centrations are naturally high. They are designed with the intent to protect the public from adverse health effects related to fluoride exposure and not as guidelines to provide health benefits.


To accomplish its task, the committee held six meetings between August 2003 and June 2005. The first two meetings involved data-gathering sessions that were open to the public. The committee heard presentations from EPA, CDC, individuals involved in fluoride research, fluoridation supporters, and antifluoridation proponents. The committee also reviewed a large body of written material on fluoride, primarily focusing on research that was completed after publication of the 1993 NRC report. The available data included numerous research articles, literature reviews, position papers, and unpublished data submitted by various sources, including the public. Each paper and submission was evaluated case by case on its own merits.

Unless otherwise noted, the term fluoride is used in this report to refer to the inorganic, ionic form. Most of the nonepidemiologic studies reviewed involved exposure to a specified fluoride compound, usually sodium fluoride. Various units of measure are used to express exposure to fluoride in terms of exposure concentrations and internal dose (see Table 1-1 and Chapter 3). To the extent possible, the committee has tried to use units that allow for easy comparisons.

In this report, the committee updates information on the issues considered in the 1993 review—namely, data on pharmacokinetics; dental effects; skeletal effects; reproductive and developmental effects; neurological and behavioral effects; endocrine effects; gastrointestinal, renal, hepatic, and immune effects; genotoxicity; and carcinogenicity. More inclusive reviews are provided on effects to the endocrine and central nervous systems, because the previous NRC review did not give those effects as much attention. The committee used a general weight-of-evidence approach to evaluate the literature, which involved assessing whether multiple lines of evidence

TABLE 1-1 Units Commonly Used for Measuring Fluoride





1 ppm

1 mg/L


1 µmol/L

0.019 mg/L

Bone ash

1 ppm

1 mg/kg



10,000 mg/kg

ABBREVIATIONS: mg/kg, milligrams per kilogram; mg/L, milligrams per liter; µmol/L, micromoles per liter; ppm, parts per million.

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