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Fluoride Exposure & Human Health Risks

Sources of Exposure

Although fluoride exists naturally in the environment, human exposure to fluoride has drastically increased since the 1940s. Since that time, an array of products containing fluoride and its compounds have been introduced to the average consumer, especially due to fluoride’s alleged role in cavities prevention. Products that may contain added fluoride include the following:

fluoride-toothpast.jpg

  • Artificially fluoridated municipal water

  • Beverages (made with fluoridated water)

  • Dental cements with fluoride

  • Dental fillings with fluoride

  • Dental gels with fluoride

  • Dental varnishes with fluoride

  • Floss with fluoride

  • Fluoride drugs ("supplements")

  • Food (that contains or has been exposed to fluoride)

  • Mouthwash with fluoride

  • Pesticides with fluoride

  • Pharmaceutical drugs with perfluorinated compounds

  • Stain resistant and waterproof items with PFC

  • Toothpaste with fluoride

In addition to these fluoride exposures, industrial pollution of fluoride and its compounds has also increased and can contaminate the air, soil, water, and vegetation in both the immediate vicinity and distant areas.(2) Anthropogenic sources of atmospheric fluoride can result from coal combustion by electrical utilities and other industries.(3) Releases can also occur from refineries and metal ore smelters,(4) aluminum production plants, phosphate fertilizer plants, chemical production facilities, steel mills, magnesium plants, and brick and structural clay manufacturers,(5) as well as copper and nickel producers, phosphate ore processors, glass manufacturers, and ceramic manufacturers.(6)

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Human Health Risks from Fluoride

The impact of the exposure levels generated from all of these sources is often overlooked. Yet, this collective exposure can produce lifelong fluoride-related illnesses. Additionally, age, gender, genetic factors, nutritional status, weight, and other factors are known to influence each person’s unique reaction to fluoride exposure. Furthermore, authors of a document for the Agency for Toxic Substance and Disease Registry (ATSDR) noted: “Existing data indicate that subsets of the population may be unusually susceptible to the toxic effects of fluoride and its compounds. These populations include the elderly, people with deficiencies of calcium, magnesium, and/or vitamin C, and people with cardiovascular and kidney problems.”7

 

In a 2006 report by the National Research Council (NRC) of the National Academy of Sciences in which the health risks of fluoride were evaluated, concerns were raised about potential associations between fluoride and osteosarcoma (a bone cancer), bone fractures, musculoskeletal effects, reproductive and developmental effects, neurotoxicity and neurobehavioral effects, genotoxicity and carcinogenicity, and effects on other organ systems.8 The following chart includes some of the specific health conditions that have been associated with fluoride exposure (9-37):

Acne & other dermatological conditions

Arterial calcification and arteriosclerosis

Bone weakness and risk of fractures

Cancer of the bone, osteosarcoma

Cardiac failure

Cardiac insufficiency

Cognitive deficits

Dental fluorosis

Diabetes

Early puberty in girls

Electrocardiogram abnormalities

Harm to the fetal brain

Hypertension

Immune system complications

Insomnia

Iodine deficiency

Lower fertility rates

Lower IQ

Myocardial damage

Neurotoxic effects, including ADHD

Osteoarthritis

Skeletal fluorosis

Temporomandibular joint disorder (TMJ disorder)

Thyroid dysfunction 

Dental Fluorosis 

Fluoride taken into the human body enters the bloodstream through the digestive tract. Most of the fluoride not released through urine is stored in the body. It is generally stated that 99% of this fluoride resides in the bone, where it is incorporated into the crystalline structure and accumulates over time.40 Thus, the teeth and bones are tissues of the body that concentrate the fluoride to which we are exposed.

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Exposure to excess fluoride can result in dental fluorosis, a condition in which the teeth enamel becomes irreversibly damaged and the teeth become permanently discolored, displaying a white or brown mottling pattern and forming brittle teeth that break and stain easily. It has been known since the 1940s that overexposure to fluoride causes this condition, which can range from very mild to severe. Dental fluorosis is also recognized as the first visible sign of fluoride toxicity. According to 2010 data from the Centers for Disease Control and Prevention (CDC), 23% of Americans aged 6-49 and 41% of children aged 12-15 exhibit fluorosis to some degree. These drastic increases of dental fluorosis were a crucial factor in the Public Health Service’s decision to lower its water fluoridation level recommendations in 2015.

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Where to go from here?

Clearly, official recommendations on fluoride use, many of which are not enforced, have been based on limited research and have only been updated after irreversible harm has occurred. Informed consumer consent is needed for all uses of fluoride, and this pertains to water fluoridation, as well as all dental-based products, whether administered at home or in the dental office. Providing education about fluoride risks and fluoride toxicity to medical and dental professionals, medical and dental students, consumers, and policy makers is crucial to improving the future of public health. There are fluoride-free strategies in which to prevent dental caries. Given the current levels of exposure, it has become a necessity to reduce and work toward eliminating avoidable sources of fluoride exposure, including water fluoridation, fluoride- containing dental materials, and other fluoridated products.

 Additional Information:

Sources below compiled for 2017 IAOMT Position Paper 

1 Kennedy D, Just A, Kall J, Cole G. International Academy of Oral Medicine and Toxicology Position Statement against Fluoride Use in Water, Dental Materials, and Other Products for Dental and Medical Practitioners, Dental and Medical Students, Consumers, and Policy Makers. IAOMT: ChampionsGate, FL. 2017.
2 Cited as Radostits et al. 2000 (Radostits OM, Gay GC, Blood DC and Hinchcliff KW. 2000. Veterinary Medicine. 9th edn. London, W B Saunders) in Swarup D, Dwivedi SK. Environmental pollution and effects of lead and fluoride on animal health. Indian Council of Agricultural Research Krishi Anusandhan Bhavan Pusa; New Delhi; 2002: Page 74.
3 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Page 44.
4 Sikora EJ, Chappelka AH. Air Pollution Damage to Plants. Alabama Cooperative Extension System. 2004. Online at http://www.aces.edu/pubs/docs/A/ANR-0913/ANR-0913.pdf. Accessed March 9, 2017.
5 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Page 44.
6 Agalakova NI, Gusev GP. Molecular mechanisms of cytotoxicity and apoptosis induced by inorganic fluoride. ISRN Cell Biology. 2012 Mar 7;2012. Online at http://downloads.hindawi.com/journals/isrn.cell.biology/2012/403835.pdf. Accessed November 1, 2016.
7 Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Fluorides, Hydrogen Fluoride, and Fluorine (F). U.S. Department of Health & Human Services, Public Health Service. ATSDR/TP-91/17. 1993. Page 112.
8 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006.
9 Shea JJ, Gillespie SM, Waldbott GL. Allergy to fluoride. Annals of Allergy. 1967 Jul;25:388-91. Online at http://fluoridealert.org/studies/shea- 1967/. Accessed March 27, 2017.
10 Mellette JR, Aeling JL, Nuss DD. Fluoride tooth paste: A cause of perioral dermatitis. Archives of Dermatology. 1976 May 1;112(5):730-1. Online at http://jamanetwork.com/journals/jamadermatology/article-abstract/535898. Accessed March 27, 2017.
11 Saunders MA. Fluoride toothpastes: A cause of acne-like eruptions. Archives of dermatology. 1975 Jun 1;111(6):793-. Online at http://jamanetwork.com/journals/jamadermatology/article-abstract/535073. Accessed March 27, 2017.
12 Tuncel E. The incidence of Moenckeberg calcifications in patients with endemic fluorosis. Fluoride. 1984 Jan 1;17(1):4-8.
And Susheela AK, Kharb P. Aortic calcification in chronic fluoride poisoning: biochemical and electronmicroscopic evidence. Experimental and Molecular Pathology. 1990 Aug 31;53(1):72-80.
In Fluoride Action Network. Cardiovascular [Internet]. http://fluoridealert.org/issues/health/cardio/. Accessed November 3, 2016.
13 Song AH, Wang TY, Jiang CY, Zhang ZB, Wang ZS. Observations on fluorotic aorta sclerosis by two dimensional echo cardiography. Endem Dis Bull. 1990;5:91-4. And Varol E, Akcay S, Ersoy IH, Ozaydin M, Koroglu BK, Varol S. Aortic elasticity is impaired in patients with endemic fluorosis. Biological Trace Element Research. 2010 Feb 1;133(2):121-7.
In Fluoride Action Network. Cardiovascular [Internet]. http://fluoridealert.org/issues/health/cardio/. Accessed November 3, 2016.
14 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Page 7.
15 Bassin EB, Wypij D, Davis RB, Mittleman MA. Age-specific fluoride exposure in drinking water and osteosarcoma. Cancer Causes & Control. 2006; 17(4): 421-428.
16 Hanhijärvi H, Penttilä I. The relationship between human ionic plasma fluoride and serum creatinine concentrations in cases of renal and cardiac insufficiency in a fluoridated community. Proceedings of the Finnish Dental Society. Suomen Hammaslääkäriseuran toimituksia. 1981;77(6):330.
In National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Page 100.
17 Hanhijärvi H, Penttilä I, Hakulinen A. Ionic plasma fluoride concentrations related to some diseases in patients from a fluoridated community. Proceedings of the Finnish Dental Society. Suomen Hammaslaakariseuran Toimituksia. 1980 Dec;77(6):324-9.
In Fluoride Action Network. Cardiovascular [Internet]. http://fluoridealert.org/issues/health/cardio/. Accessed November 3, 2016.
18 See a list of over 50 studies on this topic in Appendix A in Connett M. Citizen petition under Toxic Substances Control Act regarding the neurotoxic risks posed by fluoride compounds in drinking water. November 22, 2016. To the United States Department of Environmental Protection (EPA) by the Fluoride Action Network (FAN), the International Academy of Oral Medicine and Toxicology (IAOMT), the American Academy of Environmental Medicine (AAEM), Food & Water Watch (FWW), Moms Against Fluoridation, the Organic Consumers Association, Audrey Adams, Jacqueline Denton, Valerie Green, Kristin Lavelle, and Brenda Staudenmaier. Online at http://fluoridealert.org/wp-content/uploads/epa-petition.pdf. Accessed March 31, 2017.
19 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006.
20 Fluegge K. Community water fluoridation predicts increase in age-adjusted incidence and prevalence of diabetes in 22 states from 2005 and 2010. Journal of Water and Health. 2016 May 24:wh2016012. Online at http://jwh.iwaponline.com/content/early/2016/05/24/wh.2016.012. Accessed November 4, 2016.
21 Farkas G, et al. (1983). The fluoride content of drinking water and menarcheal age. Acta Univ Szeged Acta Biol. 29(1-4):159-168.
And Schlesinger ER, Overton DE, Chase HC, Cantwell KT. Newburgh-Kingston caries-fluorine study X III. Pediatric findings after ten years. The Journal of the American Dental Association. 1956 Mar 31;52(3):296-306.
In Fluoride Action Network. Pineal gland [Internet]. Online at http://fluoridealert.org/issues/health/pineal-gland/. Accessed November 3, 2016.
22 Karademir S, Akçam M, Kuybulu AE, Olgar S, Öktem F. Effects of fluorosis on QT dispersion, heart rate variability and echocardiographic parameters in children/Çocuklarda QT dispersiyonu, kalp hizi degiskenligi ve ekokardiyografik parametrelere florozisin etkileri. Anadulu Kardiyoloji Dergisi: AKD. 2011 Mar 1;11(2):150. And Xu R, Xu R. Electrocardiogram analysis of patients with skeletal fluorosis. Fluoride. 1997 Feb 1;30(1):16-8.
In Fluoride Action Network. Cardiovascular [Internet]. http://fluoridealert.org/issues/health/cardio/. Accessed November 3, 2016.
23 See list of studies in Appendix B in Connett M. Citizen petition under Toxic Substances Control Act regarding the neurotoxic risks posed by fluoride compounds in drinking water. November 22, 2016. To the United States Department of Environmental Protection (EPA) by the Fluoride Action Network (FAN), the International Academy of Oral Medicine and Toxicology (IAOMT), the American Academy of Environmental Medicine (AAEM), Food & Water Watch (FWW), Moms Against Fluoridation, the Organic Consumers Association, Audrey Adams, Jacqueline Denton,

Valerie Green, Kristin Lavelle, and Brenda Staudenmaier. Online at http://fluoridealert.org/wp-content/uploads/epa-petition.pdf. Accessed March 31, 2017.
24 Amini H, Shahri SM, Amini M, Mehrian MR, Mokhayeri Y, Yunesian M. Drinking water fluoride and blood pressure? An environmental study. Biological Trace Element Research. 2011 Dec 1;144(1-3):157-63. In Fluoride Action Network. Cardiovascular [Internet]. http://fluoridealert.org/issues/health/cardio/. Accessed November 3, 2016.
25 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Pages 293-294.
26 Mahlberg R, Kienast T, Hädel S, Heidenreich JO, Schmitz S, Kunz D. Degree of pineal calcification (DOC) is associated with polysomnographic sleep measures in primary insomnia patients. Sleep Medicine. 2009 Apr 30;10(4):439-45.
In Fluoride Action Network. Pineal gland [Internet]. Online at http://fluoridealert.org/issues/health/pineal-gland/. Accessed November 3, 2016.
27 Gas' kov A, Savchenkov MF, Iushkov NN. The specific features of the development of iodine deficiencies in children living under environmental pollution with fluorine compounds. Gigiena i Sanitariia. 2005(6):53. And Hong F, Cao Y, Yang D, Wangb H. Research on the effects of fluoride on child intellectual development under different environmental conditions. Chinese Primary Health Care. 2001;15(3):56-7. And Ren D, Li K, Liu D. A study of the intellectual ability of 8-14 year-old children in high fluoride, low iodine areas. Fluoride. 2008 Oct 1;41(4):319-20. And Wang XH, Wang LF, Hu PY. Effects of high iodine and high fluorine on children's intelligence and thyroid function [J]. Chinese Jouranl of Endemiology. 2001;4:020. In Fluoride Action Network. Thyroid [Internet]. Online at http://fluoridealert.org/issues/health/thyroid/. Accessed November 3, 2016.
28 Freni SC. Exposure to high fluoride concentrations in drinking water is associated with decreased birth rates. Journal of Toxicology and Environmental Health, Part A Current Issues. 1994 May 1;42(1):109-21. And Hao P, Ma X, Cheng X, Ba Y, Zhu J, Cui L. [Effect of fluoride on human hypothalamus-hypophysis-testis axis hormones]. Wei sheng yan jiu= Journal of hygiene research. 2010 Jan;39(1):53-5.
And more in Fluoride Action Network. Male fertility [Internet]. Online at http://fluoridealert.org/issues/health/fertility/. Accessed November 3, 2016.
29 Choi AL, Sun G, Zhang Y, Grandjean P. Developmental fluoride neurotoxicity: a systematic review and meta-analysis. Environmental Health Perspectives. 2012; 120(10):1362-1368. Online at https://dash.harvard.edu/bitstream/handle/1/10579664/3491930.pdf. Accessed November 3, 2016. 30 Barbier O, Arreola-Mendoza L, Del Razo LM. Molecular mechanisms of fluoride toxicity. Chemico-Biological Interactions. 2010 Nov 5;188(2):319-33. And Pribilla, O., 1968. Four cases of acute silicofluoride intoxication: clinical and pathological findings. Fluoride, 1, pp.102-9.
And Takamori T, Miyanaga S, Kawahara H, OKU-SHI I, Hirao M, Wakatsuki H, Imura Z. Elecirocardiographical Studies of the Inhabitants in High Fluorine Districts. Tokushima Journal of Experimental Medicine. 1956 May;3(1):50-3. And Varol E, Varol S. Effect of fluoride toxicity on cardiovascular systems: role of oxidative stress. Archives of toxicology. 2012. DOI 10.1007/s00204-012-0862-y.
In Fluoride Action Network. Cardiovascular [Internet]. http://fluoridealert.org/issues/health/cardio/. Accessed November 3, 2016.
31 See list of studies Appendix C in Connett M. Citizen petition under Toxic Substances Control Act regarding the neurotoxic risks posed by fluoride compounds in drinking water. November 22, 2016. To the United States Department of Environmental Protection (EPA) by the Fluoride Action Network (FAN), the International Academy of Oral Medicine and Toxicology (IAOMT), the American Academy of Environmental Medicine (AAEM), Food & Water Watch (FWW), Moms Against Fluoridation, the Organic Consumers Association, Audrey Adams, Jacqueline Denton, Valerie Green, Kristin Lavelle, and Brenda Staudenmaier. Online at http://fluoridealert.org/wp-content/uploads/epa-petition.pdf. Accessed March 31, 2017.
32 Savas S, Çetin M, Akdoğan M, Heybeli N. Endemic fluorosis in Turkish patients: relationship with knee osteoarthritis. Rheumatology International. 2001 Sep 1;21(1):30-5. And Czerwinski E, Nowak J, Dabrowska D, Skolarczyk A, Kita B, Ksiezyk M. Bone and joint pathology in fluoride-exposed workers. Archives of Environmental Health: An International Journal. 1988 Oct 1;43(5):340-3.
And more in Fluoride Action Network. Arthritis [Internet]. Online at http://fluoridealert.org/issues/health/arthritis/. Accessed November 3, 2016.
33 Nelson EA, Halling CL, Buikstra JE. Investigating fluoride toxicity in a Middle Woodland population from west-central Illinois: A discussion of methods for evaluating the influence of environment and diet in paleopathological analyses. Journal of Archaeological Science: Reports. 2016 Feb 29;5:664-71.
34 Agency for Toxic Substances and Disease Registry. Public health statement for fluorides, hydrogen fluoride, and fluorine [Internet]. September 2003. Online at https://www.atsdr.cdc.gov/phs/phs.asp?id=210&tid=38. Accessed November 3, 2016.
35 Asawa K, Singh A, Bhat N, Tak M, Shinde K, Jain S. Association of Temporomandibular Joint Signs & Symptoms with Dental Fluorosis & Skeletal Manifestations in Endemic Fluoride Areas of Dungarpur District, Rajasthan, India. Journal of clinical and diagnostic research: JCDR. 2015 Dec;9(12):ZC18. Online at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4717726/. Accessed November 3, 2016.
36 See Table 8-2 and discussion in National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Pages 236 and 238.
37 Peckham S, Lowery D, Spencer S. Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water. Journal of Epidemiology and Community Health. 2015;69(7):619-24.
38 Agency for Toxic Substances and Disease Registry. Public health statement for fluorides, hydrogen fluoride, and fluorine [Internet]. September 2003. Online at https://www.atsdr.cdc.gov/phs/phs.asp?id=210&tid=38. Accessed November 3, 2016.
39 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Page 131.
40 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006. Page 5.
41 National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA’s Standards. The National Academies Press: Washington, D.C. 2006.
42 Centers for Disease Control and Prevention. Prevalence and severity of dental fluorosis in the United States, 1999-2004. NCHS Data Brief No. 53. November 2010. Online at http://www.cdc.gov/nchs/data/databriefs/db53.htm. Accessed November 3, 2016.
43 United States Department of Health and Human Services. HHS issues final recommendation for community water fluoridation [Press release]. April 27, 2015. Online at http://www.hhs.gov/about/news/2015/04/27/hhs-issues-final-recommendation-for-community-water-fluoridation.html. Accessed November 2, 2016.

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