U.S. Public Health Service
National Institute of Dental Research
By John A. Yiamouyiannis, (excerpted)
Data collected by the National Institute of Dental Research (NIDR) of the United States Public Health Service (USPHS) produced the largest and most extensive database ever used to determine whether there is a relationship between fluoridation and tooth decay.
Released on June 21, 1988, the $3,670,000 nationwide survey examined 39,207 U.S. school children aged 5-17 from 84 different geographical areas.
Of the 84 areas, 28 had been fluoridated for 17 years or more, 29 had never been fluoridated, and 27 had been only partially fluoridated or fluoridated for less than 17 years. Age-adjusted tooth decay rates for the permanent teeth of children were determined for each of the 84 areas which were then listed in the order of increasing tooth decay rates. The listing showed clearly that there was no relation between tooth decay rates and fluoridation. Ironically, the lowest tooth decay rate reported in the survey occurred in a nonfluoridated area.
The average number of decayed, missing, and filled permanent teeth (DMFT) per child was 2.0 in the fluoridated areas, 2.0 in the nonfluoridated areas, and 2.2 in the partially fluoridated areas. The percentage of decay-free children in the fluoridated, nonfluoridated, and partially fluoridated areas was 34%, 35%, and 31%, respectively.
The foregoing results compiled from an analysis of the data gathered by NIDR were neither sought – nor reported in the NIDR release. At the Safe Water Foundation, we extracted these results from the data of the NIDR survey and submitted them to the journal, Comm. Dent. Oral Epidemiol., for publication. After reviewing the manuscript we submitted, Dr. Irwin Bross, the former Head of the Research, Design, and Analysis unit of the Sloan-Kettering Institute, former Director of Biostatistics of the Roswell Park Memorial Institute, and the current President of Biomedical Metatechnology, commented:
“The material is clear and well presented. It provides a good demonstration of its main points: There is not much difference in tooth decay rates or in the percentages of decay-free children in the three fluoridation categories.”
Also making this venture less of a gamble were papers from Canada (Gray, A.S., J. Canadian Dent. Assoc. 53, 753-755 ), and New Zealand (Colquhoun, J., Community Dent. Oral Epidemiol. 13, 37-41 ), which showed that tooth decay in fluoridated areas was the same or slightly higher than in nonfluoridated areas. Both authors were public health officials who had previously been very active in promoting fluoridation. Based on his extensive research, Dr. Colquhoun concluded that fluoridation did not reduce tooth decay. His continuing research has documented many flaws and distortions in earlier studies claiming that fluoridation reduces tooth decay and has led him to take an active role against fluoridation.
Dr. Gray’s reaction was indeed curious. In his paper, he stated, “Survey results in British Columbia with only 11% of the population using fluoridated water show lower DMFT [tooth decay] rates than provinces with 40-70% of the population drinking fluoridated water” and “school districts recently reporting the highest caries-free rates in the province were totally unfluoridated.” From this he made the absurd conclusion that fluoridation is probably only reducing tooth decay by 25%!
More incredible than Dr. Gray’s conclusion are statements in the press release accompanying the announcement of NIDR’s dental survey. As noted, the survey contained the data from which the NIDR could determine that fluoridation does not reduce tooth decay in the permanent teeth of school children in the U.S. Nevertheless, NIDR stated, “The NIDR survey did not address the question of what is causing the decline in dental caries, but Institute officials say they believe the widespread use of fluoride – in community water supplies, toothpastes, and other forms – is mainly responsible.”
To further confound its audience, the NIDR release stated, “Half the children in the United States have no tooth decay.” We found this statement to be false and misleading. Among 17-year-olds, for example, only 14% were decay-free; even among 7-year-olds, a majority had tooth decay. In comparing the results of this survey to another survey completed in 1980, the release claimed that tooth decay rates had declined. It failed to mention that the use of different areas in the 1980 survey precluded them from making a valid comparison.
Whether it is dishonesty, or incompetence, or both, that impels the NIDR to continually make false statements in a zealous promotion of fluoridation, it is certainly time we stop funding these corruptive activities and start an investigation of the Institute for fraud. If this is not done, the NIDR and the other branches of the USPHS will continue to undermine the scientific integrity of dental research.
For the text of the full article by International Center for Nutritional Research
FACT 1: FLUORIDE’S PRIMARY EFFECT IS TOPICAL, NOT SYSTEMIC
Water fluoridation began in the 1940s under the premise that swallowing fluoride is the most effective way to strengthen teeth. It is now known, however, that fluoride’s main benefit comes from topical contact with teeth, not from ingestion. Even if fluoridated water has a benefit, therefore, there is no need to swallow it.
FACT #2: THERE IS NO DIFFERENCE IN TOOTH DECAY BETWEEN FLUORIDATED AND NON-FLUORIDATED COUNTRIES.
In the United States, the Centers for Disease Control has called water fluoridation one of the “top 10 public health achievements of the twentieth century.” Yet, according to comprehensive data compiled by the World Health Organization, there is no discernible difference between the few western countries that fluoridate their water, and the majority that do not. WHO’s data also shows that, over the past 40 years, non-fluoridated countries have experienced the same (and ofter greater) declines in tooth decay as fluoridated countries.
FACT 3: FLUORIDATION’S “BENEFITS” HAVE NEVER BEEN PROVED BY A “RANDOMIZED CONTROLLED TRIAL”
A number of studies have purported to demonstrate very large benefits from drinking fluoridated water. In 2000, these studies were critically reviewed by an expert committee commissioned by the UK government (the “York Review”) and found to be of extremely poor quality. Few of the studies had controlled for factors that can greatly affect tooth decay (e.g., poverty), and no study had ever employed a “randomized controlled trial” method — the gold standard in medical research and required before most drugs can enter the market.
FACT 4: MODERN STUDIES SHOW FLUORIDATED WATER DOES NOT REDUCE THE NUMBER OF DECAYED, MISSING OR FILLED TEETH
In the early days of water fluoridation, researchers studied its effectiveness at reducing tooth decay by using the “DMFT” index (“Decayed, Missing, or Filled Teeth”). Although early researchers stated that fluoridation reduced DMFT by over 60% (Hodge 1950), modern, large scale studies have repeatedly failed to detect any significant difference in DMFT between fluoridated and non-fluoridated communities.
One of the first studies to demonstrate this was a 1986-87 national study of oral health by the National Institute of Dental Research (NIDR), which examined over 39,000 children in 84 areas of the United States. When the results of NIDR’s study were obtained through a Freedom of Information Act request, it was found that American children who had lived their whole lives in fluoridated areas did not have less tooth decay than children who had lived their entire lives in non-fluoridated areas. Other studies have since reported the same result.
FACT #5: FLUORIDATED WATER HAS A TRIVIAL EFFECT ON THE NUMBER OF DECAYED TOOTH SURFACES
Due to the difficulty of detecting differences in tooth decay using the DMFT index, most studies on water fluoridation now use a more sensitive measure called DMFS, which focuses on the number of affected tooth surfaces. Although differences in tooth decay have been found when using DMFS as the measure, the magnitude of the effect is extremely small. In the NIDR’s national survey, for example, NIDR statisticians reported an average difference between fluoridated and non-fluoridated areas of just 0.6 tooth surfaces, which is less than 1% of the 100+ tooth surfaces in a child’s mouth. Other large, modern studies have found similar results, with some studies finding no difference, and others finding average differences of just 0.12 to 0.3 tooth surfaces per child.
FACT 6: FLUORIDATED DOES NOT PREVENT ORAL HEALTH CRISES IN LOW INCOME COMMUNITIES.
In the United States, the Surgeon General has identified a “silent epidemic” of tooth decay in low-income communities and communities of color, with health departments across the country calling it an “oral health crisis.” Many of the communities with oral health crises, particularly in urban areas, have been fluoridated for decades. In Cincinnati, the city’s Dental Director described the state of oral health after 23 years of water fluoridation as follows:
‘We cannot meet the demand. It’s absolutely heartbreaking and a travesty. We have kids in this community with severe untreated dental infections. We have kids with self-esteem problems, and we have kids in severe pain and we have no place to send them in Cincinnati. People would be shocked to learn how bad the problem has become.’”
It is becoming increasingly evident, therefore, that water fluoridation cannot prevent the disastrous effects that poverty and a broken health care system have on oral health. Low-income communities need dental care, not cheap industrial chemicals in their water.
FACT #7: TOOTH DECAY DOES NOT GO UP WHEN FLUORIDATION IS STOPPED.
Where fluoridation has been discontinued in communities from Canada, the former East Germany, Cuba and Finland, the rate of tooth decay did not increase. Instead, studies of these communities have documented that the rate of tooth decay continued to decline after fluoridation ended.
FACT #8: FLUORIDATION IS MUCH MORE LIKELY TO CAUSE DENTAL FLUOROSIS THAN REDUCE DECAY
When the water fluoridation program was endorsed by U.S. health authorities in the 1950s, proponents argued that fluoridation would produce a very sharp reduction in tooth decay with only a very minimal effect on dental fluorosis. This prediction did not prove true — a fact this is readily apparent when comparing the predicted relationship with the actual relationship (as observed in the NIDR’s national survey):