DENTISTS AND FLUORIDATION.
Unfortunately, because [some] government officials have
put so much of their credibility on the line defending
fluoridation, it will be very difficult for them
to speak honestly and openly
about this issue.
We reserve the right to publish any of our outgoing correspondence
and incoming responses, or non-responses, on our web sites
as part of our policy of a ❝ Citizen’s Right-To-Know ❞
We do not support the addition of any fluorides to food,
water or air, this includes adding it to salt, or milk.
This website is not intended to diagnose or treat
disease. It is provided for educational
and informational purposes only.
Please consult an inappropriate
professional if you have
A dentist who changed his position on fluoridation. ↓↓↓
This work has been out of print.
Full text available here ↓
→ FLUORIDATION, 1979 ←
Scientific Criticisms and fluoride Dangers
By Philip R.N.Sutton
D.D.Sc. (Melb.), L.D.S., F.R.A.C.D.S.
Formerly Senior Lecturer in Dental Science,
Senior Research Fellow
[This is a rare book.]
‘Fluoride The Aging Factor’
Extracts → HERE
↓ Delayed Eruption ↓
ABSTRACTS from 3nd EADPH Congress
Third congress of the European Association of Dental Public
Health, 1999 Scientists, dentists and professionals have been
persecuted, censored, or harassed
when they oppose water fluoridation.
‘Second Look’ ↓ ↓
RUDOLF ZIEGELBECKER – Graz Austria:
❝ So while fluoridation is neither Safe and Effective, it continues to provide a convenient cover for many of the [vested] interests who stand to profit from the public being misinformed about fluoride. Unfortunately, because [some] government officials have put so much of their credibility on the line defending fluoridation, it will be very difficult for them to speak honestly and openly about this issue.
“Colorado Brown Stain”
It became known by the more scientific term – ‘Dental Fluorosis’.
❝ The illiterate of the 21st century will not be those who can’t
read or write – but those who cannot learn, unlearn, and relearn. ❞
( May be he had a bad dentist! )
❝ His work is important for reasons beyond its
specific scientific findings.
His work was motivated by the assumption that
ingested fluoride was beneficial.
– Odontophobia –
The Wall Street Journal says:
” Dentists Are Big Political Players
and do all they can to preserve their monopoly.”
— Huge donations secure their political agendas:
They boasted the largest single health-care PAC in 2008, gave nearly $13 million to state and local politicians in 2010, raising the question:
What do dentists want? Alicia Mundy has details on ‘The News Hub’.
Corporate Lobbyists In The Driving Seat
Dental Crisis in America: – After 68 years of water fluoridation foisted upon Americans by the American Dental Association and its constituents groups, a Dental Crisis exists in America. Senator Sanders introduced legislation to remedy this situation which is endorsed by 37 groups but not the ADA because it includes funding for Dental Therapists which would infringe upon dentists lucrative monopoly.
The ADA prefers fluoridation because it doesn’t stop tooth decay and doesn’t hurt their bottom line. In fact, dentists are making lots of money covering up fluoride-stained teeth with expensive veneers because American children are now over-fluoridated with up to 60% affected with dental fluorosis – white spotted, yellow, brown and/or pitted teeth. Veneers cost about $1,000 a tooth.
For some Americans, dental care means a sturdy chair, a fluoride swish, and a free toothbrush. But for one in three Americans, it’s a nightmare, including astronomical bills, crippling credit card debt, panicked visits to an emergency room, and life-threatening disease. These hardships are chronicled in a new ‘Frontline’ documentary, ‘Dollars and Dentists’, which airs tonight on PBS stations. ‘Frontline’ correspondent Miles O’Brien takes us behind the scenes of the documentary that explores America’s broken dental system. Frontline is produced by our partner WGBH. You can find when “Dollars and Dentists” is airing on your local PBS station here.
“…Editor–Jones et al claim that water fluoridation produces a 44% reduction in tooth decay in 5 year old children. 1 They fail to appreciate that fluoride causes a delay in tooth eruption of roughly a year. 2 This invalidates their data as they are not comparing like with like. Children aged five living in fluoridated areas should be compared with children aged four living in non-fluoridated areas.
When this is done there is NO benefit from water fluoridation…”
COMPETENCY CHECK: Airline pilots are required to undertake regular proficiency checks to ensure they continue to be competent and aware of new regulations. It would seem that the dental and medical professions are lax on this – they still promote fluoridation and other dangerous out of date practices…
Excerpts from: Roholm K. (1937).
Fluoride intoxication: a clinical-hygienic study with a review of the literature and some experimental investigations. London: H.K. Lewis Ltd.
“The teeth may be delayed in eruption and have abnormalities in size, shape and position, and resistance of such teeth is low.” p. 272
“The pathological enamel is brittle and readily chips off. The incisors wear down abnormally, which sometimes leads to defective occlusion and, as a secondary phenomenon, abnormal growth of opposing teeth. The incisors often exhibit lateral deviations; growth is retarded.” p. 272
See more research below – 1937 – Denmark by Kaj Roholm
↓ ↓ ↓ (large file with photos)
The above research is
STILL VALID AFTER 77 YEARS
Come on ADA it must be time to catch up!
EXTRACT FROM AUSTRALIAN DENTAL ASSOCIATION’S
WEB SITE DISCLAIMER:
❝ … The ADA Inc. shall not be responsible for information
provided herein under any theory of liability or indemnity.
Liability of ADA Inc., if any, for damages (including, without
limitation, liability arising out of contract, negligence,
strict liability, tort or patent or copyright infringement)
shall not exceed the fees paid by the user for the
particular information or service provided … ❞
See also Australian Dental Association’s
policy on amalgam → HERE ←
( Sounds very mumblecrust – Fills us with confidence ! )
FLUOROSIS AND THE WAYS TO CONTAIN IT
LARGE FILE → HERE ←
ADA / Qld. Labour Party Collusion:
The Queensland Health Department, funded The Australian Dental Association Queensland Branch, $220,000 as a CONtribution to its pro-fluoridation campaign. The request for this funding was directed to the Hon. Stephen Robertson MP. The Minister for Health at the time – Feb. 2006.
→ $educed by an attractive error ←
AMERICAN ACADEMY OF FAMILY PHYSICIANS
→ www.aafp.org ←
Representing 105,900 family physicians and medical students
Fluoridation of Public Water Supplies
SEE SHAME LETTER BELOW
Douglas E. Henley, M.D., FAAFP,
Executive Vice President American Academy of Family Physicians
P.O. Box 11210 Shawnee Mission, KS 66207-121021
Dear Dr. Henley:
We were distressed and disappointed to learn that the American Academy of Family Physicians, as a means of “diversifying our sources of funding…outside the pharmaceutical industry,” has created a “Consumer” Alliance with corporations, with the first deal being with the Coca-Cola Co.
1) As you undoubtedly know, Coca-Cola is the country’s and the world’s largest producer of the only food or beverage that has been demonstrated to promote overweight and obesity. Because of the kinds of products it markets, Coca-Cola Co. is desperate to burnish its soiled reputation…which is why it is paying hundreds of thousands of dollars to have a relationship with your organization. We anticipate that you will argue that the payment to AAFP is solely to provide information on your Web site about low-calorie beverages and sweeteners. A Coca-Cola spokeswoman was quoted in AAFP’s press release as saying, “Our partnership will help provide Americans with credible information…” Frankly, it is hard to think of any “partner” that is less appropriate or more biased, considering the company’s understandable defense of artificial sweeteners, natural sweeteners, and soft drinks. Scientists and public health officials generally agree that excess soft-drink consumption plays an important role in promoting obesity. There are questions about the safety of such artificial sweeteners as aspartame, saccharin, and acesulfame-potassium and about the utility of diet soft drinks in weight-loss. While AAFP may contend that it will have final say on the information that it provides to the public, it would be naïve to think that the AAFP would risk offending its funder—after all, one does not ordinarily bite the hand that feeds one, and there may be another grant in the future. The campaign against obesity must be waged using the most potent means possible. The AAFP’s Web site should be criticizing sugar-sweetened beverages in the strongest language and providing candid, objective advice about the health and safety questions related to diet drinks. But with Coca-Cola providing funding, the AAFP simply cannot do that. In the past, the AAFP’s Web site has said, “Limit consumption of sugar-sweetened beverages.”
2) We urge the AAFP to regain its credibility by rejecting the deal with Coca- Cola. If the AAFP declines to do that, we urge your organization to reassert its support for the public health (and its own independence) by supporting a warning label on caloric sugar- sweetened beverages and a federal tax on soft drinks to support health promotion or health insurance programs.
Sincerely, Henry Blackburn, M.D. Division of Epidemiology School of Public Health University of Minnesota Minneapolis, MN 55454 George A. Bray, M.D., MACP, MACE Boyd Professor Louisiana State University Pennington Biomedical Research Center, Baton Rouge, LADavid V.B. Britt Retired CEO, Sesame Workshop Guilford, CT 06437Brian A. Burt, B.D.Sc., M.P.H., Ph.D. Professor Emeritus University of Michigan School of Public HealthAnn Arbor, MI 48103 Carlos Arturo Camargo, Jr.,M.D. Associate Professor Department of Epidemiology Harvard School of Public Health Director, EMNet Coordinating Center Massachusetts General Hospital Boston, MA 02114 Marilyn E. Carroll, Ph.D. Professor of Psychiatry and Neuroscience Department of Psychiatry University of Minnesota Minneapolis, MN 55455Hans A. Diehl, Dr.H.Sc., M.P.H., C.N.S., FACN Director, Lifestyle Medicine Institute Clinical Professor of Preventive Medicine, School of Medicine, Loma Linda University
Loma Linda, CA 92354 Caldwell B. Esselstyn, Jr., M.D. Preventive Medicine Consultant Director Cardiovascular Disease Prevention and Reversal Program Wellness Institute Cleveland Clinic Lyndhurst, Ohio 44124Matthew W. Gillman, MD, SM Director, Obesity Prevention Program Professor, Department of Population Medicine Harvard Medical School/Harvard Pilgrim Health Care Institute Boston, MA 02215Joan Gussow, M.Ed., Ed.D., Professor Emerita of Nutrition and Education Teachers College, Columbia University New York, NY Stephen Havas, M.D., M.P.H., M.S. Adjunct Professor Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago, IL 60611 Suzanne Havala Hobbs, Dr.P.H., M.S., R.D., FADA Clinical Associate Professor and Director, Doctoral Program in Health Leadership Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill, NC Michael F. Jacobson, Ph.D.* Executive Director Center for Science in the Public Interest Washington, DC 20009
Lenny Lesser M.D.
RWJ Clinical Scholars Program University of California, Los Angeles Los Angeles, CA David A. Levitsky, Ph.D.
Stephen H. Weiss Presidential Fellow Professor of Nutrition and Psychology 112 Savage Hall, Cornell University Ithaca, NY 14853 Sushma Palmer, D.Sc., Chairman
Center for Communications, Health & the Environment
Washington, DC 20007 Barry M. Popkin, Ph.D.
Director, UNC Interdisciplinary Obesity Program
The Carla Smith Chamblee Distinguished Professor of Global Nutrition
School of Public Health
University of North Carolina at Chapel Hill
Chapel Hill, NC 27516
Bill Reger-Nash, Ed.D. Professor, Department of Community Medicine West Virginia University Morgantown, WV 26506Meir Stampfer, M.D., Dr.P.H.Professor of Nutrition and Epidemiology Department of Epidemiology Harvard School of Public Health Boston, MA 02115 Walter Willett, M.D., Dr. P.H. Chairman, Department of Nutrition Fredrick John Stare Professor of Epidemiology Harvard School of Public Health Boston, MA 02115 Grace Wyshak, Ph.D. Harvard School of Public Health 665 Huntington Avenue Boston MA 02115 Lisa R. Young, Ph.D., R.D. Department of Nutrition, Food Studies, and Public Health New York University New York, NY
* Please respond to Michael F. Jacobson, CSPI, #300, 1875 Connecticut Ave., Washington, DC 20009.cc: Ted Epperly, M.D., FAAFP, president
Lori J. Heim, M.D., FAAFP, president-elect
[ We say – Well Said ]
A Bibliography of Scientific Literature on Fluoride
→ SAFTEY DATA ←
(A Member of IADR)
❝ … Statements regarding the scientific controversy surrounding water fluoridation are generally regarded as artefacts of anti-fluoridationist activity, with actual scientific debate over water fluoridation being resolved decades ago. Almost all major dental and health organisations either support water fluoridation or have found no association between it and adverse health effects . Nonetheless, propagating the idea of an ongoing scientific debate gives the illusion of scientific uncertainty and is a favoured tactic of water fluoridation opponents. In 1978, Consumer Reports published a two-part series on fluoridation that concluded:
The simple truth is that there’s no “scientific controversy” over the safety of fluoridation. The practice is safe, economical, and beneficial. The survival of this fake controversy represents, in Consumers Union’s opinion, one of the major triumphs of quackery over science in our generation.”  And yet, more than a quarter of a century after these words were printed the manufactured ‘controversy‘ shows no signs of diminishing.
The review estimated the prevalence of fluorosis (mottled teeth) and fluorosis of aesthetic concern at around 48% and 12.5% when the fluoride concentration was 1.0 part per million, 9 although the quality of the studies was low. The evidence was of insufficient quality to allow confident statements about other potential harms (such as cancer and bone fracture). The amount and quality of the available data on side effects were insufficient to rule out all but the biggest effects
Well said Mr. Armfield,
however you have not been keeping
up with the recent science from overseas.
We hope our web site will help to keep you updated…
→ Joining_the_Dots_on_Australian_Fluoridation_Fraud ←
— A R C P O H —
Australian Research Centre For
Population Oral Health
University Of Adelaide:
ARCPOH Response to USHHS
(United States Health Service)
Extract: from letter by
Dr. Jason Armfield
❝… Hence, fluoride exposures of importance to dental fluorosis occur across the early childhood years. Fluoride exposures of importance to dental caries occur across the whole life-course. Developing policy to influence those exposures needs to take account of this fundamental difference. Actions to reduce fluorosis should be targeted at fluoride exposures that affect children in the early childhood years, while maintaining fluoride exposures across life for the prevention of dental caries… ❞
Well, what you are saying here,- in a round about way,
or are trying to cover up, is that dental fluorosis only
occurs during tooth formation, so reduce fluoride
from all other sources until after teeth have erupted, and no
NO HARM WILL BE VISIBLE, but do not lower the dose
in drinking water. However the evidence is, that damage from
fluoridation continues to the rest of the body after the teeth
are formed, – but will not be recorded on the teeth –
We do not think your response to USHHS is ethical
Please see the research papers on this web site, or our links
to them, including animal studies, which support our comments.
Artificial Water Fluoridation – No Benefit – Definite Harm
National data set collected in the U.S. in 1986-1987
(more than 16,000 children, ages 7-17, ↓
Over 21 fluorinated tranquillising compounds plus 58 brand-name major tranquillisers using F.
MORE OF OUR CONCERNS:
Caries / Dental Fluorosis
Because dental fluorosis only occurs during tooth formation, fluoride levels in water and exposure to fluoridated toothpaste needs to be low in children, or there will be evidence of harm.
Skeletal fluorosis can be misdiagnosed as arthritis,
Consumption of fluoridated water is difficult to monitor:
Fluid intake is relative to the “ambient air temperature”, work,
sport and exercise regimes. The availability of ‘clean’
bottled water, and RO filters, which are now commonplace
in many Australian households, and will distort the [your] data.
Because fluoride is medication, the dilemma will always be the dose,
— 1ppm is a rate – not a dose, and is not related to body weight,
or many other variables including nutritional status, kidney
function, weather, climate, latitude, elevation and daily temperature
variations at the fluoridation plant.
Medication by thirst, is scientifically irresponsible.
The observation of harm with fluoridation is modified by cross contamination,– some foods and drinks will be crossing borders of reticulated water supplies, some being fluoridated and some not, or at different levels (ppm).
No amount of long-winded circumlocution, technical language or
extensive discussions of the “appropriateness of study design “
can disguise the simple and obvious problems of trying to deliver
medication via the public water supply at a defined dose…
it defies logic, is contemptuous of science and it is professionally
irresponsible to pretend otherwise… See item # 3 IADR
Errors and Omissions – 2016 NHMRC Fluoridation PaperThere are only preliminary estimates available regarding how much F. is absorbed through our skin and lungs when we stand naked in our shower or soak in the bath contaminated by fluoridated water – and we also pay for this indignity in our water bill.
A MODEL OF THE ETIOLOGY OF FEAR
By Jason M. Armfield
“ Fear is a powerful and considerably aversive human emotion.”
… We agree with the above statement. Your paper is interesting and is widely researched but makes no mention of nutrition? We feel this is an major oversight. Animal and human behavior, reproduction, health and mental state are dependent on balanced nutrition and freedom from mind-altering chemicals.
Deficiencies of zinc, (especially for men and boys), some of the B vitamins, and vitamin K2 are well established and documented as essentials for a healthy body and a stable personality. Excess sugar, aspartame and alcohol can cause mental disturbances indeed any chemical that can interfere with the pineal gland will have psychological impacts. Bad parenting is a significant factor, but the Hopewood experience provided evidence that even this can be over come with a good diet and environment. Gov.info.
Fluoride in its various forms interferes with many nutrients, enzymes and minerals and the pineal gland, and as such is contraindicated. This last statement however may be at odds with your training and profession, but science is science and it is often in a lifetime that at least one change of belief is required in the bright dawn of a new revelation. Research papers from the 1930s and recent times, especially recent research from countries not influenced by U.S.A, and its commercial interests, confirm and reaffirm that fluoride in any of its forms is a hazard to plants, animals, enzymes, earth’s atmosphere and humans.
Dr. Jason M Armfield:
❝ …. Any action to lower the fluoride levels must be carefully
considered in order not to undermine the protective effect *…. ❞
[* read – Protection of our water fluoridation policy ]
→ An Inconvenient Tooth – Fluoride Documentary ←
A recent scientific report shows that fluoride disturbs the enzymes casein kinase II och alkaline phosfatase, which causes a disordered enamel formation. Thus, what dentists call innocent stains on the teeth is actually a symptom of chronic fluoride poisoning in the infant. Enamel damaged by fluorosis has been shown more susceptible to caries than normal enamel, recently in study of native children in South Africa who never experience any type of dental care. When considering the biological nature of fluorosis, it is not hard to understand that children during the period of dental development should avoid fluoride as much as possible, i.e. they should not have fluoride tablets, fluoridated chewing gum or drink fluoridated water or consume fluoridated salt.
Full text → HERE
❝ There is no right way to do the wrong thing. – Oren Arnold
When the debate is lost, slander becomes the tool of the loser. – Socrates
Professor Niyi Awofeso
School of Population Health
The University of Western Australia (M431) 35 Stirling Highway
CRAWLEY WA 6009 Australia
FLUORIDATION SURVEY AUSTRALIA
Merilyn Haines, the Director of FAN-Australia (Fluoride Action Network Australia) has found some startling statistics buried deep in official research material by ARCPOH (The Australian Research Centre Population Oral Health at the Adelaide Dental School) that could scuttle the water fluoridation program once and for all.
Haines has found in the ARCPOH statistics that the permanent teeth of children in largely unfluoridated (<5% before 2009) Queensland were erupting on average two years earlier than the children in the rest of Australia, which is largely fluoridated (see the figure below). A two-year delay would negate all the small reductions in tooth decay claimed by dental researchers since 1990.
In other words fluoridation doesn’t work. Any difference in tooth decay claimed to be due to fluoride is simply an artefact of the delayed eruption caused by fluoride.
Published and unpublished data from 2003- 2004
Australian Child Dental Health Surveys
(Unpublished data obtained by – Freedom of Information Application.)
→ www.fluorideaustralia.org/articleView.asp?Article=51 ←
See also the much quoted ↓
Why I Changed My Mind About Water Fluoridation Dr John Colquhoun, Dentist
↑ Extracts from “WHY I CHANGED MY MIND ABOUT WATER FLUORIDATION”
Dr. John Colquhoun © 1997 University of Chicago Press
→ LIST OF PAPERS ←
Bite Magazine and website:
→ Tiny teeth in tatters ←
→ Half of all six year olds have decayed teeth ←
A new study at the University of Sydney will try to find out what’s going wrong with their teeth. The tiny teeth of Australian toddlers are rotting and dental researchers at the University of Sydney are poised to start a long-term study to find out why.
Our comment: It looks like artificial water fluoridation is still not working.
Fluoride does not work for sheep, see below ↓
See more photos like this from ⇓
We are glad not to have his support!
This was a major revelation since Barrett had provided supposed expert testimony as a psychiatrist and had testified in numerous court cases. Barrett also had said that he was a legal expert even though he had no formal legal training.
The most damning testimony before the jury, under the intense cross-examination by Negrete, was that Barrett had filed similar defamation lawsuits against almost
40 people across the country within the past few years and –
HAD NOT WON ONE SINGLE ONE AT TRIAL …
During the course of his examination, Barrett also had to concede his ties to the: American Medical Association, (AMA) Federal Trade Commission (FTC)
Food [Fraud] & Drug Administration (FDA).
… Barrett is a shill for the medical and pharmaceutical cartels and
his bully tactics and unjustified discrediting of leading innovators,
scientists and health practitioners should not be tolerated …
See → Fluoride ← Credit Dr. Mercola
has been erected
to lie and obfuscate this issue. It cannot
tolerate a single chink in its armour of deceit.
No compromise, no partial admission is possible without
the integrity of the whole edifice of deception being threatened.
❝ It is difficult to get a man to understand something
when his salary depends upon his not understanding it. ❞
— Upton Sinclair —
USA To Lower Fluoride Levels:
ATLANTA 7 January 2011 (extracts from reports)
In a remarkable turnabout, federal health officials say many Americans are
getting too much fluoride, and it’s causing splotches on children’s
teeth and perhaps other, more serious problems.
The U.S. Department of Health and Human Services announced plans Friday (7 Jan) to lower the recommended level of fluoride in drinking water for the first time in nearly 50 years, based on a fresh review of the science. The announcement is likely to renew the battle over fluoridation, even though the addition of fluoride to drinking water is considered one of the greatest public health successes of the 20th century. One reason behind the change: About 2 out of 5 adolescents have tooth streaking or spottiness because of too much fluoride, a government study found recently. In extreme cases, teeth can be pitted by the mineral — though many cases are so mild only dentists notice it. The problem is generally considered cosmetic and not a reason for serious concern.
The splotchy tooth condition, fluorosis, is unexpectedly common in youngsters ages 12 through 15 and appears to have grown more common since the 1980s, according to the Centers for Disease Control and Prevention. But there are also growing worries about more serious dangers from fluoride. The Environmental Protection Agency released two new reviews of research on fluoride Friday. One of the studies found that prolonged, high intake of fluoride can increase the risk of brittle bones, fractures and crippling bone abnormalities. Critics of fluoridated water seized on the proposed change [on] Friday to renew their attacks on it — a battle that dates back to at least the Cold War 1950s, when it was denounced by some as a step toward Communism. Many activists nowadays don’t think fluoride is essential, and they praised the government’s new steps.
FULL TEXT → HERE ← Thanks Dr. Hinshaw
It was known for years that fluorides inhibit enzymes by binding with essential cofactors such as magnesium, phosphates, etc. Then, in 1981, our understanding of enzyme inhibition was significantly advanced by Dr. John Emsley at King’s College in London. He and his co-workers found that fluorides form very strong hydrogen bonds, actually the second strongest hydrogen bond ever found, with groups of atoms called amides. Now amides form linkages between amino acids, the building blocks of proteins. These linkages are broken by bonding with fluorides, thereby interfering with protein enzyme reactions. And not only are enzymatic promoted reactions inhibited, but the distorted proteins may be misidentified or not recognized by the immune system, leading to attempts to destroy the distorted proteins, causing abnormal allergic responses and auto-immune reactions. These responses to fluoride at levels found in one or two pints [parts?] of fluoridated water are listed in the ‘Physicians’ Desk Reference and the “United States Pharmcopeia”. Not to be ignored is the fact that DNA strands, think genes, are connected by hydrogen bonds. Fluoride attacks these bonds, thereby damaging our DNA, thereby creating genetic damage which may lead to birth defects, cancer and allergy. Notice that while fluoride causes a multiplicity of ill-effects, each of them results from disruptions of enzymes, other proteins and DNA.
FLUORIDE IN DRINKING WATER
A SCIENTIFIC REVIEW OF EPA’S STANDARDS
Committee on Fluoride in Drinking Water
Board on Environmental Studies and Toxicology
Division on Earth and Life Studies
NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Available Online → HERE ←
❝ Fluoride has a great affinity for the developing enamel because tooth apatite crystals have the capacity to bind and integrate fluoride ion into the crystal lattice (Robinson et al. 1996). Excessive intake of fluoride during enamel development can lead to enamel fluorosis, a condition of the dental hard tissues in which the enamel covering of the teeth fails to crystallize properly, leading to defects that range from barely discernable markings to brown stains and surface pitting. This section provides an overview of the clinical and histopathological manifestations of enamel fluorosis, diagnostic issues, indexes used to characterize the condition, and possible mechanisms.
CLINICAL AND HISTOLOGICAL FEATURES
Enamel fluorosis is a mottling of the tooth surface that is attributed to fluoride exposure during tooth formation. The process of enamel maturation consists of an increase in mineralization within the developing tooth and concurrent loss of early-secreted matrix proteins. Exposure to fluoride during maturation causes a dose-related disruption of enamel mineralization resulting in widening gaps in its crystalline structure, excessive retention of enamel proteins, and increased porosity. These effects are thought to be due to fluoride’s effect on the breakdown rates of matrix proteins and on the rate at which the by-products from that degradation are withdrawn from the maturing enamel (Aoba and Fejerskov 2002).
Clinically, mild forms of enamel fluorosis are evidenced by white horizontal striations on the tooth surface or opaque patches, usually located on the incisal edges of anterior teeth or cusp tips of posterior teeth. Opaque areas are visible in tangential reflected light but not in normal light. These lesions appear histopathologically as hypomineralization of the subsurface covered by a well-mineralized outer enamel surface (Thylstrup and Fejerskov 1978). In mild fluorosis, the enamel is usually smooth to the point of an explorer, but not in moderate and severe cases of the condition (Newbrun 1986). In moderate to severe forms of fluorosis, porosity increases and lesions extend toward the inner enamel. After the tooth erupts, its porous areas may flake off, leaving enamel defects where debris and bacteria can be trapped. The opaque areas can become stained yellow to brown, with more severe structural damage possible, primarily in the form of pitting of the tooth surface.
Enamel in the transitional or early maturation stage of development is the most susceptible to fluorosis (Den Besten and Thariani 1992). For most children, the first 6 to 8 years of life appear to be the critical period of risk. In the Ikeno district of Japan, where a water supply containing fluoride at 7.8 mg/L was inadvertently used for 12 years, no enamel fluorosis was seen in any child who was age 7 years or older at the start of this period or younger than 11 months old at the end of it (Ishii and Suckling 1991). For anterior teeth, which are of the most aesthetic concern, the risk period appears to be the first 3 years of life (Evans and Stamm 1991; Ishii and Suckling 1991; Levy et al. 2002a). Although it is possible for enamel fluorosis to occur when teeth are exposed during enamel maturation alone, it is unclear whether it will occur if fluoride exposure takes place only at the stage of enamel-matrix secretion. Fejerskov et al. (1994) noted that fluoride uptake into mature enamel is possible only as a result of concomitant enamel dissolution, such as caries development. Because the severity of fluorosis is related to the duration, timing, and dose of fluoride intake, cumulative exposure during the entire maturation stage, not merely during critical periods of certain types of tooth development, is probably the most important exposure measure to consider when assessing the risk of fluorosis (Den Besten 1999).
Dental enamel is formed by matrix-mediated biomineralization. Crystallites of hydroxyapatite (Ca10(PO4)6(OH)2) form a complex protein matrix that serves as a nucleation site (Newbrun 1986). The matrix consists primarily of amelogenin, proteins synthesized by secretory ameloblasts that have a functional role in establishing and maintaining the spacing between enamel crystallites. Full mineralization of enamel occurs when amelogenin fragments are removed from the extracellular space. The improper mineralization that occurs with enamel fluorosis is thought to be due to inhibition of the matrix proteinases responsible for removing amelogenin fragments. The delay in removal impairs crystal growth and makes the enamel more porous (Bronckers et al. 2002). DenBesten et al. (2002) showed that rats exposed to fluoride in drinking water at 50 or 100 mg/L had lower total proteinase activity per unit of protein than control rats. Fluoride apparently interferes with protease activities by decreasing free Ca2+ concentrations in the mineralizing milieu (Aoba and Fejerskov 2002).
Matsuo et al. (1998) investigated the mechanism of enamel fluorosis in rats administered sodium fluoride (NaF) at 20 mg/kg by subcutaneous injections for 4 days or at 240 mg/L in drinking water for 4 weeks. They found that fluoride alters intracellular transport in the secretory ameloblasts and suggested that G proteins play a role in the transport disturbance. They found different immunoblotting-and-pertussis-toxin-sensitive G proteins on the rough endoplasmic reticulum and Golgi membranes of the germ cells of rats’ incisor teeth.
HEALTH ISSUES AND CLINICAL TREATMENT
Whether to consider enamel fluorosis, particularly the moderate to severe forms, an adverse cosmetic effect or an adverse health effect has been the subject of debate for decades. Some early literature suggests that the clinical course of caries could be compromised by untreated severe enamel fluorosis. Smith and Smith (1940, pp.1050-1051) observed,
“There is ample evidence that mottled teeth, though they be somewhat more resistant to the onset of decay, are structurally weak, and that unfortunately when decay does set in, the result is often disastrous.”
Caries once started evidently spreads rapidly. Steps taken to repair the cavities in many cases were unsuccessful, the tooth breaking away when attempts were made to anchor the fillings, so that extraction was the only course.” Gruebbel (1952, p.153) expressed a similar viewpoint: “Severe mottling is as destructive to teeth as is dental caries. Therefore, when the concentration is excessive, defluorination or a new water supply should be recommended. The need for removing excessive amounts of fluorides calls attention to the peculiar situation in public health practice in which a chemical substance is added to water in some localities to prevent a disease and the same chemical substance is removed in other localities to prevent another disease.” Dean advised that when the average child in a community has mild fluorosis (0.6 on his scale, described in the next section), “… it begins to constitute a public health problem warranting increasing consideration” (Dean 1942, p. 29).
There appears to be general acceptance in today’s dental literature that enamel fluorosis is a toxic effect of fluoride intake that, in its severest forms, can produce adverse effects on dental health, such as tooth function and caries experience. For example:
“The most severe forms of fluorosis manifest as heavily stained, pitted, and friable enamel that can result in loss of dental function” (Burt and Eklund 1999).
“In more severely fluorosed teeth, the enamel is pitted and discolored and is prone to fracture and wear”
(ATSDR 2003, p. 19).
“The degree of porosity (hypermineralization) of such teeth results in a diminished physical strength of the enamel, and parts of the superficial enamel may break away … In the most severe forms of dental fluorosis, the extent and degree of porosity within the enamel are so severe that most of the outermost enamel will be chipped off immediately following eruption” (Fejerskov et al. 1990, p. 694).
“With increasing severity, the subsurface enamel all along the tooth becomes increasingly porous … the more severe forms are subject to extensive mechanical breakdown of the surface” (Aoba and Fejerskov 2002, p. 159).
“With more severe forms of fluorosis, caries risk increases because of pitting and loss of the outer enamel” (Levy 2003, p. 286).
“ … the most severe forms of dental fluorosis might be more than a cosmetic defect if enough fluorotic enamel is fractured and lost to cause pain, adversely affect food choices, compromise chewing efficiency, and require complex dental treatment” (NRC 1993, p. 48).
Severe enamel fluorosis is treated to prevent further enamel loss and to address the cosmetic appearance of teeth. Treatments include bleaching, microabrasion, and the application of veneers or crowns. Bleaching and microabrasion are typically used with the mild to moderate forms of enamel fluorosis. Bleaching is the least invasive procedure, but does not eliminate the dark stains associated with severe enamel fluorosis. Microabrasion involves the controlled abrasion of enamel to remove superficial stains… ❞
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However it does not address the matter of the nutrition, and
the variations in results e.g. vitamin C, magnesium, intake etc.
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