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FLUORIDE AND TEA
329
knowledge, scope of research and use of foreign-language materials, and, of course, we have collected records on all aspects of library use. One of the main aims of the project has been to determine what factors prevent research-workers from making full use of material published in languages other than English. One important aspect is the availability of translation services, and the cost, timeliness, and quality of the translations. We should like to hear from research-workers in other universities and in industry about their experiences in obtaining translations-if possible with details of the translations they have obtained: language, subject, source of translation, written or oral, length, cost, quality, about any unsuccessful attempts to obtain trans&c.-and lations-the languages concerned, and the bodies ap-
proached. We should also welcome any suggestions for improving existing arrangements. W. L. SAUNDERS Postgraduate School of Librarianship L. J. PARGETER and Information Science, W. J. HUTCHINS. Sheffield.
FLUORIDE AND TEA
SIR,-Webb-Peploe and Bradleygave details of a case crippling fluorosis with neurological complications, originally diagnosed as Paget’s disease with osteoarthritis, in a man whose only known exposure to fluoride was in the tea he drank. I have given details of dental fluorosis in of
a woman
who drank
tea
from age two, but had
never
lived
water contained fluoride 2 (F-). Jolly et al.3 reported that dental and varied without linear relationship to F-
where
skeletal fluorosis concentration in water, whereas F- toxicity varied inversely with total and calcium hardness and other sources, especially tea and alcoholic drinks, were important. These workers, the U.S. National Research Council,4 and the U.S. Food and Drug Administrationconsider that total ingestion of F- is important. The F.D.A. has put an upper limit on daily F- at 2 mg., and states that F- has not been shown to be essential to human nutrition. Tea and infusions6 fed to rats have produced dental fluorosis, while both carious and non-carious enamel 7and dentine9 of human teeth have similar F- content. Tea-fed rats have fewer carious teeth than controls,lO although growth is reduced. It was suggested 10 that tea infusions may be too weak to be effective in man, but this was refuted by Jenkins 11 since man only requires one-tenth the dose of F- required by the rat to prevent caries. He suggested that tea-drinking does not affect caries as " the tea-drinking habit is not usually well-established until most of the teeth are calcified ", but I have found no data on the tea-drinking habits of children, and little is known of children’s fluid or total fluoride intake in the U.K. I have carried out a pilot survey (to be published elsewhere) on the fluid intake, drinking-habits, tea consumption, and fluoride ingestion of 662 children aged five to fifteen, in nine schools, and find 92-5% drink tea regularly, 95% of these at the same strength as their parents. The cariogenic effect of the susar in tea must be considered. 25-33 five1. Webb-Peploe, M. M., Bradley, W. G.J. Neurol. Neurosurg. Psychiat. 1966, 29, 577. 2. 3.
Cook, H. A. Pakistan dent. Rev. 1968, 18, 100. Jolly, S. S., Singh, B. M., Mathur, O. C., Malhotra, med. J. 1968, iv, 427.
K. C. Br.
4. U.S. National Research Council. Publication no. 294, 1953. 5. U.S. Food and Drug Administration Circular, Aug. 15, 1965. 6. Reid, E. Chin. J. Physiol. 1936, 10, 259. 7. Harrison, M. F. N.Z. dent. J. 1949, 45, 2. 8. Armstrong, W. D., Singer, L. J. dent. Res. 1963, 42, 133. 9. Csernyei, J. A. Fluor. Q. Rep. 1969, 2, 116. 10. Gershon-Cohen, J., McClendon, J. F. J. Albert Einstein med. Cent. 1957, 5, 153. 11. Jenkins, G. N. Wld Rev. Nutr. Dietet. 1967, 7, 138.
DAILY F- INTAKE
(mg./DAY) FROM TBA, WATER,
Other beverages I have analysed have contained
AND OTHER SOURCES
as
much
as
1-0 p.p.m.
year-olds and 48-60 children aged seven to eight drank tea. Total fluid intake averages 1924 ml. per day in winter, and average daily tea consumption per child is 410 ml. of a 1-65% infusion, giving 1.26 mg. fluoride. I have analysed most of the common brands of tea sold in this country, and find an average ionised fluoride content of 186 mg. per kg., or 0-52 mg. per cup. Applying this average figure to the tea consumption as given by the International Tea Committee I have also calculated the Fintake of adults (45 % of whom are edentulous) and children as follows (see table). These figures show that children’s ingested fluoride is nearly four times as much without fluoridation and nearly three times as much with fluoridation, and adults’ fluoride is twice as much with and without fluoridation as Longwell’s 12 estimates which formed the basis of the Ministry of Health’s statement in 1962 13 that " The fluoride content of food, tea and other beverages is insufficient to have any ill effects in areas where water contains 1 p.p.m.". With these amounts of fluoride any possible long-term effects can no longer be ignored or lightly dismissed, and it would seem essential that the long-term effects, not only on teeth, but also on the whole of the body, should receive fullest investigation. Excretion varies with, but is always less than, the fluoride intake 14 15 and cases of fluorosis retain more F- due to lower excretion.16 Absorbed F- is taken up by bone, fibrous and tumour tissue, and infective lesions,17 while absorption by enamel would appear to be by ion exchange," 18in which tea-drinking must be involved. I thank the teachers who have assisted me in this survey. Scientific Committee for the Study of Fluoridation Hazards, London S.W.1.
H. A. COOK Hon. Secretary.
Longwell, J. Jl R. Soc. Hlth, 1957, 7, 361. 13. Rep. publ. Hlth med. Subj. 1962, no. 105. 14. Largent, E. J. A.M.A. Archs ind. Hyg. 1952, 6, 37. 15. Ham, M. P., Smith, M. D. J. Nutr. 1954, 53, 225. 16. Srikantia, S. G., Siddiqui, A. H. Clin. Sci. 1965, 28, 477. 17. French, R. J., McCready, V. R. Br. J. Radiol. 1967, 40, 655. 18. Waters, N. E. Nature, Lond. 1968, 219, 62.
12.
Appointments CLARKE, B. F., M.B. N.z., M.R.C.P.E. : consultant physician, Royal Infirmary, Edinburgh. FLORENCE, A. M., M.B. Aberd., F.F.A. R.C.S.: consultant anaesthetist, Aintree and Broadgreen Hospitals, Liverpool. GHOSH, S. K., M.B. Calcutta, D.M.R.D.: consultant radiologist, Burnley and district hospital group. GOORNEY, A. B., M.B. Edin., D.P.M., D.I.H.: consultant psychiatrist, St. Andrew’s Hospital, Northampton. Roy, S. K., M.B. Calcutta, M.R.C.P.E., D.C.H. : consultant in geriatric medicine, regional geriatric service, Aberdeen. SARKIES, J. R. W., M.R.C.S., D.O.M.S. : consultant ophthalmologist, Isle of Man Health Services Board.
TURNBULL, G. A.,
M.B.
Durh.,
consultant obstetrician and and South Westmorland hospital
M.R.C.O.G. :
gynaecologist, North Lancashire group.
M.D. L’pool, F.R.C.S., D.O.: consultant ophthalmologist, Ophthalmic Hospital, London.
WRIGHT, J. E., Western
knowledge, scope of research and use of foreign-language materials, and, of course, we have collected records on all aspects of library use. One of the main aims of the project has been to determine what factors prevent research-workers from making full use of material published in languages other than English. One important aspect is the availability of translation services, and the cost, timeliness, and quality of the translations. We should like to hear from research-workers in other universities and in industry about their experiences in obtaining translations-if possible with details of the translations they have obtained: language, subject, source of translation, written or oral, length, cost, quality, about any unsuccessful attempts to obtain trans&c.-and lations-the languages concerned, and the bodies ap-
proached. We should also welcome any suggestions for improving existing arrangements. W. L. SAUNDERS Postgraduate School of Librarianship L. J. PARGETER and Information Science, W. J. HUTCHINS. Sheffield.
FLUORIDE AND TEA
SIR,-Webb-Peploe and Bradleygave details of a case crippling fluorosis with neurological complications, originally diagnosed as Paget’s disease with osteoarthritis, in a man whose only known exposure to fluoride was in the tea he drank. I have given details of dental fluorosis in of
a woman
who drank
tea
from age two, but had
never
lived
water contained fluoride 2 (F-). Jolly et al.3 reported that dental and varied without linear relationship to F-
where
skeletal fluorosis concentration in water, whereas F- toxicity varied inversely with total and calcium hardness and other sources, especially tea and alcoholic drinks, were important. These workers, the U.S. National Research Council,4 and the U.S. Food and Drug Administrationconsider that total ingestion of F- is important. The F.D.A. has put an upper limit on daily F- at 2 mg., and states that F- has not been shown to be essential to human nutrition. Tea and infusions6 fed to rats have produced dental fluorosis, while both carious and non-carious enamel 7and dentine9 of human teeth have similar F- content. Tea-fed rats have fewer carious teeth than controls,lO although growth is reduced. It was suggested 10 that tea infusions may be too weak to be effective in man, but this was refuted by Jenkins 11 since man only requires one-tenth the dose of F- required by the rat to prevent caries. He suggested that tea-drinking does not affect caries as " the tea-drinking habit is not usually well-established until most of the teeth are calcified ", but I have found no data on the tea-drinking habits of children, and little is known of children’s fluid or total fluoride intake in the U.K. I have carried out a pilot survey (to be published elsewhere) on the fluid intake, drinking-habits, tea consumption, and fluoride ingestion of 662 children aged five to fifteen, in nine schools, and find 92-5% drink tea regularly, 95% of these at the same strength as their parents. The cariogenic effect of the susar in tea must be considered. 25-33 five1. Webb-Peploe, M. M., Bradley, W. G.J. Neurol. Neurosurg. Psychiat. 1966, 29, 577. 2. 3.
Cook, H. A. Pakistan dent. Rev. 1968, 18, 100. Jolly, S. S., Singh, B. M., Mathur, O. C., Malhotra, med. J. 1968, iv, 427.
K. C. Br.
4. U.S. National Research Council. Publication no. 294, 1953. 5. U.S. Food and Drug Administration Circular, Aug. 15, 1965. 6. Reid, E. Chin. J. Physiol. 1936, 10, 259. 7. Harrison, M. F. N.Z. dent. J. 1949, 45, 2. 8. Armstrong, W. D., Singer, L. J. dent. Res. 1963, 42, 133. 9. Csernyei, J. A. Fluor. Q. Rep. 1969, 2, 116. 10. Gershon-Cohen, J., McClendon, J. F. J. Albert Einstein med. Cent. 1957, 5, 153. 11. Jenkins, G. N. Wld Rev. Nutr. Dietet. 1967, 7, 138.
DAILY F- INTAKE
(mg./DAY) FROM TBA, WATER,
Other beverages I have analysed have contained
AND OTHER SOURCES
as
much
as
1-0 p.p.m.
year-olds and 48-60 children aged seven to eight drank tea. Total fluid intake averages 1924 ml. per day in winter, and average daily tea consumption per child is 410 ml. of a 1-65% infusion, giving 1.26 mg. fluoride. I have analysed most of the common brands of tea sold in this country, and find an average ionised fluoride content of 186 mg. per kg., or 0-52 mg. per cup. Applying this average figure to the tea consumption as given by the International Tea Committee I have also calculated the Fintake of adults (45 % of whom are edentulous) and children as follows (see table). These figures show that children’s ingested fluoride is nearly four times as much without fluoridation and nearly three times as much with fluoridation, and adults’ fluoride is twice as much with and without fluoridation as Longwell’s 12 estimates which formed the basis of the Ministry of Health’s statement in 1962 13 that " The fluoride content of food, tea and other beverages is insufficient to have any ill effects in areas where water contains 1 p.p.m.". With these amounts of fluoride any possible long-term effects can no longer be ignored or lightly dismissed, and it would seem essential that the long-term effects, not only on teeth, but also on the whole of the body, should receive fullest investigation. Excretion varies with, but is always less than, the fluoride intake 14 15 and cases of fluorosis retain more F- due to lower excretion.16 Absorbed F- is taken up by bone, fibrous and tumour tissue, and infective lesions,17 while absorption by enamel would appear to be by ion exchange," 18in which tea-drinking must be involved. I thank the teachers who have assisted me in this survey. Scientific Committee for the Study of Fluoridation Hazards, London S.W.1.
H. A. COOK Hon. Secretary.
Longwell, J. Jl R. Soc. Hlth, 1957, 7, 361. 13. Rep. publ. Hlth med. Subj. 1962, no. 105. 14. Largent, E. J. A.M.A. Archs ind. Hyg. 1952, 6, 37. 15. Ham, M. P., Smith, M. D. J. Nutr. 1954, 53, 225. 16. Srikantia, S. G., Siddiqui, A. H. Clin. Sci. 1965, 28, 477. 17. French, R. J., McCready, V. R. Br. J. Radiol. 1967, 40, 655. 18. Waters, N. E. Nature, Lond. 1968, 219, 62.
12.
Appointments CLARKE, B. F., M.B. N.z., M.R.C.P.E. : consultant physician, Royal Infirmary, Edinburgh. FLORENCE, A. M., M.B. Aberd., F.F.A. R.C.S.: consultant anaesthetist, Aintree and Broadgreen Hospitals, Liverpool. GHOSH, S. K., M.B. Calcutta, D.M.R.D.: consultant radiologist, Burnley and district hospital group. GOORNEY, A. B., M.B. Edin., D.P.M., D.I.H.: consultant psychiatrist, St. Andrew’s Hospital, Northampton. Roy, S. K., M.B. Calcutta, M.R.C.P.E., D.C.H. : consultant in geriatric medicine, regional geriatric service, Aberdeen. SARKIES, J. R. W., M.R.C.S., D.O.M.S. : consultant ophthalmologist, Isle of Man Health Services Board.
TURNBULL, G. A.,
M.B.
Durh.,
consultant obstetrician and and South Westmorland hospital
M.R.C.O.G. :
gynaecologist, North Lancashire group.
M.D. L’pool, F.R.C.S., D.O.: consultant ophthalmologist, Ophthalmic Hospital, London.
WRIGHT, J. E., Western