By The Fluoride Action Network
According to the U.S. Surgeon General, “there are profound and consequential disparities in the oral health of our citizens…” that have resulted in a “silent epidemic” of dental and oral diseases that disproportionately affects low-income and minority populations1.
Unfortunately, not only are these groups afflicted with worse dental health, but are also suffering more extensively from the public health measure carried out under the guise of improving oral health: water fluoridation.
The Environmental Injustice of Water Fluoridation
One of the goals of the U.S. Environmental Protection Agency (EPA), and particularly of its administrator Lisa Jackson, is achieving Environmental Justice for all Americans. According to the EPA (2011):
“Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. EPA has this goal for all communities and persons across this Nation.
It will be achieved when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.”
Unfortunately, the agencies and associations that continue to promote artificial water fluoridation – including the EPA’s Office of Water, the U.S. Centers for Disease Control and Prevention’s (CDC) Oral Health Division, the U.S. Department of Health and Human Services (HHS), and the American Dental Association (ADA) – have completely ignored racial, ethnic, and socioeconomic differences when stating that the level of fluoride used is “safe” for all Americans to consume in drinking water – on a daily basis, and over a lifetime.
A number of groups are particularly susceptible to fluoride’s toxic effects.
Fluoridation proponents are finally beginning to acknowledge the susceptibility of infants and children to excessive fluoride intakes, likely because they can no longer deny the obvious effects that fluoride has on the developing teeth, in the form of dental fluorosis.
Nearly 41 percent of adolescents aged 12-15 now have some form of dental fluorosis2, an outwardly visible sign of fluoride over-exposure and toxicity.
However, also included among those that are disproportionately impacted by fluoride are minorities and low-income families. The refusal by government agencies to consider these groups when determining enforceable safety standards or recommended levels for artificial fluoridation is no doubt a form of discrimination, contradicting any assertions by these agencies that they are working towards Environmental Justice for all.
Atlanta Civil Rights leaders Andrew Young and Reverend Dr. Gerald Durley recently requested that Georgia legislators repeal the state’s mandatory water fluoridation law, based on the fact that fluoride can disproportionately harm poor citizens and black families.
According to a recent press release3 , the leaders “expressed concerns about the fairness, safety, and full disclosure regarding fluoridation in letters to the state’s minority and majority legislative leaders.” In his ,
“I support the holding of Fluoridegate hearings at the state and national level so we can learn why we haven’t been openly told that fluorides build up in the body over time, (and) why our government agencies haven’t told the black community openly that fluorides disproportionately harm black Americans…”
Minorities Suffer Disproportionate Harm from Fluoridation
African American children have been found to consume significantly more total fluids and plain water, and thus receive more fluoride from drinking water, than white children4 . Additionally, African American mothers are less likely to breastfeed than most other racial groups5 . As breast milk contains very low levels of fluoride6 ), babies fed formula made with fluoridated water could receive up to 200 times more fluoride than a breast-fed baby.
Thus, African American infants and children have a higher risk of being overexposed to fluoride.
In fact, it has been known for many decades that African Americans and Hispanics are at an increased risk of developing dental fluorosis, and have a higher risk of suffering from the more severe forms of this condition7.
Data published in CDC’s Morbidity and Mortality Weekly Report in 2005 show that Black and Mexican Americans have significantly higher levels of the worst forms of dental fluorosis than do Whites, as indicated in the following table from Beltrán-Aguilar et al. (2005; Table 23).
Table 23. Enamel fluorosis* among persons aged 6-39 years, by selected characteristics – United States, National Health and Nutrition Examination Survey, 1999-2002. Source: Beltrán-Aguilar et al., 2005.
Factors that Influence Fluoride’s Toxicity
Fluoride’s toxicity is exacerbated by:
Inadequate nutrition, including lower intakes of iodine and calcium8
Certain racial groups are more likely to be lactose intolerant than others. Included among these are:
- Central and East Asians (80-100 percent lactose intolerant; de Vrese, 2001)
- Native Americans (80-100 percent lactose intolerant; National Institute of Child Health and Human Development, 2006)
- African Americans (75 percent lactose intolerant; de Vrese, 2001), and
- Southern Indians (70 percent lactose intolerant; de Vrese, 2001)
The elevated incidence of lactose intolerance may indicate lower rates of milk consumption, and higher consumption rates of water or other beverages, than whites (21 percent lactose intolerant; Scrimshaw and Murray, 1988).
Thus these groups may be more heavily exposed to fluoride in water and other beverages than are Caucasian Americans, and their calcium intakes may be compromised.
- Kidney dysfunction and diabetes, which are more prevalent among minorities than whites.
Both African Americans and Hispanics are nearly twice as likely to suffer from diabetes than are whites11.
- Inadequate supplies of vitamin C, vitamin D, magnesium, and selenium may also exacerbate fluoride’s detrimental effects12.
Inadequate Nutrition Heightens Fluoride’s Health Risks
Poor nutrition has been found to increase the incidence and severity of:
The dose of fluoride associated with disturbed endocrine function is also substantially lower if you’re deficient in iodine (NRC, 2006). Even modest levels of fluoride in drinking water (0.88 mg/L) have been associated with reduced IQ and increased frequency of hypothyroidism when combined with low iodine, even more so than with iodine deficiency alone (Lin et al., 1991).
As poor nutrition frequently occurs among low-income families, poor children and adults are therefore far more susceptible to the detrimental effects of fluoride exposure.
Low-income families typically consume substantially less fresh fruits and vegetables, and thus more processed foods, than higher income groups. In addition to generally being less nutritious, processed foods – including those containing mechanically de-boned chicken – can also contain relatively high levels of fluoride.
Moreover, the increasing dietary intake of harmful trans fats in the United States, especially among lower income groups, may have negative repercussions in terms of fluoride metabolism. According to the U.S. Department of Health and Human Services:
“Diets high in fat have been reported to increase deposition of fluoride in bone and, thus, to enhance toxicity” (HHS, 1991).
Additionally, as with African Americans, low-income children have been found to consume significantly more total fluids and plain water – and thus receive more fluoride from drinking water – than higher-income children, putting them at greater risk for fluoride’s toxic effects.
Also of concern is the inability of low-income families living in fluoridated communities to provide low-fluoride or fluoride-free water to reconstitute infant formula. Low-income families are likely not able to afford expensive filtration systems to remove fluoride from tap water, nor are they likely able to afford bottled water containing low or no fluoride.
Thus, bottle-fed infants of low-income families are at an increased risk for suffering from over-exposure to fluoride during this very sensitive developmental period.
Income Level is Strongest Indicator of Tooth Decay, Regardless of Water Fluoridation
According to the American Dental Association (ADA, 2009),
“[L]ow income is the single best predictor of high caries [cavity] experience in children. Analysis of data shows that the amount of tooth decay in children is inversely related to income level.”
In 1988, an editorial published in the Journal of Dental Research (Newbrun, 1988) reported that “About 20 to 25 percent of children are at relatively high risk of caries, despite the declining caries prevalence in the ‘fluoride generation’.” The high-risk children included the poor.
In 1995, it was found that more than 50 percent of U.S. schoolchildren had experienced cavities (Edelstein and Douglass, 1995), when preschoolers and cavities in the primary teeth were considered. According to the authors,
“Minority, low-income and underserved groups continue to experience extensive destruction in both primary and permanent teeth.”
Actually, 42 percent of five-year-olds and almost 60 percent of nine-year-olds had cavities in their primary and permanent teeth, according to National Institutes of Dental Research 1986-1987 data.
The most recent oral health statistics (1999-2004) show a direct link with tooth decay and poverty level. For example, the incidence of caries is much higher in children from families with lower income levels (HIW, Undated a-c):
% Caries rate for
% Caries rate for
% Caries rate for
|Family Income as % Federal Poverty Limit|
In 2008, the U.S. Government Accountability Office (GAO) reported that the extent of dental disease in children has not decreased, and estimated that 6.5 million children two through 18 years of age on Medicaid suffer with untreated tooth decay (GAO, 2008). In November 2010, the GAO reported “high rates of dental disease and low utilization of dental services by children in low-income families, and the challenge of finding dentists to treat them are long-standing concerns” (GAO, 2010).
A study recently published in the Journal of Dental Research15 (also found a significant relationship between tooth loss and state income inequality among adults in the United States, with the risk for tooth loss being about 20 percent greater for those living in economically “disadvantaged” areas.
Despite claims to the contrary by promoters of fluoridation, low-income children still have high rates of tooth decay even when their drinking water is artificially fluoridated.
For example, in Georgia where fluoridation is state-mandated, 44 percent of 2 to 5-year-old Head Start children have tooth decay16 . And although fluoridation is required in North Dakota, tooth decay is present in 82 percent of Native American third grade children (who are often from very low-income families) compared to 54 percent of white children17 .
In New York City – which is 100 percent fluoridated – 56 percent of low-socioeconomic third grade children have tooth decay, compared to 38 percent of high-socioeconomic third grade children18. Likewise, in Kentucky, with a nearly 100 percent t fluoridation rate, nearly 60 percent of third grade children have experienced tooth decay, yet for nearly 35 percent of these children that decay went untreated19.
More than 60 Oral Health Care Reports from the 50 States reaffirm that low-income people have the worst dental health.
More importantly, these reports present quite an extensive array of data from examinations of school age children, yet all but one of these fail to mention rates of dental fluorosis. This is despite that each and every report strongly advocates water fluoridation20.
State Dental Policies Receive Failing Grades
State dental policies fail one in five children, according to the Pew Charitable Trust21. Even some highly fluoridated states received a grade of “F” from Pew.
Included among these is West Virginia, which is 92 percent fluoridated. West Virginia’s tooth decay rate is 66 percent for 15 year-olds. By the time these children graduate from high school, the proportion has increased to 84 percent 22.
It is reported that 80 percent of dental caries in children of West Virginia is concentrated in just 25 percent of the child population. West Virginia also ranks first in the U.S. for partial and complete tooth loss among adults23.
The most recent national statistics show that the prevalence of dental caries in primary teeth significantly has increased for 2-5 year-olds, from approximately 24 percent to 28 percent between the 1988-1994 and 1999-2004 recording periods, and has increased from 40 percent to 42 percent for all children 2-11 years old24.
Meanwhile, fluoridation rates in the United States have continued to increase, from 62 percent in 1992 (CDC, 2008) to over 72 percent in 2008!25
Proponents of fluoridation would have us believe that as fluoridation rates go up, tooth decay rates will go down. But that hasn’t happened.
Instead, oral health continues to decline among children – especially those from lower income families – and symptoms of fluoride overexposure and toxicity have increased to epidemic proportions, as evidenced by the 41 percent of adolescents aged 12-15 now afflicted with dental fluorosis (Beltrán-Aguilar et al., 2010).
The Role of the EPA in Fluoridation
EPA Administrator Lisa Jackson has declared that achieving Environmental Justice for all Americans is a top priority for her agency.
As fluoride has been shown to disproportionately affect poor and minority Americans, the EPA should be giving special consideration to these groups when determining the level of fluoride in drinking water that is safe for all Americans. Unfortunately, the most recent analyses of fluoride by the EPA’s Office of Water (EPA, 2010a, 2010b) clearly indicate that the EPA is more concerned with protecting the fluoridation program than protecting the American people.
For example, the EPA’s newly proposed reference dose for fluoride (the dose of fluoride that is supposedly safe for everyone when taken every day and over a lifetime) was based on the dietary intake of fluoride recommended by the Institute of Medicine nearly 15 years ago (IOM, 1997) to prevent dental caries.
Since that time, however, it has been well established – and is now widely accepted – that the primary action of fluoride on teeth is topical, not systemic26.
As fluoride is not an essential element (i.e. not necessary for human health), any dietary recommendations for fluoride are therefore illogical and unnecessary.
Thus, EPA’s newly proposed reference dose was not based on the latest scientific findings concerning the safety of this level of fluoride, but rather on outdated recommendations by those promoting artificial water fluoridation.
This reference dose will soon be translated to a new Maximum Contaminant Level Goal (MCLG) for fluoride in drinking water. If EPA were to evaluate the true science behind fluoride toxicity – free from any interference by those promoting fluoridation – the only rational outcome would be an MCLG of ZERO, effectively ending the practice of artificial water fluoridation.
What You Can Do TODAY!
The Fluoride Action Network has a game plan to END water fluoridation in both Canada and the United States. Our fluoride initiative will primarily focus on Canada since 60 percent of Canada is already non-fluoridated. If we can get Calgary and the rest of Canada to stop fluoridating their water, we believe the U.S. will be forced to follow.
Please, join the anti-fluoride movement in Canada and United States by contacting the representative for your area below.
Contact Information for Canadian Communities:
- If you live in Ontario, Canada, please join the ongoing effort by contacting Diane Sprules at firstname.lastname@example.org.
- The point-of-contact for Toronto, Canada is Aliss Terpstra. You may email her at email@example.com.
Contact Information for American Communities:
We’re also going to address three US communities: New York City, Austin, and San Diego:
- New York City, NY: With the recent victory in Calgary, New York City is the next big emphasis. The anti-fluoridation movement has a great champion in New York City councilor Peter Vallone, Jr. who introduced legislation on January 18 “prohibiting the addition of fluoride to the water supply.”
A victory there could signal the beginning of the end of fluoridation in the U.S.
If you live in the New York area I beg you to participate in this effort as your contribution could have a MAJOR difference. Remember that one person can make a difference.
The point person for this area is Carol Kopf, at the New York Coalition Opposed to Fluoridation (NYSCOF). Email her at NYSCOF@aol.com . Please contact her if you’re interested in helping with this effort.
- Austin, Texas: Join the effort by contacting Rae Nadler-Olenick at either: firstname.lastname@example.org or email@example.com, or by regular mail or telephone:
Austin, Texas 78713
Phone: (512) 371-3786
- San Diego, California: Contact Patty Ducey-Brooks, publisher of the Presidio Sentinel at firstname.lastname@example.org.
In addition, you can:
- Comment on the EPA’s docket on the proposed ban (just scroll down a bit). It’s open for public comment up to July 5, 2011.
They published the proposed ban in the Federal Register and the deadline for comments were extended due to requests from Dow and their allies in the pesticide world (such as American Farm Bureau Federation, National Pest Management Association, North American Millers’ Association, and the California Rice Commission).
Tell the EPA you expect them to uphold their duty to protect you and your children from this toxic food fumigant.
- Make a generous tax-deductible, to help them fight for your rights to fluoride-free food and water.
- Check out, as they are working on multiple fronts to rid our food and water supplies of fluoride.
- For timely updates, join the Fluoride Action Network Facebook page.
- 1 HHS (U.S. Department of Health and Human Services). 2000. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health.
- 2 Beltrán-Aguilar ED, Barker L, Dye B. 2010. Prevalence and severity of dental fluorosis in the United States, 1999-2004. NCHS Data Brief No. 53. U.S. DHHS, CDC, National Center for Health Statistics.
- 3 Stockin DG, Osmunson B. 2011. Press Release: April 14, 2011.
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- 7 Russell, 1962; Butler et al., 1985; Williams and Zwemer, 1990; Beltrán-Aguilar et al., 2005; Martinez-Mier and Soto-Rojas, 2010
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- 15 Bernabé and Marcenes, 2011)
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- 17 ND DOH (North Dakota Department of Health). 2006. The Burden of Oral Disease in North Dakota. Oral Health Program. Health Burden Overview.pdf
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- 21 PCT (Pew Charitable Trust), Pew Center on the States. 2010. The Cost of Delay: State Dental Policies Fail One in Five Children.
- 22 WV DHHR (West Virginia Department of Health and Human Resources). 2001.
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- 25 CDC (U.S. Centers for Disease Control and Prevention). 2010c. 2008 Water Fluoridation
- 26 Featherstone, 1999; Limeback, 1999; Clarkson and McLoughlin, 2000; CDC, 2001; Warren and Levy, 2003; Fejerskov, 2004; Hellwig and Lennon, 2004; NRC, 2006; Pizzo et al., 2007; Cheng et al., 2007
- ADA (American Dental Association). 2009. Fact Sheet: Children’s Dental Disease. Online at http://tinyurl.com/3zpszn7
- ATSDR (Agency for Toxic Substances and Disease Registry). 1993. Toxicological 47 profile for fluorides, hydrogen fluoride, and fluorine. Atlanta, GA: U.S. Department of Health and Human Services, Public Health Service. Online at
- Beltrán-Aguilar ED, Barker LK, Canto MT, et al. 2005. Surveillance for dental caries, dental sealants, tooth retention, edentulism, and enamel fluorosis – United States, 1988-1994 and 1999-2002. CDC, MMWR, Surveillance Summaries, August 26, 2005, vol. 54, No SS-3, pp. 1-44.
- Bernabé E, Marcenes W. 2011. Income inequality and tooth loss in the United States. J Dent Res. Published online ahead of print April 20, 2011. doi:10.1177/0022034511400081
- Butler WJ, Segreto V, Collins E. 1985. Prevalence of dental mottling in school-aged lifetime residents of 16 Texas communities. Am J Pub Health 75(12):1408-12.
- CDC (U.S. Centers for Disease Control and Prevention). 2001. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR 50(RR-14).
- CDC (U.S. Centers for Disease Control and Prevention). 2008. Fluoridation Growth (1940-2006).
- Cheng KK, Chalmers I, Sheldon TA. 2007. Adding fluoride to water supplies. B Med J. 335:699-702.
- Clarkson J, McLoughlin J. 2000. Role of fluoride in oral health promotion. Int Dent J. 50(3):119-28.
- de Vrese M. 2001. Probiotics: compensation for lactase insufficiency. Am J Clin Nutr. Adv Biochem Eng Biotechnol. 2008;111:1-66.
- Edelstein BL, Douglass CW. 1995. Dispelling the myth that 50 percent of U.S. schoolchildren have never had a cavity. Pub Health Reports Sept-Oct, Vol. 110.
- EPA (U.S. Environmental Protection Agency). 2010a. Fluoride: Dose-Response Analysis for Non-Cancer Effects. Office of Science and Technology, Health and Ecological Criteria Division, Office of Water. 820-R-10-019.
- EPA (U.S. Environmental Protection Agency). 2010b. Fluoride: Exposure and Relative Source Contribution Analysis. Office of Science and Technology, Health and Ecological Criteria Division, Office of Water. 820-R-10-015.
- EPA (U.S. Environmental Protection Agency). 2011. Environmental Justice: Policy and Guidance.
- Featherstone JD. 1999. Prevention and reversal of dental caries: role of low level fluoride. Comm Dent Oral Epid. 27(1):31-40.
- Fejerskov O. 2004. Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Res. 38(3):182-91.
- Fisher RL, et al. 1989. Endemic fluorosis with spinal cord compression. A case report and review. Arch Int Med. 149:697-700.
- GAO (U.S. Government Accountability Office). 2008. Medicaid: Extent of dental disease in children has not decreased, and millions are estimated to have untreated tooth decay. GAO-08-1121.
- GAO (U.S. Government Accountability Office). 2010. Oral Health: Efforts Under Way to Improve Children’s Access to Dental Services, but Sustained Attention Needed to Address Ongoing Concerns. Report to Congressional Committees. GAO-11-96.
- Hellwig E, Lennon AM. 2004. Systemic versus topical fluoride. Caries Res. 38:258-62.
- HIW (Health Indicators Warehouse)Hyattsville, MD.
- HIW (Health Indicators Warehouse). Hyattsville, MD.
- HIW (Health Indicators Warehouse). Hyattsville, MD.
- HHS (U.S. Department of Health and Human Services). 1991. Review of Fluoride: Benefits and Risks. Report of the Ad Hoc Committee on Fluoride, Committee to Coordinate Environmental Health and Related Programs.
- IOM (Institute of Medicine). 1997. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. National Academies Press: Washington, DC. Pp. 288-313.
- Limeback, H. 1999. A re-examination of the pre-eruptive and post-eruptive mechanism of the anti-caries effects of fluoride: is there any anti-caries benefit from swallowing fluoride? Comm Dent Oral Epid. 27(1):62-71.
- Lin FF, Aihaiti HX, Zhao J, et al. 1991. The relationship of a low-iodine and high-fluoride environment to subclinical cretinism in Xinjiang. IDD Newsletter 7(3):24-25.
- Littleton J. 1999. Paleopathology of skeletal fluorosis. A J Phys Anthropol. 109:465-483.
- Marier JR, et al. 1963. Accumulation of skeletal fluoride and its implications. Arch Env Health 1963:664-67.
- Martinez-Mier EA, Soto-Rojas AE. 2010. Differences in exposure and biological markers of fluoride among White and African American children. J Pub Health Dent. 70:234-40.
- Murray MM, Wilson DC. 1948. Fluorosis and nutrition in Morocco; dental studies in relation to environment. Br Dent J. 84(5):97-100.
- National Institute of Child Health and Human Development. 2006. Lactose Intolerance: Information for Health Care Providers. NIH Publication No. 05-5303B.
- Newbrun E. 1988. Guest editorial: Uses and abuses of the new release/press conference. J Dent Res 67:1442.
- Pandit CG, et al. 1940. Endemic fluorosis in South India. Ind J Med Res. 28:533-558.
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- Scrimshaw NS, Murray EB. 1988. The acceptability of milk and milk products in populations with a high prevalence of lactose intolerance. Am J Clin Nutr. 48:1079-1159.
- Teotia SP, et al. 1984. Environmental fluoride and metabolic bone disease: an epidemiological study (fluoride and nutrient interactions). Fluoride 17:14-22. Online at
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- West Virginia Healthy
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