Abstract

The 1974 Safe Drinking Water Act gave regulatory oversight of public drinking water (tap water) to the U.S.
Environmental Protection Agency (EPA). FDA has responsibility for ensuring that the quality standards for bottled water
are compatible with EPA standards for tap water. According to the EPA, fluoride is voluntarily added to some drinking
water systems as a public health benefit or measure to help reduce the incidence of cavities among the population. The
decision to fluoridate a water supply is made by the State or local municipality, and is not mandated by EPA or any other
Federal entity. [1]

Leg pains, flu-like symptoms and constant headaches are suggested as side effects of toothpaste containing fluoride.
Dental fluorosis is a condition caused by over-exposure to fluoride that can cause crumbling of the enamel and
permanent damage to teeth. Higher doses of fluoride are unsafe and the side effects include bones and ligaments
weakening, and muscle weakness and nervous problems. High doses of fluoride in children before their permanent
teeth come through the gums can even cause tooth discoloration. There is a tendency of children under the age of two
to swallow everything that goes into their mouths. "Low-dose" toothpastes for children are available to prevent such
incidents

Toothpaste and fluoride rinses should not be swallowed routinely, particularly by children. It’s a good idea to make sure
that children under six years of age use only a pea-sized amount of fluoride-containing toothpaste, just in case they
swallow some.
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Safe Drinking Water Act

Fluoride compounds are salts that form when the element, fluorine, combines with minerals in soil or rocks. The benefits
of adding fluoride to drinking water is to promote dental health. However, exposure to excessive consumption of fluoride
over a lifetime may lead to increased likelihood of side effects especially bone fractures in adults, and may result in
effects on bone leading to pain and tenderness. Children aged 8 years and younger exposed to excessive amounts of
fluoride have an increased chance of developing side effects such as pits in the tooth enamel, along with a range of
cosmetic effects to teeth. [2]

In 1974, Congress passed the Safe Drinking Water Act. This law requires EPA to determine the level of contaminants in
drinking water at which no adverse health effects are likely to occur. These non-enforceable health goals, based solely
on possible health risks and exposure over a lifetime with an adequate margin of safety, are called maximum
contaminant level goals (MCLG). Contaminants are any physical, chemical, biological or radiological substances or
matter in water. [2]

The MCLG for fluoride is 4.0 mg/L or 4.0 ppm. EPA has set this level of protection based on the best available science
to prevent potential health problems. EPA has set an enforceable regulation for fluoride, called a maximum contaminant
level (MCL), at 4.0 mg/L or 4.0 ppm. MCLs are set as close to the health goals as possible, considering cost, benefits
and the ability of public water systems to detect and remove contaminants using suitable treatment technologies. In this
case, the MCL equals the MCLG, because analytical methods or treatment technology do not pose any limitation. [2]
EPA has also set a secondary standard (SMCL) for fluoride at 2.0 mg/L or 2.0 ppm. Secondary standards are non-
enforceable guidelines regulating contaminants that may cause cosmetic effects (such as skin or tooth discoloration) or
aesthetic effects (such as taste, odor, or color) in drinking water. EPA recommends secondary standards to water
systems but does not require systems to comply. However, states may choose to adopt them as enforceable standards.
Tooth discoloration and/or pitting is caused by excess fluoride exposures during the formative period prior to eruption of
the teeth in children. The secondary standard of 2.0 mg/L is intended as a guideline for an upper bound level in areas
which have high levels of naturally occurring fluoride. The level of the SMCL was set based upon a balancing of the
beneficial effects of protection from tooth decay and the undesirable effects of excessive exposures leading to
discoloration. [2]

Fluoride is voluntarily added to some drinking water systems as a public health measure for reducing the incidence of
cavities among the treated population. The decision to fluoridate a water supply is made by the s or local municipality,
and is not mandated by EPA or any other Federal entity. The Centers for Disease Control and Prevention (CDC)
provides recommendations about the optimal levels of fluoride in drinking water in order to prevent tooth decay. [2]

Some fluoride compounds, such as sodium fluoride and fluorosilicates, dissolve easily into ground water as it moves
through gaps and pore spaces between rocks. Most water supplies contain some naturally occurring fluoride. Fluoride
also enters drinking water in discharge from fertilizer or aluminum factories. Also, many communities add fluoride to their
drinking water to promote dental health. A federal law called the Emergency Planning and Community Right to Know Act
(EPCRA) requires facilities in certain industries, which manufacture, process, or use significant amounts of toxic
chemicals, to report annually on their releases of these chemicals. [2]

It is not sure if we need to specially add fluoride into water, as fluoride is a naturally occurring contaminant in the water.
Fluoride is essential for normal maintenance of teeth and bones. However, prolonged exposure to high concentration of
Fluoride is found to be deleterious to teeth, bones and other organs. Besides drinking water, Fluoride can enter the
body through food, dental products, drugs and industrial emission. People living in areas where Fluoride contamination
is much higher than the expected level, are found to suffer from not only teeth and bone problem but also other
systems, including brain and its functions. Since animals respond to the toxic effects of Fluoride like human beings, the
deleterious effects of Fluoride have been produced experimentally in animals in order to determine the mechanism
involved in the action of Fluoride. Chronic harmful side effects of fluoride in teeth, bones, heart, liver, kidneys,
gastrointestinal tract, lungs, brain have been reported. The neurotoxic side effects of Fluoride include chiefly learning
and memory impairment. Other fluoride toxic side effects also include reproduction issues and premature aging. [5]
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Fluoride Side Effects

Recognition of the harmful side effects of sodium fluoride on human reproduction is increasing, especially as it relates
to female reproduction. Female Sprague-Dawley rats were divided into three groups: one control group and two sodium
fluoride -treated groups (100 and 200 mg/L in the drinking water for 12 weeks). The results indicated that administration
of sodium fluoride lead to significant decreases in E2 and P levels in the serum and in the expression of FSHR protein.
In addition, fluoride exposure significantly increased Erα and PgR protein expression levels and LHR protein expression.
These results suggest that the reproductive hormone reduction and the abnormalities of related receptor proteins
expression are important factors underlying the decreased fertility observed in female rats that have been exposed to
sodium fluoride. [3]

Weanling male Wistar rats (three-weeks old) were divided into three groups and treated with drinking water containing
0, 5 or 50 mg/L F for 60 days (n=6/group). Liver morphometric analysis did not reveal alterations in the cellular
structures and lipid droplets were present in all groups. Most of proteins were related to metabolic process and
pronounced alterations were seen for the high-F level group. In F-treated rats, changes in the apolipoprotein E (ApoE)
and GRP-78 expression may account for the F-induced toxicity in the liver. [4]

Sodium fluoride is associated with embryonic and fetal development abnormalities. Data suggest that sodium fluoride
may interact directly with the embryo to disrupt the maintenance of normal gene imprinting during pregnancy. Long-term
sodium fluoride exposure of males may not directly affect DNA methylation of the sperm and liver, but the sperm may
signal to early embryos with abnormal gene imprinting. [6]

Increase in the sodium fluoride concentration resulted in increased fluoride deposition in brain tissue. This increased
fluoride content led to increased levels of certain neurotransmitters such as epinephrine, histamine, serotonin and
glutamate and decreased levels of norepinephrine, acetylcholine and dopamine in a dose dependent manner. Sodium
fluoride exposure led to the decrease in the levels of CD4, NK cells and IgG1 coupled with marked increase in lipid
peroxidation and impairment of the antioxidative defense system. [7]

Reference
[1] FDA website, October 2, 2013
[2] Water: Basic Information about Regulated Drinking Water Contaminants, EPA website, October 2, 2013
[3] Zhou Y et al, The toxicity mechanism of sodium fluoride on fertility in female rats. Food Chem Toxicol. 2013 Sep 23
[4] Pereira HA, et al, Proteomic analysis of liver in rats chronically exposed to fluoride. PLoS One. 2013 Sep 17;8(9)
[5] Perumal E, et al, A brief review on experimental fluorosis. Toxicol Lett. 2013 Sep 17
[6] Zhu JQ et al, Sodium fluoride disrupts DNA methylation of H19 and Peg3 imprinted genes during the early
development of mouse embryo. Arch Toxicol. 2013 Sep 13.
[7] Reddy Y et a, Effect of sodium fluoride on neuro-immunological parameters, oxidative stress and anti-oxidative
defenses. Toxicol Mech Methods. 2013 Sep 12.

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Fluoride Benefits and Side Effects