Bill Osmunson DDS, MPH
President of Washington Safe Water
1418 -112th Ave, NE 200
Bellevue, WA 98004
June 4, 2012
Gary Goldbaum, MD, MPH
Health Officer & Director
Snohomish Health District
3020 Rucker Avenue, Suite 306
Everett, WA 98201
Dear Dr. Goldbaum,
James Deal asked me to provide some background to you on what changed my mind to become opposed to fluoridation of public water.
Many are ingesting too much fluoride from many sources (especially infants), and perhaps because we are ingesting too much from other sources, the additional fluoride from public water does not show significant public health benefit. And the risks of excess fluoride are very serious.
In the 1960’s in High School I had a friend whose dad was opposed to fluoride, my friend cautioned me not to swallow toothpaste.
In 1966 I went to school in Austria and one of our teachers was opposed to fluoridation of public water based on freedom of choice and she claimed she and others were fluoridated against her will during WWII. Ethics is a high priority for me.
In 1973-4 my major professor in my MPH program took me to the Philippines for a field project and there we spent a short time with people who had goiters. Dr. Scharfenburg MD, MPH, suggested the high natural fluoride content in the area combined with inadequate iodine caused the goiters, but he was not confident in this conclusion. Those with goiters lived on the coast and ate a significant amount of fish which I felt had some iodine. Another nutrition professor claimed fluoride was a nutrient and was beneficial. Clearly they were not confident. We considered putting iodine into Pepsi drinks, but chose not to do so, in part because the dosage would be uncontrolled.
During my dental school studies, from 1974 to 1977, my professors had open minds, but they all reluctantly supported fluoridation for various reasons. The science presented was fair to good, but they were quite open to the lack of quality science and lack of evidence finding reduced dental expense. With calm judgment, they supported fluoridation.
My mentor in dental school was a cardiovascular surgeon. He repeatedly reminded me that to pass I needed to learn at least 80% of what they taught me, that 50% of what they taught me was wrong, and that they didn’t know which 50% it was. In other words, he emphasized that I should be open to scientific change.
Yes, I was open to critical scientific thinking, however, I still fell back on the confident assertions of my professors that fluoridation was “safe and effective”. Thus, when I began practicing dentistry, I promoted fluoridation and did so from 1978 until around 2000. I wrote fluoride Rx’s for supplements, provided fluoride office treatments, and spoke up publicly on fluoride’s benefits. I even played a game with my assistant, in which I would guess whether a new patient lived in a fluoridated or non-fluoridated area based on my observations of their teeth. She did not show me the new clients’ addresses. If the patient had hard, shiny teeth, I guessed they lived in a fluoridated area. If the patient had dull, soft looking teeth, I guessed they lived in a non-fluoridated area.
Science has revised and improved upon many of the theories we were taught in dental school. My professors said we would stop mercury amalgam fillings as soon as something less expensive than gold was invented. In 1984 new bonding techniques came out which worked well in the posterior teeth and I have not done any mercury fillings since that time, even for welfare and charity patients. It is not legal for me to put discarded mercury fillings in the trash or down the sewer, and so it makes no sense that it would be safe to put them in the human mouth. We now have videos of the mercury coming off the teeth with warm temperatures and brushing. The manufacturer has a long list of people who should not have them in their mouths. Yet my profession continues to say mercury fillings are safe and effective for everyone. Almost half of the dentists in the USA still use mercury fillings. There is no clinical reason to continue placing mercury fillings, but my profession protects policy rather than patients.
Around 2000, I took some additional CE courses on temporomandibular disorders (TMD, TMJ), cosmetics, full mouth reconstruction, etc. We used electronic kinesiographs and electromyography to measure the movement of the mandible and muscle function. The measured evidence clearly and consistently demonstrated what we had been taught in dental school was wrong, and that we were putting people into a muscle hypertrophied centric relation position, which resulted in muscle spasms, head aches, migraines, inner ear problems, pain, wear of teeth, reduced airway increasing sleep apnea problems, etc. Yes, dentistry is in part responsible for creating headaches because the bite is not right.
Thus, many accepted truths in dentistry have been found not to be truths, and we have changed as my profession has done more research. However, regarding both mercury fillings and TMD, my dental profession refuses to acknowledge new and relevant research. Reviewing “policy” of the American Dental Association, I must admit that the Association itself was founded because the previous dental association would not allow mercury fillings, which were cheaper than gold and therefore more popular with clients in pain. To my ADA, the financial health of the association was more important than the health of the public.
With two son-in-law dentists, I had extra time to work on tough cases and unusual problems. My thoughts went, “problems go in three’s, what is another big problem in dentistry.” At that moment I happened to be looking down at a basket of Crest toothpaste samples. I read the label, photographed it, calculated and looked in the research how much fluoride is in a “pea size amount” of tooth paste, one quarter mg, the same amount as in one glass of fluoridated water. The FDA warning is serious about not swallowing more than an incidental amount, yet we force everyone to swallow the same amount in each glass of Everett water. So who should we believe? The fine folks at the water district who are often retired plumbers, teachers, contractors, etc., or the FDA CDER? It seems obvious to me the FDA CDER has scientists who evaluate the risk/safety of chemicals for a living. Congress pays them to make the tough decisions. The FDA has never banned fluoridation, but it has never approved it – probably because the FDA is an arm of HHS and its CDC, which support fluoridation for political reasons. Why is Everett ignoring the fact that the FDA has never approved fluoridation and neither has any other federal or state agency.
I also went through the process of FDA approval for a dental device and found the FDA to be reasonable, honest, hard working scientists with excellent questions on my product. Approval was not a “slam dunk”, but they did approve the device.
As a dentist, I frequently write out prescriptions for various drugs, one of them in those days was fluoride. Fluoride is a prescription drug. Why would fluoridated water not be regulated by the same governmental body which regulates fluoride supplements?
I started my search on www.mymedline.com in earnest where there were hundreds of studies on harm caused by excess fluoride consumption. Questions must be answered: How much are we ingesting? How much are we retaining? How much are we excreting? How much do we need? How much starts to cause harm? Science does not have full answers to any of those questions, however, there is increasing evidence that we should be very cautious in administering this most chemically active of all elements to our patients.
The measured evidence is very poor, but no one disputes we are ingesting much more fluoride than the studies suggested was acceptable back in the 1940’s when fluoridation was promoted and before there were huge increases in fluoride use. In fact, many people can get too much fluoride from foods such as tea, grape products, mechanically deboned meats, etc. There are many sources of fluoride and many variables to consider such as level of water consumption. New medications containing fluoride are important and powerful, and they save lives. We need fluoride for selective applications, but who is monitoring how much fluoride we are ingesting? No one.
Many of us went privately and publicly to HHS, CDC, and EPA, explaining with measured evidence that many are ingesting more fluoride than our bodies can excrete or dispose of in our bones. After a great deal of pressure, HHS came out with their request for public comment on lowering the recommended level of fluoride added to drinking water to 0.7 ppm.
Previously, HHS had not in the past set a recommended fluoride concentration level. Further, in setting a recommended level, HHS is circumventing the scientists at the FDA CDER, who have never approved adding fluoride to drinking water at any level. Although the request for public input is valid, HHS has no jurisdiction to make such a request, evaluate the responses, or arrive at a final recommendation. The CDC is presuming to recommend what the Safe Drinking Water Act forbids any federal regulation from requiring.
The most difficult idea for me to accept was the claim by the EPA scientists through their union that fluoridation was not effective at all. I thought I had seen the benefits with my own eyes, so how could they say there was no benefit? My judgment was weighing the benefits against the risks. If fluoridation did not provide benefit, then any risk is too great.
When I put the HHS data into a graph, the clinical mistake in finding a benefit with fluoridation became clear.
In my office my assistant and I had been comparing the rich with the poor. The rich just happened to be on fluoridated water and the poor were outside of town without jobs and without fluoridated water. I had not been seeing not the effects of fluoride as much as socioeconomics and good versus bad diets. I then started to compare fluoridation and dental decay in various countries, those which fluoridate and those which do not. After all, the data to support fluoridation is not prospective randomized controlled trials, which certainly can be done, although such trials would be expensive. The data we have is mostly ecological and comparative and lower in research quality.
Attached are additional studies which have raised serious concerns that many are still ingesting too much fluoride, especially infants on formula which is most infants. I can send the appendixes if you want. Let me know how large your inbox is.
It took me perhaps 5 years of intense study before I had the courage and confidence to speak up in public against fluoridation of public water. I should be the last one to criticize anyone for promoting fluoridation because I promoted it for around 25 years. However, I had not previously read the research for myself. Even today I am confident that those dentists and other medical professionals who still promote fluoridation have not actually read both sides of the literature for themselves.
We all have biases, and it is almost impossible not to bring bias to the table. That is why I so strongly urge cities and water districts to either gain FDA CDER approval or at least get a written statement from FDA CDER with references that fluoride when used with the intent to prevent dental caries is not a drug, regardless of concentration. If the FDA CDER requires placebos to be FDA CDER approved, then concentration does not exempt FDA CDER approval.
For greater detail read my April 25, 2011, submission to HHS and CDC.
Thank you for seriously reconsidering this issue. I ask you to look at the total exposure for all subpopulations, the benefits, risks and ethics of fluoridation.
Bill Osmunson DDS, MPH
President, Washington Safe Water