- The British Fluoridation Society and the United Kingdom
National Health Service are presently promoting the supply of fluoridated
milk to schools which, they claim, will reduce the incidence of tooth decay
among socially deprived children. One dental public health officer believes
that the program should be seen as an interim measure until artificial
drinking water fluoridation schemes can be more widely introduced.
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- Aware that fluoride is a cumulative poison, the World
Health Organization website states very clearly that analysis of the children's
urine should be considered mandatory for safety reasons when school fluoridated
milk programs are introduced. The need for caution is also clearly addressed
in the Conclusions to Fluorides and Oral Health (WHO, 1994), which states:
"Dental and public health administrators should be aware of the total
fluoride exposure in the population before introducing any additional fluoride
program for caries prevention." Promoters of fluoride are generally
unaware of the existence of such warnings or the need for them.
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- A review of the studies associated with the practice
reveals that the researchers are unable to make up their minds whether
the effect of fluoridated milk is topical or systemic and their conclusions
are shrouded in ambiguous terminology claiming success without scientific
substantiation.
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- Paradoxically, in order to minimize the effects of fluoride
poisoning, toxicologists recommend milk as an antidote. This is reflected
in instructions on fluoride supplements which state that the tablets or
drops should not be taken simultaneously with milk because the calcium
in the milk inactivates the fluoride.
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- When sodium fluoride is added to milk, it reacts with
calcium and precipitation begins depositing calcium fluoride at the bottom
of the container within an hour. Calcium fluoride is very difficult for
the body to assimilate. Also, if the milk has been stored for any length
of time, there is no certainty that the children ingest any traceable amount
of the calcium fluoride.
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- Even the prestigious US National Academy of Sciences
recognizes the affinity between calcium and fluoride. In 'Dietary Reference
Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride' (1999)
National Academy Press, they note: "High intake of calcium rich foods
cause elimination of systemic fluoride in feces equal to or greater than
the fluoride intake."
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- The proponents of milk fluoridation suggest that residual
milk in the mouth acts as a time release mechanism, enabling fluoride to
remineralize the teeth. This is at odds with many studies which state that
the released fluoride combines with calcium in the saliva and forms a plaque
on the teeth which is essentially non-reactive and possibly acts as a protective
coating against further fluoride damage.
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- In response to concerns raised by antifluoridation organizations,
the fluoride experts at BFS and NHS cite studies purporting to show the
safety and efficacy of milk fluoridation programs. One study conducted
by the World Health Organization claimed that fluoridated milk reduced
cavities by 90%. However, that claim was tempered with the caveat:
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- "Results seem to confirm the caries-reducing effects
of milk fluoridation found in previous studies. Unexpected large caries
reductions obtained in this nonexperimental study, however, probably cannot
be attributed to the fluoridation of milk alone. The mere introduction
of the project might have led to other changes affecting dental caries,
such as improved oral hygiene and better dietary habits."(Pakhomov
GN et al. (1995) Dental caries-reducing effects of a milk fluoridation
project in Bulgaria. Journal of Public Health Dentistry, 55: 234-237).
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- Several milk fluoridation studies suggest that milk has
no more effect on the development of healthy teeth and bones than distilled
water. Tooth remineralization occurs because of the presence of calcium
and phosphorus in the milk.
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- Also, no study accounted for the ambient fluoride present
in the milk before adding the sodium fluoride. It is known that up to one
part per million or more of fluoride can be captured within the protein
in milk. The fluoride in the milk protein is more likely to be digested
and metabolized than the calcium fluoride created after adding sodium fluoride.
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- In order for any fluoride to show up in the blood or
urine after consuming fluoridated or nonfluoridated milk, the children
would be required to fast for at least twelve hours before drinking the
milk with a "mineral deficient" meal.
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- The World Health Organization cite only six references
on their web page, including one dating back to 1931. In fact, the only
claim made in the Borrow-WHO collaboration on milk fluoridation is quite
noncommittal:
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- "Fluoridated milk seems to keep a permanently low
level of ionized fluoride within the oral cavity promoting remineralization.
It is likely that this topical mechanism contributes to the caries-preventive
effect of fluoridated milk. However there are still a series of unanswered
questions, and additional studies should be performed to determine:
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- the age at which it is best to start drinking fluoridated
milk.
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- for how many years it should continue,
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- the frequency of consumption,
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- optimum fluoride concentration to be added,
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- anti-caries effect of milk and it's products"
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- Essentially, the National Health Service is still experimenting
with milk fluoridation schemes and using children as the test subjects.
This exercise seems a waste of time and tax payers' money because it is
based on adding the "poison to the remedy."
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- References
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- 1. Lennon MA, Jones S, Woodward SM, Some operational
aspects of school-milk fluoridation in St. Helens, Merseyside, UK, Adv
Dent Res 1995 Jul;9(2):118-9.
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- 2. Bian JY, Li RY, Wang WJ, Feasibility of milk fluoridation
and trends in dental caries of children in China, Adv Dent Res 1995 Jul;9(2):112-5.
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- 3. The possibility of school milk as a vehicle for fluoride:
epidemiological, organisational and legal considerations, Community Dent
Health 1992 Dec; 9(4):335-42.
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- 4. Stomatologiia (Mosk), Milk fluoridation program in
Codegua, Chile: evaluation after 3 years, Rev Panam Salud Publica1999 Aug;
6(2):117-21.
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- 5. A model outline of the organizational and medical
measures for the introduction of milk fluoridation projects in different
regions of Russia, 1996;Spec No:25-6.
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- 6. Ivanova K, Pakhomov GN, Moeller IJ, Vrabcheva M, Caries
reduction by milk fluoridation in Bulgaria, Adv Dent Res 1995 Jul;9(2):120-1.
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- 7. Dental caries-reducing effects of a milk fluoridation
project in Bulgaria, J Public Health Dent 1995 Fall;55(4):234-7.
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- 8. Some operational aspects of school-milk fluoridation
in St. Helens, Merseyside, UK, Adv Dent Res 1995 Jul;9(2):118-9.
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- 9. Clovis J, Hargreaves JA, Fluoride intake from beverage
consumption, Community Dent Oral Epidemiol 1988Feb;16(1):11-5.
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- 10. White CH, Milk, milk products, and dental health,
J Dairy Sci 1987 Feb;70(2):392-6.
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- 12. Dirks OB, Jongeling-Eijndhoven JM, Flissebaalje TD,
Gedalia I, Total and free ionic fluoride in human and cow's milk as determined
by gas-liquid chromatography and the fluoride electrode, Caries Res 1974;8(2):181-6.
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- 13. Larsen MJ, Ravnholt G, Dissolution of various calcium
fluoride preparations in inorganic solutions and in stimulated human saliva,
Caries Res 1994;28(6):447-54.
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- 14. Ekstrand J, Oliveby A, Fluoride in the oral environment,
Acta Odontol Scand 1999 Dec;57(6):330-3.
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- 15. Effect of fluoride addition on ionized calcium in
salivary sediment and in saliva, Scand J Dent Res 1988 Oct;96(5):399-404.
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- 16. Larsen MJ, Richards A, The Influence of Saliva on
the Formation of Calcium Fluoride-Like Material on Human Dental Enamel,
Caries Res 2001 Jan;35(1):57-60.
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- 17. Afseth J, Ekstrand J, Hagelid P, Dissolution of calcium
fluoride tablets in vitro and bioavailability in man, Scand J Dent Res
1987 Apr;95(2):191-2. Abstract:
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- The dissolution rate of CaF2 tablets in vitro and the
degree of F absorption in vivo after tablet intake in man were investigated.
50% of total F was released in 0.1 N HCl after 45 min whereas virtually
no release was seen in H2O or in 0.2 M PO4-buffer pH 6.8. In spite of the
modest release of F in simulated gastric juice in vitro no F absorption
as judged from the plasma fluoride concentration curve was seen within
6 h after intake of 4 mg F as CaF2 tablets.
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- 18. Richards A, Fejerskov O, Ekstrand J, Fluoride pharmacokinetics
in the domestic pig, J Dent Res 1982 Sep;61(9):1099-102
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- Abstract: Plasma fluoride concentrations were studied
in 11 pigs following single oral or intravenous doses of fluoride. The
results showed a less-than-20% bioavailability of fluoride when administered
with calcium-rich food. Pharmacokinetic analyses showed that the plasma
half-life varied from 0.6 to 1.4 h, depending on diet and route of fluoride
administration. These data are comparable to those reported for man, and
thus illustrate the suitability of the pig for studies of effects of fluoride
on hard tissues.
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- 19. Ekstrand J, Ehrnebo M, Influence of milk products
on fluoride bioavailability in man, Eur J Clin Pharmacol 1979 Sep;16(3):211-5
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- Abstract: The effect of milk products on the gastrointestinal
absorption of fluoride from sodium fluoride tablets was studied in five
healthy subjects. Two different diets were tested: (1) 250 ml standardized
milk (3% fat) and (2) 500 ml of milk, 3 pieces of white bread with cheese
and 150 ml of yoghurt. The 100% bioavailability of sodium fluoride tablets
during fasting was greatly decreased by coadministration of milk products:
with Diet 1 the absolute bioavailability calculated from combined plasma
and urine data was in the range 50--79% and with Diet 2 it ranged from
50--71%. It is suggested that the decreased bioavailability produced by
dairy products should be taken into account when establishing flouride
dosage regimens for prophylaxis of caries.
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- 20. WHO Collaboration WEB page on milk fluoridation cited
the following studies:
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- 1. Bánóczy J et al. (1985) Effect of fluoridated
milk on caries: 5-year results. Journal of the Royal Society of Health,
105: 99-103. 2. Milk fluoridation for the prevention of dental caries (1996)
World Health Organization and Borrow Dental Milk Foundation, Geneva. 3.
Pakhomov GN et al. (1995) Dental caries-reducing effects of a milk fluoridation
project in Bulgaria. Journal of Public Health Dentistry, 55: 234-237 .
4. Roberts LJ et al. (1931) Effect of a milk supplement on the physical
status of institutional children. American Journal of Diseases of Children,
56: 805-823. 5. Stephen KW et al. (1984) Five-year double-blind fluoridated
milk study in Scotland. Community Dentistry and Oral Epidemiology, 12:
223-229. 6. Ziegler E (1956) [ The fluoridation of milk ] Bulletin der
Schweizerischen Akademie der Medizinischen Wissenschaften, 12: 466- 480.
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