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1 Introduction
Pages 13-22

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From page 13...
... and promulgate national primary drinking-water regulations (maximum contaminant levels [MCLs]
From page 14...
... Of the approximately 10 million people with naturally fluoridated public water supplies in 1992, around 6.7 million had fluoride concentrations less than or equal to 1.2 mg/L (CDC 1993)
From page 15...
... Information on the fluoride content of public water supplies is available from local water suppliers and local, county, or state health departments. Artificial Since 1945, fluoride has been added to many public drinking-water supplies as a public-health practice to control dental caries.
From page 16...
... . EPA considered objectionable enamel fluorosis to involve moderate to severe cases with dark stains and pitting of the teeth.
From page 17...
... In 1984, the surgeon general concluded that osteosclerosis is not an adverse health effect and that crippling skeletal fluorosis was the most relevant adverse health effect when considering exposure to fluoride from public drinking-water supplies. He continued to support limiting fluoride concentrations to 2 mg/L to avoid objectionable enamel fluorosis (50 Fed.
From page 18...
... . To set that guideline, EPA reviewed data on the incidence of moderate and severe enamel fluorosis and found that, at a fluoride concentration of 2 mg/L, the incidence of moderate fluorosis ranged from 0% to 15%.
From page 19...
... · Identifythecompoundsthatcomposethe"organicfluoridepool" inhumanplasmaanddeterminetheirsources,metaboliccharacteristics, fate,andbiologicalimportance. Enamel Fluorosis · Identify sources of fluoride during the critical stages of tooth developmentinchildhoodandevaluatethecontributionofeachsource toenamelfluorosis.
From page 20...
... ofthecancersitesthataremosthighly suspect,basedondatafromanimalstudiesandthefewsuggestionsofa carcinogeniceffectreportedintheepidemiologicliterature.Suchstudies shouldbedesignedtogatherinformationonindividualstudysubjects sothatadjustmentscanbemadeforthepotentialconfoundingeffects of other risk factors in analyses of individuals. Information on fluoride exposurefromsourcesotherthanwatermustbeobtained,andestimates ofexposurefromdrinkingwatershouldbeasaccurateaspossible.In addition,analysisoffluorideinbonesamplesfrompatientsandcontrols wouldbevaluableininferringtotallifetimeexposurestofluoride.Among thediseaseoutcomesthatwarrantseparatestudyareosteosarcomas andcancersofthebuccalcavity,kidney,andbonesandjoints.
From page 21...
... Unless otherwise noted, the term fluoride is used in this report to refer to the inorganic, ionic form. Most of the nonepidemiologic studies reviewed involved exposure to a specified fluoride compound, usually sodium fluoride.
From page 22...
... . The committee also attempts to characterize fluoride exposures from various sources to different subgroups within the general population and to identify subpopulations that might be particularly susceptible to the effects of fluoride.


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