By Sonya Lunder, EWG Senior Scientist

Last month, the U.S. Department of Health and Human Services (HHS) proposed that public water systems cut back on the amount of fluoride they add to drinking water. Whether you live in a city with fluoridated water or not, you're probably aware of the longstanding debate (often more like a battle) over fluoridation.

Over the last several years, Environmental Working Group has carefully reviewed the evidence of fluoride's benefits to teeth - and its potential toxicity - and this week EWG wrote the federal agency urging it to lower fluoride levels even more than it had proposed.

Here's why:

Fluoride strengthens teeth and makes them more resistant to cavities. That's good. But fluoridated water has some significant drawbacks - especially compared to treatments that apply it directly to teeth, such as fluoridated toothpaste or other dental treatments.

1. Fluoride replaces calcium in teeth and bone. A portion of the fluoride you ingest takes the place of calcium in your teeth and bones. In places where there is lots of fluoride in water, people can develop weaker bones and serious tooth damage known as "fluorosis." Whether lower levels of fluoride have the same effects is not clear, but an estimated 40 percent of Americans have dental fluorosis, ranging from mild to severe.
2. Toothpaste works just as well, without the downsides. Last year, the European Union concluded that because of these risks, toothpaste and other topical treatments were a better option than fluoridated water.

   In their recent announcement, federal officials cited a review by the US Centers for Disease Control and Prevention as justification for continuing to fluoridate water. But when we read between the lines (a handy skill in our line of work), we noticed that the CDC review found that water fluoridation and toothpaste provide a similar level of protection, at least in adults.

   It's very worth noting that while fluoridated toothpaste contains thousands of times more fluoride than drinking water, it can be used safely to deliver the benefits directly to the teeth while minimizing how much gets into the body and bones.

3. Drinking water is an inexact delivery route. We can't tailor the amount of fluoride in drinking water for each demographic group. Pregnant women, athletes and people with diabetes all drink lots of water and as a result will likely ingest more fluoride than teens - who are rumored to subsist purely on soda.

Proposed limit not low enough, especially for vulnerable groups
The lower fluoride concentrations in drinking water being recommended by the government will still be too high for some groups. EWG estimates that 20 percent of babies less than 2 years old will end up ingesting too much fluoride, particularly babies fed powdered baby formula, which is mixed with water. Because they're so small, bottle-fed babies drink approximately 10 times more water than adults every day.

The first two years of life are a vulnerable, because babies are growing rapidly and more of the fluoride finds a permanent home in their bones or teeth. In short, for infants it's all downside and no benefit. About 10 percent of older children will also get too much fluoride from the combination of drinking water, toothpaste and the small amount of fluoride in food, pesticides and other sources.

About 40 percent of Americans have fluorosis, though it is often very mild. Regardless, we at EWG believe that it just makes sense to minimize fluoride ingestion until the safety of the proposed lower levels can be assured. Although current drinking water guidelines focus on fluoride toxicity to bone and teeth, studies from regions with high levels of naturally occurring fluoride have also found indications of neurotoxicity and hormone disruption, and even increased rates of a rare type of bone cancer in boys.

Better than nothing, but not enough
EWG does welcome this move to lower fluoride levels - for years we've been concerned about the safety of water fluoridation. That said, federal agencies haven't fully tallied the risks of fluoride and the potential to administer it more safely. The Environmental Protection Agency published a toxicity assessment that concluded that adding fluoride at 0.7 parts per million is safe, but based its calculations on some questionable assumptions. Without them, the assessment would have shown the opposite.

The point is, fluoride belongs ON your teeth, not IN your body. Surface application works and is safe - as long as kids learn to spit out their toothpaste (harder than you might think!).

Key fluoride tips for water drinkers
It's good news that the federal government wants to reduce the allowable fluoride levels in drinking water. But EWG doesn't think their proposal goes far enough, so we encourage you to take precautions at home. These are our top tips:

• NO fluoride for babies. The American Dental Association (ADA) says there is no proof of benefits before teeth emerge. Avoid mixing powdered or concentrated baby formula with fluoridated water.
• NO fluoridated toothpaste for children younger than two.
• Use less toothpaste. Use a pea-size amount of child-strength toothpaste for bigger kids, but only once they can reliably rinse and spit
• Rinse, don't chew. If you are considering a fluoride supplement, look for rinses instead of chewable tablets to lessen the amount that ends up inside your child's body.
• Alert your tap water provider. If you live in an area with fluoridated water (find out here), let your water utility know about the new federal guidance. Fluoride levels in water should not exceed 0.7 parts per million.

[A big thanks to Flickr CC & Gustty for the pearly whites]

By Olga Naidenko, EWG Senior Scientist

The lead pollution crisis of the Washington, D.C. water supply - and the culprit that caused it, the water disinfection chemical chloramine - is a powerful example of how things can go terribly wrong when water quality problems are considered and tackled in isolation.

Earlier this year, Virginia Polytechnic Institute and State University (Virginia Tech) scientists reported the shockingly high lead levels in the blood of young Washington, D.C. children tested between 2001 and 2004, when the District of Columbia's drinking water was being contaminated with lead from aging pipes.

Unfortunately, this situation is not unique: similar results have been reported in Greenville, North Carolina, according to studies by the Duke University researchers.

Chloramines and lead pipes: Not so good together
American water utilities are increasingly switching to chloramines, a mixture of chlorine and ammonia, for final disinfection of drinking water. Chloramine was supposed to be a "safer" water disinfectant than chlorine because it reduces formation of toxic chlorination byproducts. A 2005 survey by the American Water Works Association found that approximately a third of all utilities now use chloramines.

Water disinfection byproducts are associated with increased risk of cancer and possibly adverse effects on the development of the fetus, so minimizing their levels in drinking water is a good thing. Yet, chloramines drastically increase the leaching of lead from pipes. And here is a real challenge: there are tens of thousands of lead service lines in the water system administered by the DC Water and Sewer Authority. Add to these lines the lead based solder used to join copper pipe, brass and chrome plated faucets, and water fixtures, and the opportunities for lead to leach into the drinking water multiply.

We all accept that water disinfection is a public health necessity. However, we need to thoroughly consider the full impact of any chemical added to drinking water given the current water distribution infrastructure in place, not in some theoretical vacuum. As described by Duke researchers, chloramine-induced lead leaching might be lessened by the addition of anticorrosivity agents during the water treatment process. Is that sufficient for protection of public health? We really don't know! Chloramine itself has been associated with severe respiratory toxicity and skin sensitivity. Overall, despite ongoing research, water treatment chemistry is still insufficiently understood by scientists and specific water quality outcomes depend on the particular chemical interactions found in each water treatment and distribution system.

And now add fluoride
In addition to disinfection chemicals, other additives are commonly mixed with the finished drinking water before it leaves the water treatment plant. Of them, fluoride is possibly the most known. Two thirds of the U.S. municipal water supply is artificially fluoridated in an effort to prevent tooth decay. But fluoridation additives in tap water are not the same form of fluoride as found in toothpaste. Typically, water is fluoridated with fluorosilicic acid (FSA) or its salt, sodium fluosilicate, collectively referred to as fluorosilicates. In contrast, fluoride in toothpaste is usually in form of simple sodium fluoride salt, NaF.

Here comes a second unpleasant "surprise" for those in lead-piped locations: fluorosilicates have a unique affinity for lead. In fact, lead fluorosilicate is one of the most water-soluble forms of lead. In fact, fluorosilicic acid has been used as a solvent for lead and other heavy metals in metallurgy. In industrial applications, chemical engineers rely on this acid to remove surface lead from leaded-brass machine parts.

Research shows what happens when we mix it all up
What happens when fluorosilicates in water pass through lead-containing pipes and metal fixtures? Not surprisingly, the fluorosilicates extract high levels of soluble lead from leaded-brass metal parts (researchers from the Environmental Quality Institute of the University of North Carolina-Asheville performed this actual experiment).

In research published in the scientific journal Neurotoxicology, researchers found that the mixture of the two chemicals: disinfectant (whether chlorine or chloramine) with fluorosilicic acid has a drastically increased potency, leaching amazingly high quantities of lead.

Where does this lead go? Into our drinking water and right on into our bodies, where they wreak havoc by poisoning our heart, kidneys and blood, causing irreversible neurological damage and impairing reproductive function.

North Carolina researchers concluded that the supposedly innocuous - and purportedly beneficial - quantities of fluoride added to drinking water may, in fact, precipitate a cascade of serious health problems, especially when chloramines and lead pipes are added into the mix.

Do we even need fluoride in tap water?
The mixture of chloramine and fluorosilicates in drinking water causes extensive leaching of lead. We cannot dispense with water disinfection - everybody acknowledges this. Thus, chlorine and chloramine are probably here to stay for some time. On the other hand, fluoride, or, specifically, water fluoridation with fluorosilicates, is quite dispensable.

But wait - isn't fluoride the miracle chemical that improves dental health?

Well, yes and no. Much of what is publicized today in caries prevention programs worldwide is derived from the theories generated in the 1950s and '60s, when water fluoridation was actively promoted. As we now know, the main benefits of fluoride for dental health are derived from surface application on the teeth, not from ingestion.

In fact, ingestion of fluoride causes dental fluorosis, a range of adverse health effects that includes mottling, pitting, and weakening of the teeth. These risks are especially significant for infants and young children. In the U.S. and worldwide, about 30 percent of children who drink fluoridated water experience dental fluorosis. In 2006, the American Dental Association (ADA) issued an "Interim Guidance on Fluoride Intake for Infants and Young Children." ADA recommended that in areas where fluoride is added to tap water, parents should consider using fluoride-free bottled water to reconstitute concentrated or powdered infant formula to avoid excess fluoride.

According to the latest research, the anti-caries activity of fluoride is due to topical effects, which supports the value of fluoride-containing toothpaste to dental health. There is clear evidence that fluoride dental products significantly reduce the incidence of cavities. In contrast, a substantial and growing body of peer-reviewed science suggests that ingesting fluoride in tap water does not provide any additional dental benefits other than those offered by fluoride toothpaste and may present serious health risks.

To learn more about fluoride health effects, read the recent report by EWG.

The message: Don't assess chemicals in isolation
The lesson here is straightforward: it is completely unscientific to simply toss any chemical into the drinking water on the premises that this chemical might provide some benefits. The real question is: what would be the effect of this chemical given what else is going on with the water system? In case of fluoridation and chloramines, what emerges at the end of the pipe (our faucets!) is a potentially highly hazardous mixture of fluorosilicates, lead, and residual levels of disinfectants.

To protect the health of my family today, I can buy a water filter to remove heavy metals and disinfection byproducts from my drinking water with a simple pitcher filter. But to protect the health of the entire nation, we really need to consider if our current methods of water treatment can withstand scientific scrutiny, or whether they should be re-assessed so as to provide safe, healthy tap water to all Americans.

By Lisa Frack

You're probably familiar with the longstanding and often heated debate over the addition of fluoride to public water supplies. And while EWG does have an opinion on that, last week we focused on fluoride in dog food in a new report based on independent tests of 10 brands.

EWG's finding: High levels of fluoride in dog food
EWG found fluoride above healthy levels in 8 national brands of dog food marketed for both puppies and adults. The amount of fluoride in the dog food was up to 2.5 times higher than what the EPA has deemed a safe amount in drinking water.

Where is the fluoride coming from?
Some of this extra fluoride comes from the fluoridated water used to manufacture dog food. Most, however, is from the "bone meal" and various meat byproducts that are added to dog food - anything from "chicken byproduct meal" to "beef and bone meal."

These are basically ground bones, cooked with steam, dried, and mashed to make a cheap dog food filler. Since bones store fluoride, any product that includes bone meal is likely to be high in fluoride, too.

Why is excessive fluoride a problem?
Combined fluoride exposure from both food and water can easily range into unsafe territory. Routine exposure, like eating the same food every day, can predispose dogs to a variety of health problems: weakened bones, hormonal and behavior problems, and even bone cancer.

What can you do for your dog?
Check the ingredient list before you buy dog food. Look for and demand pet foods that do not include bone meal.

Read the full EWG report on fluoride in dog food.

[Thanks to MShades & Flickr CC for the pic]

I will never forget my job interview here at EWG--I woke up at 3am to catch the plane from Detroit and to make my 9am interview time. I slept for one hour the night before because I was nervous and quite honestly, scared. A few weeks before I had graduated from Michigan State University with my Master's in Public Relations and was ready to make the difference in the professional world, working for a non-profit advocacy in the nation's capital.

The moment I walked in to the EWG office, I fell in love with it. The people, the atmosphere and the décor, plastered with EWG' s slogan the power of information, made me feel right at home. As the daughter of a former journalist, I was raised with the mantra that information is power.

I spend almost 3 years here at EWG bringing that information to you, as EWG's Press Secretary. I made contact with thousands of reporters nationwide, and I've blogged since the day one. So, as I am sure you can imagine, it is with sadness that I write my last blog at Enviroblog. Friday is my last day at EWG.

It is difficult to decide what would be my favorite moment at EWG - would it be the first interview I ever set up with Fox affiliate in Boston about a fluoride industry cover-up; the time we persuaded EPA not to expose the public to chromium-6, a known carcinogen; or meeting so many people who loved EWG? Or even meeting those who worked for the "other side," and who told me openly that they fear "EWG coming after them"? It could also be the moment a few weeks ago when my mom sent me a power-point presentation in Serbian on the dangers of BPA, the issue we brought to light. The professional challenges and successes of working at EWG have helped me grow as a professional and a person. The people that I have worked with have been an inspiration to me as well as comrades in arms. We have all worked together to protect the most vulnerable populations from chemicals and toxins.

So, why am I leaving and where am I going?

I came to the US 11 years. I meant to stay for a year, to learn English. I ended up staying here much longer. The NATO bombing of my country prevented me from returning, and then school and work kept me here for another decade. Even though my years in the US have been a growing and developing experience for me, the time has come, I feel, to reunite with my family. So the move from EWG is a transcontinental one for me. Before I settle back in my city, Belgrade, I plan to spend some time teaching English at Samveda Training & Research Centre in Davangere, India.

So this is my final note, from this continent, on this blog. It's been an honor to be the part of the amazing team at EWG, as well as a writer for this blog. And as one of my favorite quotations goes: How lucky I am to have something that makes saying good-bye so hard.

[Cartoon by Steve Greenburg]

In a little-noticed but dramatic turnaround, the nation's leading fluoride advocate, The American Dental Association (ADA), issued an alert on November 9th urging parents to avoid fluoridated water when reconstituting infant formula.

The dentists are concerned that fluoride exposure at this age will permanently damage teeth, not protect them. A growing body of research also links fluoride to weakened bones, reduced thyroid activity, and possibly bone cancer in boys.

The advice, however, has gone largely unheeded. Nursery Water, the nation's leading fluoridated water for babies still markets its product nationwide at Wal-Mart and other major retailers.

In light of the new ADA recommendation, join me in signing this letter to Wal-Mart asking them to stop selling this product.

After years of downplaying the risks of excessive fluoride intake, the American Dental Association (ADA) has just released new guidelines that dramatically reduce the recommended fluoride exposure for infants and children. Though not ready to condemn fluoride entirely for its role in enamel fluorosis, the ADA has issued an “interim” advisory on fluoride intake until more research can be done. This is a promising step for the ADA, which has resolutely promoted the fluoridation of water in the past. While it's commendable that the Association is alerting parents to the risks of fluorosis, a primarily cosmetic condition, it would be even better to issue a similar moratorium on account of the recent research tying fluoridated water to bone cancer in boys.

Until further notice, ADA recommends the following measures to reduce the risk of fluorosis: