BELLOWS FALLS — Vermont Department of Health (DOH) officials are considering a recent recommendation of the federal Environmental Protection Agency's Office of Chemical Safety and Pollution Prevention regarding acceptable dosage levels of fluoride in public drinking water.
After it has studied the report and considered the information generated during a 30-day public comment period, the Vermont DOH will make its own recommendations.
The EPA now states that the “optimum” fluoride level in public drinking water is 0.7 milligrams per liter (mg/l), down from its previous standard of 1.2 mg/l. The EPA crafted its new recommendation after reviewing a National Research Council (NRC) 2006 report, Fluoride in Drinking Water: A Scientific Review of EPA's Standards.
Two-thirds of public drinking water in the United States is fluoridated, and according to the Centers for Disease Control and Prevention (CDC), almost three-quarters of people consuming water from public water systems have access to water treated with the mineral, found in rocks and soils.
Adding fluoride to drinking water is not required by the state or the federal government, but the village of Bellows Falls has done so since May of 1968.
At the Jan. 11 Village Trustee meeting, Water Department Chief Operator Ray Perry was asked by Trustee Steve Golec if he was aware of “recent talk about less fluoride in the water.” Perry said that he was and has been in contact with the state.
A history of controversy
In 2004, then-Surgeon General Richard H. Carmona wrote that “community water fluoridation continues to be the most cost-effective, equitable and safe means to provide protection from tooth decay in a community. Scientific studies have found that people living in communities with fluoridated water have fewer cavities than those living where the water is not fluoridated.”
In the early 1900s, a dentist setting up practice in Colorado found a community of people with mysteriously discolored teeth, a phenomenon later determined to be the result of naturally occurring fluoride in the local water supply. Since the discovery that the same people affected by “California Brown Tooth” had teeth notably more resistant to decay, government agencies have advocated the practice of fluoridating water.
Proponents say doing so provides a low-cost, effective preventive treatment for dental problems such as tooth decay, but those opposed say that fluoride is a known carcinogenic element that has no place in the water supply.
Dr. Paul Rowe, the Vermont DOH oral health director, said he believes the state should be doing better on the fluoridation front. He said his office works with towns to find the minimal amount of the chemical for maximum benefit.
“We may lower the recommended amount in order to do just that,” he said, to “reduce overall exposure.”
A dentist, Rowe said that “it's important that kids get fluoride while the teeth are still developing enamel” to prevent future dental problems.
The EPA's evaluation of the NRC report studied many different scenarios of how people might receive fluoride. In some areas, such as in Colorado Springs, Colo., the substance occurs naturally in the soil and has been found to cause fluorodosis, or teeth mottling, at high dosages.
People can also ingest fluoride from foods treated with sulfuryl fluoride to kill pests. Such foods include shell nuts (walnuts and cocoa beans), cereals, and dried fruit. Alternative fumigants require a longer period of time to meet required standards for food safety.
Fluoride also occurs naturally in water in varying degrees, depending on the element makeup of the rock and earth around it. According to the Vermont Department of Health, well water levels vary from 3-4 milligrams per liter in Vermont, with the highest levels in Chittenden County.
Health risks
The EPA's recommended lower dose of fluoride in drinking water specifically addressed the most vulnerable populations - children, the elderly, and those with compromised health.
The main concern for the EPA was for children younger than age 2. “A mother mixing formula from a tap that delivers fluoridated water should check with her health provider before doing so,” Rowe said.
In measuring risk assessments for children, the NRC report said that “monitoring studies indicate fluoride is ubiquitous in the food supply” and that “locally grown foods may consistently have higher or lower levels of fluoride than assumed for this assessment.”
Toothpaste, while intended to be used topically, is often swallowed by children. A thorough read of the warning label recommends medical help or a call to the Poison Control Center immediately if the toothpaste is swallowed.
The EPA noted that groups of people who chronically drink large amounts of water - such as athletes, construction workers, and people who live in warmer climates - would receive greater amounts of fluoride daily. The study also noted that people ingest the substance when drinking commercial beverages made with fluorinated water, as well as from exposure to pesticides and fruits or vegetables with fluoride that came from the soil.
EPA's aggregate assessment of fluoride exposure concludes that “the required reasonable-certainty-of-no-harm finding cannot be made for aggregate exposure of fluoride consistent with its understanding and prior application of that standard” and that “exposure estimates for [children 2 years old and younger] remain above the RfD [reference dose] even after the subtracting the contribution from toothpaste.”
The EPA's review concluded that fluoride levels in drinking water should be lowered. Doing so would “prevent children from developing severe enamel fluorosis and …reduce …lifetime accumulation of fluoride into bone ….” Maintaining present levels of fluoridation, the review continued, “is likely to put individuals at increased risk of bone fracture and possibly skeletal fluorosis, which are particular concerns for subpopulations …prone to accumulating fluoride in their bones.”
Dr. Phyllis Mullenix researched neurotoxicity of fluoride while she was head of the Toxicology Department at the Forsyth Dental Center, a world-renowned dental research institution affiliated with the Harvard Medical School.
While the study was undertaken at Forsyth's request, she ended up having to quit her position because the center did not want her to publish the findings of her 1995 paper, Neurotoxicity of Sodium Fluoride in Rats.
She is considered one of the foremost experts on the neurotoxicity of fluoride compounds.
“We concluded that the rat study flagged potential for motor dysfunction, IQ deficits and/or learning disabilities in humans,” she wrote.
Further studies linked fluoride consumption with fibromyalgia.
Mandatory medication?
The issue of “mandatory medication” administered without medical oversight through public water systems is but one concern of those opposed to fluoride use.
Since farmers can use fluoride in pesticides, during processing, and when irrigating their fruits and vegetables, concerns about aggregate fluoride consumption have driven researchers to look into health concerns since the 2006 NRC report.
Advocacy groups have been involved with collecting data on the effects of fluoride since it was approved as a fumigant by the EPA. The Environmental Working Group (EWG), Fluoride Action Network (FAN), and Beyond Pesticides/National Coalition Against the Misuse of Pesticides (BP) all link to extensive studies on their websites.
One powerful opponent to lowering fluoride levels is Dow AgroSciences. The company has been marketing sulfuryl fluoride as an alternative to methyl bromide, a pesticide that has been linked to ozone depletion in the atmosphere.
Dr. Roger D. Masters, a research professor and professor emeritus of government at Dartmouth College, notes that the subject of fluoride encounters an emotional resistance in people who believe that they are being served up a dose of poison every time they drink a glass of water.
Some of that emotional resistance stems from the history and evolution of fluoride use, which at times reads like a macabre novel, particularly because the substance is a key chemical component in the making of nuclear weapons.
Medical writer Joel Griffiths, collaborating with journalist Chris Bryson, published Fluoride, Teeth and the A-Bomb, a story published in 1997 in the Earth Island Journal. They found declassified government documents from the World War II era - including documents from the Manhattan Project, the U.S. Army Corps of Engineers effort to build the first atomic bomb - that showed a strong connection between the push for fluoridation and the dawn of the nuclear age.
Millions of tons of fluoride were used in the production of the first atomic weapons and, according to Griffiths and Bryson, it soon became clear that the chemical was “the leading chemical health hazard of the U.S. atomic bomb program - both for workers and for nearby communities.”
Griffiths and Bryson outlined how the federal government managed to quash lawsuits for fluoride damage after an accident spill in 1943, while at the same time producing studies, conducted by many of the same people involved in the Manhattan Project, that showed fluoride was safe in low doses.
Much of the damaging data about fluoride's hazards as they related to bomb production was kept classified for decades. By the time this data was uncovered, fluoridation of drinking water had come to be seen as a benign public health measure.
While Dr. Masters said he “knows of no adverse effects from the use of sodium fluoride” (the substance that Bellows Falls uses) in drinking water, “all fluorides are poison,” and therefore dangerous, as far as he is concerned.
Dr. Masters has linked elevated lead levels in the blood serum of children with levels of fluoride in the water. He explained a complicated chemical action that results in neurotoxicity when fluoride is introduced to a child's body.
“It is like introducing chewing gum to an electrical socket,” he said.
He also has evidence that behavioral problems and violence are more prevalent in communities where the combination of exposure to lead and consumption of fluoridated water occur.
“There is evidence that blood lead levels lead to lower IQs,” Masters said.
Local concerns
In 2005, Bellows Falls residents were asked whether they wanted to continue receiving fluoridated water. After attending public hearings and listening to experts, the villagers voted against stopping the practice.
Brattleboro made the decision not to fluoridate its water in 2000, despite the support of then-Gov. Howard Dean and the Vermont Dental Association.
Both municipalities cited poor dental health in the town's children as the reason for backing fluoridation. Opponents argued that fluoride should be optional, and that children could have fluoride treatments and use fluoride toothpaste if their parents sought extra dental protection.
Burlington began fluoridating its water in 1952 and was the first city in Vermont to do so. Five decades later, the Burlington Board of Health launched an investigation into fluoride usage and, several public forums later, enough signatures were gathered for a ballot vote in 2006 to halt the practice. The measure failed.
But last month, the city's Public Works Commission unanimously accepted the recommendation of a subcommittee - consisting of two commissioners, Margaret Gundersen and Jared Wood, and Assistant Director of Water/Waste Water Treatment Laurie Adams - which recommended “deferral” of fluoridation of Burlington water “until such time as there are scientific studies covering the potential health effects evaluated in the 2006 NRC report,” they wrote.
“Furthermore, we support consideration of the suspension of fluoridation given that there are other readily available sources of fluoride for dental health, and because as an additive to drinking water it takes away the choice by the public,” their report continued.
The board voted to discontinue fluoridation of the city's water based on the new findings.
“In light of recent scientific developments indicating the potential for harm to certain subsets of the population, the Burlington Board of Health recommends immediately taking a precautionary stance by discontinuing the practice of water fluoridation,” the board stated in a resolution. “It is our opinion that drinking water should be pure and safe for all.”
The recommendation is now before the City Council.