Health Effects of Ingested Fluoride (1993) / Chapter Skim
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Pages 1-14
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However, there has been an increase in the prevalence of dental fluorosis a mottling of tooth enamel that ranges from barely discernible enamel flecks in its mildest forms to staining and pitting in its severest forms; the severest forms are rare in the United States. EPA considers dental fluorosis to be a cosmetic effect and not an adverse health effect.
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EPA respondecl to the concerns by requesting that the National Research Council's Board on Environmental Studies and Toxicology (BEST) review the current toxicological and exposure data on fluoride and determine whether EPA's current MCL of 4 mg/L is acceptable for protecting the public from potential adverse health effects of fluoride.
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Concentrations in food depend on the levels in the soil, but they can increase or decrease depending on the fluoride concentrations in the water used in food preparation. Dental products available in the United States and meant to be used topically (and not ingested)
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One side effect of too much fluoride ingested in early childhood while teeth are forming, however, is dental fluorosis; the enamel covering of the teeth fails to crystallize properly, leading to defects that range from barely discernible to severe brown stain, surface pitting, and brittleness. Fluoricle intake by chilclren 2-5 years old is particularly important because the anterior (front)
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Those sources make it cliff~cult to estimate fluoride exposure; they represent a source of possible error in estimating fluoride intake in studies of the relation between fluoride exposure and dental fluorosis. Moreover, there is disagreement on whether dental fluorosis (even moderate-to-severe dental fluorosis, in which substantial tooth enamel is affected and dental treatment might be required)
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Only two additional studies collected information on individual exposure: one (essentially a geographic comparison) found an increased risk of hip fracture at water fluoride concentrations of 4 mg/L, and the other observed no difference in risk.
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However, the subcommittee concluded that the weight of evidence indicates that bone strength is not adversely affected in animals that are fed a nutritionally adequate diet unless there is long-term ingestion of fluoride at concentrations of at least 50 mg/L of drinking water or 50 mg/kg in diet. In view of the conflicting results and limitations of the current data base on fluoride and the risk of hip or other fractures, the subcommittee concludes that there is no basis at this time to recommend that EPA lower the current standard for fluoride in drinking water for this end point.
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Reports of gastrointestinal effects in humans often involve workers exposecI to unknown concentrations of fluoride in the workplace, so that the contribution of fluoride exposure to the risk of adverse health effects is unknown. The subcommittee noted that these workers could also be exposed to other toxic substances present in the work environment.
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Based on these findings, the subcommittee concludes that the fluoride concentrations associated with adverse reproductive effects in animals are far higher than those to which human populations are exposed. Consequently, ingestion of fluoride at current concentrations should have no adverse effects on human reproduction.
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The subcommittee concludes Hat the genotoxicity of fluoride should not be of concern at the concentrations found in the plasma of most people in the United States. CARCINOGENICITY More than SO epidemiological studies have examined the relation between fluoride concentrations in drinking water and human cancer.
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population will exhibit moderate or even severe dental fluorosis. However, the question of whether to consider dental fluorosis a cosmetic effect or an adverse health effect ant!
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From page 13... ...
Health Effects of Ingested Fluoride
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