New Hampshire Nursing News - December 2021

Page 14 • New Hampshire Nursing News December 2021, January, February 2022
Fluoridation of community water to prevent dental caries
is practiced in the United States, but it has not been
without controversy. According to Lanphear et al. (2020),
“the debate on the fluoridation of drinking water—one
of the most polarized, long-running, and high-decibel
controversies in public health—has been reignited as new
studies find that fluoride is toxic to the developing brain”
(para. 1). This occurs “at levels routinely found in the
general population” (para. 9).
Consider the following:
• An important research study concerning the
association between maternal fluoride exposure
during pregnancy and lower IQ scores in offspring
appeared in the Journal of the American Medical
Association-Pediatrics in August, 2019 (Green et
al.). The study states: "Fluoride exposure during
pregnancy may be associated with adverse effects on
child intellectual development, indicating the possible
need to reduce fluoride intake during pregnancy”
(Key points section, para. 3). Three of the authors (Till
et al., 2020a) state, “Our study is consistent with other
high-quality research; it is not a standalone study.
More than 50 studies have shown an association
between higher fluoride exposure and lower IQ"
(Point 2, para. 2).
• Bashash et al. (2017) also found IQ decrements in
children exposed to fluoride in utero. They report,
“In this study, higher prenatal fluoride exposure, in
the general range of exposures reported for other
general population samples of pregnant women and
nonpregnant adults, was associated with lower scores
on tests of cognitive function in the offspring at age 4
and 6-12 y” (Abstract, para. 5).
• Riddell et al. (2019) “found that higher tap water
fluoride levels and fluoridation of municipal water
supplies were associated with a higher risk of an
ADHD diagnosis as well as increased symptoms
of hyperactivity and inattention, especially among
adolescents.” This points “to a potential cumulative
effect of fluoride exposure” and highlights “the need
for further investigation of the potential for fluoridemediated
developmental neurotoxicity in populations
with water fluoridation” (Discussion section, para. 7).
• Till et al. (2020b) found, “Exposure to increasing
levels of fluoride in tap water was associated with
diminished non-verbal intellectual abilities; the effect
was more pronounced among formula-fed children”
(Abstract, para. 4). In a 2021 video, Till states that
“formula-fed infants living in fluoridated areas have
an approximate 70-fold higher fluoride intake than
exclusively breastfed infants” (video at 15:33).
• Amiri (2020, July-August) looked at the safety,
effectiveness, and ethical controversies associated
with water fluoridation. Citing the National
Toxicology Program (2019), she reports on the
“mounting evidence showing the potential
harms of exposure to fluoride, including low IQ,
neurobehavioral deficits, and endocrine dysfunction”
(p. 475).
The American Nurses Association (ANA) understands that
“Nursing as a health care profession and environmental
health as a public health discipline share many of the same
roots” (ANA, 2007, p. 4). ANA’s principles of environmental
health for nursing practice with implementation strategies
are a “call to action” that “encourage nurses to gain a
working understanding of the relationships between human
health and environmental exposures” with the integration
of this knowledge into nursing practice (ANA, 2007, p. 4 ).
In October 2003, the ANA Board of Directors adopted the
Precautionary Principle which states “if it is within one's
power, there is an ethical imperative to prevent rather
than merely treat disease, even in the face of scientific
uncertainty" (ANA, 2007, pp. 6 and 47).
The ANA presently supports water fluoridation (ANA, 2016)
but has conditioned this support partly on whether "the
most current, evidence-based, sound research supports
the benefits of public water fluoridation and does not
indicate harmful risks" (p. 1). The research, however, does
indicate harmful risks. This is a call to action for the nursing
profession.
Till (2021) states, “A lot has changed since the 1940s when
water fluoridation was first introduced. We now have
topical fluorides like toothpaste. We know more about
how fluoride works.” Amid “mounting scientific evidence
showing a consistent pattern of lower IQ associated with
early-life exposure to fluoride,” Till asks, “How much more
Fluoride's Risk to the Developing Brain
information is needed before we raise concern, at least
for a particular subset of the population?” She cautions
that “failure to act could amount to enormous costs at the
population level” (video at 21:54).
Nurses can proactively prevent harm from water
fluoridation by acknowledging “safe alternatives are
available” and “there is no benefit of fluoride to babies'
teeth before they erupt or appear” (Lanphear et al., 2020,
para. 17).
It would be prudent for the American Nurses Association to
rethink its support for water fluoridation in light of research
showing fluoride’s risk to the developing brain.
Katie Lajoie, BSN, BA, RN
Mary Schissel, BSN, RN
Disclosure: Ms. Lajoie is on the Board of Directors of the
American Environmental Health Studies Project (AEHSP),
and she is a member of AEHSP’s fluoride advisory
committee.
REFERENCES
Amiri, A. (2020). Water fluoridation: When current research
contradicts public practices. Public Health Nursing, 37(4),
475–477. https://doi.org/10.1111/phn.12758. Cited in https://
www.researchgate.net/publication/342943905_Water_
fluoridation_When_current_research_contradicts_public_
practices
American Nurses Association. (2007). ANA’s principles of
environmental health for nursing practice with implementation
strategies. Silver Spring, MD: Author https://ojin.nursingworld.
org/MainMenuCategories/WorkplaceSafety/Healthy-Nurse/
ANAsPrinciplesofEnvironmentalHealthforNursingPractice.pdf
American Nurses Association. (2016, March 18). Fluoridation of
public drinking water systems [Position statement]. https://
www.nursingworld.org/globalassets/practiceandpolicy/
nursing-excellence/ana-position-statements-secure/socialcauses-and-health-care/fluoridationpublicwaterdrinkingsyste
ms-ana-positionstatement.pdf
Bashash, M., Thomas, D., Hu, H., Angeles Martinez-Mier,
E., Sanchez, B. N., Basu, N., Peterson, K. E., Ettinger, A.
S., Wright, R., Zhang, Z., Liu, Y., Schnaas, L., Mercado-
García, A., María Téllez-Rojo, M., & Hernández-Avila,
M. (2017). Prenatal fluoride exposure and cognitive
outcomes in children at 4 and 6–12 years of age in Mexico.
Environmental Health Perspectives, 125(9), 097017. https://
doi.org/10.1289/ehp655
Green, R., Lanphear, B., Hornung, R., Flora, D., Martinez-
Mier, E. A., Neufeld, R., Ayotte, P., Muckle, G., & Till, C.
(2019). Association between maternal fluoride exposure
during pregnancy and IQ scores in offspring in Canada.
JAMA Pediatrics, 173(10), 940. https://doi.org/10.1001/
jamapediatrics.2019.1729
Lanphear, B., Till, C., & Birnbaum, L. (2020, October 7). Oped:
it is time to protect kids’ developing brains from
fluoride. Environmental Health News. https://www.ehn.
org/fluoride-and-childrens-health-2648120286/costsoutweigh-benefits
Riddell, J. K., Malin, A. J., Flora, D., McCague, H., & Till, C.
(2019). Association of water fluoride and urinary fluoride
concentrations with attention deficit hyperactivity disorder
in Canadian youth. Environment International, 133, 105190.
https://doi.org/10.1016/j.envint.2019.105190
Till, Christine. (2021, September 28). Fluoride and the developing
brain [Video]. https://vimeo.com/621670463
Till, C., Green, R., & Lanphear, B. (2020a). Association
Between Maternal Fluoride Exposure and Child
IQ-Reply. JAMA Pediatrics, 174(2), 216–217.
https://doi.org/10.1001/jamapediatrics.2019.5251
Cited in https://www.ncbi.nlm.nih.gov/pmc/articles/
PMC8101555/
Till, C., Green, R., Flora, D., Hornung, R., Martinez-Mier, E. A.,
Blazer, M., Farmus, L., Ayotte, P., Muckle, G., & Lanphear, B.
(2020b). Fluoride exposure from infant formula and child IQ
in a Canadian birth cohort. Environment International, 134,
105315. https://doi.org/10.1016/j.envint.2019.105315