Rudolf Ziegelbecker – Obituary

Graz 

Relations Between Water Fluoridation & Cancer
In Man & Animals & Effectiveness In USA & EUROPE

© Rudolf Ziegelbecker

Graz 

Swiss Canton Basel-Stadt stops 

Fluoridation of Drinking Water on 9 April 2003

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The Great Council of the Swiss Canton Basel-Stadt has, on April 9, 2003, on a motion brought forward by the Commission for Health and Social Issues, totally repealed the “Resolution of the Great Council concerning the introduction of fluoridation of drinking water for the control of caries”. The fluoridation of drinking water initiated by Basel-Stadt on May 2, 1962 was thus stopped after 41 years.  

The reasons that were given were:

4. The preventive effect of the fluoridation of drinking water could not be proved by any study. When specialists do not succeed in producing definite proof in 40 years, the issue has to be abandoned.

5. In spite of the fluoridation of drinking water caries has been on the increase with children.

6. The danger of fluorosis is played down, nobody talks about fluorosis of the bones. The fluoridation of drinking water is particularly problematic in the case of  young children and babies.

7. Less than 1% of the fluoride in drinking water is actually used for “prevention of caries”, more than 99% of the fluoridated water is used for washing, cleaning, industrial production etc. and thus only pollutes the environment, a very undesirable imbalance.

Rudolf Ziegelbecker Konradin Kreuzer

Water fluoridation and cancer in man (USA and Basel (Basle, Switzerland)):

The discussion whether or not there is a relation between water fluoridation and cancer, is on the way for a long time.
In 1975 Burk and Yiamouyiannis have forced this question in the U.S. Congress. On an other data basis I have published some to this day undiscussed studies to this subject in the eighties,,.

The following figures show the relation between drinking water fluoridation, cancer and cirrhosis of liver. The analyses are based entirely on representative and official data about cancer deaths and water fluoridation in the U.S.A. for the period of 1949-1970 (more than 20 years). The regression analyses show a highly significant relation between the rate of U.S. population fluoridated by drinking water on the one hand and the cancer mortality rate, the age-adjusted cancer mortality rate and the cirrhosis of liver mortality rate on the other hand. A possible causal relation between drinking water fluoridation, cancer and cirrhosis of liver must be considered. 

Figures C1 and C2 based on representative official data show the relation between the cancer mortality rate and the fluoridation rate (percentage people receive of fluoridated water in the U.S.A.) and the relation between the death rate from cirrhosis of liver and the square of the fluoridation rate. The relation between the fluoridation rate and the cancer rate is highly significant (R-squared: 0.974223; F-test: 755.88; p = 0.0001). The relation between the fluoridation rate and the cirrhosis of liver death rate is also highly significant (R-squared: 0.972828; F-test: 716.004; p = 0.0001).

Fig. C1

Fig. C2

Figure C3 shows the cancer mortality rate in the U.S.A. observed year by year from 1949 – 1970 and the fitted cancer mortality rate in relation to the fluoridation rate, the cirrhosis of liver death rate and a dummy variable for 1958/59 (= 1). The relation is highly significant (R-squared: 0.995344; F-test: 1,282.60; p = 0.0001). The data are representative.

Fig. C3

The equation of regression is:

y = 124.941251 + 0.364222*FR%corr(F-rate) + 1.508750*LCMRcorr(LC/ 100,000) – 1.003621*DV(=1 for 1958/59; = 0 for other years)

A  question is if there exists or does not exist a short time effect on cancer death in connection with water fluoridation. I received the data for the following analysis from the Dep. Health, Educ. and Welfare, P.H.S. Off. Health Policy, Research Statistics, Hyattsville, MD. The data are representative for the U.S.A.

The establishment of water fluoridation in a limited area suddenly changes living conditions of the inhabitants of this area by one factor. Based on the authentic data of water fluoridation and cancer mortality rate in the U.S.A., the increase of cancer deaths in relation to the increase of fluoridated inhabitants is analysed. The analysis shows that there exists a significant connection, which is not correlated with the change in the number of population. Within a short time, about 3 additional cancer deaths per 10,000 newly fluoridated inhabitants must be expected.

Figure C4 shows the comparison of the increase of the observed and of the fitted number of cancer deaths in the USA 1949-1968 in the 2-years-moving-average in connection with the number of the newly fluoridated people.

 

Fig. C4

The equation of regression is:

y = 4511.734629 + 0.0003375*Mov.Av.Diff.of(F) + 1755.03904*DV

R-squared: 0.752167; F-test: 25.79; p = 0.0001

The increase of cancer death independent of fluoridation is about 4,500 per year. In the above figure the additional increase of cancer deaths in connection with the increase of fluoridated people is shown.

Fig. 26 shows that the increase of fluoridated people year by year is significantly related with the increase of cancer death year by year over 20 years. Fluoride influences the metabolism of cells and inhibits many enzymes. We cannot exclude that people who are ill by cancer die before their time by influences of fluoride.

Judging by our actual knowledge we cannot exclude that water fluoridation influences cancer.

In Basle (Switzerland) water fluoridation was started on May 2, 1962.  Figure C5 shows the trend of cancer death in the female population in Basle before (1950-1962) and during water fluoridation (1963-1983). The increase of cancer death after the establishment of drinking water fluoridation is significant. Analogous developments have been seen in males adn in group 50 – 69 years old, age corrected..

Fig. C5

In many papers a study of Hoover 1976 (National Cancer Institute (NCI)) is cited (Hoover R N, McKay FW, Fraumeni JFJ: „Fluoridated drinking water and the occurance of cancer“. J Natl Cancer Inst 1976; 57(4):757-768). It was stated that Hoover et al have not found any association between water fluoridation and cancer. 

This study of Hoover is insufficient. E.g., Hoover et al have mixed fluori­dated communities as “unfluoridated” and unfluoridated communities as “fluoridated” and then compared. Additionally the used SMR (Standard Mortality Rate) is a speculative measure based on universal expected values (Ziegelbecker R.: Zur Frage eines Zusammenhanges zwischen Trinkwasser­fluoridierung, Krebs und Leberzirrhose. gwf-Wasser/Abwasser 1987; 128(2): 111-116s).

Therefore, the study of Hoover (1976) cannot given evidence whether or not an association between water fluoridation and cancer exists.

In my critical comments I have shown some relations between water fluoridation and cancer (Fig. 23 – 27). We cannot exclude that these relations are indicators that fluoridation influences cancer in to some extent.

Water Fluoridation and Cancer in Animals (USA)

The next figure (Fig. C6) shows the significant relation between sodium fluoride concentration (x) in drinking water and percentage (P(x)) of female mice (B6C3F1) with histiocytic sarcoma and malignant lymphoma in the National Toxicology Program (NTP TR 393). 8.66 ppm is the fluoride concentration (contamination) in the diet (without drinking water) of all groups of mice.

Fig. C6

Additional to these results, last year Stan C. Freni of the FDA published a report showing that exposure to high fluoride con­centrations in drinking water is also associated with decreased human birth rates (total fer­tility rate (TFR)) in the U.S.A.

With respect to all these negative facts and after a thorough review of scientific papers on the subject, I am convinced that fluoride added to the public drinking water supplies at the “optimal” level of one part per million (mg fluoride/litre) is scientifically and medically proven to be ineffective against dental caries and harmful to human, animal, plant and aquatic life.

The discussion whether or not there is a relation between water fluoridation and cancer, is on the way for a long time. In 1975 Burk and Yiamouyiannis have forced this question in the U.S. congress. On an other data basis I have published some to this day undiscussed studies to this subject in the eighties,,.

Taking into consideration the possible side effects of water fluoridation one has to be extremely careful with water fluoridation.

1. Other risks of fluorides and fluoridation

1.1 Dental fluorosis

Dental fluorosis is a visible sign of fluoride intoxication and also indicates fluoride intoxication of the skeleton. Teeth are part of the skeleton; the fluoride uptake by bones is significantly higher than that of teeth.

In 1938 H.T. DEAN wrote: ”Probably the first attempt to study specifically the relationship of mottled enamel to dental caries was made by McKAY (7) who, in 1929, attacked the hypothesis that dental decay might be superinduced by ‘defective’ enamel structure, by citing as evidence the observation that mottled enamel teeth, which probably constitute ‘the most poorly constructed enamel of which there is any record in the literature of dentistry,’  do not appear to show any greater liability to dental caries than do normally calcified teeth.” (Pub. Health Rep. 53: 1443-1452, 1938).

In 1941 H.T. DEAN et al wrote: ”It is obvious that whatever effect the waters with relatively high fluoride content (over 2.0 p.p.m. of F) have on dental caries is largely one of academic interest; the resultant permanent disfigurement of many of the users far outweighs any advantage that might accrue from the standpoint of partial control of dental caries.” (Pub. Health Rep. 56, 761-792, 1941).

Fig. 1

Relation between natural fluoride in drinking water and % children with dental fluorosis in the USA and in Denmark.

Even fluoride concentrations of less than 1 ppm F- can cause dental fluorosis. The data suggest that about 16% of the children develop dental fluorosis (which indicates fluoride toxicity) at a drinking water fluoridation level of 1ppm F-, about 34% at 1.5 ppm F-, and about 51% of the children at a concentration of 2 ppm F- in drinking water.

Table 1

Expected dental fluorosis in relation to the fluoride concentration in drinking water

F- = 0.5 ppm	F- = 1.0 ppm	F- = 1.5 ppm	F- = 2.0 ppm
% Ch.= 3.31%	% Ch.= 16.10%	% Ch. = 34.46%	% Ch. = 51.80%

Therefore it is scientifically inacceptable recommended daily intakes of minerals (Fluoride) for adults derives from United States 1997, 1998, 2000, 2001 with 4.0 / 3.0 mg Fluoride/day 0.7 mg Fluoride / day for infants aged 6-12-months and children 1- 3 years or 1- 4 years.

 

Fluoride cumulated in skeleton in relation to fluoride uptake as Fig. 2 shows (I. ZIPKIN, F.J. McCLURE, N.C. LEONE, W.A. LEE: Fluoride Deposition in Human Bones after Prolonged In­gestion of Fluoride in Drinking Water. Pub. Health Rep. 73 (1958) 732-740).

Fig. 2

Fluoride cumulated in skeleton in relation to age of people as Fig. 3 shows (WHO-Monograph No. 59 (1970): “Fluorides and Human Health”, page 123)

Fig. 3

1. 2. Fluorides and Risks on Skeleton

Dental fluorosis is a visible sign of fluoride intoxication and moreover indicates fluoride intoxication of the skeleton.
Teeth are part of the skeleton and the fluoride uptake in skeleton is significantly higher than in teeth. The next figure (Fig. 4) shows the relation between the increase in fluoride levels and the decrease of citrate in the skeleton.

Fig. 4

These and other results provide evidence that water fluoridation influences the metabolism of the skeletal system. It is likely that these side effects are more serious in people who are known to have bone problems:

”Neurological complications of fluorosis were also observed. Symptoms may be due to a lesion of one or more nerve roots or to involvement of the spinal cord …. Radicular features: The most important manife­stations were muscular wasting, acroparasthesiae, and pain referred along the nerve roots …. Myelopathic features: The earliest symptom of spinal-cord involvement observed in all cases was weakness of both lower limbs.  This usually started in one leg, with later progression to the other. In 12 cases, after a variable interval, the upper limbs became involved, producing a spastic quadriplegia. Paraesthesiae in one or more limbs were frequent. The pattern resembled in many ways that of spondylitic myelopathy. In general, the symptoms progress fairly rapidly with progressive deterioration and restriction of acti­vity …. Thus, the clinical picture of fluorotic myelopathy may closely simulate that of cervical spondylosis, extramedullary and intramedullary tumours of the spinal cord, subacute combined degeneration of the cord, syringomyelia and motor-neurone disease. However, in view of the distinctive clinical pattern and the radiological findings, the diagnosis of fluorosis can be readily established.” (A. SINGH & S.S. JOLLY: Chronic toxic effects on the skeletal system. In: Fluorides and Human Health. WHO Monographs Series No. 59, Geneva 1970)

It is impossible to rule out completely that overly sensitive people may show side-effects even at fluoridation levels of 1 ppm F–.

[ We now know that dietary zinc levels explain
variations in fluoride toxicity. ]

Furthermore, I cited the following 2 papers: B. PALETTA, W. BEYER, E. ROSSIPAL AND M. MINAUF (Institute for Medical Chemistry, University Graz, Pregl Labaratory): Fluoridausscheidung bei Menschen verschiedener Altersgruppen (Human Urinary Fluoride Excretion of Various Ages).  Three age groups were investigated (A – 4 to 6 years, B –  25 to 45 years and C – 60 to 70 years). Results: “1. A time drift in urinary fluoride excretion in the direction of delayed fluoride metabolism was seen in group C subjects. 2. A periodic increase in the urinary fluoride values was also seen in these elderly subjects, indicative of an altered regulatory mechanism”. (Wiener klinische Wochenschrift. 88 (6) 209-212, 1976)

 

FRATZL P, RINNERTHALER S, ROSCHGER P, KLAUSHOFER K (Institue for Physics, Montanistische Universität Leoben, Styria, and Ludwig Boltzmann Institute Vienna, Austria): Mineral Crystals after Fluoride Treatment in Osteoporosis: Summary: “Fluoride therapy may lead to an altered structure of the mineral crystals in bone which, in turn, may affect its mechanical properties.  The paper reviews recent work using small-angle x-ray scattering and back-scattered electron imaging to study this question. Characteristic changes occur in the crystallinity and in the size distribution of the mineral cristals. These changes are concentrated on isolated spots in the trabecular structure, probably corresponding to bone forming sites. The number and extension of these spots typically increase with the fluoride dose and there are indications from studies with animal models that these changes in the mineral crystals correlate with a reduced biomechanical strength of bone.” (OSTEOLOGIE Band 7, Heft 3, 1998, 130-133Verlag Hans Huber, Bern (Switzerland; http://verlag.hanshuber.com/Zeitschriften/Osteo/98/os9803.html)

Other possible side effects of fluoridation include stomach and kidney disorders, the antagonism between iodine and fluoride, Down’s syndrome, cancer, also need to be considered.

2. Dentists and their „Optimal Dose“ of Fluorides

Dentists and Public Health Officials claimed that there is an ”optimal level” of water fluoridation. This conclusion is wrong. An ”optimal level” of water fluoridation, which, it is suggested, varies from 0.6 ppm in sub-tropical regions to 1.1 ppm in temperate climates, does not exist.

The claim that there is an ”optimal dosis” of 1.0 ppm fluoride in drinking water was first made by H. T. DEAN (a dentist of the U. S. Public Health Service) following his study of 21 cities. It was later repeated by H. C. HODGE. The‘Optimal dosis’ was defined as that level which ensures ”optimal” reduction in dental caries and simultanously, minimal dental fluorosis through fluoride in drinking water. The following diagram (Fig. 12) shows this relation according to HODGE (1950).

This definition of an ”optimal dosis” of fluoride in drinking water is based on scientifically invalid premises:

1. The ”dental caries reduction” in these data is a statistical artefact, constructed by dentists of the U. S. P. H. S. who selected data, which compare incomparable cities, and exclude important other factors.

2. Since the claimed ”inverse relationship” between fluoride in water and dental caries in children does not exist there cannot be an ”optimal dosis” of fluoride in drinking water.

3. The connection between dental caries in children aged 12-14 years and dental fluorosis is arbitrary. Dental caries is in a significant relation to the age of children, while dental fluorosis is not. Moreover, the coordinates of dental caries (measured as DMFT-Index) and of dental fluorosis (measured as fluorosis-Index), both in relation to fluoride in water, differ.

4. Dental fluorosis is a visible sign of fluoride intoxication and also indicates fluoride intoxication of the skeleton. Teeth are part of the skeleton; the fluoride uptake by bones is significantly higher than that of teeth. There may also be other side effects, including cancer, Down’s syndrome, stomach and kidney disorders, which have to be taken into account.

5. The total intake of fluoride by people from other sources such as food, minerals and drinks, and environmental sources, is unknown and cannot be controlled. For this reason it is impossible to define an ”optimal dosis” of 1.0 ppm of fluoride in drinking water, and the small standard deviation of 0.1 ppm F (1.0 ± 0.1 ppm F).

6. In epidemiological studies it is very difficult to find comparable conditions in two or more samples (e.g. the ”21-cities study”). It is therefore necessary to use distribution functions for such investigations. An appropriate distribution function to study the problem of dental caries and dental fluorosis is the truncated log-normal distribution function. 

7. Figure 1 and Table 1 show the relation between fluoride content in drinking water and dental fluorosis. Figure 12 shows the relation between fluoride content in drinking water and caries experience and dental fluorosis in children,,,,,,,,,,.

Fig 12.

The next graph (Fig. 13) clearly shows that there is no ”optimal dosis” of fluoride in drinking water. Firstly, the incidence of dental caries in children (12-14 years old, age corrected) is not linked to the fluoride concentration in their drinking water. Secondly, even fluoride concentrations of less than 1 ppm F- can cause dental fluorosis. The data suggest that about 16% of the children develop dental fluorosis (which indicates fluoride toxicity) at a drinking water fluoridation level of 1ppm F-, about 34% at 1.5 ppm F-, and about 51% of the children at a concentration of 2 ppm F- in drinking water.

Fig. 13

The total intake of fluoride by people from other sources such as food, minerals and drinks, and environmental sources is unknown and cannot be controlled. For this reason, and because positive effects do not exist and because of possible side effects, it is impossible to define an ”optimal dose” of 1.0 ppm of fluoride in drinking water and the small standard deviation of 0.1 ppm F (1.0 +/- 0.1 ppm F).

3. Dentists and their “Benefits” of Fluoridation

3.1 Analysis of Relation between Natural Fluorides in Drinking Water and Dental Caries (“DEAN-Statistic”) in Children

The next figure (Fig. 14) shows the fundamental dentists’ study which was the premise to establish the introduction of water fluoridation all over the world.

In 1942, Figure 14 was published by the U.S. P. H. S. dentists H. T. Dean and F. A. Arnold Jr. et al. This figure shows an inverse relation between dental caries experience of children and the natural fluoride content of the public water supply. In the following 60 years (between 1942 and 2002) this ” inverse relation” was uncritically accepted and interpreted as proof for the beneficial effect of water fluoridation by most dentists and public health officials all over the world.

Fig. 14

Notes: The following items (a) to (h) show that the German Health Officials H. BUSSE and K. BERGMANN  knew how the “inverse relation between fluoride and dental caries” by DEAN et al — and by other authors in other studies (e. g. P. Adler (Hungary) and I. Møller (Denmark)) — had been constructed. In spite of this knowledge they used the untenable data and the GLIM-Model to construct an “inverse relation between fluoride and dental caries” in Fig. 4 in their paper “Fluoride and Dental Caries: Two different statistical approaches to the same data source” in Statistics in Medicine, Vol. 6, 823-842 (1987). This is a serious case of scientific misconduct and dishonesty.

The following analyses show conclusively and understandable that the relevant studies and papers of H. T. DEAN have serious deficiencies, are partly improbability and cannot be maintained scientifically. The “inverse relation between the natural fluoride content in drinking water and dental caries of children” as stated by H. T. DEAN does not really exist. It is not the result of a genuine caries prophylactic effect of fluoride, but from inadmissible data selections, illegal comparisons, neglect of causal factors of dental caries, statistical artifacts, and false conclusions from data.

(a) The authors (dentists of the P.H.S.) compared incomparable cities^{6,8,9,10, , ,.}

(b) The authors selected cities and children to prove: ”more fluoride in drinking water, less dental caries in children, less fluoride in water, more dental caries in children.”

(c) Authors excluded such important factors as dietary habits and eating patterns, consumption of sugar and carbohydrates, and L. Acidophilus counts in saliva from their studies (Fig. 15). In a paper published in 1941 H.T. DEAN wrote: ”The differences in the counts of L. acidophilus in the saliva corresponded to the differences in the dental caries experience in the groups of communities studied” (DEAN studied 8 Suburban Chicago Communities). In his famous 21-city-study of 1942, however, DEAN excluded the L. Acidophilus data, although the 8 suburban Chicago communities are included among the 21 cities.

Fig. 15

Relation between dental caries and L. acidophilus – concentration in saliva  in children aged 12- to 14 years in 10 cities of the 21 cities study by Dean et al.

8. The authors excluded such important factor as delayed tooth eruption. Fig. 16 and Table 2 shows the number of delayed permanent teeth in relation to the fluoride content in drinking water in 10% of the children aged 12-14 years in 12 of the 21 cities investigated in the study (tooth eruption data published only for these 12 cities by E.M. SHORT)6,. Teeth which erupted later got attacked later by caries.

Fig. 16

Delayed permanent teeth in relation to natural fluoride content in drinking water in the U.S.A.

Tab. 2

Fluoride in drinking water (ppm)	No. of maxi­mally erupted permanent teeth	No. of delayed    permanent teeth
2.6	16.3	5.4
1.8-1.9	18.8	2.9
1.2-1.3	20.3	1.4
0.5-0.6	20.8	0.9
0.0-0.1	21.7	0.0

(e) The authors also ignored the existence of an East-West decline in dental caries prevalence in the U.S.A. (Fig. 17). For instance in 1933/34 the difference between the mean DMFT of children aged 12-14 years in New Jersey and in Colorado was 5.60 – 2.74 = 2.86 DMFT. The ”reduction” was 49% (!). Some of the cities compared in the 21-cities study are several hundred, some even several thousand kilometers apart. The existence of an East-West decline in dental caries prevalence must be taken into consideration.

Fig.17

East-West decline in dental caries prevalence in the U.S.A. 1933/34, children are 12-14

 

(f) If dental caries rates are compared in children from different cities in epidemiological studies it is also necessary to establish the trends for dental caries prevalence in the previous years. Such analyses show the different increase of dental caries prevalence of 12-14 years old children from 6 cities with low fluoride between 1933/34 and 1941/42 independent of the fluoride content in drinking water (Figure 18).

(g) The analyses show that the dental caries prevalence data in the 6 cities with low fluoride concentrations are different, and that they are not linked to the fluoride in drinking water; caries in fact increased between 1933/34 and 1941/42. This increase was clearly caused by factors other than fluoride. In 1933/34, 3 cities (Elkhart (0.1 ppm F-); Lima (0.3 ppm F-); Pueblo (0.6 ppm F-)) had about the same dental caries prevalence as the highly fluoridated city of Colorado Springs (2.6 ppm F-). In the 21-cities study by H.T. DEAN and F.A. ARNOLD, Jr., et al Colorado Springs and the 6 low-fluoride cities were compared with 14 other cities. This comparison of incomparable cities led to the introduction of water fluoridation in Grand Rapids in 1945. In their comparison the authors reached the conclusion – which was based on no scientific evidence – that the differences in dental caries prevalence, which were in fact caused by factors other than fluoride, were the result of differences in the fluoride content of the public drinking water supply. In other words, the authors concluded that the different dental caries rates found in cities with low fluoride levels (where dental caries increased, yet for reasons not linked to the fluoride content in the drinking water) and cities with high fluoride concentrations proved that fluoride in drinking water was able to decrease dental caries.

Fig. 18

Change of dental caries prevalence data in the 6 cities with low and 1 city with high fluoride concentration in drinking water between 1933/34 and 1941/42. All cities are from the ”21-cities-study” by H.T. Dean et al 1941/42.

(h) The authors of the ”21-cities-study” excluded all the other components in drinking water except fluoride as possible factors influencing dental caries. In the same 10 cities in which L. acidophilus – values are available concentration of NaF in drinking water and dental caries in children are significantly negatively correlated. Fig. 19 shows this relation,

Fig. 19

Relation between Na content in drinking water (ppm) and dental caries (DMFT) in children 12 – to 14 years old in 10 cities of the ”21-cities-study” (1942)

In a ”stepwise regression analysis” with the components of F-, HCO3, Na and K as Na, Mg, SO4, Ca, Cl, Fixed residue, in drinking water and L. acidophilus in saliva of children as independent variables (Xi, i = 1, 2, …, 9) and Y = DMFT as response variable only the variables X3 = Na and X9 = L. acidophilus were included in the regression as significant and the variable X1 = F- was excluded as non-significant.

The regression equation is

(1) ln DMFT/(28-DMFT) = – 2.907 + 0.567*ln L. acido – 0.226*ln Na

R2 = 0.9899; F-test: 340.446; p = 0.0001; Partial F(L. acido) = 14.321, 

p= 0.0069; Partial F(Na) = 38.842, p = 0.0004

It is obvious that natural fluoride in drinking water in the ”21-cities-study” is not significant correlated with dental caries in children aged 12- to 14 years.

Conclusion:

The results of the above analyses of the 21-cities study by H.T. DEAN and F.A. ARNOLD, Jr. et al, (1942), show that the study is scientifically invalid and that the authors constructed the ”inverse relationship” between fluoride in drinking water and dental caries prevalence in children. A statistical artefact was created.

1. 2. Meta-Analysis of Relationship between Natural Water-fluoridation and Dental Caries in Children

Fig. 20 shows the relationship between the natural fluoride content in drinking water (ppm F) and dental caries (DMFT-Index, age corrected) in children 12 – 14 years old from 215 communities, in a coordinate system adequate to the problem11 12 13 17 . The fluoride content range is 0.0 ≤ ppm F ≤ 5.8, with an additional 0.3 ppm F (mean) from other sources (food, drink). Two regressions were made, firstly for the range 0.0 ≤ ppm F ≤ 0.35, secondly for the range 0.36 ≤ ppm F ≤ 5.8. 141 communities fell within range 1. Here, data were frequently selected by dentists according to the principle “low fluoride level — high caries prevalence”. 74 communities were in the range 0.36 ≤ ppm F ≤ 5.8. The confidence bands for the true mean of Y were 95%. Data in range 2 we can assume as approximate random sample and representative for the areas.

Statistical model is the regression equation:

(2) ln y/(28-y) = ln(a) + b.ln(x) + e(x)

In this model of regression all influences of factors on dental caries including diagnostic errors without the possible influence of fluoride be lying in the residuals e(x). x = Fluoride Concentration + 030 (ppm), y = Dental Caries (DMFT-Index),

Statistical data :

1. regression: Y = -1.678*X – 3.016; n = 141; R2 = 0.172, F = 28.938, p = .0001

2. regression: Y =  0.064*X – 2.220; n =   74; R2 = 0.0018, F = 0.131, p = 0.719

Fig. 20

Relationship between the natural fluoride content in drinking water (ppm F) and dental caries (DMFT-Index, age corrected) in children 12 – 14 years old from 215 communities

The mean DMFT in regression of range 1 for 0.35 ppm fluoride in water is y0.35 = 2.57 DMFT.

The mean DMFT in regression of range 2 for 0.70 ppm fluoride in water is y0.70 = 2.74 DMFT.

The mean DMFT in regression of range 2 for 1.00 ppm fluoride in water is y1.00 = 2.78 DMFT.

Additionally we assume that in a population many qualitative and quantitative unknown factors influence the quantities of dental caries (DMFT) and that dental caries in the population follows a truncated log-normal distribution. We sorted the quantity of yi = DMFTi, i = 1, 2, …., N and computed the cumulative frequency. The cumulativ relative frequency is Phi (z) = (i – 0.5)/N in class midpoint. We assume the cumulative distribution Phi(z) as GAUSS-distribution (normal distribution) and z = z(Phi) as the inverse function^{11 12 13 19} .

If the distribution of dental caries (DMFT) in equation (2) follows a truncated log-normal distribution we have

 

(3) z(Phi) = ln a + b*ln (DMFT/(28-DMFT))

Fig. 21 shows the distribution of dental caries (DMFT) in children 12- to 14 years old in 144 communities with natural water fluoridation in range 0.3 – 5.8 ppm fluoride (see range 2 in Fig.20). The distribution shows that the data are approximate random samples. 

The median of DMFT is  ym [DMFT] = 3.05 DMFT.

Fig. 21

Distribution of dental caries (DMFT, age-corrected) in children 12- to 14 years old in 144 communities with natural water fluoridation in range 0.3 – 5.8 ppm fluoride

Conclusion from meta – analysis of relation between natural fluoride and dental caries:

Fig. 20 proves without any doubt that the “inverse relation between natural fluoride in drinking water and dental caries in children” does not exist. Fluoridation of community water supplies does not produce the benefits claimed as a main public health strategy for the prevention of dental caries in USA, UK or other states.

3.2 Meta-Analysis of Relationship between Artificial Water-fluoridation and Dental Caries in Children in USA

The following analyses use equation (3) and data from the 1986-87 National Survey of US School-children,.

In the last 32 years I have analyzed many studies and experiments with fluoridated drinking water. Not a single study provides scientific evidence for claims that water fluoridation protects teeth and helps maintain dental health. Dentists interpreted the influences of other factors and statistical artifacts in the studies and experiments as ”benefits in the prevention of dental caries” due to water fluoridation.

A national survey of the oral health of U.S. children aged 5-17 was conducted by the National Institute of Dental Research during the 1986-87 school year. A multi-stage probability sample was drawn to represent the 43 million children in this age group. Over 39,000 children aged 5-17 received examinations. Results of the study were published in 1989 and 199024,25.

Fig. 22 shows the distribution (truncated log-normal) of dental caries in 13,882 children 5 – 17 years old (DMFT) in 30 non-fluoridated areas in the USA. The data are randomised, representative samples, and age weighted. [NF = non-fluoridated].

Results of regression analysis are: Y = 4.55936_*X + 11.81637, r² = 0.9637; The relation is highly significant: R-squared: 0.963704, F-test: 743.42, p = 0.0001.

Fig. 22 shows wide variations in DMFT in children in non-fluoridated areas. Median for children in unfluoridated areas: m = -11.81637/4.55936 = -2.591672; ym [DMFT] = (28.em)/(1+em) =  (28*0.07489)/(1.07489) = 1.95 DMFT.

 

If we assume that lifetime exposure to water fluoridation reduces dental caries by about 40% to 60% we can compute a model based on this hypothesis. In this model we use uniform random numbers between 0.40 and 0.60 and then, from the DMFT of children in non-fluoridated areas, the expected DMFT of children with lifetime exposure to fluoridation with a caries reduction of between 40% to 60%.

In Fig. 22 we show a simulation of distribution of dental caries in children, reduced by between 40% to 60% and computed from the data in Fig. 22 (distribution of dental caries in US-children living in non-fluoridated areas).

The slope = 4.56376 in Fig. 22 is about the same than of dental caries in US-children living in non-fluoridated areas (slope = 4.55936). Y = 4.56376*X + 15.29573; r² = 0.97567 The median is m = -3.35156 and ym [DMFT] = 0.94763 ≈ 0.95 DMFT. That is a ”caries reduction” of 51.3% in this simulation which dentists expected in life-long fluoridated children in the USA.

Fig. 22 summarizes the representative dental caries data (DMFT-index), applying the conditions of the truncated log-normal distribution. 13,882 children aged between 5 and 17 from unfluoridated areas were compared with 12,747 children from fluoridated areas (they had been exposed to water fluoridation throughout their lives). The figure shows wide variations in the incidence of dental caries (DMFT-Index).

 

Fig. 22 moreover shows the large differences of medians of DMFT-index between ”caries reduction” in children exposed to water fluoridation throughout their lives, as expected by dentists  (see simulation) and the real  medians of DMFT-Index in children aged between 5 and 17 in unfluoridated areas and in fluoridated areas children. There is no difference of medians of DMFT-Index.

The results of this analysis of representative caries data are:

1. Dental caries in U.S. school children aged 5-17 follows the truncated log-normal distri­bution. The relation is highly significant. Children in unfluoridated areas: R-squared: 0.963704, F-test: 743.42, p = 0.0001. Children in fluoridated areas: R-squared: 0.983749, F-test: 1,513.35, p = 0.0001. The regression equations are: Children in unfluoridated areas: z(Phi(NF)) = 4.559361*ln(DMFT/(28-DMFT)) + 11.81637, Children in fluoridated areas: z(Phi(F)) = 4.447082*ln(DMFT/(28-DMFT)) + 11.598273

2. Dental caries incidence in children in unfluoridated and fluoridated areas has virtually the same median (median for children in unfluoridated areas: -2.591672; median for children in fluoridated areas: -2.608064; 99.99% confidence interval of slope; for children in unfluoridated areas: 3.801879 and 5.316844; children in fluoridated areas: 3.919112 and 4.975051).

(c) Median of DMFT-Index in Fig. 22:

Children in non-fluoridated areas: 1.95 DMFT

Children in fluoridated areas: 1.92 DMFT …  not any ”reduction”!

Children in simulated areas: 0.95 DMFT

(d) From these results it can be concluded that in this representative survey of the National Institute of Dental Research the children receiving unfluoridated water and those receiving fluoridated water were from the same population (math.). If fluoride reduced dental caries in representative random samples by more than 5% (about 50% was stated by Dental Health Officials, dentists and promotors of fluoridation), the median and the variance would have to differ significantly and we would have two populations.

Fig. 22

Dental caries DMFT (average-age-adjusted) of children aged 5- to 17 years in non-fluoridated (NF) and fluoridated (F) areas in the U.S.A. 1986-87 (Fluoridation started before 1970) and simulation of ”caries reduction” (Red. DMFT) as expected by dentists.

Conclusion:

From these analyses and from Figure 22 we must conclude that drinking water fluoridation in the U.S.A., even in households where children received fluoridated drinking water throughout their lives, did not reduce dental caries in children.

4. Results of Alternative Methodes to Water Fluoridation in Prophylaxis of Caries with Fluoride

4.1 National Preventive Dentistry Demonstration Program

The National Preventive Dentistry Demonstration Program (NPDDP) was contacted to assess the costs and effects of various types and combinations of school-based preventive dental procedures (1977 – 1984). It was a longitudinal-field-study and included about 30.000 about 30.000 children ages 5 to 14 in 10 U.S. communities. The RAND CORPORATION of Santa Monica, CA, an independent, non profit research institution that conducts policy research and analysis on problems of national security and domestic affairs, was separately funded to conduct an independent evaluation of the effectiveness and costs associated with the various preventive procedures. The study started 1977 and ended 1984.

The next figure (Fig. 23) shows the effect of “classroom procedures” in 4 years (NF = Nonfluoridated sites: Fluoride mouthrinse once per week, One tablet per day, Plaque control, Education; F =  (Water-)Fluoridated sites: F-Rinse, Plaque control, Education). 1+2 or 5: The children were 5-6 or 10 years old, when the program starts.

Fig. 23

Fig. 23 shows that in the classroom-program only one group of children received a “save” of only about a half surface in 4 years. The “save” of teeth of the other groups of children was zero or negative.

The RAND CORPORATION stated:

• The effectiveness of regular use of fluoride mouthrinse (with or without tablets) was considerably lower than reported in other studies.

• The costs of delivering comprehensive regimens of preventive dental care were far higher than had been previously estimated.

4.2 Dental caries and fluoridation in Europe

Fluoridation was stopped in Kassel (Western Germany; 1971), in the Netherlands (1976), in Ceske Budejovice (Budweis) and Prague (Czechoslovakia; 1988), in Karl-Marx-Stadt (German Democratic Republic; 1990) and all over Eastern Germany in 1990/91. The administration of fluoride-containing tablets to school children was stopped in several Graz and Styria  (Austria; 1973), in Saarbrücken, in Saarlouis, in Bielefeld (Western Germany; 1984), in Berlin-Wilmersdorf and Berlin-Charlottenburg (Western Germany; 1985), in the province of Carinthia in Austria, 1986, and in the remaining Austrian federal states in 1994/95. Several cities and states have decided not to implement fluoridation, including St. Gallen and Geneva (Switzerland), and Berlin and Hamburg (Western Germany). Generally, water fluoridation and other fluoridation schemes in Europe are on the decrease.

Although the WHO and WHA recommended the introduction of community water fluoridation in 1969, 1975, and 1978, several European member states of WHO in fact ceased to fluoridated water. Their decision was motivated not by political reasons, but the result of growing controversy over the purported effectiveness of water fluoridation and fear of side effects. Water fluoridation was stopped in the following States: Federal Republic of Germany (fluoridation introduced 1952, stopped 1971); Sweden (introduced 1952, stopped 1971); Netherlands (introduced 1953, stopped 1976), Czechoslovakia (introduced 1958, stopped 1988/90), German Democratic Republic (introduced 1959, stopped 1990 (Spremberg 1993)), Poland (introduced 1968, stopped 1991/92); Union of Soviet Socialist Republics (introduced 1960, stopped 1990), Finland (introduced 1959, stopped 1993); outside Europe: Japan (introduced 1952, stopped 1972). Against prognosis dental caries decreased after stop of fluoridation.

The next two figures (Fig. 24 and Fig. 25) show comparisons of dental caries in adults aged 35-44 years in 25 european States and in 9 States, respectively (data of WHO)

Fig. 24

Fig. 25

The comparison shows that European countries such as Switzerland with intensive fluoridation programs (F-tablets since 1952, F-salt since 1955, water fluoridation in Basle since 1962, many individual and school programs with fluoride) and Eire (drinking water fluoridation about 60% of population since 1964 and individual programs) are ranking with high dental caries in 1983-1989.

4.3 Salt Fluoridation in Switzerland and Dental Caries

Salt fluoridation in Switzerland starts in 1956. In 1967 in 11 of the 22 cantons in Switzerland more than 90% of households used packets of F- salt (Table 3).

Table 3

Kanton	Fluorsalzbezug in kg (1967)	Fluorsalzbezug in % des Paketsalzbezuges	Fluorsalzbezug pro Kopf und Jahr (kg/Jahr)	Fluorsalzbezug pro Kopf und Tag (g/Tag)
Wallis	644 700	99	3,39	9,28
Graubünden	363 300	93	2,36	6,47
Appenzell A.-Rh.	108 900	100	2,16	5,92
St. Gallen	759 500	100	2,11	5,78
Thurgau	389 000	100	2,10	5,78
Luzern	580 100	98	2,09	5,73
Appenzell I.-Rh.	27 000	100	2,00	5,48
Freiburg	323 500	92	1,98	5,42
Neuenburg	309 000	100	1,90	5,21
Zug	118 000	98	1,89	5,18
Zürich	1 938 000	97	1,83	5,01
Aargau	490 320	59
Baselland	111 900	28
Bern	787 040	51
Glarus	37 200	58
Nidwalden	31 800	77
Obwalden	31 000	80
Schaffhausen	152 000	86
Schwyz	25 200	34
Solothurn	192 700	63
Tessin	1 400	–
Uri	37 000	51

The following figures (Fig. 26 and Fig. 27) show the dental caries of children aged 10 and 12 years with (testgroup) and without (controlgroup) salt fluoridation and a comparison with Dental Carieschildren from Canton Zurich (F-tablets and individual prophylaxis with fluoride), from Canton Basle – City (water fluoridation and individual-prophylaxis) and a comparison with children in Graz (Austria) after stop of fluoride tablet action in schools and kindergartens in March 1973.

Fig. 27

Fig. 26 and Fig. 27 show about the same decrease and increase in dental caries with fluoride salt and without fluoridation in the same time in children aged 10 and 12 years. Only one value in 12 year old children with salt fluoridation in 1982 is lower. It is possible that this is a statistical artifact because in children aged 10 years dental caries increased with salt fluoridation. The group of tests with salt fluoridation had allready from the outset less dental caries then the control’s group without fluoridation.. The children in Graz had the same denta caries and caries decrease without fluoride approximately as the children in Basle and Zürich with intensive fluoridation. This shows that other factors than fluoride determine dnetal caries.

Therefore fluoride in salt is an untenable “public health measure”. 

Summary:

The extensive analyses of comprehensive authentic data give evidence that fluoride does’nt reduce dental caries and has inacceptable toxic side effects. Therefore fluoride is unsuitable as a supplement in food and in drinking water.

   Graz, 13 August 2003

       Rudolf Ziegelbecker

The National bird symbol of Austria