ASEHA Qld

The issue of fluoride is a hot topic amongst those who do not want any more poisons in their environment.  This article will explore fluoride from various sources and examine some of the impacts it can have on human health.  It is important to understand information about fluoride as it is a substance that can cause harm.  If you are concerned about any of the information in this article you should do your own research.

What is fluoride?

Fluoride is an element and while it is thought to have therapeutic uses, there is a fine line between a therapeutic dose and a toxic dose.  While low levels of fluoride are thought to prevent dental cavities, high levels can result in tooth and bone damage, or have other consequences.  The effect of exposure to harmful substances generally depends on the dose; duration of exposure, how the exposure occurred; genetic susceptibility and whether other poisons are present   Fluoride is very irritating to the eyes, skin and respiratory tract (US.  Agency for Toxic Substances and Disease Registry.  2003).

Fluorides are ubiquitous in the environment; they are present naturally and from man-made sources.  Natural sources include the weathering and dissolution of minerals, from volcanic eruptions and marine aerosols.  Man made sources include coal combustion and process waters, waste from various industrial processing such as steel manufacture, aluminium, copper and nickel production, phosphate ore processing, phosphate fertiliser production and use, glass, brick and ceramic manufacturing, glue and adhesive manufacturing, the use of pesticides that contain fluoride and controlled fluoridation of drinking water supplies. Phosphate ore production and use along with aluminium manufacture are thought to be the major industrial sources of fluoride released into the environment (World Health Organisation.  2002)

Fluoride is combined with other substances depending on the intended use:

Hydrogen fluoride is an important compound used in the production of synthetic cryolite, aluminium fluoride, motor gasoline alkylates, chlorofluorocarbons, for etching semiconductor devices, cleaning and etching glass, cleaning brick and aluminium, tanning leather, and in commercial rust removers.  It has an annual world consumption in excess of 1 million tonnes.

Calcium fluoride is used as flux in steel, glass and enamel production, as the raw material for hydrofluoric acid and anhydrous hydrogen fluoride production, and as an electrolyte in aluminium production.

Sodium fluoride uses include the controlled fluoridation of drinking water, glue preservative, glass and enamel production, flux in steel and aluminium production, in insecticides and wood preservatives.

Sulphur hexafluoride is used extensively in various electronic components and to produce magnesium and aluminium.

Fluorosilicic acid and sodium hexafluorosilicate are used for the fluoridation of drinking-water supplies (World Health Organisation.  2002).

What happens to fluoride once it is in the environment?

Fluorides in the atmosphere can be found as gases or particulates. While most forms of fluoride do not remain airborne for long, some such as sulphur hexafluoride have an atmospheric residence time from 500 to several thousands of years (World Health Organisation.  2002). Some forms of fluoride will be absorbed by rain and into clouds and fog where they will form hydrofluoric acid and fall to the ground.  Fluoride released by volcanic activity and industry are carried by wind and rain to nearby water, soil and food sources where it will form strong associations with sediment and soil.  The transport and transformation of fluoride in water is influenced by pH, water hardness and the presence of ion-exchange materials such as clays. Fluoride is usually transported through the water cycle complexed with aluminium. In soils the transport and transformation of fluoride are influenced by pH and the formation of predominantly aluminium and calcium complexes. Fluoride is not readily leached from soils (World Health Organisation.  2002).

The uptake of fluoride by biota is determined by the route of exposure, the bioavailability of the fluoride and the uptake/excretion kinetics in the organism.  Soluble fluorides bioaccumulate in some aquatic and terrestrial biota, but little information is to hand concerning the biomagnification of fluoride in aquatic or terrestrial food-chains.  Terrestrial plants may accumulate fluorides following airborne deposition and uptake from soil (World Health Organisation.  2002).  Fluorides will accumulate in plants and animals.  In animals it will accumulate in the bones or shell instead of the soft tissue (US.  Agency for Toxic Substances and Disease Registry.  2003).

How can I be exposed to fluoride?

The general population can be exposed to fluoride in soil, the air they breathe, food they eat, water they drink, medications they take and by absorption across the skin.  Dental products have also been identified as significant sources of fluoride and recently the Canadian Government called for a reduction in the concentration of fluoride used in these products.   Those who live in areas with fluoridated water, or that are high in naturally occurring fluoride may be exposed to higher levels of fluoride.  This also applies to those who work or live near industrial areas where fluoride containing substances are used (US.  Agency for Toxic Substances and Disease Registry.  2003).  Fluoride exposure can also occur in the workplace.

The total daily intake from all sources varies considerably but is estimated to range between 0.46 mg to 5.4 mg with approximately 10% coming from unfluoridated drinking water (National Health & Medical Research Council.  1966).

Indoor air sources of fluoride

There is little data about fluoride in indoor air but some data from the Netherlands suggested that gaseous fluoride was higher inside five homes constructed in wood treated with a preservative that contained 56% fluoride (,2 – 49 ?g/m³).  In China, indoor air concentrations of fluoride were measured at 155?g/m³ in homes where coal containing high amounts of fluoride was burned (World Health Organisation.  2002).

Fluoride in food

Most foodstuffs contain at least trace amounts of fluoride.  Some foods such as dried tea leaves contain high levels (up to 287 mg/kg) because of the natural concentration in the plant.  Other foods contain levels ranging from 0.01 to 1.3 mg/kg (see tables at the end of this article).  Levels in food will depend on the concentration of fluoride in the irrigating water and surrounding environment and the uptake of the specific crop.    Some foods contain elevated concentrations of fluoride which can be influenced by the addition of superphosphate fertiliser that contains fluoride impurities to soil during growing, or irrigation water containing fluoride and the uptake of the specific crop.  The concentration of fluoride in foods grown in the vicinity of industrial emissions of fluoride can be greater than those grown in non-industrially exposed areas while the concentration of fluoride in food can be significantly increased by the use of fluoridated water during preparation or processing.   Fluoride is also found in breast milk at reported concentrations from <2 to 100?g/litre.

Although adults may have a higher absolute daily intake of fluoride in milligrams, the daily intake of fluoride by children on a milligram per kilogram body weight basis may exceed that of adults.  Infants can accumulate fluoride from breast milk, while infant feeds appear be a high source of fluoride exposure.  The ingestion of dentifrice (dental products) by young children makes a significant contribution to their total intake of fluoride. Studies indicate that children between 2 and 5 years of age may ingest between 0.11 and 0.39 g of dentifrice per brushing (World Health Organisation.  2002).

Dental products

Toothpaste may contain up to 5 mg fluoride per teaspoon.

Water

Unfluoridated - surface water sources naturally contain between <0.1 to 0.5 mg/L, fluoride rich rock formation areas from 1 to 10 mg/L.

Fluoridated – Target concentrations are generally between 0.7 to 1 mg/L, lower concentrations should be applied where there is a hot climate and higher consumption of water.

Fluoride levels in water of >1.5mg/L can cause skeletal fluorosis (National Health & Medical Research Council.  1966).

What happens to fluoride in the body?

Fluoride is not metabolised by the body but diffuses passively throughout the body compartments.  Fluoride binds readily to magnesium and calcium in the blood, tissues, teeth and bone (the largest storage site).  Fluoride has an affinity for mineralising tissues of the body, in young people this is the teeth and bones, while in older people the bones.  Forty percent of fluoride is excreted in the urine within 9 hours and over 50 percent excreted in 24 hours.  People with kidney impairment have a lower margin of safety for fluoride uptake, with up to 3 times the retention of fluoride in the body.

Consequences of over-exposure

Minor overexposure in children under 10 years can cause tooth mottling.  High chronic exposure (>20 mg/day) for greater than 10 years can cause skeletal fluorosis (brittle bones) ligament calcification (stiff joints and muscles) and increased bone density. Other symptoms attributed to over exposure are gastrointestinal distress, muscle weakness, hypocalcaemia (low calcium levels) and hyperkalemia (excess potassium).  National Health & Medical Research Council.  1996)

How can fluoride affect my health?

An acute dose of 5 mg fluoride/kg body weight has been considered to be the minimum that might lead to adverse health effects with the toxicity of fluoride dependent upon the type or species of the compound ingested.  The more soluble forms of fluoride have greater toxicity than the weakly soluble or insoluble forms (World Health Organisation.  2002).

While small levels of fluoride are thought to prevent tooth cavities, high concentrations can be harmful to human health. In adults, higher concentrations of fluoride can result in denser bones, or if the exposure is high enough, the bones and teeth can become brittle and may break.  Fluorides are very irritating to the skin, eyes and respiratory tract, while high levels such as those found in occupational exposures can damage the heart.  Some animal studies show that at very high concentrations fluoride can cause decreased fertility, sperm and testes damage (US.  Agency for Toxic Substances and Disease Registry.  2003).

Exposure to high concentrations of fluoride may cause nausea, vomiting, abdominal pain, diarrhoea, fatigue, drowsiness, coma, convulsions, cardiac arrest and death.  Dermal contact with hydrofluoric acid has been known to cause severe tissue damage, respiratory effects, cardiac arrest and deaths.  The lethal dose of sodium fluoride to the average adult has been estimated to be between 5 and 10 g (32–64 mg fluoride/kg) body weight (World health Organisation. 2002).

Studies of workers exposed to fluoride in the occupational environment include; increased incidence and death from lung and bladder cancer with increased death rates from cancers in other parts of the body.  However, no consistent pattern has been observed.  Some impacts of fluoride toxicity on mammals (domestic animals) include emaciation, stiffness of joints and abnormal teeth and bones. Other effects include lowered milk production and detrimental effects on the reproductive capacity of animals (World Health Organisation.  2002).

Since the 1960s, fluoride has been used for the treatment of age-dependent osteoporosis at high dose levels (approximately 20–30 mg fluoride/day). Although such treatment may be protective against fractures it is controversial. The most encountered side-effects of fluoride therapy include gastrointestinal pains and painful stress microfractures of the feet.  Exposure to fluoride during treatment for osteoporosis may lead to calcium deficiency owing to the stimulation of bone growth, even in cases where patients are given supplemental calcium as part of the therapeutic protocol (World Health Organisation.  2002).

How can fluoride affect child health

While fluoride use is thought to be safe and effective at preventing tooth cavities in children, ingesting excessive amounts of fluoride while teeth are being formed (around eight years old) can result in fluorosis or mottling of the teeth.  This can result in brittle teeth that break easily (US.  Agency for Toxic Substances and Disease Registry.  2003).  The whole of lifetime exposure to fluoride can result in insidious disease that impacts on joints and bones.  While evidence for this is inconclusive, it is not something that is routinely investigated or diagnosed by medical practitioners i.e. nobody is looking.

How can fluoride exposure be reduced in the home environment?

High levels of fluoride can result from swallowing fluoridated toothpaste, gels or mouth rinses.  Children should be taught not to swallow dental products.  Those who live in areas that are naturally high in fluoride should drink bottled water or use water from alternative sources (US.  Agency for Toxic Substances and Disease Registry.  2003).

Is there a medical test to measure fluoride exposure?

There is a medical test to measure fluoride exposure in urine.   A urine test can show if higher than normal exposures to fluoride have occurred.  However, this must be performed soon after exposure because fluoride that is not stored in bone leaves the body within a few days.  Such a test is done at laboratories that test for chemical exposure.  The urine test cannot predict the nature or severity of any toxic effects.  Bone sampling can be done in special cases.  This is done to measure long term exposure to fluoride in special cases (US.  Agency for Toxic Substances and Disease Registry.  2003).

Testing is available in Queensland for blood/fluoride concentrations (Queensland Health) or from independent laboratories who are more likely to do a blood serum/fluoride test. Normal serum (blood) fluoride concentration is <20 ng/ml but varies considerably with diet, water and environmental sources.  Some individuals already have high blood fluoride levels and should not be further exposed as they are approaching the upper limit of the test.  One has high aluminium levels as well as high fluoride.

Is fluoride safe?

While low levels of fluoride are reported to help prevent dental cavities, according to the International Academy of Oral Medicine and Toxicology (IAOMT) Policy Position in 2003, the fluoride debate has been ‘complicated by lack of discernment concerning the differences between effects caused by systemic exposures and topical applications. Scientific discussions have been further complicated by providing undue weight to claims of effectiveness that have resulted in the abandonment of margins of safety that are essential to any toxicological profile and establishment of public policy.’ In their ongoing examination of the toxicology data on fluoride over the last 24 years, IAOMT’s preliminary determinations conclude that ‘fluoride added to the public water supply or given as prescribed controlled-dose supplements, delivers no discernable health benefit, and causes a higher incidence of adverse health effects’. They further claim that their 2003 policy position confirms their earlier assessments that there is no discernable health benefit from ingested fluoride and the preponderance of evidence shows that ingested fluoride at dosages now prevalent in public exposures aggravates existing illnesses and causes a greater incidence of adverse health effects.  IAOMT go on to state ‘Ingested fluoride is hereby recognised as unsafe, and ineffective for the purposes of reducing tooth decay.’ Most fluoride studies IAOMT examined did not comply with scientific standards for broad based or random selection, blinded examinations, and appropriate controls. In July 2000, the cover of the Journal of the American Dental Association confirmed that the mechanism by which fluoride may impact on the reduction of dental caries is by topical application – not by ingestion.  This supports the contention that the studies that claimed large scale reduction in tooth decay are results obtained by study design bias.

Some current experiences?

Some individuals have reported that they are no longer able to drink the water, bathe in it, or use if for cooking purposes.  They are experiencing constant nausea, stomach pain (especially after eating), joint pain, severe fatigue, skin rashes and high blood pressure spikes.  While some individuals are experiencing either diarrhoea or constipation, some have no happy medium between the two.  If you are experiencing such problems please see your doctor as you may have a waterborne disease, sensitivity to fluoride, or high existing levels of fluoride and should not be further exposed as your body concentrations may be bordering on dangerous.  Unfortunately, the gut problems do not seem to resolve when the fluoridated water is replaced with water from other sources and we are left wondering if there is another toxic agent at work or a bug in the water that is hard to identify.  This may be due to a spill of recycled sewage into our drinking water.  Some have recently been reported.  By the way, when you consult your GP, do not be surprised if they know nothing about fluoride induced disease – several individuals have experienced that.

Important questions that need to be asked

Prior to the introduction of fluoride in our drinking water, did the Queensland Government:

• Survey the existing concentrations of fluoride in a cross section of the Queensland population? This is essential because if the levels are high or bordering on a lethal dose such individuals should not be further exposed to fluoride.

• Survey fluoride concentrations in food and medications to establish the level of exposure from these sources?

• Survey concentrations of fluoride already existing in our dams and other sources of drinking water?

• Survey the existing concentrations of fluoride from air and any other sources?

• Do any studies of their own to ensure the health and safety of ALL Queenslanders was not compromised?

If not, how did the government arrive at an appropriate concentration of fluoride for Queensland drinking water and how can they tell us it is safe?

The questions we then need answered are:

• Will the Queensland Government acknowledge that there are individuals in the population who should not be exposed to fluoride?

• Will the Queensland Government compensate individuals on low incomes for the added impost of having to purchase drinking water that does not contain fluoride – especially those on pensions and disability support.

• Will the Queensland Government provide whole of house water filtration systems as a medical aid for those suffering as a result of the addition of fluoride in the water supply that such people never consented to?

• Why was the case against fluoride never put to the general public to allow them to make an informed choice?

• Most importantly – what happened to our democratic right to a referendum so that we could have a say in whether or not we wanted another layer of poison inflicted upon us?

Basic human rights are not being observed.

What can I do to avoid fluoride

If your fluoride and aluminium levels are high or already bordering on toxic, avoidance is essential

1. Do not drink fluoridated water or voluntarily consume foods that are high in fluoride.

2. Watch infant foods as they tend to be higher in fluoride than adult food – especially if mixed with fluoridated water.

3. Purchase bottled water for drinking and cooking.  Ensure that this water is low in fluoride or fluoride free.

4. Investigate whole of house water filtration so that you are not exposed to fluoride via skin absorption and do not have to carry bottled water.

5. Do not allow your children to swallow toothpaste or mouthwash containing fluoride

6. Check your medications to ensure that they do not contain fluoride or aluminium

7. Watch for and avoid fluorinated products.  Fluorine accumulates in humans, the environment and the food chain. There is no known method of breaking down fluorine in the environment.

8. Sources of fluorine are Teflon coated cookware, non-stick baking papers, grease resistant fast food containers, permanent press and stain resistant finishes on clothing.

Fluoride in foodstuffs

Food	Variety	Fluoride concentration mcg/100g
Cheese	Cheddar	35
	Cottage	32
Cream	regular	3
	Powdered cream substitute	112
	Butter	3
	Buttermilk	4
Milk	regular	3
	evaporated	8
	Chocolate flavoured	84
Beverages	Tea, Black – microwaved	322
	Tea, green	125
	Tea, herbal - camomile	13
	Tea, herbal - peppermint	9
	Coffee	91
	Coffee substitute – prepared with water	125
	Coffee decaffeinated	52
	Gatorade	34
	Powerade	62
Yoghurt	Low-fat plain	12
Egg	Cooked	5
	Raw	1
Baked goods and cereals	Bread White	49
	Bread Rye	51
	Crackers	24
	Doughnuts	26
	Cornflakes	17
	Farina, cooked	51
	Oatmeal, cooked	72
	Wheat, ready to eat	27
	Spaghetti, cooked	7
	Egg noodles, cooked	6
	Rice, cooked	41
Meats and meat dishes	Beef	22
	Lamb chop, fried	32
	Bacon, cooked	34
	Ham, cured	20
	Pork roasted	42
	Chicken, fried or roasted	15
	Turkey, roast	21
	Beef casserole	57
	Fried chicken & veg	48
	Meatloaf	30
	Spaghetti & meat sauce	38
Fish	Fish fillets cooked, fried	18
	Tuna in water	19
	Tuna in oil	31
Carbonated drinks	Coca Cola	49
	Diet Coke	60
	Ginger Ale	69
	Sprite	48
	Tonic Water	83
Fruit juice drink	Orange	55
	Cranberry and apple	83
Fruit	Apple, skin on	3
	Avocado	7
	Banana	2
	Rockmelon	1
	Grapefruit	1
	Grapes	8
	Peaches, canned	7
	Pears, canned	8
	Pineapple, canned	4
Vegetables		84
	Asparagus, cooked	22
	Beans, green	19
	Broccoli, boiled	4
	Cabbage, boiled	1
	Carrots, boiled	47
	Cauliflower	1
	Corn, canned	15
	Cucumber	1
	Lettuce	5
	Peas, green	29
	Potato, boiled	29
	Potato, fried	26
	Potato, mashed	39
	Sweet potato	14
	Tomato, raw	2
	Tomato sauce	35
Fast foods	French fries McDonalds	115
	Hamburger on roll	28

US Department of Agriculture. 2004.  USDA National Fluoride Database

Concentrations of fluoride in infant foods

Food	Variety	Fluoride concentration (?g/litre)
Milk	Human	5-10
	Cow’s	30-60
Formula	Ready to feed	100-300
Concentrated liquid	Milk-based	100–300
	Isolated soybean-based	100-400
Powdered	Milk-based	400–1000
	Isolated soybean-based	1000–1600
	Most products other than dry cereals	100–300
Fruit juices	Produced with non-fluoridated water	10–200
	Produced with fluoridated water	100–1700
Dry cereals	Produced with non-fluoridated water	90–200
	Produced with fluoridated water	4000–6000
	Wet-pack cereal fruit products	2000–3000
	Poultry-containing products	100–5000

Table adapted from World Health Organisation.  2002.  Environmental Health Criteria Monograph 227

Refs

International Academy of Oral Medicine and Toxicology.  2003.  Policy Position on Ingested Fluoride and Fluoridation.

National Health & Medical Research Council.  1996.  Australian Drinking Water Guidelines

US.  Agency for Toxic Substances and Disease Registry.  2003.  ToxFAQs.  Fluoride, hydrogen fluoride and fluorine.  CAS # 7681-49-4, 7664-39-3, 7782-41-4. http://www.atsdr.cdc.gov/toxfaq.html

US Department of Agriculture.  2004.  USDA National Fluoride Database of selected beverages and foods.

World Health Organisation.  2002.  Environmental Health Criteria Monograph 227.  Fluorides.

Written By: Dorothy M Bowes* 2009

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