Pepala la IAOMT lotsutsana ndi kugwiritsa ntchito fluoride lili ndi mawu opitilira 500 ndipo limapereka kafukufuku watsatanetsatane wasayansi wokhudzana ndi zoopsa zomwe zingachitike paumoyo wokhudzana ndi kukhudzidwa kwa fluoride.
Nyuzipepala ya IAOMT yotsutsana nayo imaphatikizira zolembedwa zopitilira 500 ndipo imapereka kafukufuku watsatanetsatane wasayansi pazomwe zingachitike chifukwa cha kuwonongeka kwa fluoride.
Fluorine (F) ndichinthu chachisanu ndi chinayi pa tebulo la periodic ndipo ndi membala wa banja la halogen. Ili ndi kulemera kwa atomiki ya 18.9984, ndiyo yowonongeka kwambiri pazinthu zonse, ndipo imapanga maulamuliro olimba amagetsi. Amakopeka kwambiri ndi ma divalent cations a calcium ndi magnesium. M'malo ake aulere, fluorine ndi mpweya woipa kwambiri wachikasu wa diatomic. Komabe, fluorine imapezeka kawirikawiri muufulu wake m'chilengedwe chifukwa nthawi zambiri imaphatikizana ndi zinthu zina chifukwa chakuyambiranso kwake. Fluorine nthawi zambiri imapezeka ngati mchere
fluorspar (CaF2), cryolite (Na3AlF6), ndi fluorapatite (3Ca3 (PO4) 2 Ca (F, Cl) 2), ndipo ndi chinthu chachitatu kwambiri padziko lapansi.
Fluoride (F-) ndi mankhwala a fluorine omwe amakhala ndi ma elekitironi owonjezera, potero amawapatsa ndalama zoyipa. Kupatula kukhalapo kwachilengedwe mu mchere, komanso dothi, madzi, ndi mpweya, fluoride amapangidwanso mankhwala kuti agwiritsidwe ntchito m'madzi fluoridation amadzi, zopangira mano, ndi zinthu zina zopangidwa. Fluoride sikofunikira pakukula kwaumunthu ndi chitukuko.1
M'malo mwake, sizofunikira pachithupi chilichonse m'thupi la munthu; chifukwa chake, palibe amene adzavutike ndi kusowa kwa fluoride. Mu 2014, Dr. Philippe Grandjean waku Harvard School of Public Health ndi Dr. Philip J. Landrigan waku Icahn School of Medicine ku Mount Sinai adazindikira kuti fluoride ndi Imodzi mwamankhwala 12 ogulitsa omwe amadziwika kuti amayambitsa chitukuko cha neurotoxicity mwa anthu. 2
Gawo 5.1: Community Water Fluoridation
Kumadzulo kwa Europe, maboma ena azindikira poyera kuwopsa kwa fluoride, ndipo ndi 3% yokha mwa anthu akumadzulo kwa Europe omwe amamwa madzi amadzimadzi. 133 Ku United States, anthu aku America opitilira 66% amamwa madzi amadzimadzi. 134 Ngakhale Environmental Protection Agency (EPA) kapena boma la boma sililamula kuti madzi asungunuke ku America, komanso lingaliro loti fluoridate madzi ammudzi apangidwe ndi boma kapena tawuni yakomweko .135 136 Komabe, US Public Health Service (PHS) imakhazikitsa mayendedwe amtundu wa fluoride m'madzi akumwa am'deralo kwa iwo omwe angasankhe fluoridate, ndipo Environmental Protection Agency (EPA) imakhazikitsa milingo yonyansa yamadzi akumwa.
Pambuyo poti madzi asungunuke ku Grand Rapids, Michigan, adayamba mu 1945, mchitidwewu udafalikira kudera lonselo mzaka zotsatira. Ntchitoyi idalimbikitsidwa ndi Public Health Service (PHS) m'ma 1950, 137 ndi 1962, a PHS adapereka miyezo ya fluoride m'madzi akumwa omwe angayime zaka 50. Anatinso fluoride ingapewe kutsekemera kwa mano138 ndikuti milingo yabwino ya fluoride yowonjezeredwa m'madzi akumwa iyenera kukhala pakati pa 0.7 mpaka 1.2 milligram pa lita. 139 Komabe, a PHS adatsitsa malangizowa pamlingo umodzi wa mamiligalamu 0.7 pa lita imodzi mu 2015 chifukwa cha kuwonjezeka kwa mano a fluorosis (kuwonongeka konse kwa mano komwe kumatha kuchitika kwa ana kuchokera kufalikira kwa fluoride) ndikuwonjezera magwero a kupezeka kwa fluoride kwa anthu aku America.140
Pakadali pano, Safe Drinking Water Act idakhazikitsidwa mu 1974 kuti iteteze madzi akumwa aku America, ndipo idapatsa mphamvu EPA kukhazikitsa madzi akumwa pagulu. Chifukwa
la lamuloli, EPA ikhoza kukhazikitsa milingo yonyansa kwambiri yamadzi akumwa, komanso zolinga zosakakamiza kwambiri zonyansa (MCLGs) ndi miyezo yamadzi akumwa osakakamizika omwe ali ndi milingo yachiwiri yonyansa (SMCLs) .141 EPA imafotokoza. kuti MCLG ndi "mulingo woyipitsitsa wa zonyansa m'madzi akumwa momwe sipangakhale vuto lililonse pa thanzi la anthu, zomwe zimapangitsa kuti pakhale chitetezo chokwanira." 142 Kuphatikiza apo, EPA ikuyenereranso kuti makina amadzi opitilira MCL a fluoride "ayenera kudziwitsa anthu omwe akutumizidwa ndi dongosololi posachedwa, koma pasanadutse masiku 30 dongosololi litazindikira za kuphwanya kumeneku." 143
Mu 1975, EPA idakhazikitsa mulingo woyipitsa kwambiri (MCL) wa fluoride m'madzi akumwa pa 1.4 mpaka 2.4 milligrams pa lita. 144 Adakhazikitsa malirewa popewa matenda am'mano fluorosis. Mu 1981, South Carolina idati mano a fluorosis amangokhala zodzikongoletsera, ndipo boma lidapempha EPA kuti ichotse MCL ya fluoride. Zotsatira zake, mu 145, EPA idakhazikitsa mulingo woyipitsitsa kwambiri (MCLG) wa fluoride pa mamiligalamu 1985 pa lita. 4 M'malo mokhala ndi mano a fluorosis omwe amateteza (omwe amafunikira chitetezo chotsika), mulingo wapamwambawu unakhazikitsidwa ngati njira yodzitetezera ku mafupa a fluorosis, matenda am'mafupa omwe amayamba chifukwa cha fluoride wochulukirapo. Kugwiritsa ntchito mafupa a fluorosis monga malekezero kumathandizanso kusintha kwa MCL ya fluoride, yomwe idakwezedwa mpaka mamiligalamu 146 pa lita imodzi mu 4. 1986 Komabe, fluorosis ya mano idagwiritsidwa ntchito ngati malo omaliza a SMCL ya fluoride wa mamiligalamu awiri pa lita, yomwe idayikidwanso mu 147. 2
Kutsutsana kudatsata malamulo atsopanowa ndipo zidadzetsa milandu ku EPA. South Carolina yati palibe chifukwa chofunira MCLG (zolinga zoyipa kwambiri) za fluoride, pomwe Natural Resources Defense Council idati MCLG iyenera kutsitsidwa kutengera mano a fluorosis. 149 Khothi lidagamula kuti EPA ivomereze, koma poyang'ana momwe fluoride fluoride, EPA idalembera National Research Council (NRC) ya National Academy of Science kuti iwunikenso kuwopsa kwa fluoride.150 151
Ripoti lochokera ku National Research Council, lomwe lidatulutsidwa mu 2006, lidatsimikiza kuti MCLG ya EPA (cholinga chachikulu cha mankhwala oopsa) a fluoride iyenera kutsitsidwa.152 Kuphatikiza pakuzindikira kuthekera kwa chiopsezo cha fluoride ndi osteosarcoma (khansa ya mafupa), 2006 Lipoti la National Research Council linatchula nkhawa zokhudzana ndi minofu, mafupa, ziwalo zoberekera komanso chitukuko, matenda a neurotoxicity ndi zotsatira za neurobehaisheral, genotoxicity ndi carcinogenicity, komanso zomwe zimakhudza ziwalo zina.153
NRC idatsimikiza kuti MCLG ya fluoride iyenera kutsitsidwa mu 2006, koma EPA sinatsikebe. 154 Mu 2016, Fluoride Action Network, IAOMT, ndi magulu ena angapo ndi anthu ena adapempha EPA kuti iteteze anthu, makamaka omwe atengeka, kuchokera ku zoopsa za fluoride poletsa kuwonjezera kwa fluoride kumadzi akumwa.155 Pempholi lidakanidwa ndi EPA mu February 2017.156
Gawo 5.2: Madzi Am'mabotolo
Monga mankhwala otsukira mano ndi mankhwala ambiri amano, madzi am'mabotolo amathanso kukhala ndi fluoride.
United States Food and Drug Administration (FDA) ili ndi udindo wowonetsetsa kuti miyezo yamadzi am'mabotolo ikugwirizana ndi miyezo yamadzi apampopi yoyikidwa ndi EPA 157 komanso magawo omwe akuvomerezedwa ndi US Public Health Service (PHS). 158 FDA imalola madzi am'mabotolo omwe amakwaniritsa miyezo yake 159 kuphatikiza chilankhulo chonena kuti kumwa madzi amadzimadzi kumachepetsa chiopsezo cha mano.160
Gawo 5.3: Chakudya
A FDA adalamula kuti achepetse kuwonjezera kwa mankhwala a fluorine pachakudya pokomera thanzi la anthu mu 1977. 161 Komabe, fluoride akadalipo mchakudya chifukwa chakukonzekera m'madzi a fluoridated, kupezeka kwa mankhwala ophera tizilombo ndi feteleza, ndi zina. Mu 2004, United States Department of Agriculture (USDA) idakhazikitsa mndandanda wama fluoride mu zakumwa ndi chakudya, ndipo lipoti lofotokoza mwatsatanetsatane lidasindikizidwa mu 2005.162 Ngakhale kuti lipotili likadali lofunika, kuchuluka kwa fluoride mu chakudya ndi zakumwa mwina yawonjezeka pazaka khumi zapitazi chifukwa chogwiritsa ntchito fluoride m'matenda ophera tizilombo omwe avomerezedwa posachedwa.163 Zina zowonjezera zosagwiritsidwa ntchito zomwe zikugwiritsidwanso ntchito zilinso ndi fluoride.164
Kuphatikiza apo, mu 2006, National Research Council idalimbikitsa kuti "kuthandizira kuyerekeza kuti munthu akhoza kumwa fluoride kuchokera pakumwa, opanga ndi opanga ayenera kupereka chidziwitso pazakudya ndi zakumwa za fluoride." 165 Komabe, izi sizingachitike nthawi iliyonse mu posachedwa. Mu 2016, a FDA adasinthiranso zofunikira pakulemba chakudya pamakalata a Nutrition and Supplement Facts ndipo adagamula kuti kufotokozera kwa magulu a fluoride ndiwodzifunira pazinthu zonse zomwe zimapangidwa ndi fluoride ndi zinthu zina mwachilengedwe zomwe zimachitika ndi fluoride. Mtengo Wofotokozera Tsiku Lililonse (DRV) wa fluoride. 166
M'malo mwake, mu 2016, a FDA adaletsa perfluoroalkyl ethyl yokhala ndi zinthu zokhudzana ndi chakudya (PFCSs), zomwe zimagwiritsidwa ntchito ngati mafuta obwezeretsa mafuta pamapepala ndi papepala. 168 Izi zidachitika chifukwa chazidziwitso za poizoni ndi pempholo lomwe lidasungidwa ndi Natural Resources Defense Council ndi magulu ena.
Zina kupatula izi pazakudya za fluoride, kukhazikitsa fluoride woyenera pachakudya chifukwa cha mankhwala ophera tizilombo amagawidwa ndi FDA, EPA, ndi Food Safety and Inspection Service ku dipatimenti ya zaulimi ku US. 169
Gawo 5.4: Mankhwala ophera tizilombo
Mankhwala omwe amagulitsidwa kapena kugawidwa ku US akuyenera kulembedwa ndi EPA, ndipo EPA ikhoza kukhazikitsa kulolerana ndi zotsalira za mankhwala ophera tizilombo ngati kuwonetsedwa kuchokera pachakudya kukuwoneka kuti ndi "kotetezeka." 170
Pachifukwa ichi, mankhwala ophera tizilombo omwe ali ndi fluoride akhala akukangana:
1) Sulfuryl fluoride idalembetsedwa koyamba mu 1959 kuti iwongolere chiswe pazinyama 171 ndipo mu 2004/2005 pakuwongolera tizilombo mu zakudya zopangidwa, monga mbewu monga chimanga, zipatso zouma, mtedza wamitengo, nyemba za koko, nyemba za khofi, komanso chakudya kusamalira ndi kukonza malo ogwiritsira ntchito chakudya. 172 Milandu ya poyizoni wamunthu ngakhale imfa, ngakhale kuti ndi yosowa, yakhala ikugwirizanitsidwa ndi sulfuryl fluoride wokhudzana ndi nyumba zothandizidwa ndi mankhwala ophera tizilombo.173 Mu 2011, chifukwa cha kafukufuku wosinthidwa ndi nkhawa zomwe Fluoride Action Network idachita ( FAN), EPA idanenanso kuti sulfuryl fluoride siyikukwananso ndi chitetezo ndikuti kulolerana kwa mankhwalawa kuyenera kuchotsedwa. 174 Mu 2013, makampani opanga mankhwalawa adachita khama kwambiri kuti athetse lingaliro la EPA lofuna kutulutsa sulfuryl fluoride, ndi Pempho la EPA lidasinthidwa ndi gawo lomwe lidaphatikizidwa mu Bill Bill ya 2014. 175
2) Cryolite, yomwe imakhala ndi sodium aluminium fluoride, ndi mankhwala omwe adalembetsedwa koyamba ndi EPA ku 1957.176 Cryolite ndiye mankhwala ophera tizilombo a fluoride omwe amagwiritsidwa ntchito pakulima chakudya ku US (pomwe sulfuryl fluoride imagwiritsidwa ntchito ngati fumigant pachakudya pambuyo pa zokolola) . Cryolite imagwiritsidwa ntchito pa zipatso za citrus ndi miyala, ndiwo zamasamba, zipatso, ndi mphesa, 177 ndipo anthu amatha kudziwa izi kudzera m'zakudya zawo, chifukwa cryolite imatha kusiya zotsalira za fluoride pazakudya zomwe zagwiritsidwa ntchito. sulfuryl fluoride, EPA idafunikanso kuchotsa zololera zonse za fluoride mu mankhwala ophera tizilombo.178 Izi zikadaphatikizaponso cryolite; komabe, monga tafotokozera pamwambapa, pempholi lidasinthidwa.
Gawo 5.5: Zinthu Zamano Zogwiritsa Ntchito Kunyumba
FDA imafuna kulembedwa kuti "mankhwala osokoneza bongo" omwe amagulitsidwa pa kontrakitala, monga mankhwala otsukira mkamwa ndi kutsuka mkamwa. Mawu apadera pakulemba amasankhidwa ndi mawonekedwe a
mankhwala (mwachitsanzo gel kapena phala ndi kutsuka), komanso ndi fluoride concentration (ie 850-1,150 ppm, 0.02% sodium fluoride, ndi zina zotero.) Chenjezo la 180 ligawidwanso m'magulu azaka (mwachitsanzo azaka ziwiri kapena kupitilira apo, ochepera sikisi , Zaka 12 kapena kupitirira, ndi zina zambiri). Machenjezo ena amagwiritsidwa ntchito pazinthu zonse, monga izi:
(1) Kwa zonse fluoride dentifrice (gel, phala, ndi ufa) zogulitsa. “Khalani patali ndi ana osakwana zaka 6. [yolongosoledwa m'zilembo zakuda] Ngati zambiri zogwiritsa ntchito potsuka zimamezedwa mwangozi, pitani kuchipatala kapena pitani ku Poison Control Center nthawi yomweyo. ”181
(2) Onse fluoride muzimutsuka ndi mankhwala mankhwala gel osakaniza. “Khalani kutali ndi ana. [yolembedwa m'mawu akuda] Ngati agwiritsa ntchito kwambiri "(sankhani mawu oyenera:" kutsuka "kapena" kutsuka ")" amezedwa mwangozi, pitani kuchipatala kapena muthane ndi Poison Control Center nthawi yomweyo. "182
Nkhani yofufuza yomwe idasindikizidwa mu 2014 idadzetsa nkhawa zazikulu pazolemba izi. Makamaka, olembawo adatsimikiza kuti zopitilira 90% zomwe adayesa zidalemba chenjezo la FDA kuti ligwiritsidwe ntchito ndi ana azaka zopitilira ziwiri kumbuyo kwa chubu cha mankhwala otsukira mano komanso zazing'ono.183 Zomwezi zidanenedwa za machenjezo ochokera ku American Dental Association (ADA), lomwe ndi gulu lazamalonda osati bungwe laboma. Ofufuzawo adalemba kuti mankhwala onse opangira mano akuvomerezedwa kapena kuvomerezedwa ndi ADA adapereka chenjezo la ADA (kuti ana azigwiritsa ntchito mankhwala otsukira mtola ndi kuyang'aniridwa ndi wamkulu kuti achepetse kumeza) kumbuyo kwa chubu muzithunzi zazing'ono .184 Njira zotsatsa zinali
adanenanso kuti amalimbikitsa mankhwala otsukira mano ngati chakudya, chomwe ofufuzawo adavomereza kuti ndi njira yomwe ingapangitse ana kumeza mankhwalawo.185
Ngakhale floss yamano imagawidwa ndi FDA ngati chida cha Class I, 186 floss floss yomwe imakhala ndi fluoride (nthawi zambiri stannous fluoride) imawerengedwa kuti ndiophatikiza187 ndipo imafuna
Kugwiritsa ntchito premarket. 188 Dental floss amathanso kukhala ndi fluoride ngati mankhwala opangidwa ndi zotsekemera; 189 komabe, palibe chidziwitso chokhudza mtundu uwu wa fluoride mu mano a floss
itha kupezeka ndi olemba pepalali.
Gawo 5.6: Zinthu Zamano Zogwiritsidwa Ntchito ku Dental Office
Zambiri mwazinthu zomwe zimagwiritsidwa ntchito muofesi yamazinyo zomwe zimatha kutulutsa fluoride zimayendetsedwa ngati zida zamankhwala / mano, monga zinthu zina zotulutsira utomoni, 190 191 simenti yamano, 192 ndi zinthu zina zophatikizira. 193 Makamaka, ambiri mwa awa zipangizo zamano zimagawidwa ndi FDA ngati Class II Medical Devices, 194 kutanthauza kuti FDA imapereka "chitsimikizo chokwanira chachitetezo cha chipangizocho" popanda kugulitsa mankhwalawo pamachitidwe oyang'anira.195 Chofunika, monga gawo la gulu la FDA Njira, zida zamano zomwe zili ndi fluoride zimawerengedwa kuti ndizophatikiza, 196 ndipo ma fluoride otulutsira mbiri amayembekezeredwa kuperekedwa ngati chidziwitso chisanagulitsidwe pamsika. 197 FDA idanenanso kuti: "Zonena za kupewa kupewa kapena zina zothandizira kuloledwa ngati kuthandizidwa ndi chidziwitso cha zamankhwala chopangidwa ndi kafukufuku wa IDE [Investigational Device Exemption]. ” 198 Kuphatikiza apo, pomwe a FDA amatchula pagulu njira yotulutsira fluoride ya zida zina zobwezeretsa mano, a FDA sawalimbikitsa pagulu patsamba lawo kuti azigwiritsa ntchito kupewa c199
Mofananamo, pomwe ma varnishi a fluoride amavomerezedwa ngati Zipangizo Zachipatala Zachiwiri Zachipatala kuti azigwiritsa ntchito ngati cholumikizira ndi / kapena desensitizer ya mano, savomerezedwa kuti azigwiritsidwa ntchito poletsa kupewa. 200 Chifukwa chake, pomwe zonena za kupewa kwa caries zimapangidwa za chinthu chomwe chakhala akuphatikizidwa ndi fluoride wowonjezera, izi zimawonedwa ndi FDA ngati mankhwala osavomerezeka, osakanizidwa. Kuphatikiza apo, malamulo a FDA amapangitsa dokotala / dotolo wamankhwala kukhala woyenera kugwiritsa ntchito mankhwala ovomerezeka popanda chizindikiro. 201
Kuphatikiza apo, mu 2014, a FDA adalola kugwiritsa ntchito siliva diamine fluoride pochepetsa mphamvu ya mano. 202 Munkhani yomwe idasindikizidwa mu 2016, komiti ku University of California, San Francisco, School of Dentistry, idazindikira kuti, Kugwiritsa ntchito siliva diamine fluoride (monga kasamalidwe ka caries) tsopano ndikololedwa ndi lamulo, pakufunika chitsogozo chovomerezeka, protocol, ndi kuvomereza.203
Chofunikiranso kudziwa ndichakuti phala la fluoride lomwe limagwiritsidwa ntchito panthawi ya mano opewera (kuyeretsa) limakhala ndi ma fluoride ochulukirapo kuposa mankhwala otsukira ogulitsa mano (ie 850-1,500 ppm mu mankhwala otsukira mano 204 motsutsana 4,000-20,000 ppm fluoride mu prophy paste205). Phala la fluoride sililandiridwa ndi FDA kapena ADA ngati njira yabwino yopewera kusungunuka kwamano. 206
Gawo 5.7: Mankhwala Osakaniza Mankhwala (Kuphatikiza Zowonjezera)
Fluoride imawonjezeredwa mwadala ku mankhwala opangira mankhwala (madontho, mapiritsi, ndi lozenges omwe nthawi zambiri amatchedwa "zowonjezera" kapena "mavitamini") omwe amapatsidwa kwa ana nthawi zonse, akuti amateteza zotupa. Mu 1975, a FDA adayankha kugwiritsa ntchito mankhwala a fluoride pochotsa mankhwala atsopano a Ernziflur fluoride. Pambuyo pazochita za FDA pamaloboti a Ernziflur anali
lofalitsidwa mu Federal Register, nkhani idatulutsidwa mu Therapy Therapy yonena kuti kuvomerezedwa kwa FDA kudachotsedwa "chifukwa palibe umboni wowonekeratu wokhudzana ndi mankhwala osokoneza bongo monga momwe adanenera, kulimbikitsidwa, kapena kuperekedwa pakulemba kwake." 207 208 Nkhaniyi idatinso: " Chifukwa chake a FDA alangiza opanga mitundu yophatikizira fluoride ndi mavitamini omwe iwo
kupitiliza kutsatsa ndikuphwanya mankhwala atsopano a Federal Food, Drug, and cosmetic Act; , chifukwa chake, apempha kuti malonda azinthuzi asiye. ”209 210
Mu 2016, a FDA adatumiziranso kalata yochenjeza za nkhani yomweyo ya mankhwala osavomerezeka m'njira zosiyanasiyana kuphatikiza ma fluoride supplements omwe adalembedwa mu 1975. Kalata, yolemba
Januware 13, 2016, adatumizidwa ku Kirkman Laboratories pokhudzana ndi mitundu inayi yamankhwala opangira ana a fluoride omwe amadziwika kuti ndi othandizira kupewa mano. 211 Kalata yochenjeza ya FDA idapatsa kampaniyo masiku 15 kuti agwirizane ndi malamulo212 ndipo akutumikirabe chitsanzo china cha ana akulandila mosavomerezeka ma fluoride osavomerezeka, omwe tsopano akhala vuto ku US kwazaka zopitilira 40.
Pakadali pano, fluorine imawonjezedwanso kovomerezeka ku mankhwala ena azamankhwala. Zina mwazifukwa zomwe zadziwika kuti zikuwonjezera pamankhwalawa ndi monga akuti "zitha kuwonjezera mankhwala
kusankha, kuwathandiza kusungunuka ndi mafuta, komanso kumachepetsa liwiro lomwe mankhwalawo amapukusidwa, ndikupatsa nthawi yochuluka yogwira ntchito. ” 213 20-30% ya mankhwala omwe akuti anali ndi fluorine.214 Ena mwa mankhwala odziwika kwambiri ndi monga Prozac, Lipitor, ndi Ciprobay (ciprofloxacin), 215 komanso banja lonse la fluoroquinolone (gemifloxacin [yogulitsidwa ngati Factive], levofloxacin [yogulitsidwa ngati Levaquin], moxifloxacin [yogulitsidwa monga Avelox], norfloxacin [yogulitsidwa ngati Noroxin], ndi ofloxacin [yogulitsidwa ngati Floxin ndi generic ofloxacin]).
216
Ponena za fluoroquinolones, a FDA adapereka chenjezo latsopano pokhudzana ndi zotsatira zoyipa mu 2016, zaka zingapo mankhwalawa atayambitsidwa pamsika. Mu chilengezo chawo cha Julayi 2016, a FDA adati:
Mankhwalawa amalumikizidwa ndi kulepheretsa komanso kuwonongeka kosatha kwa minyewa, minofu, mafupa, minyewa, ndi dongosolo lamanjenje lomwe limatha kuchitika limodzi mwa wodwala yemweyo. Zotsatira zake, tidakonzanso Boxed Warning, chenjezo lamphamvu kwambiri la FDA, kuti tithetse zovuta zazikuluzi. Tidawonjezeranso chenjezo latsopano ndikusintha magawo ena a zilembo zamankhwala, kuphatikizapo Maupangiri a Mankhwala
Chifukwa cha zovuta zoyipa izi, a FDA adalangiza kuti mankhwalawa azigwiritsidwa ntchito pokhapokha ngati kulibe njira ina yothandizira odwala chifukwa zoopsa zake zimaposa
Pa nthawi ya kulengeza kwa 218 FDA, akuti aku America opitilira 2016 miliyoni amamwa mankhwalawa chaka chilichonse. 26
Gawo 5.8: Mafuta Opangira Mafuta
Mankhwala a Per- ndi polyfluoroalkyl (PFASs), omwe amatchedwanso mankhwala opaka utoto kapena mankhwala opaka mafuta (PFCs), ndi zinthu zomwe zimagwiritsidwa ntchito pamakapeti, zotsukira, zovala, zophikira,
kulongedza chakudya, utoto, mapepala, ndi zinthu zina chifukwa zimathandiza kuti moto usamayake komanso mafuta, banga, mafuta, komanso mafuta othamangitsira madzi. 220 Mwachitsanzo, perfluorooctanoic acid (PFOA) imagwiritsidwa ntchito popanga polytetrafluoroethylene (PTFE), yomwe imagwiritsidwa ntchito ku Teflon , Gore-tex, Scotchguard, ndi Stainmaster. 221
Komabe, asayansi opitilira 200 ochokera kumayiko 38 atasaina chikalata cholemba "Madrid Statement" mu 2015, nkhawa 223 zokhudzana ndi zinthu zotere komanso kulumikizana kwawo ndi matenda zidafotokozedwa.
Kuphatikiza apo, mu 2016, EPA idanena za PFSAs:
Kafukufuku akuwonetsa kuti kupezeka kwa PFOA ndi PFOS pamlingo wina kumatha kubweretsa zovuta m'thupi, kuphatikiza kukula kwa mwana wosabadwa panthawi yapakati kapena kwa makanda oyamwitsa (mwachitsanzo, kuchepa pobereka, kutha msinkhu msanga, kusiyanasiyana kwa mafupa), khansa (mwachitsanzo, testicular , impso), zotsatira za chiwindi (mwachitsanzo, kuwonongeka kwa minofu), zoteteza thupi (mwachitsanzo, kupanga chitetezo cha mthupi ndi chitetezo chamthupi), ndi zina (mwachitsanzo, kusintha kwa cholesterol) .225
Chifukwa chake, ku US, zoyesayesa zangoyamba kumene kuchepetsa kugwiritsa ntchito mankhwalawa. Mwachitsanzo, mu 2016, EPA idapereka upangiri wathanzi kwa PFOA ndi PFOS m'madzi akumwa, kuzindikira kuchuluka kapena pansi pazomwe zotsatira zoyipa zaumoyo sizimayembekezereka kuti zichitike kwa nthawi yayitali ngati magawo 0.07 pa biliyoni (magawo 70 pa thililiyoni) za PFOA ndi PFOS. 226 Monga chitsanzo china, mu 2006, EPA idalumikizana ndi makampani asanu ndi atatu kudzera pulogalamu yoyang'anira makampani asanu ndi atatuwa kuti achepetse ndikuchotsa PFOA pofika 2015.227 Komabe, EPA
adalembanso kuti "amakhalabe ndi nkhawa" ndi makampani omwe amapanga zinthu izi zomwe sizinachite nawo pulogalamuyi. 228
Gawo 5.9: Kuntchito
Kuwonetsedwa ndi fluorides (fluoride, perfluoride) kuntchito kumayendetsedwa ndi Occupational Safety & Health Administration (OSHA). Zomwe thanzi limaganiziridwa kwambiri ndi miyezo imeneyi ndi skeletal fluorosis, ndipo malire amomwe anthu amagwirira ntchito ma fluorides amalembedwa ngati 2.5 mg / m3.229
M'chaka cha 2005 chomwe chidasindikizidwa mu International Journal of Occupational and Environmental Health ndipo chidafotokozedwa pang'ono ku American College of Toxicology Symposium, wolemba Phyllis J. Mullenix, PhD, adazindikira kufunikira kwakutetezedwa bwino kuntchito ku fluorides. 230 Makamaka, Dr. Mullenix analemba kuti ngakhale miyezo ya fluoride sinasinthe:
Posachedwapa pakhala deta yomwe ikusonyeza kuti miyezo imeneyi sinateteze mokwanira ogwira ntchito omwe ali ndi fluorine ndi fluoride, komanso kuti kwazaka zambiri makampani ali ndi chidziwitso chofunikira chodziwitsa kusakwanira kwa miyezo ndikukhazikitsa njira zotetezera. 231
Mu lipoti la 2006 la National Research Council (NRC) la National Academy of Sciences pomwe kuwunika kwa fluoride kunayesedwa, nkhawa zidafotokozedwanso za mayanjano omwe angakhalepo pakati pa fluoride ndi osteosarcoma (khansa ya mafupa), mafupa a mafupa, zotupa za musculoskeletal, zotsatira zakubala ndi chitukuko, neurotoxicity ndi zotsatira za neurobehaisheral, genotoxicity ndi carcinogenicity, komanso zomwe zimakhudza ziwalo zina za ziwalo. 232
Popeza lipoti la NRC lidatulutsidwa mu 2006, maphunziro ena angapo ofunikira asindikizidwa. M'malo mwake, mu pempho la nzika la 2016 ku EPA kuchokera ku Fluoride Action Network (FAN), IAOMT, ndi magulu ena, Michael Connett, Esq., Legal Director wa FAN, adapereka mndandanda wazofufuza zatsopano zomwe zikuwonetsa kuvulaza kwa fluoride, zomwe ndizofunikira kwambiri, makamaka chifukwa cha kuchuluka kwa maphunziro owonjezera aumunthu: 233
Ponseponse, Olembera apeza ndikuyika maphunziro 196 omwe adafotokoza za neurotoxic zomwe zimapezeka chifukwa cha kuwonekera kwa fluoride pambuyo pa kuwunikiridwa kwa NRC, kuphatikiza maphunziro a anthu 61, maphunziro anyama 115, maphunziro a cell 17, ndi kuwunika kwa 3 mwatsatanetsatane.
Maphunziro a anthu a post-NRC ndi awa:
• Kafukufuku 54 wofufuza momwe fluoride imakhudzira magwiridwe antchito, kuphatikiza koma osangolekezera ku IQ, pomwe onse koma asanu ndi atatu mwa maphunzirowa akuwoneka kuti ndi ofunika
mayanjano pakati pa kuwonetseredwa kwa fluoride ndi kuchepa kwa kuzindikira
• Kafukufuku wachitatu wofufuza momwe fluoride imakhudzira ubongo wa mwana, ndipo kafukufuku aliyense mwa atatuwa amafotokoza zoyipa. 3
• Kafukufuku 4 wofufuza mayanjano a fluoride ndi mitundu ina yamankhwala osokoneza bongo, kuphatikiza ADHD, kusintha kwa khanda, komanso zizindikilo zosiyanasiyana zamitsempha.
Maphunziro a nyama za post-NRC ndi awa:
• Kafukufuku 105 wofufuza kutha kwa fluoride kuti apange kusintha kwa neuroanatomical and neurochemical, pomwe zonse koma ziwiri zokha za kafukufukuyu zimapeza zoyipa chimodzi pamlingo umodzi woyesedwa.2
• Kafukufuku 31 ofufuza momwe fluoride imakhudzira kuphunzira ndi kukumbukira, pomwe onse koma m'modzi mwa kafukufukuyu adapeza zovuta m'magulu omwe amathandizidwa ndi fluoride. 238
• Kafukufuku 18 wofufuza momwe fluoride imakhudzira magawo ena amomwe amathandizira kupatula kuphunzira ndi kukumbukira, ndi zonse koma kafukufuku m'modzi amapeza zotsatira.239
Kafukufuku wamaselo a NRC akuphatikizapo:
• Kafukufuku 17, kuphatikiza maphunziro awiri omwe adafufuza ndikupeza zotsatira pamafluoride omwe amapezeka mwazi wama America omwe amakhala mdera la fluoridated.2
Kuphatikiza pa maphunziro omwe ali pamwambapa, Opempha akupereka ndemanga zitatu zotsatila za NRC mwatsatanetsatane za zolembedwazo, kuphatikiza ziwiri zomwe zimayang'ana zolemba za anthu / IQ, ndi imodzi yomwe
imayankha zolemba za nyama / kuzindikira. 241
Zikuwonekeratu kuti zolemba zambiri zadziwika kale kuti zitha kuvulaza anthu kuchokera ku fluoride m'magulu osiyanasiyana owonekera, kuphatikiza magawo omwe akuwoneka kuti ndi otetezeka. Ngakhale iliyonse ya nkhanizi ndiyofunika kuzikambirana ndi kuzikambirana, mndandanda womwe udulembedwa waphatikizidwa pansipa ngati mawonekedwe ofotokozera zamankhwala zomwe zimakhudzana ndi kufalikira kwa fluoride, zomwe zimawonetsa zazikulu za malipoti ofunikira ndi maphunziro.
Gawo 6.1: Skeletal System
Fluoride yolowetsedwa mthupi la munthu imalowa m'magazi kudzera munjira yogaya chakudya.242 Ambiri mwa fluoride omwe samatulutsidwa kudzera mumkodzo amasungidwa mthupi. Zimanenedwa kuti 99% ya fluoride iyi imakhala mufupa, 243 momwe imaphatikizidwira mumapangidwe amakristalo ndipo imadziunjikira pakapita nthawi. 244 Chifukwa chake, sizingatsutsike kuti mano ndi mafupa ndi ziwalo za thupi zomwe zimayika fluoride kuti zomwe tikuwululidwa.
M'malo mwake, mu lipoti lake la 2006, zokambirana za National Research Council (NRC) pazowopsa kwakuthyoka kwa mafupa chifukwa cha fluoride wambiri zidatsimikiziridwa ndikufufuza kwakukulu. Makamaka,
lipotilo linati: "Ponseponse, komiti idagwirizana kuti pali umboni wasayansi woti pazinthu zina fluoride imatha kufooketsa mafupa ndikuwonjezera ngozi yophulika." 245
Gawo 6.1.1: Mano Fluorosis
Kuwonetsedwa kwa fluoride wochuluka mwa ana kumadziwika kuti kumayambitsa matenda a mano, zomwe zimapangitsa kuti mano awonongeke osasinthika ndipo mano amasandulika kosatha, kuwonetsa koyera kapena kofiirira kotsika ndikupanga mano otupa omwe amathyola komanso kuwonongeka mosavuta. akhala akudziwika mwasayansi kuyambira m'ma 246 kuti kufalikira kwa fluoride kumayambitsa vutoli, lomwe limatha kukhala lochepa kwambiri. Malinga ndi zomwe a Centers for Disease Control and Prevention (CDC) adatulutsa mu 1940, 2010% aku America azaka zapakati pa 23-6 ndi 49% ya ana azaka zapakati pa 41-12 akuwonetsa fluorosis pamlingo winawake. 15 Kuwonjezeka kwakukulu kwamitengo ya mano a fluorosis zinali zofunikira kwambiri pa chisankho cha Public Health Service kuti ichepetse malingaliro ake a fluoridation madzi mu 247
Chithunzi 1: Mano Fluorosis Ochokera Kofatsa Kwambiri Kufikira Kwambiri
(Zithunzi zochokera kwa Dr. David Kennedy ndipo amazigwiritsa ntchito ndi chilolezo kuchokera kwa omwe anakhudzidwa ndi matenda a mano.)
Zithunzi za Dental Fluorosis, chizindikiro choyamba cha poyizoni wa fluoride, kuyambira wofatsa kwambiri mpaka wolimba; Chithunzi chojambulidwa ndi Dr. David Kennedy ndipo amagwiritsidwa ntchito ndi chilolezo cha omwe adachitidwa matenda a mano
Gawo 6.1.2: Skeletal Fluorosis ndi Arthritis
Monga mano a fluorosis, chigoba cha fluorosis ndichinthu chosatsutsika chakuwonekera kwambiri kwa fluoride. Skeletal fluorosis imayambitsa mafupa olimba, kupweteka kwamalumikizidwe, mayendedwe ochepa olumikizana, ndi mkati
Matenda owopsa, msana wolimba kwathunthu. 249 Ngakhale zimawoneka kuti ndizosowa ku US, vutoli limachitika, 250 ndipo zanenedwa posachedwa kuti chigoba cha fluorosis chitha kukhala vuto lalikulu lathanzi kuposa momwe zimadziwika kale.251
Monga momwe kafukufuku wofotokozedwera mu 2016 adanenera, pakadalibe mgwirizano wamasayansi wonena za kuchuluka kwa fluoride ndi / kapena kutalika kwa fluoride kuyenera kutengedwa musanachitike chigoba cha fluorosis. 252
Ngakhale olamulira ena anena kuti mafupa a fluorosis amapezeka kokha pakatha zaka 10 kapena kupitilira apo, kafukufuku wasonyeza kuti ana atha kudwala matendawa pasanathe miyezi sikisi, 253
ndipo achikulire ena apanga izi kwa zaka ziwiri kapena zisanu ndi ziwiri.254 Momwemonso, pomwe olamulira ena akuti 10 mg / tsiku la fluoride ndilofunikira kuti apange skeletal fluorosis, kafukufuku wanena kuti kuchepa kwa fluoride (mu zina zosakwana 2ppm) zingayambitsenso matendawa. 255 Kuphatikiza apo, kafukufuku wofalitsidwa mu 2010 adatsimikizira kuti mafupa am'magazi amasiyana ndi fluoride amasiyanasiyana malinga ndi munthu.
Odwala omwe ali ndi skeletal fluorosis, fluoride amamuganiziranso kuti amayambitsa hyperparathyroidism yachiwiri komanso / kapena kuwononga mafupa ofanana ndi hyperparathyroidism yachiwiri. Vutoli, lomwe limayamba chifukwa cha matenda a impso, limayamba pomwe kuchuluka kwa calcium ndi phosphorous m'magazi kumakhala kotsika kwambiri.257 Kafukufuku angapo omwe asonkhanitsidwa ndi Fluoride Action Network (FAN) amawunika kuthekera kuti fluoride ndi imodzi zimathandizira kuti izi zitheke. 258
Chifukwa chakuti matenda a nyamakazi amakhudzana ndi mafupa a fluorosis, nyamakazi ndi gawo lina lodetsa nkhawa pokhudzana ndi kufalikira kwa fluoride. Makamaka pankhaniyi, kafukufuku adalumikiza fluoride ndi osteoarthritis, onse omwe ali ndi mafupa a fluorosis kapena opanda.259 Kuphatikiza apo, matenda olumikizana ndi temporomandibular (TMJ) adalumikizidwa ndi mano ndi mafupa a fluorosis.260
Gawo 6.1.3: Khansa ya Mafupa, Osteosarcoma
Mu 2006, NRC idakambirana za kulumikizana komwe kungakhalepo pakati pa kupezeka kwa fluoride ndi osteosarcoma. Mtundu wa khansa yapafupa amadziwika kuti ndi "gulu lachisanu ndi chimodzi lodziwika bwino la zotupa zoyipa mwa ana komanso lachitatu pachimake chotupa kwambiri kwa achinyamata." 261 NRC idatinso kuti ngakhale umboni umangoyeserera, fluoride ikuwoneka kuti itha kulimbikitsa khansa .262
Anazindikira kuti osteosarcoma inali yofunika kwambiri, makamaka chifukwa cha kufalikira kwa fluoride m'mafupa komanso kusintha kwa fluoride pama cell a mafupa.
Pomwe kafukufuku wina walephera kupeza mgwirizano pakati pa fluoride ndi osteosarcoma, malinga ndi kafukufuku yemwe Dr. Elise Bassin adachita ku Harvard School of Dental Medicine, kufalikira kwa fluoride pamlingo woyenera womwe umalumikizidwa ndi kuwonjezeka kasanu ndi kawiri kwa osteosarcoma pomwe anyamata anali Zowululidwa pakati pa zaka zapakati pa zisanu ndi zisanu ndi ziwiri. 264 Kafukufuku wa Bassin, wofalitsidwa mu 2006, ndiye kafukufuku yekhayo wokhudza osteosarcoma yemwe watenga zoopsa zakubadwa. 265
Gawo 6.2: Central Nervous System
Zomwe ma fluorides angakhudze ubongo zakhazikitsidwa bwino. Mu lipoti lawo la 2006, NRC idalongosola kuti: "Potengera chidziwitso chambiri chomwe chimachokera ku kafukufuku wa histological, chemical, and molecular, zikuwonekeratu kuti ma fluoride amatha kusokoneza magwiridwe antchito aubongo ndi thupi mwanjira zachindunji komanso zosadziwika . ”266 Matenda a dementia komanso Alzheimer's
Matendawa amatchulidwanso mu lipoti la NRC kuti lingaganizidwe kuti limatha kulumikizidwa ndi fluoride. 267
Zovuta izi zatsimikiziridwa. Kafukufuku wokhudzana ndi madzi fluoridation ndi zotsatira za IQ adayesedwa mosamala mu kafukufuku wofalitsidwa mu Okutobala wa 2012 mu Environmental Health Perspectives. 268 Mukuwunikaku kwa meta, kafukufuku 12 adawonetsa kuti madera omwe ali ndi madzi amadzimadzi omwe ali pansi pa 4 mg / L (pafupifupi 2.4 mg / L ) anali ndi ma IQ ochepera kuposa magulu owongolera. 269 Chiyambitsireni kuwunikiridwa kwa 2012, maphunziro ena owonjezera omwe apeza kuti ma IQ ochepetsedwa m'magulu omwe ali ndi zosakwana 4 mg / L a fluoride m'madzi apezeka. 270 Kunena zowona, Pempho lokhala nzika ku EPA mu 2016, Michael Connett, Esq., Mtsogoleri wa zamalamulo wa FAN, adazindikira kafukufuku 23 wofufuza zomwe zachepetsa IQ m'malo omwe magawo a fluoride akuvomerezedwa kuti ndi otetezeka ndi EPA.
Kuphatikiza apo, mu 2014, ndemanga idasindikizidwa mu The Lancet yotchedwa "Neurobehavioral effects of developmental toxicity." M'mbuyomuyi, fluoride adadziwika kuti ndi amodzi mwamankhwala 12 ogulitsa
odziwika kuti amayambitsa matenda opatsirana mwa ubongo mwa anthu.272 Ofufuzawa adachenjeza kuti: "Kulemala kwa neurodevelopmental, kuphatikiza autism, vuto la kuchepa kwa chidwi, kuchepa kwa chidwi, ndi zovuta zina zamaganizidwe, zimakhudza ana mamiliyoni padziko lonse lapansi, ndipo matenda ena akuwoneka kuti akuchulukirachulukira. Mankhwala opangidwa m'mafakitale omwe amavulaza ubongo womwe ukukula ndi zina mwazomwe zimayambitsa kufalikira. "273
Gawo 6.3: Mitsempha ya Mtima
Malinga ndi ziwerengero zomwe zidasindikizidwa mu 2016, matenda amtima ndi omwe amatsogolera kufa kwa amuna ndi akazi ku US, ndipo zimawononga dziko madola 207 biliyoni pachaka. 274 Chifukwa chake, kuzindikira
Mgwirizano pakati pa fluoride ndi mavuto amtima ndi wofunikira osati kokha kuti pakhale njira zotetezera fluoride komanso njira zokhazikitsira matenda amtima.
Kuyanjana pakati pa mavuto a fluoride ndi mtima kumakayikira kwazaka zambiri. Lipoti la 2006 NRC lidalongosola kafukufuku wochokera ku 1981 ndi Hanhijärvi ndi Penttilä omwe adanenanso kuti serum fluoride wokwera kwambiri mwa odwala omwe ali ndi vuto la mtima.275 Fluoride yakhala ikukhudzanso kuchuluka kwa magazi, 276 arteriosclerosis, 277 kusowa kwamtima, 278 electrocardiogram zovuta, 279 matenda oopsa, 280 ndi kuwonongeka kwa myocardial.281 Kuphatikiza apo, ofufuza aku China omwe adafalitsa mu 2015 adamaliza kuti: "Zotsatira zake zidawonetsa kuti, NaF [sodium fluoride], modalira ndende komanso ngakhale pang'ono mg 2 / L, idasintha morphology ya ma cardiomyocyte, kuchepa kwa mphamvu ya maselo, kuchuluka kwa kumangidwa kwa mtima, komanso kukulitsa kuchuluka kwa apoptosis. ”282
Gawo 6.4: Endocrine System
Zotsatira za fluoride pamakina a endocrine, omwe amakhala ndi tiziwalo timene timayang'anira mahomoni, awerengedwanso. Mu lipoti la 2006 NRC, akuti: "Mwachidule, umboni wa mitundu ingapo ukuwonetsa kuti fluoride imakhudza magwiridwe antchito a endocrine kapena kuyankha kwake; zotsatira za kusintha komwe kumachitika chifukwa cha fluoride zimasiyana mosiyanasiyana komanso mokoma mtima kwa anthu osiyanasiyana. ”283 Lipoti la 2006 NRC lidaphatikizaponso tebulo yosonyeza momwe kuchuluka kwa fluoride wambiri kwapezeka kusokoneza ntchito ya chithokomiro, makamaka pamene kusowa kwa ayodini pano.284 M'zaka zaposachedwa, mphamvu ya fluoride pamakina a endocrine yakhazikikanso. Kafukufuku wofalitsidwa mu 2012 adaphatikizapo sodium fluoride pamndandanda wa endocrine kusokoneza mankhwala (EDCs) okhala ndi zotsatira zochepa, 285 ndipo kafukufukuyu adatchulidwa mu lipoti la 2013 lochokera ku United Nations Environment Programme ndi World Health Organisation. 286
Pakadali pano, kuchuluka kwa vuto la chithokomiro kumalumikizidwa ndi fluoride. 287 Kafukufuku wofalitsidwa mu 2015 ndi ofufuza a University of Kent ku Canterbury, England, adati kuchuluka kwa fluoride m'madzi akumwa kumatha kuneneratu za hypothyroidism. 288 Adafotokozanso kuti: "M'madera ambiri padziko lapansi, hypothyroidism ndi vuto lalikulu lathanzi komanso kuwonjezera pazinthu zina - monga kusowa kwa ayodini - kufalikira kwa fluoride kuyenera kuwonedwa ngati komwe kumathandizira. Zotsatira za kafukufukuyu zikubweretsa nkhawa makamaka zakufunika kwa fluoridation ngati njira yabwinobwino yathanzi. ”289 Kafukufuku wina adathandizira kuyanjana pakati pa fluoride ndi hypothyroidism, 290 kuwonjezeka kwa chithokomiro chotulutsa mahomoni (THS), 291 ndi kusowa kwa ayodini. 292
Malinga ndi ziwerengero zomwe Centers for Disease Control and Prevention (CDC) idatulutsa mu 2014, anthu 29.1 miliyoni kapena 9.3% ya anthu ali ndi matenda ashuga.293 Apanso, ntchito yomwe fluoride ikhoza kukhala nayo ndikofunikira kuganizira. Ripoti la 2006 NRC lidachenjeza:
Mapeto ake pamaphunziro omwe akupezeka ndikuti kuwonetsedwa kokwanira kwa fluoride kumawoneka kuti kumawonjezera kuchuluka kwa magazi m'magazi kapena kulekerera kulekerera kwa shuga kwa anthu ena ndikuwonjezera kuopsa kwa mitundu ina ya matenda ashuga. Mwambiri, kuchepa kwa kagayidwe ka glucose kumawoneka kuti kumalumikizidwa ndi seramu kapena plasma fluoride yozungulira 0.1 mg / L kapena wamkulu mwa nyama ndi anthu (Rigalli et al. 1990, 1995; Trivedi et al. 1993; de al Sota et al. 1997) .294
Kafukufuku waphatikizanso kuti matenda a shuga amakhala ndi mphamvu yochepetsera fluoride m'thupi, 295 komanso matenda (polydispsia-polyurea) omwe amachititsa kuti anthu azidya fluoride, 296 ndi
Kafukufuku adalumikizanso kuletsa kwa insulin komanso kukana fluoride.297
Chodetsa nkhawa ndichakuti fluoride imawoneka ngati ikusokoneza ntchito ya pineal gland, yomwe imathandizira kuwongolera mayendedwe ndi mahomoni ozungulira, kuphatikiza kuwongolera kwa melatonin ndi mahomoni oberekera. A Jennifer Luke aku Royal Hospital aku London azindikira kuchuluka kwa fluoride wopezeka mu pineal gland298 ndikuwonetsanso kuti milingo iyi
amatha kufika 21,000 ppm, kuwapangitsa kukhala apamwamba kuposa ma fluoride m'mafupa kapena mano.299 Kafukufuku wina walumikiza fluoride ndi milingo ya melatonin, kusowa tulo 300, 301 komanso kutha msinkhu
mwa atsikana, 302 komanso mitengo yotsika ya chonde (kuphatikiza amuna) ndikuchepetsa ma testosterone.303
Gawo 6.5: Ndondomeko ya Mphuno
Mkodzo ndi njira yayikulu yochotsera fluoride yolowetsedwa m'thupi, ndipo dongosolo la impso ndilofunikira pakuwongolera ma fluoride mthupi. 304 305 Kutulutsa kwamikodzo kwa fluoride ndik
kutengeka ndi pH ya mkodzo, zakudya, kupezeka kwa mankhwala, ndi zina. 306 Ofufuza a nkhani ya 2015 yofalitsidwa ndi Royal Society of Chemistry adafotokoza kuti: "Chifukwa chake, kuchuluka kwa madzi a m'magazi ndi kuchuluka kwa impso kumapangitsa kuti thupi likhale lolimba chifukwa cha kudya kwa fluoride, kutengera kuchotsedwa mu mafupa komanso kutulutsa mphamvu ya fluoride ndi impso. ”307
Ripoti la 2006 NRC nalonso limazindikira udindo wa impso pakuwonekera kwa fluoride. Adanenanso kuti sizosadabwitsa kwa odwala omwe ali ndi matenda a impso kukhala ndi kuchuluka kwa plasma ndi mafupa a fluoride. 308 Iwo adanenanso kuti impso za anthu "zimayenera kutsitsa fluoride ochulukirapo 50 kuchokera ku plasma kupita mkodzo. Zigawo za impso zitha kukhala pachiwopsezo chachikulu cha poizoni wa fluoride kuposa ziwalo zofewa. ”309
Malingana ndi chidziwitso ichi, ndizomveka kuti ofufuza alumikizadi kuwonekera kwa fluoride ku zovuta ndi dongosolo la impso. Makamaka, ofufuza ochokera ku Toronto, Canada, adawonetsa kuti odwala dialysis omwe ali ndi renal osteodystrophy anali ndi fluoride wochuluka m'mafupa ndipo anazindikira kuti "fupa la fluoride lingachepetse kuchepa kwa mafupa posokoneza mchere." 310 Kuphatikiza apo, kafukufuku wokhudza ogwira ntchito omwe ali ndi cryolite lolembedwa ndi Philippe Grandjean ndi Jørgen H. Olsen lofalitsidwa mu 2004 adati fluoride imawoneka ngati yomwe ingayambitse khansa ya chikhodzodzo komanso yomwe imayambitsa khansa yamapapo.311
Gawo 6.6: Njira Yopumira
Zotsatira za fluoride pamakina opumira zimalembedwa bwino kwambiri pazolemba za
Zowonekera pantchito. Zachidziwikire, ogwira ntchito m'makampani opanga fluoride ali kwambiri
chiopsezo chachikulu chopumira fluoride kuposa omwe sagwira ntchito m'makampani; komabe mafakitale
Kugwiritsiridwa ntchito kumathandizanso kupuma kwa nzika wamba kudzera pamawonekedwe osiyanasiyana
njira.
Kutulutsa mpweya wa hydrogen fluoride ndi chitsanzo chabwino kwambiri pantchito zowonekerazo
komanso ziwopsezo zomwe sizili pantchito. Hydrogen fluoride imagwiritsidwa ntchito kupanga mafiriji, herbicides,
mankhwala, mafuta apamwamba-octane, aluminium, mapulasitiki, zida zamagetsi, fulorosenti
mababu oyatsira magetsi, ndi zitsulo ndi magalasi (monga omwe amagwiritsidwa ntchito pazida zamagetsi),
312 komanso
monga kupanga mankhwala a uranium ndi kuyeretsa kwa quartz. 313
Zomwe Zimayambitsa Matenda ndi
Prevention (CDC) yafotokoza kuti kuphatikiza pazowonekera pantchito, zosagwira ntchito
Kuwonetsedwa kwa hydrogen fluoride kumathanso kupezeka m'malo ogulitsira komanso kudzera pazinthu zomwe mumakonda
zinthu zopangidwa ndi mankhwalawa, komanso zomwe zimachitika kawirikawiri pokhudzana ndi uchigawenga wamankhwala
wothandizira. 314
Zovuta za hydrogen fluoride zitha kuwononga ziwalo zingapo, kuphatikiza ziwalo
nawo dongosolo kupuma. Kupuma mankhwala kumatha kuvulaza minofu yam'mapapo ndikuyambitsa
kutupa ndi kudzikundikira kwam'mapapo (m'mapapo mwanga edema) .315
Kutulutsa madzi a hydrogen fluoride kumatha kubweretsa imfa m'mapapu, 316 pomwe kumakhala kosalekeza, kotsika
Kutulutsa mpweya kumatha kuyambitsa mkwiyo komanso kupanikizika kwa mphuno, mmero, ndi mapapo. 317
Makamaka pantchito, mafakitale a aluminiyamu akhala akukambirana zambiri
Kafukufuku wokhudza momwe fluoride imakhudzira makina opumira a ogwira ntchito. Umboni wochokera kwa a
mndandanda wamaphunziro umawonetsa kulumikizana pakati pa ogwira ntchito pazomera zotayidwa, kuwonekera kwa
fluoride, ndi zotsatira za kupuma, monga emphysema, bronchitis, ndi mapapo ochepa
ntchito. 318
Gawo 6.7: Njira Yogaya Zakudya
Pakamwa, kuphatikiza m'madzi amadzimadzi amadzimadzi, fluoride imayamwa ndi m'mimba
dongosolo pomwe lili ndi theka la moyo la mphindi 30. 319
Kuchuluka kwa fluoride woyamwa kumadalira
milingo ya calcium, yokhala ndi calcium yambiri yochepetsa m'mimba
kuyamwa.
320 321
Komanso, malinga ndi kafukufuku wofalitsidwa mu 2015 ndi American Institute of
Chemical Engineers, kulumikizana kwa fluoride m'matumbo "kumapangitsa kupanga
hydrofluoric [HF] acid poyankha ndi hydrochloric [HCL] asidi omwe amapezeka m'mimba. Kukhala
Zowonongeka kwambiri, asidi a HF omwe amapangidwa amatha kuwononga m'mimba ndi m'matumbo
kutayika kwa ma microvilli. ”322
Gawo lina la kafukufuku wokhudzana ndi momwe fluoride imakhudzira m'mimba m'mimba ndi mwangozi
kumeza mankhwala otsukira mkamwa. Mu 2011, Poison Control Center idalandira mafoni 21,513 okhudzana ndi
Kugwiritsa ntchito mankhwala otsukira mano otsukira. 323
Chiwerengero cha anthu omwe akhudzidwa chingachitike
kukhala apamwamba kwambiri, komabe. Zovuta zakhala zikudziwika kuti zizindikiro zina za m'mimba
sizingaganizidwe mosavuta kuti ndizokhudzana ndi kumeza kwa fluoride, monga ofufuza adafotokozera mu 1997:
Makolo kapena omwe amawasamalira sangazindikire zizindikiro zomwe zimakhudzana ndi poyizoni wofatsa wa fluoride
kapena angaganize kuti ali ndi colic kapena gastroenteritis, makamaka ngati sanamuwone mwanayo
ingest fluoride. Momwemonso, chifukwa chazosazindikirika pang'ono pang'ono
Zizindikiro, kusiyanitsa komwe dokotala amapeza sikungaphatikizepo poizoni wa fluoride
popanda mbiri yakumeza kwa fluoride. 324
Madera ena am'mimba amadziwikanso kuti amakhudzidwa ndi fluoride. Mwachitsanzo,
Lipoti la 2006 NRC lidafunsa zambiri zakomwe fluoride imakhudzira chiwindi: "Ndizotheka
kuti kumeza kwa moyo kwa 5-10 mg / tsiku kuchokera kumadzi akumwa okhala ndi fluoride pa 4 mg / L atha
zimakhudza chiwindi nthawi yayitali, ndipo izi ziyenera kufufuzidwa mtsogolo
maphunziro a miliri. ”325 Monga chitsanzo china, mankhwala otsukira mano angayambitse matenda otupa m'mimba, monga
pakamwa ndi zilonda zopweteka mwa anthu ena. 326
Gawo 6.8: Chitetezo cha Mthupi
Chitetezo cha mthupi ndi gawo lina la thupi lomwe lingakhudzidwe ndi fluoride. An
Chofunika kwambiri ndikuti maselo amthupi amatuluka m'mafupa, motero mphamvu ya fluoride
pa chitetezo cha mthupi chitha kukhala chokhudzana ndi kuchuluka kwa fluoride m'mafupa. 2006
Ripoti la NRC lidalongosola izi:
Komabe, odwala omwe amakhala mdera lamadzimadzi kapena a
Madera omwe madzi akumwa mwachilengedwe amakhala ndi fluoride pa 4 mg / L ali nawo onse
anapeza fluoride m'mafupa awo ndipo atha kukhala ndi fluoride wambiri
kuchuluka m'mafupa awo. Mafupa ndipamene maselo amthupi amakula ndikuti
zitha kukhudza chitetezo chamthupi ndi kupanga ma antibodies kumankhwala akunja. 327
Matupi ndi hypersensitivities ku fluoride ndichinthu china chowopsa chokhudzana ndi chitetezo chamthupi
dongosolo. Kafukufuku wofalitsidwa m'ma 1950, 1960, ndi ma 1970 adawonetsa kuti anthu ena ali
hypersensitive to fluoride.328 Chosangalatsa ndichakuti, olemba kafukufuku omwe adalembedwa mu 1967 adanenanso
kuti pomwe ena amakayikirabe mfundo yakuti fluoride mu mankhwala otsukira mano komanso "mavitamini" angayambitse
zokometsa mtima, malipoti am'ndende omwe adatulutsidwa m'mabuku awo adatsimikiza kuti zovuta zomwe zimachitika ku
fluoride alipo.329 Kafukufuku waposachedwa atsimikizira izi. 330
Gawo 6.9: Njira Yotsutsana
Fluoride imathanso kukhudza dongosolo lokhala ndi zikuluzikulu, lomwe limakhala ndi khungu, zotupa za exocrine,
tsitsi, ndi misomali. Makamaka, momwe zimachitikira ndi fluoride, kuphatikiza fluoride wogwiritsidwa ntchito m'mano otsukira mano
adalumikizidwa ndi ziphuphu komanso zina zamatenda. 331 332 333
Kuphatikiza apo, ndikuwopseza kwamoyo
chikhalidwe chotchedwa fluoroderma chimayambitsidwa ndi hypersensitive reaction to fluorine, 334
ndipo kuphulika kwa khungu kotere (halogenoderma) kumalumikizidwa ndi odwala omwe amagwiritsa ntchito
Mankhwala opangira mano. 335
Kuphatikiza apo, tsitsi ndi misomali zawerengedwa ngati zotsatsira za
Kuwonetsedwa kwa fluoride.
336
Kudula misomali kumatha kuwonetsa kuwonekera kwakanthawi kwa fluoride337
ndikuwonekera kuchokera ku mankhwala otsukira mkamwa, 338 ndikugwiritsa ntchito fluoride woikika mu misomali kuzindikira ana
pachiwopsezo cha fluorosis wamazino wayesedwa. 339
Gawo 6.10: Fluoride Toxicity
Mlandu waukulu woyamba woti akuti poyizoni wapangidwa ndi poizoni wochokera ku fluorine udakumana ndi tsoka ku
Meuse Valley ku Belgium m'ma 1930. Chifunga ndi zinthu zina mdera lotukuka ili
yokhudzana ndi imfa ya 60 ndipo anthu masauzande angapo akudwala. Umboni wakhala ukusimba kuyambira pamenepo
ovulala awa chifukwa chakutulutsa kwa mafakitale kuchokera kumafakitale oyandikira. 340
Mlandu wina wokhudza poizoni m'mafakitale udachitika mu 1948 ku Donora, Pennsylvania, chifukwa cha chifunga ndipo
kusintha kwa kutentha. Poterepa, kutulutsa kwa gase kuchokera ku zinc, chitsulo, waya, ndi msomali
mafakitale opangira magetsi akuti akukayika kuti apha anthu 20 komanso anthu zikwi zisanu ndi chimodzi
kudwala chifukwa cha poyizoni wa fluoride. 341
Poizoni wa fluoride wochokera kuzinthu zamankhwala ku United States zidachitika mu 1974 zaka zitatu
Mnyamata wakale waku Brooklyn adamwalira chifukwa chomwa bongo wa fluoride kuchokera ku gel yama mano. Mtolankhani ku New York
Times inalemba za chochitikachi: "Malinga ndi katswiri wazamagetsi ku County Nassau, a Dr. Jesse Bidanset,
William adamwa makilogalamu masentimita makumi asanu ndi awiri mphambu awiri mwa magawo awiri a stannous fluoride solution, katatu kuchuluka
okwanira kuti aphedwe. ”342
Milandu ikuluikulu yambiri ya poyizoni wa fluoride ku United States yakhala ikuyang'aniridwa posachedwa
zaka makumi, monga kubuka kwa 1992 ku Hooper Bay, Alaska, chifukwa cha kuchuluka kwa fluoride m'madzi343 ndi poyizoni wa 2015 ku banja ku Florida chifukwa cha sulfuryl
fluoride omwe amagwiritsidwa ntchito pochizira chimbudzi kunyumba kwawo. 344
Ngakhale zitsanzo zomwe zaperekedwa pamwambapa ndi zakupha koopsa (kuchuluka kwambiri, kwakanthawi kochepa) poyizoni, kosatha
(mlingo wochepa, nthawi yayitali) poyizoni ayeneranso kuganiziridwa. Zambiri zokhudza fluoride
Poizoni akukupezeka kuti athandizire kuti amvetsetse bwino vutoli. Kuntchito
lofalitsidwa mu 2015, ofufuza adawunikiranso zowona kuti chizindikiro choyamba cha poyizoni wa fluoride ndi mano
fluorosis ndipo fluoride ndiyomwe imasokoneza enzyme.345
Kuphatikiza apo, ndemanga yomwe idasindikizidwa mu
2012 idafotokoza mwatsatanetsatane za kuopsa kwa kawopsedwe ka fluoride m'maselo: "Yoyambitsa
pafupifupi njira zonse zodziwika bwino zama cellular kuphatikiza njira zodalira mapuloteni a G,
caspases, ndi mitochondria- ndi njira zolumikizirana ndiimfa, komanso zoyambitsa zingapo
zosintha zamagetsi ndi zolemba, kuphatikiza kufotokozera zingapo zokhudzana ndi apoptosis
majini, pomalizira pake amatsogolera ku imfa kwa maselo. ”346
Kufunika kwa poizoni wa fluoride kuti adziwike kwambiri kunasanthula mu 2005
lofalitsidwa ndi "Poizoni wa fluoride: chithunzi ndi zidutswa zobisika." Wolemba Phyllis J.
Mullenix, PhD, adayamba nkhaniyi, yomwe idaperekedwa mwapadera ku American College of
Msonkhanowu wa Toxicology, powachenjeza kuti: “Mbiri yakale yonena za poizoni wa fluoride
m'mabuku azachipatala adalola kuti ikhale imodzi mwazosamvetsetseka kwambiri, zosazindikira,
ndipo ananamizira mavuto azaumoyo ku United States lerolino. ”347
Tikawerenga Gawo 7 lapitalo za kuwonekera kwa fluoride, zimawonekeratu kuti kuchuluka kwa kafukufuku kumafunikira motani pasanakhale "kotetezeka" kulikonse komwe fluoride ikupezeka. Kusowa kwa umboni uku kumafika patali kuposa zomwe sizikudziwika pakadali pano. Kuperewera kwa maumboni kumakhudzanso zomwe zikudziwika kale zakugwiritsa ntchito kwa fluoride anthu, makamaka pokhudzana ndi "phindu" lake lopewa zotupa.
Gawo 8.1: Kusowa Kogwira Ntchito
Fluoride m'mazinyo otsukira mano ndi zinthu zina zogulira amawonjezera chifukwa akuti amachepetsa kutaya mano. Ubwino wa mtundu uwu wa fluoride ndiwokhudzana ndi momwe amathandizira pakuletsa kupumira kwa mabakiteriya a Streptococcus mutans, bakiteriya yemwe amasintha shuga ndikutuluka kukhala asidi womata womwe umasungunula enamel. 504 Makamaka, kulumikizana kwa fluoride ndi gawo la mchere mano amatulutsa fluorohydroxyapatite (FHAP kapena FAP), ndipo zotsatira zake zanenedwa kuti ndizowonjezera kukonzanso ndikuchepetsa kutsitsa kwa mano. Ngakhale akatswiri akugwiritsa ntchito njirayi ya fluoride, zatsimikiziranso kuti fluoride imagwira ntchito makamaka kuti ichepetse kuwola kwa mitu (kutanthauza kuipukuta mpaka mano ndi mswachi), mosiyana ndi mwadongosolo (mwachitsanzo, kumwa kapena kumeza fluoride kudzera m'madzi) kapena njira zina) .505
Ngakhale phindu la fluoride lafotokozedwa momveka bwino m'mabuku asayansi, kafukufuku nawonso adakayikira izi. Mwachitsanzo, ofufuza ochokera ku Yunivesite ya Massachusetts Lowell adalongosola mikangano ingapo yokhudzana ndi kugwiritsa ntchito timadzi ta fluoride munkhani yomwe idasindikizidwa mu Journal of Evidence-Based Dental Practice mu 2006. Atatchula kafukufuku yemwe adachitika mu 1989 kuchokera ku National Institute of Dental Research omwe sanapeze zambiri Kusiyana kwa ana omwe amalandira fluoride ndi omwe sakulandira fluoride, olembawo adafufuza kafukufuku wina wosonyeza kuti maiko akutukuka m'mayiko otukuka achepetsa popanda kugwiritsa ntchito fluoride. 506 Olembawo adanenanso za kafukufuku wosonyeza kuti fluoride sichithandiza kupewa kuwola kwa dzenje ndi kuphulika (komwe kuli mtundu wofala kwambiri wamazino ku US) kapena popewa kuwola kwa dzino la botolo la ana (lomwe limapezeka kwambiri kumadera osauka) .507
Monga chitsanzo china, kafukufuku woyambirira adagwiritsa ntchito kuthandizira kusintha kwa madzi ngati njira yochepetsera kusungunuka kwamano pambuyo pake idawunikidwanso, ndipo kuthekera kwakusokoneza deta kunadziwika. Poyamba, kuchepetsedwa kwa mano owola komanso odzaza (DFT) omwe adatoleredwa pakafukufuku adamasuliridwa ngati umboni wothandiza kwa madzi fluoridation. Komabe, kafukufuku wotsatira wa Dr. John A. Yiamouyiannis adanenanso kuti madzi osungunuka atha kuchititsa kuti mano ayambe kuphulika.508 Kuphulika kochedwa kumeneku kumadzetsa mano ochepa motero, kusabola, kutanthauza kuti mitengo yotsika ya DFT inali zimayambitsidwa ndi kusowa kwa mano motsutsana ndi zomwe akuti fluoride imakhudza mano.
Zitsanzo zina m'mabuku asayansi zakhala zikukayikira momwe fluoride imagwiritsidwira ntchito popewa kuwola kwa mano. Kuunikanso kwa 2014 kunatsimikizira kuti mphamvu ya anti-caries ya fluoride imadalira calcium ndi magnesium mu enamel ya mano komanso kuti njira yokumbutsira mafuta mu enamel ya mano siyodalira fluoride.509 Kafukufuku wofalitsidwa mu 2010 adazindikira kuti lingaliro la "mano a fluoride olimbikitsa" Sangathenso kuwonedwa ngati yofunika kuchipatala pakuchepa kulikonse kwa caries komwe kumalumikizidwa ndi kugwiritsidwa ntchito kwa fluoride.510 Kuphatikiza apo, kafukufuku wanena kuti kuwonetsetsa kwa fluoride kumakhala ndi zotsatira zochepa (ngati zilipo) pamano, 511 512 ndipo ofufuza aperekanso chidziwitso chakuti mano fluorosis (chizindikiro choyamba cha fluoride toxicity513) ndichokwera m'magulu aku US okhala ndi madzi amadzimadzi motsutsana ndi omwe alibe.
Komanso malipoti ena akuwonetsa kuti m'mene mayiko amatukuka, kuwonongeka kwa anthu kudakwera mpaka anayi mpaka asanu ndi atatu mano otayika, akusowa, kapena odzaza (m'ma 1960) kenako ndikuwonetsa kutsika kwakukulu (kuchuluka kwamasiku ano), ngakhale fluoride gwiritsani. Amanenedwapo kuti kuwonjezeka kwaukhondo wamkamwa, mwayi wopewa zodzitetezera, ndikuzindikira kuwopsa kwa shuga ndizomwe zimapangitsa kuti pakhale kuwonongeka kwa mano. Kaya zifukwa zingakhale zotani, ziyenera kuzindikirika kuti kuchepa kwa mano kumachitika popanda kugwiritsa ntchito madzi amadzimadzi, 515 kotero zikuwoneka kuti zinthu zina kupatula fluoride ndizomwe zidasintha. Chithunzi chachiwiri pansipa chikuwonetsa kuwonongeka kwa mano ndi mayiko a fluoridated ndi omwe alibe fluoridated kuyambira 2-1955.
Chithunzi 2: Njira Zowola Mano M'mayiko Osungunuka ndi Osasunthika, 1955-2005
Zina zingapo ndizofunikira pamalingaliro aliwonse okhudzana ndi kugwiritsa ntchito fluoride popewa kupindika. Choyamba, ziyenera kudziwikanso kuti fluoride sichinthu chofunikira pakukula kwaumunthu ndi chitukuko.516 Chachiwiri, fluoride yadziwika kuti ndi imodzi mwamankhwala 12 a mafakitale "omwe amadziwika kuti amachititsa kuti thupi likhale ndi matendawa." 517 Ndipo pamapeto pake, American Dental Association (ADA) idafufuza kafukufuku wina mu 2013 pokhudzana ndi momwe fluoride imagwirira ntchito ndi zotsatira zake:
Kafukufuku amafunika pokhudzana ndi ma fluoride osiyanasiyana apakhungu kuti azindikire momwe amagwirira ntchito ndi zoteteza pakamagwiritsa ntchito mulingo waposachedwa wa fluoride exposure (ndiko kuti, madzi a fluoridated ndi mankhwala otsukira mano a fluoride) ku United States. Kafukufuku wokhudzana ndi njira yogwiritsira ntchito fluoride kuti amange kapena kusintha kusintha kwa caries, komanso momwe timadzi ta fluoride timathandizira pakuthyola mano, amafunikiranso.518
Gawo 8.2: Kusowa Umboni
Kutchulidwa kwa kusadziwikiratu kwa milingo yomwe zotsatira za fluoride pamachitidwe amunthu zidapangidwa papepala ili. Komabe, ndikofunikira kunena mobwerezabwereza kusowa kwa umboni wokhudzana ndi kugwiritsa ntchito fluoride, motero, Gulu 4 limapereka chidule cha machenjezo okhwima ochokera kuboma, asayansi, ndi akuluakulu ena okhudzana ndi zoopsa komanso zosatsimikizika zokhudzana ndi kugwiritsa ntchito mankhwala opangira madzi.
Gulu 4: Ndemanga Zosankhidwa za Machenjezo a Fluoride Omwe Amagawidwa Ndi Zogulitsa / Njira ndi Gwero
| ZOKHUDZA / NTCHITO YOFUNIKA | Ndemanga / S | SOURCE YA DZIWANI |
|---|---|---|
| Fluoride wogwiritsa ntchito mano, kuphatikiza madzi fluoridation | "Kuchuluka kwa matenda otupa mano sikukhudzana kwenikweni ndi kuchuluka kwa fluoride mu enamel, ndipo kuchuluka kwa enamel fluoride sikuti kumathandiza kwambiri popewera kutuluka kwa mano." "Kafukufuku wowerengeka wowona ngati mankhwala otsukira mano a fluoride, gel osamba, kutsuka, ndi varnish aliwonse mwa anthu achikulire alipo." | Zomwe Zimayambitsa Kuletsa Matenda ndi Kuteteza Matenda (CDC). Kohn WG, Maas WR, Malvitz DM, Presson SM, Shaddik KK. Malangizo pakugwiritsa ntchito fluoride popewa ndikuwongolera kutaya kwamano ku United States. Kuwonongeka ndi Kufa Kwapasabata Yonse: Malangizo ndi Malipoti. 2001 Aug 17: i-42. |
| Kulowetsa Zakudya Zakudya: Zolimbikitsidwa Zolandila Zakudya ndi Zokwanira | "Ponseponse, komiti idagwirizana kuti pali umboni wasayansi woti pazinthu zina fluoride imatha kufooketsa mafupa ndikuwonjezera ngozi yophulika." | Bungwe la National Research Council. Fluoride M'madzi Akumwa: Kuunikiranso Kwa Sayansi Miyezo ya EPA. Nyuzipepala ya National Academies: Washington, DC 2006. |
| Fluoride m'madzi akumwa | "Cholinga cha Maximum Contaminant Level Goal (MCLG) cha fluoride m'madzi akumwa chizikhala zero." | Katoni RJ. Kubwereza kwa 2006 United States National Research Council Report: Fluoride M'madzi Akumwa. Fluoride. 2006 Jul 1; 39 (3): 163-72. |
| Kusintha kwamadzi | "Kutulutsa kwa fluoride kumalumikizana kwambiri ndi kutsekemera kwa mano ndipo kumatha kuonjezera chiopsezo cha mano kwa ana operewera zakudya m'thupi chifukwa cha kuchepa kwa calcium ndi enamel hypoplasia ..." | Peckham S, Awofeso N. Kusintha kwamadzi: kuwunikiranso zovuta zamthupi za ingested fluoride monga chithandizo chamankhwala pagulu. Sayansi Yapadziko Lonse. 2014 Feb 26; 2014. |
| Fluoride muzogulitsa mano, chakudya, ndi madzi akumwa | "Popeza kugwiritsa ntchito mankhwala opangira mano a mano komanso kumwa zakudya ndi zakumwa zopangidwa ndi madzi a fluoridate kwawonjezeka kuyambira pomwe HHS idalimbikitsa kuchuluka kwa fluoridation, anthu ambiri atha kukhala ndi fluoride yambiri kuposa momwe amayembekezera." | Tiemann M.Fluoride m'madzi akumwa: kuwunikanso za fluoridation ndi malamulo. BiblioKuchita. 2013 Apr 5. Congressional Research Service Report for Congress. |
| Kudya kwa fluoride mwa ana | Anthu ambiri akuti mankhwala a 'fluoride' abwino kwambiri akhala akuvomerezedwa kwa zaka zambiri kuyambira pakati pa 0.05 ndi 0.07 mg fluoride pa kilogalamu ya kulemera kwa thupi koma kutengera umboni wochepa wasayansi. ” "Zomwe apezazi zikusonyeza kuti kukhala wopanda vuto linalake sikungakhudze kwenikweni kudya kwa fluoride, pomwe fluorosis imadalira kwambiri kudya kwa fluoride." | Warren JJ, Levy SM, Broffitt B, Cavanaugh JE, Kanellis MJ, Weber ‐ Gasparoni K. Zoyang'ana pakudya bwino kwa fluoride pogwiritsa ntchito mano fluorosis ndi zotulukapo za mano-kafukufuku wamtali. Zolemba pa Zaumoyo Waanthu. 2009 Mar 1; 69 (2): 111-5. |
| Fluoride-yotulutsa zida zobwezeretsa mano (mwachitsanzo kudzazidwa kwamano) | “Komabe, sizikutsimikiziridwa ndi omwe akuyembekezeka kukhala achipatala ngati kuchuluka kwa matenda opatsirana pogonana kumachepetsa kwambiri kutulutsa fluoride kwa zinthu zobwezeretsa. ” | Wiegand A, Buchalla W, Attin T. Kuwunikanso pazinthu zotulutsa zotulutsa fluoride-fluoriderelease ndikutenga zinthu, ma antibacterialactivity ndi mphamvu pakasinthidwe. Zida Zamano. 2007 Mar 31; 23 (3): 343-62. |
| Zinthu Zamano: siliva diamine fluoride | "Popeza siliva diamine fluoride ndi yatsopano ku mano a ku America ndi maphunziro a mano, pakufunika malangizo oyenerera, kuvomereza, ndi kuvomereza." "Sizikudziwika bwinobwino zomwe zingachitike ngati mankhwala ataletsedwa patatha zaka 2-3 ndikufunika kafukufuku." | Horst JA, Ellenikiotis H, PM wa Milgrom, Komiti Yotsutsa ya UCSF Silver Caries Arrest. Protocol ya UCSF ya Caries Kumangidwa Pogwiritsa Ntchito Siliva Diamine Fluoride: Zomveka, Zisonyezo, ndi Chivomerezo. Zolemba pa California Dental Association. 2016 Jan; 44 (1): 16. |
| Matenda a fluoride ogwiritsa ntchito mano | “Omwe anali mgululi anali otsika chitsimikizo chokhudza phindu la 0.5% ya fluoride phala kapena gel osakaniza m'mano osatha a ana komanso pazu la mizu chifukwa zinali zochepa pazogwiritsira ntchito zinthuzi kunyumba. ” “Kafukufuku amafunikira pokhudzana ndi mphamvu ndi kuopsa kwa mankhwala pazinthu zotsatirazi: kudzipangira, mphamvu ya mankhwala, magalasi ogwiritsira ntchito kunyumba, mankhwala otsukira mano kapena madontho; 2% adagwiritsa ntchito gel osakaniza a sodium fluoride; njira zina zoperekera, monga thovu; mafupipafupi ogwiritsa ntchito ma varnish a fluoride ndi ma gels; kugwiritsa ntchito mphindi imodzi ya APF gel; komanso zinthu zosiyanasiyana (zogwiritsira ntchito kunyumba ndi zothandiza). ” | Pezani nkhaniyi pa intaneti Weyant RJ, Tracy SL, Anselmo TT, Beltrán-Aguilar ED, Donly KJ, Frese WA, Hujoel PP, Iafolla T, Kohn W, Kumar J, Levy SM. Matenda a fluoride oletsa kupewa caries: Chidule cha malingaliro pazachipatala zomwe zasinthidwa ndikuthandizira kuwunika mwatsatanetsatane. Zolemba za American Dental Association. 2013; 144 (11): 1279-1291. |
| Fluoride “supplements” (mapiritsi) | "Kusagwirizana pakati pa zotsatira zikuwonetsa kuti mapiritsi a fluoride alibe mphamvu." | Tomasin L, Pusinanti L, Zerman N. Udindo wamapiritsi a fluoride mu prophylaxis of caries mano. Annali diStomatologia. 2015 Jan; 6 (1): 1. |
| Mankhwala, fluorine mu mankhwala | "Palibe amene angadziwiretu zomwe zingachitike m'thupi la munthu pambuyo poti atulutsa mankhwala amadzimadzi." | Strunecká A, Patočka J, Connett P. Fluorine mu zamankhwala. Zolemba za Applied Biomedicine. 2004; 2: 141-50. |
| Kumwa madzi okhala ndi poly- ndi perfluoroalkyl zinthu (PFASs) | "Kuwonongeka kwa madzi akumwa ndi mankhwala a poly- ndi perfluoroalkyl (PFASs) kumabweretsa chiopsezo ku chitukuko, chitetezo chamthupi, kagayidwe kachakudya, komanso thanzi la ogula." "... zambiri zamadzi akumwa zowonetsedwa ndi PFAS zikusowa pafupifupi gawo limodzi mwa magawo atatu a anthu aku US." | Hu XC, Andrews DQ, Lindstrom AB, Bruton TA, Schaider LA, Grandjean P, Lohmann R, Carignan CC, Blum A, Balan SA, Higgins CP. Kudziwika kwa Poly-and Perfluoroalkyl Substances (PFASs) M'madzi Akumwa aku US Olumikizidwa ndi Malo Amakampani, Malo Ophunzitsira Moto Moto, ndi Malo Othandizira Madzi Owonongeka. Makalata a Science Science & Technology. 2016 Oct 11 |
| Kuwonekera pantchito ku fluoride ndi fluoride kawopsedwe | “Kuunikanso zambiri zomwe sizinafalitsidwe zokhudzana ndi zotsatira za kupuma koopsa kwa fluoride ndi fluorine zikuwulula kuti magwiridwe antchito apano amateteza mosakwanira. ” | Mullenix PJ. Poizoni wa fluoride: chithunzi ndi zidutswa zobisika. International Journal of Occupational and Environmental Health. 2005 Okutobala 1; 11 (4): 404-14 |
| Kuunikiranso miyezo yachitetezo pakuwonekera kwa fluorine ndi fluorides | "Tikangoganizira za calcium yokhayokha, timamvetsetsa kuthekera kwa fluoride kowononga maselo, ziwalo, zotupa, ndi ziwalo." | Prystupa J. Fluorine -wunikanso zolemba zamakono. Kuwunikiridwa kochokera ku NRC ndi ATSDR pamiyeso yachitetezo pakuwonetsedwa ndi fluorine ndi fluorides. Njira ndi Njira Zoyeserera. 2011 Feb 1; 21 (2): 103-70. (Adasankhidwa) |
Gawo 8.3: Kusowa kwa Makhalidwe
Chodetsa nkhaŵa china chokhudza fluoride wotuluka m'madzi akumwa ndi chakudya ndichokhudzana ndi kupanga ma fluoride omwe amagwiritsidwa ntchito m'madzi. Malinga ndi Centers for Disease Control and Prevention (CDC), mitundu itatu ya fluoride imagwiritsidwa ntchito popangira madzi am'magulu:
- Fluorosilicic acid: yankho lamadzi lomwe limagwiritsidwa ntchito ndimadzi ambiri ku United States. Fluorosilicic acid amatchedwanso hydrofluorosilicate, FSA, kapena HFS.
- Fluorosilicic acid: yankho lamadzi lomwe limagwiritsidwa ntchito ndimadzi ambiri ku United States. Fluorosilicic acid amatchedwanso hydrofluorosilicate, FSA, kapena HFS.
- Sodium fluorosilicate: chowonjezera chowuma, chosungunuka kukhala yankho asanawonjezeredwe m'madzi. Sodium fluoride: chowonjezera chowuma, chomwe chimagwiritsidwa ntchito m'madzi ang'onoang'ono, chimasungunuka kukhala yankho lisanathiridwe m'madzi.519
Kutsutsana kwabuka chifukwa cha kulumikizana kwa mafakitale ndi izi. CDC yafotokoza kuti thanthwe la phosphorite limatenthedwa ndi sulfuric acid kuti apange 95% ya fluorosilicic acid omwe amagwiritsidwa ntchito popanga madzi fluoridation.520 CDC yafotokozanso kuti: "Chifukwa kupezeka kwa zinthu za fluoride ndikokhudzana ndi kupanga feteleza wa phosphate, kupanga mankhwala a fluoride kumatha komanso zimasinthasintha kutengera zinthu monga kusasinthika kwa mitengo yakunja ndi kugulitsa kwa feteleza kunja. ”521 Chikalata chaboma chochokera ku Australia chanenanso poyera kuti hydrofluosilicic acid, sodium silicofluoride ndi sodium fluoride zonsezi" zimachokera kwa opanga feteleza wa phosphate. "522 Chitetezo Othandizira kuwonekera kwa fluoride adakayikira ngati kulumikizana kwamafakitale kotereku kuli koyenera komanso ngati kulumikizana kwa mafakitale ndi mankhwalawa kumatha kubisa zomwe zimachitika chifukwa cha kufalikira kwa fluoride.
Nkhani yokhudza zamakhalidwe abwino yomwe ikubwera chifukwa chokhudzidwa ndi makampaniwa ndikuti magulu omwe amayendetsedwa ndi phindu amawoneka kuti akufotokozera zosintha zomwe zimapanga kafukufuku "wabwino kwambiri", ndipo pakadali pano, sayansi yopanda tsankho imakhala yovuta kupeza ndalama, kupanga, kufalitsa, ndi kulengeza. Izi ndichifukwa choti ndalama zophunzirira zazikulu zitha kukhala zodula kwambiri, koma mabungwe omwe ali ndi mafakitale amatha kupeza ndalama zothandizira ochita kafukufuku wawo. Atha kukhala ndi nthawi yowunikiranso njira zosiyanasiyana zakufotokozera malipoti (monga kusiya ziwerengero zina kuti apeze zotsatira zabwino), ndipo atha kulengeza za kafukufuku amene akuthandiza ntchito zawo. Tsoka ilo, mbiri yawonetsa kuti mabungwe omwe ali ndi mwayi amatha kuvutitsa asayansi odziyimira pawokha ngati njira yomalizira ntchito yawo ngati ntchitoyi ikuwonetsa zovulaza zopangidwa ndi zoipitsa za mafakitale ndi zonyansa.
Zowonadi izi, za sayansi yopanda malire zadziwika pakufufuza kwa fluoride. Olemba za ndemanga yomwe idasindikizidwa mu Scientific World Journal mu 2014 adalongosola kuti: "Ngakhale kusungunuka kwamadzimadzi kwamadzi kwakhala njira yovuta yodziwitsa anthu zaumoyo wawo kuyambira pomwe adayamba, ofufuza-omwe akuphatikiza asayansi ndi akatswiri odziwika padziko lonse lapansi-akhala akuvutika kuti afalitse nkhani zakumadzi m'madzi m'maphunziro azam'madzi zamaphunziro. ”523
Kuphatikiza apo, kusamvana kwa chidwi kumatha kulumikizidwa mwachindunji ndi kafukufuku wokhudzana ndi kuwonekera pazakudya zamafuta opaka mafuta (PFCs). Munkhani yomwe idasindikizidwa mu 2012, kafukufuku wokhudza kudya kuchokera ku PFC adayesedwa ndi dziko. Wolembayo adawonetsa kuti zidziwitso zochokera ku US zinali zochepa kwambiri, zomwe zidangokhala zolembedwa za 2010 ndi akatswiri angapo aku America, komanso kafukufuku wothandizidwa ndi 3M yemwe adakhala kafukufuku woyamba kusanachitike 2010 (ndipo adati zitsanzo zambiri Zakudya zinali ndi zodetsa zomwe sizinazindikiridwe.) 524 Komabe, ofufuza zamaphunziro adatulutsa zotsatira zosiyana ndi zomwe 3M adalemba ndikulemba mu 2010 kuti: "Ngakhale zoletsedwa ndizogulitsa, tidapeza ma POPs [zosakanikirana zowononga zachilengedwe] mu chakudya cha US, ndi zosakaniza za izi mankhwala amadyedwa ndi anthu aku America mosiyanasiyana. Izi zikusonyeza kufunikira kokulitsa kuyesa kwa chakudya cha mankhwala oipitsa. ”525
Mikangano yosangalatsanso yadziwika kuti imalowetsa mabungwe aboma omwe akukhudzidwa ndi malamulo azitsamba oopsa. Nkhani ya 2014 Newsweek yolembedwa ndi Zoë Schlanger ya mutu wakuti "Kodi EPA Imakonda Makampani Pofufuza Zowopsa Zamankhwala?" anaphatikizaponso mawu ochokera kwa katswiri wazachilengedwe a Michelle Boone omwe ananena kuti "'zonse kapena zambiri zomwe zimagwiritsidwa ntchito poyesa zoopsa zitha kubwera kuchokera kufufuzidwe zopangidwa ndi mafakitale, ngakhale pali zotsutsana [zotsutsana]."
Zimadziwika mosavuta kuti makampani amano amakhala ndi vuto lalikulu ndi fluoride chifukwa phindu limapangidwa ndi mabungwe omwe amapanga mankhwala opangira mano a fluoride. Kuphatikiza apo, njira zokhudzana ndi fluoride yoyendetsedwa ndi dokotala wamankhwala komanso wamano amathanso kupeza phindu m'maofesi amano, 527 528 ndi mafunso okhudzana ndi kukakamizidwa kwa odwala fluoride.529
Pokhudzana ndi machitidwe azachipatala ndi mano, mwala wapangodya wa mfundo zaumoyo wodziwika kuti ndi njira yodzitetezera uyeneranso kuganiziridwa. Mfundo yayikulu ya lamuloli yamangidwa pa lumbiro lachipatala loti "choyamba, osavulaza" Komabe, kugwiritsa ntchito njira yodzitetezera kwamakono kumathandizidwadi ndi mgwirizano wapadziko lonse lapansi.
Mu Januwale 1998, pamsonkhano wapadziko lonse wophatikiza asayansi, maloya, opanga malamulo, komanso akatswiri azachilengedwe ochokera ku US, Canada ndi Europe, chikalata chovomerezeka chidasainidwa ndikudziwika kuti "Wingspread Statement on the Precautionary Principle." 530 Mmenemo, uphungu wotsatira ukuperekedwa: "Ntchito ikakhala kuti ikuwopseza thanzi la anthu kapena chilengedwe, njira zodzitetezera ziyenera kuchitidwa ngakhale ngati zoyambitsa zina ndizoyambitsa ubale sizinakhazikitsidwe kwathunthu mwasayansi. Poterepa, wothandizira ntchito, osati pagulu, ayenera kukhala ndi umboni. ”531
N'zosadabwitsa kuti kufunika kogwiritsa ntchito moyenera njira yodzitetezera kwalumikizidwa ndi kugwiritsa ntchito fluoride. Olemba nkhani ya mu 2006 ya mutu wakuti “Kodi Mfundo Yodzitetezera Ikutanthauzanji pa Umboni Wogwiritsa Ntchito Mano?” adanenanso zakufunika kofotokozera za kuwonjezeka kochokera kuzinthu zonse za fluoride ndi kusiyanasiyana kwa anthu, komanso kunena kuti ogula amatha kufikira "mulingo woyenera" wa fluoridation osamwa madzi a fluoridated.532 Kuphatikiza apo, ofufuza owunikira omwe adasindikiza mu 2014 adalongosola zaudindo wazodzitchinjiriza mfundo yoti agwiritse ntchito pakugwiritsa ntchito fluoride, ndipo adatenga lingaliro ili popitilira apo pomwe amati kumvetsetsa kwathu kwamasiku ano kwamano "kumachepetsa gawo lililonse lalikulu mtsogolo la fluoride popewa caries." 533
Fluoride Position Paper Olemba
Dr. Jack Kall, DMD, FAGD, MIAOMT, ndi Fellow of the Academy of General Dentistry ndi Purezidenti wakale wa mutu wa Kentucky. Iye ndi Accredited Master of the International Academy of Oral Medicine and Toxicology (IAOMT) ndipo kuyambira 1996 wakhala Wapampando wa Board of Directors. Amagwiranso ntchito pa Bioregulatory Medical Institute's (BRMI) Board of Advisors. Ndi membala wa Institute for Functional Medicine ndi American Academy for Oral Systemic Health.
Dr. Griffin Cole, MIAOMT adalandira Mastership yake ku International Academy of Oral Medicine ndi Toxicology ku 2013 ndipo adalemba kabuku ka Academy's Fluoridation Brochure ndi Scientific Review ya Ozone yomwe ikugwiritsidwa ntchito pamankhwala a mizu. Iye ndi Purezidenti wakale wa IAOMT ndipo akutumikira pa Board of Directors, Mentor Committee, Fluoride Committee, Conference Committee and is the Fundamentals Course Director.
Dr. David Kennedy adachita udokotala wa mano kwa zaka zoposa 30 ndipo adapuma pantchito yachipatala ku 2000. Iye ndi Purezidenti Wakale wa IAOMT ndipo waphunzitsa madokotala a mano ndi akatswiri ena azaumoyo padziko lonse lapansi pa nkhani za chitetezo cha mano, mercury toxicity, ndi fluoride. Dr. Kennedy amadziwika padziko lonse lapansi ngati woyimira madzi abwino akumwa, mankhwala a mano achilengedwe komanso ndi mtsogoleri wodziwika bwino pantchito yoteteza mano. Dr. Kennedy ndi mlembi komanso wotsogolera wa filimu yopambana mphoto ya Fluoridegate.
