Fillings, Fluoride, and Fear > Health Issues

By John E. Dodes, D.D.S.
Posted: Tuesday, April 2, 2002

ARTICLES
Publication Date: April 2, 2002

The two most pervasive and dangerous controversies in dentistry involve the false allegations against silver-amalgam fillings and fluoridation.

Fillings

Dental silver-amalgam fillings (amalgams) are an alloy of silver, copper, tin, zinc, and elemental mercury (quicksilver). Mercury has a long history of use in medicaments — for example Mercurochrome (an antiseptic) — and is currently widely used in electrical applications, chlorine production, and dental restorations. Nineteenth-century felt-hat makers are the classic example of mercury poisoning because many workers absorbed high amounts of mercury through their skin and lungs due to the mercuric-nitrate solutions they used to soften the felt. These workers developed tremors, incoherent speech, difficulty in walking, and weakened mental functioning. The problem was immortalized by the Mad Hatter in Alice in Wonderland. Even today, mercury can be a hazard for workers in thermometer factories and in plants that use mercury to make chlorine and caustic soda.

In December 1990 60 Minutes, CBS's popular TV program, presented a segment, "Poison In Your Mouth," which suggested that the mercury in amalgam dental fillings could cause serious health problems. Thousands of viewers besieged their dentists, asking to have their amalgams replaced and a number of state officials introduced legislation to ban amalgam fillings. The furor that the 60 Minutes segment produced led the Public Health Service (PHS) to undertake a costly and intensive study of amalgam fillings. The PHS report, published in 1993, concluded that amalgam fillings were safe. Recently, physicians with large public audiences, such as Dr. Robert Atkins and Dr. Andrew Weil, have also warned of the potential "dangers" of amalgam fillings.

Amalgam fillings have restored billions of teeth in their 150-year history. Because of the ease with which they can be placed, their longevity, and their low cost, amalgams have been an unqualified public health success. But the economic foundation of dental practice has been adversely affected by fluoridation, which has led to a marked decrease in the amount of tooth decay, and by managed care, which has lowered reimbursement for many dentists. The result has been some dentists who are a bit too eager to find new reasons to treat patients. Dental greed and ignorance of the scientific facts, coupled with the media's irresponsibility and lack of skeptical scrutiny, have encouraged a great many patients to have their silver fillings replaced in order to prevent or cure many diseases and conditions for which scientific causes have not, as of yet, been discovered. Some of these patients have been seriously injured by these unnecessary treatments.

The cardinal rule of toxicology is; "only the dose makes a poison." The overwhelming weight of scientific evidence is that the amount of mercury that may be released from silver-amalgam fillings is far below the threshold value that would pose any danger to adults or children. It must also be remembered that the political restraints placed on amalgam use in certain European countries are a response to a desire to lower the environmental impact of dental mercury waste released into the air and water rather than a response to any alleged dangers to patients with amalgams. Studies have also shown that the body's mercury burden is highest immediately after placement or removal of amalgams. This information casts doubt on the causes of any claimed improvement of symptoms immediately following amalgam removal.

As we enter the twenty-first century, the loss of such a useful and low-cost method of tooth repair would definitely lead to a dental public health crisis. In 1993 James Mason, M.D., the Assistant Secretary for Health, reaffirmed the PHS position that: "there are no data to compel a change in the current use of dental amalgam."

Fluoride

Fluoridation of water supplies has been a controversial subject for over sixty years. Much of the debate concerns questions of safety. Over 35,000 papers on fluoridation have been published in the years since fluoride supplementation was first proposed as an effective way of decreasing tooth decay. The overwhelming conclusion is that fluoride is safe and cost-effective.

Tooth decay is the most common human disease and is the principal cause of tooth loss from childhood through middle age. Recent surveys have found that over 94% of adults have had decayed teeth. In 1997, the United States spent over $50.6 billion on dental care.

The most famous study of the effects of fluoridation occurred in the 1940s in Newburgh and Kingston, New York. These cities are located thirty-five miles apart near the Hudson River and both had populations of about 30,000 and were also similar in their demographics. Newburgh's water supply was fluoridated while Kingston's was not. After ten years the study found that there were no medical differences between the two groups except for the fact that Newburgh's children had almost 60% fewer cavities. Many studies have confirmed these findings in the years since.

Fluoride is one of Earth's most common elements and is therefore present in variable amounts in all water supplies. In growing children the fluoride will be incorporated throughout the entire tooth. In adults fluoride will continue to be absorbed by the enamel surface, lending the teeth a temporary resistance to decay. The amount of decay reduction caused by fluoridation of local water supplies has decreased over the last forty years, probably because of improved dental hygiene and widespread use of fluoride toothpaste. In 1991, fluoride was found to reduce the incidence of cavities 20-40% in children and 15-35% in adults.

Fluoride ingested through community water systems has a large margin of safety. Fluoride intake at 1ppm has never been shown to have any negative effect on disease or death rates.

In the United States, 62.2% of the population has access to public water supplies that are optimally fluoridated. Over 360 million people worldwide, in approximately sixty countries are also fluoridated. Dr. C. Everett Koop, the former Surgeon General of the United States has stated, "Fluoridation is the single most important commitment that a community can make to the oral health of its citizens." It is imperative to continue to fluoridate water systems throughout the world, and it is far more beneficial than campaigns based on unnecessary fears.

Responses:

April 3, 2002

John Dodes' article on silver fillings is about the most absurd I have ever read. To suggest that European governments ban mercury fillings to prevent leakage in to air and water is ludicrous. Mercury fillings break down over long periods of time and mercury out gasses from the fillings. To say that the exposure is negligible is not accurate because no one knows how much is harmful within a twenty- or thirty-year period. Disease becomes present due to a failure of the immune system. Mercury poisoning from fillings will, over time, weaken the immune system, and seemingly unrelated medical conditions will appear.

I wish that the ADA and AMA would take proactive stances on issues like this instead of continuing to deny the evidence until they are buried by it and then all of a sudden announcing some profound new discovery that those of us interested in the alternative health field have known about for years.

—Raas

April 8, 2002

John Dodes is correct that fluoride reduces tooth decay in communities that add it to their drinking water. The problem is, I don't want fluoride in my water whether it reduces tooth decay or not. The government has no business adding it. If I want fluoride, I will buy fluoridated toothpaste. If you want children to have healthy teeth, start selling milk with fluoride. Give away free toothpaste. Sell mouthwash with fluoride. But don't poison my water!

—Mark

April 8, 2002

Since it is nearly impossible to buy toothpaste without fluoride, why does anyone need to put it in the water? Big waste of money, benefiting only the makers and marketers of fluoride.

—Bill Adams

April 10, 2002

Perhaps this dentist is missing some very valid and vital information on these two topics. He ought to check all the relevant events that occurred here in California over the issue of mercury fillings and the behavior of the California Dental Association. The governor ended up by firing all of the members of a state department dealing with dentistry!

Has Dodes ever wondered why the companies manufacturing these dental amalgams used their lobbyists to pay the American Dental Association significant fees over many years?

As to the fluoride in our water supply preventing tooth decay without adverse long-term health effects: he is so very wrong! Firstly, it was only introduced as a means of profitably disposing of the large amount of wastes generated by the aluminum industry.

Yes, we know that putting fluoride in the water means that everyone gets a little with every drink they take. That is precisely the crux of this problem. Fluorides are among the most potent oxidizers on earth. The long-term consumption of them does have serious detrimental effects on people, and if he thinks there is no reputable epidemiology to back this up, then I suggest that this man's intentions or common sense are very seriously flawed.

Perhaps what he and your readers should examine are the newer insights into the human body by such scientists as Dr. Patrick Flanagan and others who can show how chemicals and various long-term influences produce highly damaging free radicals that are associated with many diseases. Dodes also might want to know that almost every commercial toothpaste is incorrectly formulated. They are all highly oxidized and thereby tend make the formation of dental deposits more difficult to remove!

And last but not least: Why do they put a poison label on each and every tube of toothpaste? After a certain point, those of us who are adults can no longer benefit from any hardening of tooth enamel from fluoride, so why don't the commercial makers of toothpaste offer us ones without it? Market competition is why. If you convince everyone that fluoride is necessary to good dental health, then you can't compete as well if you don't have it in your product. This is rubbish!

—Robert Fort

April 10, 2002

Dr. Ruth Kava of ACSH replies:

Strange: I just checked out my tube of Crest (which does contain fluoride) and didn't see any poison label. Am I missing something here?

April 12, 2002

Dodes replies:

I'm gratified that my article generated so much interest. Obviously, those who are opposed to fluoridation and amalgam fillings will always find fault with an objective analysis of these topics. "Raas" makes numerous unsupported allegations, all of which have been scientifically disproven.

Mark is against a wonderful public health service. I wonder if he is also against chlorination of the water supply — or would he rather be back in the days of typhus fever and dysentery? Fluoride is much more effectively delivered in water than by any other means. In Europe they have done experiments with fluoridated salt (similar to iodinized salt) but have not found it to be as effective. Mark, fluoride will not poison your water.

Robert Fort also makes unsupported allegations, including the classic wail of those without evidence: that there's a conspiracy. If Fort has evidence of collusion between the ADA and the amalgam and fluoride manufacturers, I recommend that he take his evidence to the Attorney General (unless he's in on the fix also).

In reality, fluoridation has adversely affected the income of dentists by preventing decay, and amalgam fillings are far less expensive and longer-lasting than white composite fillings. Both fluoridation and amalgams have been a boon to the health and wellbeing of the public.

—John E. Dodes, D.D.S.

April 12, 2002

I'd like Mr. Dodes to cite the proofs that he refers to. My wife has nerve problems, possibly attributable to mercury poisoning, probably from the dental work done in her youth. This was a diagnosis from a qualified dentist, confirmed by other sources. We have yet to have the amalgam fillings removed, so if he has proof that the amalgams are not at fault, I'd like to see it.

Sincerely,

R. Anthony Steele

April 25, 2002

The good Doctor Dodes has apparently not heard of fluorosis. In the 1920's a cluster of children with skeletal deformations was reported in St. David, Arizona, a small farming community. It was concluded that the level of naturally occurring fluoride in the local groundwater was the cause.

It is my personal opinion that forty-five years of fluoridated water and toothpaste has made my teeth brittle.

—Paul McKnight

September 30, 2002

Dodes says in a reply, "Obviously, those who are opposed to fluoridation and amalgam fillings will always find fault with an objective analysis of these topics." Yet, I find a similar comment could be made about Dodes' pro-fluoridation position.

There are many independent studies that have raised serious human health problems that Dodes fails to present — enough to cause the scientists at the EPA to unanimously reject fluoridation, even though the EPA administration takes Dodes' position. Europe is only 2% fluoridated and their cavity rate is lower than the U.S.'s.

Perhaps the real culprit is sugar! Of course, we can't tell Kellogg's and PepsiCo to lower their sugar levels, now can we?

—Chris T.

October 27, 2002

I have recently been diagnosed with head and neck cancer with unknown primary. I am forty-three years of age, have never smoked, and am a moderate drinker of beer but have been using Scope or Listerine for twenty-five years and have been to the same dentist for over twenty years and nobody ever mentioned the alcohol content in these mouthwashes, and there are no warning labels on mouthwashes that they could be hazardous to our health.

Why do beer and liquor have warning labels but not mouthwash? They all have alcohol. Both of my dental oncologist and radiation doctor say that the alcohol in mouthwash can affect the squamous cells that line the interior of your mouth and that this is the most probable cause of my squamous cell carcinoma. They say you should never use any alcohol-based mouthwashes. The potential risk of cancer is too high. They also say if you want to continue use of alcohol-based mouthwashes you should dilute them in half with water.

—jbridson2000

ACSH replies:

There were a few studies that appeared to show a correlation between mouthwash use and oral cancers, but the studies also showed that tobacco users were far more likely to use mouthwash and that this might account for any correlation, since some 90% of oral cancer cases are associated with tobacco use. According to a review of such studies in the British Medical Journal by Joanna M. Zakrzewska in 1999, " There is little convincing evidence that mouthwash use, poor oral hygiene, or oral infections of viral origin play an important role in the aetiology [of oral cancers]" (thus you may hear warnings about some of the more obvious negative health effects of excessive alcohol consumption but are unlikely to see any cancer warnings on alcohol).

If, as you say, your head and neck cancer are of "unknown primary," it seems possible that the medical professionals who talked to you about a squamous cell cancer/mouthwash link were simply offering theories rather than making official diagnoses about the origin of cancer, but you are better off discussing the matter further with your doctor(s) rather than relying on secondhand theorizing, whether from us or from medical personnel who may not be experts on your particular condition.

March 22, 2003

As with most pro-amalgam articles I've read, I found Dr. Dodes' article heavy on emotion and low on substance. First, it references the Public Health Service (PHS) report on amalgam fillings ( http://www.health.gov/environment/amalgam1/ct.htm) as giving an authoritative conclusion that amalgam fillings are safe. Yet Appendix III of the report ("Evaluation of Risks Associated With Mercury Vapor from Dental Amalgam") concludes with the following:

"At the mercury doses produced by amalgam fillings, the evidence is not persuasive that the wide variety of non-specific symptoms attributed to fillings and 'improvement' after their removal are attributable to mercury derived from the fillings. Conversely, the evidence is not persuasive that the potential for toxicity at the levels attributable to dental amalgams should be totally disregarded. The potential for effects at levels of exposure produced by dental amalgam restorations has not been adequately studied." [Appendix III, section 17, paragraph 7]

As the primary conclusion of the evaluation, this passage certainly doesn't inspire confidence that amalgam fillings are safe! Additionally, in Table 3 of the same document, substantial, credible evidence is given for the reduction in mercury levels in blood and urine after amalgam removal. The report states:

"Table 3 shows a summary of the study findings on mercury in blood and urine. The blood values are about twice as high for subjects with amalgams as for those without amalgams. The urine results show a range of about 3.5 to nearly 6 times higher values for those with amalgams compared with those without amalgams. In the amalgam removal study, the decrease in blood mercury value was almost by a factor of 2 within the 1-year follow-up period. During the same period, the reduction in urine mercury was by a factor of 3.7." [Appendix III, Section 6, paragraph 7]

Additionally, Dr. Dodes' article (as with most mercury-related articles I've read) seems preoccupied with mercury toxicity and nothing more. Specifically, I've not found any literature rebutting the cancer-promoting effects of mercury. Elemental mercury is not carcinogenic per se; however, mercury (like most toxic metals) is neutralized in the body by binding with selenium. One would conclude that the higher the levels of toxic metal in the body, the more rapidly selenium is depleted in the body. Selenium deficiency has been correlated with various cancers. In an article in Alternative Medicine Review, Dr. David Quig states the following:

"The pro-oxidant properties of the [toxic] metals are exacerbated by their inhibitory effects on antioxidant processes. Hg and Cd have high affinities for glutathione (GSH), which is the primary intracellular antioxidant and conjugating agent. Importantly, a single atom of Cd or Hg can bind to, and cause the irreversible excretion of, up to two GSH tripeptides. The metal-GSH conjugation process is desirable in that it results in the excretion of the toxic metal into the bile. However, it can deplete the cell of GSH and thus decrease antioxidant capacity. Lead-induced depletion of intracellular GSH and increased levels of malondialdehyde in brain and liver have been demonstrated in animal models. It has also been demonstrated that Hg not only directly removes GSH from the cell, but also inhibits the activities of two key enzymes involved in GSH metabolism: GSH synthetase and GSH reductase. Hg also inhibits the activities of the free radical quenching enzymes catalase, superoxide dismutase, and perhaps GSH peroxidase. The inhibition of GSH peroxidase has been attributed to the formation of a mercury-selenide complex. Selenium is an integral component of GSH peroxidase." ["Cysteine Metabolism and Metal Toxicity," Alternative Medicine Review, Vol 3, No. 4, August 1998]

Given the uncertainty in the toxicity effects of low-but-consistent concentrations of mercury, the clear reductions of levels of mercury in both blood and urine after amalgam filling removal, and the connection between toxic metals and a reduction of key antioxidants produced by the body, I find it difficult to understand why the dental community refuses to let go of its dogma regarding amalgam fillings. At the very least, the community should concede that not enough data exists to make proper judgement and should push for more research, rather than immediately leap to a defensive posture and hide behind 150 years of "successful" use of amalgam fillings.

—David L. McDonald, B.S.E.

March 3, 2004

That article about fluoride is badly ill-informed.

It has been proven several times in the past thirty years that fluoride in higher doses causes a lot of ill effects, and with the amount of fluoride that is already in the water and many foods, toothpaste can tip the levels right past the recommended levels per day. Procter & Gamble themselves admitted that one tube of toothpaste can kill a small child. That fact speaks in volumes.

It actually sounds like a bit of propaganda to me. I am very suspicious of the writer's investments of interest. It is a toxic waste product that is highly dangerous and ought to be studied more seriously before people write such vague essays as this.

Has it ever occurred to this writer that it might be a little odd that the government insists on adding chemicals and refuses to assure us by running a proper specified study to prove it's safe for human consumption (this has never been done)?

Here is about 10% of the reasons people are so worried: Fluoride has been used in the past (WW2) to keep prisoners docile and calm. It is a main ingredient of the atomic bomb. In too-high doses (which most people cannot avoid every day) it causes fluorosis of the bones.

Millions of people, all over the Western world especially, are forming campaign groups to try and educate people and have it removed from the water, yet the governments won't even assure us with proper tests on the particular kinds of fluoride and partner toxins added to our water. Chemicals react differently when combined with other manmade chemicals in a big way — chlorine and arsenic for instance. Both are in the fluoride product, which a lot of water companies buy in Britain anyway.

Yours sincerely,

Isla