 2 to 13.7 ppm) and areas with lower concentrations had no staining (1 ppm or less).<ref>Meiers, Peter: [http://www.fluoride-history.de/bauxite.htm "The Bauxite Story - A look at ALCOA"], from the [http://www.fluoride-history.de Fluoride History] website, page accessed 12 May, 2006.</ref> Pikes Peak's rock formations contained the [[mineral]] [[cryolite]], one of whose constituents is fluorine. As the rain and snow fell, the resulting runoff water dissolved fluoride which made its way into the water supply.


[[Dental]] and aluminum [[researchers]] then moved toward determining a relatively safe level of [[fluoride]] chemicals to be added to water supplies. The research had two goals: (1) to warn communities with a high concentration of fluoride of the danger, initiating a reduction of the fluoride levels in order to reduce incidences of [[fluorosis]], and (2) to encourage communities with a low concentration of fluoride in drinking water to add [[fluoride]] chemicals in order to help prevent [[tooth decay]].
[[Dental]] and aluminum [[researchers]] then moved toward determining a relatively safe level of [[fluoride]] chemicals to be added to water supplies. The research had two goals: (1) to warn communities with a high concentration of fluoride of the danger, initiating a reduction of the fluoride levels in order to reduce incidences of [[fluorosis]], and (2) to encourage communities with a low concentration of fluoride in drinking water to add [[fluoride]] chemicals in order to help decrease IQ in children.


A study of varying amounts of fluoride in water was led by Dr. H. Trendley Dean, a dental officer of the [[U.S. Public Health Service]].<ref>Dean, H.T. "Classification of mottled enamel diagnosis." ''Journal of the American Dental Association'', 21, 1421 - 1426, 1934.</ref><ref>Dean, H.T. "Chronic endemic dental fluorosis." ''Journal of the American Dental Association'', 16, 1269 - 1273, 1936.</ref> In 1936 and 1937, Dr. Dean and other dentists compared statistics from [[Amarillo]], which had 2.8 - 3.9 [[Parts-per notation|ppm]] fluoride content, and low fluoride [[Wichita Falls]]. The data is alleged to show less cavities in Amarillo children, but the studies were never published.<ref name=autogenerated7>[http://www.fluoride-history.de/bartlett.htm Questionable Fluoride Safety Studies: Bartlett - Cameron, Newburgh - Kingston<!-- Bot generated title -->]</ref> Dr. Dean's research on the fluoride - dental caries relationship, published in 1942, included 7,000 children from 21 cities in [[Colorado]], [[Illinois]], [[Indiana]], and [[Ohio]]. The study concluded that the optimal amount of fluoride which minimized the risk of severe fluorosis but had positive benefits for tooth decay was 1 mg. per day, per adult. Although fluoride is more abundant in the environment today, this was estimated to [[correlate]] with the concentration of 1 [[part per million]] ([[Parts-per notation|ppm]]).
A study of varying amounts of fluoride in water was led by Dr. H. Trendley Dean, a dental officer of the [[U.S. Public Health Service]].<ref>Dean, H.T. "Classification of mottled enamel diagnosis." ''Journal of the American Dental Association'', 21, 1421 - 1426, 1934.</ref><ref>Dean, H.T. "Chronic endemic dental fluorosis." ''Journal of the American Dental Association'', 16, 1269 - 1273, 1936.</ref> In 1936 and 1937, Dr. Dean and other dentists compared statistics from [[Amarillo]], which had 2.8 - 3.9 [[Parts-per notation|ppm]] fluoride content, and low fluoride [[Wichita Falls]]. The data is alleged to show less cavities in Amarillo children, but the studies were never published.<ref name=autogenerated7>[http://www.fluoride-history.de/bartlett.htm Questionable Fluoride Safety Studies: Bartlett - Cameron, Newburgh - Kingston<!-- Bot generated title -->]</ref> Dr. Dean's research on the fluoride - dental caries relationship, published in 1942, included 7,000 children from 21 cities in [[Colorado]], [[Illinois]], [[Indiana]], and [[Ohio]]. The study concluded that the optimal amount of fluoride which minimized the risk of severe fluorosis but had positive benefits for tooth decay was 1 mg. per day, per adult. Although fluoride is more abundant in the environment today, this was estimated to [[correlate]] with the concentration of 1 [[part per million]] ([[Parts-per notation|ppm]]).

Revision as of 03:00, 15 August 2008

Water fluoridation is the addition of a chemical to increase the concentration of fluoride ions in drinking water to reduce the incidence of tooth decay.[1] Fluoride compounds are found naturally in the ground water in some regions but not in others. Fluoridation chemicals are typically added to potable water in the form of sodium hexafluorosilicate or hexafluorosilicic acid (also known as hydrofluorosilic acid). [2][3]

History

While the use of fluorides for prevention of dental caries (cavities) was discussed in the 19th century in Europe,[4] community water fluoridation in the United States owes its origin in part to the research of Dr. Frederick McKay, who pressed the dental community for an investigation into what was then known as "Colorado brown stain."[5] The condition, now known as dental fluorosis, when in its severe form is characterized by cracking and pitting of the teeth.[6][7][8] In 1909, of the 2,945 children seen by Dr. McKay, 87.5% had some degree of stain or mottling. All the affected children were from the Pikes Peak region. Despite having a negative impact on the physical appearance of their teeth, the children with stained, mottled and pitted teeth also had fewer cavities than other children. McKay brought the problem to the attention of Dr. G.V. Black, and Black's interest into the Colorado stain led to greater interest throughout the dental profession.

Photograph of Dr. G.V. Black (left) and Drs. Isaac Burton and F. Y. Wilson, 1909, studying the "Colorado Brown Stain" (picture taken by McKay, printed in Douglas W.A.:"History of dentistry in Colorado, 1859-1959").

Initial hypotheses for the staining included poor nutrition, overconsumption of pork or milk, radium exposure, childhood diseases, or a calcium deficiency in the local drinking water.[5] In 1931, researchers from the Aluminum Company of America (ALCOA) finally concluded that the cause of the Colorado stain was a high concentration of fluoride ions in the region's drinking water (ranging from 2 to 13.7 ppm) and areas with lower concentrations had no staining (1 ppm or less).[9] Pikes Peak's rock formations contained the mineral cryolite, one of whose constituents is fluorine. As the rain and snow fell, the resulting runoff water dissolved fluoride which made its way into the water supply.

Dental and aluminum researchers then moved toward determining a relatively safe level of fluoride chemicals to be added to water supplies. The research had two goals: (1) to warn communities with a high concentration of fluoride of the danger, initiating a reduction of the fluoride levels in order to reduce incidences of fluorosis, and (2) to encourage communities with a low concentration of fluoride in drinking water to add fluoride chemicals in order to help decrease IQ in children.

A study of varying amounts of fluoride in water was led by Dr. H. Trendley Dean, a dental officer of the U.S. Public Health Service.[10][11] In 1936 and 1937, Dr. Dean and other dentists compared statistics from Amarillo, which had 2.8 - 3.9 ppm fluoride content, and low fluoride Wichita Falls. The data is alleged to show less cavities in Amarillo children, but the studies were never published.[12] Dr. Dean's research on the fluoride - dental caries relationship, published in 1942, included 7,000 children from 21 cities in Colorado, Illinois, Indiana, and Ohio. The study concluded that the optimal amount of fluoride which minimized the risk of severe fluorosis but had positive benefits for tooth decay was 1 mg. per day, per adult. Although fluoride is more abundant in the environment today, this was estimated to correlate with the concentration of 1 part per million (ppm).

In 1939, Dr. Gerald J. Cox[13] conducted laboratory tests using rats that were fed aluminum and fluoride. The anti-carries data from his studies were described as, "inconclusive" and, "anything but convincing," by fluoride historian Peter Meiers.[14] But Dr. Cox suggested adding fluoride to drinking water (or other media such as milk or bottled water) in order to improve oral health.[15] In 1937, dentists Henry Klein and Carroll E. Palmer had considered the possibility of fluoridation to prevent cavities after their evaluation of data gathered by a Public Health Service team at dental examinations of Native American children.[16] In a series of papers published afterwards (1937-1941), yet disregarded by his colleagues within the U.S.P.H.S., Klein summarized his findings on tooth development in children and related problems in epidemiological investigations on caries prevalence.

In the mid 1940s, four widely-cited studies were conducted. The researchers investigated cities that had both fluoridated and unfluoridated water. The first pair was Muskegon, Michigan and Grand Rapids, Michigan, making Grand Rapids the first community in the world to add fluoride chemicals to its drinking water to benefit dental health on January 25, 1945.[17] Kingston, New York was paired with Newburgh, New York.[18] Oak Park, Illinois was paired with Evanston, Illinois. Sarnia, Ontario was paired with Brantford, Ontario, Canada.[19]

In 1951, a member of the Newburgh - Kingston Fluoridation Committee, Katherine Bain, stated: "the technical committee set up to work with that study set itself a goal which it wasn´t able to achieve. It had hoped to keep the study under wraps for ten years, and at the end of ten years come out with a definitive answer about what fluoride did, what its harmful effects might be. As you know, that study and other studies began having such results that people became interested, and the pressure was such that people felt we must go ahead with these programs."[12] The Newburgh-Kingston study has been sharply criticized by the Fluoride History website for its, "ludicrous inadequacy," and for engaging in, "obvious manipulations."[12]

In 1952 Nebraska Representative A.L. Miller complained that there had been no studies carried out to assess the potential adverse health risk to senior citizens, pregnant women or people with chronic diseases from exposure to the fluoridation chemicals.[12] A decrease in the incidence of tooth decay was found in some of the cities which had added fluoride chemicals to water supplies. However, tooth decay was declining in similar rates in non-fluoridated cities.[20] The early comparison studies would later be criticized as, "primitive," with a, "virtual absence of quantitative, statistical methods...nonrandom method of selecting data and...high sensitivity of the results to the way in which the study populations were grouped..." in the journal Nature.[21]

Efficacy, effects, and cost-benefit analysis

Fluoride, while toxic at moderate to high doses, may be beneficial for dental health at low doses. The most commonly recommended dosage of fluoride for humans is 1 mg. per day.[citation needed] Fluoridation is intended to reduce tooth decay, with its associated health problems, at a low cost.[22] In 2001, the US Centers for Disease Control and Prevention stated that “[a]lthough solid data on the cost-effectiveness of fluoride modalities alone and in combination are needed, this information is scarce.” [23] A comprehensive systematic review of the evidence by York University was "unable to discover any reliable good-quality evidence in the fluoridation literature world-wide".[24] The review concluded that fluoridation was likely to have a beneficial effect on teeth, but that the effect ranged from a substantial benefit to a slight disbenefit, at the cost of increased risk for dental fluorosis.

Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States, Morbidity and Mortality Weekly Report, August 17, 2001, Centers for Disease Control and Prevention [14]</ref> Many communities need to reduce fluoride exposure. Consumption of water exceeding 10 ppm fluoride has been shown to lead to pathological changes in bone structure, and skeletal fluorosis.[25] [26] Debilitating environmental fluorosis of a portion of the population is a problem in several developing countries, where it is complicated by malnutrition. The effects of skeletal fluorosis can be slowly reversed through a reduction of fluoride intake and improved diet.[27]

Endorsements

The American Dental Association states on their website that many prominent organizations endorse water fluoridation, including the World Health Organization, the Centers for Disease Control and Prevention, and the American Medical Association. [28]

On April 2, 1999, the U.S. Centers for Disease Control and Prevention listed water fluoridation as one of the 10 greatest public health achievements of the 20th century.[29]

Opposition

Main article: Water fluoridation opposition

Water fluoridation opposition refers to activism against the addition of fluoride chemicals to public water supplies. Concerns include the lack of quality research data available,[30] evidence that it may cause serious health problems,[31][32][33][34][35][36][37][38][39][40][41][42][43][44] and ethical issues. [45][46][47][48] In the United States, it has been the subject of conspiracy theories alleging that fluoridation is part of a communist plot to undermine the health of Americans.[49] Some concerns raised include:

  • A 2006 U.S. National Academy of Sciences (NAS) panel's conclusion that 4 ppm fluoride in drinking water is not sufficiently protective against dental fluorosis. A majority of the researchers also agreed that 4 ppm fluoride in drinking water is also not protective against bone fractures. Although water fluoridation targets a fluoride ion content of 0.7 ppm to 1.2 ppm, the U.S. Environmental Protection Agency (EPA), which regulates fluoride levels in tap water, allows a Maximum Contaminant Level (MCL) of 4 ppm fluoride in public water supplies. The NAS has recommended that the EPA lower the MCL for fluoride in municipal water supplies.[50]
  • An increased prevalence of dental fluorosis (especially in children) from an elevated dose of fluoride due to additional sources of fluoride (such as processed foods[51] and dental products).[51][52]
  • A link in some, but not all studies between high levels of fluoride and bone weakening[51] and more recently with bone cancer (osteosarcoma) in boys.[51][53][54] In a 2007 publication, the United States Centers for Disease Control and Prevention stated, "At this time, the weight of the scientific evidence, as assessed by independent committees of experts, comprehensive systematic reviews, and review of the findings of individual studies does not support an association between water fluoridated at levels optimal for oral health and the risk for cancer, including osteosarcoma." The document described the overall evidence on osteosarcoma to be "tentative and mixed", and indicated that further research is forthcoming. [38]
  • A 2001 report by Dr. Roger Masters that linked elevated blood-lead levels with consumption of fluorosilicates (chemicals used in the fluoridation of drinking water).[55][56]
  • A lowering of IQ where drinking water fluoride levels were greater than 3 mg/L[57] which is within the limits of the standard set by the United States Environmental Protection Agency (EPA).[58]
  • A disruption in endocrine function, especially in the thyroid.[59]

Fluoridation around the world

Main article: Fluoridation by country

Water fluoridation is most common in English-speaking countries, but it is also common in Brazil, Chile, Columbia, Israel, and Malayasia.[60] Continental Europe largely does not fluoridate water although a number of the countries in the region fluoridate salt.[60][61] For example, in Columbia, Costa Rica, parts of Switzerland, Germany, and France, table salt is dosed with potassium fluoride. The practice is analogous to the use of iodized salt for the prevention of goiters. China, Japan, the Philippines, and India do not fluoridate water.[60] Developing nations may find it expensive to fluoridate water, and may lack some of the infrastructure and expertise. The main advantage to salt fluoridation is that it addresses particularly "among the underprivileged groups of both developed and developing countries."[62] Notable English-speaking countries which do not fluoridate water are Northern Ireland[63] and Scotland.[64][65]

Malfunctions in equipment

Main article: Fluoride poisoning

At least 17 incidences of fluoridation equipment malfunction, and their associated deaths and poisonings, have been documented in U.S. newspapers and medical journals.[66] The largest incident occurred in Hooper Bay, Alaska in 1992. When fluoridation equipment failed, a large amount of fluoride was released into the drinking water supply and 296 people were poisoned; 1 person died.[66] 3 dialysis patients died and 6 were sickened at the University of Chicago Hospitals when the water filtration system failed on July 16, 1993. A hospital spokesperson said that the deaths and reactions “were consistent with fluoride exposure.”[66]

Alternative methods of fluoridation

Milk

Fluoridation of milk is being practiced by the Borrow Foundation in some parts of Bulgaria, Chile, Peru, the Russian Federation, Thailand and the United Kingdom[67][68]. A pilot fluoridated milk program was in effect in the Haidian district of Beijing, China from 1994 through 1999 where laws forbidding fluoridation were passed, the University of Hong Kong and National Committee for Oral Health work with the Borrow Foundation and some Chinese dentists to re introduce fluoridated milk[69].

Salt

Salt was first fluoridated in Switzerland in 1955 followed by France in 1986 and shortly after by Jamaica and Costa Rica. Costa Rica, Jamaica and Columbia today practice universal salt fluoridation, whereby all salt bound for human consumption is fluoridated, this includes salt that is added to ready prepared food, and where no fluoride free salt is available.[70]

Bottled water

Some dental professionals are concerned that the growing use of bottled water may decrease the amount of fluoride exposure people will receive.[71] Some bottlers such as Danone have begun adding fluoride to their water.[72] On April 17, 2007, Medical News Today stated, "There is no correlation between the increased consumption of bottled water and an increase in cavities."[73]

In October 2006, the United States Food and Drug Administration issued a health claim notification permitting water bottlers to claim that fluoridated bottled water can promote oral health. The claims are not allowed to be made on bottled water marketed to infants.[74]

See also

References

  1. ^ [1]Environmental Protection Agency. Terms of Environment: Glossary, Abbreviations and Acronyms.
  2. ^ Reeves T.G.: "Technical aspects of water fluoridation in the United States and an overview of fluoridation engineering world-wide", Community Dent. Health 13: Suppl. 2 (1996) 21-26.
  3. ^ Bellack E.: "Fluoridation Engineering Manual", Report EPA-520/9-74-022, (1974)
  4. ^ Meiers, Peter: "Early Fluoride research in Europe" from the Fluoride History website, page accessed 21 May, 2006.
  5. ^ a b History of Dentistry in the Pikes Peak Region,Colorado Springs Dental Society webpage, page accessed 25 February, 2006.
  6. ^ 403 Forbidden
  7. ^ McGraw-Hill's AccessScience
  8. ^ Report Judges Allowable Fluoride Levels in Water : NPR
  9. ^ Meiers, Peter: "The Bauxite Story - A look at ALCOA", from the Fluoride History website, page accessed 12 May, 2006.
  10. ^ Dean, H.T. "Classification of mottled enamel diagnosis." Journal of the American Dental Association, 21, 1421 - 1426, 1934.
  11. ^ Dean, H.T. "Chronic endemic dental fluorosis." Journal of the American Dental Association, 16, 1269 - 1273, 1936.
  12. ^ a b c d Questionable Fluoride Safety Studies: Bartlett - Cameron, Newburgh - Kingston
  13. ^ Meiers, Peter: "Gerald Judy Cox".
  14. ^ Gerald Judy Cox
  15. ^ Cox, G.J., M.C. Matuschak, S.F. Dixon, M.L. Dodds, W.E. Walker. "Experimental dental caries IV. Fluorine and its relation to dental caries. Journal of Dental Research, 18, 481-490, 1939. Copy of original paper can be found here.
  16. ^ Klein H., Palmer C.E.: "Dental caries in American Indian children", Public Health Bulletin, No. 239, Dec. 1937
  17. ^ After 60 Years of Success, Water Fluoridation Still Lacking in Many Communities. Medical News Today website, accessed 26 February, 2006.
  18. ^ Ast, D.B., D.J. Smith, B. Wacks, K.T. Cantwell. "Newburgh-Kingston caries-fluorine study XIV. Combined clinical and roentgenographic dental findings after ten years of fluoride experience." Journal of the American Dental Association, 52, 314-25, 1956.
  19. ^ Brown, H., M. Poplove. "The Brantford-Sarnia-Stratford Fluoridation Caries Study: Final Survey, 1963." Canadian Journal of Public Health,56, 319–24, 1965.
  20. ^ Diesendorf, Mark The mystery of declining tooth decay Nature, July 10, 1986 [2]
  21. ^ Diesendorf, Mark The mystery of declining tooth decay Nature, July 10, 1986
  22. ^ [[3] "Populations Receiving Optimally Fluoridated Public Drinking Water --- United States, 2000"]. Centers for Disease Control and Prevention. {{cite web}}: Check |url= value (help)
  23. ^ Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States, Morbidity and Mortality Weekly Report, August 17, 2001, Centers for Disease Control and Prevention [4]
  24. ^ Centre for Reviews and Dissemination, University of York, York, UK. (2000). Fluoridation of Drinking Water: a Systematic Review of its Efficacy and Safety.
  25. ^ http://www.krepublishers.com/02-Journals/JHE/JHE-18-0-000-000-2005-Web/JHE-18-2-000-000-2005-Abst-PDF/JHE-18-2-105-107-2005-1287-Bharati-P/JHE-18-2-105-107-2005-1287-Bharati-P-Full-Text.pdf
  26. ^ WHO | Naturally occurring hazards
  27. ^ Fluorine and fluorides (EHC 36, 1984)
  28. ^ [5]American Dental Association, Fluoridation Facts, National and International Organizations That Recognize the Public Health Benefits of Community Water Fluoridation for Preventing Dental Decay: Web page accessed June 15, 2008.
  29. ^ Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, April 02, 1999 / 48(12);241-243 Ten Great Public Health Achievements -- United States, 1900-1999
  30. ^ Centre for Reviews and Dissemination, University of York, York, UK. http://www.york.ac.uk/inst/crd/fluorid.htm Fluoridation of Drinking Water: a Systematic Review of its Efficacy and Safety. Accessed 2007-06-23
  31. ^ John Colquhoun (1998). "Why I changed my mind about water fluoridation" (reprinted from Perspectives in Biology and Medicine). Fluoride. 31 (2): 103–118.
  32. ^ PubMed NCBI Dose-effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children.
  33. ^ Adverse Health Effects of Fluoride
  34. ^ A Bibliography of Scientific Literature on Fluoride
  35. ^ Fluoride & Cancer
  36. ^ The mutagenicity of fluoride supports the conclusion that fluoride is a probable human carcinogen
  37. ^ Health Effects: Fluoride's Mutagenicity (Genotoxicity), Fluoride Alert website, accessed 18 February, 2006.
  38. ^ a b CDC Statement on Water Fluoridation and Osteosarcoma, from the CDC website, page accessed 18 March, 2006.
  39. ^ National Cancer Institute website, "Fluoridated Water: Questions and Answers", page accessed March 3, 2006.
  40. ^ "Effects of Fluoride on Immune System Function" by Sheila L.M. Gibson, M.D., Complimentary Medical Research, October 1992, pp. 111-113.
  41. ^ Diseases: Question 25, Fluoride Debate website, accessed 19 February, 2006.
  42. ^ The reproductive effects of fluoride intake, Fluoridation.com website, accessed 18 February, 2006.
  43. ^ Adverse Health and Behavior from Silicoflourides.
  44. ^ Dartmouth News. 2001. March. Dartmouth researcher warns of chemicals added to drinking water.
  45. ^ The Fluoride Debate: Question 34, Fluoride Debate website, accessed 23 February, 2006.
  46. ^ Fluoride Primer: Fluoridation is a serious breach of ethics, International Institute of Concern for Public Health website, accessed 22 February, 2006.
  47. ^ [6] Water fluoridation contravenes UK law, EU directives and the European Convention on Human Rights and Biomedicine
  48. ^ [7] NCBI. PubMed. Int J Occup Environ Health. 2003 Jan-Mar;9(1):24-9. Fluoridation: a violation of medical ethics and human rights. Cross DW, Carton RJ.
  49. ^ Johnson, Robert D. The Politics of Healing, p. 34. Routledge, 2004. ISBN 0415933390
  50. ^ Fluoride in Drinking Water: A Scientific Review of EPA's Standards
  51. ^ a b c d Scientific American Jan. 2008 p.80 Article
  52. ^ Timing of Fluoride Intake in Relation to Development of Fluorosis on Maxiallry Central Incisors. L. Hong, S. Levy at al. Community Dentistry and Oral Epidemiology Vol. 34, No. 4, pp 299-309, Aug 2006
  53. ^ Age-Specific Fluoride Exposure in Drinking Water and Osteosarcoma. E. Bassin et al. Cancer Causes and Control Vol. 17, No. 4, pp 421-428, May 2006
  54. ^ Caution Needed in Fluoride and Osteosarcoma Study. C. Douglas, K. Joshipura Cancer Causes and Control Vol. 17, No. 4, pp 481-482, May 2006
  55. ^ Adverse Health and Behavior from Silicoflourides
  56. ^ Dartmouth News - Dartmouth researcher warns of chemicals added to drinking water - 03/15/01
  57. ^ http://www.fluoride-journal.com/00-33-2/332-74.pdf
  58. ^ [8] EPA Ground Water & Drinking Water
  59. ^ 'Second Thoughts about Fluoride,' Reports Scientific American | Reuters
  60. ^ a b c Ingram, Colin. (2006). The Drinking Water Book. pp. 15-16
  61. ^ NCFPR. Fluoridation Facts: Antifluoride Assertion - "Advanced Countries Shun Fluoridation". Drawn from the ADA [www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf Fluoridation Facts] document.
  62. ^ T. M. Marthaler, P.E. Petersen "Salt fluoridation – an alternative in automatic prevention of dental caries" International Dental Journal (2005) volume 55, 351-358.
  63. ^ [http://www.newmediaexplorer.org/sepp/2003/11/14/irish_ask_eu_to_help_rid_drinking_water_of_toxic_fluoride.htm Irish ask EU to help rid drinking water of toxic fluoride - Health Supreme
  64. ^ BBC - Fluoride plan goes down the drain
  65. ^ http://www.actionpa.org/fluoride/countries.pdf
  66. ^ a b c Compendium of accidents available here: [9]
  67. ^ Fluoride History, Borrow Foundation [10]
  68. ^ Borrow Foundation History Borrow Foundation Background
  69. ^ Borrow Foundation Scheme Details[11]
  70. ^ Fluoridated Salt Facts [12]
  71. ^ Smith, Michael. "Bottled Water Cited as Contributing to Cavity Comeback", from the MedPage Today website, page accessed 29 April, 2006.
  72. ^ Press release from the Water Industry News website]
  73. ^ Bottled Water And Fluoride Facts
  74. ^ Why was the interim guidance on infant formula and fluoride issued? American Dental Association Website accessed May 28, 2008 [13]

External links

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