The Fluoride Debate







Question 1
Question 2
Question 3
Question 4
Question 5
Question 6
Question 7
Question 8

Question 9
Question 10
Question 11
Question 12

Question 13
Question 14

Question 15
Question 16
Question 17

Question 18
Question 19
Question 20
Question 21
Question 22
Question 23
Question 24
Question 25
Question 26
Question 27
Question 28
Question 29
Question 30
Question 31
Question 32
Question 33


Question 34
Question 35
Question 36
Question 37
Question 38
Question 39
Question 40

Question 41
Question 42
Question 43



Question 33.
Does fluoridation present difficult engineering problems?

ADA's Fluoridation Facts Short Answer
No. Properly maintained and monitored water fluoridation systems do not present difficult engineering problems.

ADA's Fluoridation Facts Long Answer
With proper planning and maintenance of the system, fluoride adjustment is compatible with other water treatment processes. Today's equipment allows water treatment personnel to easily monitor and maintain the desired fluoride concentration. Automatic monitoring technology is available that can help to assure that the fluoride concentration of the water remains within the recommended range. Depending on the climate, the range for optimally fluoridated water is 0.7-1.2 ppm for an individual water plant.27

There are only three basic compounds used to fluoridate community drinking water:

  1. sodium fluoride, a white, odorless crystalline material
  2. sodium fluorosilicate, a white or yellow-white, odorless crystalline powder
  3. fluorosilicic acid, a white to straw-colored liquid.

The three fluoride compounds are derived from the mineral apatite which is a mixture of calcium compounds. Apatite contains 3% to 7% fluoride and is the main source of fluorides used in water fluoridation at the present time. Apatite is also the raw material used for production of phosphate fertilizers;27, 203 however, standards and minimum requirements have been established for all three compounds used in water fluoridation.204

From time to time, opponents of water fluoridation allege that the three compounds used in water fluoridation are impure or contain impurities at a level that may be potentially harmful. To help ensure the public's safety, compounds used for water fluoridation conform to standards established by the American Water Works Association.204 The American Water Works Association (AWWA) is an international nonprofit scientific and educational society dedicated to the improvement of drinking water quality and supply. Regarding impurities, the AWWA Standards state, "The [fluoride compound] supplied under this standard shall contain no soluble materials or organic substances in quantities capable of producing deleterious or injurious effects on the health of those consuming water that has been properly treated with the [fluoride compound]." Certified analyses of the compounds must be furnished by the manufacturer or supplier.204

When added to community water supplies fluoride compounds become diluted to the recommended range of 0.7 to 1.2 parts per million. At 1 ppm, one part of fluoride is diluted in a million parts of water. Large numbers such as a million can be difficult to visualize. While not exact, the following comparisons can be of assistance in comprehending one part per million:

  • 1 inch in 16 miles
  • 1 minute in 2 years
  • 1 cent in $10,000

Additional discussion on this topic may be found in Question 21.

Fluoride compounds are added to the water supply as liquids, but are measured by two basic types of devices, dry feeders or solution feeders (metering pumps). By design, and with proper maintenance and testing, water systems limit the amount of fluoride that can be added to the system (i.e., the use of a day tank that only holds one day's supply of fluoride) so prolonged over-fluoridation becomes a mechanical impossibility.27 It is very important that the water treatment operators responsible for monitoring the addition of fluoride to the water supply be appropriately trained, and that the equipment used for this process is adequately maintained.203 As with any mechanical equipment, water fluoridation equipment should be tested, maintained and replaced as needed. State health departments can procure federal grant monies for these purposes.

While the optimal fluoride concentration found in drinking water has been proven safe, water plant operators and engineers may be exposed to much higher fluoride levels when handling fluoride compounds at the water treatment facility.27 In order to prevent overexposure to fluoride compounds by water plant operators, and ensure that fluoridated water systems provide optimal fluoride levels, the Centers for Disease Control and Prevention and the Occupational Safety and Health Administration provide guidelines/ recommendations for managers of fluoridated public water systems.203, 204 Adherence to these guidelines should assure continuous levels of optimally fluoridated drinking water while maintaining safe operation of all fluoridated water systems.

Allegations that fluoridation causes corrosion of water delivery systems are not supportable.27 Corrosion by drinking water is related primarily to dissolved oxygen concentration, pH, water temperature, alkalinity, hardness, salt concentration, hydrogen sulfide content and the presence of certain bacteria. Under some water quality conditions, a small increase in the corrosivity of drinking water that is already corrosive may be observed after treatment with alum, chlorine, fluorosilicic acid or sodium florosilicate. In such cases, further water treatment is indicated to adjust the pH upward. This is part of routine water plant operations.

Repeat of Question 33.
Does fluoridation present difficult engineering problems?

Opposition's Response

There have been problems. One man died, and a woman was hospitalized "in critical condition near death," and at least 296 other citizens became ill as a result of "very high levels of fluoride" in a Hooper Bay, Alaska well on May 23, 1992. The symptoms — nausea, vomiting, diarrhea, fatigue and tingling arms and hands — "are compatible with acute fluoride poisoning." (Anchorage Daily News and The Anchorage Times, May 28-30, 1992.)

"An accidental leak of fluoride into the water supply of Annapolis caused the death ... of a 65-year-old man with kidney problems. ... Dr. Homez Guard said the death of Lawrence Blake on November 13 was caused by acute fluoride intoxication." ("Fluoride leak blamed for Annapolis death," San Jose Mercury, Nov. 29, 1979.)

See "Fluoridation Accidents and Poisonings" at for over twenty incidences, which includes the following (but with more details):

  1. Officials of Middletown, MD warned residents by radio in November, 1993 not to drink or cook with city water due to high fluoride levels. Malfunctioning fluoridation equipment caused excessive fluoride levels of 70 parts per million (ppm) in the distribution system. This is 70 times the normal level and almost 18 times the level considered safe by EPA. The Maryland State Department of Health stated that they did not plan to do a health survey to determine if any residents experienced symptoms of fluoride poisoning.

    "Based on other fluoridation accidents, the 70 ppm of fluoride is sufficient to cause vomiting, diarrhea, skin rashes, fever, and other effects. In 1986, a fluoridation accident in New Haven (North Brantford), Connecticut, resulted in the public receiving water with 51 ppm fluoride for twelve hours. A health survey, conducted four days later on 312 persons, determined that 55 of those experienced symptoms of fluoride poisoning which lasted from 1-60 hours." (The Townsend Letter for Doctors, October 1994, "Middletown Maryland Latest City to Receive Toxic Spill of Fluoride in their Drinking Water," report by Robert Carton, Ph.D., and The Truth About Fluoride, Inc.)

  2. February 1992 — Rice Lake, Wisconsin: Residents vomiting. Centers for Disease Control stated that 150 water consumers potentially at risk. Pump overfed fluoride for two days, thought to have reached 20 ppm.
  3. September 1991 — Calgary, Alberta, Canada: Fluoride diffuser problems in six machines. Leak of seven liters (quarts) of fluoride sent two water treatment personnel to the hospital for oxygen after breathing the fluoride fumes. Gary Lamb, engineer, stated that "This product is an acid so we can't put it through a steel pipe because it corrodes, but plastic isn't strong enough."
  4. July 1991 — Portage, Michigan: Approximately 40 children with abdominal pains, sickness, vomiting and diarrhea at an arts and crafts show at school. One of the city's fluoride injector pumps failed. Fluoride levels not determined at the time, but later tested at 92 ppm.
  5. October 1990 — Westby, Wisconsin: Four families suffered a week of diarrhea, upset stomach and burning throats. Fluoride equipment malfunctioned, causing the fluoride to surge to 150 ppm. The water utility supervisor said he had expected the fluoride to be ten times normal since it had burned his mouth. The fluoride corroded the copper off the pipes in area homes, 70 times higher than the EPA recommended limit. Westby Council stopped fluoridating.
  6. March 1986 — New Haven (North Branford) Connecticut: Of the 312 persons interviewed four days after the accident, in the 127 households at risk, 18% had symptoms of abdominal cramping, nausea, headache, diarrhea, vomiting, diaphoresis (profuse sweating), and fever. This did not include those with rashes and irritation from bathing and washing dishes. The fluoride peaked at 51 ppm. The acidic fluoride leached copper; the Connecticut State Dental Director chastised water department personnel for not recognizing immediately that public complaints were due to fluoride and not copper. This accident was finally reported two years later in the American Journal of Public Health, June 1988.
  7. The Baltimore Sun reported in a November 1979 story on the fluoridation accident that, "Even though state and county health officials learned of the spill nine days after it occurred, no public announcement was made and the City Council was not told of the situation for six more days ..." And, quoted a County Health officer stating that the delay in notification was because "We didn't want to jeopardize the fluoridation program ... "

The toxicity and corrosiveness of fluoride compounds the risk of fluoridation equipment malfunction and operator error for all fluoridated water systems.

"When a city or village is fluoridated, no thought is given to the fact that there will be damage to the pipes of the water system, meters, hot water heaters and tanks and other equipment. Fluoride is extremely corrosive. The hard fact that this damage occurs comes as quite a shock a few years later." (See 33-1: "Fluoridation Damages Water Systems," by Harvey Petraborg, M.D., Oct. 7, 1964). To reduce some of this damage, the water companies are now required to add alkalizing agents when the acid level gets excessively high due to the added silicofluorides. This is just one more thing that is added to the water, but is never mentioned.

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