Speaker 1: Ouch. It's nineteen sixty four and I'm at the Fight
Speaker 1: of the Century and I just lost I got my
Speaker 1: tooth pulled. And why did I lose my tooth? I
Speaker 1: didn't really know then, but I do now. It was
Speaker 1: bacteria versus floride, and I didn't have any It was
Speaker 1: bacteria poop to be exact acid. I'm eating candy. My
Speaker 1: mom doesn't really know how much I'm eating cereal that's
Speaker 1: called sugar smacks or frosted flakes with a sugar bowl
Speaker 1: that we got to use sugar because my mom was
Speaker 1: sleeping and we didn't want to wake her because we
Speaker 1: were five kids and my mom needed her sleep in
Speaker 1: the morning. So hiding in plain sight in nineteen sixty
Speaker 1: four was fluoride. It had just entered the water in
Speaker 1: New York City and it was in some toothpastes. Blord
Speaker 1: knows if I brushed my teeth, I can't remember. We
Speaker 1: probably did, but we certainly didn't have fluoride treatments at
Speaker 1: the dentist. And so why did I lose my teeth
Speaker 1: at that time? Because it's not one thing, It's not
Speaker 1: one quantity of one thing. It's an approach to health
Speaker 1: reasonable amounts of sugar fluoride in the water to build
Speaker 1: the teeth strong. And I know that. And why do
Speaker 1: I know that? Well, I don't remember if I said
Speaker 1: this is Rafael, and it is, but this is doctor Santore.
Speaker 1: Also in nineteen seventy four, about ten years after I
Speaker 1: got my tooth pulled, I went to dental school and
Speaker 1: I learned a lot about how to fix broken teeth.
Speaker 1: I didn't learn as much how to keep them from
Speaker 1: getting broken, how to keep them from getting decayed. That
Speaker 1: came with time and maturity. And after forty five years,
Speaker 1: I have a lot of stories, but I only want
Speaker 1: to tell you one or two. So what happened In
Speaker 1: nineteen eighty I was treating patients and I was finished
Speaker 1: with all my resus and sees and things. And I
Speaker 1: noticed that I would fix teeth that had cavities on
Speaker 1: top of the fillings on top of the teeth that
Speaker 1: just had cavities. Boy, that lactic acid and all those
Speaker 1: things that bacteria produce and they erode teeth were working
Speaker 1: really hard against me. And I started to see a
Speaker 1: change in the late eighties. And in nineteen eighty seven,
Speaker 1: Willibrook closed and that is where we saw lots of
Speaker 1: patients who came to the hospital I worked at where
Speaker 1: I did anesthesia and taught pediatric residents how to do
Speaker 1: dentistry and how to think about healthcare for the handicapped.
Speaker 1: And we saw over about ten years before Willibrook closed
Speaker 1: and even after, while we were treating the handicapped in
Speaker 1: the larger New York area mostly Brooklyn, but larger New
Speaker 1: York area, that the kids were getting less cavities. We
Speaker 1: started speaking to the parents and we start looking at
Speaker 1: the data, and we realized that there was a revolution,
Speaker 1: that the bacteria was starting to lose the battle. And
Speaker 1: we weren't quite sure why. It seemed common sense that
Speaker 1: people brush their teeth, but it had to be more
Speaker 1: than that, because the handicapped kids could not brush their
Speaker 1: teeth well, their parents were always exhausted caring for them,
Speaker 1: and it was a difficult environment. In about nineteen ninety one,
Speaker 1: varnishes came out that we dentists could use in the
Speaker 1: teeth and before we put the restorations in them. And
Speaker 1: in nineteen ninety six, my son, my firstborn son, was
Speaker 1: six years old and he had no cavities. And I
Speaker 1: noticed because I treated the kids in his class that
Speaker 1: they had no cavities. And I started to put together
Speaker 1: the relationship between good healthcare and systemic fluoride as well
Speaker 1: as topical fluoride, and they do different things, and we
Speaker 1: argue to this day about which one is better, and
Speaker 1: they are both important. But the thing about systemic fluoride
Speaker 1: is it's the quiet giant that works behind the scenes.
Speaker 1: And that's what I came to realize as a dentist
Speaker 1: in the trenches, so to speak, trying to prevent teeth
Speaker 1: from being destroyed. In the year twenty twenty five. I
Speaker 1: can tell you without a doubt from treating different communities
Speaker 1: with different advantages and access, that fluoride in all its forms,
Speaker 1: properly used is a gift to children. And I share
Speaker 1: that with every parent that comes in and I show
Speaker 1: them X rays. I have so many X rays that
Speaker 1: show such a long history that we went from decay
Speaker 1: and fillings to very little decay or almost mos none
Speaker 1: and no feelings. And I thank you for listening to this,
Speaker 1: and I hope you heard a simple message with all
Speaker 1: the honesty that I meant for you to have and
Speaker 1: to hear.
Speaker 2: Thank you.
Speaker 3: I've that so good.
Speaker 4: Ray, Thank you so so much for sharing that with us.
Speaker 3: Yeah, thank You're the best, the.
Speaker 4: Best, A man who goes by many names, Raphael, doctor Santore,
Speaker 4: Uncle Ray, my husband's uncle Ray. So but I really
Speaker 4: did appreciate that perspective of like, here's a noticeable difference.
Speaker 5: You know.
Speaker 4: I feel like sometimes big public health measures we don't
Speaker 4: see the impact right away, right, we only see the
Speaker 4: impact when they're taken away. But I love that with
Speaker 4: that additional fluoride to the water, it was like, here
Speaker 4: is a very clear night and day difference.
Speaker 6: Right, we can really see the effects. And from someone
Speaker 6: who's on literally the front line of it, right, holding teeth.
Speaker 3: Day in and day out.
Speaker 4: Yeah, yeah, yeah, we really appreciate it, super super appreciate it.
Speaker 7: Hi.
Speaker 4: I'm Aaron Welsh and I'm erin onmant Updike And this
Speaker 4: is this podcast Will Kill You.
Speaker 3: Part two of Fluoride Part two. Yeah, it's on me today.
Speaker 4: I am just thinking how weird it is, and like,
Speaker 4: I don't know if I get it. I don't know
Speaker 4: if it's like nice, if I'm like comfortable not having
Speaker 4: anything to say, you know, nothing to hold anybody. I mean,
Speaker 4: it's not I get to just like sit back and relax.
Speaker 3: I liked it last week.
Speaker 6: I would love to do more of those. Very nervous
Speaker 6: about this week. But so last week, if you missed it,
Speaker 6: we went through Aaron Welsh went through the history of fluoride,
Speaker 6: how we figured out what it does, when we started
Speaker 6: putting it in our water, slash when it was always there,
Speaker 6: we stopped.
Speaker 4: Putting it in our water in some places.
Speaker 6: And the history, yes, of the anti fluoridation movement. So
Speaker 6: today I am going to talk to us about Honestly, Erin,
Speaker 6: this is going to be just a very long winded
Speaker 6: episode for me to end with essentially the same conclusion
Speaker 6: that you stated last week that as of right now,
Speaker 6: there there is no data of harm to our health
Speaker 6: from drinking water with fluoride added to it at the
Speaker 6: specific concentrations that we add to it, right that's the
Speaker 6: TLDR TLDL tld listen.
Speaker 3: Yep, there you go.
Speaker 6: But let me tell you it took me a very
Speaker 6: long time, quite a lot of research and a real
Speaker 6: emotional journey to get to that conclusion.
Speaker 4: So okay, I'm curious about the emotions. Number one. Number two,
Speaker 4: I think that that illustrates how challenging it can be
Speaker 4: yes if you have questions to get to the bottom
Speaker 4: of one hundred questions per.
Speaker 6: But we will do our best to do that today
Speaker 6: with first going into some detail on like what a
Speaker 6: carry or a cavity like we talked about last week,
Speaker 6: really is how it forms?
Speaker 4: Quick question, is it ya carries?
Speaker 3: I don't know.
Speaker 6: Erin, I still don't know, and I'm probably just going
Speaker 6: to call it cavity because that's my word.
Speaker 4: Okay, I'm finally carries seem so weird, I know, I
Speaker 4: kept I kept trying to like adjust the verb noun.
Speaker 6: It's like the dental carries. Okay, how dental carries form?
Speaker 3: How about that?
Speaker 4: How dental carries forms? What carries carries is? What's the
Speaker 4: singular of carries? Yeah, we need we clearly do. I
Speaker 4: think it's like deer and deer.
Speaker 3: No that I can't accept that. I think it might
Speaker 3: see the end, but carries is plural and singular whatever
Speaker 3: Aaron listen is.
Speaker 6: We're going to talk about how they form, how fluoride
Speaker 6: actually works to protect against the formation of dental carries,
Speaker 6: where we're getting that fluoride from, and then of course
Speaker 6: all of the controversies if that is the right word
Speaker 6: about the supposed or.
Speaker 3: Possible negative health effects of fluoride.
Speaker 6: Okay, okay, so we're gonna talk about today, but first,
Speaker 6: but first, it's quarantine.
Speaker 4: It's quarantine. Ay time, we're drinking the same thing we
Speaker 4: did last week, and that is pulling.
Speaker 3: Teeth, pulling teeth. Yeah, yeah, okay.
Speaker 4: It's we don't quite remember the ingredients. But that's okay
Speaker 4: because you know what, you know, it would have been
Speaker 4: so easily accessible in my notes. Yeah, but that's okay
Speaker 4: because you know where you can find that on our website.
Speaker 3: Yeah, this podcast, podcast.
Speaker 4: Or all of our social media channels.
Speaker 6: We're there, Instagram, this podcast will kill you Blue Sky.
Speaker 5: I don't remember either tpwky or this podcast will kill
Speaker 5: you Facebook.
Speaker 6: We still exist there, TikTok. Also, you know what I mean,
Speaker 6: just just follow us.
Speaker 4: Check it, check it out.
Speaker 6: There's mint in it, there's elderflower. It's like it's delicious.
Speaker 4: Let's let's do a web a website spiel. We've got transcripts,
Speaker 4: We've got sources. Because I know that you're gonna want
Speaker 4: to re up more on floride.
Speaker 3: Yeah you are.
Speaker 4: We've got some. We've got some sources. We've got a
Speaker 4: link to where you can submit your first hand account.
Speaker 4: We've got links to the books that we feature on
Speaker 4: these episodes, and our book club episodes and more things
Speaker 4: that was a terrible website should beel You did your best.
Speaker 4: Thank you.
Speaker 1: That's all.
Speaker 4: It's all I can do.
Speaker 6: It's all I can hope for rate review and subscribe
Speaker 6: on your favorite podcaster.
Speaker 3: Yeah you can.
Speaker 4: We're on YouTube.
Speaker 3: YouTube the let's go, let's go. Okay, after a break,
Speaker 3: we'll do it.
Speaker 6: I just want to also set the stage really quick, okay,
Speaker 6: and remind us of what a global public health prop
Speaker 6: Dental carries are.
Speaker 3: Gonna use them as a plural.
Speaker 6: It's both a plural and a singular. So you're in
Speaker 6: the clear, okay, I cannot get it wrong. So the
Speaker 6: World Health Organization estimates, and this is a little bit
Speaker 6: old data, but it's still what is cited that two
Speaker 6: point four billion people across the globe have untreated dental
Speaker 6: carries in their permanent teeth, and six hundred and twenty
Speaker 6: one million kiddos have untreated dental carries in their primary teeth.
Speaker 6: So this is a huge public health problem. There was
Speaker 6: a really great Nature review Nature Reviews Disease Primer's paper
Speaker 6: from twenty seventeen that I used heavily for the carries section,
Speaker 6: and it estimates that sixty to ninety percent of children
Speaker 6: and the vast majority of adults are affected by dental
Speaker 6: carries at some point in their life, and they're actually
Speaker 6: considered the single most common chronic childhood disease.
Speaker 5: Like what I mean, I'm not surprised, I know, And
Speaker 5: like many chronic infectious diseases, we do see disparities in
Speaker 5: prevalence as well as access to care, with children of
Speaker 5: color and children in lower income areas having significantly higher
Speaker 5: prevalence and difficulties in access to care.
Speaker 6: Although globally it is still the case, though this is
Speaker 6: changing due to dietary changes. Higher income countries actually tend
Speaker 6: to have slightly more carries than lower income countries, So
Speaker 6: that's largely dietary differences and how much sugar we eat. Okay,
Speaker 6: and that's the end that I'm going to say about sugar,
Speaker 6: because today is about fluoride. Okay, Let's talk about how
Speaker 6: dental carries form. There's two main components that exist for
Speaker 6: the formation of dental carries. First is issues with the
Speaker 6: enamel itself, and the second is the components of the
Speaker 6: oral microbiome. So let's start there. Our oral microbiome is
Speaker 6: just so varied. We have so many different things that
Speaker 6: live in our mouth. We've got bacteria, yeast, viruses, protozoa,
Speaker 6: even our did you know that I did.
Speaker 3: Not know neither.
Speaker 4: How did they get there?
Speaker 6: How did they get there? Many of these organisms are
Speaker 6: commensals or even beneficial to our mouth and to our health,
Speaker 6: but some are what we call kryogenic.
Speaker 3: And all of.
Speaker 6: These helpful and unhelpful organisms, because I can't just say bacteria.
Speaker 3: It's more than just bacteria.
Speaker 6: They live together, and they grow and form this very
Speaker 6: complex biofilm on our teeth surface that.
Speaker 3: We call plaque plack.
Speaker 6: And each surface of each one of our teeth is
Speaker 6: its own little micro environment, with its own little microbiome.
Speaker 4: So there's like there's like whole mouth.
Speaker 6: And then there's like each little surface of its tooth.
Speaker 6: It's going to be a little bit different. Yeah, isn't
Speaker 6: that great to think about?
Speaker 4: I am very curious, Okay, And so I assume that
Speaker 4: there's like a fairly there that there's a gradient from
Speaker 4: front to too, like if you're closer to the back
Speaker 4: of your mouth. What's going on there?
Speaker 6: For no idea? We should do a whole episode on
Speaker 6: the oral microbiome.
Speaker 4: Really we should, though, we should like flossing. Listen, we
Speaker 4: should talk about floss.
Speaker 3: You know, we've talked a lot about floss.
Speaker 4: You and I you talked a lot about more than
Speaker 4: you would expect.
Speaker 3: I know.
Speaker 6: Okay, but listen, let's get back to the oral microbiome
Speaker 6: in the contee.
Speaker 4: Of visual teeth, et cetera.
Speaker 6: Yeah, so, under certain environmental conditions, for example, high concentrations
Speaker 6: of fermentable carbohydrates like sugar, or conditions like say a
Speaker 6: reduction in saliva, we can see a shift in this
Speaker 6: microbiome to favor certain bacteria, including various species that are
Speaker 6: more either acid producing, so they make more acid from
Speaker 6: these fermentable carbohydrates, or they're just very tolerant of this acid.
Speaker 6: And it's not just like one, one or two species
Speaker 6: of bacteria. We used to think it was just like
Speaker 6: maybe a couple different species that were the main causes
Speaker 6: of dental carries.
Speaker 3: It's not.
Speaker 6: It's this whole ecological community that shifts to favor acid production,
Speaker 6: and that is the first step in the formation of
Speaker 6: dental carries. Is this shift in the oral microbiome to
Speaker 6: favor acid production, and we most often see this due
Speaker 6: to things like regular exposure to sugars.
Speaker 4: Okkay, so we've got this. The first thing, like the
Speaker 4: inciting incident, is the sugar, and then that just sort
Speaker 4: of selects for this ecosystem exact acid or caryogenic.
Speaker 6: Then we have the hard stuff, our enamel. So as
Speaker 6: the acid production from these bacteria starts to build up
Speaker 6: in our mouth, the pH of course is going to drop.
Speaker 6: Acid has a low pH, and that drops the pH
Speaker 6: at the surface of our enamel, which is the outermost
Speaker 6: part of our teeth that surrounds the denteene right. Enamel
Speaker 6: is mostly made of a substance called hydroxy appetite, which
Speaker 6: is basically just a compound of calcium and phosphate and hydroxyl,
Speaker 6: which is like oxygen and hydrogen. And in the presence
Speaker 6: of acid, what happens is that this becomes soluble. So
Speaker 6: there's a partial demineralization of this outer surface of the tooth.
Speaker 6: And as this hydroxy appetite starts to demineralize, then you
Speaker 6: have an increase in porosity, right, So then this acid
Speaker 6: can diffuse even deeper and cause further demineralization, releasing more
Speaker 6: calcium and more phosphate from this enamel. Right, and this process,
Speaker 6: don't ask questions yet, aarin.
Speaker 4: I can see you take a see me up.
Speaker 6: Yeah, this process and the fact that, like we have
Speaker 6: saliva in our mouth which serves as a buffer. Eventually
Speaker 6: we're gonna wash out some of this acid. Eventually you
Speaker 6: will have remineralization, right because the calcium and phosphate are
Speaker 6: being released, Your saliva is coming into buffer and eventually
Speaker 6: things even out to where the calcium and phosphate is
Speaker 6: gonna redeposit and you can remineralize this unless you can't
Speaker 6: because if you continue to have acid production, if you
Speaker 6: don't have enough saliva, et cetera, then this demineralization process
Speaker 6: can continue until you end up damaging the pulp of
Speaker 6: the tooth, which can then damage the canal, the root canal,
Speaker 6: and then you end up meeting a root canal or
Speaker 6: an extraction. But this process demineralization and then remineralization, mineralization,
Speaker 6: it's hard word to say this is happening in our
Speaker 6: mouth all the time. I think that we think of
Speaker 6: our teeth as like static, right, they're just like little
Speaker 6: bones sitting in our mouth, But they're not. They're alive
Speaker 6: and they are constantly changing in response to the environment
Speaker 6: of our mouth.
Speaker 4: Okay, can you tell me about why low saliva is bad?
Speaker 6: Saliva is a buffer in power in that acid base system,
Speaker 6: and so with out the saliva, then you don't have
Speaker 6: that buffer. Yeah, and then why there's probably more.
Speaker 4: But the short answer why acid? Like why do these
Speaker 4: microbes produce acid? Is it like a competition thing with
Speaker 4: other microbes that's just to kind of like stake out
Speaker 4: more space and claim that's a deeper dive.
Speaker 3: I don't know.
Speaker 6: Is it just that that's like a byproduct of the
Speaker 6: production of sugars, right, That's what it seems like. It's
Speaker 6: like they produce mostly lactic acid as a result of
Speaker 6: the production or the digestion of sugars. So it's just
Speaker 6: like they're poop right right, Yeah, Okay, but that's just
Speaker 6: like all of that was just dental carries. That's just
Speaker 6: what's happening in our mouth. Where the heck does fluoride
Speaker 6: come in? I haven't even said the word fluoride yet.
Speaker 4: It's just lurking in the background.
Speaker 3: It is. It is erin.
Speaker 6: So it is like you said last week, Aaron, you
Speaker 6: kind of went into this fluoride is it's just a
Speaker 6: mineral salt that's present in our environment. Like all of
Speaker 6: us are being exposed to fluoride through various sources. Fluoride
Speaker 6: is like the ion form of fluorine, the element which
Speaker 6: is I learned, the thirteenth most abundant element in our
Speaker 6: Earth's crust. It's just there, it's around, it's in a
Speaker 6: lot of different mineral compounds, and it's absorbed very well
Speaker 6: via our GI tract when we are.
Speaker 3: Exposed to it.
Speaker 6: But how does it work in our teeth to protect
Speaker 6: them from dental carries. There are several mechanisms that we
Speaker 6: know of now. How fluoride works. First is that it
Speaker 6: delays that initial demineralization process. Basically, fluoride itself you can
Speaker 6: think of as acting like a buffer it because of
Speaker 6: when fluoride precipitates versus becomes soluble compared to calcium phosphates
Speaker 6: and the hydroxyl groups that's in hydroxy appetite. In the
Speaker 6: presence of fluoride, you have to have a lower pH
Speaker 6: a more acidic environment before that de mineralization starts.
Speaker 3: Does that make sense.
Speaker 4: Yeah, yeah, yeah, like lowers or it raises the bar
Speaker 4: or like you got to be even more acidic if
Speaker 4: you want to do damage.
Speaker 3: Here exactly exactly.
Speaker 6: And then on top of that, again because of the
Speaker 6: chemical properties, it also hastens that process of remineralization. It
Speaker 6: returns that neutral pH faster to favor remineralization. Right, so
Speaker 6: you're like less demineralizing and more remineralizing.
Speaker 4: Wow, Okay, so it's like a twofold. It protects you
Speaker 4: and it also helps to repair fast exactly.
Speaker 6: Yeah, and there are more mechanisms too. It also can
Speaker 6: interfere with like the bacteria themselves that form this biofilm,
Speaker 6: they can fluoride can interfere with glycolysis, so some of
Speaker 6: the specific like metabolic processes in that bacteria that live
Speaker 6: in our mouths, especially those carryogenic ones, so that they're
Speaker 6: just not as efficient. It's thought that this is probably
Speaker 6: not like the most important mechanism, but it is yet
Speaker 6: another mechanism by which fluoride is helping the oral microbiome
Speaker 6: of our teeth, which is cool. And all of these
Speaker 6: events happen even at very low levels of fluoride in
Speaker 6: our mouths, like less than one part per million. At
Speaker 6: high levels of fluoride, it can also penetrate through the
Speaker 6: plaque and then be incorporated into our enamel itself. So
Speaker 6: instead of that hydroxy appetite, you can have fluoride there
Speaker 6: instead of the OH group. So it's called fluoro appetit.
Speaker 6: Did you know that shark enamel is made almost entirely
Speaker 6: of fluoro appetate?
Speaker 4: All like what they.
Speaker 6: Don't ask watertails are like, is there a lot of
Speaker 6: fluoride in salt water in the ocean. There's like one
Speaker 6: to one point five parts per million in saltwater. So nah,
Speaker 6: not really, I mean there's so amazing Okay, Yeah, So
Speaker 6: that that's some of the other ways. And like we
Speaker 6: talked about last week, erin if we are ingesting fluoride
Speaker 6: systemically in our water, in our food, whatever pre eruption
Speaker 6: i e. When we are little before our first teeth
Speaker 6: pop out, it also has been shown to make our
Speaker 6: enamel more resistant to the development of carries later on,
Speaker 6: especially the deep, craggly bits of our teeth that aren't
Speaker 6: ever going to be exposed to topical fluoride.
Speaker 4: Ah okay, And this is both for baby teeth and
Speaker 4: permanent teeth.
Speaker 6: All these mechanisms. Yes, yes, And I want to actually
Speaker 6: stop here for a second and take a pause, because
Speaker 6: this already what I have said, is one of the
Speaker 6: points that many of the papers and the rhetoric that
Speaker 6: pushes back against the idea of community water fluoridation really
Speaker 6: tends to stick on because it is true. And we
Speaker 6: talked a little bit about this last week. We know
Speaker 6: now that the primary mechanism of action of fluoride is
Speaker 6: actually topical, so it is what is happening in on
Speaker 6: and around our teeth, in our saliva, in this dental plaque,
Speaker 6: et cetera. There are, though, these so called systemic effects
Speaker 6: in that there is data, pretty clear data that there's
Speaker 6: a pre eruptive benefit to having exposure to fluoride before
Speaker 6: your teeth even form, but the primary way that it
Speaker 6: works thereafter is by existing in our mouths and around
Speaker 6: our teeth. But when you really then think about all
Speaker 6: of the different ways that we could be then exposing
Speaker 6: people to fluoride, that fact that it is topical, that
Speaker 6: it is low levels, that it is a constant exposure,
Speaker 6: actually favors water fluoridation because we're drinking it multiple times
Speaker 6: a day every day compared to say milk or salt fluoridation,
Speaker 6: which are other more targeted strategies that other countries use,
Speaker 6: for like large scale fluoride distribution. Right, because drinking it
Speaker 6: in our water is this constant low concentration flow. Plus
Speaker 6: than anything that's absorbed systemically is then going to be
Speaker 6: re secreted into our saliva, although at even lower levels,
Speaker 6: right right, right.
Speaker 4: I mean it's it's that the fact that it's if
Speaker 4: it's if you're drinking it, then it's then you have
Speaker 4: the systemic fluoride in your saliva, bathing your teeth right
Speaker 4: in fluoride.
Speaker 6: Right, it's also when that water is in your mouth,
Speaker 6: So it's not just like having to be absorbed by
Speaker 6: your giatract it's also every single time I've been swishing
Speaker 6: my water a lot more since reading about this, Probably ridiculous,
Speaker 6: but really.
Speaker 4: Yeah, Okay, so I have a question about the development
Speaker 4: of teeth when.
Speaker 6: Oh no, Aaron, Yeah, ask me questions about things they
Speaker 6: didn't research.
Speaker 3: Okay, go ahead, I.
Speaker 4: Mean take it away, like when do teeth develop?
Speaker 8: I mean, I pass, Okay, I'm sorry.
Speaker 4: I was just thinking, like, at what level when is
Speaker 4: exposure to systemic fluoride? Yeah, for tooth development, Like, really,
Speaker 4: what is that critical time period?
Speaker 6: Yeah, I don't know, and I didn't see the specific
Speaker 6: data on that. They all just say like pre eruptive,
Speaker 6: because I think by the time, so like six months
Speaker 6: to twelve months is when your first baby teeth usually
Speaker 6: start to appear, and then the obviously adult teeth you
Speaker 6: start to lose. Your baby teeth usually by six years
Speaker 6: old is like the earliest, sometimes a little bit earlier,
Speaker 6: So it's sometime in that time frame, like before the
Speaker 6: eruption of especially your adult teeth. But yeah, I don't
Speaker 6: I don't have an answer to that, Aaron.
Speaker 7: Okay, okay, But so what are the different ways that
Speaker 7: we have used this knowledge that we now have about
Speaker 7: how effective Florida is and the ways that it's effective
Speaker 7: to prevent dental carries?
Speaker 6: What are the different ways that we've been using this
Speaker 6: to improve public health? And you kind of set the
Speaker 6: stage for us for this a lot last week, Aaron.
Speaker 6: In the US community, water fluoridation is the way that
Speaker 6: we as a society, I guess, I don't know, as
Speaker 6: a what's the word nation? Yeah, country, the word I
Speaker 6: was looking for, Okay. It is the way that we
Speaker 6: as a country have decided to do oral health right
Speaker 6: is community water fluoridation. We've been doing it for almost
Speaker 6: eighty years. It's had tremendous and very measurable public health impacts.
Speaker 6: And it is not just the US. Countries around the
Speaker 6: globe have been using widely admitted stirred fluoride for the
Speaker 6: prevention of dental carries for a really long time. Some countries,
Speaker 6: instead of using it in the water, have decided to
Speaker 6: use milk supplementation, the way that we fortify milk with
Speaker 6: vitamin D in the US. Other countries have used salt,
Speaker 6: like the way that we fortify salt with iodine here
Speaker 6: in the US.
Speaker 3: Are we sensing a theme here?
Speaker 4: Yeah?
Speaker 6: And then community water fluoridation or CWF is the most widespread.
Speaker 6: It's covered an estimated four hundred million people in twenty
Speaker 6: five different countries worldwide.
Speaker 4: It's actually less than I thought, Fewer than I thought.
Speaker 6: Okay, yeah, I mean that doesn't account for everyone who
Speaker 6: just gets it from naturally floridated sources, which we'll talk about.
Speaker 6: But I also just want to do a plug real
Speaker 6: quick here, and I have a paper to back this
Speaker 6: up that our water fluoridation systems are very, very impressively
Speaker 6: good at keeping the concentrations at that point seven parts
Speaker 6: per million or milligrams per liter that they are expected
Speaker 6: to like better than I expected, honestly, like very verging
Speaker 6: at it.
Speaker 4: And I think that's a talk point of some anti
Speaker 4: floridationists where they're like, they're not really measuring the water,
Speaker 4: it's just like a ballpark.
Speaker 3: They actually do a very good job of it.
Speaker 6: Yea, the US Public Health Surface and the ADA report,
Speaker 6: their estimate is that drinking fluoridated water at the level
Speaker 6: that they recommend, which again I'm going to say this
Speaker 6: a million times zero point seven milligrams per leader, which
Speaker 6: is the same as parts per million, reduces dental carries
Speaker 6: by twenty five percent in children and adults. And that
Speaker 6: number already is now contentious because recently some papers that
Speaker 6: have tried to look at, like, what is the benefit
Speaker 6: just of floridating our water, specifically in more recent years,
Speaker 6: since the advent of other dental hygiene options, like we
Speaker 6: didn't used to have fluoridated toothpaste, we didn't used to
Speaker 6: have fluoride sealants, et cetera. So some papers that have
Speaker 6: tried to look just at more recent data estimate a
Speaker 6: lower benefit, maybe like a three to four percent reduction
Speaker 6: in carries. And this is based on a Cochrane review
Speaker 6: that came out last year as well as a paper
Speaker 6: out of the UK that looked at like ten years
Speaker 6: of UK data.
Speaker 3: But at the same.
Speaker 6: Time, other recent papers, including one out of Australia from
Speaker 6: twenty seventeen and one out of Brazil in twenty twenty one,
Speaker 6: actually had much higher carry reduction estimates from their water fluoridation.
Speaker 6: So we don't know the exact amount, but the data
Speaker 6: is clear across the board that there is a reduction
Speaker 6: in dental carries, and every paper that has looked at
Speaker 6: the financial impacts consistently finds that community water fluoridation is
Speaker 6: a cost effective intervention even when its impacts are less.
Speaker 4: Okay, okay, So I just I really want to understand
Speaker 4: why there are such discrepancies and so like, Historically those
Speaker 4: numbers were much higher even than twenty five percent, right,
Speaker 4: I mean, even the.
Speaker 6: Brazil paper from twenty twenty one at like was a
Speaker 6: fifty percent reduction.
Speaker 4: So right, yeah, So what can account for that three
Speaker 4: to four percent?
Speaker 6: I don't know in all honesty, Aaron, I mean, is
Speaker 6: it just that we have so many other options that
Speaker 6: are doing a very good job. And so we've seen
Speaker 6: I don't know, because it's not like we've seen reductions
Speaker 6: and carries like carries are, if anything, on the rise.
Speaker 6: So I don't know, Okay, I don't have a good
Speaker 6: answer for you. I just can tell you that is
Speaker 6: what the data shows. Yeah, so we we grains of salt,
Speaker 6: all of this, okay, okay, but consistently a reduction and
Speaker 6: like what level of reduction in carry's prevalence do we
Speaker 6: have to hit for this to be considered important if
Speaker 6: we know that it's cost effective. That is like so
Speaker 6: far beyond my expertise, right, this is like these are
Speaker 6: the big questions.
Speaker 4: I mean, it's still it's still to me comes down
Speaker 4: to the fact that, like this is a community public
Speaker 4: health approach, correct, versus you have to go then go
Speaker 4: to the store and buy mouthwashing and buy the right
Speaker 4: toothpaste and go to the dentists and all the things
Speaker 4: that cost a lot of money. Whereas floridated water.
Speaker 6: It's just yeah, yeah, yeah, and I will take a
Speaker 6: reasonable solution, doesn't it. And so that's what we've decided. Okay,
Speaker 6: So now we have to get into what I know
Speaker 6: that everyone probably really wants to know is there's a
Speaker 6: lot of people talking about that fluoride is actually quite
Speaker 6: harmful to us. So what does the data show? What
Speaker 6: are the risks, if any, of having fluoride in our water?
Speaker 6: There are only two potential harms that are worth talking
Speaker 6: about in detail today, So that's what I'm going to
Speaker 6: focus on. But I do just want to point out
Speaker 6: that there are an endless array of things that fluoride
Speaker 6: has been blamed for and.
Speaker 3: Continues to be blamed for.
Speaker 6: Kidney dispruption, kidney stones, bladder cancer, all cancer, sex, hormone disruption, ADHD, diabetes,
Speaker 6: liver dysfunction, infertility, muscular skeletal pain. Throw a dart at
Speaker 6: your Path of physiology textbook. Someone has made a claim
Speaker 6: that florid has caused it.
Speaker 4: I mean, last week, what did I say?
Speaker 5: Undo?
Speaker 6: Financially, there's actually data that fluoride in the water people
Speaker 6: work more and they have better income and stuff. There's
Speaker 6: some papers that say that, which is so interesting.
Speaker 4: I mean, yeah, you're not having to go to the
Speaker 4: dentist to like for emergency dental it carries repair all
Speaker 4: the time.
Speaker 3: Whatever, what does the data show?
Speaker 6: Okay, let's let's look at this. Yeah, there are some
Speaker 6: things that we know for sure. There is very consistent
Speaker 6: evidence of absolutely no association between fluoride exposure and cancer
Speaker 6: or cancer related mortality, or bone cancer specifically, or hip
Speaker 6: fracture or down syndrome or kidney stones, so that we
Speaker 6: can say definitely no.
Speaker 3: Association, no association.
Speaker 6: Thyroid dysfunction is another thing that people say is caused
Speaker 6: by fluoride. There is really limited evidence for any association
Speaker 6: one way. There are papers, some of which show an association,
Speaker 6: some of which do not show an association. At this point,
Speaker 6: we cannot make any solid conclusion for thyroid dysfunction and
Speaker 6: most of the rest of these claims. There is simply
Speaker 6: no data to even evaluate these associations, which just means
Speaker 6: that anyone who says that these associations exist is lying.
Speaker 6: It does not mean that, for sure, there's absolutely no
Speaker 6: way that this could ever be related, but there's literally
Speaker 6: no data to support these ideas. Okay, but there are
Speaker 6: two outcomes that are worth digging into a little bit
Speaker 6: more because of the wealth of information that we have
Speaker 6: on the subject and all of the controversies that exist
Speaker 6: right now. And those two are skeletal fleurosis okay, and
Speaker 6: impacts on intelligence as measured by IQ, but which is
Speaker 6: often conflated as just this blanket idea of neurotoxicity.
Speaker 4: Mm hmm.
Speaker 3: So let's get into these too, shall we.
Speaker 4: I'm very excited for this.
Speaker 3: Yeah, yeah, excited. It is not the word I would use.
Speaker 4: I am.
Speaker 3: Yeah, it's excited. We're excited. Listen.
Speaker 6: Skeletal fluorosis Okay, Aaron, you talked to us a lot
Speaker 6: last week about dental fluorosis, and that is when we're
Speaker 6: exposed to a lot of fluoride and then our teeth
Speaker 6: get modeled enamel from it because of the fluoride actually
Speaker 6: accumulating in our teeth. So much like fluoride can accumulate
Speaker 6: in our teeth, if we're exposed at high levels, it
Speaker 6: can also accumulate in our bones. And this can lead
Speaker 6: to deficient mineralization, essentially because fluoride is getting taken up
Speaker 6: in our bones instead of the other minerals that would
Speaker 6: normally get taken up in our bones. So then you
Speaker 6: just have a change in your bone structure and potentially
Speaker 6: weaker bones. Now, remember that we have very strong data
Speaker 6: that there's no association between community water fluoridation and hip fractures,
Speaker 6: which is one of our main metrics to look at,
Speaker 6: like the strength of bones. Okay, but skeletal fluorosis is
Speaker 6: something that definitely can happen and does happen. It generally
Speaker 6: happens at long term intakes of six to fourteen milligrams
Speaker 6: of fluoride or more per day.
Speaker 4: Okay, So what is that in terms of parts per million?
Speaker 4: What should we should?
Speaker 5: We?
Speaker 4: Err in math a little bit, Yes, we should.
Speaker 3: I can't wait.
Speaker 6: Okay, if you this is Aaron Math trademark, I could
Speaker 6: be wrong, but I did the math.
Speaker 3: Okay.
Speaker 6: If you got all of your fluoride from drinking water
Speaker 6: in the US, from optimally fluoridated sources, then you would
Speaker 6: be drinking water that was point seven milligrams per liter
Speaker 6: or parts per million. Okay, you would have to drink
Speaker 6: eight and a half liters of water per day. If
Speaker 6: you got all of your fluoride from water, you would
Speaker 6: have to drink eight and a half liters of water
Speaker 6: per day just to get six milligrams of fluoride in
Speaker 6: your diet. I don't know about you, but I can't
Speaker 6: even get myself to drink two leaders eight and a
Speaker 6: half liters of water per day. That would not be
Speaker 6: a healthy amount to drink, okay, And.
Speaker 4: So that just remind me again the range that leads
Speaker 4: to that is suggested to lead to skeletal fluorosis.
Speaker 6: So six to fourteen milligrams per day puts you at
Speaker 6: higher risk of skeletal fluorosis. It does not mean that
Speaker 6: you will have it, but ingestion of six milligrams or
Speaker 6: more per day puts, like, at a population level, some
Speaker 6: people are going to end up with skeletal fluorosis.
Speaker 4: Okay.
Speaker 6: Now, no one is getting one hundred percent of their
Speaker 6: daily fluoride from water. It's estimated that in the US
Speaker 6: we get like forty to seventy percent of our daily
Speaker 6: fluoride intake from our water and the rest from other
Speaker 6: bottled beverages.
Speaker 3: Food. Black tea has so much fluoride in it. Who really?
Speaker 6: Yeah? And you know toothpaste, especially our kids who are
Speaker 6: just like chugging that stuff. Yeah yeah, yeah, so annoying
Speaker 6: that they do that.
Speaker 4: Personal delicious though, right, Yeah?
Speaker 3: Why do they make it so delicious?
Speaker 4: Is it delicious?
Speaker 2: No?
Speaker 6: But they think it is. It's like bubblegum flavor, and
Speaker 6: it's so gross.
Speaker 4: Anyways, bubble gum flavor. Toothpaste grosses me out.
Speaker 3: Yeah, you'd say, but I buy it.
Speaker 6: If you assume, then, on the low end, that you
Speaker 6: get forty percent of your fluoride from water, we can
Speaker 6: air and math this as well. In order to get
Speaker 6: to that six milligrams a day, you'd have to still
Speaker 6: be drinking like three and a half liters of water
Speaker 6: three point four liters of water, and somehow getting another
Speaker 6: two point six milligrams from somewhere else. And you'd be
Speaker 6: hard pressed to get that from your other dietary sources.
Speaker 6: Eating a lot of toothpaste, I guess might get you there.
Speaker 6: So the math just does not work out. And there
Speaker 6: are some pretty large meta analyzes that have estimated like
Speaker 6: what does water have to be at for someone to
Speaker 6: have an increased risk of skeletal fluorosis from their drinking.
Speaker 4: Water from just daily drinking.
Speaker 6: Yeah right, you've got to be looking at higher than
Speaker 6: three point seven to three point eight parts per million.
Speaker 4: Which in water, if you were getting something from like
Speaker 4: deep well that has not been evaluated.
Speaker 6: Then you definitely could be drinking that. So realistically, bottom line,
Speaker 6: skeletal fluorosis is not something that is a concern from
Speaker 6: drinking water at the levels that we see in optimally
Speaker 6: fluoridated water systems.
Speaker 4: Question, Yes, how is skeletal fluorosis diagnosed?
Speaker 6: Oh, that's a really good question. I don't actually know
Speaker 6: the full answer to that.
Speaker 4: Okay, yeah, So do we know the prevalence of skeletal fluorosia?
Speaker 6: No, in areas that like the highest prevalence in areas
Speaker 6: that have like really high levels of water fluoridation. I've
Speaker 6: seen like maybe ten or eleven, twelve percent, but like
Speaker 6: across the globe, it's pretty low. But it certainly is
Speaker 6: a risk in areas that have really high fluorid levels.
Speaker 6: And I think there are probably some populations somewhere that
Speaker 6: have much higher levels than that, But I don't have
Speaker 6: like global estimates or anything.
Speaker 4: And so this would be like in areas where you
Speaker 4: see higher like maybe there are geographic areas with higher
Speaker 4: hip fractures than you might suspect there's higher levels of
Speaker 4: fluorid in the drinking water something like that.
Speaker 6: I don't know that I would even go that far, honestly. Okay, Yeah,
Speaker 6: I don't think that we have any data to support
Speaker 6: those kinds of estimates. No, Okay, Yeah, Now on the
Speaker 6: other hand, mild dental fluorosis, which again dental fluoresis you
Speaker 6: get from having higher levels of fluoride in your water.
Speaker 6: We do still see some degree of mild dental fluorosis,
Speaker 6: which is it's considered mild if it's not enough to
Speaker 6: cause significant cosmetic concerns, but like a dentist would see
Speaker 6: it on your teeth. Depending on the study. There's some
Speaker 6: estimates of like ten to twelve percent of the population
Speaker 6: in areas that are like optimally fluoridating their water can
Speaker 6: still have a mild dental thorrosis. So that is real,
Speaker 6: but that's it's not real for skeletal thluorrosis at the
Speaker 6: levels of optimally floridated water.
Speaker 4: It's not like having health impacts, correct, it's having teeth,
Speaker 4: like the appearance of teeth, correct of your teeth.
Speaker 6: And only in a small proportion of the population, right right, right, correct.
Speaker 6: So now a very quick diversion a little bit more
Speaker 6: numbers before we get into the possible neurotoxic effects of fluoride,
Speaker 6: because these numbers are going to get really important because surprise, surprise,
Speaker 6: we need a little bit of nuance here. Okay, I've
Speaker 6: said one hundred times already. The US Public Health Service
Speaker 6: recommends that if communities are going to add fluoride to
Speaker 6: their water, they do so at a level of point
Speaker 6: seven milligrams.
Speaker 4: Per leader or parts really parts realion.
Speaker 7: Yeah.
Speaker 6: Now, the EPA, which is the body who is in
Speaker 6: charge of regulating and enforcing standards for things like our
Speaker 6: drinking water, their standard for the maximum amount of fluoride
Speaker 6: that should be in our drinking water is four milligrams
Speaker 6: per leader. That is the level at which they can
Speaker 6: actually enforce something. Their recommended maximum is two milligrams per leader,
Speaker 6: but it's not actually forable. So if a community, for example,
Speaker 6: has fluoride naturally occurring in their water between two and four,
Speaker 6: the EPA can be like, hey, listen, that's a little high,
Speaker 6: but they cannot do anything about it unless it's above four.
Speaker 4: Okay. This this brings to mind a question about the
Speaker 4: fluoridation laws that are currently being or anti fluoridation laws
Speaker 4: that are currently being discussed or have already been passed,
Speaker 4: like in Utah and Florida. If there is naturally occurring fluoride,
Speaker 4: and this is maybe this is like a question that
Speaker 4: maybe you can't answer.
Speaker 3: But if it is, the questionnaire and it is.
Speaker 4: It is the question if there is naturally occurring fluoride
Speaker 4: in one of these states where if you're not allowed
Speaker 4: to add fluoride to your water, is there anything done
Speaker 4: to reduce the fluoride in that water?
Speaker 6: That is the question, because it also is who is
Speaker 6: checking it and who is enforcing those regulations? Right, because
Speaker 6: the EPA is in charge of detecting this and of
Speaker 6: enforcing these regulations. What teeth do they have to be
Speaker 6: able to enforce those regulations? The more that we defund
Speaker 6: the EPA, what ability do they even have to be
Speaker 6: doing the water testing that they need to be doing
Speaker 6: to make sure that our florid is at a safe level,
Speaker 6: especially in places with naturally occurring fluoride.
Speaker 4: I'm sure a corporation would love to know, hop in
Speaker 4: and charge a great deal of money for that.
Speaker 3: That's a great idea.
Speaker 6: Privatization, Yeah, listen for what it's worth. The World Health
Speaker 6: Organization recommends that drinking water should have no more than
Speaker 6: one point five milligrams per leader. That's their maximum that
Speaker 6: should be allowed in drinking water. And they say that
Speaker 6: for any place who is adding fluoride for community water fluoridation,
Speaker 6: they should do so at a level between point five
Speaker 6: and one milligrams per leader.
Speaker 4: Okay.
Speaker 6: And these numbers, especially that World Health Organization recommendation of
Speaker 6: no more than one point five miligrams per leader. That
Speaker 6: number is important, So keep that in your brain.
Speaker 3: Okay.
Speaker 4: Okay, yep.
Speaker 6: Back in twenty fifteen, so like a decade ago, now,
Speaker 6: the recommendation in the US for optimally floorated water was
Speaker 6: a little bit different. It was like a range you
Speaker 6: could go anywhere from point seven to one point two, okay,
Speaker 6: But then because of the incidents of dental thuosis being
Speaker 6: higher at levels above one, they decided to lower it too.
Speaker 6: Point seven. Back in twenty fifteen. That same year is
Speaker 6: when they established a task force through the NIH actually
Speaker 6: not the CDC, but through the National Toxicology Program to
Speaker 6: look into the effects of fluoride on neurodevelopment and specifically
Speaker 6: on IQ.
Speaker 4: Okay.
Speaker 6: The results of that have now been published just ten
Speaker 6: this year.
Speaker 3: Okay.
Speaker 6: There was a monograph by the National Toxicology Program that
Speaker 6: came out in August twenty twenty four, and then in
Speaker 6: January of this year a like subsequent an additional meta
Speaker 6: analysis that was published in Jama Pediatrics. Okay, so I'm
Speaker 6: going to tell you the conclusions of this study. Aaron, Yeah,
Speaker 6: there is a dose response relationship between exposure to high
Speaker 6: levels of fluoridated water and lower IQ scores in children
Speaker 6: plain English.
Speaker 3: Yeah, kids who are.
Speaker 6: Drinking water that has higher levels of fluoride, specifically, kids
Speaker 6: who are drinking water with more than one point five
Speaker 6: milligrams per liter of fluoride may have slightly lower IQs
Speaker 6: than kids who are drinking water with less fluoride. And
Speaker 6: it's like it goes up with the amount of fluoride
Speaker 6: above one point five milligrams per lid.
Speaker 4: Above one point five and there's a like the more fluoride,
Speaker 4: the higher the reduction in IQ, which, as we maybe
Speaker 4: know is is not a the best metric for things,
Speaker 4: but it is a metric. Yeah you have? Do you have?
Speaker 6: There's so much and bursting to say, and it's it's hard, okay, Yeah,
Speaker 6: And I cannot get too in depth on the exact
Speaker 6: effects size of this because we don't have those exact
Speaker 6: numbers from drinking water itself, Like what is what are
Speaker 6: we talking about? How much of a reduction in IQ?
Speaker 6: They didn't actually estimate those numbers from drinking water, but
Speaker 6: they also looked in this meta analysis at urinary fluoride,
Speaker 6: which is it's a little bit problematic to use because
Speaker 6: we excrete most of the floor that we drink in
Speaker 6: our urine. But the like concentrations are going to vary
Speaker 6: depending on the time and how much water are you drinking,
Speaker 6: blah blah blah. But in any case, for every one
Speaker 6: milligram per liter increase in urinary fluoride, we saw in
Speaker 6: this meta analysis a one point six y three points
Speaker 6: decline in IQ.
Speaker 4: Okay, Okay, just again to like set just so that
Speaker 4: I understand this is in Okay, maybe i'll phrase it
Speaker 4: this way. Yeah, which communities in the US have water
Speaker 4: that's higher than one point five parts per million.
Speaker 6: Before I can even get into that airin. None of
Speaker 6: the studies that were in this meta analysis were in
Speaker 6: the US.
Speaker 3: None of them.
Speaker 6: Almost every single study that was included in this meta
Speaker 6: analysis were done in places that had naturally high levels
Speaker 6: of fluoridation. None of them were in places that were
Speaker 6: adding fluoride to the water at optimum fluorid concentrations.
Speaker 3: A lot of the.
Speaker 6: Studies that were a lot of the studies that had
Speaker 6: you know, like low fluoride versus high fluoride their low
Speaker 6: fluorid concentrations were actually at levels that are consistent with
Speaker 6: what we consider fluoridated water, right because like across the board,
Speaker 6: everyone's got higher fluorid. So high fluoride was like above
Speaker 6: two and low fluoride was zero point five point eight. Okay,
Speaker 6: I know this is so it's too much.
Speaker 4: No, no, no, no, okay. So so this this, this review,
Speaker 4: this meta analogy, this, I guess, this this task force. Yes,
Speaker 4: that was established in the.
Speaker 3: Part of the National Toxicology Program. Yeah, I guess.
Speaker 6: I don't know if it was a tech task force.
Speaker 6: Feels official, but yeah.
Speaker 4: Okay, okay, okay. But there was not a single study
Speaker 4: that it was included that was done that was based
Speaker 4: in the US. No looking at water that is community
Speaker 4: fluoridated in the US.
Speaker 2: No.
Speaker 6: Another meta analysis from a couple of years ago, published
Speaker 6: in twenty twenty three, which one could argue might be
Speaker 6: more relevant to the question of like, is fluoridating our
Speaker 6: water two point seven parts per million potentially harmful, found
Speaker 6: no reduction in IQ between unfloridated water, which had an
Speaker 6: average florid concentration of point two parts per million, and
Speaker 6: optimally fluoridated water, which was at point seven parts per million.
Speaker 6: And if you look at this, that is actually entire
Speaker 6: highly consistent with this newer meta analysis from twenty twenty five.
Speaker 6: Because all of the data in this meta analysis showed
Speaker 6: that there was a potential for reduction in IQ at
Speaker 6: levels higher than one point five, there was no association
Speaker 6: scene for IQ at lower levels than one point five
Speaker 6: milligrams per leader. That association broke down and fell apart.
Speaker 6: There was no data to support it in this large
Speaker 6: meta analysis.
Speaker 4: So if you're looking at a graph of this, maybe
Speaker 4: this is a terrible thing to do on a podcast,
Speaker 4: but hey, we're video now. I'm just gonna use my hands. Yeah,
Speaker 4: But if you're looking at a graph of this, and
Speaker 4: on the x axis the bottom, it's fluoride levels in
Speaker 4: the water, and it's on the y axis is IQ
Speaker 4: reduction and IQ or something. Yeah, it's a straight level
Speaker 4: from zero from like no fluoride in the water all
Speaker 4: the way past what the point seven optimally fluoridated water,
Speaker 4: keep going still straight line until you get to like
Speaker 4: one point five above, and then it starts to you know,
Speaker 4: change exactly.
Speaker 6: Okay, that's the conclusionaryan So you asked, sorry, you asked earlier,
Speaker 6: how much? How many people are getting more than one
Speaker 6: point five?
Speaker 3: Yeah, okay.
Speaker 6: In the US, it's estimated that two point nine million
Speaker 6: people are served by groundwater or private wells that have
Speaker 6: concentrations greater than one point five, and several hundred thousand
Speaker 6: having concentrations higher than two point oh which is again
Speaker 6: the EPA non enforceable maximum recommended, or even some above
Speaker 6: four point oh which is above what is even supposed
Speaker 6: to be enforceable by the EPA. Globally, it's estimated that
Speaker 6: fifty seven million people at least receive water that is
Speaker 6: naturally fluoridated, which means who heck knows what the concentration
Speaker 6: of fluoride is.
Speaker 4: Right right, right, fascinating compared to.
Speaker 6: Two hundred million people in the US who are estimated
Speaker 6: to get their water from optimally fluoridated community water fluoridation
Speaker 6: sources at point seven parts per million.
Speaker 4: I mean this just to me speaks even further to
Speaker 4: that the point of the anti fluoridation movement is not
Speaker 4: to actually like protect health, it's just to deregulate and
Speaker 4: be anti expert. Because I really do want to know
Speaker 4: whether these states that are introducing these anti fluoride bands
Speaker 4: or these fluorid bands are doing anything in the communities
Speaker 4: that are served by naturally floridated water at levels that
Speaker 4: are shown to have any sort of health impact.
Speaker 6: Yeah, And I also want to point out a big
Speaker 6: difference that I noticed, because again, I there are so
Speaker 6: many papers on this, and there are so many papers
Speaker 6: that have a very clear bent to them, right, because
Speaker 6: I mean even scientists, like we all have our own biases,
Speaker 6: right totally, and some of them have a very clear bent.
Speaker 6: Some of them it's maybe less clear. And I mean
Speaker 6: in both directions, right, Like, some are very clearly like
Speaker 6: pro florid, and some are very clearly anti florid, and
Speaker 6: a lot are somewhere in between, but from the scientific
Speaker 6: side and not from like the social media side or
Speaker 6: the political side or the like we like it is
Speaker 6: a neurotoxin, it's killing us side right right. All of
Speaker 6: the papers, even the ones that are very concerned about
Speaker 6: florid in their water, the main concern that I took
Speaker 6: away from those is the potential effect of maternal ingestion
Speaker 6: of high levels of fluoride. Yeah, infant ingestion of high
Speaker 6: levels of florid, especially in the context which I will
Speaker 6: say I had not thought about before of formula use,
Speaker 6: like if babies are not breast fed and are fed
Speaker 6: by formula, because some formulas actually have relatively higher levels
Speaker 6: of fluoride. So then if you are also using fluoridated water,
Speaker 6: whether naturally fluoridated or optimally fluoridated, because infants are so tiny,
Speaker 6: could you potentially be getting too much in those tiny humans?
Speaker 6: But even on those points there has been very mixed
Speaker 6: results from even like long term studies. There was a
Speaker 6: paper from twenty nineteen in jama Pediatrics that cut a
Speaker 6: lot of press and it seems was very controversial that
Speaker 6: showed a for looking specifically at maternal ingestion of fluoridated
Speaker 6: water in Canada where they optimally.
Speaker 3: Floridate their water.
Speaker 6: Okay, they showed a reduction in IQ in those babies
Speaker 6: born to people who are drinking floridated water, but only
Speaker 6: in boys, and that was not true in girls, and
Speaker 6: it was not true if you looked at all babies.
Speaker 6: So that was a little bit like, we don't understand
Speaker 6: how that could be. And then another analysis on I
Speaker 6: don't know if it was the exact same cohort or
Speaker 6: but like using that same study because it was like
Speaker 6: this really huge study in Canada that came out a
Speaker 6: couple years later actually did not show any difference in
Speaker 6: IQ once they accounted for exposure after birth. So even
Speaker 6: kids who are drinking fluoride in their water did not
Speaker 6: have lower IQ than those who were not drinking floridated water.
Speaker 6: So again the data is still a little bit messy,
Speaker 6: like there's not a clear there's not a clear association
Speaker 6: there at optimally floridated levels.
Speaker 4: Right, Okay, I think I'm just confused by those studies
Speaker 4: are like what they're what the conclusions are. I mean,
Speaker 4: basically it sounds like it's noisy and a mess and.
Speaker 6: A mess and there's still not like there is not
Speaker 6: the conclusion that optimally fluoridated water has an impact on IQ.
Speaker 4: And I think here that's that's the message that gets lost, yes,
Speaker 4: because people will just say fluoride, right, and there is
Speaker 4: a big difference between fluoride and optimally like naturally fluoridated,
Speaker 4: right and optimally fluoridated or like managed fluoride.
Speaker 3: Level, manage fluorid levels.
Speaker 6: And just just to make this drive this point home
Speaker 6: with regards to any of the other so called neurotoxic effects,
Speaker 6: because sometimes fluoride just gets labeled as like a neurotoxin.
Speaker 6: There is not any data to back up any of
Speaker 6: the other claims headaches, insomnia, lethargy, autism, ADHD. There's no
Speaker 6: data whatsoever that positively associates fluoride in our water with
Speaker 6: any of those other neurologic effects. Only IQ, and only
Speaker 6: at levels that are higher than the World Health Organization
Speaker 6: maximum recommended level twice as high as what we see
Speaker 6: in community water fluoridation.
Speaker 4: Twice as high.
Speaker 3: Yeah. So for me, I one of.
Speaker 6: The main conclusions that I come to when we look
Speaker 6: at this debate on fluoride is that there is always
Speaker 6: going to be a certain degree of uncertainty in science.
Speaker 3: Right.
Speaker 6: We've talked preached a lot o Yeah, and that can
Speaker 6: sometimes feel really scary. But the nature of the scientific
Speaker 6: process and scientific inquiry is to keep asking questions, could
Speaker 6: we do this better? Can we make this safer? Can
Speaker 6: we improve on our processes? What changes do we need
Speaker 6: to make, What studies do we need to do to
Speaker 6: gather more data?
Speaker 4: I mean, it's why we revised the optimally floridated level
Speaker 4: two point seven.
Speaker 3: That's exactly your secondly revised it. Right.
Speaker 6: At the same time, we have to function as a society.
Speaker 6: Our governments are regulatory bodies. They have to make the
Speaker 6: best decisions that they can based on the data that
Speaker 6: we have. And that is exactly what has happened and
Speaker 6: continues to be happening when it comes to fluoride. No
Speaker 6: one is not looking at this problem. There is so
Speaker 6: much data now that we have that at the levels
Speaker 6: of fluoride that exist in some of the naturally fluoridated areas,
Speaker 6: we need to figure out how to lower fluoride levels
Speaker 6: in those communities because we could potentially be causing harm. Yeah,
Speaker 6: and there is data that at the level of zero
Speaker 6: point seven milligrams per leader, at less than one point five,
Speaker 6: there is a significant improvement in our dental health and
Speaker 6: no adverse effects other than a slight increase in mild
Speaker 6: dental fluoroesis I mean?
Speaker 4: And some of this stuff, Like, I think it's hard
Speaker 4: because and we talked about this a little last week.
Speaker 4: We've been fluoridating water for eighty years and things have
Speaker 4: and we've learned a lot in that time, and we've
Speaker 4: made adjustments accordingly in that time, and we've been open.
Speaker 4: I do think I think there's sometimes an accusation from
Speaker 4: certain individuals or people with certain agendas to say that
Speaker 4: science just barges ahead without thinking of the consequences.
Speaker 3: Twice we do.
Speaker 4: Sometimes we do there. I mean, there's this is this
Speaker 4: podcast will kill you. I talked about a lot of
Speaker 4: instances where that's happened exactly. But I think when it
Speaker 4: comes to florid, like just like you said that the questions,
Speaker 4: the fact that there are still some unanswered questions is
Speaker 4: not cannot erase the fact that we have answered many, many,
Speaker 4: many questions about floride and optimally fluoridated water.
Speaker 6: Yeah, exactly, I do think it's It's not this is
Speaker 6: not the end of the floride story. There's going to
Speaker 6: be more data, more studies that keeping done, especially at
Speaker 6: like trying to pull apart the nuances. Should we go
Speaker 6: from point seven two point five two point.
Speaker 3: Six two point six five? I don't know. Can we
Speaker 3: keep doing better?
Speaker 4: And I think some of the data will come from
Speaker 4: these states that are choosing to stop fluoridating.
Speaker 3: We already have data.
Speaker 6: You mentioned last week Aaron in Calgary in Canada, where
Speaker 6: they took florid out of the water. There was a
Speaker 6: ten year analysis that has looked so far and seen
Speaker 6: a slight not like a huge, but a slight increase
Speaker 6: in dental carries there compared to Edmonton, which still has
Speaker 6: floridated water. There's also a few other studies that I
Speaker 6: cite that are looking at exactly the same thing. So
Speaker 6: in places where they've taken floride out of the water,
Speaker 6: what do we see, We see worse dental health. The
Speaker 6: other thing I think that for me this really points
Speaker 6: out is like the importance of our federal regulatory bodies
Speaker 6: and how essential they are in keeping our drinking water safe.
Speaker 6: Because if we're talking about, oh my gosh, we're looking
Speaker 6: at this potentially extremely harmful chemical and all of these
Speaker 6: effects then and like our community water systems are actually
Speaker 6: poisoning us. First of all, we got to look at
Speaker 6: the data. So we need some scientists to actually look
Speaker 6: at the data and explore all of this nuance, which
Speaker 6: they've done, And then we need our regulatory agencies to
Speaker 6: be able to identify what the limits should be and
Speaker 6: enforce those limits.
Speaker 4: So I mean, it was going to fund that, right,
Speaker 4: these jobs should exist, and some of them no longer
Speaker 4: exactly take it away, right, what pathogens are in milk? Right,
Speaker 4: like what bird flu in milk. You know, it's just
Speaker 4: there's so much.
Speaker 6: That's the thing that's so I think frustrating about the
Speaker 6: discourse surrounding florid right now is it's like, we'll take
Speaker 6: this out of our water when it's like what then who?
Speaker 3: What?
Speaker 2: Like?
Speaker 6: First of all, who is going to do that? Second
Speaker 6: of all, who who is going to enforce this? What
Speaker 6: about all the places that are already have it there?
Speaker 6: Like the politics of it are just so different from
Speaker 6: what the science shows right now.
Speaker 4: Oh and I think that's the whole point, right, I know,
Speaker 4: florid is a tool to you know again, deregulate and
Speaker 4: privatize and change who the experts are.
Speaker 7: I know.
Speaker 6: Well, if you want to become an expert on this,
Speaker 6: let me tell you where to read. Okay, yes, I
Speaker 6: already mentioned there was a great Nature Reviews Disease Primer's
Speaker 6: paper just about dental carries. It was called Dental Carries
Speaker 6: from twenty seventeen. A couple of other great papers that
Speaker 6: I had on the mechanism of action of florid. Actually, Aaron,
Speaker 6: did you read this one from the Journal Dental Research
Speaker 6: on twenty nineteen. It was called florid motive action. Once
Speaker 6: there was an observant dentist.
Speaker 4: Uh no, I didn't.
Speaker 3: I really it was quite historical, but it was really
Speaker 3: really fun.
Speaker 6: Then when we get into the you know, the meat
Speaker 6: of what people want. The paper from twenty twenty five
Speaker 6: from Gama Pediatrics was by Taylor at All Florid Exposure
Speaker 6: and Children's IQ Scores, A systematic review in meta analysis.
Speaker 6: The one from a couple of years earlier that looked
Speaker 6: at more relevant florid levels was by Kumar at All
Speaker 6: in the Journal Public Health. That was titled Association between
Speaker 6: Low florid Exposure and Children's Intelligence A meta analysis relevant
Speaker 6: to Community water floridation. There was another one I actually loved.
Speaker 6: Sorry I'm giving shout outs longer than I usually do,
Speaker 6: but this one was super great from twenty twenty four
Speaker 6: by Tayhar at All. I'm sorry if I'm pronouncing that wrong.
Speaker 6: In Critical Reviews and Toxicology. This paper looked not just
Speaker 6: at IQ, but this one looked at every claim that
Speaker 6: people have made about fluoride. What is the evidence epidemiologically,
Speaker 6: what is the toxological evidence, what is the evidence in
Speaker 6: animals in vitro? And it came up with this really
Speaker 6: comprehensive table to look at all of these and so
Speaker 6: that is a really great paper. You can check out
Speaker 6: the list of sources from this episode and every single
Speaker 6: one of our episodes on our website, this podcast.
Speaker 3: Will kill you dot com. There do you kill anymore
Speaker 3: any more?
Speaker 4: Thank you again so much to doctor Santore for sharing
Speaker 4: that story with us. We appreciate you so much.
Speaker 3: We really do.
Speaker 6: Thank you also to Bloodmobile for providing the music for
Speaker 6: this episode and all of our episodes.
Speaker 4: All of them. Thank you to Tom and Leanna and
Speaker 4: Pete and Brent and Jess and everyone at exactly right
Speaker 4: who helps this to happen, helps this to happen, helps
Speaker 4: us make this happen. Yeah, there we go. We'll go
Speaker 4: with that.
Speaker 6: And thank you to all of you for listening, for watching,
Speaker 6: for joining us on this journey.
Speaker 4: We're talking with journey for now, but we're not done
Speaker 4: with teeth or gums or flossing or whatever. Wait anyway.
Speaker 4: Thank you also to our wonderful patrons. We appreciate your
Speaker 4: support so very much.
Speaker 3: Thank you well.
Speaker 4: Until next time, brush your teeth, you filed the animals,
Speaker 4: and wash your hands.
Speaker 3: Boom