Posted by mattdds on September 28, 2003, at 14:44:27
In reply to Re: Fluoride ....matt and jan » mattdds, posted by Larry Hoover on September 28, 2003, at 9:10:47
Hey Lar,
>>You've been MIA for a while. Howzit goin'?
Been practicing for the clinical part of the Northeast Regional Boards (NERB) for licensure. Blah! I took them last Saturday (crossing fingers).
More fluoro-babble, ;).
>>Case studies and anecdote, but lots of the latter. If you went into the "thyroid community", you would see many such reports.
You conceded that there was no epidemiology to support increased endocrine problems with fluoridation. And Larry, you're a scientist! As such, you should be aware that anecdotal evidence and self-reports from the "thyroid community" are not enough!
I'm not saying we should ignore anecdotes, and it *should* be investigated. You say the decision not to study it on an epidemiologic scale may have been political. This may well be the case, but, nevertheless, the evidence is still not there.
Absence of evidence is not evidence of absense, true. But there is no absence of evidence of evidence for the anticariogenic effect of fluoride. For all we know, there may be many harmful substances that we regularly ingest, but are unaware of. But until we get evidence that they are doing real harm, we make decisions to use them based on the benefits.
I really feel that after nearly 60 years of fluoridation, if there were any significant toxic reactions, we would probably know about them by now.
>>First of all, you are right about one thing. the evidence is not *always* pro-fluoride
Another thing about this. Early studies with fluoridation were unequivocal. Mind you, these were in the 30's and 40's, long before dentists were teaching you to brush and floss. These were the days of "G.V. Black dentistry". Drill, fill and bill. Dental hygienists were "dental nurses". So the declines in caries back then were certainly not from changes in oral hygiene, as you seemed to imply that they are now. In these early studies there was a large, obvious anticariogenic effect in big populations, such as Grand Rapids Michigan. BTW, you mentioned methodological problems with this body of evidence. What are they?
More recent studies have had more variability. Is this because fluoride no longer works? Or never did? Possible, but not likely. Anti-fluoridationist types have used this observation to argue that communities without fluoridated water have had similar declines fluoridated communities.
There is a logical explanation for this. Nowadays, even in non-fluoridated communities, people are getting a heck of a lot more fluoride than they think! Beverages (colas, juices, beer, etc.) and foods are usually bottled and processed in fluoridated areas and shipped out. This has been called the "dilution effect".
So even the "non-fluoridated" communities that are experiencing declines in caries are in reality very much "fluoridated" in a sense.
As for the Null article. I read it, but it would take days to point out the flaws in his arguments.
BTW, have you visited his website? I hope you are not under the impression that this guy is without some serious biases. I mean, this guy's site is sponsored by none other than The Vitamin Shoppe! The supplement industry, and those with whom they are in "cahoots" (e.g. Null) rely on vague psueudoscientific "syndromes", usually which include every symptom imaginable, to make mega-bucks off their products that purport to cure such diseases! I would not be in the least surprised if there exist supplements that claim to help alleviate "fluoride-induced thyroid toxicity syndrome".
I got really tired of him repeating that NaF was used as rat poison. While this is true, he totally ignored the dose. Lithium is extremely toxic at high enough doses, but few would argue that it should not be used because it is toxic at high doses. And I realize fluoride is not at all "necessary" for survival. But neither is Klonopin. But I can't imagine living without that beloved drug.
Also, I don't really care that fluoride was discovered by serendipity and perhaps with some influence from Alcoa and the aluminum industry. Who cares? The fact is that it works to prevent tooth decay. His biased history merely serves to detract from this very simple fact. Classic "red herring" arguments abound in his paper.
I hate to use ad hominem arguments, but this is a guy with a long history of making extremely wild claims. His "Ph.D" is from a "nontraditional", unaccredited school without a campus. He also marketed a number of supplements through MLM, all of which were ordinary vitamins and minerals with spectacular sounding names. I remember him promoting bee pollen, when that was the supplement du jour.
Not that those have anything to do with his arguments. But his arguments are poor to begin with, IMVHO.
>>Scientific arrogance? Mere ignorance?
Why are North American researchers so much more ignorant and arrogant than Russian and Chinese ones? I'm confused here. Sure, science in North America isn't perfect, but what makes you think that Russia and China are so much more knowledgable and humble?
>>but the existence of a benefit does not affect any assessment of detriment
But why start out with the assumption of a detriment? Again, we agreed that there have been no epidemiologic studies to show any increase of any disease at 1 ppm.
>>I did a major paper for the WWF on TEGDMA and bis-GMA resins, and the like. It has a dental section. If I can find it, I'd be happy to email it to you. In situ polymerization is not benign, but it can be optimized.
I'd be very interested. mkphi@msn.com.
>How about fluoride only for the carious?
Caries prevalence is extremely high! Also, define carious? What is an acceptable DMFS or DMFT at which we decide to intervene. Plus, by the time we find out who is "carious", whatever that means, it's already too late!
>>I'm not looking to demonize dentistry. I'm pro informed consent.
Huh? Though fluoridation is beneficial to the dental health of people of all ages, children are the main target. Children of the age when systemic fluoride is most useful are not capable of making those decisions for themselves. And, as adults, when we have strong evidence that we can intervene preventatively, it becomes an issue of neglect if we do not.
>>There are other measures with substantial benefit. I'm not sure that fluoride should be a cornerstone intervention.
Of course there are, but this assumes strict adherence, which in the real world can be a problem. Toothbrushing, even without fluoride is beneficial, although not quite to the extent that it is with fluoridated toothpaste. Flossing prevents interproximal smooth-surface decay quite well, but how many people floss regularly? Pit and fissure sealants are remarkably effective, but it appears you have your beef with TEGDMA and bis-GMA as well.
>Consider the trivialization of sexual dysfunction as a side-effect of SSRI meds. Surely, the success of Viagra points out the non-trivial nature of sexual potency.
This is a poor analogy, in my VHO. Fluoride has no noticible side effects, assuming you are not at ridiculously high "rat poison" doses, which are not advocated in the first place. You won't see anybody getting anorgasmia, akathisia, or tardive dyskinesia from drinking tap water.
I really am not even convinced of the thyroid toxicity, especially at at or around 1 ppm. But perhaps that's just my North American ignorance or arrogance ;). Of course there will always be those who will believe that it *was* the tap water that is the source of their problems. And of course, there is no way to directly disprove that.
Please answer these questions. In your opinion.
1. When a patient has a cavity, what dental restorative material (or treatment) do you deem safe (or least harmful in terms of overall health - including dental health).
2. Should we remove all fluoride from the water? Or just stop supplementing it.
3. What is your take on pit and fissure sealants?
4. What about topical fluoride? Is this reasonable, in your opinion?
5. What about endodontic (root canal) therapy and gutta percha? (I notice that anti-amalgam and fluoride types also tend to be anti-gutta percha).Do you have any better ideas than are currently out there? (No sarcasm at all intended, seriously).
Thanks for making me think Larry. You're good! Funny thing is, I bet both of our opinions have been solidified. That's how debate usually works! But it's fun. I enjoy debating with people who can still maintain a sense of humor despite the disagreement.
Take care,
Matt
poster:mattdds
thread:263511
URL: http://www.dr-bob.org/babble/20030928/msgs/263973.html