Ep 179 Fluoride 2: Fighting tooth and nail

In last week’s episode, we traced the history of fluoridation (and the anti-fluoridation movement) to its roots in the early 20th century, but we left you wondering whether there’s anything to back up the health claims that anti-fluoridationists make. Today, we get deep into the weeds of the fluoride literature, explaining how this mineral works, the difference between topical and systemic fluoride, and whether fluoridation has been linked to any health issues. The details matter, and don’t you worry - we’ve got plenty of nitty gritty for you to feast on.

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Episode Transcript

Speaker 1 (00:00):
Ouch. It's nineteen sixty four and I'm at the Fight
of the Century and I just lost I got my
tooth pulled. And why did I lose my tooth? I
didn't really know then, but I do now. It was
bacteria versus floride, and I didn't have any It was

(00:21):
bacteria poop to be exact acid. I'm eating candy. My
mom doesn't really know how much I'm eating cereal that's
called sugar smacks or frosted flakes with a sugar bowl
that we got to use sugar because my mom was
sleeping and we didn't want to wake her because we
were five kids and my mom needed her sleep in

(00:41):
the morning. So hiding in plain sight in nineteen sixty
four was fluoride. It had just entered the water in
New York City and it was in some toothpastes. Blord
knows if I brushed my teeth, I can't remember. We
probably did, but we certainly didn't have fluoride treatments at
the dentist. And so why did I lose my teeth

(01:02):
at that time? Because it's not one thing, It's not
one quantity of one thing. It's an approach to health
reasonable amounts of sugar fluoride in the water to build
the teeth strong. And I know that. And why do
I know that? Well, I don't remember if I said
this is Rafael, and it is, but this is doctor Santore.

(01:25):
Also in nineteen seventy four, about ten years after I
got my tooth pulled, I went to dental school and
I learned a lot about how to fix broken teeth.
I didn't learn as much how to keep them from
getting broken, how to keep them from getting decayed. That
came with time and maturity. And after forty five years,

(01:47):
I have a lot of stories, but I only want
to tell you one or two. So what happened In
nineteen eighty I was treating patients and I was finished
with all my resus and sees and things. And I
noticed that I would fix teeth that had cavities on
top of the fillings on top of the teeth that

(02:10):
just had cavities. Boy, that lactic acid and all those
things that bacteria produce and they erode teeth were working
really hard against me. And I started to see a
change in the late eighties. And in nineteen eighty seven,
Willibrook closed and that is where we saw lots of

(02:30):
patients who came to the hospital I worked at where
I did anesthesia and taught pediatric residents how to do
dentistry and how to think about healthcare for the handicapped.
And we saw over about ten years before Willibrook closed
and even after, while we were treating the handicapped in

(02:50):
the larger New York area mostly Brooklyn, but larger New
York area, that the kids were getting less cavities. We
started speaking to the parents and we start looking at
the data, and we realized that there was a revolution,
that the bacteria was starting to lose the battle. And
we weren't quite sure why. It seemed common sense that

(03:13):
people brush their teeth, but it had to be more
than that, because the handicapped kids could not brush their
teeth well, their parents were always exhausted caring for them,
and it was a difficult environment. In about nineteen ninety one,
varnishes came out that we dentists could use in the
teeth and before we put the restorations in them. And

(03:35):
in nineteen ninety six, my son, my firstborn son, was
six years old and he had no cavities. And I
noticed because I treated the kids in his class that
they had no cavities. And I started to put together
the relationship between good healthcare and systemic fluoride as well

(03:56):
as topical fluoride, and they do different things, and we
argue to this day about which one is better, and
they are both important. But the thing about systemic fluoride
is it's the quiet giant that works behind the scenes.
And that's what I came to realize as a dentist

(04:18):
in the trenches, so to speak, trying to prevent teeth
from being destroyed. In the year twenty twenty five. I
can tell you without a doubt from treating different communities
with different advantages and access, that fluoride in all its forms,

(04:40):
properly used is a gift to children. And I share
that with every parent that comes in and I show
them X rays. I have so many X rays that
show such a long history that we went from decay
and fillings to very little decay or almost mos none

(05:01):
and no feelings. And I thank you for listening to this,
and I hope you heard a simple message with all
the honesty that I meant for you to have and
to hear.

Speaker 2 (05:13):
Thank you.

Speaker 3 (05:59):
I've that so good.

Speaker 4 (06:02):
Ray, Thank you so so much for sharing that with us.

Speaker 3 (06:06):
Yeah, thank You're the best, the.

Speaker 4 (06:08):
Best, A man who goes by many names, Raphael, doctor Santore,
Uncle Ray, my husband's uncle Ray. So but I really
did appreciate that perspective of like, here's a noticeable difference.

Speaker 5 (06:24):
You know.

Speaker 4 (06:24):
I feel like sometimes big public health measures we don't
see the impact right away, right, we only see the
impact when they're taken away. But I love that with
that additional fluoride to the water, it was like, here
is a very clear night and day difference.

Speaker 6 (06:41):
Right, we can really see the effects. And from someone
who's on literally the front line of it, right, holding teeth.

Speaker 3 (06:47):
Day in and day out.

Speaker 4 (06:49):
Yeah, yeah, yeah, we really appreciate it, super super appreciate it.

Speaker 7 (06:54):
Hi.

Speaker 4 (06:54):
I'm Aaron Welsh and I'm erin onmant Updike And this
is this podcast Will Kill You.

Speaker 3 (07:00):
Part two of Fluoride Part two. Yeah, it's on me today.

Speaker 4 (07:06):
I am just thinking how weird it is, and like,
I don't know if I get it. I don't know
if it's like nice, if I'm like comfortable not having
anything to say, you know, nothing to hold anybody. I mean,
it's not I get to just like sit back and relax.

Speaker 3 (07:20):
I liked it last week.

Speaker 6 (07:22):
I would love to do more of those. Very nervous
about this week. But so last week, if you missed it,
we went through Aaron Welsh went through the history of fluoride,
how we figured out what it does, when we started
putting it in our water, slash when it was always there,
we stopped.

Speaker 4 (07:40):
Putting it in our water in some places.

Speaker 6 (07:43):
And the history, yes, of the anti fluoridation movement. So
today I am going to talk to us about Honestly, Erin,
this is going to be just a very long winded
episode for me to end with essentially the same conclusion
that you stated last week that as of right now,
there there is no data of harm to our health

(08:06):
from drinking water with fluoride added to it at the
specific concentrations that we add to it, right that's the
TLDR TLDL tld listen.

Speaker 3 (08:18):
Yep, there you go.

Speaker 6 (08:21):
But let me tell you it took me a very
long time, quite a lot of research and a real
emotional journey to get to that conclusion.

Speaker 4 (08:28):
So okay, I'm curious about the emotions. Number one. Number two,
I think that that illustrates how challenging it can be
yes if you have questions to get to the bottom
of one hundred questions per.

Speaker 6 (08:44):
But we will do our best to do that today
with first going into some detail on like what a
carry or a cavity like we talked about last week,
really is how it forms?

Speaker 4 (08:53):
Quick question, is it ya carries?

Speaker 3 (08:56):
I don't know.

Speaker 6 (08:57):
Erin, I still don't know, and I'm probably just going
to call it cavity because that's my word.

Speaker 4 (09:01):
Okay, I'm finally carries seem so weird, I know, I
kept I kept trying to like adjust the verb noun.

Speaker 6 (09:09):
It's like the dental carries. Okay, how dental carries form?

Speaker 3 (09:13):
How about that?

Speaker 4 (09:14):
How dental carries forms? What carries carries is? What's the
singular of carries? Yeah, we need we clearly do. I
think it's like deer and deer.

Speaker 3 (09:29):
No that I can't accept that. I think it might
see the end, but carries is plural and singular whatever
Aaron listen is.

Speaker 6 (09:39):
We're going to talk about how they form, how fluoride
actually works to protect against the formation of dental carries,
where we're getting that fluoride from, and then of course
all of the controversies if that is the right word
about the supposed or.

Speaker 3 (09:55):
Possible negative health effects of fluoride.

Speaker 6 (09:58):
Okay, okay, so we're gonna talk about today, but first,
but first, it's quarantine.

Speaker 4 (10:03):
It's quarantine. Ay time, we're drinking the same thing we
did last week, and that is pulling.

Speaker 3 (10:09):
Teeth, pulling teeth. Yeah, yeah, okay.

Speaker 4 (10:11):
It's we don't quite remember the ingredients. But that's okay
because you know what, you know, it would have been
so easily accessible in my notes. Yeah, but that's okay
because you know where you can find that on our website.

Speaker 3 (10:26):
Yeah, this podcast, podcast.

Speaker 4 (10:28):
Or all of our social media channels.

Speaker 6 (10:30):
We're there, Instagram, this podcast will kill you Blue Sky.

Speaker 5 (10:35):
I don't remember either tpwky or this podcast will kill
you Facebook.

Speaker 6 (10:39):
We still exist there, TikTok. Also, you know what I mean,
just just follow us.

Speaker 4 (10:45):
Check it, check it out.

Speaker 6 (10:46):
There's mint in it, there's elderflower. It's like it's delicious.

Speaker 4 (10:51):
Let's let's do a web a website spiel. We've got transcripts,
We've got sources. Because I know that you're gonna want
to re up more on floride.

Speaker 3 (11:02):
Yeah you are.

Speaker 4 (11:03):
We've got some. We've got some sources. We've got a
link to where you can submit your first hand account.
We've got links to the books that we feature on
these episodes, and our book club episodes and more things
that was a terrible website should beel You did your best.
Thank you.

Speaker 1 (11:20):
That's all.

Speaker 4 (11:21):
It's all I can do.

Speaker 6 (11:21):
It's all I can hope for rate review and subscribe
on your favorite podcaster.

Speaker 3 (11:26):
Yeah you can.

Speaker 4 (11:27):
We're on YouTube.

Speaker 3 (11:29):
YouTube the let's go, let's go. Okay, after a break,
we'll do it.

Speaker 6 (11:52):
I just want to also set the stage really quick, okay,
and remind us of what a global public health prop
Dental carries are.

Speaker 3 (12:03):
Gonna use them as a plural.

Speaker 6 (12:05):
It's both a plural and a singular. So you're in
the clear, okay, I cannot get it wrong. So the
World Health Organization estimates, and this is a little bit
old data, but it's still what is cited that two
point four billion people across the globe have untreated dental
carries in their permanent teeth, and six hundred and twenty

(12:26):
one million kiddos have untreated dental carries in their primary teeth.
So this is a huge public health problem. There was
a really great Nature review Nature Reviews Disease Primer's paper
from twenty seventeen that I used heavily for the carries section,
and it estimates that sixty to ninety percent of children
and the vast majority of adults are affected by dental

(12:48):
carries at some point in their life, and they're actually
considered the single most common chronic childhood disease.

Speaker 5 (12:54):
Like what I mean, I'm not surprised, I know, And
like many chronic infectious diseases, we do see disparities in
prevalence as well as access to care, with children of
color and children in lower income areas having significantly higher
prevalence and difficulties in access to care.

Speaker 6 (13:13):
Although globally it is still the case, though this is
changing due to dietary changes. Higher income countries actually tend
to have slightly more carries than lower income countries, So
that's largely dietary differences and how much sugar we eat. Okay,
and that's the end that I'm going to say about sugar,
because today is about fluoride. Okay, Let's talk about how

(13:33):
dental carries form. There's two main components that exist for
the formation of dental carries. First is issues with the
enamel itself, and the second is the components of the
oral microbiome. So let's start there. Our oral microbiome is
just so varied. We have so many different things that

(13:56):
live in our mouth. We've got bacteria, yeast, viruses, protozoa,
even our did you know that I did.

Speaker 3 (14:01):
Not know neither.

Speaker 4 (14:03):
How did they get there?

Speaker 6 (14:04):
How did they get there? Many of these organisms are
commensals or even beneficial to our mouth and to our health,
but some are what we call kryogenic.

Speaker 3 (14:16):
And all of.

Speaker 6 (14:17):
These helpful and unhelpful organisms, because I can't just say bacteria.

Speaker 3 (14:22):
It's more than just bacteria.

Speaker 6 (14:24):
They live together, and they grow and form this very
complex biofilm on our teeth surface that.

Speaker 3 (14:30):
We call plaque plack.

Speaker 6 (14:33):
And each surface of each one of our teeth is
its own little micro environment, with its own little microbiome.

Speaker 4 (14:43):
So there's like there's like whole mouth.

Speaker 6 (14:46):
And then there's like each little surface of its tooth.
It's going to be a little bit different. Yeah, isn't
that great to think about?

Speaker 4 (14:53):
I am very curious, Okay, And so I assume that
there's like a fairly there that there's a gradient from
front to too, like if you're closer to the back
of your mouth. What's going on there?

Speaker 6 (15:05):
For no idea? We should do a whole episode on
the oral microbiome.

Speaker 4 (15:10):
Really we should, though, we should like flossing. Listen, we
should talk about floss.

Speaker 3 (15:15):
You know, we've talked a lot about floss.

Speaker 4 (15:17):
You and I you talked a lot about more than
you would expect.

Speaker 3 (15:20):
I know.

Speaker 6 (15:21):
Okay, but listen, let's get back to the oral microbiome
in the contee.

Speaker 4 (15:25):
Of visual teeth, et cetera.

Speaker 6 (15:27):
Yeah, so, under certain environmental conditions, for example, high concentrations
of fermentable carbohydrates like sugar, or conditions like say a
reduction in saliva, we can see a shift in this
microbiome to favor certain bacteria, including various species that are

(15:49):
more either acid producing, so they make more acid from
these fermentable carbohydrates, or they're just very tolerant of this acid.
And it's not just like one, one or two species
of bacteria. We used to think it was just like
maybe a couple different species that were the main causes
of dental carries.

Speaker 3 (16:06):
It's not.

Speaker 6 (16:07):
It's this whole ecological community that shifts to favor acid production,
and that is the first step in the formation of
dental carries. Is this shift in the oral microbiome to
favor acid production, and we most often see this due
to things like regular exposure to sugars.

Speaker 4 (16:24):
Okkay, so we've got this. The first thing, like the
inciting incident, is the sugar, and then that just sort
of selects for this ecosystem exact acid or caryogenic.

Speaker 6 (16:36):
Then we have the hard stuff, our enamel. So as
the acid production from these bacteria starts to build up
in our mouth, the pH of course is going to drop.
Acid has a low pH, and that drops the pH
at the surface of our enamel, which is the outermost
part of our teeth that surrounds the denteene right. Enamel

(16:59):
is mostly made of a substance called hydroxy appetite, which
is basically just a compound of calcium and phosphate and hydroxyl,
which is like oxygen and hydrogen. And in the presence
of acid, what happens is that this becomes soluble. So
there's a partial demineralization of this outer surface of the tooth.
And as this hydroxy appetite starts to demineralize, then you

(17:23):
have an increase in porosity, right, So then this acid
can diffuse even deeper and cause further demineralization, releasing more
calcium and more phosphate from this enamel. Right, and this process,
don't ask questions yet, aarin.

Speaker 4 (17:41):
I can see you take a see me up.

Speaker 6 (17:43):
Yeah, this process and the fact that, like we have
saliva in our mouth which serves as a buffer. Eventually
we're gonna wash out some of this acid. Eventually you
will have remineralization, right because the calcium and phosphate are
being released, Your saliva is coming into buffer and eventually
things even out to where the calcium and phosphate is

(18:05):
gonna redeposit and you can remineralize this unless you can't
because if you continue to have acid production, if you
don't have enough saliva, et cetera, then this demineralization process
can continue until you end up damaging the pulp of
the tooth, which can then damage the canal, the root canal,

(18:26):
and then you end up meeting a root canal or
an extraction. But this process demineralization and then remineralization, mineralization,
it's hard word to say this is happening in our
mouth all the time. I think that we think of
our teeth as like static, right, they're just like little
bones sitting in our mouth, But they're not. They're alive
and they are constantly changing in response to the environment

(18:49):
of our mouth.

Speaker 4 (18:51):
Okay, can you tell me about why low saliva is bad?

Speaker 6 (18:56):
Saliva is a buffer in power in that acid base system,
and so with out the saliva, then you don't have
that buffer. Yeah, and then why there's probably more.

Speaker 4 (19:07):
But the short answer why acid? Like why do these
microbes produce acid? Is it like a competition thing with
other microbes that's just to kind of like stake out
more space and claim that's a deeper dive.

Speaker 3 (19:20):
I don't know.

Speaker 6 (19:21):
Is it just that that's like a byproduct of the
production of sugars, right, That's what it seems like. It's
like they produce mostly lactic acid as a result of
the production or the digestion of sugars. So it's just
like they're poop right right, Yeah, Okay, but that's just
like all of that was just dental carries. That's just
what's happening in our mouth. Where the heck does fluoride
come in? I haven't even said the word fluoride yet.

Speaker 4 (19:42):
It's just lurking in the background.

Speaker 3 (19:44):
It is. It is erin.

Speaker 6 (19:47):
So it is like you said last week, Aaron, you
kind of went into this fluoride is it's just a
mineral salt that's present in our environment. Like all of
us are being exposed to fluoride through various sources. Fluoride
is like the ion form of fluorine, the element which
is I learned, the thirteenth most abundant element in our

(20:08):
Earth's crust. It's just there, it's around, it's in a
lot of different mineral compounds, and it's absorbed very well
via our GI tract when we are.

Speaker 3 (20:18):
Exposed to it.

Speaker 6 (20:19):
But how does it work in our teeth to protect
them from dental carries. There are several mechanisms that we
know of now. How fluoride works. First is that it
delays that initial demineralization process. Basically, fluoride itself you can
think of as acting like a buffer it because of

(20:43):
when fluoride precipitates versus becomes soluble compared to calcium phosphates
and the hydroxyl groups that's in hydroxy appetite. In the
presence of fluoride, you have to have a lower pH
a more acidic environment before that de mineralization starts.

Speaker 3 (21:00):
Does that make sense.

Speaker 4 (21:01):
Yeah, yeah, yeah, like lowers or it raises the bar
or like you got to be even more acidic if
you want to do damage.

Speaker 3 (21:08):
Here exactly exactly.

Speaker 6 (21:10):
And then on top of that, again because of the
chemical properties, it also hastens that process of remineralization. It
returns that neutral pH faster to favor remineralization. Right, so
you're like less demineralizing and more remineralizing.

Speaker 4 (21:29):
Wow, Okay, so it's like a twofold. It protects you
and it also helps to repair fast exactly.

Speaker 6 (21:36):
Yeah, and there are more mechanisms too. It also can
interfere with like the bacteria themselves that form this biofilm,
they can fluoride can interfere with glycolysis, so some of
the specific like metabolic processes in that bacteria that live
in our mouths, especially those carryogenic ones, so that they're
just not as efficient. It's thought that this is probably

(21:58):
not like the most important mechanism, but it is yet
another mechanism by which fluoride is helping the oral microbiome
of our teeth, which is cool. And all of these
events happen even at very low levels of fluoride in
our mouths, like less than one part per million. At

(22:18):
high levels of fluoride, it can also penetrate through the
plaque and then be incorporated into our enamel itself. So
instead of that hydroxy appetite, you can have fluoride there
instead of the OH group. So it's called fluoro appetit.
Did you know that shark enamel is made almost entirely
of fluoro appetate?

Speaker 4 (22:39):
All like what they.

Speaker 6 (22:42):
Don't ask watertails are like, is there a lot of
fluoride in salt water in the ocean. There's like one
to one point five parts per million in saltwater. So nah,
not really, I mean there's so amazing Okay, Yeah, So
that that's some of the other ways. And like we
talked about last week, erin if we are ingesting fluoride

(23:02):
systemically in our water, in our food, whatever pre eruption
i e. When we are little before our first teeth
pop out, it also has been shown to make our
enamel more resistant to the development of carries later on,
especially the deep, craggly bits of our teeth that aren't
ever going to be exposed to topical fluoride.

Speaker 4 (23:24):
Ah okay, And this is both for baby teeth and
permanent teeth.

Speaker 6 (23:29):
All these mechanisms. Yes, yes, And I want to actually
stop here for a second and take a pause, because
this already what I have said, is one of the
points that many of the papers and the rhetoric that
pushes back against the idea of community water fluoridation really
tends to stick on because it is true. And we

(23:51):
talked a little bit about this last week. We know
now that the primary mechanism of action of fluoride is
actually topical, so it is what is happening in on
and around our teeth, in our saliva, in this dental plaque,
et cetera. There are, though, these so called systemic effects

(24:14):
in that there is data, pretty clear data that there's
a pre eruptive benefit to having exposure to fluoride before
your teeth even form, but the primary way that it
works thereafter is by existing in our mouths and around
our teeth. But when you really then think about all
of the different ways that we could be then exposing

(24:35):
people to fluoride, that fact that it is topical, that
it is low levels, that it is a constant exposure,
actually favors water fluoridation because we're drinking it multiple times
a day every day compared to say milk or salt fluoridation,
which are other more targeted strategies that other countries use,

(24:57):
for like large scale fluoride distribution. Right, because drinking it
in our water is this constant low concentration flow. Plus
than anything that's absorbed systemically is then going to be
re secreted into our saliva, although at even lower levels,
right right, right.

Speaker 4 (25:14):
I mean it's it's that the fact that it's if
it's if you're drinking it, then it's then you have
the systemic fluoride in your saliva, bathing your teeth right
in fluoride.

Speaker 6 (25:25):
Right, it's also when that water is in your mouth,
So it's not just like having to be absorbed by
your giatract it's also every single time I've been swishing
my water a lot more since reading about this, Probably ridiculous,
but really.

Speaker 4 (25:37):
Yeah, Okay, so I have a question about the development
of teeth when.

Speaker 6 (25:46):
Oh no, Aaron, Yeah, ask me questions about things they
didn't research.

Speaker 3 (25:49):
Okay, go ahead, I.

Speaker 4 (25:50):
Mean take it away, like when do teeth develop?

Speaker 8 (25:54):
I mean, I pass, Okay, I'm sorry.

Speaker 4 (26:08):
I was just thinking, like, at what level when is
exposure to systemic fluoride? Yeah, for tooth development, Like, really,
what is that critical time period?

Speaker 6 (26:19):
Yeah, I don't know, and I didn't see the specific
data on that. They all just say like pre eruptive,
because I think by the time, so like six months
to twelve months is when your first baby teeth usually
start to appear, and then the obviously adult teeth you
start to lose. Your baby teeth usually by six years

(26:39):
old is like the earliest, sometimes a little bit earlier,
So it's sometime in that time frame, like before the
eruption of especially your adult teeth. But yeah, I don't
I don't have an answer to that, Aaron.

Speaker 7 (26:50):
Okay, okay, But so what are the different ways that
we have used this knowledge that we now have about

(27:14):
how effective Florida is and the ways that it's effective
to prevent dental carries?

Speaker 6 (27:19):
What are the different ways that we've been using this
to improve public health? And you kind of set the
stage for us for this a lot last week, Aaron.
In the US community, water fluoridation is the way that
we as a society, I guess, I don't know, as
a what's the word nation? Yeah, country, the word I
was looking for, Okay. It is the way that we

(27:40):
as a country have decided to do oral health right
is community water fluoridation. We've been doing it for almost
eighty years. It's had tremendous and very measurable public health impacts.
And it is not just the US. Countries around the
globe have been using widely admitted stirred fluoride for the

(28:01):
prevention of dental carries for a really long time. Some countries,
instead of using it in the water, have decided to
use milk supplementation, the way that we fortify milk with
vitamin D in the US. Other countries have used salt,
like the way that we fortify salt with iodine here
in the US.

Speaker 3 (28:16):
Are we sensing a theme here?

Speaker 4 (28:18):
Yeah?

Speaker 6 (28:19):
And then community water fluoridation or CWF is the most widespread.
It's covered an estimated four hundred million people in twenty
five different countries worldwide.

Speaker 4 (28:29):
It's actually less than I thought, Fewer than I thought.

Speaker 6 (28:31):
Okay, yeah, I mean that doesn't account for everyone who
just gets it from naturally floridated sources, which we'll talk about.
But I also just want to do a plug real
quick here, and I have a paper to back this
up that our water fluoridation systems are very, very impressively
good at keeping the concentrations at that point seven parts
per million or milligrams per liter that they are expected

(28:54):
to like better than I expected, honestly, like very verging
at it.

Speaker 4 (28:59):
And I think that's a talk point of some anti
floridationists where they're like, they're not really measuring the water,
it's just like a ballpark.

Speaker 3 (29:05):
They actually do a very good job of it.

Speaker 6 (29:08):
Yea, the US Public Health Surface and the ADA report,
their estimate is that drinking fluoridated water at the level
that they recommend, which again I'm going to say this
a million times zero point seven milligrams per leader, which
is the same as parts per million, reduces dental carries
by twenty five percent in children and adults. And that

(29:31):
number already is now contentious because recently some papers that
have tried to look at, like, what is the benefit
just of floridating our water, specifically in more recent years,
since the advent of other dental hygiene options, like we
didn't used to have fluoridated toothpaste, we didn't used to

(29:52):
have fluoride sealants, et cetera. So some papers that have
tried to look just at more recent data estimate a
lower benefit, maybe like a three to four percent reduction
in carries. And this is based on a Cochrane review
that came out last year as well as a paper
out of the UK that looked at like ten years
of UK data.

Speaker 3 (30:13):
But at the same.

Speaker 6 (30:13):
Time, other recent papers, including one out of Australia from
twenty seventeen and one out of Brazil in twenty twenty one,
actually had much higher carry reduction estimates from their water fluoridation.
So we don't know the exact amount, but the data
is clear across the board that there is a reduction
in dental carries, and every paper that has looked at

(30:36):
the financial impacts consistently finds that community water fluoridation is
a cost effective intervention even when its impacts are less.

Speaker 4 (30:45):
Okay, okay, So I just I really want to understand
why there are such discrepancies and so like, Historically those
numbers were much higher even than twenty five percent, right,
I mean, even the.

Speaker 6 (30:58):
Brazil paper from twenty twenty one at like was a
fifty percent reduction.

Speaker 4 (31:01):
So right, yeah, So what can account for that three
to four percent?

Speaker 6 (31:06):
I don't know in all honesty, Aaron, I mean, is
it just that we have so many other options that
are doing a very good job. And so we've seen
I don't know, because it's not like we've seen reductions
and carries like carries are, if anything, on the rise.
So I don't know, Okay, I don't have a good
answer for you. I just can tell you that is
what the data shows. Yeah, so we we grains of salt,

(31:29):
all of this, okay, okay, but consistently a reduction and
like what level of reduction in carry's prevalence do we
have to hit for this to be considered important if
we know that it's cost effective. That is like so
far beyond my expertise, right, this is like these are
the big questions.

Speaker 4 (31:46):
I mean, it's still it's still to me comes down
to the fact that, like this is a community public
health approach, correct, versus you have to go then go
to the store and buy mouthwashing and buy the right
toothpaste and go to the dentists and all the things
that cost a lot of money. Whereas floridated water.

Speaker 6 (32:03):
It's just yeah, yeah, yeah, and I will take a
reasonable solution, doesn't it. And so that's what we've decided. Okay,
So now we have to get into what I know
that everyone probably really wants to know is there's a
lot of people talking about that fluoride is actually quite
harmful to us. So what does the data show? What
are the risks, if any, of having fluoride in our water?

(32:29):
There are only two potential harms that are worth talking
about in detail today, So that's what I'm going to
focus on. But I do just want to point out
that there are an endless array of things that fluoride
has been blamed for and.

Speaker 3 (32:43):
Continues to be blamed for.

Speaker 6 (32:45):
Kidney dispruption, kidney stones, bladder cancer, all cancer, sex, hormone disruption, ADHD, diabetes,
liver dysfunction, infertility, muscular skeletal pain. Throw a dart at
your Path of physiology textbook. Someone has made a claim
that florid has caused it.

Speaker 4 (32:59):
I mean, last week, what did I say?

Speaker 5 (33:01):
Undo?

Speaker 6 (33:01):
Financially, there's actually data that fluoride in the water people
work more and they have better income and stuff. There's
some papers that say that, which is so interesting.

Speaker 4 (33:13):
I mean, yeah, you're not having to go to the
dentist to like for emergency dental it carries repair all
the time.

Speaker 3 (33:22):
Whatever, what does the data show?

Speaker 6 (33:24):
Okay, let's let's look at this. Yeah, there are some
things that we know for sure. There is very consistent
evidence of absolutely no association between fluoride exposure and cancer
or cancer related mortality, or bone cancer specifically, or hip
fracture or down syndrome or kidney stones, so that we

(33:48):
can say definitely no.

Speaker 3 (33:49):
Association, no association.

Speaker 6 (33:51):
Thyroid dysfunction is another thing that people say is caused
by fluoride. There is really limited evidence for any association
one way. There are papers, some of which show an association,
some of which do not show an association. At this point,
we cannot make any solid conclusion for thyroid dysfunction and
most of the rest of these claims. There is simply

(34:13):
no data to even evaluate these associations, which just means
that anyone who says that these associations exist is lying.
It does not mean that, for sure, there's absolutely no
way that this could ever be related, but there's literally
no data to support these ideas. Okay, but there are
two outcomes that are worth digging into a little bit

(34:34):
more because of the wealth of information that we have
on the subject and all of the controversies that exist
right now. And those two are skeletal fleurosis okay, and
impacts on intelligence as measured by IQ, but which is
often conflated as just this blanket idea of neurotoxicity.

Speaker 4 (34:54):
Mm hmm.

Speaker 3 (34:55):
So let's get into these too, shall we.

Speaker 4 (34:57):
I'm very excited for this.

Speaker 3 (34:58):
Yeah, yeah, excited. It is not the word I would use.

Speaker 4 (35:01):
I am.

Speaker 3 (35:03):
Yeah, it's excited. We're excited. Listen.

Speaker 6 (35:07):
Skeletal fluorosis Okay, Aaron, you talked to us a lot
last week about dental fluorosis, and that is when we're
exposed to a lot of fluoride and then our teeth
get modeled enamel from it because of the fluoride actually
accumulating in our teeth. So much like fluoride can accumulate
in our teeth, if we're exposed at high levels, it

(35:28):
can also accumulate in our bones. And this can lead
to deficient mineralization, essentially because fluoride is getting taken up
in our bones instead of the other minerals that would
normally get taken up in our bones. So then you
just have a change in your bone structure and potentially
weaker bones. Now, remember that we have very strong data
that there's no association between community water fluoridation and hip fractures,

(35:50):
which is one of our main metrics to look at,
like the strength of bones. Okay, but skeletal fluorosis is
something that definitely can happen and does happen. It generally
happens at long term intakes of six to fourteen milligrams
of fluoride or more per day.

Speaker 4 (36:10):
Okay, So what is that in terms of parts per million?
What should we should?

Speaker 5 (36:15):
We?

Speaker 4 (36:15):
Err in math a little bit, Yes, we should.

Speaker 3 (36:17):
I can't wait.

Speaker 6 (36:17):
Okay, if you this is Aaron Math trademark, I could
be wrong, but I did the math.

Speaker 3 (36:25):
Okay.

Speaker 6 (36:26):
If you got all of your fluoride from drinking water
in the US, from optimally fluoridated sources, then you would
be drinking water that was point seven milligrams per liter
or parts per million. Okay, you would have to drink
eight and a half liters of water per day. If
you got all of your fluoride from water, you would

(36:47):
have to drink eight and a half liters of water
per day just to get six milligrams of fluoride in
your diet. I don't know about you, but I can't
even get myself to drink two leaders eight and a
half liters of water per day. That would not be
a healthy amount to drink, okay, And.

Speaker 4 (37:00):
So that just remind me again the range that leads
to that is suggested to lead to skeletal fluorosis.

Speaker 6 (37:06):
So six to fourteen milligrams per day puts you at
higher risk of skeletal fluorosis. It does not mean that
you will have it, but ingestion of six milligrams or
more per day puts, like, at a population level, some
people are going to end up with skeletal fluorosis.

Speaker 4 (37:21):
Okay.

Speaker 6 (37:22):
Now, no one is getting one hundred percent of their
daily fluoride from water. It's estimated that in the US
we get like forty to seventy percent of our daily
fluoride intake from our water and the rest from other
bottled beverages.

Speaker 3 (37:36):
Food. Black tea has so much fluoride in it. Who really?

Speaker 6 (37:42):
Yeah? And you know toothpaste, especially our kids who are
just like chugging that stuff. Yeah yeah, yeah, so annoying
that they do that.

Speaker 4 (37:52):
Personal delicious though, right, Yeah?

Speaker 3 (37:54):
Why do they make it so delicious?

Speaker 4 (37:56):
Is it delicious?

Speaker 2 (37:57):
No?

Speaker 6 (37:57):
But they think it is. It's like bubblegum flavor, and
it's so gross.

Speaker 4 (38:01):
Anyways, bubble gum flavor. Toothpaste grosses me out.

Speaker 3 (38:05):
Yeah, you'd say, but I buy it.

Speaker 6 (38:07):
If you assume, then, on the low end, that you
get forty percent of your fluoride from water, we can
air and math this as well. In order to get
to that six milligrams a day, you'd have to still
be drinking like three and a half liters of water
three point four liters of water, and somehow getting another
two point six milligrams from somewhere else. And you'd be

(38:29):
hard pressed to get that from your other dietary sources.
Eating a lot of toothpaste, I guess might get you there.
So the math just does not work out. And there
are some pretty large meta analyzes that have estimated like
what does water have to be at for someone to
have an increased risk of skeletal fluorosis from their drinking.

Speaker 4 (38:50):
Water from just daily drinking.

Speaker 6 (38:52):
Yeah right, you've got to be looking at higher than
three point seven to three point eight parts per million.

Speaker 4 (38:57):
Which in water, if you were getting something from like
deep well that has not been evaluated.

Speaker 6 (39:02):
Then you definitely could be drinking that. So realistically, bottom line,
skeletal fluorosis is not something that is a concern from
drinking water at the levels that we see in optimally
fluoridated water systems.

Speaker 4 (39:16):
Question, Yes, how is skeletal fluorosis diagnosed?

Speaker 6 (39:20):
Oh, that's a really good question. I don't actually know
the full answer to that.

Speaker 4 (39:25):
Okay, yeah, So do we know the prevalence of skeletal fluorosia?

Speaker 6 (39:29):
No, in areas that like the highest prevalence in areas
that have like really high levels of water fluoridation. I've
seen like maybe ten or eleven, twelve percent, but like
across the globe, it's pretty low. But it certainly is
a risk in areas that have really high fluorid levels.
And I think there are probably some populations somewhere that
have much higher levels than that, But I don't have

(39:49):
like global estimates or anything.

Speaker 4 (39:51):
And so this would be like in areas where you
see higher like maybe there are geographic areas with higher
hip fractures than you might suspect there's higher levels of
fluorid in the drinking water something like that.

Speaker 6 (40:03):
I don't know that I would even go that far, honestly. Okay, Yeah,
I don't think that we have any data to support
those kinds of estimates. No, Okay, Yeah, Now on the
other hand, mild dental fluorosis, which again dental fluoresis you
get from having higher levels of fluoride in your water.
We do still see some degree of mild dental fluorosis,

(40:23):
which is it's considered mild if it's not enough to
cause significant cosmetic concerns, but like a dentist would see
it on your teeth. Depending on the study. There's some
estimates of like ten to twelve percent of the population
in areas that are like optimally fluoridating their water can
still have a mild dental thorrosis. So that is real,

(40:45):
but that's it's not real for skeletal thluorrosis at the
levels of optimally floridated water.

Speaker 4 (40:51):
It's not like having health impacts, correct, it's having teeth,
like the appearance of teeth, correct of your teeth.

Speaker 6 (40:58):
And only in a small proportion of the population, right right, right, correct.
So now a very quick diversion a little bit more
numbers before we get into the possible neurotoxic effects of fluoride,
because these numbers are going to get really important because surprise, surprise,
we need a little bit of nuance here. Okay, I've

(41:22):
said one hundred times already. The US Public Health Service
recommends that if communities are going to add fluoride to
their water, they do so at a level of point
seven milligrams.

Speaker 4 (41:30):
Per leader or parts really parts realion.

Speaker 7 (41:33):
Yeah.

Speaker 6 (41:33):
Now, the EPA, which is the body who is in
charge of regulating and enforcing standards for things like our
drinking water, their standard for the maximum amount of fluoride
that should be in our drinking water is four milligrams
per leader. That is the level at which they can
actually enforce something. Their recommended maximum is two milligrams per leader,

(41:59):
but it's not actually forable. So if a community, for example,
has fluoride naturally occurring in their water between two and four,
the EPA can be like, hey, listen, that's a little high,
but they cannot do anything about it unless it's above four.

Speaker 4 (42:15):
Okay. This this brings to mind a question about the
fluoridation laws that are currently being or anti fluoridation laws
that are currently being discussed or have already been passed,
like in Utah and Florida. If there is naturally occurring fluoride,
and this is maybe this is like a question that

(42:36):
maybe you can't answer.

Speaker 3 (42:37):
But if it is, the questionnaire and it is.

Speaker 4 (42:39):
It is the question if there is naturally occurring fluoride
in one of these states where if you're not allowed
to add fluoride to your water, is there anything done
to reduce the fluoride in that water?

Speaker 6 (42:53):
That is the question, because it also is who is
checking it and who is enforcing those regulations? Right, because
the EPA is in charge of detecting this and of
enforcing these regulations. What teeth do they have to be
able to enforce those regulations? The more that we defund
the EPA, what ability do they even have to be

(43:14):
doing the water testing that they need to be doing
to make sure that our florid is at a safe level,
especially in places with naturally occurring fluoride.

Speaker 4 (43:20):
I'm sure a corporation would love to know, hop in
and charge a great deal of money for that.

Speaker 3 (43:25):
That's a great idea.

Speaker 6 (43:26):
Privatization, Yeah, listen for what it's worth. The World Health
Organization recommends that drinking water should have no more than
one point five milligrams per leader. That's their maximum that
should be allowed in drinking water. And they say that
for any place who is adding fluoride for community water fluoridation,
they should do so at a level between point five
and one milligrams per leader.

Speaker 4 (43:48):
Okay.

Speaker 6 (43:49):
And these numbers, especially that World Health Organization recommendation of
no more than one point five miligrams per leader. That
number is important, So keep that in your brain.

Speaker 3 (43:58):
Okay.

Speaker 4 (43:58):
Okay, yep.

Speaker 6 (44:00):
Back in twenty fifteen, so like a decade ago, now,
the recommendation in the US for optimally floorated water was
a little bit different. It was like a range you
could go anywhere from point seven to one point two, okay,
But then because of the incidents of dental thuosis being
higher at levels above one, they decided to lower it too.

(44:22):
Point seven. Back in twenty fifteen. That same year is
when they established a task force through the NIH actually
not the CDC, but through the National Toxicology Program to
look into the effects of fluoride on neurodevelopment and specifically
on IQ.

Speaker 4 (44:43):
Okay.

Speaker 6 (44:44):
The results of that have now been published just ten
this year.

Speaker 3 (44:49):
Okay.

Speaker 6 (44:50):
There was a monograph by the National Toxicology Program that
came out in August twenty twenty four, and then in
January of this year a like subsequent an additional meta
analysis that was published in Jama Pediatrics. Okay, so I'm
going to tell you the conclusions of this study. Aaron, Yeah,
there is a dose response relationship between exposure to high

(45:14):
levels of fluoridated water and lower IQ scores in children
plain English.

Speaker 3 (45:22):
Yeah, kids who are.

Speaker 6 (45:23):
Drinking water that has higher levels of fluoride, specifically, kids
who are drinking water with more than one point five
milligrams per liter of fluoride may have slightly lower IQs
than kids who are drinking water with less fluoride. And
it's like it goes up with the amount of fluoride

(45:44):
above one point five milligrams per lid.

Speaker 4 (45:47):
Above one point five and there's a like the more fluoride,
the higher the reduction in IQ, which, as we maybe
know is is not a the best metric for things,
but it is a metric. Yeah you have? Do you have?

Speaker 6 (46:07):
There's so much and bursting to say, and it's it's hard, okay, Yeah,
And I cannot get too in depth on the exact
effects size of this because we don't have those exact
numbers from drinking water itself, Like what is what are
we talking about? How much of a reduction in IQ?
They didn't actually estimate those numbers from drinking water, but

(46:29):
they also looked in this meta analysis at urinary fluoride,
which is it's a little bit problematic to use because
we excrete most of the floor that we drink in
our urine. But the like concentrations are going to vary
depending on the time and how much water are you drinking,
blah blah blah. But in any case, for every one
milligram per liter increase in urinary fluoride, we saw in

(46:54):
this meta analysis a one point six y three points
decline in IQ.

Speaker 4 (47:00):
Okay, Okay, just again to like set just so that
I understand this is in Okay, maybe i'll phrase it
this way. Yeah, which communities in the US have water
that's higher than one point five parts per million.

Speaker 6 (47:15):
Before I can even get into that airin. None of
the studies that were in this meta analysis were in
the US.

Speaker 3 (47:21):
None of them.

Speaker 6 (47:22):
Almost every single study that was included in this meta
analysis were done in places that had naturally high levels
of fluoridation. None of them were in places that were
adding fluoride to the water at optimum fluorid concentrations.

Speaker 3 (47:39):
A lot of the.

Speaker 6 (47:40):
Studies that were a lot of the studies that had
you know, like low fluoride versus high fluoride their low
fluorid concentrations were actually at levels that are consistent with
what we consider fluoridated water, right because like across the board,
everyone's got higher fluorid. So high fluoride was like above
two and low fluoride was zero point five point eight. Okay,

(48:02):
I know this is so it's too much.

Speaker 4 (48:04):
No, no, no, no, okay. So so this this, this review,
this meta analogy, this, I guess, this this task force. Yes,
that was established in the.

Speaker 3 (48:13):
Part of the National Toxicology Program. Yeah, I guess.

Speaker 6 (48:16):
I don't know if it was a tech task force.
Feels official, but yeah.

Speaker 4 (48:19):
Okay, okay, okay. But there was not a single study
that it was included that was done that was based
in the US. No looking at water that is community
fluoridated in the US.

Speaker 2 (48:31):
No.

Speaker 6 (48:32):
Another meta analysis from a couple of years ago, published
in twenty twenty three, which one could argue might be
more relevant to the question of like, is fluoridating our
water two point seven parts per million potentially harmful, found
no reduction in IQ between unfloridated water, which had an
average florid concentration of point two parts per million, and

(48:53):
optimally fluoridated water, which was at point seven parts per million.
And if you look at this, that is actually entire
highly consistent with this newer meta analysis from twenty twenty five.
Because all of the data in this meta analysis showed
that there was a potential for reduction in IQ at
levels higher than one point five, there was no association

(49:16):
scene for IQ at lower levels than one point five
milligrams per leader. That association broke down and fell apart.
There was no data to support it in this large
meta analysis.

Speaker 4 (49:29):
So if you're looking at a graph of this, maybe
this is a terrible thing to do on a podcast,
but hey, we're video now. I'm just gonna use my hands. Yeah,
But if you're looking at a graph of this, and
on the x axis the bottom, it's fluoride levels in
the water, and it's on the y axis is IQ

(49:50):
reduction and IQ or something. Yeah, it's a straight level
from zero from like no fluoride in the water all
the way past what the point seven optimally fluoridated water,
keep going still straight line until you get to like
one point five above, and then it starts to you know,
change exactly.

Speaker 6 (50:13):
Okay, that's the conclusionaryan So you asked, sorry, you asked earlier,
how much? How many people are getting more than one
point five?

Speaker 3 (50:31):
Yeah, okay.

Speaker 6 (50:32):
In the US, it's estimated that two point nine million
people are served by groundwater or private wells that have
concentrations greater than one point five, and several hundred thousand
having concentrations higher than two point oh which is again
the EPA non enforceable maximum recommended, or even some above

(50:55):
four point oh which is above what is even supposed
to be enforceable by the EPA. Globally, it's estimated that
fifty seven million people at least receive water that is
naturally fluoridated, which means who heck knows what the concentration
of fluoride is.

Speaker 4 (51:10):
Right right, right, fascinating compared to.

Speaker 6 (51:14):
Two hundred million people in the US who are estimated
to get their water from optimally fluoridated community water fluoridation
sources at point seven parts per million.

Speaker 4 (51:24):
I mean this just to me speaks even further to
that the point of the anti fluoridation movement is not
to actually like protect health, it's just to deregulate and
be anti expert. Because I really do want to know

(51:45):
whether these states that are introducing these anti fluoride bands
or these fluorid bands are doing anything in the communities
that are served by naturally floridated water at levels that
are shown to have any sort of health impact.

Speaker 6 (52:00):
Yeah, And I also want to point out a big
difference that I noticed, because again, I there are so
many papers on this, and there are so many papers
that have a very clear bent to them, right, because
I mean even scientists, like we all have our own biases,
right totally, and some of them have a very clear bent.

(52:21):
Some of them it's maybe less clear. And I mean
in both directions, right, Like, some are very clearly like
pro florid, and some are very clearly anti florid, and
a lot are somewhere in between, but from the scientific
side and not from like the social media side or
the political side or the like we like it is
a neurotoxin, it's killing us side right right. All of

(52:42):
the papers, even the ones that are very concerned about
florid in their water, the main concern that I took
away from those is the potential effect of maternal ingestion
of high levels of fluoride. Yeah, infant ingestion of high
levels of florid, especially in the context which I will
say I had not thought about before of formula use,

(53:02):
like if babies are not breast fed and are fed
by formula, because some formulas actually have relatively higher levels
of fluoride. So then if you are also using fluoridated water,
whether naturally fluoridated or optimally fluoridated, because infants are so tiny,
could you potentially be getting too much in those tiny humans?
But even on those points there has been very mixed

(53:25):
results from even like long term studies. There was a
paper from twenty nineteen in jama Pediatrics that cut a
lot of press and it seems was very controversial that
showed a for looking specifically at maternal ingestion of fluoridated
water in Canada where they optimally.

Speaker 3 (53:45):
Floridate their water.

Speaker 6 (53:46):
Okay, they showed a reduction in IQ in those babies
born to people who are drinking floridated water, but only
in boys, and that was not true in girls, and
it was not true if you looked at all babies.
So that was a little bit like, we don't understand
how that could be. And then another analysis on I

(54:07):
don't know if it was the exact same cohort or
but like using that same study because it was like
this really huge study in Canada that came out a
couple years later actually did not show any difference in
IQ once they accounted for exposure after birth. So even
kids who are drinking fluoride in their water did not
have lower IQ than those who were not drinking floridated water.

(54:30):
So again the data is still a little bit messy,
like there's not a clear there's not a clear association
there at optimally floridated levels.

Speaker 4 (54:38):
Right, Okay, I think I'm just confused by those studies
are like what they're what the conclusions are. I mean,
basically it sounds like it's noisy and a mess and.

Speaker 6 (54:49):
A mess and there's still not like there is not
the conclusion that optimally fluoridated water has an impact on IQ.

Speaker 4 (54:57):
And I think here that's that's the message that gets lost, yes,
because people will just say fluoride, right, and there is
a big difference between fluoride and optimally like naturally fluoridated,
right and optimally fluoridated or like managed fluoride.

Speaker 3 (55:14):
Level, manage fluorid levels.

Speaker 6 (55:15):
And just just to make this drive this point home
with regards to any of the other so called neurotoxic effects,
because sometimes fluoride just gets labeled as like a neurotoxin.
There is not any data to back up any of
the other claims headaches, insomnia, lethargy, autism, ADHD. There's no
data whatsoever that positively associates fluoride in our water with

(55:39):
any of those other neurologic effects. Only IQ, and only
at levels that are higher than the World Health Organization
maximum recommended level twice as high as what we see
in community water fluoridation.

Speaker 4 (55:54):
Twice as high.

Speaker 3 (55:54):
Yeah. So for me, I one of.

Speaker 6 (55:59):
The main conclusions that I come to when we look
at this debate on fluoride is that there is always
going to be a certain degree of uncertainty in science.

Speaker 3 (56:10):
Right.

Speaker 6 (56:11):
We've talked preached a lot o Yeah, and that can
sometimes feel really scary. But the nature of the scientific
process and scientific inquiry is to keep asking questions, could
we do this better? Can we make this safer? Can
we improve on our processes? What changes do we need
to make, What studies do we need to do to
gather more data?

Speaker 4 (56:32):
I mean, it's why we revised the optimally floridated level
two point seven.

Speaker 3 (56:36):
That's exactly your secondly revised it. Right.

Speaker 6 (56:39):
At the same time, we have to function as a society.
Our governments are regulatory bodies. They have to make the
best decisions that they can based on the data that
we have. And that is exactly what has happened and
continues to be happening when it comes to fluoride. No
one is not looking at this problem. There is so
much data now that we have that at the levels

(57:01):
of fluoride that exist in some of the naturally fluoridated areas,
we need to figure out how to lower fluoride levels
in those communities because we could potentially be causing harm. Yeah,
and there is data that at the level of zero
point seven milligrams per leader, at less than one point five,
there is a significant improvement in our dental health and

(57:23):
no adverse effects other than a slight increase in mild
dental fluoroesis I mean?

Speaker 4 (57:28):
And some of this stuff, Like, I think it's hard
because and we talked about this a little last week.
We've been fluoridating water for eighty years and things have
and we've learned a lot in that time, and we've
made adjustments accordingly in that time, and we've been open.
I do think I think there's sometimes an accusation from

(57:52):
certain individuals or people with certain agendas to say that
science just barges ahead without thinking of the consequences.

Speaker 3 (58:00):
Twice we do.

Speaker 4 (58:01):
Sometimes we do there. I mean, there's this is this
podcast will kill you. I talked about a lot of
instances where that's happened exactly. But I think when it
comes to florid, like just like you said that the questions,
the fact that there are still some unanswered questions is
not cannot erase the fact that we have answered many, many,
many questions about floride and optimally fluoridated water.

Speaker 6 (58:23):
Yeah, exactly, I do think it's It's not this is
not the end of the floride story. There's going to
be more data, more studies that keeping done, especially at
like trying to pull apart the nuances. Should we go
from point seven two point five two point.

Speaker 3 (58:39):
Six two point six five? I don't know. Can we
keep doing better?

Speaker 4 (58:42):
And I think some of the data will come from
these states that are choosing to stop fluoridating.

Speaker 3 (58:49):
We already have data.

Speaker 6 (58:50):
You mentioned last week Aaron in Calgary in Canada, where
they took florid out of the water. There was a
ten year analysis that has looked so far and seen
a slight not like a huge, but a slight increase
in dental carries there compared to Edmonton, which still has
floridated water. There's also a few other studies that I
cite that are looking at exactly the same thing. So

(59:12):
in places where they've taken floride out of the water,
what do we see, We see worse dental health. The
other thing I think that for me this really points
out is like the importance of our federal regulatory bodies
and how essential they are in keeping our drinking water safe.
Because if we're talking about, oh my gosh, we're looking

(59:34):
at this potentially extremely harmful chemical and all of these
effects then and like our community water systems are actually
poisoning us. First of all, we got to look at
the data. So we need some scientists to actually look
at the data and explore all of this nuance, which
they've done, And then we need our regulatory agencies to
be able to identify what the limits should be and

(59:57):
enforce those limits.

Speaker 4 (01:00:00):
So I mean, it was going to fund that, right,
these jobs should exist, and some of them no longer
exactly take it away, right, what pathogens are in milk? Right,
like what bird flu in milk. You know, it's just
there's so much.

Speaker 6 (01:00:15):
That's the thing that's so I think frustrating about the
discourse surrounding florid right now is it's like, we'll take
this out of our water when it's like what then who?

Speaker 3 (01:00:25):
What?

Speaker 2 (01:00:26):
Like?

Speaker 6 (01:00:27):
First of all, who is going to do that? Second
of all, who who is going to enforce this? What
about all the places that are already have it there?
Like the politics of it are just so different from
what the science shows right now.

Speaker 4 (01:00:39):
Oh and I think that's the whole point, right, I know,
florid is a tool to you know again, deregulate and
privatize and change who the experts are.

Speaker 7 (01:00:50):
I know.

Speaker 6 (01:00:51):
Well, if you want to become an expert on this,
let me tell you where to read. Okay, yes, I
already mentioned there was a great Nature Reviews Disease Primer's
paper just about dental carries. It was called Dental Carries
from twenty seventeen. A couple of other great papers that
I had on the mechanism of action of florid. Actually, Aaron,
did you read this one from the Journal Dental Research
on twenty nineteen. It was called florid motive action. Once

(01:01:13):
there was an observant dentist.

Speaker 4 (01:01:15):
Uh no, I didn't.

Speaker 3 (01:01:16):
I really it was quite historical, but it was really
really fun.

Speaker 6 (01:01:21):
Then when we get into the you know, the meat
of what people want. The paper from twenty twenty five
from Gama Pediatrics was by Taylor at All Florid Exposure
and Children's IQ Scores, A systematic review in meta analysis.
The one from a couple of years earlier that looked
at more relevant florid levels was by Kumar at All

(01:01:41):
in the Journal Public Health. That was titled Association between
Low florid Exposure and Children's Intelligence A meta analysis relevant
to Community water floridation. There was another one I actually loved.
Sorry I'm giving shout outs longer than I usually do,
but this one was super great from twenty twenty four
by Tayhar at All. I'm sorry if I'm pronouncing that wrong.
In Critical Reviews and Toxicology. This paper looked not just

(01:02:04):
at IQ, but this one looked at every claim that
people have made about fluoride. What is the evidence epidemiologically,
what is the toxological evidence, what is the evidence in
animals in vitro? And it came up with this really
comprehensive table to look at all of these and so
that is a really great paper. You can check out

(01:02:26):
the list of sources from this episode and every single
one of our episodes on our website, this podcast.

Speaker 3 (01:02:31):
Will kill you dot com. There do you kill anymore
any more?

Speaker 4 (01:02:36):
Thank you again so much to doctor Santore for sharing
that story with us. We appreciate you so much.

Speaker 3 (01:02:43):
We really do.

Speaker 6 (01:02:45):
Thank you also to Bloodmobile for providing the music for
this episode and all of our episodes.

Speaker 4 (01:02:49):
All of them. Thank you to Tom and Leanna and
Pete and Brent and Jess and everyone at exactly right
who helps this to happen, helps this to happen, helps
us make this happen. Yeah, there we go. We'll go
with that.

Speaker 6 (01:03:03):
And thank you to all of you for listening, for watching,
for joining us on this journey.

Speaker 4 (01:03:08):
We're talking with journey for now, but we're not done
with teeth or gums or flossing or whatever. Wait anyway.
Thank you also to our wonderful patrons. We appreciate your
support so very much.

Speaker 3 (01:03:23):
Thank you well.

Speaker 4 (01:03:25):
Until next time, brush your teeth, you filed the animals,
and wash your hands.

Speaker 3 (01:03:33):
Boom