Fluoridation News Quarterly

Vol 1 January 2019

American Fluoridation Society

Fluoridation News

Fluoride exists in water naturally. The public health initiative of water fluoridation is simply the adjustment of that fluoride to the level at which maximum dental decay benefit will be obtained with no adverse health effects.

In This Issue:

  • Comments From The President
  • Latest Research News
  • Recent Activities of AFS
  • AFS Training Program
  • Myth Busters
  • T-Shirt Info – “F Yeah!”
  • About the AFS

Board of Directors

President: Johnny Johnson, Jr,. DMD, MS

Vice-President: Myron Allukian, Jr,. DDS, MPH

Secretary: Jennifer Martinson, BS, RDH

Treasurer: Kurt L. Ferré, DDS

Communications Officer: Steven D. Slott, DDS

Board Emeritus:  Charles C. Haynie, MD, FACS

Help support our cause by donating to AFS today!

Comments From AFS President, Dr. Johnny Johnson

Welcome!!  I want to jump right into a very exciting community water fluoridation (CWF) effort that was on the ballot this past Election Day in a Florida town barely an hour away from my home. We won this vote to continue CWF by a 65 to 35% margin!

This battle had all of the tough challenges that you could throw into the mix:

The mayor was anti-CWF and made this a mission of hers to cease it after three decades.

The community was relatively uninformed about CWF and had no idea this was being challenged.

The proposal was placed on a very long ballot in an off-year general election .

What wasn’t expected by the mayor and two city council members that supported her goal to put it to a referendum was the response of the local community. And were they unpleasantly surprised. The silent majority was highly motivated to turn out in droves to soundly defeat this attempt to cease CWF.

I would like to recognize the local leaders who were key in educating the community on what was going on. As well, I cannot emphasize the role that the media played in constantly educating the families in Brooksville. That ranged from the local radio stations, newspaper, to NPR and NBC National News.

In local campaigns like this, it’s crucial to have respected people outside of the dental and medical community who are on your side.

( Continued after AFS Training Program Section … )

AFS President, Dr. Johnny Johnson

Latest Research News

2018 Studies by Slade, Sanders, Maas, et al. Demonstrate Effectiveness of Fluoridation, and Improvement in Health Disparities of the Underserved Population

The first study, Water Fluoridation and Dental Caries in US Children (published in the June, 14 ,2018 edition of the Journal of Dental Research) sought to evaluate associations between availability of community water 􀃓uoridation (CWF) and dental caries experience in the U.S. child and adolescent population. Using County-level estimates of the percentage of population served by CWF (% CWF) from the Centers for Disease Control and Prevention’s Water Fluoridation Reporting System merged with dental examination data from 10 y of National Health and Nutrition Examination Surveys (1999 to 2004 and 2011 to 2014) the study concluded:

“These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth.”

The second study, Water Fluoridation Lessens Income-Related Inequality in Dental Caries of U.S. Children and Adolescents ( G. Slade, A. Sanders, published in JAMA Pediatrics) it was noted:

This is the first U.S. study to show evidence that water fluoridation attenuates income-related inequalities in dental caries. The degree of attenuation was less pronounced in the permanent dentition, possibly because the level of decay was about half that of primary teeth. Greater attenuation in the permanent dentition might be seen in early adulthood, as the burden of Decayed, Missing, Filled Surfaces doubles between adolescence and early adulthood.”

Criticisms of Recent NTP Study Without Merit

The recent animal study by the National Toxicology Program (NTP) has predictably concluded no adverse cognitive effects on rats, resulting in equally predictable criticism of the study by the same fluoridation opponents who had initially requested the study be performed, promoted it as “what could be the most significant scientific development of them all” lauding the NTP for its “cutting-edge scientific tools”, and claimed it “could end fluoridation”. (Fluoridealert December 11, 2015)

As would be expected, once it became public that the results of this study did not support the claims of opponents, the usual conspiracy/corruption, improper methods, and other groundless claims, began being leveled at the NTP study by those same opponents who had themselves requested and promoted the study and the integrity of the NTP.

In response to these criticisms, principle author of the NTP study, Dr. Jean Harry, stated the following:

The rationale for strain selection was based on three factors.

  • For learning and memory tasks requiring detection of visual cues, rats with pigmented eyes offer better visual acuity than albino rats (Prusky et al 2002). As presented in the NTP systematic review, longer latencies for learning and memory tasks in fluoride-exposed rats raised the possibility that some deficits may also be due to compromised vision.

  • The Long-Evans Hooded rat is a cross-breed of Wistar albino females with wild gray males. Thus, it allowed us to stay with the predominant Wistar rat genetic background yet have the benefit of pigmented eyes.

  • Research groups such as National Institute on Drug Abuse (NIDA) have long employed Long-Evans Hooded rats for behavioral tests such as those used in the McPherson et al (2018) paper, and such research provided us a strong historical database for the behavior in rats maintained on the standard diet used in the McPherson et al (2018) study.

In summary, far from generating “false results” that may “misinform the public”, our data utilize an exposure level near the recommended level for human exposure and provide an extensive, systematic evaluation of sensory, motor, and cognitive function in a relevant animal model. Instead of misleading regulators and the public, the results of the McPherson et al (2018) help clarify a generally confusing database and can only facilitate decisions concerning the safety of fluoride exposure through the drinking water.

AFS Training Program

Dr. Johnny Johnson conducting an AFS Training

The AFS train-the-trainer program is for dental and medical professionals, oral health coalitions, state health departments, and interested advocates for oral health and water fluoriation.

The program is designed to create a cadre of dental professionals who will become trainers in their respective states with these objectives:

  • Enhance the fluoride-related knowledge of dental professionals in their states;
  • Provide guidance for dental professionals to have brief, productive conversations with patients and the public about fluoride and fluoridation;
  • Encourage dental professionals to identify health fairs, monthly health observances and other events as proactive opportunities to educate the public about fluoride and fluoridation;
  • Identify dental professionals who can serve as public spokespersons on CWF and/or provide testimony to state or local governmental bodies;
  • Engage dental professionals to approach CWF decision-makers to provide education and scientific materials, appropriately framed for the health literacy of the decision-makers;

Within the past year, the AFS has provided this valuable training in five states, with plans to increase this yearly.

Comments From AFS President … Continued

Case in point: Reverend Frankie Burnett, who is a former City Council member in Brooksville and staunch supporter of CWF. Rev. Burnett was critical in encouraging many people, especially the African American community, to step up and be counted at the polls. I worked with several local advocates to distribute 150 t-shirts with the slogan “Keep Brooksville Fluoridated, Vote Yes.” These t-shirts were widely worn and helped us advertise the upcoming election.

Ashley Thomas was another person I want to praise. She is the Public Information Officer for the Florida Department of Health in Hernando County. Ashley worked tirelessly to provide educational materials to families in Brooksville. She also appeared with me on many of the 6-7 radio interviews that were produced by the local radio stations. The media and other stakeholders helped to raise awareness that CWF (and good oral health) were in jeopardy, including:

AFS President, Dr. Johnny Johnson, DMD, MS

  • Hernando County Times newspaper

  • Hernando County Government Broadcasting Station interview

  • WWJB (AM) and WXJB (FM)

  • WUSF (University of South Florida) and NPR

  • Florida Dental Association: Yard signs, engaging local dentists, and media assistance.

  • NBC National News


Folks, this is the kind of help that AFS wants to bring to your community.. We can help you with your local battle(s), provide you with materials and documents to rebuke claims by opponents, as well as provide “boots on the ground expert testimony” at your request. All of this is at no or little cost to you. We are funded by a grant from Delta Dental of California’s “Community Care Foundation, Oral Health Education Fund”.

Get in touch by emailing me!

Dr. Johnny Johnson, AFS President



Hundreds of studies now link fluoridation to brain disorders.


When considering studies put forth as evidence, it is not enough to simply consider quantities and titles. Those putting forth the evidence must be held accountable to provide quotes and other information from within the studies themselves, to support their claims about these studies in regard to fluoride at the concentration level at which water is fluoridated. Because activists list study titles, does not mean that these studies are valid, or relevant to fluoride at the optimal level. Neither does it mean that the conclusions of these studies have been correctly represented by these activists. PubMed lists over 55,000 studies on fluoride. Within that large volume of studies can certainly be found a relatively few titles which, without a review of the studies, seem to support the antifluoridation position. In their latest petition to the EPA to end fluoridation, antifluoridation petitioners cited these “hundreds of studies” as supporting evidence of their claims of neurotoxicity of fluoride. In its 40 page rejection of this petition, EPA reviewers….citing facts, evidence, and peer-reviewed science…..systematically dismantled all of the arguments of the petitioners, while pointing out the invalidity, irrelevance, and misrepresentation by petitioners, of the studies presented as their evidence. When considering studies put forth as evidence, it is not enough to simply consider quantities and titles. Those putting forth the evidence must be held accountable to provide quotes and other information from within the studies themselves, to support their claims about these studies, in regard to fluoride at the concentration level at which water is fluoridated.


“Pharmaceutical grade” fluoride is more desirable than “industrial grade” fluoride


The use of terms “pharmaceutical grade” and “industrial grade” fluoride are misleading. Regardless the compound used for fluoridation, the fluoride ions released into water by these compounds are identical. Thus, the only difference is in the cost of the substances, and the potential amount of contaminants which may be introduced by the substances. Not only are “pharmaceutical grade” fluoridation substances significantly more expensive to use than “industrial grade”, they potentially introduces significantly greater amounts of contaminants into the water than do “industrial grade” fluoridation substances such as the widely used hydrofluorosilic acid. While the level of contaminants in “pharmaceutical grade” may be entirely within a safe range for the single-shot uses such as toothbrushing for which they are produced, when multiplied by the large volume necessary for fluoridation of entire water systems, the amount of contaminants released by these substances could very well exceed safe levels. The “industrial grade” fluoridation substances, on the other hand, are designed for large volume use, and are considerably more pure on a large volume level than are “pharmaceutical level”.

From the CDC: Some have suggested that pharmaceutical grade fluoride additives should be used for water fluoridation. Pharmaceutical grading standards used in formulating prescription drugs are not appropriate for water fluoridation additives. If applied, those standards could actually exceed the amount of impurities allowed by AWWA and NSF/ANSI in drinking water. The U.S. Pharmacopeia-National Formulary (USP-NF) publishes monographs on tests and acceptance criteria for substances and ingredients by manufacturers for pharmaceuticals. The USP 29 NF–24 monograph on sodium fluoride provides no independent monitoring or quality assurance testing. The USP does not include acceptance criteria for fluorosilicic acid or sodium fluorosilicate. As a result, the manufacturer is responsible for quality assurance and reporting. The USP does not provide specific protection levels for individual contaminants, but establishes a relative maximum exposure level for a group of related contaminants. Some potential impurities have no restrictions by the USP, including arsenic, some heavy metals regulated by the U.S. EPA, and radionuclides. Given the volumes of chemicals used in water fluoridation, a pharmaceutical grade of sodium fluoride for fluoridation could potentially contain much higher levels of arsenic, radionuclides, and regulated heavy metals than an NSF/ANSI Standard 60-certified product. In addition, AWWA-grade sodium fluoride is preferred over USP-grade sodium fluoride for use in water treatment facilities because the granular AWWA product is less likely to result in exposureto fluoride dust by water plant operators than the more powder-like USP-grade sodium fluoride.
CDC Article: Community Water Fluoridation


There are IQ reductions associated with fluoridated water


The main studies on which fluoridation opponents base their claim of IQ reduction are the 2011 meta-analysis of Choi and Grandjean (erroneously referred to as the “Harvard Study” by opponents), and the 2017 Bashash, et al. study of effects of prenatal fluoride exposure on the offspring of pregnant women residing in unfluoridated Mexico. Neither of these studies has any applicability to fluoridated water in the United States, for various reasons. In contrast, several studies which do, indeed address fluoride at the relevant level, clearly demonstrate there to be no association of fluoridated water with IQ.


Mass Medication/Personal Choice


A. There is no medication involved in water fluoridation. There are only fluoride ions, identical to those which humans have ingested in water since the beginning of time. To suddenly proclaim these ions to be medication has no merit. In spite of repeated efforts by fluoridation opponents through the decades to have fluoridation declared “forced medication”, no court of last resort has ever affirmed that argument.

B. There is no personal choice affected by water fluoridation. Removal of choice would mean that people are forced to consume fluoridated water, with no alternatives. Individuals are free to consume fluoridated water or not. Entirely their choice. Anyone who chooses not to consume such water may obtain fluoride-free bottled water, filters to remove fluoride from their own water, or to obtain and purify water from streams rivers, or other sources. While these alternatives involve cost and/or inconvenience, it must be realized that no one is guaranteed the right to have fluoride-free water piped directly into their dwellings. Fluoride at the optimal level at which water is fluoridated is colorless, tasteless, odorless, and causes no adverse effects on anyone. It therefore has no impact on water quality. Those who choose not to consume fluoridated water do so not because of quality issues of the water, but because of personal preference. Therefore, any cost or inconvenience involved in satisfying that personal preference is their responsibility to bear, not that of society.

AFS F-Yeah! T-Shirts

AFS T-Shirt: Fluoridation? F-Yeah!

The Story of the “F-Yeah!” Shirts

In May 2013, public health advocates in Portland, OR lost an emotional campaign to end their city’s distinction of being the the largest city in the United States that doesn’t fluoridate its public water supply.

Portland is the home to AFS Treasurer, Dr. Kurt Ferré, and a dental colleague who lives in the same neighborhood. It is also home to the sister of the colleague, who thought that the lawn sign with a smiley mouth for the pro-fluoridation campaign, was “too nice”. Being a high school chemistry teacher she took it upon herself to create a limited edition of her own, edgy, lawn sign for “Portlandia”. Taking the symbol for Fluorine from the Periodic Table she stenciled “Yeah!” to its right and placed the ballot measure number at the bottom. One of these creative lawn signs was placed in front of the home of her brother, the dentist friend of Dr. Ferré. Of course, Ferré noticed the sign immediately.

Win or lose there are always “lessons learned” from a political campaign. Dr. Ferré was asked to speak about the Portland fluoridation campaign at the 2014 National Oral Health Conference (NOHC) in Ft. Worth. Wanting to end his talk on a positive (and humorous) note, Dr. Ferré told the story of the “F Yeah!” lawn sign, held up the sign, and shouted “F Yeah! This was met with enthusiastic applause. A dental hygienist friend of Ferré’s immediately approached him afterwards and said, “Kurt, we need to make T-shirts with ‘F Yeah!’ on the fronts of them.

Since 2015 the AFS has had an exhibit booth at the NOHC spreading the word about the AFS “boots on the ground” advocacy for fluoridation, and selling tees. The edgy nature of the front of the tee has made for an excellent conversation starter, especially at dental and public health conferences. However, wearing the tee out in public was often met with blank stares. The board decided that the word “FLUORIDATION” placed above the F symbol might be a better configuration. The edgy “F Yeah!” would catch the attention of people, who would then notice the word “FLUORIDATION”.

While the new design will be the only one officially available from the AFS, as some Oregon public health colleagues have expressed a preference for the edginess of the original front logo, that logo will be available upon request.

The new tees will be available at the 2019 NOHC in Memphis in April. For any who can’t wait until then, however, tees can be ordered by contacting Kurt Ferré at kferre51@gmail.com . Cost is $20.00 + $5.00 for postage and handling.

About The American Fluoridation Society

The American Fluoridation Society was founded in 2014 by a group of concerned professionals anxious to see all residents of the United States served by community water systems enjoy the benefits of community water fluoridation (CWF). Equally important to this Society is to prevent rollback attempts by opponents of CWF, as well as to initiate CWF where it has not been previously available.