Community Water Fluoridation

• Learn about LB1387: The bill removes the 2008 fluoride mandate for cities and villages with populations over 1,000 and limits the public water supply fluoridation level to no more than 0.7 mg per liter of water. 2023-24 public records requests highlight the need for the bill.
• Call your Senator and ask them to pass LB1387
• Tell your family and friends about LB1387
• Follow the bill with the free Unicameral Bill Tracker

• 2/21/2024, LB1387 Fluoride Hearing Media Coverage, Lincoln’s Open Source
• 2/20/2024, Nebraska proposal would put local water fluoridation to public referendum, Nebraska Examiner (repeated at 1011 Now)
• 2/19/2024, Union County leaders vote to remove fluoride from water supply passes, WOWT 6 News, Omaha
• 2/15/2024, Nebraska Legislature to consider bill to put limits on fluoride in drinking water, WOWT 6 News, Omaha
• 2/13/2024, Nebraska NDEE Record Request Response
• 2/13/2024, Collier County FL votes to halt CWF and Dr. Joel. Bohemier brief testimony
• 2/5/2024, City of Lincoln fluoride treatment at upper limit while Omaha reduces risks and maintains compliance, Lincoln’s Open Source
• 11/14/2023, Nebraska NDEE Record Request Response
• 7/14/2023, Nebraska NDEE Record Request Response
• 2/5/2024 Union County Votes To Remove Fluoride From Public Water
• 11/7/2023, Dallas City Council Committee CWF Briefing, Video Part 1, Part 2, with Drs. Bruce Lanphear, Griffin Cole, and John Staniland. News article. Council member Gay Willis erroneously claims NTP Board Chair K. Gray critical of NTP fluoride report with Dr. Cole rebuttal in Part 2, 32:50 minute mark.
• 2/16/2019, Utah City Recovers From Drinking Water Ban Caused By Fluoride Spill, WaterOnline.com
• News at Moms Against Fluoride

• Nebraska LB1387 Hearing, EPA Trial and NTP Assessment of Toxicity
• Little Things Matter – “The Impact of Fluoride on Brain Development” 5-minute video on the impact of fluoride on IQ
• Fluoride Action Network – fluoridation chemicals
• Moms Against Fluoride Historical Documents
• Dallas for Safer Water
• Water Talk, WaterOnline.com
• Terms
• Community Water Fluoridation (CWF)
• Parts Per Million (ppm) = Milligrams Per Liter (mg/L)

Answer: 4.0 mg/L

“Potential health effects from long-term exposure above the MCL 4.0 mg/L, bone disease (pain and tenderness of the bones); children may get mottled teeth. Sources of fluoride contaminant in drinking water, water additive which promotes strong teeth; erosion of natural deposits; discharge from fertilizer and aluminum factories.” EPA Drinking Water Regulations

Answer: The impact of changes in ground water fluoride levels and ingesting high levels of fluoridated products can cause fluoride toxicity that may not be associated with fluoride. Fluorosis is the first visible sign of fluoride toxicity.

Acute Symptoms

Acute symptoms include abnormal levels of calcium and potassium in the blood, irregular or slow heartbeat, cardiac arrest, tremors, weakness, abdominal pain, abnormal taste in mouth, diarrhea, drooling, eye irritaion, headache, nausea and vomiting, tremors. Mount Sinai Library

The lethal dose of fluoride for most adult humans is estimated at 32 to 64 mg. Ingestion of fluoride can produce gastrointestinal discomfort at doses from 10 to 15 mg. Bradford D. Gessner; Michael Beller; John P. Middaugh; Gary M. Whitford (13 January 1994). “Acute fluoride poisoning from a public water system”. New England Journal of Medicine. 330 (2): 95–99

Chronic Symptoms – fluorosis is the first visible sign of fluoride toxicity, mild to moderate symptoms go undiagnosed.

“Based on its review of available data on the toxicity of fluoride, the subcommittee concludes that EPA’s current MCL of 4 mg/L for fluoride in drinking water is appropriate as an interim standard. At that level, a small percentage of the U.S. population will exhibit moderate or even severe dental fluorosis.”

Health Effects of Ingested Fluoride, Subcommittee on Health Effects of Ingested Fluoride, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council, August 1993, p.11

“Estimating the incidence of toxic fluoride exposures nationwide also is complicated by the existence of biases. Parents or caregivers may not notice the symptoms associated with mild fluoride toxicity or may attribute them to colic or gastroenteritis, particularly if they did not see the child ingest fluoride. Similarly, because of the nonspecific nature of mild to moderate symptoms, a physician’s differential diagnosis is unlikely to include fluoride toxicity without a history of fluoride ingestion.”

Shulman JD, Wells LM. (1997). Acute fluoride toxicity from ingesting home-use dental products in children, birth to 6 years of age. Journal of Public Health Dentistry 57: 150-8. https://pubmed.ncbi.nlm.nih.gov/9383753/

Ch 2-002.04A “Community water systems experiencing fluoride levels above 2.0 milligrams per liter must notify the public as required.”

Ch 4 -010.01 – “Public notice must be provided as soon as practical but no later than 12 months from the day the water system learns of the exceedance.” Regulations Note that the effective date on the cover of Title 179 PDF file is 6/14/2023 while the effective date of Chapter 1 is 8/27/1983.

Hydrofluorosilicic acid, a byproduct of manufacturing hazardous waste disposal.

City of Lincoln Product: “Request to please confirm that the chemical additives derived from phosphate fertilizer manufacturing, referenced on page 21 and 25 of the attached October 25, 2023 Water Fluoridation Training slides, are industrial grade and not GMP food or pharmaceutical grade.” 11/2/2023 Aksamit public records request.

NDEE Public Records Response, 11/13/2023: “Industrial grade,” “GMP food,” or “pharmaceutical grade” is not terminology we utilize with regards to chemicals in public drinking water applications. Per the “Recommended Standards for Water Works”, 2007 Edition referenced in Title 179 NAC 7-007.01, chemicals used in drinking water applications “shall comply with the appropriate ANSI/AWWA standards, and/or ANSI/NSF Standard 60.” This is confirmed during the plan review process prior to a chemical feed system being added to a water system, and subsequently verified during routine inspections of the public water system.”

CDC Measured levels of impurities including arsenic, lead, and radionuclides. American Water Works Association: Trace Contaminates in Water Treatment Chemicals

Lincoln Annual Supply 12/20/22 – 12/19/23, Hawkins Water Treatment Group, cost $69,580, approximately 350,000 pounds per year, Lincoln Lancaster County Active Contracts search for fluoridation contract https://col.ionwave.net/ActiveContractList.aspx

NIH National Library of Medicine: The Fluoride Debate, Pros and Cons, “Since the fluoride benefit is mainly topical, perhaps it is better to deliver fluoride directly to the tooth instead of ingesting it (34). Fluoride toothpaste, rinses and varnish applications have proven their effectiveness in some countries, but they are still not universally affordable.”

Answer: Biological dentistry – a paradigm shift by dental practice to embrace the concepts of prevention and intervention.

“Dental caries progression or reversal depends upon the balance between demineralization and remineralization and can be visualized for clinical purposes as the “caries balance.” This balance is determined by the relative weights of the sums of pathological factors and protective factors.”

“The most recent NHANES survey2 for the period 1999-2002 shows that caries levels at all ages are still a major problem, especially among teenagers. With all of the scientific evidence that we have about caries prevention, including many clinical trials of various agents, why is it that dental practice has not embraced the concepts of prevention and intervention? For example, a review by Anderson et al.3 laid out step-by-step procedures that would reduce dental decay in individuals. This excellent article was never embraced by the profession.”

“The knowledge is in the literature. It is time for us to translate the laboratory and clinical findings into actual practice and to deal with the disease that is dental caries. It is time for a paradigm shift.”

Caries Prevention and Reversal Based on the Caries Balance, John Featherstone, MSc, PhD, Pediatric Dentistry, 2006

Instead of complying with EPA regulations for hazardous waste disposal, industry not only avoids those expensive costs it recoups collection costs by selling the hazardous waste as a chemical product.

1983 Letter from the EPA: “In regard to the use of fluorsilicic acid as a source of fluoride for fluoridation, this Agency regards such use as an ideal environmental solution to a long-standing problem. By recovering by-product fluorsilicic acid from fertilizer manufacturing, water and air pollution are minimized.” Rebecca Hammer, Deputy Assistant Administrator for Water

2/15/2024 DHHS LB1387 Hearing: The past President of the Nebraska Dental Association testified that the CWF treatment level has been 0.7 ppm for the past 9 years.

7/14/2023 NDEE Public Record Request Response: “The amount of fluoride currently prescribed in these regulations is based on an outdated CDC recommendation regarding optimum fluoride levels.” See also 11/14/2023 NDEE Response and 2/13/2024 NDEE Response

Jessica Meeske, Hastings Dentist, “The neat thing about dental fluoridation is it helps everybody.”

Senator Joel Johnson, “Message is simple. This is safe. It’s cheap and it works….better teeth and better health for, basically our children but basically also for all of us.”

Source: 1/24/2007 LB245 HHS Committee Hearing

Michael Connett: “So CDC agrees with NRC that it is apparent that fluorides have the ability to interfere with the functions of the brain and the body by direct and indirect means.” Casey Hannah, “Yes, CDC in connection with the intergovernmental work group.” 12 min. mark deposition of Casey Hannah, CDC 11/6/2018 Fluoride trial deposition footage

“Conclusion: Practitioners should be aware that children are exposed to multiple sources of fluoride during the tooth development period. Reducing fluoride intake from reconstituted infant formula alone will not eliminate the risk of fluorosis development. It is also important that clinicians provide advice to parents regarding the proper use of fluoridated toothpastes along with informed prescription of fluoride supplements. The panel acknowledges and encourages clinicians to follow the American Academy of Pediatrics’ guidelines for infant nutrition, which advocate exclusive breastfeeding to age 6 months and continued through at least age 12 months unless specifically contraindicated. Human breast milk has been shown to have consistently low levels (0.005-0.01 ppm) of fluoride.” Evidence-based Clinical Recommendations Regarding Fluoride Intake From Reconstituted Infant Formula and Enamel Fluorosis, Journal of the American Dental Association January 2011

Is Fluoridated Drinking Water Safe? Harvard Public Health Magazine, Spring 2016

Comments by Philippe Grandjean,

Adjunct professor of environmental health, Harvard T.H. Chan School of Public Health:

“We should recognize that fluoride has beneficial effects on dental development and protection against cavities. But do we need to add it to drinking water so it gets into the bloodstream and potentially into the brain? To answer this, we must establish three research priorities.

“First, since dental cavities have decreased in countries both with and without water fluoridation, we need to make sure we are dosing our water with the proper amount of fluoride for dental medicine purposes, but no more.

“Second, we need to make sure fluoridation doesn’t raise the risk of adverse health effects. In particular, we need basic research on animals that would help us understand the mechanisms by which fluoride may be toxic to the developing brain.

“Third, we need to find out if there are populations highly vulnerable to fluoride in drinking water—bottle-fed infants whose formula is made with tap water, for example, or patients undergoing dialysis. If these individuals are at risk, their water must come from a source that is lower in fluoride.”

The CDC website “My Water’s Fluoride” Nebraska page

November 29, 2023 Public Record Request: The CDC Fluoridation Status Report (Nebraska, 2022) entries for the City of Lincoln and for Douglas County MUD under Fluoride Concentration are both 0.70 (link https://nccd.cdc.gov/DOH_MWF/Reports/FlStatus_Rpt.aspx).

The City of Lincoln 2022 Water Quality Report fluoride level ranged from 0.899 – 0.901 ppm. The report states, “Fluoride is added in treatment to bring the natural fluoride level of about 0.4 ppm to the State recommended level of 0.8 – 1.5 ppm.” Please provide the procedure and the metric used for the fluoride concentration level reported to the CDC, i.e. does it represent the yearly average from testing or some other metric?

2/13/2024 NDEE Response: The 0.70 ppm entries on the status report appear to be default optimal levels for fluoridated public water systems, provided by CDC, in accordance with CDC’s current recommendations. Historically, the data reported to CDC through WFRS represented monthly averages, based on reports received each month from fluoridated water systems.  Fluoride data for naturally fluoridated, and unfluoridated systems is representative of routine monitoring conducted per SDWA requirements.

“to use the studies you called out on Calgary and Edmonton, where it’s a great experiment, it was actually done in 2021, that prevalence of caries in the primary definition was significantly higher in Calgary where fluoride was stopped than in Edmonton where it’s still fluoridated. And, the conclusion, which is what we should all be looking at, is our finding are consistent with an adverse impact of fluoridation cessation on children’s dental health in Calgary.” Gay Willis, Dallas City Council Committee, 11/7/23, 32:50 minute mark

Full Comments – committee member G. Willis, 11/7/2023 and incorrect attribution of comments from an April 2023 ADA letter to NTP chair Dr. Gray, “So going back to the presentations, on page 6, there’s, something has been pulled out, from a draft meta-analysis manuscript on fluoride, in April 2023, so I went and followed your footnote, and I was really concerned to see a letter from Dr. Kathleen Gray, the chair of this NTP board of scientific counselors, who called out something from the national academy of sciences, and engineering and medicine that is considered the gold standard for providing independent and objective advice on complex scientific issues, who asked specifically that things like this not be pulled out and put forth as fact. And, it said NTP ignored the recommendation, instead, the latest version is full of non-contextualized statements about potential associations and the evidence of being unclear. In one area NTP even states lower concentrations of fluoride may be, may support reduced IQ in humans without offering any data or context to support this claim. You have got the leading authority imploring this group to not put this forth because it has not achieved the peer review that it should so, I, just, since you’re putting it on the record, I’m putting this on the record. I went thought and looked at these. You know, I’ve got to say that in coming before a governing body of the ninth largest city in America, and not footnoting some of these things is so disappointing, I mean, this was the opportunity to bring the A game. Now my colleagues may not know that in my former, former life and, and marketing, I worked with Johnson & Johnson Medical on wound care and have helped them prepare their medical posters for a global audience. And, you don’t cherry-pick things, you look at results and conclusions, and so that’s where you start. That’s where you get the information. And, so, to use the studies you called out on Calgary and Edmonton, where it’s a great experiment, it was actually done in 2021, that prevalence of caries in the primary definition was significantly higher in Calgary where fluoride was stopped than in Edmonton where it’s still fluoridated. And, the conclusion, which is what we should all be looking at, is our finding are consistent with an adverse impact of fluoridation cessation on children’s dental health in Calgary. And, to point to the need for universal publicly-funded prevention activities including but not limited to fluoridation. You call out Featherstone. The conclusion, the headline to draw from this is caries progression or reversal is determined by the balance between protective and pathological factors. Fluoride, the key agent in battling caries, works primarily via topical mechanisms. Brunelle and Carlos, the results suggest that the water fluoridation has played a dominate role in the decline in caries and must continue to be a major prevention methodology so, it goes on and on. We’ve also got something that was shown in our last round of this in America. In Alaska, in Juneau and Anchorage (study) where one city decided to end fluoridation and nine years later the expense on cavity treatments had increased 47% in Juneau, while it increased only 5% in Anchorage, where there was fluoridation so you know to come before us and pull out little pieces here and there when this was your moment is just disappointing to me. And so it forced me to go in and do a lot of research that didn’t even start with a footnote that middle school presentations have and so I just want my colleagues to understand this because I do feel like we’ve explored this. I took it very seriously to dig into this. I really did. And, what I’m coming up with is not changing the recommendation of our county health official, of our federal health officials.”

Is Fluoridated Drinking Water Safe? Harvard Public Health Magazine, Spring 2016

Comments by Philippe Grandjean – Cochrane Collaboration Review

Adjunct professor of environmental health, Harvard T.H. Chan School of Public Health:

“But many experts now question the scientific basis for the intervention. In June 2015, the Cochrane Collaboration —a global independent network of researchers and health care professionals known for rigorous scientific reviews of public health policies—published an analysis of 20 key studies on water fluoridation. They found that while water fluoridation is effective at reducing tooth decay among children, “no studies that aimed to determine the effectiveness of water fluoridation for preventing caries [cavities] in adults met the review’s inclusion criteria.”

“The Cochrane report also concluded that early scientific investigations on water fluoridation (most were conducted before 1975) were deeply flawed. “We had concerns about the methods used, or the reporting of the results, in … 97 percent of the studies,” the authors noted. One problem: The early studies didn’t take into account the subsequent widespread use of fluoride-containing toothpastes and other dental fluoride supplements, which also prevent cavities. This may explain why countries that do not fluoridate their water have also seen big drops in cavity rates (see chart).”

“To prevent skeletal fluorosis, the U.S. Environmental Protection Agency (EPA) set the maximum contaminant level (MCL) for fluoride at 4 mg/L of drinking water.”
https://nap.nationalacademies.org/read/2204/chapter/2#2

Health Effects of Ingested Fluoride, Subcommittee on Health Effects of Ingested Fluoride, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council, August 1993, p.59

“To prevent skeletal fluorosis, the U.S. Environmental Protection Agency (EPA) set the maximum contaminant level (MCL) for fluoride at 4 mg/L of drinking water.”
https://nap.nationalacademies.org/read/2204/chapter/2#2

Health Effects of Ingested Fluoride, Subcommittee on Health Effects of Ingested Fluoride, Committee on Toxicology, Board on Environmental Studies and Toxicology, Commission on Life Sciences, National Research Council, August 1993, p.59

“Currently the molecular mechanism responsible for dental fluorosis remains unclear, but it is known that fluorotic enamel has higher protein content and is therefore softer than nonfluorosed enamel.”
Sierant ML, Bartlett JD. (2011). A Potential Mechanism for the Development of Dental Fluorosis. In: Interface Oral Health Science (K Sasaki, et al., eds).

“Both collagenous and noncollagenous components appear to undergo structural alterations during fluorosis, although the precise mechanisms are unclear.” Moseley R, et al. (2003). The influence of fluoride exposure on dentin mineralization using an in vitro organ culture model. Calcified Tissue International