Rudolf Ziegelbecker by mikesanye

VIEWS: 12 PAGES: 36

									Rudolf Ziegelbecker 1
FORUM FÜR VERANTWORTBARE ANWENDUNG
DER WISSENSCHAFT, BASEL
Peterstalstrasse 29, A-8042 Graz
Telefon/Fax +43 316 47 11 28
<ziegelbecker.sen@utanet.at>

                                                                                        Graz, 30 March 2003
                                                                                         Deadline 31 March 2003



To
Codex Alimentarius Commission FAO/WHO
CX 5/20     CL 2003/4-NFSDU January 2003
Committee on Nutrition and Foods for Special Dietary Uses (CCNFSDU)


Dr. Rolf Grossklaus                                   Secretary
Director and Professor                                Codex Alimentarius Commission
Federal Institute for Risk Assessment                 Joint FAO/WHO Food Standards Programme - FAO
P.O.Box 233 00 13                                     Viale delle Terme di Caracalla,
D-14191 Berlin, Germany                               I-00100 Roma, Italy
<ccnfsdu@bfr.bund.de>                                 <codex@fao.org>




              Comments and Scientific Critique
on the report of the Working Group to consider Section 3.1 Es-
sential Composition in the Proposed Draft Revised Standard for
                   Infant Formula at (Step 3)
The EXPERT GROUP ON VITAMINS AND MINERALS stated in the „EVM STATEMENT ON FLUORIDE“ that
fluoride supplements to drinking water and foods is carried out as a public health measure and determining
maximum levels of supplementation has to take place within the context of local exposure and involves a
consideration of risks and benefits which is not in the terms of reference of the EVM.



My Opinion: The extensive analyses of comprehensive authentic data give evidence that
fluoride does'nt reduce dental caries and has inacceptable toxic side effects. Therefore
fluoride is unsuitable as a supplement in food. Fluoride in drinking water, salt, milk, and other
foods is an untenable "public health measure".

1
   Engineer and physicist, retired 31.12.1989, formerly scientist at the Center for Electron Microscopy of the
Technical University of Graz and at the Institute for Environmental Research at the Research Center Graz .
Member of the "International Biometric Society (IBS)", member of the "International Society for Fluoride Research
(ISFR)", Foundation member of the "Forum für verantwortbare Anwendung der Wissenschaft, Basel (1973)",
former member of the "Scientific Council of the International Society for Research on Civilisation Diseases and
Vital Substances" (1970) and of the "Scientific Councel of the International Scientific Academy for the Protection
of Life, for Environmental and Biopolitics, Luxembourgh" (1971). I am a member of the "Kommission gemäss § 13
Tierversuchsgesetz" BGBl.Nr. 501/1989 i.d.F. BGBl.I Nr. 169/1999 unter Vorsitz des Bundesministers für
Wissenschaft in Wien, Austria.

Physical, chemical and biological qualities and quantities of fluorides cannot be influenced by governments and
international organizations. Therefore the independable scientific level of knowledge must be in consideration.
                                                        2


In the following you find comprehensive scientific evidence that
fluoridation has no benefits in prophylaxis of dental caries but
inacceptable side effects and risks. Fluoridation is an untenable
public health measure. Fluoride is ineffective against dental caries.


„EVM STATEMENT ON FLUORIDE
At the October 2001 meeting of the Expert Group, it was agreed that fluoride was not in their remit. A draft
statement explaining this was considered at the December meeting. The final version is attached.
Expert Group on Vitamins and Minerals Secretariat, January 2002

This paper has been prepared for consideration by the Expert Group on Vitamins and Minerals and does not
necessarily represent the final views of the Group:
EXPERT GROUP ON VITAMINS AND MINERALS
EVM STATEMENT ON FLUORIDE
At the start of their task, the EVM drew up a list of vitamins and minerals to be considered. These were vitamins
and minerals which were either generally considered to be essential and/or which were available as food
supplements. Fluoride is thought to be essential, though this has been difficult to demonstrate experimentally.
Although fluoride supplements are only available as licensed medicines, fluoride was included in the EVM
programme as it has been used to fortify particular foodstuffs on a local basis in order to improve dental health.
Two of the major sources of exposure (drinking water and dental products, the latter being considered either
licensed medicines or cosmetics) are neither foods nor food supplements.
The EVM have concluded that it is inappropriate for them to comment on fluoride with regard to food fortification
since this is carried out as a public health measure. Determining maximum levels of supplementation has to take
place within the context of local exposure and involves a consideration of risks and benefits which is not in the
terms of reference of the EVM.
The review commissioned by the FSA for the EVM will remain available for information purposes. This should not
be taken to mean that the EVM have endorsed or approved this review.

This paper has been prepared for consideration by the Expert Group on Vitamins and Minrals and does not
necessarily represent the final views of the Group.“


                                             Comments:

   Fluoride is not an essential trace element. It occurs in the human body like many other
    not essential trace elements.
   Dental caries is not a disease from lack of fluoride. Dental caries has other causes.
   There is no fluoride lack in the human body, at most a fluoride surplus.
   There is no "optimal" dose for fluoride.
   The "harmlessness threshold" of 1 ppm fluoride constructed by fluoride proponents is
    wrong.
   Already at 1 ppm fluoride in drinking water produces visible dental fluorosis in about 16%
    of the persons affected. That is a permanent damage done to the enamel and the first
    visible sign of fluoride intoxication.


It is right that fluorides are neither foods nor food supplements as stated by the EVM
GROUP, but fluorides are used as food supplements:

                                                                                                                2
                                                 3


     Fluoride added to drinking water gets into various foods and drinks, teas, beers,....
      Fluoride is also added to salt, milk, bred, butter, cheese, conserves, eating in canteens,
      and many others. Fluorides easily soluble in water as used in fluoridation measures are
      very toxic.
     These is not only a large problem for adults, but also a very large problem for infants and
      kids, especially, and cannot controlled. Therefore it is need to eliminate such toxic
      chemicals from food of people.


Therefore "fluoride" must be discussed and all artificial fluorides in food must be
eliminated. From scientific standpoint it is without any relevance if or if not fluoride
with regard to food fortification is a public health measure and "Determining maximum
levels of supplementation has to take place within the context of local exposure and
involves a consideration of risks and benefits which is not in the terms of reference of
the EVM".

Under independent scientific aspects and without any doubt, fluoridation has only
risks und no benefits as a public health measure.



1. Risks of fluorides and fluoridation

1.1      Dental fluorosis
Dental fluorosis is a visible sign of fluoride intoxication and also indicates fluoride intoxication
of the skeleton. Teeth are part of the skeleton; the fluoride uptake by bones is significantly
higher than that of teeth.


In 1938 H.T. DEAN wrote: ”Probably the first attempt to study specifically the relationship of
mottled enamel to dental caries was made by McKAY (7) who, in 1929, attacked the
hypothesis that dental decay might be superinduced by 'defective' enamel structure, by citing
as evidence the observation that mottled enamel teeth, which probably constitute 'the most
poorly constructed enamel of which there is any record in the literature of dentistry,' do not
appear to show any greater liability to dental caries than do normally calcified teeth.” (Pub.
Health Rep. 53: 1443-1452, 1938).


In 1941 H.T. DEAN et al wrote: ”It is obvious that whatever effect the waters with relatively
high fluoride content (over 2.0 p.p.m. of F) have on dental caries is largely one of academic
interest; the resultant permanent disfigurement of many of the users far outweighs any



                                                                                                  3
                                                                          4


advantage that might accrue from the standpoint of partial control of dental caries.” (Pub.
Health Rep. 56, 761-792, 1941).
                                                                        Fig. 1
Relation between natural fluoride in drinking water and % children with dental
fluorosis in the USA and in Denmark.

                                            y = 2.48 527 9x - 1 .65 055 4, r2 = .7957 04
                                5
                                4     Re lati on be tween                                                        99 .9 9%
                                      Na tural Fl uori de i n
                                3     Dri nki ng Wa te r an d %
                                      Ch il dren wi th Dental
           ln %Ch/(100-%Ch )




                                2
                                      Fl uo ro si s
                                1
                                0
                               -1
                               -2
                               -3
                               -4
                                                                                      R. Zie gel be cker, Fe br.1 993
                               -5
                                 -1             -.5               0           .5             1             1.5              2
                                                             1 pp m F                         l n(x) o f Fl uo ri d (ppm)



Even fluoride concentrations of less than 1 ppm F- can cause dental fluorosis. The data
suggest that about 16% of the children develop dental fluorosis (which indicates fluoride
toxicity) at a drinking water fluoridation level of 1ppm F-, about 34% at 1.5 ppm F-, and about
51% of the children at a concentration of 2 ppm F- in drinking water.
                                                                        Table 1
Expected dental fluorosis in relation to the fluoride concentration in drinking water
      F- = 0.5 ppm                                     F- = 1.0 ppm                 F- = 1.5 ppm                     F- = 2.0 ppm
     % Ch.= 3.31%                                     % Ch.= 16.10%                % Ch. = 34.46%                  % Ch. = 51.80%



Therefore it is scientifically inacceptable recommended daily intakes (TRDAs/PRIs) of
minerals (Fluoride) for adults derives from different countries and organizations such
as have done France, 2001 (2.5/2.0 mg F/day); Germany, Austria, Switzerland, 2000
(3.8/3.1 mg F/day); Portugal, 1982 (2,7 mg F/day); United kingdom, 1991 (3.7/3.0 mg
F/day); United States 1997, 1998, 2000, 2001 (4/3 mg F/day), and of these the Reference
Labelling Value (RLV) 5 March 2003 3,5 mg F/day) by the Scientific Committee on Food
of the European Commission Health & Consumer Protection Directorate General,
Direction C, SCF/CS/NUT/GEN/18 Final 6 MARCH 2003.




                                                                                                                                    4
                                                                         5


From these scientifically inacceptable recommended daily intakes (TRDAs/PRIs) of
minerals (Fluoride) for adults the different countries and organizations constructed
their recommended daily intakes (TRDAs/PRIs) of minerals (Fluoride) for infants aged
6-12-months and children 1- 3 years or 1-4 years. The Scientific Committee on Food of
the European Commission Health & Consumer Protection Directorate General,
Direction C, SCF/CS/NUT/GEN/18 Final 6 MARCH 2003 constructed the Reference
Labelling Value (RLV) 5 March 2003 0.7 mg F/day for infants aged 6-12-months and
children 1- 3 years or 1-4 years.


Fluoride cumulated in skeleton in relation to fluoride uptake as Fig. 2 shows (I. ZIPKIN, F.J.
McCLURE, N.C. LEONE, W.A. LEE: Fluoride Deposition in Human Bones after Prolonged
Ingestion of Fluoride in Drinking Water. Pub. Health Rep. 73 (1958) 732-740).


                                                                       Fig. 2

                                           y = .095 15x + .02 92, r2 = .995 64                       Ili ac cre st
                                           y = .088 87x + .03 77, r2 = .994 93                       Ri b
                                           y = .091 03x + .05 024, r2 = .99 203                      Ve rtebra
                                                                                                     Sternum
                                     .45
                                      .4
       dry fat-free bone (percent)
       Fluoride concentration of




                                     .35
                                      .3
                                     .25
                                      .2
                                     .15
                                      .1
                                     .05
                                       0
                                           0     .5      1      1.5      2        2.5   3      3.5          4        4.5
                                            Fluoride conce ntration of drinking w ater (ppm)



Fluoride cumulated in skeleton in relation to age of people as Fig. 3 shows (WHO-
Monograph No. 59 (1970): "Fluorides and Human Health", page 123)




                                                                                                                           5
                                                                                                    6


                                                                                                  Fig. 3


                                                                            y = 52 3.024 - 5.98x + .29x 2
                                                                           r2 = 0 .7 183 8; F = 9 8.210 2; p = 0.00 01
                                        30 00


                                        25 00
        Fluoride content (ppm in ash)




                                        20 00


                                        15 00


                                        10 00


                                               50 0


                                                       0
                                                        10       20          30          40        50       60      70          80   90   10 0
                                                                                              Age (years)




1.2    Fluorides and Risks on Skeleton

Dental fluorosis is a visible sign of fluoride intoxication and moreover indicates fluoride
intoxication of the skeleton. Teeth are part of the skeleton and the fluoride uptake in skeleton
is significantly higher than in teeth. The next figure (Fig. 4) shows the relation between the
increase in fluoride levels and the decrease of citrate in the skeleton.
                                                                                                  Fig. 4

                                                      2. 3
                                                      2. 2                                                                Il i ac crest
                                                      2. 1                                                                Ri b
                                                         2                                                                    t
                                                                                                                          Ve r ebra
                                 Cit(%) in skeleton




                                                      1. 9
                                                      1. 8
                                                      1. 7
                                                      1. 6
                                                      1. 5
                                                      1. 4       pp m F
                                                      1. 3       <1 .0            1. 0              2. 6                 4 .0
                                                      1. 2
                                                             0        .1          .2      .3         .4     .5      .6          .7   .8   .9
                                                                                         F(%) i n bo ne ash




These and other results provide evidence that water fluoridation influences the metabolism of
the skeletal system. It is likely that these side effects are more serious in people who are
known to have bone problems:




                                                                                                                                                 6
                                                7


”Neurological complications of fluorosis were also observed. Symptoms may be due to a
lesion of one or more nerve roots or to involvement of the spinal cord .... Radicular features:
The most important manifestations were muscular wasting, acroparasthesiae, and pain
referred along the nerve roots .... Myelopathic features: The earliest symptom of spinal-cord
involvement observed in all cases was weakness of both lower limbs. This usually started in
one leg, with later progression to the other. In 12 cases, after a variable interval, the upper
limbs became involved, producing a spastic quadriplegia. Paraesthesiae in one or more
limbs were frequent. The pattern resembled in many ways that of spondylitic myelopathy. In
general, the symptoms progress fairly rapidly with progressive deterioration and restriction of
activity .... Thus, the clinical picture of fluorotic myelopathy may closely simulate that of
cervical spondylosis, extramedullary and intramedullary tumours of the spinal cord, subacute
combined degeneration of the cord, syringomyelia and motor-neurone disease. However, in
view of the distinctive clinical pattern and the radiological findings, the diagnosis of fluorosis
can be readily established.” (A. SINGH & S.S. JOLLY: Chronic toxic effects on the skeletal
system. In: Fluorides and Human Health. WHO Monographs Series No. 59, Geneva 1970)


It is impossible to rule out completely that overly sensitive people may show side-
effects even at fluoridation levels of 1 ppm F-.


Furthermore, I cited the following 2 papers: B. PALETTA, W. BEYER, E. ROSSIPAL AND M.
MINAUF: Fluoridausscheidung bei Menschen verschiedener Altersgruppen (Human Urinary
Fluoride Excretion of Various Ages). Three age groups were investigated (A - 4 to 6 years, B
- 25 to 45 years and C - 60 to 70 years). Results: "1. A time drift in urinary fluoride excretion
in the direction of delayed fluoride metabolism was seen in group C subjects. 2. A periodic
increase in the urinary fluoride values was also seen in these elderly subjects, indicative of
an altered regulatory mechanism". (Wiener klinische Wochenschrift. 88 (6) 209-212, 1976)


FRATZL P, RINNERTHALER S, ROSCHGER P, KLAUSHOFER K: Mineral Crystals after
Fluoride Treatment in Osteoporosis: Summary: "Fluoride therapy may lead to an altered
structure of the mineral crystals in bone which, in turn, may affect its mechanical properties.
The paper reviews recent work using small-angle x-ray scattering and back-scattered
electron imaging to study this question. Characteristic changes occur in the crystallinity and
in the size distribution of the mineral cristals. These changes are concentrated on isolated
spots in the trabecular structure, probably corresponding to bone forming sites. The number
and extension of these spots typically increase with the fluoride dose and there are
indications from studies with animal models that these changes in the mineral crystals
correlate with a reduced biomechanical strength of bone." (OSTEOLOGIE Band 7, Heft 3,


                                                                                                7
                                                                                              8


1998,                                                  130-133Verlag               Hans                   Huber,                Bern               (Switzerland;
http://verlag.hanshuber.com/Zeitschriften/Osteo/98/os9803 .html)
Other possible side effects of fluoridation include stomach and kidney disorders, the
antagonism between iodine and fluoride, Down’s syndrome, cancer, also need to be
considered.




1.3                                            Fluoride and Down Syndrom

Figure 5 depicts the relation between natural fluoride concentrations in drinking water and
the number of children born with Down‟s syndrome per 10,000 births of mothers aged
younger than 40 years (data from Burgstahler2).
                                                                                           Fig. 5


Natural and Artificial Fluoride in Drinking Water and its Relation to Down Syndrome

                                              10
                                                                                             1 pp m a rti fi ci al
                                               9                                             wa te r fl uo ri da ti on
  Number of children wit h mongolism/10.000




                                               8

                                               7
                                                                                                                                                 95 %
                                               6
  birth of mothers < 40 years




                                               5

                                               4

                                               3                                                                                         Na tu ral water
                                                                                                                                         flu orid atio n
                                               2

                                              -2.5           -2            -1.5      -1                   -.5               0              .5              1
                                                     Fluoride in drinking w ater          [ln (F pp m)]                  1 pp m F   R. Zi egel be cker, 4/19 95




1.4                                            Fluoridation and cancer:

The next figure (Fig. 6) shows the significant relation between sodium fluoride concentration
(x) in drinking water and percentage (P(x)) of female mice (B6C3F1) with histiocytic sarcoma
and malignant lymphoma in the National Toxicology Program (NTP TR 393). 8.66 ppm is the
fluoride concentration (contamination) in the diet (without drinking water) of all groups of
mice.




                                                                                                                                                                  8
                                                                               9


                                                                            Fig. 6


          Indiv idua l Anima l Tumor Pa thology of Fema l Mice in the 2-Year
          Drinking Water S tudy of Sodium Fluoride"
                             .45
                                       "S ystemic Le sions:            Mul ti pl e                      95 %
                              .4       orga ns (Hi stio cyti c sarcoma ;
                                       Lympho ma mal ig nant lympho cyti c;                                    17 5 ppm NaF
                             .35
                                       Lympho ma mal ig nant mixed,
                              .3       Lympho ma mal ig nant                                        10 0 ppm NaF
                                       un di fferen ti ated cell type )"
            P(x)/(1 -P(x))




                             .25
                                                                                                                 99 .9 %
                              .2

                             .15                                       25 p pm NaF
                              .1

                             .05                                        y = .174 42x - .3 4719 , r2 = .9 989 6
                                               0 pp m Na F (p ai re d con trol group )    R. Zie gel be cker, März 19 93
                               0
                                   2       2.25     2.5     2.75       3     3.25     3.5    3.75   4     4.25      4.5    4.75
                                                                               l n(x + 8.66)

Additional to these results, last year Stan C. Freni of the FDA published a report showing that
exposure to high fluoride concentrations in drinking water is also associated with decreased
human birth rates (total fertility rate (TFR)) in the U.S.A.


With respect to all these negative facts and after a thorough review of scientific papers on the
subject, I am convinced that fluoride added to the public drinking water supplies at the
"optimal" level of one part per million (mg fluoride/litre) is scientifically and medically proven
to be ineffective against dental caries and harmful to human, animal, plant and aquatic life.


The discussion whether or not there is a relation between water fluoridation and cancer, is on
the way for a long time. In 1975 Burk and Yiamouyiannis have forced this question in the
U.S. congress. On an other data basis I have published some to this day undiscussed
studies to this subject in the eighties3,4,5.


The following figures show the relation between drinking water fluoridation, cancer and
cirrhosis of liver. The analyses are based entirely on representative and official data about
cancer deaths and water fluoridation in the U.S.A. for the period of 1949-1970 (more than 20



2
    Burgstahler AW. Editorial Review: Fluoride and Down's Syndrome (Mongolism). Fluoride 8 (1) 1-11; (2) 120
    1975
3
    Ziegelbecker, R.: Zur Frage eines Zusammenhanges zwischen Trinkwasserfluoridierung, Krebs und
    Leberzirrhose. gwf-Wasser/Abwasser 128, (H. 2), 111- 116, 1987
4
    Ziegelbecker, R. Ziegelbecker, R. Ch.: On water fluoridation and its relation to cancer. Poster on the XVIth.
    Conference of the International Society for Fluoride Research (ISFR). ZYMA-Auditorium NYON (Switzerland)
    August 31 - September 2, 1987

                                                                                                                                  9
                                                                                        10


years). The regression analyses show a highly significant relation between the rate of U.S.
population fluoridated by drinking water on the one hand and the cancer mortality rate, the
age-adjusted cancer mortality rate and the cirrhosis of liver mortality rate on the other hand.
A possible causal relation between drinking water fluoridation, cancer and cirrhosis of liver
must be considered.


Figures 7 and 8 based on representative official data show the relation between the cancer
mortality rate and the fluoridation rate (percentage people receive of fluoridated water in the
U.S.A.) and the relation between the death rate from cirrhosis of liver and the square of the
fluoridation rate. The relation between the fluoridation rate and the cancer rate is highly
significant (R-squared: 0.974223; F-test: 755.88; p = 0.0001). The relation between the
fluoridation rate and the cirrhosis of liver death rate is also highly significant (R-squared:
0.972828; F-test: 716.004; p = 0.0001).
                                                                                     Fig. 7
                                                      y = .589 68x + 1 37.642 593 , r2 = .97 422 3
                                                                           CMR co rr. (CM/10 0000 )
                                    16 5
                                                       Re lati on be tween the Ca nce r De ath Rate
                                    16 0               an d th e Fl uorid atio n Rate 194 9-197 0 in
                                                                                       e
                                                       the U.S.A. (based o n re pres ntative data)
          CMR corr. (CM/100000)




                                                                                                                                 99 .9 9%
                                    15 5


                                    15 0


                                    14 5


                                    14 0

                                                                                                         R. Zie gel be cker; Fe br. 19 93
                                    13 5
                                        -5            0        5        10        15         20         25        30       35       40        45
                                                                                     FR% corr.(F-rate)


                                                                                     Fig. 8
                                                      y = .003 555 x + 9.5644 13, r2 = .972 828
                                                                          LCMR corr.(LCM/100 000 )
                                               16
                                                       Re lati on be tween Ci rrh osis o f Li ve r
                                               15      De ath Rate and the Sq uare of th e
                                                       Fl uo ri da ti on Ra te 1 949 -1 970 i n th e
                      LCMR corr.(LCM/100000)




                                               14      U.S.A. (da ta are represen tati ve )
                                                                                                                                  99 .9 9%

                                               13

                                               12

                                               11

                                               10
                                                                                                       R. Zie gel be cker, Fe br. 19 93
                                                9
                                               -200   0      20 0      40 0      60 0       80 0   10 00        12 00    14 00     16 00     18 00
                                                                                        x^ 2 of FR% corr.




5
    Ziegelbecker, R.: Belastung durch Fluorid — Zusammenhang mit Krebs und Leberzirrhose. Proceedings Vth
    intern. conference BIOINDICATORES DETERIORISATIONIS REGIONIS II. Liblice 23.5. - 27.5.1988.
    CZECHOSLOVAK ACADEMY OF SCIENCES. Ceske Budejovice 1989. S. 204-211, 1989

                                                                                                                                                     10
                                                                                 11




Figure 9 shows the cancer mortality rate in the U.S.A. observed year by year from 1949 -
1970 and the fitted cancer mortality rate in relation to the fluoridation rate, the cirrhosis of
liver death rate and a dummy variable for 1958/59 (= 1). The relation is highly significant (R-
squared: 0.995344; F-test: 1,282.60; p = 0.0001). The data are representative.


                                                                               Fig. 9


                                                     Line Chart for columns: X1Y1 … X1Y 2
                                                   CMR co rr. (CM/10 0000 )          Fi tte d CMR(FR, L CMR, DV)
                                    16 5
                                             Observe d and Fitted Can cer Morta li ty
                                             Ra te i n Rel ati on to the Flu orid atio n
                                    16 0
                                             Ra te, Ci rrho si s of Li ver Death Ra te ,
          CMR corr. (CM/10 000 0)




                                             an d a Dummy Va ri ab le for 1 959 /6 0 in
                                    15 5     the U.S.A. 19 49-19 70


                                    15 0


                                    14 5


                                    14 0
                                                                                           R. Zie gel be cker, Fe br. 19 93
                                    13 5
                                     ## ##      19 50   ## ##     19 55 ## ##      19 60 ## ##      19 65 ## ##       19 70   ## ##
                                                                                    Ye ar

The equation of regression is:
y = 124.941251 + 0.364222*FR%corr(F-rate) + 1.508750*LCMRcorr(LC/ 100,000) -
1.003621*DV(=1 for 1958/59; = 0 for other years)


A   question is if there exists or does not exist a short time effect on cancer death in
connection with water fluoridation. I received the data for the following analysis from the Dep.
Health, Educ. and Welfare, P.H.S. Off. Health Policy, Research Statistics, Hyattsville, MD.
The data are representative for the U.S.A.


The establishment of water fluoridation in a limited area suddenly changes living conditions
of the inhabitants of this area by one factor. Based on the authentic data of water fluoridation
and cancer mortality rate in the U.S.A., the increase of cancer deaths in relation to the in-
crease of fluoridated inhabitants is analysed. The analysis shows that there exists a
significant connection, which is not correlated with the change in the number of population.




                                                                                                                                      11
                                                                     12


Within a short time, about 3 additional cancer deaths per 10,000 newly fluoridated
inhabitants must be expected.


Figure 10 shows the comparison of the increase of the observed and of the fitted number of
cancer deaths in the USA 1949-1968 in the 2-years-moving-average in connection with the
number of the newly fluoridated people.


The increase of cancer death independent of fluoridation is about 4,500 per year. In the
above figure the additional increase of cancer deaths in connection with the increase of
fluoridated people is shown.


The equation of regression is:
y = 4511.734629 + 0.0003375*Mov.Av.Diff.of(F) + 1755.03904*DV
R-squared: 0.752167; F-test: 25.79; p = 0.0001


                                                                  Fig. 10


                                              Line Chart for columns: X1Y1 … X1Y 2
                                                        Mov.A v. *Di ff.CMco rr
                                                       Fi tte d Mov.Av. *Diff. CMcorr (F;DV)
                                75 00

                                70 00
        Mov.A v. *Diff.CMcorr




                                65 00

                                60 00

                                55 00

                                50 00
                                                                             R. Zie gel be cker, Fe br. 19 93
                                45 00
                                    19 48 19 50 19 52 19 54 19 56 19 58 19 60 19 62 19 64 19 66 19 68 19 70
                                                                       Ye ar




In Basle (Switzerland) water fluoridation was started on May 2, 1962. Figure 11 shows the
trend of cancer death in the female population in Basle before (1950-1962) and during water
fluoridation (1963-1983). The increase of cancer death after the establishment of drinking
water fluoridation is significant. Analogous developments have been seen in males.




                                                                                                                12
                                                                                  13


                                                                               Fig. 11


                                     Pe rcent can cer dea th (%CD) of the femal e po pul ati on in B asle (Swi tzerl and )
                              -5.6

                              -5.7

                              -5.8
    ln(x) of %CD/(100 -%CD)




                              -5.9

                                -6

                              -6.1

                              -6.2
                                           Wi th out water fl uori dati on            Du ri ng wa te r flu orida ti on 1 963 -1 983
                              -6.3         19 50-19 62

                              -6.4
                                7.57 4     7.57 6    7.57 8      7.58        7.58 2      7.58 4     7.58 6     7.58 8      7.59     7.59 2    7.59 4
                                                                                 ln(x) of ye ar              R. Zie gel be cker, Apri l 19 95




Taking into consideration the possible side effects of water fluoridation one has to be
extremely careful with water fluoridation. A relation between fluoridation and cancer
cannot be excluded and constitutes an enormous risk.




2. Dentists and their „Optimal Dose“ of Fluorides

Dentists and Public Health Officials claimed that there is an ”optimal level” of water
fluoridation. This conclusion is wrong. An ”optimal level” of water fluoridation, which, it is
suggested, varies from 0.6 ppm in sub-tropical regions to 1.1 ppm in temperate climates,
does not exist.


The claim that there is an ”optimal dosis” of 1.0 ppm fluoride in drinking water was first made
by H. T. DEAN (a dentist of the U. S. Public Health Service) following his study of 21 cities. It
was later repeated by H. C. HODGE. The„Optimal dosis‟ was defined as that level which
ensures ”optimal” reduction in dental caries and simultanously, minimal dental fluorosis
through fluoride in drinking water. The following diagram (Fig. 12) shows this relation
according to HODGE (1950).




                                                                                                                                                  13
                                              14


This definition of an ”optimal dosis” of fluoride in drinking water is based on scientifically
invalid premises:


(a)    The ”dental caries reduction” in these data is a statistical artefact, constructed by
       dentists of the U. S. P. H. S. who selected data, which compare incomparable cities,
       and exclude important other factors.


(b)    Since the claimed ”inverse relationship” between fluoride in water and dental caries in
       children does not exist there cannot be an ”optimal dosis” of fluoride in drinking water.


(c)    The connection between dental caries in children aged 12-14 years and dental
       fluorosis is arbitrary. Dental caries is in a significant relation to the age of children,
       while dental fluorosis is not. Moreover, the coordinates of dental caries (measured as
       DMFT-Index) and of dental fluorosis (measured as fluorosis-Index), both in relation to
       fluoride in water, differ.


(d)    Dental fluorosis is a visible sign of fluoride intoxication and also indicates fluoride
       intoxication of the skeleton. Teeth are part of the skeleton; the fluoride uptake by
       bones is significantly higher than that of teeth. There may also be other side effects,
       including cancer, Down‟s syndrome, stomach and kidney disorders, which have to be
       taken into account.


(e)    The total intake of fluoride by people from other sources such as food, minerals and
       drinks, and environmental sources, is unknown and cannot be controlled. For this
       reason it is impossible to define an ”optimal dosis” of 1.0 ppm of fluoride in drinking
       water, and the small standard deviation of 0.1 ppm F (1.0 ± 0.1 ppm F).


(f)    In epidemiological studies it is very difficult to find comparable conditions in two or
       more samples (e.g. the ”21-cities study”). It is therefore necessary to use distribution
       functions for such investigations. An appropriate distribution function to study the
       problem of dental caries and dental fluorosis is the truncated log-normal distribution
       function.
(g)    Figure 1 and Table 1 show the relation between fluoride content in drinking water
       and dental fluorosis. Figure 12 shows the relation between fluoride content in




                                                                                              14
                                                              15


         drinking         water          and       caries      experience   and      dental       fluorosis      in
                    6 7 8 9 10 11 12 13 14 15 16
         children , , , , , , , , , , .
                                                            Fig 12.




The next graph (Fig. 13) clearly shows that there is no ”optimal dosis” of fluoride in drinking
water. Firstly, the incidence of dental caries in children (12-14 years old, age corrected) is not
linked to the fluoride concentration in their drinking water. Secondly, even fluoride
concentrations of less than 1 ppm F- can cause dental fluorosis. The data suggest that about
16% of the children develop dental fluorosis (which indicates fluoride toxicity) at a drinking


6
   Ziegelbecker, R.: Kritischer Beitrag zu den Grundlagen der Kariesprophylaxe mit Fluoriden. Int. J. Vitalstoffe-
Zivilisationskrankheiten 14, H.6, 229-233, 1969
7
    Ziegelbecker, R.: Kritischer Beitrag zu den Grundlagen der Kariesprophylaxe durch Fluoride. gwf-
wasser/abwasser 111, H. 8, 463-464, 1970
8
   Ziegelbecker, R.: Falsche Prämissen der Fluorkariesprophylaxe. Schweiz. Monatsschr. Zahnheilk. 81, Nr. 3,
215-239, 1971
9
  Ziegelbecker, R.: Über die Hypothesen der Kariesprophylaxe mit Fluoriden. Int. J. protectio vitae 16, H 3., 105-
109, 1971
10
   Ziegelbecker, R.: Fluoride sind keine Kariesprophylaktika. Erfahrungsheilk. 20, H. 12, 389-402, 1971
11
    Ziegelbecker, R.: Natürlicher Fluoridgehalt des Trinkwassers und Karies. gwf-Wasser/Abwasser 122 (H.11),
495-497, 1981
12
   Ziegelbecker, R.: Fluoridated water and teeth. Fluoride 14, No. 3, 123-128, 1981
13
    Ziegelbecker, R.: On the problem of data selections in fluoridation statistics. (Paper to XVIth Conference. Int.
Soc. for Fluoride Research). ZYMA Auditorium, NYON, 31.8. - 2.9.1987, and Abstracts p. 14.
14
    Ziegelbecker, R.: Zur Beurteilung der Fluoridbelastung in der Umwelt. Proceedings IVth intern. conference
BIOINDICATORES DETERIORISATIONIS REGIONIS II. Liblice 28.6. - 2.7.1982. CZECHOSLOVAK ACADEMY
OF SCIENCES. Ceske Budejovice 1986. S. 355-371
15
    Ziegelbecker R Ch. Lognormal Distributions - a theoretical model for biomonitoring. Vth International
Conference Bioindicatores Deteriorisationis Regionis. Czechoslovak Academy of Sciences. Ceske Budejoviee 23-
27.51988, Proceedings 37-43 1989.
16
    Ziegelbecker R. Fluoride. Nichtöffentliche Sachverständigenanhörung "Fluoride". 10. Deutscher Bundestag.
Ausschuß für Jugend, Familie und Gesundheit (13. Ausschuß). Stenographisches Protokoll des Bundestages
Nr.57. Bonn 25.9.1985.

                                                                                                                15
                                                                                        16


water fluoridation level of 1ppm F-, about 34% at 1.5 ppm F-, and about 51% of the children
at a concentration of 2 ppm F- in drinking water.




                                                                                      Fig. 13


                                                 RELATION BETWEEN FLUORIDE CONTENT OF DRINKING WATER, CARIES
                                                 EXP ERIENCE AND DENTAL FLUOROSIS     (a fter R. Zi eg el becke r (1 996 ))
                                             5                                                                                 5
                                             4                                                                                  4
                                             3                                                                                  3

                                             2




                                                                                                                                                               % childre n with de ntal fluorosis
                  ln(DMFT/(28 -DMFT))a.c.




                                                                                                                                2




                                                                                                                                    ln (% Zfl./(100 -%Zfl.))
     DMF c ount




                                             1                                                                                  1

                                             0                                                                                  0

                                            -1                                                                                 -1

                                            -2                                                                                 -2

                                            -3                                                                                 -3

                                            -4                                                                                 -4

                                            -5                                                                                 -5
                                                          -.4        -.2           0            .2      .4      .6        .8
                                                                        l og(x) of F(0 .3 -6 .6 pp m)
                                                                  Fluoride content of drinking w a te r (ppm)




The total intake of fluoride by people from other sources such as food, minerals and
drinks, and environmental sources is unknown and cannot be controlled. For this
reason, and because positive effects do not exist and because of possible side
effects, it is impossible to define an ”optimal dose” of 1.0 ppm of fluoride in drinking
water and the small standard deviation of 0.1 ppm F (1.0 +/- 0.1 ppm F).




3.                            Dentists and their "Benefits" of Fluoridation

3.1                           Analysis of Relation between Natural Fluorides in Drinking
                              Water and Dental Caries ("DEAN-Statistic") in Children

                                                                                                                                                               16
                                                       17



The next figure (Fig. 14) shows the fundamental dentists' study which was the premise to
establish the introduction of water fluoridation all over the world.


In 1942, Figure 14 was published by the U.S. P. H. S. dentists H. T. Dean and F. A. Arnold
Jr. et al. This figure shows an inverse relation between dental caries experience of children
and the natural fluoride content of the public water supply. In the following 60 years (between
1942 and 2002) this ” inverse relation” was uncritically accepted and interpreted as proof for
the beneficial effect of water fluoridation by most dentists and public health officials all over
the world.
                                                     Fig. 14




Notes: The following items (a) to (h) show that the German Health Officials H. BUSSE and K. BERGMANN
knew how the "inverse relation between fluoride and dental caries" by DEAN et al — and by other authors in other
studies (e. g. P. Adler (Hungary) and I. Møller (Denmark)) — had been constructed. In spite of this knowledge
they used the untenable data and the GLIM-Model to construct an "inverse relation between fluoride and dental
caries" in Fig. 4 in their paper "Fluoride and Dental Caries: Two different statistical approaches to the same data
                                                        17
source" in Statistics in Medicine, Vol. 6, 823-842 (1987) . This is a serious case of scientific misconduct and
dishonesty.



The following analyses show conclusively and understandable that the relevant studies and
papers of H. T. DEAN have serious deficiencies, are partly improbability and cannot be


17
     Busse, H., Bergmann, E., Bergmann, K.: Fluoride and Dental Caries: Two different statistical approaches to
     the same data source. Statistics in Medicine, Vol. 6, 823-842 (1987)

                                                                                                               17
                                                   18


maintained scientifically. The "inverse relation between the natural fluoride content in drinking
water and dental caries of children" as stated by H. T. DEAN does not really exist. It is not
the result of a genuine caries prophylactic effect of fluoride, but from inadmissible data
selections, illegal comparisons, neglect of causal factors of dental caries, statistical artifacts,
and false conclusions from data.
                                                                               6,8,9,10,18 ,19 ,20.
(a) The authors (dentists of the P.H.S.) compared incomparable cities
(b) The authors selected cities and children to prove: ”more fluoride in drinking water, less
     dental caries in children, less fluoride in water, more dental caries in children.”
(c) Authors excluded such important factors as dietary habits and eating patterns,
     consumption of sugar and carbohydrates, and L. Acidophilus counts in saliva from their
     studies (Fig. 15). In a paper published in 1941 H.T. DEAN wrote: ”The differences in the
     counts of L. acidophilus in the saliva corresponded to the differences in the dental caries
     experience in the groups of communities studied” (DEAN studied 8 Suburban Chicago
     Communities). In his famous 21-city-study of 1942, however, DEAN excluded the L.
     Acidophilus data, although the 8 suburban Chicago communities are included among the
     21 cities.
                                                Fig. 15


Relation between dental caries and L. acidophilus - concentration in saliva in children
aged 12- to 14 years in 10 cities of the 21 cities study by Dean et al.




18
   DVGW: Dokumentation zur Frage der Trinkwasserfluoridierung. DVGW-Schriftenreihe Wasser Nr. 8, ZfGW-
Verlag 1975. R. Ziegelbecker: 5. Kritische Betrachtungen zu Statistiken. p 36 - 46
19
     Ziegelbecker, R.: Auswertung und Interpretation epidemiologischer Daten am Beispiel der
Trinkwasserfluoridierung und der Zeckenschutzimpfung. Handout ROES-Seminar Advances in Biometry.
International Biometric Society, Basel (Switzerland) 28 September 1999
20
    Ziegelbecker, R.: Rechtfertigen kariesprophylaktische Erfolge in der Relation zur Schadensmöglichkeit
Fluoreinsatz? In U. Rheinwald: Zahnkaries und Fluoride — ein Diskussionsgespräch. A. W. Gentner Verlag
Stuttgart 1974, S. 53-106

                                                                                                      18
                                                                         19


                                                  y = 1.20 8x - 2 .7 59, r2 = .939
                                 2.2


                                   2


                                 1.8
            ln(DMFT/(28-DMFT))




                                 1.6


                                 1.4


                                 1.2


                                   1


                                  .8

                                                                                                R. Zi egel be cker, 8/19 99
                                  .6
                                   2.6      2.8        3         3.2          3.4         3.6         3.8          4          4.2
                                                                   l n(x) o f L. aci do




(d)    The authors excluded such important factor as delayed tooth eruption. Fig. 16 and
       Table 2 shows the number of delayed permanent teeth in relation to the fluoride
       content in drinking water in 10% of the children aged 12-14 years in 12 of the 21 cities
       investigated in the study (tooth eruption data published only for these 12 cities by E.M.
                                       21
       SHORT)6, . Teeth which erupted later got attacked later by caries.


                                                                       Fig. 16
Delayed permanent teeth in relation to natural fluoride content in drinking water in the
                                                                       U.S.A.




21
   Ziegelbecker, R.: Acerca de la demostracion de una acelerada presentacion de caries y una retrasada
erupcion de las piezas dentarias permanentes por el aporte incrementado de fluor. Folia Clinica International XX,
No. 5, 332-350, 1970

                                                                                                                                    19
                                            20




                                          Tab. 2


  Fluoride in drinking      No. of maximally            No. of delayed
     water (ppm)           erupted permanent           permanent teeth
                                  teeth
              2.6                     16.3                       5.4
            1.8-1.9                   18.8                       2.9
            1.2-1.3                   20.3                       1.4
            0.5-0.6                   20.8                       0.9
            0.0-0.1                   21.7                       0.0

(e)   The authors also ignored the existence of an East-West decline in dental caries
      prevalence in the U.S.A. (Fig. 17). For instance in 1933/34 the difference between the
      mean DMFT of children aged 12-14 years in New Jersey and in Colorado was 5.60 -
      2.74 = 2.86 DMFT. The ”reduction” was 49% (!). Some of the cities compared in the
      21-cities study are several hundred, some even several thousand kilometers apart.
      The existence of an East-West decline in dental caries prevalence must be taken into
      consideration.
                                          Fig.17


East-West decline in dental caries prevalence in the U.S.A. 1933/34, children are 12-14




                                                                                         20
                                             21




(f)   If dental caries rates are compared in children from different cities in epidemiological
      studies it ialso necessary to establish the trends for dental caries prevalence in the
      previous years. Such analyses show the different increase of dental caries
      prevalence of 12-14 years old children from 6 cities with low fluoride between 1933/34
      and 1941/42 independent of the fluoride content in drinking water (Figure 18).


(g)   The analyses show that the dental caries prevalence data in the 6 cities with low
      fluoride concentrations are different, and that they are not linked to the fluoride in
      drinking water; caries in fact increased between 1933/34 and 1941/42. This increase
      was clearly caused by factors other than fluoride. In 1933/34, 3 cities (Elkhart (0.1

      ppm F-); Lima (0.3 ppm F-); Pueblo (0.6 ppm F-)) had about the same dental caries
      prevalence as the highly fluoridated city of Colorado Springs (2.6 ppm F-). In the 21-
      cities study by H.T. DEAN and F.A. ARNOLD, Jr., et al Colorado Springs and the 6
      low-fluoride cities were compared with 14 other cities. This comparison of
      incomparable cities led to the introduction of water fluoridation in Grand Rapids in
      1945. In their comparison the authors reached the conclusion - which was based on
      no scientific evidence - that the differences in dental caries prevalence, which were in
      fact caused by factors other than fluoride, were the result of differences in the fluoride
      content of the public drinking water supply. In other words, the authors concluded that
      the different dental caries rates found in cities with low fluoride levels (where dental
      caries increased, yet for reasons not linked to the fluoride content in the drinking



                                                                                             21
                                                        22


          water) and cities with high fluoride concentrations proved that fluoride in drinking
          water was able to decrease dental caries.
                                                     Fig. 18


Change of dental caries prevalence data in the 6 cities with low and 1 city with high
fluoride concentration in drinking water between 1933/34 and 1941/42. All cities are
from the ”21-cities-study” by H.T. Dean et al 1941/42.




(h)       The authors of the ”21-cities-study” excluded all the other components in drinking
          water except fluoride as possible factors influencing dental caries. In the same 10
          cities in which L. acidophilus - values are available concentration of NaF in drinking
          water and dental caries in children are significantly negatively correlated. Fig. 19
          shows this relation22,




                                                     Fig. 19


      Relation between Na content in drinking water (ppm) and dental caries (DMFT) in
            children 12 - to 14 years old in 10 cities of the ”21-cities-study” (1942)

22
      Ziegelbecker, R.: Natural Water Fluoridation: Multifactorial Influences on Dental Caries in 21 Cities Study.
      XVIIth Conference of the International Society for Fluoride Research, Budapest; June 22-25, 1989

                                                                                                               22
                                                                           23


                                                       y = -.2 97x + 2 .4 43, r2 = .968

                               2.2


                                 2


                               1.8
          ln(DMFT/(28-DMFT))




                               1.6


                               1.4


                               1.2


                                 1


                                .8

                                         R. Zi egel be cker, 8/19 99
                                .6
                                     1      1.5       2       2.5      3        3.5        4   4.5   5   5.5   6
                                                                           l n(x) o f Na


In a ”stepwise regression analysis” with the components of F-, HCO3, Na and K as Na, Mg,
SO4, Ca, Cl, Fixed residue, in drinking water and L. acidophilus in saliva of children as
independent variables (Xi, i = 1, 2, ..., 9) and Y = DMFT as response variable only the
variables X3 = Na and X9 = L. acidophilus were included in the regression as significant and

the variable X1 = F- was excluded as non-significant.


The regression equation is


(1)                                          ln DMFT/(28-DMFT) = - 2.907 + 0.567*ln L. acido - 0.226*ln Na
                                             R2 = 0.9899; F-test: 340.446; p = 0.0001; Partial F(L. acido) = 14.321,
                                             p= 0.0069; Partial F(Na) = 38.842, p = 0.0004


It is obvious that natural fluoride in drinking water in the ”21-cities-study” is not significant
correlated with dental caries in children aged 12- to 14 years.




Conclusion:


The results of the above analyses of the 21-cities study by H.T. DEAN and F.A.
ARNOLD, Jr. et al, (1942), show that the study is scientifically invalid and that the

                                                                                                                       23
                                                     24


authors constructed the ”inverse relationship” between fluoride in drinking water and
dental caries prevalence in children. A statistical artefact was created.




3.2      Meta-Analysis             of     Relationship            between          Natural        Water-
         fluoridation and Dental Caries in Children

Fig. 20 shows the relationship between the natural fluoride content in drinking water (ppm F)
and dental caries (DMFT-Index, age corrected) in children 12 - 14 years old from 215
communities, in a coordinate system adequate to the problem11                   12 13 17 23.   The fluoride
content range is 0.0 ≤ ppm F ≤ 5.8, with an additional 0.3 ppm F (mean) from other sources
(food, drink). Two regressions were made, firstly for the range 0.0 ≤ ppm F ≤ 0.35, secondly
for the range 0.36 ≤ ppm F ≤ 5.8. 141 communities fell within range 1. Here, data were
frequently selected by dentists according to the principle "low fluoride level — high caries
prevalence". 74 communities were in the range 0.36 ≤ ppm F ≤ 5.8. The confidence bands
for the true mean of Y were 95%. Data in range 2 we can assume as approximate random
sample and representative for the areas.


Statistical model is the regression equation:


(2)                                ln y/(28-y) = ln(a) + b.ln(x) + e(x)


In this model of regression all influences of factors on dental caries including diagnostic
errors without the possible influence of fluoride be lying in the residuals e(x). x = Fluoride
Concentration + 030 (ppm), y = Dental Caries (DMFT-Index),


          Statistical data :
          1. regression: Y = -1.678*X - 3.016; n = 141; R2 = 0.172, F = 28.938, p = .0001
          2. regression: Y = 0.064*X - 2.220; n = 74; R2 = 0.0018, F = 0.131, p = 0.719


                                                   Fig. 20


Relationship between the natural fluoride content in drinking water (ppm F) and dental
caries (DMFT-Index, age corrected) in children 12 - 14 years old from 215 communities

23
      Ziegelbecker R, Ziegelbecker R C. WHO Data on Dental Caries and Natural Water Fluoride Levels. Fluoride
      26 263-266 1993.

                                                                                                          24
                                                                                     25



                                              l n(x) o f (F(0-0.35)+0 .3 pp m)                      l n(x) o f (F(0.36+5.8)+0.3 ppm)
                                      .5

                                       0

                                     -.5
  ln DMFT/(28 -DMFT), ag e co rr.




                                      -1

                                    -1.5
                                      -2

                                    -2.5

                                      -3

                                    -3.5

                                      -4
                                       -1.5      -1             -.5              0             .5               1            1.5       2
                                                                       l n(x) o f (F(0-5.8)+0.3 ppm)



The mean DMFT in regression of range 1 for 0.35 ppm fluoride in water is y0.35 = 2.57
DMFT.


The mean DMFT in regression of range 2 for 0.70 ppm fluoride in water is y0.70 = 2.74
DMFT.


The mean DMFT in regression of range 2 for 1.00 ppm fluoride in water is y1.00 = 2.78
DMFT.


Additionally we assume that in a population many qualitative and quantitative unknown
factors influence the quantities of dental caries (DMFT) and that dental caries in the
population follows a truncated log-normal distribution. We sorted the quantity of yi = DMFTi, i
= 1, 2, ...., N and computed the cumulative frequency. The cumulativ relative frequency is Phi
(z) = (i - 0.5)/N in class midpoint. We assume the cumulative distribution Phi(z) as GAUSS-
distribution (normal distribution) and z = z(Phi) as the inverse function11 12 13 19 .


If the distribution of dental caries (DMFT) in equation (2) follows a truncated log-normal
distribution we have


(3)                                                          z(Phi) = ln a + b*ln (DMFT/(28-DMFT))




                                                                                                                                       25
                                                                     26


Fig. 21 shows the distribution of dental caries (DMFT) in children 12- to 14 years old in 144
communities with natural water fluoridation in range 0.3 - 5.8 ppm fluoride (see range 2 in
Fig.20). The distribution shows that the data are approximate random samples.


The median of DMFT is ym [DMFT] = 3.05 DMFT.


                                                                   Fig. 21


 Distribution of dental caries (DMFT, age-corrected) in children 12- to 14 years old in
    144 communities with natural water fluoridation in range 0.3 - 5.8 ppm fluoride

                                         y = 1.27 76x + 2 .6 8396 , r2 = .9 8432
                                3


                                2


                                1
           z=z(Phi=(i-0.5)/N




                                0


                               -1


                               -2
                                                                                    R. Zie gel be cker, 8/19 99
                               -3
                                 -4   -3.5       -3         -2.5          -2       -1.5       -1         -.5      0
                                                                                    o
                                                      l n DMFT/(28-DMFT ), al te rsk rr.




Conclusion from meta - analysis of relation between natural fluoride and dental caries:


Fig. 20 proves without any doubt that the "inverse relation between natural
fluoride in drinking water and dental caries in children" does not exist.
Fluoridation of community water supplies does not produce the benefits
claimed as a main public health strategy for the prevention of dental caries in
UK or other states.




                                                                                                                      26
                                                      27


3.2     Meta-Analysis              of     Relationship            between          Artificial        Water-
        fluoridation and Dental Caries in Children in USA

The following analyses use equation (3) and data from the 1986-87 National Survey of US

School-children24,25.


In the last 32 years I have analyzed many studies and experiments with fluoridated
drinking water. Not a single study provides scientific evidence for claims that water
fluoridation protects teeth and helps maintain dental health. Dentists interpreted the
influences of other factors and statistical artifacts in the studies and experiments as
”benefits in the prevention of dental caries” due to water fluoridation.


A national survey of the oral health of U.S. children aged 5-17 was conducted by the National
Institute of Dental Research during the 1986-87 school year. A multi-stage probability sample
was drawn to represent the 43 million children in this age group. Over 39,000 children aged
5-17 received examinations. Results of the study were published in 1989 and 199024,25.


         Fig. 22 shows the distribution (truncated log-normal) of dental caries in 13,882
children 5 - 17 years old (DMFT) in 30 non-fluoridated areas in the USA. The data are
randomised, representative samples, and age weighted. [NF = non-fluoridated].


Results of regression analysis are: Y = 4.55936*X + 11.81637, r2 = 0.9637; The relation is
highly significant: R-squared: 0.963704, F-test: 743.42, p = 0.0001.


Fig. 22 shows wide variations in DMFT in children in non-fluoridated areas. Median for
children in unfluoridated areas: m = -11.81637/4.55936 = -2.591672; ym [DMFT] =
(28.em)/(1+em) = (28*0.07489)/(1.07489) = 1.95 DMFT.


If we assume that lifetime exposure to water fluoridation reduces dental caries by about 40%
to 60% we can compute a model based on this hypothesis. In this model we use uniform
random numbers between 0.40 and 0.60 and then, from the DMFT of children in non-
fluoridated areas, the expected DMFT of children with lifetime exposure to fluoridation with a
caries reduction of between 40% to 60%.

24
     U.S. Dept. of Health and Human Services, USPHS, National Institutes of Health: Oral Health of United States
     Children. The National Survey of Dental Caries in U.S. School children: 1986-1987. National and Regional
     Findings. NIH Publication No. 89-2247, September 1989
25
     Yiamouyiannis, J. A.: Water Fluoridation and Tooth Decay: Results from the 1986-1987 National Survey of
     U.S. Schoolchildren. Fluoride 23, No. 2, 55-67, 1990

                                                                                                            27
                                                28



In Fig. 22 we show a simulation of distribution of dental caries in children, reduced by
between 40% to 60% and computed from the data in Fig. 22 (distribution of dental caries in
US-children living in non-fluoridated areas).


The slope = 4.56376 in Fig. 22 is about the same than of dental caries in US-children living
in non-fluoridated areas (slope = 4.55936). Y = 4.56376*X + 15.29573; r2 = 0.97567 The
median is m = -3.35156 and ym [DMFT] = 0.94763 ≈ 0.95 DMFT. That is a ”caries reduction”
of 51.3% in this simulation which dentists expected in life-long fluoridated children in the
USA.


Fig. 22 summarizes the representative dental caries data (DMFT-index), applying the
conditions of the truncated log-normal distribution. 13,882 children aged between 5 and 17
from unfluoridated areas were compared with 12,747 children from fluoridated areas (they
had been exposed to water fluoridation throughout their lives). The figure shows wide
variations in the incidence of dental caries (DMFT-Index).


Fig. 22 moreover shows the large differences of medians of DMFT-index between ”caries
reduction” in children exposed to water fluoridation throughout their lives, as expected by
dentists (see simulation) and the real medians of DMFT-Index in children aged between 5
and 17 in unfluoridated areas and in fluoridated areas children. There is no difference of
medians of DMFT-Index.


The results of this analysis of representative caries data are:


(a)    Dental caries in U.S. school children aged 5-17 follows the truncated log-normal
distribution. The relation is highly significant. Children in unfluoridated areas: R-squared:
0.963704, F-test: 743.42, p = 0.0001. Children in fluoridated areas: R-squared: 0.983749, F-
test: 1,513.35, p = 0.0001. The regression equations are: Children in unfluoridated areas:
z(Phi(NF)) = 4.559361*ln(DMFT/(28-DMFT)) + 11.81637, Children in fluoridated areas:
z(Phi(F)) = 4.447082*ln(DMFT/(28-DMFT)) + 11.598273


4      Dental caries incidence in children in unfluoridated and fluoridated areas has virtually
the same median (median for children in unfluoridated areas: -2.591672; median for children
in fluoridated areas: -2.608064; 99.99% confidence interval of slope; for children in
unfluoridated areas: 3.801879 and 5.316844; children in fluoridated areas: 3.919112 and
4.975051).


                                                                                            28
                                                                    29




(c)              Median of DMFT-Index in Fig. 22:
                 Children in non-fluoridated areas:                      1.95 DMFT
                 Children in         fluoridated areas:                  1.92 DMFT ... not any ”reduction”!
                 Children in         simulated areas:                    0.95 DMFT


                                                               Fig. 22
    Dental caries DMFT (average-age-adjusted) of children aged 5- to 17 years in non-
    fluoridated (NF) and fluoridated (F) areas in the U.S.A. 1986-87 (Fluoridation started
           before 1970) and simulation of ”caries reduction” (Red. DMFT) as expected by
                                                             dentists.

                  l n(DMFT[NF])/(28 -DMFT), z(Ph i)[NF]                  l n(x) o f Red .DMFT/(2 8-Red .DMFT), z=z(Phi )
                  l n (DMFT[F])/(28-DMFT), z(Phi )[F]

                  2.5
                     2
                  1.5
                     1
      z(Ph i)




                    .5
                     0
                   -.5
                   -1
                 -1.5
                   -2
                 -2.5
                    -3.8      -3.6      -3.4      -3.2         -3        -2.8     -2.6      -2.4      -2.2       -2        -1.8
                                                        l n(DMFT)/(2 8-DMFT)

5               From these results it can be concluded that in this representative survey of the National
Institute of Dental Research the children receiving unfluoridated water and those receiving
fluoridated water were from the same population (math.). If fluoride reduced dental caries in
representative random samples by more than 5% (about 50% was stated by Dental Health
Officials, dentists and promotors of fluoridation), the median and the variance would have to
differ significantly and we would have two populations.


Conclusion:
From these analyses and from Figure 22 we must conclude that
drinking water fluoridation in the U.S.A., even in households where



                                                                                                                           29
                                                                             30


children received fluoridated drinking water throughout their lives,
did not reduce dental caries in children.
4.     Results of Alternative Methodes to Water Fluoridation
       in Prophylaxis of Caries with Fluoride


4.1    National Preventive Dentistry Demonstration Program
The National Preventive Dentistry Demonstration Program (NPDDP) was contacted to
assess the costs and effects of various types and combinations of school-based preventive
dental procedures (1977 - 1984). It was a longitudinal-field-study and included about 30.000
about 30.000 children ages 5 to 14 in 10 U.S. communities. The RAND CORPORATION of
Santa Monica, CA, an independent, non profit research institution that conducts policy
research and analysis on problems of national security and domestic affairs, was separately
funded to conduct an independent evaluation of the effectiveness and costs associated with
the various preventive procedures. The study started 1977 and ended 1984.


The next figure (Fig. 23) shows the effect of "classroom procedures" in 4 years (NF =
Nonfluoridated sites: Fluoride mouthrinse once per week, One tablet per day, Plaque control,
Education; F = (Water-)Fluoridated sites: F-Rinse, Plaque control, Education). 1+2 or 5: The
children were 5-6 or 10 years old, when the program starts.
                                                                        Fig. 23
                                          95 % c onfidenc e inte rv a ls for "clas sroom
                                                effects" (number of surfac es sav ed)
                                                      1
                                                               NF 1+2             F 1+2
                                                                                          F5
                         Number of surface s sav ed




                                                                        NF 5




                                                      0




                                                      -1
                                                           0     1       2          3     4    5



Fig. 23 shows that in the classroom-program only one group of children received a "save" of
only about a half surface in 4 years. The "save" of teeth of the other groups of children was
zero or negative.

                                                                                                   30
                                             31



The RAND CORPORATION stated:
   The effectiveness of regular use of fluoride mouthrinse (with or without tablets) was
    considerably lower than reported in oher studies.
   The costs of delivering comprehensive regimens of preventive dental care were far
    higher than had been previously estimated.


4.2    Dental caries and fluoridation in Europe

Fluoridation was stopped in Kassel (Western Germany; 1971), in the Netherlands (1976), in
Ceske Budejovice (Budweis) and Prague (Czechoslovakia; 1988), in Karl-Marx-Stadt
(German Democratic Republic; 1990) and all over Eastern Germany in 1990/91. The
administration of fluoride-containing tablets to school children was stopped in several Graz
and Styria (Austria; 1973), in Saarbrücken, in Saarlouis, in Bielefeld (Western Germany;
1984), in Berlin-Wilmersdorf and Berlin-Charlottenburg (Western Germany; 1985), in the
province of Carinthia in Austria, 1986, and in the remaining Austrian federal states in
1994/95. Several cities and states have decided not to implement fluoridation, including St.
Gallen and Geneva (Switzerland), and Berlin and Hamburg (Western Germany). Generally,
water fluoridation and other fluoridation schemes in Europe are on the decrease.


Although the WHO and WHA recommended the introduction of community water fluoridation
in 1969, 1975, and 1978, several European member states of WHO in fact ceased to
fluoridated water. Their decision was motivated not by political reasons, but the result of
growing controversy over the purported effectiveness of water fluoridation and fear of side
effects. Water fluoridation was stopped in the following States: Federal Republic of Germany
(fluoridation introduced 1952, stopped 1971); Sweden (introduced 1952, stopped 1971);
Netherlands (introduced 1953, stopped 1976), Czechoslovakia (introduced 1958, stopped
1988/90), German Democratic Republic (introduced 1959, stopped 1990 (Spremberg 1993)),
Poland (introduced 1968, stopped 1991/92); Union of Soviet Socialist Republics (introduced
1960, stopped 1990), Finland (introduced 1959, stopped 1993); outside Europe: Japan
(introduced 1952, stopped 1972). Against prognosis dental caries decreased after stop of
fluoridation.




                                                                                         31
                                                   32


The next two figures (Fig. 24 and Fig. 25) show comparisons of dental caries in adults aged
35-44 years in 25 european States and in 9 States, respectively (data of WHO26)
                                                Fig. 24



                    DM FT in Europa 1983- 89, 35 - 44jährige
                 No rwe gen                                                                   25
                   Schwei z                                                           22 ,3
                No rd irla nd                                                        21 ,8
               Öste rrei ch                                                          21 ,7
             Irl an d (Re p)                                                 19 ,4
                    En gl and                                               19 ,1
                        Po le n                                           18 ,6
            Ju gosl awi en                                               18
                 Dä nemark                                               17 ,8
                 Schwed en                                              17 ,5
                         BRD                                            17 ,5
             Ni ed erl an de                                            17 ,4
     Land




                   Fi nn la nd                                        16 ,7
                 Bu lg ari en                                        16 ,5
                         DDR                                        16
                     Un garn                                        15 ,8
            Grie che nl and                                     14 ,5
                         USA                                    14 ,3
                      Ita li en                                13 ,8
                        Mal ta                              12 ,7
              Sa n Ma ri no                               12
                 Ru mäni en                               11 ,9
                      Tü rkei                            11 ,6
                   Sp ani en                             11 ,6
                  Po rtuga l                            10 ,9
                                  0              10                       20                       30
                                                                           R. Ziegelbecker, 8. 11.1994
                                               DMFT




                                                Fig. 25




26
   D. FELDMANN, A.F. HEFTI, Ph. deCROUSAZ, Th.M. MARTHALER, P. HOTZ, G.D. MENGHINI, P. VOCK:
"Zahnkaries (DMFT) bei Erwachsenen in der Schweiz 1988." Schweiz. Monatsschr. Zahnmed. Vol. 103: 7/1993,
p. 835-843

                                                                                                        32
                                                    33



                        Extrahie r te (M ), ge füllte (F), kariöse (D) Zähne
                        in Europa 1983-89, 35 - 44jährige

                        Schwei z
                                                                                    M
                Irl an d (Re p)                                                     F
                                                                                    D
                         En gl and

                           Po le n
                La nd




                             BRD

                          Un garn

               Grie che nl and

                          Tü rkei

                         Sp ani en

                                     0         10                20                   30
                                                                 R. Ziegelbecker, 8.11.1994
                                                    DMFT


The comparison shows that european countries such as Switzerland with intensive
fluoridation programs (F-tablets since 1952, F-salt since 1955, water fluoridation in Basle
since 1962, many individual and school programs with fluoride) and Eire (drinking water
fluoridation about 60% of population since 1964 and individual programs) are ranking with
high dental caries in 1983-1989.


4.3      Salt Fluoridation in Switzerland and Dental Caries

Salt fluoridation in Switzerland starts in 1956. In 1967 in 11 of the 22 cantons in Switzerland
more than 90% of households used packets of F- salt27 (Table 3).


                                                Table 3
Kanton                   Fluorsalzbezug   Fluorsalzbezug       Fluorsalzbezug        Fluorsalzbezug
                         in kg (1967)     in % des             pro Kopf und          pro Kopf und
                                          Paketsalzbezug       Jahr (kg/Jahr)        Tag (g/Tag)
                                          es
Wallis                   644 700          99                   3,39                  9,28
Graubünden               363 300          93                   2,36                  6,47
Appenzell A.-Rh.         108 900          100                  2,16                  5,92
St. Gallen               759 500          100                  2,11                  5,78
Thurgau                  389 000          100                  2,10                  5,78

27
   H.J. WESPI: "Entwicklung, gegenwärtiger Stand und Verbesserungsvorschläge für die Kariesprophylaxe mit
Fluorsalz in der Schweiz". Schweiz. Mschr. Zahnheilk. 78: 651, 1968)


                                                                                                      33
                                                                       34


Luzern                                580 100                98                          2,09                                                        5,73
Appenzell I.-Rh.                      27 000                 100                         2,00                                                        5,48
Freiburg                              323 500                92                          1,98                                                        5,42
Neuenburg                             309 000                100                         1,90                                                        5,21
Zug                                   118 000                98                          1,89                                                        5,18
Zürich                                1 938 000              97                          1,83                                                        5,01
Aargau                                490 320                59
Baselland                             111 900                28
Bern                                  787 040                51
Glarus                                37 200                 58
Nidwalden                             31 800                 77
Obwalden                              31 000                 80
Schaffhausen                          152 000                86
Schwyz                                25 200                 34
Solothurn                             192 700                63
Tessin                                1 400                  -
Uri                                   37 000                 51


The following figures (Fig. 26 and Fig. 27) show the dental caries of children aged 10 and 12
years with (testgroup) and without (controlgroup) salt fluoridation and a comparison with
Dental Carieschildren from Canton Zurich (F-tablets and individual prophylaxis with fluoride),
from Canton Basle - City (water fluoridation and individual-prophylaxis)28 and a comparison
with children in Graz (Austria) after stop of fluoride tablet action in schools and kindergartens
in March 197329.



                       Karie sv e rgle ich be i 10jährige n Kinde r n:
                                                                                                                  DMFT                         K ontrol le
                                             Ko ntrol l e (K anton Fri bo urg/Neuchatel )                         DMFT                         F-S al z
                                        4
                                                                                                                  DMFT                         B ase l
                                                    Fl uo rsal z-Grupp e (Ka nton Waa dt)                         DMFT                         Zürich
                                                                                                                  DMFT                         Graz

                                        3                                                                         Graz (ohn e Fl uor)
                   DMFT (10jährige)




                                        2
                                                                                                                    Zürich (Tabl. seit 1963)
                                                                                          Basel (TWF seit 1962)




                                        1




                                        0
                                            19 70       19 74      19 78       19 82                 19 77         19 80
                                                                                       R. Ziegelbecker, 8. 11.1994

                                                                       Ja hr



28
   Ph.de CROUSAZ et al: "Caries Prevalence in Children After 12 Years of Salt Fluoridation in a Canton of
Switzerland. Helv. Odont. Acta 29, Nr.3/1985. 813
29
   R. Ziegelbecker: Letter to the Codex-Commission of Austria 12 November 1994.

                                                                                                                                                             34
                                                                  35



                                                               Fig. 27

                           Karie sv e rgle ich be i 12jährige n Kinde r n:

                                        Ko ntrol l e (K anton Fri bo urg/Neuchatel )                     DMFT                  1 2j     K ontr
                                    8
                                                                                                         DMFT                  1 2j     F-S al z
                                                                                                         DMFT                  1 2j         e
                                                                                                                                        B as l
                                           Fl uo rsal z-Grupp e (Ka nton Waa dt)                         DMFT                  1 2j     Zürich
                                                                                                         DMFT                  1 2j     Graz
                                    6
                 DMFT (12jährige)




                                                                                                          Graz (ohn e Fl uor)

                                    4




                                                                                                             Zürich (Tabl. seit 1963)
                                                                                  Basel (TWF seit1962)
                                    2




                                    0
                                        19 70     19 74      19 78        19 82                19 77        19 80
                                                                              R. Ziegelbecker, 8. 11.1994
                                                                  Ja hr




Fig. 26 and Fig. 27 show about the same decrease and increase in dental caries with
fluoride salt and without fluoridation in the same time in children aged 10 and 12 years. Only
one value in 12 year old children with salt fluoridation in 1982 is lower. It is possible that this
is a statistical artifact because in children aged 10 years dental caries increased with salt
fluoridation. The group of tests with salt fluoridation had allready from the outset less dental
caries then the control's group without fluoridation.. The children in Graz had the same denta
caries and caries decrease without fluoride approximately as the children in Basle and Zürich
with intensive fluoridation. This shows that other factors than fluoride determine dnetal
caries.


Therefore fluoride in salt is an untenable "public health measure".


Summary:
The extensive analyses of comprehensive authentic data give
evidence that fluoride does'nt reduce dental caries and has
inacceptable toxic side effects. Therefore fluoride is unsuitable as a
supplement in food.
                                                      Rudolf Ziegelbecker e.h.



                                                                                                                                                   35
                                 36


See also enclose:
   Compendium of summaries
   DEAN-Criticism
   ListingResultsFluoridation
   Neue Ergebnisse




                                      36

								
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