Osmunson BMJ Letter
2
Response to British Medical Journal article: Adding fluoride to water supplies. Ch eng et al. BMJ.2007; 335: 699-702 (6 October) http://www.bmj.com/rapid-response/2011/11/01/fluoridation-time-reevaluate F luori d a tion: Ti me to r e e va luat e 19 October 2007 Bill Osmunson DDS, MPH, Cosmetic Comprehensive Dentist Bellevue, Washington 9804 The BMJ needs to be commended for further opening the scient ific debate on fluoridation. For the first 25 years of dental practice I promoted the addition of fluoride to water, in part because I thought I could “see” the difference between those on fluoridated water and those without. Unfortunately, I was actually comparing socioeconomics rather than fluoridation. As more patients have come in requesting extensive cosmetic dentistry, sometimes costing tens of thousands of dollars to correct their dental fluorosis, I decided it was time to look at the sources, dosage, efficacy, and benefits of i ngested fluoride. Looking at the current literature was like a knee in the gut.1 FLUORIDE EXPOSURE: Clearly fluoride exposure has increased over the last 60 years. Dental fluorosis is up 50% to a third of children. More dental and medical products and medications contain fluoride. Permitted residue levels from fluoride based pesticides and post-harvest fumigants (ProFume, Dow Agro Chemical) have significantl y increased in just the last decade. Mechanically deboned meat can be much higher in bone/fluoride content. Grape products and some tea have high levels of fluoride. Apparently no agency is the legal intermediary, the doctor, responsible for monitoring the public’s total exposure to fluoride. Some people are more sensitive to chemicals and unable to excrete excess fluoride. Synergistic effects from groups of chemicals are relatively unknown. It appears any benefit of fluoride is from a topical application and not from ingested fluoride. BENEFITS OF FLUORIDATION: “Evidence for whether an intervention works when applied in the community at large is referred to as its effectiveness. . . . Effectiveness studies more accurately reflect results that may be expected from the implementation of interventions.”2 If fluoride actually provides a “life time” reduction of dental decay, certainly after 60 years of fluoridation we should see clear evidence of effectiveness. Unfortunately, comparing developed countries finds all have reduced dental decay to simi lar levels regardless of fluoridation. Comparing states within the USA based on the percentage of t he population fluoridated finds no improved dental health or reduction of decay regardless of the percentage fluoridated. Co mparing similar states such as Washington Sta te (59% fluoridated) with Oregon State (19% fluoridated) actually finds slightly better dental health in the less fluoridated Oregon. Co mparing counties within states finds similar oral health, with similar socioeconomics, regardless of fluoridation.3 Studies on fluoridation have not included the confounding factor of delayed tooth eruption or looked at life time benefits.4 It is a flawed assumption to expect fluoridated children with fewer cavities will "therefore" have a life time of fewer cavities. Several studies have actually found an increase in dental decay and tooth loss with fluoridation. Without clear, undisputed, life ti me benefits from fluoridation, any risk or expense is unacceptable. Co mmunities have stopped fluoridation with no increase in dental decay.5 The experiment of fluoridation is currently being promoted without good scientific and ethical review of continued life time benefits. The US National Academy of Sciences 2006 report confirmed potential benefits from fluoridation are during the deve lopment of the tooth, up to about age 8. It makes no sense to have a lifetime uncontrolled dose of fluoride for everyone when the potential benefits are only up to age 8. Lifetime exposure must be considered. DENTAL RISKS OF FLUORIDATION: As a Cosmetic Dentist, it is not uncommon to have patients receive gorgeous porcelain veneers to correct their dental fluorosis, white and brown damage from too much ingested fluoride. Costs range from several hundred dollars to well over $25,000 and need to be retreated every 10 to 20 years for life time costs which may exceed $100,000 per person. With a third of children having dental fluorosis, the true costs for cosmetic damage to teeth alone is in the trillions of dollars. A side effect seldom raised by cosmetic dentists. Certainly most will not seek treatment, but the public liability for damage is significant. Public Health Dentists seldom provide cosmetic dentistry and therefore under rate the increased dental damage from fluoridation. MEDICAL RISKS OF FLUORIDATION: Many committees reviewing fluoridation are composed of Dentists. It is not in the purview of Dentistry to diagnose thyroid, hormonal, skeletal, kidney, liver, brain, skeletal disorders or cancers outside the oral cavity. Epidemiologists, Toxicologists and Medical Prof essionals unwisely rely on their Dental counterparts to diagnose safety for body organs from fluoridation and Dentists would be practicing outside their scope of training and licensure to appropriately weig h the gravity of medical side effects. Historic gr ound was covered in the USA when scientists opposed to fluoridation were permitted on the National Academy of Science 2006 report to the US Environmental Protection Agency which unanimously found the EPA’s Maximum Contaminant Level was not protective.6
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Cosmetic dentist Bill Osmunson's informative letter to the British Medical Journal.
Transcript of Osmunson BMJ Letter
5/16/2018 Osmunson BMJ Letter - slidepdf.com
http://slidepdf.com/reader/full/osmunson-bmj-letter 1/3
Response to British Medical Journal article: Adding fluoride to water supplies. Cheng et al.BMJ.2007; 335: 699-702 (6 October)http://www.bmj.com/rapid-response/2011/11/01/fluoridation-time-reevaluate
Fluoridation: Time to reevaluate 19 October 2007
Bill Osmunson DDS, MPH,Cosmetic Comprehensive Dentist
Bellevue, Washington 9804
The BMJ needs to be commended for further opening the scientific debate on fluoridation. For the first 25 years of dental practice I promoted the addition of fluoride to water, in part because I thought I could “see” the difference between those on fluoridated wateand those without. Unfortunately, I was actually comparing socioeconomics rather than fluoridation. As more patients have come irequesting extensive cosmetic dentistry, sometimes costing tens of thousands of dollars to correct their dental fluorosis, I decided itwas time to look at the sources, dosage, efficacy, and benefits of ingested fluoride. Looking at the current literature was like a kneethe gut.1
FLUORIDE EXPOSURE: Clearly fluoride exposure has increased over the last 60 years. Dental fluorosis is up 50% to a third of children. More dental and medical products and medications contain fluoride. Permitted residue levels from fluoride based pesticidand post-harvest fumigants (ProFume, Dow Agro Chemical) have significantly increased in just the last decade. Mechanically
deboned meat can be much higher in bone/fluoride content. Grape products and some tea have high levels of fluoride. Apparently nagency is the legal intermediary, the doctor, responsible for monitoring the public’s total exposure to fluoride. Some people are mosensitive to chemicals and unable to excrete excess fluoride. Synergistic effects from groups of chemicals are relatively unknown. Iappears any benefit of fluoride is from a topical application and not from ingested fluoride.
BENEFITS OF FLUORIDATION: “Evidence for whether an intervention works when applied in the community at large is referreas its effectiveness. . . . Effectiveness studies more accurately reflect results that may be expected from the implementation of interventions.”2 If fluoride actually provides a “life time” reduction of dental decay, certainly after 60 years of fluoridation we shou
see clear evidence of effectiveness. Unfortunately, comparing developed countries finds all have reduced dental decay to simi lar leregardless of fluoridation. Comparing states within the USA based on the percentage of the population fluoridated finds no improvedental health or reduction of decay regardless of the percentage fluoridated. Comparing similar states such as Washington Sta te (59fluoridated) with Oregon State (19% fluoridated) actually finds slightly better dental health in the less fluoridated Oregon. Comparicounties within states finds similar oral health, with similar socioeconomics, regardless of fluoridation.3 Studies on fluoridation hanot included the confounding factor of delayed tooth eruption or looked at life time benefits.4
It is a flawed assumption to expect fluoridated children with fewer cavities will "therefore" have a life time of fewer cavities. Severstudies have actually found an increase in dental decay and tooth loss with fluoridation. Without clear, undisputed, life time benefitfrom fluoridation, any risk or expense is unacceptable. Communities have stopped fluoridation with no increase in dental decay.5 Texperiment of fluoridation is currently being promoted without good scientific and ethical review of continued life time benefits.
The US National Academy of Sciences 2006 report confirmed potential benefits from fluoridation are during the development of thtooth, up to about age 8. It makes no sense to have a lifetime uncontrolled dose of fluoride for everyone when the potential benefitsonly up to age 8. Lifetime exposure must be considered.
DENTAL RISKS OF FLUORIDATION: As a Cosmetic Dentist, it is not uncommon to have patients receive gorgeous porcelainveneers to correct their dental fluorosis, white and brown damage from too much ingested fluoride. Costs range from several hundrdollars to well over $25,000 and need to be retreated every 10 to 20 years for life time costs which may exceed $100,000 per perso
With a third of children having dental fluorosis, the true costs for cosmetic damage to teeth alone is in the trillions of dollars. A sideffect seldom raised by cosmetic dentists. Certainly most will not seek treatment, but the public liability for damage is significant.Public Health Dentists seldom provide cosmetic dentistry and therefore under rate the increased dental damage from fluoridation.
MEDICAL RISKS OF FLUORIDATION: Many committees reviewing fluoridation are composed of Dentists. It is not in the purviof Dentistry to diagnose thyroid, hormonal, skeletal, kidney, liver, brain, skeletal disorders or cancers outside the oral cavity.Epidemiologists, Toxicologists and Medical Professionals unwisely rely on their Dental counterparts to diagnose safety for bodyorgans from fluoridation and Dentists would be practicing outside their scope of training and licensure to appropriately weigh thegravity of medical side effects. Historic ground was covered in the USA when scientists opposed to fluoridation were permitted on National Academy of Science 2006 report to the US Environmental Protection Agency which unanimously found the EPA’s
Maximum Contaminant Level was not protective.6
5/16/2018 Osmunson BMJ Letter - slidepdf.com
http://slidepdf.com/reader/full/osmunson-bmj-letter 2/3
The US Center for Disease Control and American Dental Association have cautioned infants should not be given fluoridated waterfluoridated water be used for making infant formula.7 More than 3 out of 4 infants receive formula. Consider that all are medicatedwith fluoridation, yet the water is not safe for our most vulnerable, our babies. We are now asking moms to haul their infant, its footoys, clothes, and now water. Parents in third world countries can usually boil their water to make it safe for infants, but manycommunities consciously put chemicals in the public water which can’t even be boiled out or traditional filters used to make it safeinfants.
The biggest problem in the US scientific community is the fear Universities, Medical and Dental Associations and Journals have inpermitting discussion, debate and scientific review of fluoridation. One state medical association requested $50,000 for a short privpresentation of concerns. Others permit review only by their legal counsel. The BMJ should be commended for their willingness towhat few other scientists are willing to do, open scientific discussion.
Bill Osmunson DDS, MPH Aesthetic Dentistry of Bellevue [email protected]
1. The CDC also references Horowitz and Ismail 1996, Johnston 1994, Ripa 1990, Stookey and Beiswanger 1995, however all thesreviewed topical application of fluoride, not the addition of fluoride to water. http://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htm
2. http://www2.nidcr.nih.gov/sgr/sgrohweb/chap7.htm
3. National Survey of Children's Health. http://mchb.hrsa.gov/oralhealth/portrait/1cct.htm
http://www.cdc.gov/oralhealth/waterfluoridation/fact_sheets/states_stats2002.htm---(No longer there)
The National Survey of Children's Health 2003. Rockville, Maryland: U.S. Department of Health and Human Services, 2005
U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau
http://www.doh.wa.gov/cfh/Oral_Health/Documents/SmileSurvey2005FullReport.pdf---(No longer there)
http://www.oregon.gov/DHS/ph/oralhealth/docs/databook.pdf#search='Oregon%20Decay%20experience
BRFSS 2002 http://www.dhs.state.or.us/dhs/ph/chs/brfs/02/orahea/dentvisi.shtml---(No longer there)http://apps.nccd.cdc.gov/brfss/display.asp?state=WA&cat=OH&yr=2004&qkey=6610&grp=0&SUBMIT4=Go Sample size OR 3and WA 12,926 2004 data
National Survey of Children's Health. http://mchb.hrsa.gov/oralhealth/portrait/1cct.htm U.S. Department of Health and Human
Services, http://www.fluoridationcenter.org/papers/2002/cdcmmwr022102.htm---(No longer there)
http://quickfacts.census.gov/qfd/states/41000.html
4. Our analysis shows no convincing effect of fluoride-intake on caries development." Komarek A, et al. (2005). A Bayesian analyof multivariate doubly-interval-censored dental data. Biostatistics 6:145-55.
5. Kugel (sp) and Fischer 1997, Seppä et al. 1998
6. www.nap.edu/catalog/11571.html Fluoride in Drinking Water: A Scientific Review of EPA’s Standards 2006
7. http://www.cdc.gov/fluoridation/safety/infant_formula.htm www.ada.org see also Pizzo G, et al Community water fluoridatioand caries prevention: a critical review, Clin Oral Investig. 2007 Feb 27.
Competing interests: None
(Typo corrections and links checked and updated with permission. K. Case, April 2012)
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