Fluoride in Drinking Water: A Scientific Review of EPA's Standards

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Most people associate fluoride with the practice of intentionally adding fluoride to public drinking water supplies for the prevention of tooth decay. However, fluoride can also enter public water systems from natural sources, including runoff from the weathering of fluoride-containing rocks and soils and leaching from soil into groundwater. Fluoride pollution from various industrial emissions can also contaminate water supplies. In a few areas of the United States fluoride concentrations in water are much higher than normal, mostly from natural sources. Fluoride is one of the drinking water contaminants regulated by the U.S. Environmental Protection Agency (EPA) because it can occur at these toxic levels. In 1986, the EPA established a maximum allowable concentration for fluoride in drinking water of 4 milligrams per liter, a guideline designed to prevent the public from being exposed to harmful levels of fluoride. Fluoride in Drinking Water reviews research on various health effects from exposure to fluoride, including studies conducted in the last 10 years.
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Product Details

  • ISBN-13: 9780309101288
  • Publisher: National Academies Press
  • Publication date: 12/22/2006
  • Pages: 530
  • Product dimensions: 5.90 (w) x 8.90 (h) x 1.30 (d)

Table of Contents

Summary     1
Introduction     13
Fluoride in Drinking Water     14
History of EPA's Regulation of Fluoride     16
Committee's Task     18
Committee's Approach     21
Structure of the Report     22
Measures of Exposure to Fluoride in the United States     23
Sources of Fluoride Expostire     24
Recent Estimates of Total Fluoride Exposure     54
Total Exposure to Fluoride     55
Summary of Exposure Assessment     64
Biomarkers of Exposure, Effect, and Susceptibility     69
Findings     81
Recommendations     87
Pharmacokinetics of Fluoride     89
Overview of Fluoride Chemistry, Units, and Measurement     89
Short Review of Fluoride Pharmacokinetics: Absorption, Distribution, and Elimination     90
Pharmacokinetic Models     92
Fluoride Concentrations in Human Bone Versus Water Concentration     93
Fluoride Concentrations in Bones after Clinical Studies     96
Comparative Pharmacokinetics of Rats and Humans     98
Organofluorine Compounds     99
Factors Modifying Pharmacokinetics and Their Implications for Potentially Susceptible Populations     99
Findings     101
Research Recommendations     101
Effects of Fluoride on Teeth     103
Enamel Fluorosis     103
Other Dental Effects     126
Findings     127
Recommendations     130
Musculoskeletal Effects     131
Chemistry of Fluoride As It Relates to Mineralizing Tissues     131
Effect of Fluoride on Cell Function     133
Effects of Fluoride on Human Skeletal Metabolism     138
Effect of Fluoride on Chondrocyte Metabolism and Arthritis     177
Findings     178
Recommendations     180
Reproductive and Developmental Effects of Fluoride     181
Reproductive Effects     181
Developmental Effects     193
Findings     204
Recommendations     204
Neurotoxicity and Neurobehavioral Effects     205
Human Studies     205
Animal Studies     214
Neurochemical Effects and Mechanisms     218
Findings     220
Recommendations     222
Effects on the Endocrine System     224
Thyroid Follicular Cells     224
Thyroid Parafollicular Cells      236
Parathyroid Glands     238
Pineal Gland     252
Other Endocrine Organs     256
Summary     260
Recommendations     266
Effects on the Gastrointestinal, Renal, Hepatic, and Immune Systems     268
GI System     268
The Renal System     280
Hepatic System     292
Immune System     293
Findings     295
Recommendations     302
Genotoxicity and Carcinogenicity     304
Genotoxicity     304
Carcinogenicity     316
EPA Guidelines and Practice in Setting MCLGs Regarding Carcinogenicity     334
Findings     335
Recommendations     338
Drinking Water Standards for Fluoride     340
Current Methods for Setting Standards for Drinking Water     340
New Risk Assessment Considerations     342
Fluoride Standards     345
Findings and Recommendations     352
References     354
Biographical Information on the Committee on Fluoride in Drinking Water     411
Measures of Exposure to Fluoride in the United States: Supplementary Information     416
Ecologic and Partially Ecologic Studies in Epidemiology     439
Comparative Pharmacokinetics of Rats and Humans     442
Detailed Information on Endocrine Studies of Fluoride     447
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