Does fluoride in drinking water risk IQ loss?

A U.S. federal court is examining a controversial link between fluoride and neurotoxicity.

Necessidade e urgência de revisão da regulamentação brasileira sobre dentifrícios fluoretados, e posicionamento da academia brasileira de odontologia / Necessity and urgency to change the brazilian regulation about fluoride toothpastes, and the statement of the brazilian academy of dentistry why the current brazilian regulation about fluoride toothpastes requires urgent revision?

Introdução: a primeira regulamentação sobre dentifrícios fluoretados do Brasil (Portaria no 22, de 20/12/1989, da ex-Secretaria Nacional de Vigilância Sanitária) estabelecia não só a concentração máxima de fluoreto total (1500 ppm F) que um dentifrício deveria conter em termos de segurança de produto de higiene, como a mínima de fluoreto quimicamente solúvel (potencialmente ativo contra cárie) para garantir o benefício anticárie da escovação dental. Objetivo: demonstrar a necessidade e urgência de revisão da vigente regulamentação brasileira sobre dentifrícios fluoretados e registrar o posicionamento da Academia Brasileira de Odontologia. Fonte de Dados: Lilacs, PubMed, SciELO e nos arquivos do laboratório de Bioquímica Oral da FOP-UNICAMP. Síntese dos Dados: desde 1994, a Portaria nº 22 sofreu contínuas modificações culminando com a resolução ANVISA RDC No 530 de 04/08/2021. As mudanças feitas não foram baseadas no conhecimento científico mundial, do qual a Odontologia brasileira é referência. Assim, desde a primeira mudança feita em 1994, não mais foi dada importância à qualidade do fluoreto de um dentifrício, priorizando apenas a quantidade máxima de fluoreto total que ele deveria conter. Dezenas de publicações científicas tem sido feitas alertando para esse erro histórico, mas até o momento se mostraram infrutíferas. Trata-se de problema de saúde pública, pois em acréscimo tem afetado a população mais vulnerável à cárie dentária. Conclusão: a necessidade e urgência da revisão da resolução ANVISA nº 530, requer ação da sociedade como um todo, razão desta revisão e posicionamento formal circunstanciado da Academia Brasileira de Odontologia (AcBO).

Introduction: the first Brazilian regulation on fluoride toothpastes (Ordinance No 22 of 12/20/1989, of the National Health Surveillance Secretariat) established not only the maximum concentration of total fluoride (1500 ppm F) that a toothpaste should contain in terms of safety oral hygiene product, but also the minimum concentration of fluoride chemically soluble fluoride (potentially active against caries) that should contain to have ensure the anticaries benefit of toothbrushing. Objective: to prove the need and urgency of reviewing the current Brazilian regulation on fluoridated toothpastes and record the statement of the Brazilian Academy of Dentistry. Sources of data: Lilacs, PubMed, and SciELO databases and in the files of the Laboratory of Oral Biochemistry from FOP-UNICAMP. Synthesis of data: since 1994, the Ordinance No. 22 underwent continuous changes, culminating in 08/04/2021 with the resolution ANVISA RDC No 530. The changes made were not based on the best scientific evidence of the subject, that has the Brazilian Dentistry as an international reference. Thus, since the first change made in 1994, less importance has been given to the quality of fluoride in a toothpaste than the maximum amount of total fluoride that it should contain. Dozens of scientific publications have been made warning of this historic mistake, but so far, they have been shown fruitless. It is a public health problem that affects mainly underprivileged populations, who are most vulnerable to dental caries. Conclusion: the need and urgency for a revision of the Brazilian regulation ANVISA RDC No 530 to ensure that the population receives fluoride toothpaste with a minimum concentration of soluble fluoride with anticaries potential is the reason of this review and the formal position of the Brazilian Academy of Dentistry (AcBO).

Fluoride Revolution and Dental Caries: Evolution of Policies for Global Use.

Epidemiological studies over 70 y ago provided the basis for the use of fluoride in caries prevention. They revealed the clear relation between water fluoride concentration, and therefore fluoride exposure, and prevalence and severity of dental fluorosis and dental caries. After successful trials, programs for water fluoridation were introduced, and industry developed effective fluoride-containing toothpastes and other fluoride vehicles. Reductions in caries experience were recorded in many countries, attributable to the widespread use of fluoride. This is a considerable success story; oral health for many was radically improved. While previously, water had been the only significant source of fluoride, now there are many, and this led to an increase in the occurrence of dental fluorosis. Risks identified for dental fluorosis were ingestion of fluoride-containing toothpaste, water fluoridation, fluoride tablets (which were sometimes ingested in areas with water fluoridation), and infant formula feeds. Policies were introduced to reduce excessive fluoride exposure during the period of tooth development, and these were successful in reducing dental fluorosis without compromising caries prevention. There is now a much better understanding of the public perception of dental fluorosis, with mild fluorosis being of no aesthetic concern. The advantages of water fluoridation are that it provides substantial lifelong caries prevention, is economic, and reduces health inequalities: it reaches a substantial number of people worldwide. Fluoride-containing toothpastes are by far the most important way of delivering the beneficial effect of fluoride worldwide. The preventive effects of conjoint exposure (e.g., use of fluoride toothpaste in a fluoridated area) are additive. The World Health Organization has informed member states of the benefits of the appropriate use of fluoride. Many countries have policies to maximize the benefits of fluoride, but many have yet to do so.

[Fluoride intake through consumption of water from municipal network in the INMA-Gipuzkoa cohort]. / Ingesta de flúor a través del consumo de agua de abastecimiento público en la cohorte INMA-Gipuzkoa.

OBJECTIVE: To estimate fluoride intake through consumption of water from the municipal network in pregnant women and their children from the INMA-Gipuzkoa cohort and to compare these intakes with recommended levels. In Euskadi (Spain), fluoridation of drinking water is compulsory in water supplies for more than 30,000 inhabitants. METHOD: 575 pregnant women (recruitment, 2006-2008) and 424 4-year-old children (follow-up, 2010-2012) have been included. Fluoride levels in drinking water were obtained from the water consumption information system of the Basque Country (EKUIS). Water consumption habits and socioeconomic variables were obtained by questionnaire. RESULTS: 74.9% and 87.7% of women and children consumed water from the municipal network. Average fluoride levels in fluoridated water were 0.805 (SD: 0.194) mg/L during baseline recruitment and 0.843 (SD: 0.080) mg/L during follow up, at 4 years old of the children. Average and 95th percentile of fluoride intake were 0.015 and 0.026mg/kg per day in women and 0.033 and 0.059mg/kg per day in children. Considering only fluoride provided by drinking water, 8.71% of children living in fluoridated areas exceeded intake level recommended by the European Food Safety Authority, consisting in 0.05mg/kg per day. CONCLUSION: The results show that ingested levels of fluoride through consumption of municipal water can exceed the recommended levels in children and encourages further studies that will help in fluoridation policies of drinking water in the future.

[The impact of tap water fluoridation on human health]. / Consecuencias de la fluoración del agua potable en la salud humana.

The purpose of this review is to describe the osteological, neurological, endocrine and dermatological effects of fluoride ingestion. Additional aims are to evaluate whether the Chilean tap water fluoridation program has had any impact on dental health, and analyze the basis for the Chilean elementary school milk fluoridation program, which is targeted at children living in places where tap water has a fluoride concentration less than 0.3 mg/L, without any artificial fluoridation process. We discuss the finding that both public measures have no direct or remarkable effect on dental health, since topical dental hygiene products are the main and most effective contributors to the prevention of dental decay. We also suggest that the permanent and systematic ingestion of fluorides imposes health risks on the population. Therefore, we recommend reevaluating the national fluoridation program for public tap water and the elementary school milk program.

Consecuencias de la fluoración del agua potable en la salud humana / The impact of tap water fluoridation on human health

The purpose of this review is to describe the osteological, neurological, endocrine and dermatological effects of fluoride ingestion. Additional aims are to evaluate whether the Chilean tap water fluoridation program has had any impact on dental health, and analyze the basis for the Chilean elementary school milk fluoridation program, which is targeted at children living in places where tap water has a fluoride concentration less than 0.3 mg/L, without any artificial fluoridation process. We discuss the finding that both public measures have no direct or remarkable effect on dental health, since topical dental hygiene products are the main and most effective contributors to the prevention of dental decay. We also suggest that the permanent and systematic ingestion of fluorides imposes health risks on the population. Therefore, we recommend reevaluating the national fluoridation program for public tap water and the elementary school milk program.

Princípios e regras invocados no debate de uma política intersetorial de saúde: a proposta de revogação da fluoretação da água no Brasil / Principles and rules invoked at an intersectoral health policy debate the brazilian fluoridattion's annulment proposal

A fluoretação da água de abastecimento público é uma tecnologia de saúde pública, definida pelo ajuste da concentração do fluoreto para prevenção da cárie dentária em nível populacional. Por ser uma medida integrante da Política Nacional de Saúde Bucal e envolver diferentes setores de ação, é uma política pública intersetorial abrangente que beneficia os grupos populacionais independentemente das diferenças econômicas ou sociais desde que a rede de água alcance tanto as áreas mais ricas quanto as mais pobres. O Brasil atravessa um período de intensas transformações e as políticas públicas são instituídas através do sistema político, formado por um governo presidencialista, multipartidário e bicameralista, num processo dinâmico, havendo a possibilidade de formulações contrárias às políticas já instituídas. Em 2003, foi apresentado um projeto de lei propondo a revogação da fluoretação da água. O objetivo deste estudo foi identificar princípios e regras invocados numa política intersetorial de saúde, analisando a tramitação do Projeto de Lei No. 510/2003 na Câmara dos Deputados do Congresso Nacional do Brasil. Trata-se de um estudo descritivo por meio de pesquisa documental na qual foram selecionados registros de áudio, atas, pronunciamentos e pareceres publicados no Diário Oficial da Câmara, gerados na tramitação do Projeto de Lei em questão. Na interpretação do material, utilizou-se o neoinstitucionalismo histórico como referencial teórico considerando as influências recíprocas entre as normas e convenções oficiais e oficiosas inerentes à estrutura organizacional da sociedade e os atores em suas estratégias nos rumos, trajetórias e conteúdo das políticas públicas em um dado contexto histórico. O PL tramitou durante cerca de 13 meses, havendo a apresentação à mesa diretora do plenário da Câmara, em seguida a passagem pela Comissão de Constituição e Justiça e Cidadania, para verificar se há alguma inconstitucionalidade no projeto, a Comissão de Seguridade Social e da Família, onde o relator designado emitiu parecer pela rejeição da proposição e após tramitação na Comissão de Minas e Energia, foi arquivado. Destaca-se, além do Deputado Carlos Souza, o Deputado Roberto Gouveia (PT/SP), que explanou a respeito de sua posição quanto à rejeição ao Projeto de Lei, e o relator do parecer, Deputado Dr. Francisco Gonçalves (PTB/MG). Da interpretação do material, emergiram os princípios da segurança da intervenção, dos custos econômicos e do direito à saúde como elementos centrais no debate das políticas públicas intersetoriais. Dentre as entidades envolvidas ressaltam-se os Conselhos Federal e Regionais de Odontologia, a Associação Brasileira de Odontologia, a Organização Mundial da Saúde, os Ministérios da Saúde e das Cidades, Associação Brasileira de Engenharia Sanitária e Ambiental, dentre outras. São apresentadas e discutidas as características do jogo de interesses e do contexto conflitivo. A principal contribuição do trabalho foi a produção de conhecimento científico relacionado aos princípios e regras invocados numa política intersetorial num contexto de intensas mudanças nos planos político, econômico e cultural de transição da sociedade moderna rumo a pós-modernidade

The fluoridation of public water supplies is a public health technology, defined be the fluorine concentration adjustment aiming the prevention of dental caries into the population. Being part of Brazilians National Policy of Oral Health that involves different public sectors of action, it is a wide-ranging intersectorial public policy that benefits populational groups independently of their economic or social differences as long as the water system reach evenly the rich and the poor city areas. Brazil is passing through an intense transformation period and the public policies are established by the political system, constituted by a government that is presidential, multiparty, bicameral, into a dynamic process, enabling proposals against public policies that were previously constituted. By the year 2003, a law project was presented proposing annulment of water fluoridation. This study aimed to identify the principles and rules invoked at an intersectoral health policy, analyzing procedural protocols of Law Project 510/2003 at the Deputy Chamber from Brazilian parliament. This research is a descriptive study using documental research, where documents such as meetings audios, minutes, statements and political opinions published at the Official Chambers Diary were elected, resulting from the procedural protocols of the discussed Law Project. To interpret the findings, historical neoinstitutionalism was used as a theoretical reference considering the reciprocal influences between official and officious standards and conventions related to the societal organizational structure and the actors into their strategies at the course, path and public policy substance into a given historical context. The Law Project was carried on through 13 months, beginning its way by the presentation to the Board of Directors at the Chamber of Deputies plenary, followed by the Constitution and Justice and Citizens Commission, to see if there is any unconstitutionality at the Law Project, Social Security and Family Commission, where the rapporteur Deputy gave an opinion against the proposition and after proceeding to Energy and Mines Commission, the Project Law was archived. Additionally to Deputy Carlos Souza, it is important to mention Deputies Roberto Gouveia, from Laboral Party of Sao Paulo state, which explained his position against the Law Project, and the opinion rapporteur, Deputy Dr. Francisco Gonçalves, Brazilian Laboral Party of Minas Gerais state. From the findings interpretation, the principles of the interventions security, the economic costs and healthiness right emerged as key elements of the intersectoral public policies debate. Among the entities that were involved at the procedure protocols, Federal and Regional Dentistry Councils, Brazilian Dentistry Association, World Health Organization, Brazilian Government Health Department and Cities Department, Brazilian Sanitary and Ambiental Engineering Association and others took place into discussion. The interest play characteristics are shown and discussed as well as the characteristics of the conflictive context. This studys main contribution was a scientific knowledge related to the principles and rules invoked at an intersectoral policy into an intense change of political, economic and social plans context of transition of the modern society towards post modernity

Risk Assessment of Fluoride Intake from Tea in the Republic of Ireland and its Implications for Public Health and Water Fluoridation.

The Republic of Ireland (RoI) is the only European Country with a mandatory national legislation requiring artificial fluoridation of drinking water and has the highest per capita consumption of black tea in the world. Tea is a hyperaccumulator of fluoride and chronic fluoride intake is associated with multiple negative health outcomes. In this study, fifty four brands of the commercially available black tea bag products were purchased and the fluoride level in tea infusions tested by an ion-selective electrode method. The fluoride content in all brands tested ranged from 1.6 to 6.1 mg/L, with a mean value of 3.3 mg/L. According to our risk assessment it is evident that the general population in the RoI is at a high risk of chronic fluoride exposure and associated adverse health effects based on established reference values. We conclude that the culture of habitual tea drinking in the RoI indicates that the total cumulative dietary fluoride intake in the general population could readily exceed the levels known to cause chronic fluoride intoxication. Evidence suggests that excessive fluoride intake may be contributing to a wide range of adverse health effects. Therefore from a public health perspective, it would seem prudent and sensible that risk reduction measures be implemented to reduce the total body burden of fluoride in the population.

Necessity to review the Brazilian regulation about fluoride toothpastes.

The aim of this study was to evaluate the adequacy of the Brazilian legislation about fluoride toothpaste. A search was conducted in LILACS, Medline and SciELO databases about the fluoride concentration found in Brazilians toothpastes, using descriptors on health. Publications since 1981 have shown that some Brazilian toothpastes are not able to maintain, during their expiration time, a minimum of 1,000 ppm F of soluble fluoride in the formulation. However, the Brazilian regulation (ANVISA, Resolution 79, August 28, 2000) only sets the maximum total fluoride (0.15%; 1,500 ppm F) that a toothpaste may contain but not the minimum concentration of soluble fluoride that it should contain to have anticaries potential, which according to systematic reviews should be 1,000 ppm F. Therefore, the Brazilian regulation on fluoride toothpastes needs to be revised to assure the efficacy of those products for caries control.

How the MDA Is Working Proactively to Preserve Community Water Fluoridation in Michigan.

Community water fluoridation has famously been called "one of the top 10 public health advances of the 20th century." Its record of success in dental health is unsurpassed. And yet now, in the 21st century, were seeing renewed anti-fluoride activity across the country and right here in our local communities. The MDA is stepping up to the challenge with a new, proactive campaign to ensure that Michigan citizens continue to enjoy fluoridation's benefits.

"It Was Almost a Guerilla-Style Attack". How Boyne City Lost Fluoridation--And Got It Back.

The "antis" tried to get rid of fluoride in Boyne City. In fact, they succeeded--and fluoride was removed from the water supply. But thanks to concerned local citizens and dentists, the voters had a chance to decide the issue once and for all. Now, fluoride's back.

Necessity to review the Brazilian regulation about fluoride toothpastes / Necessidade de revisão da regulamentação brasileira sobre dentifrícios fluoretados

The aim of this study was to evaluate the adequacy of the Brazilian legislation about fluoride toothpaste. A search was conducted in LILACS, Medline and SciELO databases about the fluoride concentration found in Brazilians toothpastes, using descriptors on health. Publications since 1981 have shown that some Brazilian toothpastes are not able to maintain, during their expiration time, a minimum of 1,000 ppm F of soluble fluoride in the formulation. However, the Brazilian regulation (ANVISA, Resolution 79, August 28, 2000) only sets the maximum total fluoride (0.15%; 1,500 ppm F) that a toothpaste may contain but not the minimum concentration of soluble fluoride that it should contain to have anticaries potential, which according to systematic reviews should be 1,000 ppm F. Therefore, the Brazilian regulation on fluoride toothpastes needs to be revised to assure the efficacy of those products for caries control.

O presente estudo analisou a adequação da regulamentação brasileira vigente sobre dentifrícios fluoretados. Foi realizada busca da literatura sobre a concentração de flúor nos dentifrícios brasileiros, tendo como fontes Lilacs, Medline e SciELO, com uso de descritores em saúde. Publicações sobre a composição de dentifrícios fluoretados brasileiros têm mostrado desde 1981 que nem todos os dentifrícios são capazes de manter durante o prazo de validade uma concentração mínima de 1.000 ppm F. Esse problema ocorre não só com dentifrícios adquiridos no mercado como com aqueles distribuídos por serviços públicos de saúde. Entretanto, a legislação brasileira (Resolução 79, Anvisa, 28/8/2000) apenas estabelece que um dentifrício não pode conter mais que 0,15% (1.500 ppm F) de flúor total, sem estabelecer o mínimo de flúor solúvel que ele deveria conter para ter potencial anticárie, a qual de acordo com revisões sistemáticas deve ser igual ou maior que 1.000 ppm F. Concluiu-se que a regulamentação brasileira sobre dentifrícios fluoretados necessita ser revisada, garantindo a eficácia desses produtos para o controle da cárie.