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• W2001567256 abstract "Sir—Sharon Hillier and colleagues1Hillier S Cooper C Kellingray S Russell G Hughes H Coggon D Fluoride in drinking water and risk of hip fracture in the UK: a case-control study.Lancet. 2000; 355: 265-269Summary Full Text Full Text PDF PubMed Scopus (59) Google Scholar have confirmed what we already suspected, that naturally occurring fluorides in a water supply at up to 2 ppm do not result in significant skeletal disorders after a lifetime's exposure. They failed, however, to engage two issues crucial to artificial fluoridation of water.We have no reason to continue assuming that water fluoride governs the average fluoride consumption of the population drinking it. The association between water and urinary fluoride shown by McClure and Kinser in the 1940s2Fluorine content of urine in relation to fluorine in drinking water. Public Health Reports 59 1575-91; 1944.Google Scholar no longer holds true: the wide range and up to four-fold increase of urinary fluoride in British people by 1997 means that fluoride must be coming from other sources.3Mansfield PJ The distribution of urinary fluoride concentration in the UK.Fluoride. 1999; 32: 27-32Google Scholar By confining their study to the effect of fluorides in water, Hillier and colleagues have evaded the main issue—the total daily exposure to fluorides from all sources. A large part of the wide variation in bone fluoride they show may be significantly associated with total fluoride, rather than water fluoride intake. Hillier and colleagues could have assayed serum fluoride or 24-h urinary fluoride output in all participants in their study.Equally, the investigators could have included people from neighbouring Newcastle, where artificial fluoridation has been in place for several decades. It is assumed that the biodynamics of fluoride at 1 ppm are the same, whatever the cation; but very little has been done to confirm this,4Feldman I Morken D Hodge HC The state of fluoride in drinking water.J Dent Res. 1957; 36: 192-202Crossref PubMed Scopus (9) Google Scholar and some studies5Jenkins GN Edgar WM Some observations on fluoride metabolism in Britain.J Dent Res. 1973; 52: 984-985Google Scholar indicate the contrary. Fluoridation with the calcium salt is not an option: we need more assurance of the safety of the fluorosilicates that are actually used.A relatively small case-control study comparing femoral and urinary fluoride in patients with hip fracture who live in an artificially fluoridated area, with matched controls from the trauma department in the same hospital, would settle both these issues once and for all. Sir—Sharon Hillier and colleagues1Hillier S Cooper C Kellingray S Russell G Hughes H Coggon D Fluoride in drinking water and risk of hip fracture in the UK: a case-control study.Lancet. 2000; 355: 265-269Summary Full Text Full Text PDF PubMed Scopus (59) Google Scholar have confirmed what we already suspected, that naturally occurring fluorides in a water supply at up to 2 ppm do not result in significant skeletal disorders after a lifetime's exposure. They failed, however, to engage two issues crucial to artificial fluoridation of water. We have no reason to continue assuming that water fluoride governs the average fluoride consumption of the population drinking it. The association between water and urinary fluoride shown by McClure and Kinser in the 1940s2Fluorine content of urine in relation to fluorine in drinking water. Public Health Reports 59 1575-91; 1944.Google Scholar no longer holds true: the wide range and up to four-fold increase of urinary fluoride in British people by 1997 means that fluoride must be coming from other sources.3Mansfield PJ The distribution of urinary fluoride concentration in the UK.Fluoride. 1999; 32: 27-32Google Scholar By confining their study to the effect of fluorides in water, Hillier and colleagues have evaded the main issue—the total daily exposure to fluorides from all sources. A large part of the wide variation in bone fluoride they show may be significantly associated with total fluoride, rather than water fluoride intake. Hillier and colleagues could have assayed serum fluoride or 24-h urinary fluoride output in all participants in their study. Equally, the investigators could have included people from neighbouring Newcastle, where artificial fluoridation has been in place for several decades. It is assumed that the biodynamics of fluoride at 1 ppm are the same, whatever the cation; but very little has been done to confirm this,4Feldman I Morken D Hodge HC The state of fluoride in drinking water.J Dent Res. 1957; 36: 192-202Crossref PubMed Scopus (9) Google Scholar and some studies5Jenkins GN Edgar WM Some observations on fluoride metabolism in Britain.J Dent Res. 1973; 52: 984-985Google Scholar indicate the contrary. Fluoridation with the calcium salt is not an option: we need more assurance of the safety of the fluorosilicates that are actually used. A relatively small case-control study comparing femoral and urinary fluoride in patients with hip fracture who live in an artificially fluoridated area, with matched controls from the trauma department in the same hospital, would settle both these issues once and for all. Muddying the waters: fluoride in drinking waterAuthors' reply Full-Text PDF" @default.
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• W2001567256 date "2000-05-01" @default.
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• W2001567256 title "Muddying the waters: fluoride in drinking water" @default.
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• W2001567256 doi "https://doi.org/10.1016/s0140-6736(05)72547-2" @default.
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