• graphic areas with high and low fluoride concentration in drinking water and make use of individual information about water consumption. These studies also should collect individual information on bone fluoride concentrations and intake of fluoride from all sources, as well as reproductive history, past and current hormonal status, intake of dietary and supplemental calcium and other cations, bone density, and other factors that might influence the risk of hip fracture.

Carcinogenicity

  • Conduct one or more highly focused, carefully designed analytical studies (case control or cohort) of the cancer sites that are most highly suspect, based on data from animal studies and the few suggestions of a carcinogenic effect reported in the epidemiologic literature. Such studies should be designed to gather information on individual study subjects so that adjustments can be made for the potential confounding effects of other risk factors in analyses of individuals. Information on fluoride exposure from sources other than water must be obtained, and estimates of exposure from drinking water should be as accurate as possible. In addition, analysis of fluoride in bone samples from patients and controls would be valuable in inferring total lifetime exposures to fluoride. Among the disease outcomes that warrant separate study are osteosarcomas and cancers of the buccal cavity, kidney, and bones and joints.

paste, dental rinses). On the basis of those reviews, the committee was asked to evaluate independently the scientific basis of EPA’s MCLG of 4 mg/L and SMCL of 2 mg/L in drinking water and the adequacy of those guidelines to protect children and others from adverse health effects. The committee was asked to consider the relative contribution of various fluoride sources (e.g., food, dental-hygiene products) to total exposure. The committee also was asked to identify data gaps and make recommendations for future research relevant to setting the MCLG and SMCL for fluoride. Addressing questions of economics, risk-benefit assessment, and water-treatment technology was not part of the committee’s charge.

The committee is aware that some readers expect this report to make a determination about whether public drinking-water supplies should be fluoridated. That expectation goes beyond the committee’s charge. As noted above, the MCLG and SMCL are guidelines for areas where fluoride con-



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