2011/10/05 Council Agenda Packet

Fluoridation of community water, supplies to an "optimal" concentration is assumed to be a practical public health measure resulting in a substantial reduction in the incidence of dental caries) Because of the important role of the kidney in the excretion of ingested fluoride, serious questions re- garding the safety of fluoride for patients with renal insufficiency, parti- cularly for patients on maintenance dialysis, have arisen in recent years. Studies indicate that during the advanced stages of renal failure, blood and bone fluoride concentrations increase. However, only seven cases of fluo- rosis have been reported in the medical literature and all of these:occurred in patients with renal disease who were exposed to naturally occurring fluo- ride concentrations exceeding recommended levels over a prolonged period. The possible role of fluoride in modifying the evolutions of bone disease before the initiation of hemodialysis is not clear, although fluoride does not appear to be a major factor. Patients on maintenance dialysis Who drink a fluridated water'and are treated with the artificial kidney using.dialysate prepared with fluoridated water receive much more fluoride than normal persons. Despite this, no cases of typical skeletal fluorosis have been reported in a large population of patients who have undergone this form of treatment worldwide for prolonged periods during the past decade.2 In certain centers there appears to be an increase in a form of bone disease leading to spontaneous fractures and an increase in unmineralized bone in patients who are exposed to fluoride which has been prepared with tap water that has not been further purified. However, tap water frequently contains a number of substances which may have a skeletal effect, including aluminum.3 The only prospective controlled study failed to demonstrate a statistically significant fluoride effect on bones over a period of 2.5 years.4 - 1 ..