BOH Agenda 032520 - Laserfiche WebLink

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Expert Evaluation by Ann Newman Chelminski MPH, MD. • Disease states that cannot tolerate water fluoridation levels such as kidney disease/renal transplant and autoimmune diseases o Renal toxicity - because fluoride is primarily renally excreted, it is clear that those with impaired renal function could be at risk of fluoride toxicity due to decreased excretion. There have been deaths in dialysis patients due to lethal cardiac arrhythmias after machine dysfunction caused abnormally high levels of fluoride in dialysate solution 12. There have also been incidences of acute fluoride toxicity with inadvertent additions of large quantities of fluoride to public drinking water. At lower levels of exposure there is no apparent strong association between low level fluoride exposure and the development of chronic renal disease. Dialysis centers should follow professional recommendations for water quality for dialysis. Studies summarized in the CADTH' review suggest a protective effect of lower levels of fluoride on the incidence of kidney stones. A study of people with skeletal fluorosis (indicating long term high levels of exposure) found an association with reported kidney stones. • Fluoride causes thyroid problems and skeletal fluorosis diagnosed as arthritis o Osteosarcoma - High levels of fluoride have known potential bone toxicity. Studies have looked at the risk of the bone cancer, osteosarcoma, related to fluoride exposure. Some studies have found higher levels of fluoride in the drinking water of patients with osteosarcoma than in that of controls, but often had water supplies containing fluoride levels higher than those found in American community drinking water. A study in the U.S. by Levy and Leclerc2 found no association. A large epidemiologic study by Blakey et a13 reviewed 25 years of data on Ewing sarcoma and osteosarcoma in Great Britain and found no association 18