![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by bobabuoy on September 26, 2003, at 12:54:40
Has anyone ever heard of concrete evidence linking fluoride to depression? I've heard rumors of fluoride interacting with serotonin.
I currently take Prozac 80mg and luvox 100mg for OCD/Depression. I used a higher concentration fluoride toothpaste at night prescribed by the dentist and the next day was one of the worst days I've ever had. I was so depressed and had absolutely no motivation/energy.
Posted by linkadge on September 26, 2003, at 13:45:55
In reply to Fluoride, posted by bobabuoy on September 26, 2003, at 12:54:40
How much floride is in the water??
Linkadge
Posted by Wildflower on September 26, 2003, at 14:40:20
In reply to Fluoride, posted by bobabuoy on September 26, 2003, at 12:54:40
You may want to ask your pdoc.
As far as I've found, flouride contributes to Hypothyroidism. Hypothyroidism symptoms include: fatigue, depression, weight gain, muscle and joint pains and heart disease.
Also, I've found research that the majority of European countries do not add flouride to their water due to the health concerns.
Posted by mattdds on September 26, 2003, at 17:19:28
In reply to Fluoride, posted by bobabuoy on September 26, 2003, at 12:54:40
Hi,
I've never heard of any good evidence that fluoride, even in high concentrations, is associated with psychiatric symptoms. I'd be curious to see any such evidence, as I always try to keep an open mind.
All the claims I've seen connecting fluoride with (insert disease), have tended to be hyperbolic and not based on real hard evidence. You can find similarly spectacular claims about dental amalgam (silver fillings).
Of course, I suppose I could be (am likely?) biased, due to my training. I'm a 4th year dental student.
You probably used Prevident, which is 1.1% fluoride. Quite high. This stuff is amazing in terms of remineralizing small caries.
Assuming you are not swallowing the gel, and you are using it as directed, I doubt your low mood had anything to do with the toothpaste.
I would do an experiment. Continue to use the Prevident and see if the bad mood continues.
Of course, if you hold a belief that fluoride is causing your problems, this could become a self-fulfilling prophecy, and the experiment would backfire. So, in a sense, your *beliefs* regarding fluoride, rather than the fluoride itself, could be the problem.
I am betting that if you continue to use it, your moods will eventually go back to however they were before you started using Prevident.
Anyway, sorry you're having a tough time. Hope you feel better! If nothing else, we do know that fluoride is very good for your teeth!
Best,
Matt
Posted by tealady on September 26, 2003, at 18:12:38
In reply to Re: Fluoride » bobabuoy, posted by mattdds on September 26, 2003, at 17:19:28
> Hi,
>
> I've never heard of any good evidence that fluoride, even in high concentrations, is associated with psychiatric symptoms. I'd be curious to see any such evidence, as I always try to keep an open mind.
>
I guess these links don't really show direct evidence
http://bruha.com/pfpc/html/references__9.html
http://bruha.com/pfpc/html/g_q_11_.html
http://www.google.com/search?q=cache:m1EVuwBURjIC:www.espimetals.com/msds%27s/sodiumfluoride.pdf+fluoride+half+life&hl=enDepression is a hypothyroid symptom so that would be my guess on the way fluoride causes depression. Luckily it lifts on the removal of the fluoride source, at least for short term exposure. If it is being caused by this route, fatigue should probably be expected to accompany the depression.
> All the claims I've seen connecting fluoride with (insert disease), have tended to be hyperbolic and not based on real hard evidence. You can find similarly spectacular claims about dental amalgam (silver fillings).
>
isn't this similar to tobacco smoke?> Of course, I suppose I could be (am likely?) biased, due to my training. I'm a 4th year dental student.
lol
>
> You probably used Prevident, which is 1.1% fluoride. Quite high. This stuff is amazing in terms of remineralizing small caries.
>
> Assuming you are not swallowing the gel, and you are using it as directed, I doubt your low mood had anything to do with the toothpaste.
>
> I would do an experiment. Continue to use the Prevident and see if the bad mood continues.
>
> Of course, if you hold a belief that fluoride is causing your problems, this could become a self-fulfilling prophecy, and the experiment would backfire. So, in a sense, your *beliefs* regarding fluoride, rather than the fluoride itself, could be the problem.
>
I've always been uncomfortable with these arguments.> I am betting that if you continue to use it, your moods will eventually go back to however they were before you started using Prevident.
>
> Anyway, sorry you're having a tough time. Hope you feel better! If nothing else, we do know that fluoride is very good for your teeth!As always, in moderation. One of my kids has soft stained teeth, and spongy centred back teeth..perhaps from drinking too much water instead of soft drink?
We live at the end of a pipeline where levels tend to concentrate.
You just can't afford to use all bottled mineral water, and it also has its own problems.
The problem with fluoridating water is, the consumers really do not have any choice in being unable to remove it, without removing all beneficial minerals etc thru expensive, slow reverse osmosis.Fluoridating toothpaste..you have a choice. Although the non fluoride toothpastes have been removed from most big supermarkets lately.
Best, Jan
Posted by mattdds on September 26, 2003, at 21:43:58
In reply to Re: Fluoride » mattdds, posted by tealady on September 26, 2003, at 18:12:38
Hello,
>>I guess these links don't really show direct evidence
http://bruha.com/pfpc/html/references__9.html
http://bruha.com/pfpc/html/g_q_11_.html
http://www.google.com/search?q=cache:m1EVuwBURjIC:www.espimetals.com/msds%27s/sodiumfluoride.pdf+fluoride+half+life&hl=enThe articles you quoted have some pretty major flaws. Most of the articles quoted are extremely outdated, and made some absurd claims trying to link oral cancer, gingivitis, and periodontitis to fluoride.
I just did a search on pubmed for "fluoride and hypothyroidism" and some other similar searches. I did find some endocrine studies that used extremely large doses of fluoride on rats to try to suppress the thyroid. But this cannot in any way be translated to epidemiology. In other words, there has been no study that I am aware of that shows increased rates of hypothyroidism from fluoridation or topical fluorides in a dental care setting. Heck, if you drink distilled water in large enough amounts, it will kill you.
> All the claims I've seen connecting fluoride with (insert disease), have tended to be hyperbolic and not based on real hard evidence. You can find similarly spectacular claims about dental amalgam (silver fillings).
>
>isn't this similar to tobacco smoke?I have no idea what you mean by this. I think you would have a very difficult time comparing dental amalgam to smoking in terms of toxicity. There really is no comparison. But that's a totally different story.
> Of course, if you hold a belief that fluoride is causing your problems, this could become a self-fulfilling prophecy, and the experiment would backfire. So, in a sense, your *beliefs* regarding fluoride, rather than the fluoride itself, could be the problem.
>
>I've always been uncomfortable with these arguments.Notice I said beliefs about fluoride *could* influence mood. An example: what if you erroneously believed that you ingested a toxic substance? Wouldn't you react with panic, regardless of whether it was really toxic or not?
You're assuming, by default, that it was the fluoride that induced depression. How do you know this, and how can I reliably arrive at the same conclusion? Now I'm not saying it's impossible that fluoride was the culprit, I just don't see any evidence for it, so the burden of proof is with you (if that is what you're arguing).
I am just pointing out that there is a *possibility* (great likelihood in my opinion) that beliefs about fluoride will influence symptoms. Fluoride, at levels used clinically, is not associated with any disease. Otherwise, entire cities would have increased rates of certain diseases. Reality is that the only disease that changes is dental caries, and quite obviously for the better.
What makes you uncomfortable with the idea that beliefs can influence symptoms? It's a pretty widely accepted idea. I hope you will at least concede that this does sometimes occur.
>>As always, in moderation.
Right. 1 ppm in drinking water is the level determined to have the most benefits with fewest adverse effects. Prevident is not meant for long term use, and certainly not meant to be ingested. It is mainly used for incipient decay that can be reversed so you don't have to drill it out. So in that sense, you may be saving yourself from the dreaded amalgam (or bis-GMA resins - even worse according to some scaremongers) by using fluoride. You will also save a heck of a lot of tooth structure. Take your pick.
>>u just can't afford to use all bottled mineral water.
Nor would you want to. I see kids in my pediatric rotation come in whose mothers did not let them drink tap water and only had bottled. They tend to have mouths with rampant decay. The mother typically says the child brushes regularly, and eats a normal diet. It's really sad to see kids with mouths in that bad of shape, and in my opinion, it could be considered neglect. In fact, bottled water intake is considered a *risk factor* for dental decay on our patient charts. Then, I see kids come in, who never brush their teeth, but drink tap water, and have no cavities.
>and it also has its own problems.
The problem with fluoridating water is, the consumers really do not have any choice in being unable to remove it, without removing all beneficial minerals etc thru expensive, slow reverse osmosis.It really is a public health issue. Nobody is trying to poison you. Now, think about it. If dentists wanted to make money, wouldn't they be telling you about how bad fluoride is? Wouldn't all the dental industry be skewing the data against fluoridation so they could push more expensive restorative materials and treatments? Believe me, there is a lot of money at stake here, and if there were *any* reliable evidence that fluoride induced psych disorders, we dentists would be happy to revert back to the days of "drilling, filling and billing", if it were in the patient's best interest.
>>Fluoridating toothpaste..you have a choice. Although the non fluoride toothpastes have been removed from most big supermarkets lately
Topical fluoride in the form of toothpaste is *not* a substitute for *systemic* ingestion via water. It needs to be chronically given during tooth development so it incorporates fully into the tooth structure. Otherwise, with toothpaste, it doensn't penetrate past the outer layer. Also, kids usually "choose" not to brush their teeth anyway!
I don't mean to sound argumentative, but I'm afraid it's too late. :). I'm not out to poison anybody, and I don't make a dime off fluoride. I just think the burden of proof is pretty big if you are going to argue that fluoride causes psychiatric or endocrine disorders.
Best,
Matt
Posted by tealady on September 27, 2003, at 0:15:34
In reply to Re: Fluoride » tealady, posted by mattdds on September 26, 2003, at 21:43:58
> I have no idea what you mean by this. I think you would have a very difficult time comparing dental amalgam to smoking in terms of toxicity. There really is no comparison. But that's a totally different story.
I was only suggesting a slight similarity to the tobacco lobby story for many decades.. From memory only, I thought the arguments went like "There is no DIRECT proof, so tobacco smoking could not be the cause of any harm"
>
> > Of course, if you hold a belief that fluoride is causing your problems, this could become a self-fulfilling prophecy, and the experiment would backfire. So, in a sense, your *beliefs* regarding fluoride, rather than the fluoride itself, could be the problem.
> >Agree with above. If one did expect to be poisoned, one would probably feel depressed the next day. But I didn't get the impression this is what happened to bobabuoy.
> " used a higher concentration fluoride toothpaste at night prescribed by the dentist and the next day was one of the worst days I've ever had. I was so depressed and had absolutely no motivation/energy. "
I formed the impression(perhaps incorrectly) he did NOT expect to feel worse the next day when he used the toothpaste, but was looking for a cause for his unexpected depression and wondered if there could be a link.
> You're assuming, by default, that it was the fluoride that induced depression. How do you know this, and how can I reliably arrive at the same conclusion? Now I'm not saying it's impossible that fluoride was the culprit, I just don't see any evidence for it, so the burden of proof is with you (if that is what you're arguing).No, I wasn't. which is why I said, "Depression is a hypothyroid symptom so that would be my guess on the way fluoride causes depression. .... IF IT IS BEING CAUSED BY THIs ROUTE, fatigue should probably be expected to accompany the depression.
I only said this as I had previously read the lab rat /high levels of fluoride studies you mentioned. And I said, I would not expect if one was being made a bit hypo, that the ONLY problem would be depression, I would expect fatigue too at least!...so we kind agree here?
Looking back he does mention energy and motivation..both also symptoms of hypo..of course it does not prove anything.
> Reality is that the only disease that changes is dental caries, and quite obviously for the better.Yes there is an admittedly a decrease in dental caries, but a far more significant decrease is just occuring with time..perhaps from school clinics which have been introduced gradually in the past 30 years?
"Dental decay rates have been falling for three decades in both fluoridated and unfluoridated communities. "
http://www.fluoride-journal.com/98-31-4/314-232.htm
>
> What makes you uncomfortable with the idea that beliefs can influence symptoms? It's a pretty widely accepted idea. I hope you will at least concede that this does sometimes occur.Sure, I meant I was uncomfortable with the idea of dismissing symptoms saying they are caused by beliefs without investigating further...
>
> >>As always, in moderation.
>
> Right. 1 ppm in drinking water is the level determined to have the most benefits with fewest adverse effects.Well ours is stated as 0.9 - 1.5 mg/L. I do not know how this converts to ppm.
They emphasize the minimum levels are always met, and range is mostly met at test sites...so look high end of this range or bit abovePrevident is not meant for long term use, and certainly not meant to be ingested. It is mainly used for incipient decay that can be reversed so you don't have to drill it out. So in that sense, you may be saving yourself from the dreaded amalgam (or bis-GMA resins - even worse according to some scaremongers) by using fluoride. You will also save a heck of a lot of tooth structure. Take your pick.
I actually do agree with you on this use of fluoride.
>
> >>u just can't afford to use all bottled mineral water.
>
> Nor would you want to. I see kids in my pediatric rotation come in whose mothers did not let them drink tap water and only had bottled. They tend to have mouths with rampant decay. The mother typically says the child brushes regularly, and eats a normal diet. It's really sad to see kids with mouths in that bad of shape, and in my opinion, it could be considered neglect. In fact, bottled water intake is considered a *risk factor* for dental decay on our patient charts.That's interesting.
> Then, I see kids come in, who never brush their teeth, but drink tap water, and have no cavities.
>Are you sure you are not also making assumptions based on your own expectations here?
Amongst my family I have one brother and mother with lots of decay, and my father and another brother with absolutely NO decay, perfect hard teeth, never visited a dentist in their lives!...non fluoridated water, similar diets, dental hygiene etc...
> The problem with fluoridating water is, the consumers really do not have any choice in being unable to remove it, without removing all beneficial minerals etc thru expensive, slow reverse osmosis.
>
> It really is a public health issue. Nobody is trying to poison you. Now, think about it.If dentists wanted to make money, wouldn't they be telling you about how bad fluoride is?
Wouldn't all the dental industry be skewing the data against fluoridation so they could push more expensive restorative materials and treatments? Believe me, there is a lot of money at stake here, and if there were *any* reliable evidence that fluoride induced psych disorders, we dentists would be happy to revert back to the days of "drilling, filling and billing", if it were in the patient's best interest.I don't really believe dentists would think like this..or that it is part of the argument.
But if one was just merely arging in terms of cold logic, te argument would be ..
"dentists secretly know fluoride is bad and softens bones and teeth..so let's make up some story to get the water authorites to put fluoride into the water..that way we get more work! OOPs and lets ensure that these new composites also slowly release fluoride over years just to make sure,and let's put some patches on the kids back teeth with high levels of fluoride in them too hey!"...sorry, the argument works both ways
How did my daughter's teeth sound to you ..like too much fluoride, or something else and not typical of too much fluoride?
.. chalky-like teeth with yellow mottled and spongy centre of back teeth
I was interested in your opinion.
Since buying bottled water to partly replace, and cutting the fluoride toothpaste over a few years, enamel is whiter and more glassy looking
I'm not assuming anything, I just wondered. It could have been high temperatures during teeth development, viruses, estrogen kicking in now ..any no of things.> I don't mean to sound argumentative, but I'm afraid it's too late. :). I'm not out to poison anybody,
Matt, I never meant to imply you were. Sorry if you thought so.
Best, Jan
Posted by joebob on September 27, 2003, at 11:28:05
In reply to Re: Fluoride » mattdds, posted by tealady on September 26, 2003, at 18:12:38
go to your health food store
my wife and i had periodontal problems, bad, and upon switching to an auyervedic toothpaste, they dissappeared......anectodatal but true
Posted by joebob on September 27, 2003, at 11:34:28
In reply to Re: Fluoride » bobabuoy, posted by mattdds on September 26, 2003, at 17:19:28
i had a set of serious health challenges that i enventually traced to mercury poisoning from my fillings..........upon removing the fillings most disappeared, except the psych types
removing mercury from the brain is hard.....
the evidence for mercury causing psych problems is fairly convincing to me, but you will have to searh the european data to get much of it.....you certainly ain't gonna get it from the ADA
> Hi,
>
> I've never heard of any good evidence that fluoride, even in high concentrations, is associated with psychiatric symptoms. I'd be curious to see any such evidence, as I always try to keep an open mind.
>
> All the claims I've seen connecting fluoride with (insert disease), have tended to be hyperbolic and not based on real hard evidence. You can find similarly spectacular claims about dental amalgam (silver fillings).
>
> Of course, I suppose I could be (am likely?) biased, due to my training. I'm a 4th year dental student.
>
> You probably used Prevident, which is 1.1% fluoride. Quite high. This stuff is amazing in terms of remineralizing small caries.
>
> Assuming you are not swallowing the gel, and you are using it as directed, I doubt your low mood had anything to do with the toothpaste.
>
> I would do an experiment. Continue to use the Prevident and see if the bad mood continues.
>
> Of course, if you hold a belief that fluoride is causing your problems, this could become a self-fulfilling prophecy, and the experiment would backfire. So, in a sense, your *beliefs* regarding fluoride, rather than the fluoride itself, could be the problem.
>
> I am betting that if you continue to use it, your moods will eventually go back to however they were before you started using Prevident.
>
> Anyway, sorry you're having a tough time. Hope you feel better! If nothing else, we do know that fluoride is very good for your teeth!
>
> Best,
>
> Matt
Posted by Larry Hoover on September 27, 2003, at 12:39:39
In reply to Re: Fluoride » mattdds, posted by tealady on September 27, 2003, at 0:15:34
> > Reality is that the only disease that changes is dental caries, and quite obviously for the better.I wouldn't be too sure of that. Methinks you may have "dental student credulity disorder". <grin>
Here's one accessible article:
http://www.tldp.com/issue/157-8/157fluor.htm> Yes there is an admittedly a decrease in dental caries, but a far more significant decrease is just occuring with time..perhaps from school clinics which have been introduced gradually in the past 30 years?
And dental caries are in substantial decline in Europe, where fluoridation is virtually unknown.
> "Dental decay rates have been falling for three decades in both fluoridated and unfluoridated communities. "
> http://www.fluoride-journal.com/98-31-4/314-232.htm
> > Right. 1 ppm in drinking water is the level determined to have the most benefits with fewest adverse effects.
>
> Well ours is stated as 0.9 - 1.5 mg/L. I do not know how this converts to ppm.Same thing. Given that the mass of one litre of water is 1,000 grams (by definition), the ratio is convertible via: mg/1000 g, which is the same as 1g/1,000,000 g, or part per million by mass.
About fluoride and caries, the evidence isn't always pro-fluoride:
Quintessence Int. 2003 May;34(5):354-60.
Dental caries and fluorosis in low- and high-fluoride areas in Turkey.
Ermis RB, Koray F, Akdeniz BG.
Department of Restorative Dentistry and Endodontics, School of Dentistry, Suleyman Demirel University, Isparta, Turkey. banu_ermis@yahoo.com
OBJECTIVE: The aim of this study was to investigate the caries prevalence of children living in either low- or high-fluoride areas and to relate caries experience to the severity of dental fluorosis. METHOD AND MATERIALS: A total of 278 12- to 14-year-old schoolchildren, 149 in a low-fluoride area (LFA) and 129 in a high-fluoride area (HFA), were included in the study. The naturally occurring fluoride concentrations in the drinking water were 0.30 to 0.40 ppm in the LFA, 1.42 to 1.54 ppm in the HFA1, and 1.55 to 1.66 ppm in the HFA2. Dental caries was recorded with the World Health Organization criteria, and dental fluorosis was measured using the Tooth Surface Index of Fluorosis. RESULTS: The percentages of children who had an average TSIF > or = 1 were 0%, 29%, and 77% in the LFA, HFA1, and HFA2, respectively. The mean decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled permanent surfaces (DMFS) were 0.84 +/- 0.98 and 1.58 +/- 2.24 in LFA, 1.30 +/- 1.46 and 1.78 +/- 2.52 in HFA1, and 1.26 +/- 1.42 and 1.97 +/- 2.60 in HFA2, respectively. There was no significant difference in caries prevalence among children living in low- and high-fluoride areas when evaluated with an analysis of covariance model, including the frequency of toothbrushing. Toothbrushing frequency had a significant effect on the decayed teeth, decayed surfaces, DMFT, and DMFS. In high-fluoride areas, there was no relationship between caries prevalence and severity of fluorosis. CONCLUSION: Increasing water fluoride levels were associated with higher prevalence and severity of dental fluorosis and had no influence on caries experience in children with poor oral hygiene.
The article link, above, has some arguments presented which are due, at least, for consideration.The link between thyroid hypofunction and fluoride exposure is quite firm in humans, but most of the evidence has been presented in papers in Russian and Chinese. Rodents appear to be immune to fluorine/thyroid toxicity, but we're not rodents. Cows can't handle fluorine, just as a comparison.
What underlies the "1 ppm fluoride is safe" argument appears to be the idea that there is a toxic threshold, below which there is no adverse effect. That, however, is not true. The toxic effect is continuous, and variable in different populations exposed to the same dose. Looking at whole-population parameters will not reveal the effect on thyroid function in susceptible individuals, because it is a rather rare effect. But the incidence of thyroid toxicity at 1 ppm fluoride is not zero. As there are so many variables which affect thyroid function, finding unequivocal evidence is probably not possible. Dismissing the link altogether requires acceptance of the null hypothesis, and I'm not willing to do that.
Lar
Posted by mattdds on September 27, 2003, at 12:59:05
In reply to non flouridated toothpaste » tealady, posted by joebob on September 27, 2003, at 11:28:05
Hi there,
Periodontal disease is actually very well understood. It's also a pretty simple problem. One thing dental researchers are quite certain of is that *plaque* is by far the largest etiologic factor in around 95% of periodontal diseases.
It is caused by an immunologic response to plaque - which contains bacteria, that release endotoxins. The result is destruction of the periodontal ligaments and bone loss from chronic inflammation.
If you are arguing that periodontal disease is caused by fluoride, this is just not supported by any reliable evidence. Again, it is *very* clear that plaque is the culprit. Loeb's studies on Swedish dental students have pretty much proven this to be the case.
It's really very simple, remove the plaque and tartar, maintain oral hygiene and the inflammation and periodontal disease will be arrested. It's really a pretty simple disease with a very simple and reliable cure. If there is true bone loss and periodontal ligament destruction with pocketing - toothbrushing alone will not arrest it. A procedure called scaling and root planing (or periodontal surgery) that removes subgingival calculus and plaque is indicated.
The endotoxins from the bacteria in plaque cause periodontal disease and bone loss - not fluoride! This is one thing that is virtually undisputed in dentistry.
Thanks,
Matt
P.s. I've never heard of true periodontitis (with bone and attachment loss) resolving without scaling and root planing or periodontal surgery. If a toothpaste and mechanical removal (brushing)solved your problems, it is very unlikely you had periodontitis to begin with. Most likely you had gingivitis - much different as it doesn't involve bone loss and ligament destruction with resultant pocketing. Periodontitis is associated with deep pockets which cannot be accessed with a toothbrush.
Posted by Larry Hoover on September 27, 2003, at 13:20:59
In reply to Re: Fluoride ....matt and jan » tealady, posted by Larry Hoover on September 27, 2003, at 12:39:39
> I wouldn't be too sure of that. Methinks you may have "dental student credulity disorder". <grin>I just realized that my light-hearted comment, above, might be construed as a put-down, and I most certainly did not mean it that way. If I offended you, I am sorry. I felt that our "relationship" was solid, and that the comment was within the bounds of banter between friends.
Lar
Posted by mattdds on September 27, 2003, at 14:15:59
In reply to Re: Fluoride ....matt and jan » tealady, posted by Larry Hoover on September 27, 2003, at 12:39:39
Hey Larry,
Good to hear from you again!
>>Methinks you may have "dental student credulity disorder". <grin>
Hey, this is a real disorder you're making fun of! And yes, I suspect I do meet some of the DSM-IV criteria for it. Is there any cure short of dropping out of dental school? I gotta pay the loans back somehow.
First of all, you are right about one thing. the evidence is not *always* pro-fluoride. But then again, when is the evidence *always* pro-anything? I would say with a good degree of confidence that the vast majority of evidence shows a great deal of caries reduction (usually 50%) with appropriate levels of fluoride. If you search hard enough, you can find an article to support nearly any pet hypothesis.
As an anecdotal finding, all the older practitioners I talk to in the clinic say that the "golden age" of dentistry was before fluoridation. Now, due to lower levels of decay, you are starting to see dentists offer treatments like tooth whitening and veneers or other esthetic "treatments".
The abstract you pasted was investigating *fluorosis*, and how it related to DMFT and DMFS. It was not studying fluoridation at appropriate levels. It studied 3 areas. One with natuaral levels of fluoride, and two with approximately 50% above the recommended amount. No population with the recommended 1 ppm was included. So it's difficult to extrapolate from this. Also, the sample size was small, compared to say, an n of the size of Grand Rapids, Michigan.
>>The link between thyroid hypofunction and fluoride exposure is quite firm in humans, but most of the evidence has been presented in papers in Russian and Chinese
Possible. But why are North American researchers so unaware or unconvinced of this? I should be honest here and say that I've never investigated this. I'd be curious to know at what levels fluoride has been shown to induce hypothyroidism. Are they similar to what is used in fluoridated water? Are there any epidemiological studies showing increases in hypothyroidism that is clearly linded to fluoridation of public water? If you're dismissing large epidemiological studies, how do we know that certain individuals are susceptible, as you say? Case studies? Little cameras inside their thyroid that watches the fluoride do its harm?
>>What underlies the "1 ppm fluoride is safe" argument appears to be the idea that there is a toxic threshold, below which there is no adverse effect. That, however, is not true. The toxic effect is continuous, and variable in different populations exposed to the same dose
First of all, keep in mind *natural* water contains fluoride, sometimes up to 0.5 ppm or more.
Second. I have trouble with your argument that fluoride causes disease along a continuum. Couldn't you say the same thing of nearly any substance - including ones like selenium, vitamin A, and zinc? This is even more true with things like psych drugs. We are giving psychiatric drugs to a certain population. We are weighing the relative risk of adverse events to benefits and deciding that the benefits outweigh the risks. Same with fluoridation. It is a drug (although again, it is found in natural water at 50% of "fluoridated" water), but we've found a level where the benefits greatly outweigh the risks.
But if you can show me some convincing evidence that hypothyroidism is significantly on the rise from fluoridation, I would be happy to agree with you that public water should not be fluoridated. Perhaps, in that case, systemic fluoride supplements would be an alternative (to protect people susceptible to getting hypothyroidism from fluoride). On the other hand, supplements would place a huge economic burden on people (public fluoridation is dirt cheap compared to individual supplementation), and treatment adherence would be a problem.
>>Looking at whole-population parameters will not reveal the effect on thyroid function in susceptible individuals, because it is a rather rare effect
So it's rare? So how are we so certain it even exists at all? You say that the link is "firmly established" in Russian and Chinese literature, but I know of no such link. Again, if you have references, please! I'm not married to any of my ideas.
On the other hand, tooth decay certainly is not rare! And if you don't think tooth decay is a serious enough disease to warrant taking some calculated risks, consider that edentulism has been strongly associated with a decreased lifespan. This is not to mention the obvious decrease in quality of life - even with a good set of dentures. I would even argue that edentulism can precipitate depression - and this is *not* rare. I have already seen it firsthand many times in my very short clinical experience. Can you imagine living without teeth? Even the best dentures are, pretty obviously, dentures, and don't even come close to paralleling natural dentition in terms of function. What about living with severely painful or decayed teeth? I know it would affect me!
If the dental profession listened to all the anti-information, we would have *no* treatment options short of pulling teeth and fabricating dentures. Fluoride is bad. Dental amalgam is bad. Bis-GMA resins are worse. Cast metals are causing Lupus. Endodontic therapy causes NICO. If we do gold work (about the only totally inert material), it's not cost-effective enough.
So tell me what the ideal solution is, in your mind? We must take some (very well calculated, in my opinion) risks to make headway in *any* disease, and this includes dental disease.
I always appreciated a good exchange with you Larry, even if we seem to be of different minds much of the time (except for CBT, of course ;))
Best,
Matt
Posted by mattdds on September 27, 2003, at 14:21:45
In reply to Re: Fluoride ....matt, apology, posted by Larry Hoover on September 27, 2003, at 13:20:59
Larry,
Give me a friggin' break, man! I was laughing, and if you read my post, you'll know I wasn't offended in the least. I'd really have to twist that one to feel offended.
I do appreciate your concern though.
Anyhow, I'm looking for a good CBT therapist who specializes in this stubborn disorder, and haven't had much luck so far.
Take care,
Matt
Posted by mattdds on September 27, 2003, at 14:58:32
In reply to Re: Fluoride » mattdds, posted by tealady on September 27, 2003, at 0:15:34
Hello,
>>Agree with above. If one did expect to be poisoned, one would probably feel depressed the next day. But I didn't get the impression this is what happened to bobabuoy.
Good point. I jumped the gun on this one. On rereading boba's post, you're right, it didn't seem anticipated.
>>No, I wasn't. which is why I said, "Depression is a hypothyroid symptom so that would be my guess on the way fluoride causes depression. .... IF IT IS BEING CAUSED BY THIs ROUTE, fatigue should probably be expected to accompany the depression.
Again, I misinterpreted what you said. Sorry! You meant *if* the depression was being caused by fluoride toxicity, then you would expect hypothyroid symptoms. Gotcha.
Larry, who is also posting about this says there is some good evidence in Russian and Chinese studies linking hypothyroidism and fluoride. I was not aware of this, and am curious now. I have my doubts, but I'm nonetheless curious.
>>Yes there is an admittedly a decrease in dental caries, but a far more significant decrease is just occuring with time..perhaps from school clinics which have been introduced gradually in the past 30 years?
I've wondered this myself, if the decline is multifactorial. I do think that the bulk of the evidence shows that fluoride is doing a lot. But other factors (e.g. increased awareness, better hygiene, sealants) are contributing as well. I think the studies take these factors into consideration, though.
>Are you sure you are not also making assumptions based on your own expectations here?
I'm not sure at all! I'm painfully aware of my own biases, but I still have them nonetheless :). It's just that the conclusions I've reached parallel the experience. This is not very good evidence, but nonetheless interesting to me.
>>How did my daughter's teeth sound to you ..like too much fluoride, or something else and not typical of too much fluoride?
.. chalky-like teeth with yellow mottled and spongy centre of back teeth
I was interested in your opinion.If it is a focal area (just the back teeth, you said?), it is more likely enamel hypoplasia, which can be caused by any number of things that occur during that particular tooth's development (e.g. trauma, virus, fever). Did she take tetracycline when younger? This doesn't cause hypoplasia, but appears as an intrinsic stain.
Teeth with fluorosis appear opaque, white and with a pitted look. The upper front teeth (with fluorosis) appear brown. It's treated with enamel microabrasion, quite successfully.
>>Since buying bottled water to partly replace, and cutting the fluoride toothpaste over a few years, enamel is whiter and more glassy looking
I'm not assuming anything, I just wondered. It could have been high temperatures during teeth development, viruses, estrogen kicking in now ..any no of things.Hmm. I really doubt it's the lack of fluoride. Topical fluoride only penetrates the outer layer. Fluoride is known to close the microscopic pores in enamel and actually smooth the surface, when used topically.
I really have no explanation for your smoother enamel. But I'm glad it feels smooth to you, lol.
Best,
Matt
Posted by Larry Hoover on September 28, 2003, at 9:10:47
In reply to Re: Fluoride ....matt and jan » Larry Hoover, posted by mattdds on September 27, 2003, at 14:15:59
> Hey Larry,
>
> Good to hear from you again!You've been MIA for a while. Howzit goin'?
> >>Methinks you may have "dental student credulity disorder". <grin>
>
> Hey, this is a real disorder you're making fun of! And yes, I suspect I do meet some of the DSM-IV criteria for it. Is there any cure short of dropping out of dental school? I gotta pay the loans back somehow.Just wait till you get the bills for setting up a practise. You don't know debt yet.
BTW, the reason I apologized was that I recalled your response to my first use of the word quack. Humour does not carry well on the net.
> First of all, you are right about one thing. the evidence is not *always* pro-fluoride.
Sure, but unless you invoke the randomness argument (weak), it raises the question of how to better account for the data.
>
> As an anecdotal finding, all the older practitioners I talk to in the clinic say that the "golden age" of dentistry was before fluoridation. Now, due to lower levels of decay, you are starting to see dentists offer treatments like tooth whitening and veneers or other esthetic "treatments".When I first went to dentists, nobody was teaching me how to brush, and all that good stuff, either.
> The abstract you pasted was investigating *fluorosis*, and how it related to DMFT and DMFS.It had more than that in there. Maybe you're skimming again? <grin>
"The mean decayed, missing, and filled permanent teeth (DMFT) and decayed, missing, and filled permanent surfaces (DMFS) were 0.84 +/- 0.98 and 1.58 +/- 2.24 in LFA, 1.30 +/- 1.46 and 1.78 +/- 2.52 in HFA1, and 1.26 +/- 1.42 and 1.97 +/- 2.60 in HFA2, respectively. There was no significant difference in caries prevalence among children living in low- and high-fluoride areas when evaluated with an analysis of covariance model, including the frequency of toothbrushing. "
> It was not studying fluoridation at appropriate levels. It studied 3 areas. One with natuaral levels of fluoride, and two with approximately 50% above the recommended amount.But consistent with Jan's fluoridation levels. Really, do you know how hard it would be to put just 1 ppm into the water? As someone who has intimate knowledge of water treatment technology, I can assure you that target levels have significant error bars permitted, and that most often, excess fluoride is considered to be the side to which the errors are encouraged. I was trying to show that Jan's real-life experience had real-life evidence.
> No population with the recommended 1 ppm was included. So it's difficult to extrapolate from this.
Uhhh, that would be interpolate.
> Also, the sample size was small, compared to say, an n of the size of Grand Rapids, Michigan.
I'm familiar with that body of evidence, but I haven't read the methodology (a specialty of mine....conclusions really depend on methodology far more than they do on data itself).
> >>The link between thyroid hypofunction and fluoride exposure is quite firm in humans, but most of the evidence has been presented in papers in Russian and Chinese
>
> Possible. But why are North American researchers so unaware or unconvinced of this?Scientific arrogance? Mere ignorance?
> I should be honest here and say that I've never investigated this.
Ooooh, that's refreshing.
> I'd be curious to know at what levels fluoride has been shown to induce hypothyroidism. Are they similar to what is used in fluoridated water?
It's hard to tell, from most abstracts. I'd like to point out that the levels implicated in these two studies are well below the fluoride intake(orders of magnitude less, in fact), on a mg/kg basis, that declared fluoridation safe in rodent studies.
I have some translated articles in storage (I studied fluoride as an undergrad), but I found these on Pubmed. There are others which address the issues, but "no abstract available".
Probl Endokrinol (Mosk). 1985 Nov-Dec;31(6):25-9.
[Action of the body fluorine of healthy persons and thyroidopathy patients on the function of hypophyseal-thyroid the system]
[Article in Russian]
Bachinskii PP, Gutsalenko OA, Naryzhniuk ND, Sidora VD, Shliakhta AI.
Altogether 123 persons were examined: 47 healthy persons, 43 patients with thyroid hyperfunction and 33 with thyroid hypofunction. It was established that prolonged consumption of drinking water with a raised fluorine content (122 +/- 5 mumol/l with the normal value of 52 +/- 5 mumol/l) by healthy persons caused tension of function of the pituitary-thyroid system that was expressed in TSH elevated production, a decrease in the T3 concentration and more intense absorption of radioactive iodine by the thyroid as compared to healthy persons who consumed drinking water with the normal fluorine concentration. The results led to a conclusion that excess of fluorine in drinking water was a risk factor of more rapid development of thyroid pathology. Indicators of the fluorine content in daily urine provide most of the information on changes of the fluorine amount in the body.
Probl Endokrinol (Mosk). 1983 Jul-Aug;29(4):32-5.
[Indices of the pituitary-thyroid system in residents of cities with various fluorine concentrations in drinking water]
[Article in Russian]
Sidora VD, Shliakhta AI, Iugov VK, Kas'ianenko AS, Piatenko VG.
The thyroid 131I consumption, the hypophyseal thyrotropic hormone content and the blood serum total thyroxin and triiodothyronine concentrations were studied in equal groups of healthy humans and donors, living in two cities with an enhanced or decreased fluorine content in drinking water. Iodine deficiency and adaptive amplification of the hypophyseal-thyroid system, not ensuring an absolute compensation, were found in the citizens, using drinking water with an increased fluorine content, accompanied by an augmented incidence of functional disturbance, which structure remained relatively unchanged.
> Are there any epidemiological studies showing increases in hypothyroidism that is clearly linded to fluoridation of public water?
It has not been investigated, to my knowledge. That's a political decision, IMHO. Absence of evidence is not evidence of absence.
> If you're dismissing large epidemiological studies, how do we know that certain individuals are susceptible, as you say? Case studies?
Case studies and anecdote, but lots of the latter. If you went into the "thyroid community", you would see many such reports.
> Little cameras inside their thyroid that watches the fluoride do its harm?
Unnecessary hyperbole, IMHO.
> >>What underlies the "1 ppm fluoride is safe" argument appears to be the idea that there is a toxic threshold, below which there is no adverse effect. That, however, is not true. The toxic effect is continuous, and variable in different populations exposed to the same dose
>
> First of all, keep in mind *natural* water contains fluoride, sometimes up to 0.5 ppm or more.That has no relevance to the issue of toxicity. Natural waters can contain over 100 ppm. Skeletal and dental fluorosis are simply the easiest measures of toxicity to examine. The absence thereof, or assessment as "minor" on those index scales, serve only to focus the attention away from other biochemical indices.
> Second. I have trouble with your argument that fluoride causes disease along a continuum.I'm speaking as a toxicologist. Arsenic, lead, mercury, all are continuous variables. Individual differences determine the exact point on the continuum for a particular dose, but for each dose, there is a bell-curve distribution of toxic effects across the entire population. Fluoride is one of those toxicants.
> Couldn't you say the same thing of nearly any substance - including ones like selenium, vitamin A, and zinc?
No, because those are essential for health. In other words, there is a minimum in the adverse effects plot (which may well be zero) which corresponds with the maximum benefit plot. There is no zero on the fluoride adverse effects plot. There is a maximum on the beneficial effects plot, (arbitrarily set at 1 ppm in water, in this argument), but the existence of a benefit does not affect any assessment of detriment.
> This is even more true with things like psych drugs. We are giving psychiatric drugs to a certain population. We are weighing the relative risk of adverse events to benefits and deciding that the benefits outweigh the risks.
Touchy subject, dude. These forums are full of people who have weighed the risks and benefits in different ways than did e.g. the prescribing doctor or the pharmaceutical company. 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.
> Same with fluoridation. It is a drug (although again, it is found in natural water at 50% of "fluoridated" water), but we've found a level where the benefits greatly outweigh the risks.
As assessed by people who may be: 1. ignorant of evidence of adverse effect; 2. in a position of inherent conflict of interest; 3. unwilling to challenge the status quo; 4. unwilling to risk the political fallout; 5. unwilling to risk the civil liability attaching to acknowledgement that risk is attached to the practise in question.
> But if you can show me some convincing evidence that hypothyroidism is significantly on the rise from fluoridation, I would be happy to agree with you that public water should not be fluoridated.
The thyroid issue is not the only one to consider. Did you read the Gary Null article I linked, earlier? It's kind of an introduction to the issues. No point re-inventing the wheel. Null did a good job, and it's fully referenced.
> Perhaps, in that case, systemic fluoride supplements would be an alternative (to protect people susceptible to getting hypothyroidism from fluoride).
How about fluoride only for the carious?
> On the other hand, supplements would place a huge economic burden on people (public fluoridation is dirt cheap compared to individual supplementation), and treatment adherence would be a problem.
Only for the non-carious, IMHO. Trust me, the aluminum smelting industry has to find ways to dispose of the fluoride produced as a byproduct. Individual fluoride treatments would fall dramatically in price if the market for water treatments disappeared.
> >>Looking at whole-population parameters will not reveal the effect on thyroid function in susceptible individuals, because it is a rather rare effect
>
> So it's rare?Not so common as to be in percent terms, is what I meant. You just can't see the trees for the forest.
> So how are we so certain it even exists at all? You say that the link is "firmly established" in Russian and Chinese literature, but I know of no such link. Again, if you have references, please!
I posted a couple, above. Somewhere I have translations of other stuff, but I don't have ready access.
> I'm not married to any of my ideas.
I prefer women, myself.
> On the other hand, tooth decay certainly is not rare! And if you don't think tooth decay is a serious enough disease to warrant taking some calculated risks, consider that edentulism has been strongly associated with a decreased lifespan.
There are other measures with substantial benefit. I'm not sure that fluoride should be a cornerstone intervention.
> This is not to mention the obvious decrease in quality of life - even with a good set of dentures. I would even argue that edentulism can precipitate depression - and this is *not* rare. I have already seen it firsthand many times in my very short clinical experience. Can you imagine living without teeth? Even the best dentures are, pretty obviously, dentures, and don't even come close to paralleling natural dentition in terms of function. What about living with severely painful or decayed teeth? I know it would affect me!
As above.
> If the dental profession listened to all the anti-information, we would have *no* treatment options short of pulling teeth and fabricating dentures. Fluoride is bad. Dental amalgam is bad. Bis-GMA resins are worse. Cast metals are causing Lupus. Endodontic therapy causes NICO. If we do gold work (about the only totally inert material), it's not cost-effective enough.
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.
> So tell me what the ideal solution is, in your mind? We must take some (very well calculated, in my opinion) risks to make headway in *any* disease, and this includes dental disease.I'm not looking to demonize dentistry. I'm pro informed consent. Nobody consented to have fluoride added to water. People who think they know better than anybody else made that decision. And, if you read the Null article, you'll see just how much politics was involved.
> I always appreciated a good exchange with you Larry, even if we seem to be of different minds much of the time (except for CBT, of course ;))I enjoy it, too. You're a worthy opponent (in debate context).
> Best,
>
> MattYou too, bud.
Lar
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
Posted by Larry Hoover on September 28, 2003, at 19:08:03
In reply to Re: Fluoride ....matt and jan » Larry Hoover, posted by mattdds on September 28, 2003, at 14:44:27
> 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).Rather superstitious, but I'll cross my eyes for you, anyway.
> 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.Not epidemiology, no. There hasn't been any such study, despite the increase in hypothyroid in America. Levothyroxine (T4) is the fourth most common prescription drug, the incidence is rising, and exposure to fluoride is, as well. I can't say there's a link, without evidence. But no one has looked.
> 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 sure that you'll find the evidence in the links I provide, later. I did a better job, this time.
> 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.
I would say it is political, but then again, I'm biased against any suppression of evidence. See the EPA link, below, and the suppression of the evidence for carcinogenesis of fluoride.
> This may well be the case, but, nevertheless, the evidence is still not there.
It's commonly accepted that fluoride reduces thyroid function, and people with reduced thyroid function do better when they avoid fluoride. Evidence below.
> Absence of evidence is not evidence of absense, true. But there is no absence of evidence of evidence for the anticariogenic effect of fluoride.
Even that is being reconsidered, according to recent reports.
> For all we know, there may be many harmful substances that we regularly ingest, but are unaware of.
I have no doubt about that.
> But until we get evidence that they are doing real harm, we make decisions to use them based on the benefits.
See references, below.
> 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.
....unless the evidence was suppressed.
> >>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?I haven't reviewed the methodology myself, but I've see it suggested that the comparison of the two communities in Michigan was manipulated. I'll see if I can find the specifics, again.
> More recent studies have had more variability. Is this because fluoride no longer works? Or never did? Possible, but not likely.There could be unmeasured variables. It's all epidemiology, not case-control.
> Anti-fluoridationist types have used this observation to argue that communities without fluoridated water have had similar declines fluoridated communities.
They seem to have shown a similar decline.
> 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".
I can't help being pedantic, once in a while. That's the diffusion effect, also known as the halo effect.
> So even the "non-fluoridated" communities that are experiencing declines in caries are in reality very much "fluoridated" in a sense.
Emphasis on the "very much", apparently.
> As for the Null article. I read it, but it would take days to point out the flaws in his arguments.OK, I was being lazy. My bad.
Consider:
http://www.fluorideaction.org/hirzy-interview.htm
http://www.fluoridealert.org/nrc-paper.pdf
http://www.fluoridealert.org/hp-epa.htm
http://www.slweb.org/bibliography.htmlFrom the second link:
The following is a listing of adverse health effects that have been documented at water concentrations at, or below, the current EPA MCL of 4 ppm. (The list has been taken from Paul Connett's presentation to the NRC Committee.)0.3-0.7 ppm: 21.6% dental fluorosis on at least two teeth (Heller, 1997)
0.7-1.2 ppm: 29.9% dental fluorosis on at least two teeth (Heller, 1997)
0.9 ppm: further reduction of IQ for iodide deficient children. (LinFa-Fu 1991)
(~1.0 ppm): bone fractures in children associated with the severity of dental fluorosis (Alarcon-Herrera, 2001)
<1.0 ppm: accumulation in pineal gland (Luke, 2001)
1.0 ppm: earlier menstruation in girls (Schlesinger, 1956)
1.0 ppm: increased cortical bone defects (Schlesinger, 1956)
1.0 ppm: osteosarcoma in young males (SEER, 1991; Cohn, 1992 - mixed)
1.0 ppm: bone levels associated with arthritic symptoms (comparison of bone level data with bone levels that cause pre-clinical fluorosis)
1.0 ppm: reduced cortical bone density (Phipps, 2000)
1.0 ppm: increased hip fracture (mixed epidemiological findings)
1.0 ppm: increased uptake of aluminum into rat brain and beta amyloid deposits (Varner, 1998)
2.3-4.5 mg (equiv. to 1.0 ppm): reduced hyperthyroidism (Galletti & Joyet, 1958)
1.0 ppm: 48% dental fluorosis (McDonagh, 2000)
1.0 ppm: increased uptake of lead into children’s blood with silicofluorides in water fluoridation (Masters and Coplan, 1999, 2000)
1.2 ppm: longer reaction times, poorer visuospatial recognition in children (Calderon, 2000)
1.5 ppm: mineralization defects in human bone. (Alhava 1985)
1.6 ppm: increased rate of sister chromatid exchange in humans (Sheth, 1994;Joseph, 1995)
1.7 ppm: clinical skeletal fluorosis in people in US with kidney impairments (Juncos and Donadio, 1972)
1.8 ppm: lowering of IQ (regression line est) (Xiang, 2003)
2.3 ppm: impaired thyroid function (Bachinski, 1985)
3.0 ppm: reduced fertility (Freni, 1994)
3.0 ppm: human-equivalent water levels that produce skeletal fluorosis in rats with kidney impairment. (Turner 1996)
4.0 ppm: produces daily doses (11.6 mg/day from water alone) that exceed the doses estimated to cause clinical skeletal fluorosis (10-20 mg/day for 10-20 years) (EPA data online; NRC 1993).
4.0 ppm: produces bone concentrations (avg. 6,400 ppm) which exceed the bone concentrations (6,000+) that cause clinical skeletal fluorosis. (Gordon & Corbin 1992; Turner 1993)
4.0 ppm: produces bone concentrations (avg. 6,400 ppm) which exceed the bone concentrations (4,500 ppm) found to weaken animal bone (Turner 1993).
4.0 ppm: reduced bone density of cortical bone in humans (Phipps 1990; Sowers 1991).
4.0-4.3 ppm: increased bone fractures in humans (Li 2001; Sowers 1991)
BTW, even the 1 ppm water concentration concept is the result of a frank error. The original recommendation for fluoride supplementation was 1 mg fluoride added to one litre of water, i.e. a single dose of 1 mg per day.
> 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".Nice try, but no. The recommended therapy is reverse-osmosis water filtration, or distillation.
> 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.I don't know that there has ever been an identified process, essential for health, that requires fluoride.
> 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.Fine. Let's bury Null. Check the other URLs I gave.
> 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.OK. My bad.
> >>Scientific arrogance? Mere ignorance?
>
> Why are North American researchers so much more ignorant and arrogant than Russian and Chinese ones? I'm confused here.North American scientists routinely dismiss the work of Eastern European and Eastern scientists, particularly if it was done during the Cold War era. At least, they remain ignorant of the findings. At worst, they dismiss the data without due consideration. So, ignorant, or arrogant, depending on the rationale.
> Sure, science in North America isn't perfect, but what makes you think that Russia and China are so much more knowledgable and humble?
I didn't intend a comparison on humility or ego grounds, but simply that there is a whole body of evidence that is not taken into account. In my more recent foray into the 'net, I also found that there is a huge body of evidence of fluoride adversely affecting thyroid function, but it is in German. So, even German sources are ignored.
> >>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.That apparent oversight has been corrected, above. Osteosarcoma and bone density/defects, 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.Can that take huge emails? It's a big document (if I can find an computer-friendly copy).
> >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 was coining a word. What descriptor do you use to identify "somebody with caries"?
> >>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.All dependent on the risk-benefit analysis, which has up until now, scrupulously avoided assessing the true risk, IMHO.
> >>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.They are profound endocrine disrupters. Once polymerized, they may be safe, but there is evidence of slow depolymerization, as well.
I know, rock and a hard place. I'm not trying to suggest alternatives, as I am less knowledgeable than you, without doubt.
> >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.It shows that risk-benefit analysis varies in form from the perspective of the overseer and the subject. (Actually, I'm thinking perpetrator/victim.)
> 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.
Unless it contains all those pharmaceutical drugs that have recently been found to resist degradation in sewage treatment facilities.....
> 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 ;).North American DDS arrogance, perhaps?
> 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.
Only epedemiology. That's all we'll ever have, pro or con.
> Please answer these questions. In your opinion.I'll come back to these. My dinner is ready. My computer is quirky, so if I don't post this now, it may be gone when I come back.
Lar
Posted by Larry Hoover on September 29, 2003, at 8:04:51
In reply to Re: Fluoride ....matt and jan » Larry Hoover, posted by mattdds on September 28, 2003, at 14:44:27
> 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).As I recall, the best restoratives are those which cure with visible light. I cannot recall which base monomer system, though. I really have to find my earlier report..... Problem is, it may well be outdated, even though I think it was written seven years ago.
Definitely not amalgam. And occlusive surfaces do present a problem. I need to find that paper.
> 2. Should we remove all fluoride from the water? Or just stop supplementing it.
Stop supplementation, and reduce fluoride if natural levels are high. The latter would be a costly intervention.
> 3. What is your take on pit and fissure sealants?
No problem, if properly applied. Inter-operator variability is a big problem. Also, non-fluoride sealants. There is no proven benefit of fluoridated sealants.
> 4. What about topical fluoride? Is this reasonable, in your opinion?
With precautions, yes. It is not a systemic treatment. No problem, with precautions against ingestion.
> 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).
Gutta percha appears to be problematic due to two different factors: a) the solvent; b) cross-reactivity in those allergic to latex. Why not just use MTA for obturation, and avoid the issue altogether? Or a hyroxyapatite preparation?
> Do you have any better ideas than are currently out there? (No sarcasm at all intended, seriously).No, I wouldn't presume to make suggestions. I'm far better at criticizing other people's choices. <grin>
> Thanks for making me think Larry. You're good!Awww, ain't you sweet!
> Funny thing is, I bet both of our opinions have been solidified. That's how debate usually works!
Good debate, yes. I hate the kind that slides into ad hominem, or such.
Frankly, I found out enough stuff to convince me that I should avoid fluoride, and see if it affects my own health problems. Very hard to create a controlled manipulation, however, due to the halo/diffusion effect.
> But it's fun. I enjoy debating with people who can still maintain a sense of humor despite the disagreement.
It would be better if you admitted you were wrong, but what the hey. <wink>
> Take care,
>
> MattLater bud,
Lar
Posted by Larry Hoover on September 29, 2003, at 9:46:15
In reply to Re: Fluoride ....matt and jan » Larry Hoover, posted by mattdds on September 28, 2003, at 14:44:27
> >>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.I found a draft version. It's really quite a large file, and the references section is huge, too. Let me know if you can accept large attachments at that email address. It's in an older Wordperfect format.
After re-reading the section on dental sealants, I withdraw my support for their use, which I expressed in an earlier response to your questions. I had hard-copy of every paper I referenced, and I spent many, many hours in the library at school of dentistry at the U of Toronto. I may not understand dentistry the way you do, but I'm satisfied with the accuracy of the toxicology and chemistry I present.
Lar
Posted by Wolf Dreamer on October 1, 2003, at 2:45:07
In reply to Re: Fluoride » mattdds, posted by tealady on September 27, 2003, at 0:15:34
tealady: Amongst my family I have one brother and mother with lots of decay, and my father and another brother with absolutely NO decay, perfect hard teeth, never visited a dentist in their lives!...non fluoridated water, similar diets, dental hygiene etc...
What did they eat? Dr. Price went about long ago studying native people around the world, and found that those that ate nothing but meat had perfect teeth, while those that began eating a more Western diet started to have problems.
http://www.sumeria.net/health/price.htmlhttp://www.price-pottenger.org/about.htm
This is the end of the thread.
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