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139
11/71
TOXIC EFFECTS OF FLUORIDE NOT PROPERLY
INVESTIGATED — SAFETY OF FLUORIDATION NOT
PROVED
Statement by Prof. Arvid Carlsson, Gothenburg
Professor Arvid Carlsson is head of the Pharmacology
Department of Gothenburg University, and is also
adviser to the Swedish Government on such questions.
In November, 1969, he addressed a memorandum to the
Swedish Health Department (Social Board) urging that
fluoridation should not be approved.
On 25th February, 1970, the Swedish Medical
Association's Journal ("Lakartidningen", vol.67, pp.
943-953) published a paper by Prof. Carlsson in which
he gave his views as a pharmacologist on fluoridation of
public water supplies.
The following is a summary of some of the main
points.
First he deals with the argument that fluorides are
found naturally in water supplies and the recommendation
of Prof. Hugo Theorell and Prof. Linus Pauling in
favour of "the fluoridation of drinking water in which
the concentration of fluoride ion is less than the average
for natural waters". Prof. Carlsson points out that it
may be relevant to consider what mankind has been
accustomed to over past centuries and millenia. Surface
waters and shallow wells contained probably less than
0.2 ppm (parts per million) of fluoride. Thus, this "cannot
be used as a basis for adding 1 ppm F to drinking
water, in any case not in Sweden."
The same argument applies in Britain where it is rare
to find natural waters with even as much as 0.1 ppm F.
Fluoridation would raise the level tenfold.
Fluoride and Tooth Decay
Prof. Carlsson refers to the claims made in U.S.A.
that 1 ppm F in drinking water can give well over 50
per cent reduction in the number of carious teeth in
children and young people. He points out that in comparing
one district with another account should be taken
not only of differences in the amount of fluoride in the
water supply, but of many other factors which affect
tooth decay. He points out that in the Swedish experiment
at Norrkoping, which extended over ten years "the
number of carious teeth decreased only about 25 per
cent in 7- and 14-year old children."
It may be added that the British experiment after
eleven years showed a similar reduction in 11-year old
children (3 teeth decayed instead of 4).
He also points out that in Swedish investigations the
application of fluoride directly to the teeth by a mouth
wash or by brushing the teeth with a fluoride tooth
paste reduced the development of new carious lesions
by about one half. The results of fluoridation in
Norrkoping were inferior to this. He mentions that there
may be a risk of overdose if fluoride tooth pastes or
mouth washes are used in a fluoridated area.
Damage to Teeth and Bones
Prof. Carlsson says "With high intake of fluoride, the
ameloblasts are damaged, resulting in irreversible injury
to the enamel." The ameloblasts are the cells which
form the enamel of the teeth. The injury to the teeth is
known as dental fluorosis or, from the appearance of
the teeth, as "mottled enamel". He says that "the
margin of safety as regards damage to the enamel by
use of water with so-called optimal fluoride content
would seem to be negligible or non-existent."
On the question of damage to bone (skeletal fluorosis)
he refers to the Report submitted by the Director
General of the World Health Organization to the World
Health Assembly in 1969 which said that among people
living in areas with 8 to 20 ppm F in the water supply
cases of osteoporosis had been reported. The Report
went on to say: "Some doubt exists, however, about
the possible relationship of the latter condition to
fluoride ingestion. Higher concentrations of fluoride in
water may be regarded as unsafe." It concluded that the
safety margin was very large. Prof. Carlsson comments
that "these statements are based upon an opinion which
has now been discarded." He refers to a case of highgrade
disabling osteofluorosis reported by Gvdell in
Sweden (1968) in a patient who had been exposed for
19 years to 4 ppm F in water associated with high water
consumption. A similar case was reported by Sauerbrunn
(1965) in U.S.A. with exposure to 2.4 to 3.5 ppm F for
43 years. "Other severe cases with still lower fluoride
content have been reported from, among other places,
India, the Near East, and North Africa."
Other III Effects
Professor Carlsson points out that the methods used
for estimating the amount of fluoride in blood and
tissues up till about six years ago gave misleading
values, but it was on these that assurances that fluoridation
is safe were based.
He refers to the fact that the kidney is the most
important organ for eliminating fluoride from the body.
There is evidence that kidney impairment can lead to
fluorine poisoning from water containing much lower
amounts of F than those alleged by W.H.O. to be safe.
It should be added that since the W.H.O. Report
mentioned by Professor Carlsson was published, that
body has issued a monograph on "Fluorides and Human
Health" which admits that a daily intake of 2 to 8 mg
of F may cause skeletal fluorosis. An intake of 2 mg
is what would be derived from 1¾ pints of fluoridated
water, apart from any that might be derived from food.
He also mentions that patients subjected to haemodialysis
(artificial kidney treatment) may, if fluoridated
water is used, receive dangerous quantities of F into the
blood stream.
Professor Carlsson considers that far too little
research has been devoted to the action of fluorides in
various tissues of the body, and that more attention
ought to be paid to the possible interaction of fluorides
with other drugs now in use or proposed for use in the
future.
Fluoridation Statistics
Another point made by Professor Carlsson is that
"the possibilities of divergent effects on different individuals
have been disregarded in the fluoride literature."
As an example he refers to the comparison between
fluoridated Newburgh and the unfluoridated city of
Kingston in which the blood haemoglobin levels were
recorded showing that in the former city 5.9 per cent of
the children had levels less than 13g/100ml, as contrasted
with 2.4 per cent in the latter city. The comment
of the authors of this research (Schlesinger et al. 1956b)
was that the mean for the two groups was closely alike,
but says Prof. Carlsson they did not point out that the
difference in the frequency of the low haemoglobin
count was statistically significant, as it was. Nor did
they attach any significance to the fact that four children
from Newburgh (as contrasted with none from Kingston)
were referred to their doctors because of "blood
findings". They summarized their report by saying: "No
differences of medical significance could be found
between the two groups of children; thus further
evidence was added to that already available on the
safety of water fluoridation."
Professor Carlsson adds that "In another study which