Why is water fluoridation accepted in the US

Tap water in the US: Many children with better teeth, only a few with more lead in their blood

Chapel Hill - Tap water containing fluoride protects children from tooth decay in the United States. Earlier studies have already shown this. According to current data, however, a small proportion of tap water drinkers also had elevated levels of lead in their blood. This is the result of researchers from the University of North Carolina at Chapel Hill in a publication in American Journal of Preventive Medicine (2017; doi: 10.1016 / j.amepre.2017.09.004).

Anne E. Sanders and her team examined nearly 16,000 children and adolescents between the ages of 2 and 19 who had participated in the National Health and Nutrition Examination Survey (NHANES). Blood values ​​were available from more than 12,000 participants, from around 5,600 dental examinations.

Around 15 percent of children and adolescents stated that they did not drink tap water that in the USA, unlike in Germany, is artificially enriched with fluoride. However, the authors did not know the actual fluoride content of the tap water.

The researchers found increased lead concentrations in the blood, which the authors determined to be at least 3 micrograms per deciliter, more in those who drank tap water (3.1 percent versus 1.9 percent; adjusted prevalence ratio = 0.62). Less than 1 percent of children achieved more than 5 micrograms of lead per deciliter.

At the same time, tooth decay occurred less frequently in tap water drinkers. Almost every second person had caries on at least one affected tooth. Of those who did not drink tap water, 55.3 percent were affected by tooth decay (adjusted prevalence ratio = 1.13; tap water drinkers as reference).

Fluoride levels

  • Sea water: around 1 mg / l
  • Drinking water in Germany: <0.3 mg / l
  • Drinking water USA: 0.7 mg / l
  • Caries prophylaxis: about 0.05 mg / kg body weight (BgVV 2001)

Lead content

  • Drinking water in Germany (since December 2013): <0.010 mg / l

Only a small minority of children are affected by elevated lead levels, says Sanders. Nevertheless, it draws attention to the health consequences of the heavy metal. How many households have excessively high lead levels in tap water cannot be said on the basis of the NHANES data. The benefits of caries protection outweigh them: “The US population should drink fluoridated tap water regardless of age. There is no recommendation for an upper limit. ”The Center for Disease Control and Prevention only updated the guideline for the optimal fluorine content in tap water in 2015. 0.7 mg / l is recommended. Researchers attribute the benefits of fluorine to direct contact with tooth enamel. However, some experts also suspect the incorporation of fluorine into the germs of the teeth, which could result in increased fluoridation of teeth in the development stage. On the other hand, opponents of drinking water fluoridation do not only reject compulsory medication for the entire population. They also fear unwanted side effects.

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Tap water in Germany contains less fluorine

Drinking water fluoridation does not take place in Germany. The Federal Institute for Risk Research (BfR) announced in 2005 that the fluoride levels in drinking water are generally low. More than 90 percent of drinking water contains less than 0.3 mg fluoride per liter. At the same time, the BfR emphasizes the beneficial effect of fluoride in preventing tooth decay.

The Federal Institute for Consumer Health Protection and Veterinary Medicine (BgVV) announced in a statement that the optimal fluoride intake for caries prophylaxis in oral care products, especially in children's toothpastes, is a total intake of 0.05 to 0.07 mg fluoride / kg body weight per day. As early as 1999, the BgVV made an express recommendation for the use of fluoridated table salt as an additional measure to combat tooth decay.

Limit value for lead in German tap water at 0.01 mg / l

The Federal Environment Agency (UBA) in Germany also warns of a health hazard from lead in drinking water. Even in very low amounts, lead can damage the nervous system in unborn babies, infants and small children and impair blood formation and intelligence development. The limit value for lead in tap water was therefore further reduced in the Federal Republic of Germany on December 1, 2013 to a maximum of 0.010 mg / l.

“With the new limit value, lead pipes are practically unusable as drinking water pipes. If the lead limit value is exceeded in a pipe, the health department can oblige the water supplier or the landlord to remedy the cause of the excess. In fact, a complete replacement of the lead pipes will usually be necessary, ”said Jochen Flasbarth, President of the UBA. © gie / aerzteblatt.de