Anti-fluoride “expert” finds the real reason oral health has improved – and it’s not fluoride

Anti-fluoride campaigners always promote people like Geoff Pain as “renowned” or “world experts.” They aren’t. Pain has no credible scientific publications on fluoride.

No, in fact, he claims lead is responsible for tooth decay and the improvement in oral health is a result of removing airborne lead contamination. And the “proof” is even in the title of his report – “Global Decline in Tooth Decay correlates with reduced Airborne Lead (Pb) but water Fluoridation prevents further progress“

Mind you, the word “correlate” appears only twice in the document – once in the title and once in the abstract. Nowhere else. Scientists usually restrict the use of words like this to results of proper statistical analyses – but he presents no evidence of a correlation anywhere in the document.

OK, we shouldn’t expect any better. This document is just another one of a series of documents, dressed up as scientific publications, supported by cobbled together citations which are often are irrelevant or don’t support the claims made. Produced by Geoff Pain, well-known Australian anti-fluoride activist, whose concept of scientific publication is to upload his unreviewed documents on to Researchgate. I have written about his citation trawling and false “publication” before in my article  An anti-fluoride trick: Impressing the naive with citations

But, perhaps he is on to something. Irrespective of fluoride (he has a hangup about that element) perhaps lead is somehow implicated in oral health problems. So let’s see what the document actually claims.

It has three aims:

1: Rejection of all evidence of the beneficial effects of fluoridation

He describes the evidence for fluoridation as “false” and “absurd.”

Of course, he doesn’t consider for a minute any of the many studies providing evidence of beneficial effects – he just relies on the naive use of selected World Health Organisation (WHO) data which the Fluoride Action Network is well-known for. I have written about this before (see, for example, Fluoridation: Connett’s naive use of WHO data debunked).

This simply argues that the fact that oral health has improved over time in both fluoridated and unfluoridated countries is “proof” that fluoridation has no effect.

Here is the graph he uses:

This figure is meaningless because of the huge influence of inter-country differences on these data, irrespective of fluoridation. That doesn’t require a scientific training to see. These differences introduce so much noise into the data that no conclusion is possible about the influence of fluoridation. Robyn Whyman pointed this out in his report for the National Fluoridation Information Service – “Does delayed tooth eruption negate the effect of water fluoridation?“:

“Studies that appropriately compare the effectiveness of water fluoridation do not compare poorly controlled inter-country population samples. They generally compare age, sex, and where possible ethnicity matched groups from similar areas. Inter-country comparisons of health status, including oral health status, are notoriously difficult to interpret for cause and effect, because there are so many environmental, social and contextual differences that need to be considered.”

The figure does not differentiate between fluoridated and unfluoridated areas within countries – a comparison that is more valid. When we look at the same WHO data for fluoridated and unfluoridated areas we can see the beneficial effect. For example, in the data from the Republic of Ireland:

2: Evidence for an effect of lead exposure on oral health

I can accept that – but certainly would not go as far as Pain’s claim that “lead exposure reduction as the major factor in tooth decay decline.” In fact, the articles he cites suggest that the association of  lead exposure with tooth decay is probably weak in most cases.

For example, he cites Gemmel et al., (2002) but ignores what that paper actually says:

“In summary, our findings are consistent with those of several other recent studies (e.g., Campbell et al. 2000; Moss et al. 1999) in suggesting a weak association between children’s lead exposure and caries in primary teeth. The association was region specific, however, suggesting that its magnitude depends on the local distributions of other, more important caries risk factors such as fluoride exposure, diet, and other aspects of environment. The most likely direct role for lead exposure in the development of dental caries, therefore, is as a modifier of host susceptibility. We cannot reject the hypothesis, however, that an elevated lead level is a surrogate or proxy index of some other factor that is itself directly cariogenic.”

Similarly, he cites Martin et al., (2007) but ignores what that paper actually concluded:

“We conclude that this study provides only weak evidence, if any, for an association of low-level lead exposure with dental caries.”

Mind you, he also cites Wiener et al., (2015) who reported:

“This study indicated a strong association of blood lead levels with increasing numbers of carious teeth in children aged 24–72 months.”

But still not evidence that lead is the major factor involved.

Pain ignores suggestions that results may suggest modification of the role of fluoride

I wonder if those who indulge in citation trawling ever actually read the papers they cite. Far from Pain’s citations being evidence of a lack of effect from fluoridation, in almost all cases they suggest the observed effects could be due to modification of the more important effect of fluoride on oral health.

For example, Martin et al., (2007) point out:

” Mechanisms which have been offered to explain the potential association include lead effects on salivary gland development and function (Watson et al., 1997; Bowen, 2001), effects on enamel formation (Lawson et al., 1971; Kato et al., 1977; Appleton, 1991; Watson et al., 1997), and an interference with fluoride uptake in saliva (Gerlach et al., 2002). “

Come on Geoff. Spend some time and actually read the articles you have trawled for your citations.

3: Fluoridation means increase lead concentration in tap water

Having rejected any beneficial role for fluoride and presented lead as the major influence on oral health Pain now puts it all together to “prove” that fluoridation actually enhances tooth decay by increasing dietary lead intake. Why? Because of:

“deliberate addition of Lead as a major contaminant of phosphate fertilizer industrial waste used in Fluoridation plus the exacerbation of Plumbosolvency by Fluoride”

The first point about lead contamination of fluoridating chemicals relies in a naive interpretation of the certificates of analysis required for these chemicals. Just because a very low concentration of lead is recorded in these certificates does not mean this causes an increase in dietary lead intake.

I showed in the article “Chemophobic scaremongering: Much ado about absolutely nothing“ that the fluoridating chemicals contribute less than 0.05% to the lead in tap water – already present from natural sources!

Pain’s reference to “exacerbation of Plumbosolvency” relies on a limited study which reported an association between blood lead levels in children and the treatment of tap water in the US. Of course, the release of lead from pipe fittings can be a problem irrespective of water treatment – which is why authorities recommend one should let the water run for a while first thing in the morning to get rid of such impurities. However, the studies Pain relies on seem to attribute plumbosolvency to specific chlorinating chemicals rather than fluoride.

One can make a simple check, however. In New Zealand authorities regularly make chemical analyses of their tap water available. These do not show increased lead concentrations after fluoridation.

Conclusion

So, again, Geoff Pain has indulged in citation trawling and confirmation bias to produce this report. The citations he uses do not support his claims.

Dietary intake of lead may be one of many factors influencing dental health – but his citations do not in any way support his assertion that it is the “major factor”. Nor do they support his claim that fluoridation does not have a beneficial effect on oral health.

In fact, it is Geoff Pain, not health authorities, who is making the “false” and “absurd” claims.

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Anti-fluoridationists now scaremonger about silica in your drinking water

Orthosilicic acid exists in drinking water. This is an idealised presentation because of polymerisation reactions. In practice, analysts measure “reactive silica.”

Well – that’s what we can infer from a new campaign of the Fluoride Action Network (FAN).

But what is the link with fluoride – the whole reason for FAN’s existence? Well, they base this campaign on the well-known hydrolysis of the fluorosilicates used in community water fluoridation to form the hydrated fluoride anion and silica. (Although these campaigners are confused here as they will also often claim fluorosilicates do not hydrolyse and survive to come out of your tap and poison you).

Then they claim that “silicic acid” (silica in solution) dissolves lead from the pipes and fittings and this lead causes brain damage. A double-barreled danger as they also claim the fluoride also damages your brain. What’s more – they also claim that “silicic acid” may dissolve your teeth!

But there are two problems with this:

1. Your drinking water contains silica whether it is fluoridated or not. So their warnings about the silica in fluoridated water should also be valid for “fluoride-free” water which they promote!
2. They do not have a viable chemical mechanism for silica dissolving your pipes (and there are plenty of other mechanisms which can result in corrosion of pipes anyway). The same for your teeth. This claim is just not supported by the chemical literature.

I will just concentrate here on the “evils” of silica (or “orthosilicic acid”) that are being promoted by FAN and leave the lead story for another day. These “evils” all come down to concepts being promoted by Richard Sauerheber who FAN describes as “the ultimate citizen chemist.” (OK, he is their ultimate citizen chemist). His argument is presented in Silicic Acid – How Does Fluorosilicic Acid Leach Lead? Why Does Fluorosilicic Acid Leach Lead So Much More Than Sodium Fluoride?

Is silicic acid the bogy Sauerheber claims?

His article is confused and convoluted. But it starts with the assumption that silica in drinking water (silicic acid or orthosilicic acid) is bad. He declares:

“Neither fluoride nor silicic acid are constituents of normal pristine human or mammalian blood, but rather are contaminant materials, . . “

And he states:

“The mass treatment of public fresh drinking water with industrial fluorosilicic acid to produce fluoride ion at 1.0 ppm also produces approximately 6 ppm sodium ion and .7 ppm orthosilicic acid. None of these is found in or belongs in fresh drinking water.”

Let’s stop right there and check out his claim that sodium and “orthosilicic acid” are not found in fresh drinking water.

Here is some data for drinking water in fluoridated and unfluoridated areas of Auckland, New Zealand, taken from the WATERCARE ANNUAL WATER QUALITY REPORT 2013. The data are for 15 unfluoridated treatment plants and 8 fluoridated treatment plants.

These are average figures over all the plants. But values for silica as high as 64 mg/L in the unfluoridated plants and 44 mg/L in the fluoridated plant were recorded. The corresponding figures for sodium were 140 and 22 mg/L.

So Sauerheber is completely wrong. Unfluoridated water does contain silica and sodium. And at concentrations much higher than could be accounted for by added fluoridating chemicals – he calculated 0.7 mg/L – 0.7 ppm) for silica. In fact, the values are higher for the unfluoridated treatment plants in these examples.

Fluoridation makes a minuscule contribution to the concentration of these chemical species in drinking water.

Forget about fluoridation. If silica (and sodium) are such problems then Sauerheber should be campaigning against unfluoridated water as well. Even the “pristine” water in his local river or spring – silica is a normal and natural component of surface and bore waters.

But Sauerheber is also wrong about the dangers of silica in drinking water. Of course silica is present in “normal pristine human or mammalian blood” because it is part of our diet (Bisse et al 2005). It is a component of many of our foods. Sauerheber is simply attempting to confuse the issue because of the current lack of knowledge about the role of silica in the body.

But Jugdaohsingh et al., (2015) say:

“Silicon (Si) is a natural trace element of the mammalian diet and although it has not been demonstrated unequivocally that mammals have a requirement for Si there is increasing evidence to suggest that it may be important for the normal health of bone and the connective tissues. Indeed, severe dietary Si deprivation in growing animals appears to cause abnormal growth and defects of the connective tissues”

Given that silica appears to be important the presence of it in our drinking water is as an advantage. According to Jugdaohsingh (2007):

“Drinking water and other fluids provides the most readily bioavailable source of Si in the diet, since silicon is principally present as Si(OH)₄, and fluid ingestion can account for ≥ 20% of the total dietary intake of Si.”

One trick Sauerheber uses is to cite reports of the danger of inhaled silica dust – which can cause cancers and silicosis. Completely irrelevant because of its different chemical form. This is equivalent to the trick often used by anti-fluoride campaigners of citing reports of results of industrial pollution or studies from areas of endemic fluorosis to support their attacks on community water fluoridation.

Will silica dissolve your teeth?

This claim is completely unsupported – no citations and purely a figment of Sauerheber’s imagination. He claims:

“Orthosilicic ‘weak’ acid has been long used in agriculture to break down solid calcium phosphate Ca₃(PO4)₂, thereby releasing soluble phosphate ion in soils even at neutral pH, for uptake by plant life. The reaction of silicic acid with calcium phosphate under neutral pH conditions is:

H₄SiO₄ + Ca₃(PO₄)₂ →  HPO₄^-2 + 3Ca²⁺ + PO₄^-3+ H₃SiO₄^–.

This reaction occurs at a pH where any strong acid would have been neutralized. Orthosilicic acid is reluctant to dissociate and can break down calcium phosphate. This reaction is relevant not only to calcium phosphate in soil but also to calcium phosphate in teeth enamel. By means of orthosilicic acid, enamel is subject to slow and progressive degradation. “

This is a new one on me – and I spent many years researching the dissolution of apatite (the natural calcium phosphate) in soil and the factors influencing that. This arose because unacidulated phosphate rocks were being used in New Zealand agriculture. These material contain insoluble phosphate – in contrast to superphosphate which contain soluble phosphate.

The phosphate rocks used are mainly apatites and are complex (because of isomorphous substitution). A specific chemical equation for their dissolution depends on composition and environmental pH. But, in general, acid (H+) reacts with the apatite to produce Ca²⁺+ H₂PO₄^–, H₂O, F^–, Cl^–, CO₂, etc.

H⁺ + Ca₁₀(PO₄)₆(OH,F,Cl)₂ → Ca²⁺ + H₂PO₄^– + H₂O + Cl^– + F^– + CO₂

Dissolution is promoted by the presence of acid (H⁺) and removal of dissolution products (particularly Ca²⁺). The calcium in soil solution can inhibit apatite dissolution – it drives the equation above to the left. The later is important because New Zealand agricultural soils have relatively high levels of calcium. On the other hand, our research showed that when soils are leached to remove calcium this can promote dissolution of the natural fluorapatite in the soil. (Perrott and Kear 2004). Removal of calcium from solution drives the above equation to the right.

Apatite particle size, fluoride content and substitution of other species in the apatite structure can also influence the dissolution rate of these materials in soil. But silica, or silica in soil solution – that is a new one on me!

Pity Sauerheber didn’t give a citation to support his claim that silica “has been long used in agriculture to break down solid calcium phosphate Ca₃(PO4)₂, thereby releasing soluble phosphate ion in soils even at neutral pH, for uptake by plant life.” I would be very interested to see the evidence – but I cannot find anything in the scientific literature to support Sauerheber’s statement. It appears to be a figment of his imagination and anti-fluoride bias.

In the same unsupported manner, Sauerheber is suggesting silica (“orthosilicic acid”) may be dissolving our teeth. He even provides a chemical equation for it:

2H₄SiO₄ + Ca₃(PO4)₂ → 2HPO₄^-2 + 2H₃SiO₄^– + 3Ca²⁺

First,  the primary mineral in teeth is a bioapatite (Ca₁₀(PO₄)₆(OH,F,Cl)₂) not Ca₃(PO4)₂. And H₃SiO₄^– is not stable at the pH of drinking water or saliva so his idea is destroyed by the immediate reaction:

H⁺ + H₃SiO₄^–→ H₄SiO₄

In other words, Sauerheber’s equation above is driven to the left at the neutral and acid pH values of saliva and drinking water.

Incidentally, it is the presence of Ca²⁺, H₂PO₄^– and F^– in our saliva (derived from food and drink) that drives the dissolution equation for apatite to the left. It prevents dissolution (acid attack or demineralisation) and promotes remineralisation. This the surface or “topical” mechanism that reduces decay in existing teeth when fluoridated water is used.

Sauerheber’s confusion

Sauerheber’s arguments are chemically confused – probably because he is driven by a wish to find anything connected with fluoride to be bad. He is confused by terminology because the silica in solution is often called orthosilicic acid, or silicic acid. But the point is that this species (whatever it is – the chemistry of silica in water is very complex) is not dissociated at neutral pH values near 7.  (more correctly only 0.18% of it is – Belton et al., 2012). It is a very weak acid -significant dissociation to form the anion only occurs at higher pH values according to the equation:

OH^– + H₄SiO₄ → H₃SiO₄^– + H₂O

Enamel attack is caused by acid (H⁺) not an unionized silica species or silicate anion. At these high pH values, dissociation of silicic acid at high pH does not produce H⁺. It actually removes OH^–.

The same confusion is behind Sauerheber’s assertion that leaching of lead from pipes and plumbing is caused by “orthosilicic acid.” He says:

“it is the intact orthosilicic acid, the predominant form present over the pH range 7-10 (sic) that is leaching lead or lead salts from pipes and plumbing fixtures.”

In fact, acid in drinking water is one of the causes of lead leaching. The chemical species responsible is H⁺ and that is why treatment plants adjust pH levels to reduce acidity. Silica in  solution does not make a contribution to the (H⁺) concentration.

But if it did then we should be concerned about all water as fluoridating chemicals make only a minuscule contribution to silica in water.

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