Fluorine

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In high concentrations, soluble fluoride salts are toxic and skin or eye contact with high concentrations of many fluoride salts is dangerous. Referring to a common salt of fluoride, sodium fluoride (NaF), the lethal dose for most adult humans is estimated at 5 to 10 g (which is equivalent to 32 to 64 mg/kg elemental fluoride/kg body weight).[1][2][3] Ingestion of fluoride can produce gastrointestinal discomfort at doses at least 15 to 20 times lower (0.2–0.3 mg/kg) than lethal doses.[4] Although helpful for dental health in low dosage, chronic exposure to fluoride in large amounts interferes with bone formation. In this way, the most widespread examples of fluoride poisoning arise from consumption of ground water that is abnormally fluoride-rich.[5]

Causes[edit]

Regulatory background[edit]

For optimal dental health, the World Health Organization recommends a level of fluoride from 0.5 to 1.0 mg/L (milligrams per litre), depending on climate.[6] Adverse effects are possible at fluoride levels far above this recommended dosage. The United States Health and Human Services Department recommends 0.7 milligrams of fluoride per liter of water – the lower limit of the current recommended range of 0.7 to 1.2 milligrams.[7]

Acute toxicity[edit]

World map with several land areas highlighted, especially in China, India, east Africa, southwest U.S., and Argentina.
Geographical areas associated with groundwater having over 1.5 mg/L of naturally occurring fluoride, which is above recommended levels.[8]

In India an estimated 60 million people have been poisoned by well water contaminated by excessive fluoride, which is dissolved from the granite rocks. The effects are particularly evident in the bone deformations of children. Similar or larger problems are anticipated in other countries including China, Uzbekistan, and Ethiopia.[5]

Historically, most cases of acute fluoride toxicity have followed accidental ingestion of sodium fluoride based insecticides or rodenticides.[9] Currently, in advanced countries, most cases of fluoride exposure are due to the ingestion of dental fluoride products.[10] Although exposure to these products does not often cause toxicity, in one study 30% of children exposed to fluoride dental products developed mild symptoms.[10] Other sources include glass-etching or chrome-cleaning agents like ammonium bifluoride or hydrofluoric acid,[11][12] industrial exposure to fluxes used to promote the flow of a molten metal on a solid surface, volcanic ejecta (for example, in cattle grazing after an 1845–1846 eruption of Hekla and the 1783–1784 flood basalt eruption of Laki), and metal cleaners. Malfunction of water fluoridation equipment has happened several times, including a notable incident in Alaska.[4]

Organofluorine compounds[edit]

Organofluorine compounds only rarely release F− under biological conditions and thus are rarely sources of fluoride poisoning. In order for fluoride poisoning to occur, a compound must release fluoride (F−) ions. Whereas most organofluorine compounds may not release F− because of the strength of the carbon–fluorine bond and its tendency to strengthen as more fluorine atoms are added to a carbon, some compounds do, such as methoxyflurane. The fluorine atom is pervasive in drugs, e.g. Prozac and many other substances such as freon, Teflon, and blood serum (PFOS, PFOA, and PFNA).

Fluoride in toothpaste[edit]

Children may experience gastrointestinal distress upon ingesting sufficient amounts of flavored toothpaste. Between 1990 and 1994, over 628 people, mostly children, were treated after ingesting too much fluoride-containing toothpaste. "While the outcomes were generally not serious," gastrointestinal symptoms appear to be the most common problem reported.[13]

Chronic toxicity[edit]

Although there is some contradictory evidence on the issue, the only generally accepted adverse effect of fluoride at levels used for water fluoridation is dental fluorosis. It is a condition caused by 'excessive' intake of fluoride ions over an extended period of time during tooth development (before teeth erupt into the mouth), and can cause yellowing of teeth, hypothyroidism, or brittling of bones and teeth. The definition of 'excessive' in the context of fluorosis falls on the order of parts per million (ppm) and is generally accepted to mean significantly higher than the 0.7 to 1.2 ppm amounts recommended for fluoridated water. Fluoride in small amount is considered by most dentists to be beneficial to teeth (see Fluoride therapy).

Consumption of fluoride at levels beyond those used in fluoridated water causes skeletal fluorosis.[14][15].

Other adverse effects may be possible at fluoride intake levels above the recommended dosage, and defluoridation is recommended in these cases. In 1986 the United States Environmental Protection Agency (EPA) established a maximum contaminant level (MCL) for fluoride at a concentration of 4 milligrams per litre (mg/L), which is the legal limit of natural fluoride allowed in the water. In 2006, a 12-person committee of the US National Research Council (NRC) reviewed the health risks associated with fluoride consumption[16] and unanimously concluded that the maximum contaminant level of 4 mg/L should be lowered. The EPA has yet to act on the NRC's recommendation.[17][18] The limit was previously 1.4 – 2.4 mg/L, but it was raised to 4 mg/L in 1985.[19]

Excess fluoride consumption has been studied as a factor in the following:

  • A weakening of bones, leading to an increase in hip and wrist fracture.[20] The National Research Council found the overall evidence "suggestive but inadequate for drawing firm conclusions about the risk or safety of exposures at [2 mg/L]", but states that fractures do seem to increase as fluoride is increased from 1 mg/L to 4 mg/L, suggesting a "continuous exposure-effect" dose-response relationship at these levels.[16]:170
  • Adverse effects on the kidney. Within the recommended dose, no effects are expected, but chronic ingestion in excess of 12 mg/day are expected to cause adverse effects, and an intake that high is possible when fluoride levels are around 4 mg/L.[16]:281 Those with impaired kidney function are more susceptible to adverse effects.[16]:292
  • Little research has been done on possible liver damage, although some studies suggest negative effects at chronic ingestion of 23 mg/day.[16]:292
  • Chromosomal damage and interference with DNA repair.[16]:304 Overall, the literature from in vitro and rodent studies does not indicate genotoxicity, but the in vivo human studies are inconsistent.[16]:316
  • Four epidemiological studies have noted a correlation between increased fluoride and low IQ.[16]:205-223 The most rigorous of these compared an area with mean water concentration of 0.36 ± 0.15 mg/L (range 0.18-0.76 mg/L) to an area with 2.47 ± 0.79 mg/L (range 0.57-4.50 milligrams per liter [mg/L]). Most of these studies did not publish important details, making them difficult to evaluate. If these correlations are caused by fluoride, the mechanism is not known, but the National Research Council speculates that effects on the thyroid could lead to poor test results.[16]:208 Two Chinese meta-analyses which included the previously mentioned studies have also noted this correlation.[21][22] The high-fluoride areas studied had fluoride levels above those used in water fluoridation.
  • The NRC report stated that "many of the untoward effects of fluoride are due to the formation of AlFx [aluminum fluoride] complexes".[16]:219 This topic has been identified previously as cause for concern.[23] The NRC noted that rats administered fluoride had twice as much aluminum in their brains.[16]:212
  • Fluoride's effect on the thyroid is more severe when iodine is deficient, and fluoride is associated with lower levels of iodine.[23] Thyroid effects in humans were associated with fluoride levels 0.05-0.13 mg/kg/day when iodine intake was adequate and 0.01-0.03 mg/kg/day when iodine intake was inadequate.[16]:263 Its mechanisms and effects on the endocrine system remain unclear.[16]:266 After concluding the National Research Council report the chair of the panel, John Doull, commented that the "thyroid changes bother me".[24]

Effects[edit]

Excess fluoride consumption has been studied as a factor in the following:

Brain[edit]

A meta analysis conducted on 27 epidemiological studies (most from China), concluded that exposure to "high levels" of fluoride in childhood was associated with a reduction in IQ. The authors note that this research is not applicable to the safety of artificial water fluoridation because the adverse effects on IQ was found with fluoride levels that were much higher than typically found in artificially fluoridated water.[25] However, they conclude that more research is required to assess the adverse effects on children’s neurodevelopment.[26][27] The meta analysis has been criticized for failing to account for confounding factors. For example, in some of the studies fluoride exposure came from the burning of high fluoride content coal, and used a control group from an area in which wood was used as fuel.[28] A more recent study followed individuals over 38 years to see if fluoride exposure affected IQ and they concluded there was no link between fluoride exposure and IQ, or fluoride as a neurotoxin.[29]

Four epidemiological studies have noted a correlation between increased fluoride and low IQ.[16]:205–223 The most rigorous of these compared an area with mean water concentration of 0.36 ± 0.15 mg/L (range 0.18–0.76 mg/L) to an area with 2.47 ± 0.79 mg/L (range 0.57–4.50 mg/L). Most of these studies did not publish important details, making them difficult to evaluate. If these correlations are caused by fluoride, the mechanism is not known, but the National Research Council speculates that effects on the thyroid could lead to poor test results.[16]:208 Two Chinese meta-analyses which included the previously mentioned studies have also noted this correlation.[30][31] The high-fluoride areas studied had fluoride levels above those used in water fluoridation.

Bones[edit]

Whilst fluoridated water is associated with decreased levels of fractures in a population,[32] toxic levels of fluoride have been associated with a weakening of bones and an increase in hip and wrist fractures. The U.S. National Research Council concludes that fractures with fluoride levels 1–4 mg/L, suggesting a dose-response relationship, but states that there is "suggestive but inadequate for drawing firm conclusions about the risk or safety of exposures at [2 mg/L]".[16]:170

Consumption of fluoride at levels beyond those used in fluoridated water for a long period of time causes skeletal fluorosis. In some areas, particularly the Asian subcontinent, skeletal fluorosis is endemic. It is known to cause irritable-bowel symptoms and joint pain. Early stages are not clinically obvious, and may be misdiagnosed as (seronegative) rheumatoid arthritis or ankylosing spondylitis.[33]

Kidney[edit]

Fluoride induced nephrotoxicity is kidney injury due to toxic levels of serum fluoride, commonly due to release of fluoride from fluorine-containing drugs, such as methoxyflurane.[34][35][36]

Our fluoride dosage is determined by our intake of fluoride from all sources, including but not exclusive to fluoridated water.[16]:23 Within the recommended dose specific to age, no adverse effects are anticipated for those healthy renal function, but chronic ingestion in excess of 12 mg/day are expected to cause adverse effects in even the most healthy individual.[16]:281 There are insufficient studies on the impact of long term exposure to low dose fluoride exposure on susceptible populations.[16]:340-353 Those with impaired kidney function are more susceptible to adverse effects. [16]:292

The kidney injury is characterised by failure to concentrate urine, leading to polyuria, and subsequent dehydration with hypernatremia and hyperosmolarity. Inorganic fluoride inhibits adenylate cyclase activity required for antidiuretic hormone effect on the distal convoluted tubule of the kidney. Fluoride also stimulates intrarenal vasodilation, leading to increased medullary blood flow, which interferes with the counter current mechanism in the kidney required for concentration of urine.

Fluoride induced nephrotoxicity is dose dependent, typically requiring serum fluoride levels exceeding 50 micromoles per liter (about 1 ppm) to cause clinically significant renal dysfunction,[37] which is likely when the dose of methoxyflurane exceeds 2.5 MAC hours.[38][39] (Note: "MAC hour" is the multiple of the minimum alveolar concentration (MAC) of the anesthetic used times the number of hours the drug is administered, a measure of the dosage of inhaled anesthetics.)

Elimination of fluoride depends on glomerular filtration rate. Thus, patients with renal insufficiency will maintain serum fluoride for longer period of time, leading to increased risk of fluoride induced nephrotoxicity.

Teeth[edit]

The only generally accepted adverse effect of fluoride at levels used for water fluoridation is dental fluorosis, which alters the appearance of teeth. Dental fluorosis occurs during tooth development, i.e. under age 8. The American Dental Association and Center for Disease Control attest that it is mostly mild and usually only an aesthetic concern. Compared to unfluoridated water, fluoridation to 1 mg/L is estimated to cause fluorosis in one of every 6 people (range 4–21), and to cause fluorosis of aesthetic concern in one of every 22 people (range 13.6–∞).[32]

However, Public Health Service and Center for Disease Control records reveal a racial disparity in the incidence and severity of dental fluorosis. Per CDC records from 2012, African Americans in optimally fluoridated communities suffered from 58% dental fluorosis compared to the 36% dental fluorosis experience of their white neighbors. Moreover, most of the moderate to severe fluorosis was seen in the non-white populations. [40] [41] [42]

Thyroid[edit]

Fluoride's suppressive effect on the thyroid is more severe when iodine is deficient, and fluoride is associated with lower levels of iodine.[clarification needed][23] Thyroid effects in humans were associated with fluoride levels 0.05–0.13 mg/kg/day when iodine intake was adequate and 0.01–0.03 mg/kg/day when iodine intake was inadequate.[16]:263 Its mechanisms and effects on the endocrine system remain unclear.[16]:266

Effects on aquatic organisms[edit]

Fluoride accumulates in the bone tissue of fishes and in the exoskeleton of aquatic invertebrates. The mechanism of fluoride toxicity in aquatic organisms is believed to involve the action of fluoride ions as enzymatic poisons.[43]

Mechanism[edit]

Like most soluble materials, fluoride compounds are readily absorbed by the stomach and intestines, and excreted through the urine. Urine tests have been used to ascertain rates of excretion in order to set upper limits in exposure to fluoride compounds and associated detrimental health effects.[44] Ingested fluoride initially acts locally on the intestinal mucosa, where it forms hydrofluoric acid in the stomach.

The NRC report stated that "many of the untoward effects of fluoride are due to the formation of AlFx [aluminum fluoride] complexes".[16]:219 This topic has been identified previously as cause for concern.[23] The NRC noted that rats administered fluoride had twice as much aluminum in their brains.[16]:212 When water (1 ppm fluoride) is boiled in aluminum cookware more aluminum is leached and more aluminum fluoride complexes are formed. However, an epidemiological study found that a high-fluoride area had one-fifth the Alzheimer's that a low-fluoride area had,[45] and a 2002 study found that fluoride increased the urinary excretion of aluminum.[46]

Pregnancy[edit]

• A landmark U.S. government-funded study published in 2017 found a strong relationship between pregnant women’s exposure to fluoride and the subsequent IQ of their offspring. The higher the fluoride levels of the urine of the women (a measure of their total exposure to fluoride regardless of source), the lower the IQ of the children[47] • A 2019 study found a nearly 300% increase in ADHD prevalence in adolescents in Canadian communities with fluoridated water supplies, compared to those living in nonfluoridated communities[48]

Water filtration[edit]

Filters capable of removing fluoride include reverse osmosis, deionizers and activated alumina adsorption media such as Berkey filters.[49]


References[edit]

<templatestyles src="Reflist/styles.css" />

  1. ↑ Gosselin, RE; Smith RP; Hodge HC (1984). Clinical toxicology of commercial products. Baltimore (MD): Williams & Wilkins. pp. III-185–93. ISBN 0-683-03632-7.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  2. ↑ Baselt, RC (2008). Disposition of toxic drugs and chemicals in man. Foster City (CA): Biomedical Publications. pp. 636–40. ISBN 978-0-9626523-7-0.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  3. ↑ IPCS (2002). Environmental health criteria 227 (Fluoride). Geneva: International Programme on Chemical Safety, World Health Organization. p. 100. ISBN 92-4-157227-2.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  4. ↑ 4.0 4.1 Bradford D. Gessner; Michael Beller; John P. Middaugh; Gary M. Whitford (13 January 1994). "Acute fluoride poisoning from a public water system" [archive]. New England Journal of Medicine. 330 (2): 95–99. doi:10.1056/NEJM199401133300203 [archive]. PMID 8259189 [archive].<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  5. ↑ 5.0 5.1 Pearce, Fred (2006). When the Rivers Run Dry: Journeys Into the Heart of the World's Water Crisis. Toronto: Key Porter. ISBN 978-1-55263-741-8.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  6. ↑ WHO Expert Committee on Oral Health Status and Fluoride Use. Fluorides and oral health [archive] [PDF]. 1994.
  7. ↑ http://www.reuters.com/article/2011/01/08/us-usa-fluoride-idUSTRE7064CM20110108 [archive]
  8. ↑ National Health and Medical Research Council (Australia). A systematic review of the efficacy and safety of fluoridation [archive] [PDF]. 2007 [Retrieved 2009-10-13]. <templatestyles src="Module:Citation/CS1/styles.css" />ISBN 1-86496-415-4. Summary: Yeung CA. A systematic review of the efficacy and safety of fluoridation. Evid Based Dent. 2008;9(2):39–43. doi:10.1038/sj.ebd.6400578 [archive]. PMID 18584000 [archive]. Lay summary [archive]: NHMRC, 2007.
  9. ↑ Nochimson G. (2008). Toxicity, Fluoride [archive]. eMedicine. Retrieved 2008-12-28.
  10. ↑ 10.0 10.1 Augenstein WL, Spoerke DG, Kulig KW; et al. (November 1991). "Fluoride ingestion in children: a review of 87 cases" [archive]. Pediatrics. 88 (5): 907–12. PMID 1945630 [archive]. Explicit use of et al. in: |author= (help)CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  11. ↑ Wu ML, Deng JF, Fan JS (November 2010). "Survival after hypocalcemia, hypomagnesemia, hypokalemia and cardiac arrest following mild hydrofluoric acid burn". Clinical Toxicology (Philadelphia, Pa.). 48 (9): 953–5. doi:10.3109/15563650.2010.533676 [archive]. PMID 21171855 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  12. ↑ Klasaer AE, Scalzo AJ, Blume C, Johnson P, Thompson MW (December 1996). "Marked hypocalcemia and ventricular fibrillation in two pediatric patients exposed to a fluoride-containing wheel cleaner". Annals of Emergency Medicine. 28 (6): 713–8. doi:10.1016/S0196-0644(96)70097-5 [archive]. PMID 8953969 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  13. ↑ Jay D. Shulman; Linda M. Wells (1997). "Acute Fluoride Toxicity from Ingesting Home-use Dental Products in Children, Birth to 6 Years of Age". Journal of Public Health Dentistry. 57 (3): 150–158. doi:10.1111/j.1752-7325.1997.tb02966.x [archive]. PMID 9383753 [archive].<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  14. ↑ http://209.85.173.104/search?q=cache:ZhsLcgzSdPAJ:www.sierrachem.com.au/MSDS_ACID_CLEANER.doc+fluoride+fluoridosis&hl=en&ct=clnk&cd=11&gl=au&lr=lang_en%7Clang_ja [archive]
  15. ↑ http://sis.nlm.nih.gov/enviro/iupacglossary/glossaryf.html [archive]
  16. ↑ 16.00 16.01 16.02 16.03 16.04 16.05 16.06 16.07 16.08 16.09 16.10 16.11 16.12 16.13 16.14 16.15 16.16 16.17 16.18 16.19 16.20 16.21 16.22 16.23 Committee on Fluoride in Drinking Water, National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards National Academies Press. Free full-text [archive]. Cite error: Invalid <ref> tag; name "NRC2006" defined multiple times with different content
  17. ↑ EPA: Community Water Fluoridation, FAQ [archive]
  18. ↑ EPA: Setting Standards for Safe Drinking Water [archive]
  19. ↑ EPA Fluoride Standards: Focus on Fluorosis [archive]
  20. ↑ Colquhoun J (1997). "Why I changed my mind about water fluoridation". Perspect Biol Med. 41 (1): 29–44. PMID 9394474 [archive].<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles> Reprinted in Fluoride. 31 (2): 103–18. 1998 http://fluoride-journal.com/98-31-2/312103.htm [archive]. Missing or empty |title= (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  21. ↑ Liu M, Qian C (2008). "[Effect of endemic fluorosis on children's intelligence development: a Meta analysis.]". Zhongguo Dang Dai Er Ke Za Zhi (in Chinese). 10 (6): 723–5. PMID 19102839 [archive]. Unknown parameter |month= ignored (help)CS1 maint: unrecognized language (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  22. ↑ Tang QQ, Du J, Ma HH, Jiang SJ, Zhou XJ (2008). "Fluoride and children's intelligence: a meta-analysis". Biol Trace Elem Res. 126 (1–3): 115–20. doi:10.1007/s12011-008-8204-x [archive]. PMID 18695947 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  23. ↑ 23.0 23.1 23.2 23.3 Strunecká A, Strunecký O, Patocka J (2002). "Fluoride plus aluminum: useful tools in laboratory investigations, but messengers of false information" [archive] (PDF). Physiol Res. 51 (6): 557–64. PMID 12511178 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  24. ↑ Fagin D (2008). "Second thoughts about fluoride". Sci. Am. 298 (1): 74–81. PMID 18225698 [archive]. Unknown parameter |month= ignored (help)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  25. ↑ Lefler, Dion (11 September 2012). "Harvard scientists: Data on fluoride, IQ not applicable in U.S." [archive] The Wichita Eagle. Retrieved 5 March 2014.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  26. ↑ Anna L. Choi, Guifan Sun, Ying Zhang, and Philippe Grandjean (2012). "Developmental fluoride neurotoxicity: a systematic review and meta-analysis" [archive]. Environ. Health Perspect. USA: National Center for Biotechnology Information. 120 (10): 1362–8. doi:10.1289/ehp.1104912 [archive]. PMC 3491930 [archive]. PMID 22820538 [archive].CS1 maint: uses authors parameter (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  27. ↑ "Neurobehavioural effects of developmental toxicity" [archive]. The Lancet Neurology, Volume 13, Issue 3, Pages 330 - 338, March 2014. USA: Elsevier Ltd.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  28. ↑ Sabour S, Ghorbani Z (March 2013). "Developmental fluoride neurotoxicity: clinical importance versus statistical significance" [archive]. Environ. Health Perspect. 121 (3): A70. doi:10.1289/ehp.1206192 [archive]. PMC 3621182 [archive]. PMID 23455234 [archive].<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  29. ↑ Broadbent, Jonathan M.; Thomson, W. Murray; Ramrakha, Sandhya; Moffitt, Terrie E.; Zeng, Jiaxu; Foster Page, Lyndie A.; Poulton, Richie (15 May 2014). "Community Water Fluoridation and Intelligence: Prospective Study in New Zealand" [archive]. American Journal of Public Health: e1–e5. doi:10.2105/AJPH.2013.301857 [archive]. Retrieved 4 July 2014.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  30. ↑ Liu M, Qian C (2008). "[Effect of endemic fluorosis on children's intelligence development: a Meta analysis.]". Zhongguo Dang Dai Er Ke Za Zhi (in Chinese). 10 (6): 723–5. PMID 19102839 [archive]. Unknown parameter |month= ignored (help)CS1 maint: unrecognized language (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  31. ↑ Tang QQ, Du J, Ma HH, Jiang SJ, Zhou XJ (2008). "Fluoride and children's intelligence: a meta-analysis". Biol Trace Elem Res. 126 (1–3): 115–20. doi:10.1007/s12011-008-8204-x [archive]. PMID 18695947 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  32. ↑ 32.0 32.1 McDonagh, Marian S.; Whiting, Penny F; Wilson, Paul M.; et al. (7 October 2000). "Systematic review of water fluoridation" [archive]. BMJ. 321 (7265): 855–859. doi:10.1136/bmj.321.7265.855 [archive]. PMC 27492 [archive]. PMID 11021861 [archive].<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  33. ↑ Gupta R, Kumar AN, Bandhu S, Gupta S (2007). "Skeletal fluorosis mimicking seronegative arthritis". Scand. J. Rheumatol. 36 (2): 154–5. doi:10.1080/03009740600759845 [archive]. PMID 17476625 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  34. ↑ Cousins MJ, Skowronski G, Plummer JL. Anaesthesia and the kidney. Anaesth Intensive Care. 1983 Nov;11(4):292-320.
  35. ↑ Baden JM, Rice SA, Mazze RI. Deuterated methoxyflurane anesthesia and renal function in Fischer 344 rats. Anesthesiology. 1982 Mar;56(3):203-6.
  36. ↑ Mazze RI. Methoxyflurane nephropathy. Environ Health Perspect. 1976 Jun;15:111-9.
  37. ↑ Cousins MJ, Greenstein LR, Hitt BA, Mazze RI. Metabolism and renal effect of enflurane in men. Anesthesiology 1976; 44:44-53.
  38. ↑ VanDyke R. Biotransformation of volatile anesthetics with special emphasis on the role of metabolism in the toxicity of anesthetics. Can Anaesth Soc J 1973;20:21-33.
  39. ↑ White AE, Stevens WC, Eger EI II, Mazze RI, Hitt BA. Enflurane and methoxyflurane metabolism at anesthetic and subanesthetic concentrations. Anesth Analg 1979;58:221-4/
  40. ↑ Nidel Law (2014). "Freedom of Information Act on Disproportionate Harm to African Americans" [archive]. Retrieved 6 Dec 2014.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  41. ↑ HHS and CDC documents (2014). "Internal communications accessed through Freedom of Information Act" [archive] (PDF). Retrieved 6 Dec 2014.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  42. ↑ :Kumar, JV; Swango, PA (1999). Fluoride exposure and dental fluorosis in Newburgh and Kingston, New York, policy implications [archive]. Community Dentistry & Oral Epidemiology 27:171-80.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  43. ↑ Camargo, Julio A. (January 2003). "Fluoride toxicity to aquatic organisms: a review". Chemosphere. 50 (3): 251–264. doi:10.1016/S0045-6535(02)00498-8 [archive].<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  44. ↑ Baez, Ramon J.; Baez, Martha X.; Marthaler, Thomas M. (2000). "Urinary fluoride excretion by children 4–6 years old in a south Texas community" [archive]. Revista Panamericana de Salud Pública/Pan American Journal of Public Health. 7 (4): 242–248. doi:10.1590/s1020-49892000000400005 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  45. ↑ Li L (2003). "The biochemistry and physiology of metallic fluoride: action, mechanism, and implications". Crit. Rev. Oral Biol. Med. 14 (2): 100–14. doi:10.1177/154411130301400204 [archive]. PMID 12764073 [archive].<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles> Free full-text [archive].
  46. ↑ Chiba J, Kusumoto M, Shirai S, Ikawa K, Sakamoto S (March 2002). "The influence of fluoride ingestion on urinary aluminum excretion in humans". Tohoku J. Exp. Med. 196 (3): 139–49. doi:10.1620/tjem.196.139 [archive]. PMID 12002270 [archive].CS1 maint: multiple names: authors list (link)<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles> Free full-text [archive].
  47. ↑ Fluoride Awareness- Interview with Paul Connett [archive]
  48. ↑ Fluoride Awareness- Interview with Paul Connett [archive]
  49. ↑ https://takecontrol.substack.com/p/fluoride-health-risks [archive]

Books[edit]

  • Fluoride the Aging Factor
  • Connett, Paul_ Beck, James_ Micklem, H S_ Burgstahler, Albert W (Foreword) - The Case Against Fluoride_ How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics
  • Christopher Bryson - The Fluoride Deception-Seven Stories Press (2006)

Links[edit]

https://naturalnewsblogs.com/avoid-fluoride-like-the-plague/ [archive]

https://stevekirsch.substack.com/p/the-case-against-fluoride [archive]

https://dailysceptic.org/archive/how-the-medical-establishment-covered-up-the-harms-of-adding-fluoride-to-drinking-water/ [archive]

https://takecontrol.substack.com/p/fluoride-health-risks [archive]

https://robertyoho.substack.com/p/170-steve-kirsch-the-case-against [archive]

https://unbekoming.substack.com/p/fluoride [archive]

https://articles.mercola.com/sites/articles/archive/2024/04/05/prenatal-fluoride-exposure-lowers-children-iq.aspx [archive] https://takecontrol.substack.com/p/prenatal-fluoride-exposure-lowers-children-iq [archive]

https://takecontrol.substack.com/p/fluoride-poison-on-tap-documentary [archive]

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