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Fluoride Concentrations of Drinking Water in South Africa
M. MOOLA1, S.R. GROBLER2, A. LOUW2, and U. CHIKTE3, 1University of the Western Cape, South Africa, 2University of the Western Cape, Cape Town, South Africa, 3University of Stellenbosch, Tygerberg, South Africa
Objectives: Until now no drinking water fluoridation has been implemented in South Africa. Therefore, the need for tables with drinking water fluoride concentrations for the prescription of fluoride supplementations is important. Drinking water samples were obtained from municipalities or district municipalities throughout the Republic of South Africa. Despite major efforts certain municipalities/district municipalities still failed to respond to our request and consequently their fluoride concentrations could not appear in the Tables of this article.
Methods: The fluoride levels were determined potentiometrically with the aid of a combination fluoride ion selective electrode. Results: Of the 870 sources to which bottles were sent, 586 containing water samples were returned, constituting a response rate of 67.4%. For all nine provinces the lowest fluoride level found was less than 0.1 ppm and the highest value 4.6 ppm (Twee Rivieren).
Conclusion: From the results it can be concluded that many drinking water sources, including major cities (less than 0.6 ppm F), are in need of fluoride addition in some or other way, of which water fluoridation is the most economical. Furthermore, de-fluoridation of water should also be considered as important unless other drinking water supply sources can be obtained.
Community Dentistry
The Preliminary Program for Scientific Meeting of the South African Division of IADR (September 6-7, 2006)
Top Level Search http://iadr.confex.com/iadr/safdiv06/preliminaryprogram/abstract_87319.htm
South African Government Gazette, 16 April 1997
Notice 667 of 1997
Department of Health
White Paper for the Transformation of the Health System in South Africa
. . . . .
13.2. The incidence of common oral diseases should be reduced by the promotion of health, prevention of oral diseases and provision of basic curative and rehabilitative oral health service.
13.2.1 Minimum package of oral health care
a) A defined minimum package of oral health care should be provided to the priority groups listed above. this package should consist of an annual examination, bitweing radiographs, cleaning of teeth, simple 1- 3 surface fillings, fissure sealants and emergency relief of pain and infection control.
b) Systemic water fluoridation
(i) Systemic water fluoridation should be implemented immediately, at least in the major metropolitan areas of South Africa, the remaining areas being phased in systematically.
(ii) Alternative methods of fluoridation, such as the use of fluoride toothpaste and fluoride mouth-rinses, should be introduced in schools and among priority groups
(iii) Legislation to enable the fluoridation of milk and salt should be pursued
(iv) Dietary supplements (fluorides and vitamins) should be included as part of the Integrated Nutrition Programme
Fluoridation in South Africa
Fluoride is an example of an basic element which may be beneficial at low concentrations, but which has a narrow margin of safety, and is detrimental to health at higher concentrations. This applies not only to human beings but also to animals and aquatic creatures. The beneficial concentration for humans is 0.7 to 1 milligram per liter and 0 to 2 mg/l for animals.
Detrimental levels fro humans start at 1.5 mg/l with tooth staining. Damage to teeth and skeleton occurs at around 3 mg/l according to the World Health Organisation. At levels exceeding 3 mg/l serious skeletal damage may occur. Continuous use of fluoride above 8 mg/l usually leads to loss of teeth as well as crippling due to vertebral damage. Death from acute fluoride poisoning may occur if concentration exceed 100 mg/l.
The aquatic ecosystems are even more sensitive. The target water quality value for fluoride for aquatic life protection is 0.75 mg/l, and the chronic exposure value (where chronic toxicity to aquatic life appears) is 1.5 mg/l. Excess fluoride once added to a water supply is both difficult and expensive to remove.
As South Africa is a water scarce country, one of the basic principles of the Water Act (Act 54 of 1956) is that water after use must be returned to the river from which it was abstracted. Following this principle, repeated cycles of abstraction and return of used water to the river systems are of widespread occurrence and indeed a necessity in this country, this is particularly so in the interior of the country. In order to keep the returned water fit for use it is imperative that additions of soluble pollutants are kept to a minimum, as the dissolved salts progressively increase in concentration with each use cycle. This type of excessive concentration has already occurred with sulfate as a consequence of its presence in mining output.
The practice of the addition of fluoride to the optimum concentration of 1 mg/l is based on the assumption that the water only goes through once cycle of use and is not reused repeatedly.
If fluoridation were to be practised on a large scale in the interior of the country, this might mean that fluoride removal technologies would have to be installed by downstream users.
Fluoride dosing control and particularly accurate analysis of fluoride concentrations is not a simple exercise which implies that it would be extremely difficult for smaller water supply facilities to control accurately the level of fluoride dosed. Because of the small margin of safety between beneficial and toxic levels of fluoride, the consequence of accidental overdosing will be extremely serious.
A particularly dangerous aspect of fluoridation is that fluoride does not impart any taste or smell to the water. Thus the consumer is unable to protect himself in the event of accidental over-fluoridation of water. By contrast, over chlorination is very obvious to the consumer through the strong taste and odour of the chlorine.
The strict control and monitoring that is needed to implement fluoridation implies that many small municipalities will find it difficult to safely do this. Even more difficult will be the implementation of fluoridation technology to safeguard aquatic ecosystems, not to mention man. Safe fluoridation and inevitable fluoridation will only be possible in the case of large well managed water boards.
By contrast, chlorine used for water disinfection, has a very wide margin between harmless concentrations and toxic concentrations. The consequences of slight overdosing with chlorine are not nearly so serious as in the case with fluoride. Yet despite the large safety margin of chlorine dosing, fish deaths due to chlorine overdosing have already occurred in this country.
Water actually used for drinking purposes only constitutes a small fraction of the water used for domestic purposes. The major portion being used for watering gardens and washing purposes. This has two implications: Firstly that fluoridation of domestic water is a wasteful method of ensuring optimum fluoridation levels. Secondly, that long term detrimental effects may occur due to build up of fluoride levels in irrigated soils.
It is worth noting that water of some areas have already naturally a fluoride level of about half of 0.75 mg/l. Further, the naturally occurring fluoride is 'Calcium fluoride', whereas the fluoride additive is 'Sodium fluoride' which is rated as highly poisonous. http://home.intekom.com/tm_info/fluor1.htm
A study on the physiological and behavioral effects of Sodium Fluoride is published on October 12, 1994. The study is done by Mullenix, Denbensten, Schunior and Kernan, from the Toxicology Department, Forsyth Research Institute in Boston, the Department of Radiation Oncology, Harvard Medical School, the Department of Paediatric Dentistry, Eastman Dental Center, and the Veterinary Diagnostic Laboratory at Iowa State University.
According to the study, published in Neurotoxicology and Teratology, Vol 17, No. 2, pp. 169-177, 1995, while fluorides have a great number of effects on the body, the effect on the brain and central nervous system structures were examined, and it was found that fluorides affect the hippocampus, which is the central processor which integrates inputs from the environment, memory, and motivational stimuli to produce behavioral decisions and modify memory.
Note: Now it can be seen why the Nazis and Soviets used fluorides in the prison camp water supplies to reduce the will to resist and make the prisoners docile and not tend to question authority. It is the primary reason it is added to water supplies, since there is no credible scientific evidence it exists in the water supply for any other purpose.
After several years, we have found no credible evidence, only anecdotal reviews by groups with a vested interest in keeping toxic fluorides in use. (See 1957, Montreal Neurological Institute, and the case of H.M). This 1994 study also showed that "effects on behavior relate directly to plasma fluoride levels in the brain, and fluoride accumulation in the brain, establishing that long-term accumulation of fluorides in the brain does occur, even with minimal doses. http://opengov.ideascale.com/a/dtd/4177-4049
http://www.bibliotecapleyades.net/salud/salud_fluor06.htm
http://video.google.com/videoplay?docid=-3949434744498031545&hl=en#