1) New scientific information has not been considered.

The Pennsylvania legislature hasn't held hearings on the fluoridation issue since the late 1980s. A huge number of scientific studies have accumulated in this time, showing harm from water fluoridation.

See this Fluoride Health Database for a compilation of the science relating to various health impacts of fluoride ingestion.

National Academy of Sciences (National Research Council) March 2006 Report

After three years of research, a distinguished panel reviewed over 1,000 scientific papers on fluorides and concluded that EPA's standard for fluoride in drinking water is unsafe and must be lowered to protect public health.

The report documents fluoride's role in dental fluorosis (damage to tooth enamel), skeletal fluorosis (brittle bones; increase risk of fractures), impaired thyroid function and possible links to diabetes, reduced IQ, early onset of puberty and more.

Since the level in fluoridated drinking water systems (1 ppm) is so close to the "not-officially-safe-anymore" 4 ppm Maximum Contaminant Level, the already unusually narrow margin of safety would have to all but vanish to allow fluoridation to continue with a lower standard. Already, there are many in the population who drink more water than average (athletes, diabetics, kidney patients, etc.) or who are exposed through toothpaste, tea, fluoridated pesticide residues, juices or other fluoride sources -- and are already getting more than the current (now known to be unsafe) Maximum Contaminant Level.

"Fluoride in Drinking Water: A Scientific Review of EPA's Standards," Committee on Fluoride in Drinking Water, National Research Council, March 2006. (4.5 MB file; 450 pages)

The National Academy's own press release on the report:
"EPA Standard for Fluoride in Drinking Water Is Not Protective; Tooth Enamel Loss, Bone Fractures of Concern at High Levels"

Many More Resources Related to the NRC Report

Summary of National Academy of Science NRC report - Fluoride in Drinking Water

Review of the 2006 US National Research Council Report: Fluoride in Drinking Water

Relevance of the NRC report to fluoridation
Pro-fluoridation groups argue that the report isn't relevant to water fluoridation because it studies the 4ppm limit and drinking water systems are fluoridated at 1ppm. This article shows how it's very relevant.

2) Most fluoride is wasted

According to the American Water Works Association:

We drink very little of our drinking water. Generally speaking, less than 1% of the treated water produced by water utilities is actually consumed. The rest goes on lawns, in washing machines, and down toilets and drains.

Why put fluoridation chemicals in the drinking water when 99% of it will just be distributed back into the environment, missing its intended purpose? Fluorides going back down the drain ultimately return to rivers, streams and groundwater sources as contaminants. Chemicals commonly used in water fluoridation programs (hydrofluosilicic acid) are obtained from the scrubbers of the phosphate industry and are legally regulated as hazardous waste if dumped in rivers, lakes or other water bodies -- yet they're no longer regulated as waste when distributed through drinking water systems as "medicine" and ending up in our rivers and streams anyway.

Installing fluoridation equipment is an expensive affair and local governments, municipal authorities and private water suppliers will bear the cost and liability. Proper installation of fluoridation equipment requires expensive special equipment and careful handling. Spills and overfeeds have occurred many times in Pennsylvania. Most of the systems that would be affected by the mandate are smaller ones where the per-person costs will be quite high -- far exceeding the costs estimated by the PA Dental Association. This is an unfunded and costly mandate that is generally opposed by municipal water systems, both public and private.

House Bill 1649 would require 730 drinking water systems in the state to install costly equipment and start handling these hazardous chemicals. These investments may be a complete waste as soon as EPA lowers their standard -- since a lower standard could easily end the current practice of water fluoridation.

Documents from Utah showing that costs of installing fluoridation equipment turned out to be many times higher than projected by public health agencies:
• Salt Lake City (original cost estimate of $1.5 million grew to over $2.6 million)
• Jordan Valley Water Conservation District
• Metropolitan Water District of Salt Lake and Sandy
• Taylorsville Bennion Improvement District (original cost estimate of $210,000 grew to over $1 million)

Doubling fluoridation in PA will worsen fluoridation chemical shortages and increase costs.

Fluoridation Chemical Shortages and Rising Costs



Over 90% of the chemicals used to fluoridate water systems are the hazardous waste byproducts (fluosilisic acid, or "FSA") of the phosphate industry. As phosphate production drops and water fluoridation increases, there's been a shortage of FSA in North America and prices have increased dramatically.

If PA mandates water fluoridation, roughly doubling the state's demand for fluoridation chemicals, how will the demand be met when water systems throughout North America are already experiencing shortages? How will the increased demand affect the already-rising cost of the chemicals -- even for the water systems in the state that are currently buying them?

In 2007, the American Water Works Association and the Pennsylvania Department of Environmental Protection have both issued warnings about shortages in fluoridation chemicals.

Cleveland Water, which uses FSA, has seen the price of the chemical rise 105 percent over the two years from 2005-2007. [Update: this domestic shortage seems to have been overcome by the reduction of the fluoridation levels since 2011, and importation of fluoridation chemicals from China.]

4) Fluoride is NOT good for teeth

Many studies - new and old - have shown that the alleged benefits of fluoride are topical and that ingesting fluoride does not help fight cavities. See http://www.fluoridealert.org/issues/caries/ for links to studies showing that fluoridation does not help teeth. Swallowing fluoride to prevent tooth decay makes as much sense as swallowing suntan lotion to prevent sun burns.

Fluoridation Doesn't Work
(According to State, National And International Health Agency Data)

STATE: Worst tooth decay is in fluoridated major cities

A 2000 PA Department of Health study showed that, by far, Pittsburgh has the highest percentage of 15-year-olds with cavities -- over 70% (the statewide average is just under 50%). Pittsburgh has been fluoridated since the 1950s. Philadelphia (also fluoridated since the 1950s) also has tooth decay rates above the state average. Outside of Philadelphia and Pittsburgh, most of the rest of the state is not fluoridated. The study also shows that Philadelphia and Pittsburgh have the state's highest rates of dental fluorosis (fluoride-induced discoloration of tooth enamel).

See: Summary of Pennsylvania Oral Health Needs Assessment (see Table 2R on p2)
See full study here

The high tooth decay rate in Pittsburgh was reported in the Pittsburgh Tribune-Review: "Sink your teeth into health care" (2/13/2005)

See PA DEP data on which water systems in Pennsylvania are fluoridated

NATIONAL: Income, Not Fluoridation Status Determines Dental Health

State-by-state data from the U.S. Centers for Disease Control and the U.S. Department of Health and Human Services shows that good dental health is a function of income (access to dental care), but unrelated to the percentage of people exposed to fluoridation in a state.

INTERNATIONAL: Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries

World Health Organization data shows that tooth decay rates are falling over time in many developed countries, whether they're fluoridated or not. Most aren't fluoridated and their tooth decay rates are falling faster than in the handful of countries where most people are fluoridated. See second chart in this page.

DENTAL HEALTH EXPERTS: Fluoridation Doesn't Work

The Journal of the American Dental Association -- in the cover story of their July 2000 issue -- states that ingested fluoride does not reduce tooth decay and that the action is topical (when applied to teeth, but not when swallowed).

Several studies presented at the annual American Association for Dental Research conference in March 2006 showed that water fluoridation is causing increased dental fluorosis (discolored teeth), but has been ineffective at reducing tooth decay.

Additional documentation can be found here: Fluoride & Tooth Decay (Caries)

A statement signed by over 4,000 professionals (including dentists) calls for an end to water fluoridation: 2007 Professionals Statement

5) Fluoride is actually BAD for teeth

Dental fluorosis, the white, yellow, or brown pitting/mottling of teeth, is caused by fluoride exposure. See:
• Pictures of Dental Fluorosis
• Dental Fluorosis

According to the Centers for Disease Control, 41% of U.S. children aged 12-15 and 36% of children 16-19 now have some form of dental fluorosis, with 2 to 4% of children having the moderate to severe stages.

The worst dental fluorosis in PA is in Pittsburgh and Philadelphia; both cities have been fluoridated since the 1950s. This is documented in the Summary of Pennsylvania Oral Health Needs Assessment (see Table 13R on p6). This study, done for the PA Department of Health is not online in full. This report summary used to be on the PA Department of Health's website, but was removed, perhaps because we've pointed legislators to it, showing that the Department of Health's own data undermined their promotion of water fluoridation. The summary was also archived by archive.org on 6/30/2006.

6) The ADA and CDC recommend against fluoridated water for babies

The American Dental Association and the Centers for Disease Control are now recommending that parents of newborns avoid using fluoridated water when mixing infant milk formula for their babies -- but they offer no outreach to tell parents this information, and no funds to pay for low-income families to purchase other sources of water.

The ADA's policy change, in November 2006, recommending that fluoridated water NOT be used for preparing infant formula -- in order to prevent ingestion of too much fluoride by babies and to lower the risk of dental fluorosis. They recommend using "purified, distilled, deionized, demineralized, or produced through reverse osmosis." Based on new studies on the risks of fluoride causing permanent damage to teeth if babies up to 12 months are exposed, the CDC now recommends (as of Dec. 2006) that infant formula not be prepared with fluoridated water. Who will bear the financial burden of notifying parents and ensuring a non-fluoridated water supply for them? Formula made with fluoridated water contains 250 times more fluoride than the average 0.004 ppm concentration found in human breast milk in non-fluoridated areas.

American Dental Association: "ADA offers interim guidance on infant formula and fluoride" (11/9/2006)

Centers for Disease Control: "Background: Infant Formula and the Risk for Enamel Fluorosis" (12/15/2006)

7) Fluoridation is not ethical / Can't control the dose

Even if fluoride ingestion were effective at preventing tooth decay, it makes no sense to administer medication via the public water supply, where there is no control over the dose people get. No credible doctor would give out medication and say "take as much as you want" ­ yet dentists do exactly that when they promote water fluoridation.

In most areas of toxicology, it's standard to have a safety margin of 10-100 times between the "safe dose" and the level at which a chemical is known to cause harm. This is done to protect sensitive populations, like the young, the elderly and those in poor health. With fluoride, there is no margin of safety. Negative health effects have been found in the range of 1-4 parts per million (ppm). The "recommended" level for water is 1 ppm [lowered to 0.7 ppm in 2011]. The EPA maximum contaminant level is 4 ppm. Since people are now exposed to fluoride in their drinking water, toothpaste, plus a variety of foods made/processed with fluoridated water or sprayed with fluoridated pesticides, the general population is exposed to ever-higher doses, pushing many over any "safe" limit.

Ask any toxicologist, and they'll tell you that "the dose makes the poison." The National Academy of Sciences has already advised the Environmental Protection Agency that their "safe" dose of 4 parts per million (ppm) isn't safe and needs to be lowered. There is already no margin of safety between the 4 ppm unsafe limit and the 1 ppm concentration administered through the drinking water. A margin of safety is usually at least 10 times, not four. Now, with the standard needing to be lowered, the margin of safety essentially vanishes. You can find more of this discussed in the article on the relevance of the NRC report to fluoridation.

Water treatment plants can control the concentration but can't control the dose that an individual receives, since there's no way to control how much water someone drinks. Some people drink far more water than average, like diabetics and athletes, and are at higher risk for overexposure. Water treatment plants also cannot control how much fluoride exposure someone gets from other sources, like toothpaste, tea, juices and other sources high in natural fluorides and fluoridated pesticides. Some people are already overexposed.

Why use fluoridated water to shower, flush toilets, wash dishes, water gardens or wash cars? Why use industrial waste rather than the pharmaceutical grade fluoride that is used in toothpaste? Why force people to ingest chemicals that aren't needed to make drinking water safe? Fluoride toothpaste ­ for those who want fluoride ­ is cheap. Distillers or reverse osmosis filters (which, unlike carbon filters, can remove fluoride from drinking water) are expensive.

See: Citizens for Safe Drinking Water info on total fluoride exposure (includes info on sources other than water that already exceed recommended limits, documents from the Congressional investigation on fluoridation and much more)

8) Numerous other health problems are tied to fluoride exposure

The waste products used to fluoridate drinking water systems -- collected in the pollution control systems of phosphate fertilizer factories -- come contaminated with arsenic, lead and radionuclides and are added, unprocessed, to drinking water supplies. These contaminants, and the fluorides themselves, contribute to a a range of health problems.

See: Fluoride Health Effects Database
[Health effects documented include arthritis, bone fractures, osteosarcoma (bone cancer), dental fluorosis, IQ loss and learning disabilities and effects on kidney and thyroid function.]

9) Environmental groups and EPA professionals unions are opposed to fluoridation

In 1985, a U.S. Environmental Protection Agency (EPA) employee complained to their union that they were forced to write a regulation supporting a safe drinking water standard for fluoride (4 parts per million) that is known to cause serious dental fluorosis -- the white, yellow or brown spotting or mottling of tooth enamel. EPA higher-ups argued this was only cosmetic and not a health effect.

In April 1998, after trying to resolve this ethics issue internally for years, the union representing approximately 1,500 scientists, lawyers, engineers and other professional employees at EPA Headquarters in Washington, D.C. took a public stand opposed to water fluoridation. The union stated:

"our opposition to drinking water fluoridation has grown, based on the scientific literature documenting the increasingly out-of-control exposures to fluoride, the lack of benefit to dental health from ingestion of fluoride and the hazards to human health from such ingestion. These hazards include acute toxic hazard, such as to people with impaired kidney function, as well as chronic toxic hazards of gene mutations, cancer, reproductive effects, neurotoxicity, bone pathology and dental fluorosis."

Their concern has increased as the scientific evidence against fluoridation accumulates. In August 2005, eleven EPA unions representing over 7,000 environmental and public health professionals wrote to Congress and called for a national moratorium on drinking water fluoridation programs. The unions acted following revelations of an apparent cover-up of evidence from Harvard School of Dental Medicine linking fluoridation with elevated risk of a fatal bone cancer in young males. The union representing scientists at the EPA Region III office in Philadelphia, which covers Pennsylvania is one of the unions signed onto this statement.

These concerns were affirmed in the March 2006 National Academy of Sciences review of EPA's standard for fluoride in drinking water, which found that the standard is NOT protective of public health and must be lowered.

Other Experts Opposed to Fluoridation:

Professionals Statement of Concern
Statement of Concern Signers

Newer Professionals' Statement Calling For End To Fluoridation

The Sierra Club also has a national policy opposed to mandatory fluoridation.

10) Most of the world rejects fluoridation

Most countries in the world have chosen NOT to fluoridate, including nearly all of Europe. Few nations actually fluoridate and some have had serious problems with high naturally-occurring levels of fluoride, causing them to work to REMOVE fluoride from the water to prevent crippling skeletal fluorosis (similar to osteoporosis in its effects).

Most Countries Reject Water Fluoridation

Water Fluoridation Status of OECD Nations

How Many Nations Fluoridate Their Water?

http://www.actionpa.org/fluoride/reasons.html