collecting data on general dietary status and dietary factors that could influence the response, such as calcium, iodine, selenium, and aluminum intakes
characterizing and grouping individuals by estimated (total) exposure, rather than by source of exposure, location of residence, fluoride concentration in drinking water, or other surrogates
reporting intakes or exposures with and without normalization for body weight (e.g., mg/day and mg/kg/day), to reduce some of the uncertainty associated with comparisons of separate studies
addressing uncertainties associated with exposure and response, including uncertainties in measurements of fluoride concentrations in bodily fluids and tissues and uncertainties in responses (e.g., hormone concentrations)
reporting data in terms of individual correlations between intake and effect, differences in subgroups, and differences in percentages of individuals showing an effect and not just differences in group or population means.
examining a range of exposures, with normal or control groups having very low fluoride exposures (below those associated with 1 mg/L in drinking water for humans).
The effects of fluoride on various aspects of endocrine function should be examined further, particularly with respect to a possible role in the development of several diseases or mental states in the United States. Major areas for investigation include the following:
thyroid disease (especially in light of decreasing iodine intake by the U.S. population);
nutritional (calcium deficiency) rickets;
calcium metabolism (including measurements of both calcitonin and PTH);
pineal function (including, but not limited to, melatonin production); and
development of glucose intolerance and diabetes.