The Environmental and Economical Impacts Concerning the Cessation of Fluoridation in America Thomas Sipes American Public University Fluoridation of America’s drinking water has long been considered an economically sound and beneficial treatment responsible for good dental health. While topical fluoride applications promote healthy teeth and gums, it is not an environmental or economically sound addition to our municipal water supplies. By its nature and manufacture, fluoride is an immediate threat to humans and a cumulative threat to the environment. Its addition to municipal water also places an unnecessary expense on the budgets of communities. Its harmful accumulation in ecosystems and humans adds to already rising medical costs. The discontinuation of fluorination will not reduce the quality of our dental health; it would improve the quality of water that is released into our ecosystems daily in the form of waste water while reducing medical expenses needed to treat overexposure. Fluoride is a known toxic compound that should never have been allowed into our water beyond natural occurrences. Natural occurrences can often be too high as well. Fluorine (F) is a naturally occurring element in the environment. Fluoride (F2) is the name given to soluble fluorine. Fluorine is a highly reactive chemical that readily forms compounds with the majority of the other elements including the noble gases. Since fluorine creates bonds so easily with other elements, it is used in many industrial processes including water treatment in the form of sodium fluoride (NaF). Once the bonds are made with other elements, they are there for life. As stated by Jefferson Labs, “Fluorine is the most reactive of all elements and no chemical substance is capable of freeing fluorine from any of its compounds” (n.d.). Sodium fluoride is listed as highly toxic in the MSDS which clearly states that ingestion can lead to poisoning and even death. The majority of water municipalities’ (90%) use the more available fluosilicic acid and sodium fluorosilicate in place of sodium fluoride. Fluosilicic acid and sodium fluorosilicate are EPA regulated toxic by-products of the industrial smelting processes. Since fluosilicic acid (H2SiF6) and sodium fluorosilicate (Na2SiF6) are more commonly used as a cheap replacement for sodium fluoride, their toxicity will be included here as well. Fluosilicic acid is listed as a toxin in the MSDS, which recommends medical attention if ingested. Sodium fluorosilicate is also listed as a toxin in the MSDS with similar exposure recommendations. The FDA has never approved any of these compounds for ingestion, and for good reason. Trace amounts of fluoride (3-5 mg per day) are recommended, though not necessary, for maintaining the health of teeth and bones (Lenntech, 2009). This amount is naturally present in many water supplies without need of additional supplements. Currently, the majority of municipal water supplies supplement their water with an additional 1ppm of soluble fluorine, fluosilicic acid or sodium fluorosilicate to reduce dental carries. This addition is performed on the advice of the American Dental Association and the American Medical Association. Agricultural irrigation is generally performed using non-fluorinated water. But, food, beverage, cosmetic and hygiene product manufacturers use fluorinated water in their production and packaging process. These added factors introduce immeasurable amounts of accumulating fluoride into the human body. A 2002 report by the CDC notes a 9% increase in dental fluorosis in the past 20 years and recommended timely surveillance to monitor fluoride exposure from multiple sources (CDC, 2005). This report was updated in 2007 with the following results: 41% of children aged 12-15 now have some form of fluorosis, whereas 36% of children 16-19 have fluorosis (CDC, 2007). The presence of fluorosis in teeth, while only a cosmetic defect, is a clear indicator of fluorine overexposure in our children. Dental fluorosis is an irreversible condition caused by overexposure to fluoride during tooth forming years. The World Dental Organization states, “Over the past 50 years, the prevalence of dental fluorosis has increased quite dramatically in the United States and other fluoridated countries” (2008). Dental fluorosis is an expensive condition to treat. Left untreated, it can cause embarrassment for school-aged children, resulting in psychological stress and damaged self-esteem (World Dental, 2008). Common treatments include tooth bleaching, microabrasion, and conservative composite restorations or the use of porcelain veneers. Porcelain veneers have a nationwide cost average of $1,150 per veneer. Costs of cosmetic treatments are generally not covered under insurance, so there is no data to demonstrate the total nationwide cost of this procedure. Our children should not have to suffer from the psychological effects of ugly teeth without due cause. Neither should their parents have to shoulder the cost of the side effects of water fluoridation. Overexposure to fluoride can give rise to crippling skeletal fluorosis (Fawell, 2006). Clinical trials have formed a definitive link between excessive fluoride exposure and osteoporosis in humans in areas of municipal fluorination (Academics Press, 1993). There has been an alarming rate of increase (55%) in osteoporosis fractures between 1999 and 2005 (House Calls, 2009). It was estimated that 29.5 million women and 11.7 million men in the United States were afflicted with osteoporosis in 2002. This equates to an estimated $18 billion annually in medical costs (Barefield, 1996). The projected cost of care for osteoporosis patients over the next 20 years is $474 billion (AAOS, 2009). These estimates do not attempt to place economic values on time lost from work or pain and suffering. There are other factors to consider in the risk of osteoporosis, but to eliminate even a small fraction of this massive amount would be an economical achievement. As of January 7, 2011 the Department of Health and Human Services has recognized the connection between Stage II skeletal fluorosis and fluoride overexposure and recommended a reduction in fluoride additions to water (HHS, 2011). There are definitive studies linking fluoridation to increased lead uptake in humans (Lead, 2010). Lead poisoning is shown to cause learning disabilities and behavioral problems in youth and adolescents, as well as contribute to dementia and Alzheimer’s disease in adults. Prior to 1995, fluoride was thought to only affect teeth and bones. Laboratory studies have demonstrated the central nervous system is vulnerable to fluoride and could lead to lowered IQ’s and learning disabilities (Mullenix, 1998). Many pediatricians currently counsel parents to avoid using tap water for the mixing of baby formula due to the toxic effects of fluoride on infant neurology. The CDC recommends not using fluorinated tap water for mixing infant formula because of the possibility of dental fluorosis (CDC, 2011). Dental fluorosis is the only physically visible sign of fluoride overexposure. The ADHD/ADD epidemic which was completely unheard of before the 1950’s has grown to 13% (6 million) of the nation’s schoolchildren (Baughman, 2000). Fluoride was introduced as a water additive in 1945. Since that time, the diagnoses of ADHD and ADD have increased to become a national medical issue among children and adults. The total economic cost of ADHD was estimated in 2000 to be $31.6 billion per year (Medscape, 2005). This estimate does not include the numerous undiagnosed cases that are yet unaware of their condition. Although it is difficult to estimate the effects of fluoridation on the rise of Alzheimer’s and dementia cases because of humanity’s increasing longevity obscuring the results, evidence does point to a likely increase due to fluorination and increased lead absorption. The direct and indirect cost of Alzheimer’s and dementia for 2010 is estimated at $184 billion and rising (Kennard, 2006). Currently there are no therapies that can prevent, delay or stop the progression of Alzheimer’s. The care of Alzheimer’s patients is expected to skyrocket with costs estimated at $20 trillion over the next 40 years (Turgeon, 2010). Once fluoride is introduced to the municipal water supply, it remains bonded in the water until removed by further bonding with soil, plant or animal compounds. Wastewater treatment plants are unable to remove the fluorine compounds from their effluent. So, of the billions of gallons treated with this chemical the great majority is reintroduced to the environment unused by humans via wastewater. Once in wastewater it is either leached to the soil where plants will absorb it along with other nutrients or released into major waterways as effluent, where it will contaminate the water until settling into the silt of the streambed or flowing into the ocean where it will accumulate in the seabed. The EPA allows a level of 1.5ppm for fluoride discharge into fresh water streams from wastewater treatment facilities. Studies have shown that fluoride at levels below 1.5ppm have lethal effects on some aquatic species. This level has caused notable reductions in salmon, trout and mussel populations in the Columbia River (Marnell, 2010). The decline in salmon stocks, especially Chinook and Coho, is a major economic problem for both commercial and sport fisheries. The estimated economic impact of closing commercial and sport salmon fishing in California alone is $255 million per year (Shepherd, n.d.). How much of the decline is due to fluoride is difficult to say; but any rate of decline in an already threatened economic sector is too much. Fluoride effluent levels will be diluted to normal levels after distance according to the size and volume of the waterway. The mighty Mississippi required 16 km to return to its normal fluoride level of .2mg/L after leaving the Minneapolis/St. Paul effluent discharge site (Foulkes, 1994). Fluoride is a persistent bio-accumulator. To date, fluoride has received relatively little attention as a contaminant of the ecosystem. When fluoride leaches into soil it forms strong bonds with the soil that prevent it from leaching (ATSDR, 2003). This makes it continually available for plants to uptake along with their required nutrients. The availability increases dramatically in the presence of saline soils (Weinstein, 2004). Fluoride interferes with hydrogen bonding and inhibits numerous enzymes (Connett, 2004). By interfering with hydrogen bonding it stunts the growth of vegetation by denying the necessary for growth. When absorbed by plants along with other nutrients, it accumulates mainly within the leaves making it available at concentrated levels for livestock consumption. The consumption by livestock further concentrates the levels of fluoride in bones and teeth, which are in turn consumed by humans where it ends up further concentrated in our bones and teeth. There has been no research to determine the effects of fluoride on soil microbes and biota. Fluoridation of the nation’s municipal water supplies costs an estimated $.50 cents per person per year (CDC, 2009). As of the 2010 census, the population of the United States is 308,745,538. Fluoridation costs this country $154,372,769 per year. I believe this is an undervalued estimate as municipalities of under 20,000 consumers cost considerably more per person to fluorinate. According to the CDC, the estimated annual cost savings for dental carries is $17 per person in fluoridated communities. This amounts to a national yearly savings of roughly $1.5 billion (CDC, 2009). The evidence that substantiates this estimate has been challenged by more recent studies of dental carries. In a survey of 39,000 children, ages 5-17, there was no discernible difference in dental carries between fluoridated and non-fluoridated communities (Hileman, 1989). It is now an accepted scientific fact that the topical use of fluoride plays the major role in the prevention of dental carries and systemic use of fluoride has negligible benefits (Pizzo, 2007). In fact, the United States shows a higher rate of dental carries compared to other developed countries that do not fluorinate their municipal water supplies at all (Connett, 2004). I will first approach my final assessment in a qualitative manner. The process of fluorination fails to provide significant results in reducing dental carries and in fact demonstrates a slight increase in carries in comparison to non-fluorinated communities. The rise in fluorosis statistics shows a prevalence of overexposure in our youth. The links between overexposure and the dramatic rise of detrimental health effects since the inception of fluorination poses alarming possibilities for the continued use of fluoride as a treatment of municipal water. It is apparent that fluorination does not increase the quality of life for humans as was once believed (Fluoride Action Network, n.d.). In contrast, it seems to decrease quality of life standard for a substantial portion of the population. Its demonstrated toxicity to plant and animal life coupled with its cumulative storage abilities in ecosystems and humans makes it an undesired and long term threat to the environment. Though the total environmental damage is not completely understood, its negative effects have been solidly demonstrated in certain areas of research. The quantitative approach assesses the economic contribution of fluorination to the national economy. While hotly contested as false claims, current estimates show a positive economic effect to the use of fluorination equating to a nationwide savings of $1.35 billion per year in dental care. The health care estimates aligned with the treatment of fluoride overexposure are not so easily produced due to lack of understanding and research. So, for the sake of agreeability I will proceed by placing the nominal value of only 1% to the health care issues with links to fluorination. The epidemic of ADHD/ADD will be given the economic value of $316 million. The conditions known as Alzheimer’s/Dementia will be given the economic value of $1.84 billion. The medical costs of osteoporosis will be given the economic value of $180 million. At only 1%, these economic values total $2.34 billion. With the other issues such as lowered IQ’s of children, dental fluorosis, and environmental damage the results are too obscure to assign an economic value. Even with the ridiculously low assignments to these major health care issues and the inability to assign economic value to other equally valid economic factors, the disputed benefits of fluorination fall $1 billion (annually) short of an economically beneficial practice. As the medical costs increase over time as estimated, this margin will increase as well. This analysis is contingent on the fact that fluorination is truly beneficial to dental health and that the assigned 1% value is realistic. I believe that further research will show these values to be of a much higher percentage. The chemical fluorine has been under heavy scrutiny for many years concerning its addition to municipal water supplies. Even the EPA’s own union members have openly opposed fluorination because of its toxicity (Hirzy, 1999). A resolution voted unanimously by EPA professionals, “As professionals who are charged with assessing the safety of drinking water, we conclude that the health and welfare of the public are not served by the addition of this substance to the public water supply” (Graham, 1999). The great majority of environmental and human health studies have been aimed at the chemical compound sodium fluoride (NaF). Sodium fluoride is not the primary chemical used for municipal water treatment. The primary compounds used for treatment are fluorosilicic acid (H2SiF6) and sodium fluorosilicate (Na2SiF6). These primary chemicals have never been tested for safety in human ingestion (EPA, 2000). If these compounds were not sold to water municipalities they would cost industry millions in disposal costs. The known economic damages to the environment and human health caused by the use of these chemicals far outweigh the meager (if any) benefits derived from their addition to municipal water supplies. If fluoride is so dangerous, then why do we put it in our water? It has been suggested that the answer is because it’s an effective method of ridding industry of toxic by-products (Shattuck, 2001). The economic impact on the ecosystem may only be questioned at this time, but the impact to human health is fast becoming apparent. Fluorination can no longer be considered the great achievement it was once believed. The bio-availability and persistent environmental accumulation of this chemical will bring economic woe to the nation too proud to admit it has erred in its judgment. Fluorination at best is detrimental to the economy; at worst it is a medical nightmare at the root of untold billions of current and future medical expenses. Bibliography: AAOS. (2009). Osteoporosis and Bone Health. American Academy of Orthopedic Surgeons. Retrieved from http://www.aaos.org/news/aaosnow/may09/clinical8.asp Academics Press. (1993). Health Effects of Ingested Fluoride. Committee on Toxicology. National Academy Press. Washington, D.C. (pgs 51-72). Retrieved from American Public University System Online Library at: http://site.ebrary.com/lib/apus/docDetail.action?docID=10057060 ATSDR. (2004). ToxFAQs™ for Fluorine, Hydrogen Fluoride, and Fluorides. Agency for Toxic Substances and Disease Registry. Atlanta, Georgia. http://www.atsdr.cdc.gov/toxfaqs/tf.asp?id=211&tid=38 Barefield, Eric. (1996). Osteoporosis-Related Hip Fractures Cost $13 Billion to $18 Billion Yearly. Moving Toward Healthier Diets. Retrieved from http://www.ers.usda.gov/publications/foodreview/jan1996/frjan96e.pdf Baughman, Fred. (2000). THE RISE AND FALL OF ADD/ADHD. Alliance against Mandated Mental Health Screening & Psychiatric Drugging of Children. Retrieved from http://www.ritalindeath.com/adhd.htm CDC. (2005). Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis --- United States, 1988--1994 and 1999—2002. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm CDC. (2007). 2755 Prevalence of Enamel Fluorosis Among 12-19 Year-Olds, U.S., 1999-2004. Retrieved from http://iadr.confex.com/iadr/2007orleans/techprogram/abstract_92598.htm CDC. (2009). Cost Savings of Community Water Fluoridation. Center for Disease Control and Prevention. Department of Health and Human Services. Atlanta, Georgia. Retrieved from http://www.cdc.gov/fluoridation/fact_sheets/cost.htm CDC. (2011). Overview: Infant Formula and Fluorosis. Center for Disease Control and Prevention. Department of Health and Human Services. Atlanta, Georgia. Retrieved from http://www.cdc.gov/fluoridation/safety/infant_formula.htm Connett, Paul. (2004). 50 Reasons to Oppose Fluoridation. Fluoride Action Network. Retrieved from http://www.fluoridealert.org/50-reasons.htm DHHS. U.S. Department of Health and Human Services. (2011). HHS and EPA announce new scientific assessments and actions on fluoride. Retrieved from http://www.hhs.gov/news/press/2011pres/01/20110107a.html DHHS. U.S. Department of Health and Human Services. (2011). Proposed HHS Recommendation for Fluoride Concentration in Drinking Water for Prevention of Dental Caries. Washington, D.C. Retrieved from http://www.hhs.gov/news/press/2011pres/01/pre_pub_frn_fluoride.html EPA. (2000). In a letter from Robert Thurnau. Treatment Technology Evaluation Branch. Water Supply and Water Resources Division. Retrieved from http://www.fluoridealert.org/images/letters/EPA-Masters.jpg Fawell, J., World Health Organization. (2006). Fluoride in Drinking Water. World Health Organization. Retrieved from American Public University System Online Library at: http://site.ebrary.com/lib/apus/docDetail.action?docID=10161469 Fluoride Action Network. (n.d.) HEALTH EFFECTS: Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries. Retrieved from http://www.fluoridealert.org/health/teeth/caries/who-dmft.html Foulkes, RG., Anderson, AC. (1994). Impact of Artificial Fluoridation on Salmon Species in the Northwest USA and British Columbia, Canada. Retrieved from http://www.fluoridation.com/enviro.htm Graham, John., Morin, Pierre-Jean. (1999). Artificial Fluoridation: HIGHLIGHTS IN NORTH AMERICAN LITIGATION DURING THE TWENTIETH CENTURY ON ARTIFICIAL FLUORIDATION OF PUBLIC WATER SUPPLIES. Retrieved from http://www.law.fsu.edu/journals/landuse/vol142/graham-final2.pdf Hileman, Bette. (1989). New Studies Cast Doubt on Fluoridation Benefits. Chemical and Engineering News. Retrieved from http://www.fluoridealert.org/NIDR.htm House Calls. (2009). Disturbing Rise in Osteoporosis Fractures. Health Revelations. Retrieved from http://healthrevelations.com/2009/08/21/osteoporosis-fractures/ Hirzy, William Dr. (1999). Why EPA's Headquarters Professionals' Union Opposes Fluoridation. Retrieved from http://www.fluoridealert.org/hp-epa.htm Jefferson Lab. (n.d.). Its Elemental: The Element Fluorine. Retrieved from http://education.jlab.org/itselemental/ele009.html Kennard, Christine. (2006). Statistics about the Financial Costs of Alzheimer's Disease. Retrieved from http://alzheimers.about.com/od/financialissues/a/Costs_Alzheimer.htm Lead. (2010). Fluoridation Increases Lead Absorption in Children. Lead Action News. (vol. 7. no. 4). Retrieved from http://www.lead.org.au/lanv7n4/L74-11.html Lenntech. (2009). Recommended daily intake of vitamins and minerals. Retrieved from http://www.lenntech.com/recommended-daily-intake.htm Marnell, Niamh. (2010). Fluoride from Municipal Water Supplies is Toxic to Fish. DC Bureau. Washington, DC. Public Education Center. Retrieved from http://dcbureau.org/20100706719/Bulldog-Blog/fluoride-from-municipal-water-supplies-is-toxic-to-fish.html Medscape. (2005). Costs of Attention Deficit-Hyperactivity Disorder (ADHD) in the US: Excess Costs of Persons with ADHD and Their Family Members in 2000. Medscape Today News. Retrieved from http://www.medscape.com/viewarticle/500028 Mullenix, Phyllis. (1998). Central Nervous System Damage from Fluorides. Retrieved from http://www.fluoridatio n.com/brain2.htm Pizzo, G. (2007). Community water fluoridation and caries prevention: a critical review. Clinical Oral Investigations. (vol.11, no.3) pg 189-193. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/17333303 Shattuck, Anita. (2001). The Fluoride Debate. Health Way House. San Marcos, California. Retrieved from http://www.fluoridedebate.com/ Shepherd, Jim. (2011). California Salmon Fishing Ban. http://fishing.about.com/od/troutandsalmon/a/salmon_ban.htm Turgeon, Jordan. (2010). Alzheimer’s disease will cost U.S. $20 trillion over the next 40 years. Medill Reports - Chicago, Northwestern University. Retrieved from http://news.medill.northwestern.edu/chicago/news.aspx?id=165094 Weinstein, Leonard., Davison, Alan. (2004). Fluorides in the Environment: Effects on Plants and Animals. CABI Publishing. Retrieved from American Public University System Online Library at: http://site.ebrary.com/lib/apus/docDetail.action?docID=10070253 World Dental. (2008). Dental Fluorosis. Condition or Disease? Dental Health Magazine. World Dental Organization. Retrieved from http://worldental.org/teeth/dental-fluorosis-condition-or-disease/103/ Additional (unused) links: Fluoride Action Network. (2007). The Professionals' Statement Calling for an End to Water Fluoridation. Retrieved from http://www.fluoridealert.org/statement.august.2007.html Limeback, Hardy Dr. (2000). Why I am now officially opposed to adding fluoride to drinking water. Retrieved from http://www.fluoridealert.org/limeback.htm PAGE \* MERGEFORMAT 1 Running Head ENVIRONMENTAL AND ECONOMIC IMPACTS OF FLUORIDATION