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The fact that fluoride can damage your bones, often quite seriously, is no longer in dispute. Just ask the millions of people throughout the world who currently suffer from skeletal fluorosis-a crippling bone disease caused by too much fluoride and marked by irregular bone growth and calcification of the joints.

Of course, it takes a high dose of fluoride to cause crippling fluorosis.

But fluoride accumulates over time, so the severity of skeletal fluorosis exists along a continuum, with the earlier stages produced by lower doses and marked by more subtle symptoms, such as joint pain and stiffness.

These early symptoms, which may not be accompanied by obvious bone changes, are often very hard to distinguish from common forms of arthritis. And, indeed, researchers over the years have repeatedly cautioned that the early stages of skeletal fluorosis may be misdiagnosed as a form of arthritis.

In 2006, skeletal fluorosis was identified by the US National Research Council (NRC) as an adverse effect that needs to be considered by the EPA when lowering the maximum safe level of fluoride in water.  While case studies in recent years have documented advanced skeletal fluorosis in the US among high-tea drinkers, the EPA has done no serious analysis of the extent to which the disease may be occurring throughout the country.