01/23/2008
Pros and Cons of Fluoride
Every so often I read an article or news report on the overuse of various medical procedures and the costs to our healthcare system. Last week I suspected that this was indeed the situation in the case of my wife who, as I mentioned last week, fell and ended up in the hospital with severe pain in her chest and back. Two sets of X-rays showed no fractures and the assumption was that her pain was due to bruised ribs and/or other trauma. After being readmitted to the hospital, a new doctor took over her case. She ordered a CTscan, which at the time I thought might involve more X-ray exposure than necessary. However, the CTscan showed a compression fracture in a vertebra in the spine! My wife was fitted with a brace and is now in a rehabilitation center, hoping that the fracture will heal without surgery.
With my life being so medically oriented these days, I was attracted by an article by Dan Fagin titled “Second Thoughts about Fluoride” in the January 2008 Scientific American. Growing up in the 1930s and 1940s, as did most of my schoolmates I had my share of cavities and dreaded those visits to the dentist. Until I was in my forties, I never had any Novocain when I received those mercury amalgam fillings.
I didn’t know that near my birthplace of Denver, in Colorado Springs in the early 1900s, a dentist named Frederick McKay was intrigued by reports of a staining and mottling of the teeth in children born in Colorado Springs. The phenomenon went by the name of Colorado Brown Stain. McKay noted that those children who moved into Colorado Springs did not show signs of the brown stain and he suspected that there was something in the water that affected the enamel of the teeth that had not yet erupted in the native born children. It wasn’t until 1930 that McKay, following up reports of Colorado Brown Stain in children in a town in Arkansas, spurred an analysis of the town’s water supply. The analysis, performed by chemist H. V. Churchill, revealed a relatively high level of naturally occurring fluoride. Colorado Brown Stain became a disease known as dental fluorosis.
Fast forward to 1945. It was that year that Grand Rapids, Michigan took to heart a recommendation by Henry Trendley Dean, head of the dental hygiene unit at the National Institute (now Institutes) of Health. Dean had come to the conclusion that, at levels of less than 1 milligram of fluoride per liter, there would be little risk to health and that, based on the work of McKay and Churchill, there should be a positive effect on dental health if fluoride were added to the water supply. (In those communities where the Colorado Brown Stain was prevalent, the fluoride concentrations were around 2.5 milligrams per liter or higher.) By the 1950s the push to add fluorides had expanded to hundreds of communities. I remember that there were heated objections from various groups and individuals concerned about adverse health effects as well as about enforced medication of entire communities.
However, fluoridation of public water supplies became the norm and today over half of us in the USA are drinking fluoridated water. In addition, fluoridated toothpastes were introduced and I personally embraced fluoridated Crest, hoping to cut down on those pesky dental visits. Today, one is bombarded by commercials and ads for whitening teeth and I look at my 80- year-old teeth and wonder if my failure to match those pearly white ones in the ads is due to overuse of fluorides. Actually, after reading the Scientific American article, I find there may be more serious concerns than having white teeth.
Let’s look at the enamel of a tooth. It is composed primarily of a mineral known as hydroxylapatite, composed of molecules of a particular form of calcium phosphate containing a hydroxyl (OH) group. One mode of tooth decay occurs when particles of food trapped between teeth react with bacteria, a process that forms lactic acid. There are two competing reactions going on. The lactic acid dissolves the enamel while calcium ions and phosphate ions present in saliva tend to form hydroxylapatite, effectively remineralizing the enamel. If the lactic acid is faster at dissolving the enamel than the remineralization, a cavity forms.
When fluoride is present or is applied, some of the fluorine atoms replace some of the hydroxyl groups, forming the compound fluoroapatite. This compound is more resistant to the lactic acid and in addition catalyzes the deposition of calcium and phosphate, thus speeding up the remineralization process. In so doing, the fluoride hinders tooth decay. This is all well and good but what happens if a young child ingests too much fluoride?
The excess fluoride blocks the removal of proteins that control the formation of hydroxylapatite and, when these proteins hang around too long, staining and uneven coloration can result as well as pitting or other uneven tooth growth. A critical period in enamel growth in preemergent teeth is the toddler stage. Fluoride consumption may stay high in toddlers partly because toddlers have apparently been found to swallow more than half their toothpaste despite being told to spit it out!
Sources other than toothpaste, such as soft drinks and juice drinks may contain significant amounts of fluoride, often introduced from water added during processing. Indeed, those who drink a lot of water can exceed the level of fluoride optimal for dental health. Colorado Brown Stain or fluorosis isn’t considered a health hazard but stained or irregularly shaped teeth aren’t exactly great for one’s self esteem. However, teeth are one thing; bones are another. Fluoride that doesn’t get excreted or incorporated into teeth will almost certainly end up in bone.
Here’s where things get a bit dicey. It seems that large amounts of fluoride spur the formation of osteoblasts, the cells that stimulate the building of bone. With all the talk about osteoporosis and loss of bone on aging, you might say that the extra fluoride is doing a good thing, producing more bone. Unfortunately, the fluoride produces more bone, but of a different structure than normal bone and this fluoride-induced bone is weaker than normal bone, increasing the risk of fracture!
There is also concern that, by stimulating excess production of osteoblasts, the excess fluoride might be causing oteosarcoma, the most common form of bone cancer. A vigorously disputed paper involving rats suggest a link but other researchers are highly critical of the study. Equally controversial are studies suggesting links between fluoride and hyperactivity, lower IQ and abnormal thyroid activity.
At present, there’s a renewal of the controversy of some six decades ago when fluoridation of water supplies was first introduced. Today, the antifluoridationists are at one extreme while at the other extreme there are those who feel, as did one surgeon general, that fluoridation is one of the ten greatest achievements of the twentieth century and should be expanded to embrace even more water supplies. Who knows how and when, if ever, this controversy will be resolved?
Oh well, being well beyond the toddler stage, I’ll continue to use my fluoridated toothpaste. Hey, I do spit it out.
Allen F. Bortrum
|