May 20 2014

New Study Shows Fluoride Safe

Public controversy over the safety of fluoridation programs continues, in some towns leading to successful resistance to water fluoridation. As a public health issue, the scientific evidence for risks vs benefits should be at the core of this debate. A new study sheds significant light on this question.

Some anti-fluoridation activists will latch onto any claim they feel supports their opposition (common behavior in any context), and this leads to a great deal of nonsensical conspiracy-mongering. My favorite is the claim that public water fluoridation is all a plot to allow companies to cheaply dump industrial waste into the public water supply.

These sorts of claims distract from the real issues, and in my opinion does a disservice to the anti-fluoridation movement. I don’t mind the existence of opposition movements, even if I disagree with their position. They can serve a useful function in driving public debate and keeping the powers that be honest and transparent.

When they utilize highly emotional but irrational arguments, however, they relegate their own movement to the crank fringe, they marginalize what might be legitimate issues, and they can lead segments of the public into making fear-based and ultimately harmful decisions. They also miss their opportunity to run an effective and ethical opposition which focuses on legitimate scientific issues, and to effectively advocate for the rights of individuals. (Again, I am not saying I agree with any particular such campaign – but at least focus on the real issues.)

Public water fluoridation programs are a proven safe and effective method to improve oral health. It should also be noted that such programs do not always add fluoride to water – they deliberately adjust the level of fluoride in the water supply to optimal levels. Sometimes this involves reducing fluoride levels, but often involves adding fluoride.

The new study involves the safety of such fluoride programs, and specifically addresses the question of whether or not there is an adverse effect on neurological development, as measured by standard IQ testing.

This issue was recently in the news following the infamous “Harvard study” that claimed to show an adverse effect from fluoride on IQ. I discussed the study here – which was really a systematic review and meta-analysis. In short, the researchers looked at studies that compared high vs low exposure to fluoride and measured IQ. They found that the high exposure group had a lower IQ compared to the low exposure group.

There are two main flaws with concluding from this study that fluoridations programs are not safe. The first is that the high fluoride exposure group (2-10 mg/L range) had exposures that were much higher than what is deliberately maintained in public fluoridation programs (0.5-1.0 mg/L range), which was considered the low fluoride exposure group in these studies.

In other words – the review really showed that the level of flouride in public water supplies with deliberate fluoridation is safe when compared to much higher levels of exposure.

The second major flaw was that the high exposure groups had exposure from toxic sources, such as burning coal, or from high natural sources of fluoride. These types of exposure potentially introduce many confounding factors, that were not controlled for.

The bottom line is that this review of studies provided no evidence that fluoridation programs are a risk to intellectual development, and if anything adds to the evidence for the safety of fluoridation programs (since that level of exposure was associated with a higher IQ).

The new study, unlike the studies in the Harvard review, is a study of exposure to fluoride through a public fluoridation program. This is an impressive study, in that it is a prospective study with a 38 year follow up involving over a thousand subjects with a 95.4% retention.

We conducted a prospective study of a general population sample of those born in Dunedin, New Zealand, between April 1, 1972, and March 30, 1973 (95.4% retention of cohort after 38 years of prospective follow-up). Residence in a CWF area, use of fluoride dentifrice and intake of 0.5-milligram fluoride tablets were assessed in early life (prior to age 5 years); we assessed IQ repeatedly between ages 7 to 13 years and at age 38 years.

The results were dead negative – no difference in IQ among any of the groups, regardless of fluoride exposure. There was a trend toward higher IQ in the fluoride exposed group, but this was not statistically significant, so the study was negative. The lack of correlation held up even when they corrected for possible confounders, like socioeconomic status.

This is as good as it gets for an observational study – a nicely controlled environment, large population, good long term follow up.

Conclusion

This latest study adds to the body of evidence showing that public fluoridation programs are safe, and specifically addresses the issue of IQ that was raised by the Harvard systematic review (which, to reiterate, wasn’t really relevant but was seized upon for anti-fluoridation propaganda).

For public controversies such as whether or not to adjust the level of fluoride in public water supplies, my wish is for the debate to be centered on and informed by the relevant science. If the question comes down to – what does the best scientific evidence say? Then that is something that can be objectively resolved.

Questions about ethics and the rights of individuals vs the duty of the state are more difficult to resolve objectively as there is a measure of personal value in the mix. That is where democracy comes in – we have to collectively decide what freedoms we will surrender in exchange for which public benefits.

But at least let the discussion be informed by proper science, and not obscured by pseudoscience, fear-mongering, and nonsense.

56 responses so far

56 Responses to “New Study Shows Fluoride Safe”

  1. Teaseron 20 May 2014 at 12:03 pm

    How ironic, Dr Mercola’s daily email was about fluoride as well. Evidently the Dallas City Council is open to debating the issue. He opens his article with the following statement:

    Mercola: “Open, honest debate is crucial to furthering knowledge, resolving controversies and moving forward on important questions of public interest.

    Debate as a form of reasoning and education can be traced back to ancient times, when philosophical debates were held in ancient Greece. To be successful, there must be integrity on both sides as well as respect.

    Name-calling and disrespect have no place in a debate of matters relating to public health, but in the case of water fluoridation, this has been the standard procedure of fluoridation promoters for many decades.

    So imagine everyone’s surprise when in a recent Dallas city council meeting, three council members not only held back such insults but actually agreed that it was time to open up an honest discussion about the city’s water fluoridation practices.”

    Dr Novella’s conclusion:
    “For public controversies such as whether or not to adjust the level of fluoride in public water supplies, my wish is for the debate to be centered on and informed by the relevant science. If the question comes down to – what does the best scientific evidence say? Then that is something that can be objectively resolved.

    Questions about ethics and the rights of individuals vs the duty of the state are more difficult to resolve objectively as there is a measure of personal value in the mix. That is where democracy comes in – we have to collectively decide what freedoms we will surrender in exchange for which public benefits.

    But at least let the discussion be informed by proper science, and not obscured by pseudoscience, fear-mongering, and nonsense.”

    Both statements are in agreement as to how to frame the debate. Avoid name calling, pseudoscience nonsense, look at the science and make conclusions based on the evidence.

    As a layman I find it difficult to determine which scientific evidence bears the most weight. As usual this is an ongoing issue and reliance on one study does not provide definitive guidance.

    This article from the Dallas Observer made some astute points in regards to a recent Lancet study:

    “And for this recent paper, 25 of the 27 fluoride studies they looked at were in China, the authors told me by email. They’re not claiming any knowledge of the safety of American drinking water fluoridation, they wrote, and they’ve written that “fluoride released into the ground water in China in some cases greatly exceeded levels that are typical in the U.S.”

    “These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S.,” they wrote. “On the other hand, neither can it be concluded that no risk is present.”

    The authors of Lancet cannot disregard the possibility that fluoride in drinking water is without risk.

    Lancet:
    Neurobehavioural effects of developmental toxicity
    Dr Philippe Grandjean MD a b Corresponding AuthorEmail Address, Philip J Landrigan MD c

    Dallas Observer News
    In Dallas, an Anti-Fluoride Movement for Once Not Dismissed
    Long dismissed as kooks, Dallas’ anti-fluoride activists are speaking out again. This time, we might listen.
    By Jim Schutze Thursday, May 8 2014

    I would like a choice regarding fluoride use. Unilaterally imposing fluoride on the public reeks of central planning and a one size fits all approach. Why not offer FDA approved dose controlled fluoride supplements prescribed by the family dentist? That is more science based than dosing the population at large. Leave the water supply alone.

  2. RickKon 20 May 2014 at 1:05 pm

    I agree with Teaser, leave the water alone.

    More and more studies indicate that we are too concerned about controlling our health. We are too worried about healthy teeth, healthy bones, healthy organs and we are too hygenic. Children not exposed to parasites and other microorganisms suffer from inappropriate immune responses like peanut allergy. A major culprit in this hygiene-mania is our control of the water supply. There simply aren’t enough bacteria, parasites and spurious minerals in our water.

    As Teaser says, stop messing with the water. Stop the filtration. Stop balancing out the regional differences in mineral concentrations. Some parts of the country have higher natural levels of flouride – much higher than these government-controlled flouridation programs, and some have lower. If someone wants their kids to have strong teeth, they can move! Similarly, if they want to subject their children to the potential health risks of removing bacteria from drinking water, they can boil it.

    Also, by treating our drinking water, we blunt the positive effects of evolution on the human species. Think how much stronger the stomachs and immune systems of our (surviving) great grandchildren will be after a few generations of proper, natural, untreated water.

    Finally I’m personally tired of paying for all these agencies and facilities to continually tweak the water supply based on whatever the science of the day says. It is not my problem if a bunch of kids want stronger teeth.

    So I’m with Teaser – get big government out of our water. If it’s good enough for the fish, it’s good enough for us.

  3. Jacob Von 20 May 2014 at 2:44 pm

    Teaser and RickK have clearly not seen the effects of poor dental care, extreme tooth decay, and tooth loss among marginal populations, nor do they appear to appreciate the serious health and functioning impact of having unhealthy and rotting teeth. The same populations that benefit the most from fluoridated public water systems are the least likely to effectively use a supplied fluoride supplement or have access to regular dental care. Many of the arguments against water fluoridation are rooted in historical and absurd conspiracy theories, while other arguments seem rooted in political hubris and uncaring ignorance.

  4. Steven Novellaon 20 May 2014 at 2:46 pm

    Jacob – I’m pretty sure that Rick is being sarcastic. But it’s sad that it is so hard to tell the difference these days.

  5. Teaseron 20 May 2014 at 3:01 pm

    RicKK – Nice retort. You obviously do not care the least for your precious bodily fluids. And you forgot to mention urine.

    Portland will flush 38 million gallons of water after man urinates in Mt. Tabor Reservoir

    ““When you see the video, he’s leaning right up because he has to get his little wee wee right up to the iron bars. There’s really no doubt what he’s doing,” Shaff said.

    “It’s stupid. You can see the sign that says: ‘This is your drinking water. Don’t spit, throw, toss anything in it.’ He’s four feet away from that sign. Unless he’s from North Dakota and just moved here, he’s got to know that’s our drinking water.”

    http://www.oregonlive.com/portland/index.ssf/2014/04/portland_will_flush_38_million.html

  6. RickKon 20 May 2014 at 4:01 pm

    :)

    Just wish I could spell.

    Tooth decay can lead to many unpleasant issues. Controlling fluoride levels at some safe non-zero value is fine with me. Besides, if we’re so worried about possible impacts to IQ, there are many more high-value targets than the tenuous fluoridation link.

  7. Jacob Von 20 May 2014 at 4:14 pm

    Apologies’ if I missed any sarcasm after only one reading; my time being what it is…

  8. Bruceon 20 May 2014 at 4:37 pm

    To be fair, if you did not know RickK from previous posts it could very well have been something a lot of cranks would say.

    Nice though, I enjoyed it.

  9. BillyJoe7on 20 May 2014 at 6:09 pm

    I raise my eyes with the first sentence but broke into a smile with the second paragraph. (:
    Nice slam dunk of Teaser’s “leave the water supply alone” trope.

    Oh, and an appropriate still from Dr. Strangelove.

  10. Bill Openthalton 20 May 2014 at 6:17 pm

    RichK —

    Nicely done, sir! Such a joy to see sarcasm and irony without a smiley.

    The start of your final sentence reminds me of a famous t-shirt.

  11. Teaseron 20 May 2014 at 7:34 pm

    Mercola and Novella, the same topic on the same day!? My post was like shooting fish in a barrel.

    Good job RickK! You hit the big fat slow pitch softball right out of the park! WOOHOO! Skeptic Homerun!

  12. RickKon 20 May 2014 at 9:00 pm

    Teaser,

    Since you’re good with google, and since this is a topic on which you appear motivated and educated, can you discuss how the Lancet paper handled fluoride? Can you please share with us a brief description of the studies that the authors of the Lancet article used to draw their conclusions on fluoride, and please summarize the criticisms of the paper?

    Much appreciated!

  13. ccbowerson 20 May 2014 at 9:52 pm

    A little late to the party, but the RickK satire took me a while to realize, and I’m a big fan of the genre.

    Teaser’s reference to Mercola as being is a bit ironic, given his unreasonable stance on fluoridation over many years. Steve is among the most balanced people who regularly comments on health and science, and Mercola is one of the most ideological. Like Dr Oz, his methods are so deliberate, that I know longer question whether he is being intellectually honest. They are both intelligent enough, and use strategies obvious enough, to indicate that they knowlingly take stances that best butter their bread.

    I’m frankly amazed that these tactics are not obvious to everyone, since it doesn’t take specialized knowledge to see the red flags. But perhaps I underestimate the effect of not having a strong background in skepticism and science, plus having charismatic intelligent people telling you things that are ideologically appealing. Perhaps that comes across as condescending, but that is the conclusion I arrive to.

    Google “Mercola flouride” and I get articles from him:

    “Fluoride – Dangers of Fluoridation”

    quote – “Learn about the dangers of fluoride and why the practice of water fluoridation should be ended now.”

    “10 Fluoride Facts You Should Know”

    (of course and all 10 facts are slanted to fear monger)

    Teaser. I am glad you follow Steve’s blog from time to time. Since, I think you have said that skepticism is new to you, I think it is important to incorporate a skeptical source for your information, and Steve is among the most balanced for the general public. Mercola is an intelligent guy, but not a good source of information. He is not intellectually honest.

  14. Teaseron 20 May 2014 at 10:58 pm

    RickK – No bueno

    ccbowers – I am too lazy to unsuscribe from mercola so each morning I quickly review his topics and then hit delete. I like to look at the studies and articles he references. I am by no means a true believer. There are informational vectors everywhere. That’s what I am doing here.

  15. ccbowerson 20 May 2014 at 11:26 pm

    Bad sources of information can drive me crazy, although that doesn’t stop me from going to the drudgereport regularly. I do want to know where people are coming from, and seeing where they get their (mis) information is informative from time to time.

    With the proliferation of podcasts, I no longer listen to talk radio, but there was a time that I would drive myself crazy with that. There are so many great podcasts with really good information that I can’t justify that sort of masochism. I do get concerned that with everyone tailoring their media to their ideological preferences, that that will further fragment the general population such that we will not even be able to discuss topics reasonably.

  16. RickKon 20 May 2014 at 11:31 pm

    “RickK – No bueno”

    Yeah, didn’t think so.

  17. Mlemaon 21 May 2014 at 12:14 am

    The history of fluoridation is rife with conspiracy theories. They likely stem from the era of it’s inception: post WW2. I’d like to see better community education regarding water fluoridation. Many people don’t realize their water is fluoridated. The CDC provides the following guidance for families with infants:
    http://www.cdc.gov/fluoridation/safety/infant_formula.htm

    In 2011, US Health and Human Services dropped their recommended water level to .7 from a previously recommended range of 0.7-1.2 ppm. My city adds fluoride and the concentration reported currently is 2.48 ppm, with 4ppm being the maximum allowed by the EPA. You can check your own city’s report – look under Inorganic Contaminants, where copper and barium may also appear. (My drinking water also contains atrazine, from pesticide runoff – yum) I don’t know why my city’s fluoride level is twice as high as the recommended amount. Perhaps there was a good fluoride salesman at the town meeting :)

    Fluorosis rates in children have continued to increase since the inception of fluoridation. There’s no evidence that communities which fluoridate have a lower rate of dental caries than those that don’t. In fact, the precipitous drop in dental caries worldwide in recent decades has been similar in all countries, regardless of whether or not they fluoridate a lot, a little or not at all. Scientists say the drop may be due to fluoridated toothpastes, oral hygiene, or better nutrition. It’s unclear. The CDC has failed to report this global context of fluoridation and has instead concluded that it’s fluoridated water which has decreased tooth decay in the US.

    As a skeptic, I question the wisdom of supplementation. As I said, many aren’t aware of it. And even many who are don’t realize who might be negatively impacted. Fluoridation costs money for the municipality. And it costs money to avoid drinking fluoridated water. People with bad kidneys (a growing group with diabetes on the rise) probably want to avoid added fluoride. The National Kidney Foundation recommends that fluoride concentration monitoring at treatment plants should be capable of detecting the actual fluoride levels directly. Fluoride enters our diet from many other sources now too. Processed food has more than fresh food, reconstituted juice has more than juice not made from concentrate. Grape juice has a high amount due to the use of fluoride pesticides. If we ever did need supplementation, it highly doubtable that we do now.

    Kidney disease affects the black community disproportionately. Also, in poverty-stricken areas, mothers are less able to afford water without fluoride to mix formula. And since fluorosis, for some unknown reason, is also more prevalent in black children than white children, this also becomes an issue of social justice. Should people have the choice to drink fluoridated water or not? To me, this is a case of a small group of people deciding what they think is best for everyone, regardless of individual needs.

    Phosphate fertilizer companies have benefited from being able to sell sodium hexafluorosilicate to municipalities. Sodium hexafluorosilicate is a waste product of production which is expensive to dispose of under federal regulations. Since this form of fluoride was never tested for safety in fluoridation (as sodium fluoride was, which is now used in less than 10% of fluoridation) and sodium hexafluorosilicate appears to increase lead uptake in children (again a greater problem in poorer communities), some scientists are calling for further testing.

    http://www.slweb.org/APHA-silicofluorides.html
    http://www.dartmouth.edu/~news/releases/2001/mar01/flouride.html

    I think this is where the idea that fertilizer industries have been behind the push to fluoridate, and to prevent fluoridation cessation, comes from. Fluoridation is a way for some industries to make money from a waste product by selling it to the public instead of having to pay to dispose of it.

  18. Lumen2222on 21 May 2014 at 1:10 pm

    Can we back up to Teaser’s link regarding the Portland reservoir? Because that is some grade-A crazy right there.

    They wanted to flush an entire OPEN AIR reservoir because one person peed into it. Is this some sort of perversion of the naturalistic fallacy? Man made urine is “unnatural” but bird shit is “organic”? Or are they just assuming that the birds are holding it while they fly over, because hey… there’s a sign letting them know it’s our drinking water…

  19. mumadaddon 21 May 2014 at 1:22 pm

    Surely water doesn’t go unprocessed from reservoir to tap anyway?

  20. BBBlueon 21 May 2014 at 1:46 pm

    Mlema,

    I think this is where the idea that fertilizer industries have been behind the push to fluoridate, and to prevent fluoridation cessation, comes from. Fluoridation is a way for some industries to make money from a waste product by selling it to the public instead of having to pay to dispose of it.

    Conspiracy theory, much? I’m sure the Food Babe would agree with you, and I suppose Monsanto is the real power behind contaminating our precious bodily fluids.

    The primary water supply for many communities is groundwater; water that has percolated through soils, disolving minerals and carrying both natural and anthropogenic contaminates along the way. For instance, a certain amoung of lead and arsenic occur “naturally” in drinking water.

    Yes, sodium hexafluorosilicate is derived from phosphate rock and it does contain impurities, however, upon what basis does that represent a hazard to human health if the contribution of those impurities is orders of magnitude less than those which occur naturally at concentrations well below MCL?

    Oh, by the way, FDA standards allow for 1.4-2.4 mg/L fluoride in domestic bottled water with no added fluoride and 0.8-1.7 mg/L for domestic bottled water with added fluoride. So if you want to consume the domestic bottled water with the strictest standard for fluoride, best to ask for the product with added fluoride.

  21. BBBlueon 21 May 2014 at 1:55 pm

    Lumen2222,

    “Our customers have an expectation that their water is not deliberately contaminated. We have the ability to meet that expectation while minimizing public health concerns,” David Shaff, Portland Water Bureau administrator, said in a statement.

    No perversion of naturalistic fallacy, it is a naturalistic fallacy. That, and it was yucky.

  22. Lumen2222on 21 May 2014 at 2:06 pm

    I feel like someone should give them a version of the lecture I used to get at the dinner table as a child. The one about the “starving children in Africa”.

    Portland! There are thirsty children in SoCal who would be grateful for that water you want to dump in the sewer!

  23. Mlemaon 21 May 2014 at 2:26 pm

    BBBlue,
    I’m simply pointing out that the silicofluorides added to water come to us from the manufacture of fertilizer, not from groundwater. They haven’t been tested for human safety. Only sodium fluoride has (currently less than 10% of fluoridation). Silicofluorides added to drinking water act differently than sodium fluoride and are implicated in a number of potential health concerns.
    Please read the links I provided.

    Your note on bottled water simply points up what I’m saying. There’s fluoride in everything we eat and drink. If you’re going to set up a municipal water system to remove impurities and contaminants from the water, why would you add one back in? Especially in a form that’s been implicated in increased lead poisoning in children. Take out as much fluoride as you can. Whatever’s still in there is enough. If the majority want fluoridation, then use sodium fluoride. At least we know it doesn’t add more problems than the fluoride ion itself.

    I’d be interested in knowing what conspiracy theory you think I’m advancing.

  24. Teaseron 21 May 2014 at 2:33 pm

    A year ago Portland voted against adding fluoride to their water supply. (Much less urine)

    http://www.oregonlive.com/portland/index.ssf/2013/05/oregon_official_felt_pressure.html

    “Dental health statistics have been key for the pro-fluoride campaign, and any change for the worse could have bolstered their arguments. For instance, the website run by Healthy Kids, Healthy Portland highlights a 49 percent increase of untreated dental decay among children between 2002 and 2007. But new 2012 statistics show that increase has been fully wiped away and the percentage of kids with untreated decay is now below 2002 levels.”

  25. Ekkoon 21 May 2014 at 3:13 pm

    Mlema,
    You are making all kinds of strong statements about lack of safety and and asking others to read links you’ve provided. How thoroughly have you investigated these links yourself before coming to these conclusions?

    For example, your first link’s source says this:
    “SiF treated water is not like NaF treated water because [SiF6] 2- (a) is unlikely to dissociate completely under water plant conditions, producing only free fluoride and silicic acid without side reactions.”
    The reference they provide for this leads to this study from 1969:
    http://onlinelibrary.wiley.com/doi/10.1002/jctb.5010190402/abstract

    Where it says, in the very first sentence of the abstract:
    “Evidence from specific-ion electrode and conductivity measurements at 25° confirms that sodium fluorosilicate, at the concentration normally present in public water supplies, is dissociated to at least 95%.”
    Now “at least 95%” is not 100%, I will agree, but what evidence is there that whatever small percentage doesn’t disocciate is associated with any safety issues at all?

    What evidence is there for your claim that it leads to lead uptake in children? Quote something specific – don’t just copy paste a link and expect everyone to have to navigate through multiple references to find if there is a basis to the evidence or not.
    Before making strong conclusive statements like you have, especially ones that contradict consensus currently, you should at least read more thoroughly.

  26. BBBlueon 21 May 2014 at 3:58 pm

    Mlema,

    Phosphate fertilizer companies have benefited from being able to sell sodium hexafluorosilicate to municipalities. Sodium hexafluorosilicate is a waste product of production which is expensive to dispose of under federal regulations.

    The conspiracy you are suggesting is one where montetary gain is driving demand for sodium hexafluorosilicate. There is no other reason to raise the issue in this context. Obviously, those municipal water systems that fluoridate will look for the best deal possible on materials that meet NSF standards. What do monetary gain and disposal costs for fertilizer companies have to do with the physical properties and toxicology of sodium hexafluorosilicate?

    Let’s see, 1975 doctoral thesis found acetylcholinesterase inhibition to be amplified by SiF complex. In German, so I guess I will have to pass on reviewing that one. Studies that indicate too much lead is not good for you. Yup, I think I can probably agree with that. Perhaps you can help me out, exactly what evidence in the 2001 resolution submitted by Coplan and Carton supports your argument?

    Then there is the claim in the Dartmouth News that “…public drinking water treated with sodium silicofluoride or fluosilicic acid, known as silicofluorides (SiFs), is linked to higher uptake of lead in children.” based on Master’s work published in NeuroToxicology, 21(6):2000, that was largely a statistical exercise in which the authors state: “We are aware that statistical association should not be confused with causation.”

    My take on this is that since sodium hexafluorosilicate is not a novel, synthesized compound and disassociates into known constituents, all of which have well-described toxicological effects and established MCLs, absent evidence not found among your references, there is little reason to suspect that a source of fluoride which meets NSF standards represents a significant risk to human health. To claim otherwise based on your references tends toward an appeal to nature.

    Finally, one man’s “waste” is another man’s “byproduct”. There are a number of uses for sodium hexafluorosilicate, and I think you overestimate the incentive represented by its use as a drinking water additive and as a disposal expense.

  27. Mlemaon 21 May 2014 at 10:24 pm

    Ekko – you’re right. I’m relieved to report that the lead uptake correlation has been disproved by the EPA.
    http://www.epa.gov/nrmrl/wswrd/cr/pubs/rrbansky_schockawwa_ac2000.PDF
    thanks

    BBBlue,
    I’m not suggesting a conspiracy. I didn’t say there was anything underhanded or secretive going on. Dr. Novella said that his favorite fluoridation conspiracy theory is that it’s all “a plot to allow companies to cheaply dump industrial waste into the public water supply.” I was just pointing out where I think that one came from. The fluorosilicates come from the fertilizer industry. They make money on it. Big deal.

    Personally, I think it’s ridiculous to add contaminants like fluoride to our water (along with the heavy metals you’ve shown come along with the product). An appeal to nature would be: “leave all the natural contaminants in there!” No, I want them removed as much as humanly possible. And I don’t want any added back in. I think we ought to try to reduce the fluoride present in water supplies that have above .7ppm. And any municipalities that are fortunate enough to be removing more should discontinue fluoridation. I’m not asking the toothpaste companies to take fluoride out. I’m just asking for the best water product i can get from my tap. But to each his own. Oh, wait – to me YOUR own, right? :)

    I’m encouraged that the NRC, EPA and HHS continue to review the issue of fluoridation in order to account for the increased intake of fluoride from our diet and to try to reduce fluorosis in children and the risk of toxicity to vulnerable populations. I’m also glad that this currently remains a community issue.

  28. BBBlueon 22 May 2014 at 1:10 am

    Mlema,

    So if fluoridation contributes a minuscule amount of lead, far less than background levels of lead, and a trivial amount in regards to possible human health effects as per the EPA reference above, and if fluoridation proved to be an effective, preventative treatment for dental caries, would you still be against it? I understand there is a legitimate debate to be had in terms of whether or not fluoridation’s time has come and gone, but that is a different subject.

    While “leave all the natural contaminants in there!” may be considered an appeal to nature under some circumstances, it really doesn’t apply here because there is no claim that lead is good. In this context, an appeal to nature is more like claiming that added lead of any amount is somehow different or worse than naturally occurring lead in drinking water. Same as if one were to argue that there is a practical difference between minuscule amounts of human urine and the urine of other animals in a reservoir.

    I am not saying to add lead if there is no anticipated benefit, but if there is clearly a significant benefit and the amounts of lead added to the system are so trivial as to be almost nonexistent, then arguments against fluoridation based on lead are extremely weak.

    Do you also contend that the hazards of chlorinating drinking water contaminated by human pathogens are not worth the sanitizing activity?

  29. FishGuy1on 22 May 2014 at 8:01 am

    Hi guys!
    Have there been any studies showing a drop-off/lack of drop-off of any conditions supposedly linked to fluoride in countries that once added it to their water supply and later stopped the practice?

    Thanks.

  30. praktikon 22 May 2014 at 2:06 pm

    This sparked an interesting comment thread on a friends FB page.

    Here is her comment:

    “Yeah, except for people who have a sensitivity to it. I have a medically (western) confirmed fluoride sensitivity that causes rashes in and around my mouth if above a certain threshold. This study only tells part of the story. Peanuts are also safe, except for some people. The issue with mass fluoridation is that there is no choice.”

    Strange to see the “medically confirmed” language, someone asked what her threshold was, did she find it?

    “Only through trial… I had to work with my medical practitioner to identify all possible sources of fluoride that I have control over eliminating (toothpaste, mouthwash, certain kinds of table salt). Rash went away. When I challenge with fluoride products, it comes back. Can’t eliminate water, so lucky there are other things I could try to eliminate to get it down. That’s my story! I know it is meant for public good, but regardless of the evidence published regarding safety, I am concerned about mass medication programs on an ethical basis – lack of individual consent, lack of choice, no mechanism for opt out.”

    So I did some googling and my first red flag was that with near unanimity, the fluoride/allergy connection was the province of motivated anti-fluoride activist sites and natural news, but I did find a few respectable sources.

    Check page 232 for an interesting view into the allergic potential of fluoride:

    http://books.google.ca/books?id=Abh47vD7JTEC&pg=PA232&lpg=PA232&dq=fluoride+allergic&source=bl&ots=Jzpb0QjYgn&sig=caRqihp0vzgK4FwKBjETjBq3Z3Y&hl=en&sa=X&ei=7u59U7nAAeLE8AH3xIDoAw&ved=0CDIQ6AEwATge#v=onepage&q=fluoride%20allergic&f=false

    Now I don’t want to be saying someone is imagining something without evidence, but my gut is telling me this person was the victim of someone who irresponsibly fingered fluoride as a potential issue, and through eliminating these sources she either A) elminated *other things* in her intake from avoiding sources of fluoride that were giving her issues or B) the actions of these eliminations and the belief that fluoride was the cause enabled her to psychologically perceive improvement?

    I am not about to start putting this person to the question but I am skeptical of her story… In skeptical resources the allergy connection is almost never discussed, seems to focus more on effectiveness and more tradition things like fluorosis…

  31. Ekkoon 22 May 2014 at 2:29 pm

    praktik,
    Your post (I realize part of it is quoting someone else) uses both “medically (western) confirmed fluoride sensitivity” and “flouride allergy”. Sensitivities (like food intolerances) and allergies are very different. I have never heard of a “medically confirmed flouride sensitivity”. Does such a think exist? I’m fairly confident that people cannot be allergic to minerals though…

  32. Mlemaon 23 May 2014 at 4:39 pm

    BBBlue, I get it. You support fluoridation – for yourself, for me, and for all the world. But you haven’t provided any convincing evidence that it’s of benefit to me. And in this case, my standard of convincing is the only one that counts, since I’m the one you want to drink it (don’t bother linking me to the studies, I’ve read them). If you were a doctor prescribing this as prophylaxis, i would know you’d considered any contraindications. And I would have sought you out for assistance and you would have explained the risks and benefits and, in the end, left the decision to me. And you would have said: don’t mix your baby’s formula with this, and don’t give it to your mama who’s on dialysis.

    “Do you also contend that the hazards of chlorinating drinking water contaminated by human pathogens are not worth the sanitizing activity?”

    We chlorinate to kill pathogens. We don’t want to get sick. That’s why we have to contend with the by-products of chlorination in the water. People who can afford it usually try to mitigate the effects of chlorination. It’s good, better, best in these situations. Nothing’s perfect. We’ve seriously sickened and even killed people with human error in fluoridation. I think those families could make a case that the risk of fluoridation outweighs the benefits.

  33. Mlemaon 23 May 2014 at 4:40 pm

    FishGuy1, yes. Fluoridation has been linked to the rate of fluorosis in children. Also, there appears to be a drop, globally, in the rate of dental caries, regardless of fluoridation cessation – although I would encourage you to look at the research yourself. It’s a difficult thing to study, and even though I’m against adding fluoride to water – I’m hesitant to make further conclusive remarks. There’s a lot of contradiction in the research and it would take a lot of time to evaluate its quality. Some meta-reviews have concluded that the quality of research in this area is still lacking.

  34. Teaseron 23 May 2014 at 5:33 pm

    OH OH Portland!
    http://www.oregonlive.com/portland/index.ssf/2014/05/portland_issues_boil_water_not.html

    “The Portland Water Bureau issued a city-wide boil notice on Friday morning after water staffers detected E. coli in three separate tests during the past three days.”

    “Routine inspections at two of the city’s Mt. Tabor reservoirs produced the three positive E. coli tests. City employees performed the tests, according to Jaymee Cuti, bureau spokesperson.”

    Makes me wonder if the pee story was a cover for the need to dump 38 gallons of water.

    Other Portland Headlines:

    Portland boil water alert: No need to boil water for pets
    Five easy dinners you can make tonight without water

  35. BBBlueon 25 May 2014 at 7:09 pm

    Mlema,

    Here is the fundamental question, in my opinion: We have established MCLs that define what is safe in terms of fluoride concentration in drinking water. If the addition of fluoride to drinking water has a significant public benefit, and it can be reliably controlled to remain at concentrations less than statutory MCL, what is the compelling reason why it should not be added?

    You have made claims about what scientists say

    Fluorosis rates in children have continued to increase since the inception of fluoridation. There’s no evidence that communities which fluoridate have a lower rate of dental caries than those that don’t. In fact, the precipitous drop in dental caries worldwide in recent decades has been similar in all countries, regardless of whether or not they fluoridate a lot, a little or not at all. Scientists say the drop may be due to fluoridated toothpastes, oral hygiene, or better nutrition.

    …but provided no evidence in support of those claims. Not saying you are wrong, just saying I’m not going to take your word for it.

    Seems to me that one either has to make a case as to why fluoridation is of little benefit or establish the fact that observing MCLs is not sufficiently protective of the public’s health. You have implied both but have supported neither with sound evidence.

    Not unlike the situation with pesticides. There are clear benefits in using pesticides and no conclusive evidence to support the claim that concentrations below MRLs as established by law in the food you eat causes harm. Sure, pesticides are toxins and too much is harmful, but that is not relevant to claims made about the amounts actually found in food. And if you argue that there is no such thing as a safe pesticide residue, then you are expressing an opinion, not a fact based on science.

  36. Bill Openthalton 26 May 2014 at 3:38 am

    BBBlue —

    …but provided no evidence in support of those claims. Not saying you are wrong, just saying I’m not going to take your word for it.

    We are dealing with fundamental beliefs, for which humans almost universally search for confirmation instead of information. This argument against fluoridation (the drop in caries is realm but it’s caused by something else, even fluoridated toothpaste) is eerily similar to the argument against vaccination (the drop in infectious diseases is real, but caused by something else, like better hygiene). Even when presented with reliable arguments, the proposition is so off-putting the brain finds a way round accepting it.

    My guess is that these beliefs have been classified as moral issues, and are no longer subject to the rules applied to “reality” issues. Morality is about living together, and it is more important to be a part of the community than to be correct (as in “in line with available evidence”). It’s the same approach people use to continue to justify political strategies that have failed, or decry those that are working, but are not part of their political orientation.

    I’m sure I can find such convictions in my own mind.

  37. Mlemaon 27 May 2014 at 11:00 pm

    Here’s an older study which shows no difference between fluoridation and non-fluoridation in rate of dental caries. Maybe you can find a newer study which contradicts it. Please link to research, and not CDC or ADA publications. (use their list of references to search for pro-fluoridation studies if you like)
    http://www.fluorideresearch.org/232/files/FJ1990_v23_n2_p055-067.pdf

    In fact, what I find is that the rate of dental caries has decreased globally, regardless of fluoridation.
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/figure/fig1/

    Considerations on optimal fluoride intake using dental fluorosis and dental caries outcomes–a longitudinal study.
    http://www.ncbi.nlm.nih.gov/pubmed/19054310

    Doctors are concerned that infants and young children are ingesting too much fluoride. The mechanism of possible benefit is topical application. Therefore, there’s no benefit to children under about age 7 – and fluoridated water increases the risk of fluorosis in young children (a sign of fluoride toxicity) Pediatricians advise purchasing low-fluoride baby formula, or mixing with non-fluoridated water. (an unwelcome expense for many new mothers, and information which isn’t readily available to many parents) Also, with increased fluoride content in food, controlling intake gets difficult.

    Since there’s no way to determine or control dosage, and there are contraindications for people with kidney or thyroid problems, it seems to me that you’re the one who needs to provide proof of benefit and safety. If you want me to drink fluoridated water, you have to show me how it’s safe for me and my family, even though you know nothing of our ages or health status. Oh, and not just safe, but beneficial.

    MCLs change you know. But whether or not fluoride (a toxic compound) is necessary for human health doesn’t change. It’s not necessary. It’s not required in any way. So, even though I said you don’t need to link me to the evidence, I’ve changed my mind. Show me how fluoride is beneficial to the degree that we can justify dosing everyone, regardless of age or health status, and regardless of whether or not we have a way to control how much they ingest.

  38. grabulaon 27 May 2014 at 11:36 pm

    @mlema

    No cdc or Ada references bit It’s Ok for you to post from flourideresearch.org? Sounds like a double standard to me.

    Also, can I just link the study mentioned in this blog post since, you know, that’s one of them showing it’s safe.

  39. rezistnzisfutlon 28 May 2014 at 1:38 am

    In Europe, some municipalities do not fluoridate their water supply either because well water is naturally already sufficient, or they go with fluoridated table salt. No matter how you cut it, it’s fluoridation that has reduced dental caries, but only the means of fluoridation are different.

    Fluorideresearch.org (International Society for Fluoride Research), an anti-fluoridation activist group. But OK, let’s look at the study they cite.

    Commissioned by the Safe Water Foundation, no apparent peer review other than International Society for Fluoride Research’s “journal” Fluoride. Examines 39,207 school children 5-17 in 84 areas in the US. 24 regions were fluoridated for more than 17 years, 30 were never fluoridated, and 27 were partially fluoridated for less than 17 years. The conclusion is that there is no distinguishable difference between the groups. I did not see any controls. Why weren’t the municipal water supplies tested for fluoride levels? What were the differences between municipalities, and how significant are they? What were the decisions behind why some of the regional water supplies were supplemented with fluoride and others were not?

    Where I live, and much of the region of the country I live in, water fluoride levels already present are relatively high, mostly due to hydrogeothermal activity, so artificially increasing them isn’t appropriate. This is only one confounding factor among apparently no controls included. Considering that Fluoride appears to be a pay-to-play journal, it’s little surprise this study made it to publication. Furthermore, this study was conducted in 1987 and published in 1990, so it’s not really cutting edge.

    As for the chart you provided, you should read the actual study, in full, and not cherry pick like you often do. It represents the worse case of any scientific water fluoridation question: more study is needed.

    You have yet to demonstrate your claims that water fluoridation is of no benefit or actually causes harm.

    Here are some studies indicating that it works:
    PMID: 24603270 (March 2014)
    PMID: 24428350 (Feb 2014)
    PMID: 24308395 (Nov 2013 – Milk Fluoridation)
    PMID: 24308394 (Nov 2013 – Salt Fluoridation – A paper reviewing effects of salt fluoridation)
    PMID: 24308393 (Nov 2013)
    PMID: 24293810 (Jun 2013)

    CDC statement on water fluoridation programs:
    “For 65 years, community water fluoridation has been a safe and healthy way to effectively prevent tooth decay. CDC has recognized water fluoridation as one of 10 great public health achievements of the 20th century.”

    ADA statement on water fluoridation programs:
    “The American Dental Association unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay. This support has been the Association’s position since policy was first adopted in 1950.”

    “Best available evidence suggests that public water fluoridation is an effective way for preventing caries, and may be a valid choice as a population intervention. More studies are needed to explore potential nondental adverse effects of fluoridation on various populations.”

    There is a virtual glut of studies, papers, and professional opinions from scientists to regulation agencies regarding the safety and efficacy of water fluoridation. This flies in the face of the weak evidence brought against it. This is why I ride you so much, mlema, because this is what you do – you present opinion as fact then find weak supporting evidence, often gish galloping us with link after link to bad studies and activist websites, what, to win by attrition? To hope that you present so much information that people will quit looking it up? I stopped responding to you so much because of time, I got tired of chasing down your poor supporting evidence, and it’s like Natural News at this point to where we can count on it being, at best, weak.

    That being said, I don’t think anyone will disagree that more study is always warranted. If at some point definitive evidence mounts pointing to harm, lack of necessity, or better means of dissemination, I can’t imagine many people (including us pesky skeptics) would be opposed to it. As BBBlue already said, you have made factual claims, but have yet to demonstrate that A) fluoridation isn’t necessary, or B) that it’s actually harmful.

  40. Mlemaon 28 May 2014 at 10:04 pm

    Rez, although your criticisms of the first study I linked to may be valid, the chemistry of fluoride and human physiology haven’t changed. That’s why I was hoping you might provide a similar study that had been conducted more recently. But you haven’t. And many studies divide groups based on fluoridated vs. non-fluoridated without further qualification.

    “As for the chart you provided, you should read the actual study, in full, and not cherry pick like you often do. It represents the worse case of any scientific water fluoridation question: more study is needed.”

    I didn’t cherry pick anything – I was hoping anyone might link to the study itself (I didn’t want to put more than three links in the comment, and most people relate better to visuals) I don’t know what your problem with the paper is. It’s simply an informational assessment, and talks about a number of pertinent issues. Here, I’ll link to it:
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/

    “You have yet to demonstrate your claims that water fluoridation is of no benefit or actually causes harm.”

    Here’s the problem: studies in this area are not of good quality. And, if you want me to drink fluoridated water, it’s not up to me to prove to you that there’s no benefit or that it causes harm. It’s up to YOU to prove that its benefits are worth the harm. Fluoride is a toxin. There’s no physiological requirement in the human body. Your argument for me drinking it is: as long as you drink a little and not too much, it’s good for your teeth. The problem is, how are you going to make sure I get just a certain amount, based on my weight and consumption, and nothing more? What if my kidneys don’t excrete it properly? What if I’m less than seven years old and have no adult teeth to benefit (the mechanism is said to be topical application, which water would provide as it washes over the teeth, or lingers in the mouth) – how do we justify dosing children? Children are the ones who are ending up with fluorosis – a lifelong defect unless corrected by expensive treatment.

    “Here are some studies indicating that it works:”

    OK. First you need to understand that i accept that topical fluoride application may help in some way. With that being the case, I accept likewise that fluoridated water may provide some benefit. However this doesn’t reflect on the appropriateness of fluoridated water for preventing caries, nor does it justify the incidence of fluorosis in children (to whom there is no benefit at a young age anyway) Nor does it address other potential harm. So, an unqualified “it works” can’t be had.

    But anyway, first study:

    PMID: 24603270 (March 2014)
    “An alternative marker for the effectiveness of water fluoridation: hospital extraction rates for dental decay, a two-region study.”
    I don’t have any problems with this study. But you should realize that it may suffer from the same shortfall you noted in the first study I linked to. Hospital patients were grouped according to the region they came from, as “largely fluoridated” or “largely unfluoridated”. So I’d need to see more data to determine whether it really examined the correlation between fluoride ingestion and extraction. And what about other factors like socioeconomic status? Since these were geographic regions, there’s a strong possibility of other factors affecting the outcome.

    second study: (I don’t know if this is the one you want, but I couldn’t find anything under where that designation took me, except this):
    http://www.ncbi.nlm.nih.gov/pubmed/24738787
    Dental caries and fluorosis experience of 8-12-year-old children by early-life exposure to fluoride.
    Seems to show an association between fluoride, caries and fluorosis. I would say it supports both our viewpoints. Fluoride in water may reduce caries, but it increases fluorosis.

    third study, and fourth study:
    Both of these address methods of delivering fluoride which offer better control than water fluoridation, while simultaneously offering choice of participation in what amounts to a medical dental treatment.
    From the milk study:
    “An advantage of the method is that a precise amount of fluoride can be delivered under controlled conditions.”
    From the salt study:
    “Based on the success of water fluoridation, a gynecologist started adding of fluoride to salt.” (sorry, couldn’t resist :) But again, voluntary ingestion.

    Fifth study:
    really doesn’t offer anything except an opinion that fluoridation is beneficial. And there may be an error in saying that “A pre-eruptive effect of fluoride exists in reducing caries levels in pit and fissure surfaces of permanent teeth…” The jury’s out on this. I guess there’s no evidence that there’s any beneficial incorporation in pre-eruption teeth, only the effect of fluorosis when the dose is too high.

    Sixth study:
    The economic value of Quebec’s water fluoridation program. (?) Not sure if this is the one you wanted me to see,
    Talks about the theoretical economic benefit from water fluoridation. There are many things to consider with regards to cost benefit. I think this is irrelevant to convincing me that I should drink it, or want my city to fluoridate my water.

    Since basically what this amounts to is: if you’re forcing me to drink fluoridated water, regardless of my age and health status, you really ought to give me some scientific justification that the benefit outweighs the risk. I would say that this requires you to confirm the mechanism, establish solid dosage which delivers benefit without toxicity (which would require a health assessment) and ensure dosage control. One more time: it’s not up to me to show that adding a toxin to my water in a relatively small amount will not benefit me and will instead harm me. It’s up to YOU to show that adding a toxin(s) is safe and worthwhile.

    As far as the CDC and ADA statements, they’re not valuable as far as convincing me to drink it.

    “There is a virtual glut of studies, papers, and professional opinions from scientists to regulation agencies regarding the safety and efficacy of water fluoridation. This flies in the face of the weak evidence brought against it.”

    Blah blah blah. I don’t want to drink it. Why should you be able to decide that I must?

    That’s why I’d rather have people do their own research. Of course I’m going to do my best to show that fluoride risk isn’t worth the benefit. I think fluoridation is a bad idea. And I also think that if one understands the histology and physiology, that’s evident. But the studies are weak as far as what’s needed for any one person to gain any supposed benefit that they don’t already get in other ways. Likewise, few good studies on harm exist, and proponents always say “that’s a high level that you’d never get through fluoridation”. The point is, it’s toxic and we don’t have any control over how much any one person is getting, or how that amount will affect that individual person.

    “That being said, I don’t think anyone will disagree that more study is always warranted. If at some point definitive evidence mounts pointing to harm, lack of necessity, or better means of dissemination, I can’t imagine many people (including us pesky skeptics) would be opposed to it. As BBBlue already said, you have made factual claims, but have yet to demonstrate that A) fluoridation isn’t necessary, or B) that it’s actually harmful.”

    How much demonstration do you need? How is fluoridation necessary? THERE IS NO PHYSIOLOGICAL REQUIREMENT FOR FLUORIDE. FLUORIDE IS A TOXIN AND YOU CAN’T CONTROL HOW MUCH ANY ONE PERSON IS GETTING THROUGH FLUORIDATED WATER. Sorry to yell, but jeesh. Since there’s no physiological requirement, and fluoride is toxic at different levels to different individuals, and offers no benefit that can’t be gained in a more controlled way through other methods, you have to show why the harm of fluorosis (the documented adverse effect) is worth it. Also, you have to show why people with kidney insufficiency or thyroid problems should have to drink it.

    A better means of dissemination would be in milk, or in table salt, as you’ve referenced above. This allows choice and control. Again, for the umpteenth time, a lot of people don’t even know they’re drinking fluoride. How is this a good application of science? When doctors are only recently figuring out how fluoride’s benefits and harm actually work?

    And, you don’t need to answer this of course, but how do you feel about adding lithium to water to reduce suicides? There seems to be a strong correlation with lithium in the water and a reduced suicide rate. Also, I’d like to see someone assess the situation in Kentucky. Kentucky has had mandated fluoridation for many years. What are the results? I haven’t taken the time to explore this too much.

  41. Mlemaon 29 May 2014 at 3:01 pm

    Actually, if you live in an area where there are lots of psychiatrists prescribing lithium, it’s probably already in your drinking water. It’s excreted in the urine and isn’t filtered completely by water treatment facilities. Interesting!

  42. BBBlueon 01 Jun 2014 at 3:13 pm

    Mlema,

    Blah blah blah. I don’t want to drink it. Why should you be able to decide that I must?

    It’s not me you should worry about; it is government-run healthcare.

    For instance, in Australia, where there exists a publicly funded universal healthcare system, 69% of the population was receiving the minimum recommended dose of fluoride as of 2003 and in 2012, a review was conducted to determine the cost effectiveness of expanding fluoridation to all communities of at least 1,000 people.

    Public dental care in Australia is in crisis; omitted from the Medicare scheme for universal healthcare access in 1984, and under-funded for many years, there is now a sharp divide in dental health between rich and poor, and between those in the cities and those in the bush… Children from low income and Indigenous families experience higher rates of decay, which contributes to the on-going cycle of disadvantage. Community Dentistry and Oral Epidemiol 2012; 40: 369–376

    The practical-minded Aussies acknowledge the fact that too much fluoride during tooth development increases the risk of dental fluorosis, and have addressed those concerns, at least in part, with policy measures to “…encourage the use of smaller amounts of toothpaste when brushing and to discourage toothpaste consumption (eating/licking).” Policies which they claim have significantly reduced the prevalence of dental fluorosis in children in South Australia.

    The recommendation made in the 2012 report was to extend fluoridation coverage as a cost-effect means for the government-run healthcare system to address “…dental health disparities and inequalities in access to dental care.”

    I don’t think it is too far-fetched to presume that the same arguments will be made here by public officials as ACA increases its grip on our healthcare system.

  43. rezistnzisfutlon 02 Jun 2014 at 8:23 pm

    Mlema,

    Long story short, there is a glut of positive evidence for safety and efficacy, and a dearth of positive evidence for the harm and ineffectiveness of it. You have made several claims primarily based around A) that water fluoridation is unsafe, and B) that it is ineffective, therefore unnecessary at best (outright harmful at worst). I have no interest in nitpicking fine and minute details of particular studies – that’s an activist ploy intended to muddy waters and catch one in an “aha moment”, as if that would negate the entire line of reasoning. The reason I posted what I did was to highlight the number of studies in favor as to opposed, as well as the strength of evidence for each position. Yes, some studies have holes in them, but their conclusions stand not just by their strengths, but the reinforcing effect of so many other studies that converge around the same conclusions.

    For dental fluorosis cases, the solution is simple – reduce the personal use of over-the-counter fluoride products. This comes down to a matter of education as many people are often under the mistaken impression that if some fluoride is good, more must be better. Unfortunately, the concept of toxicity seems to be lost of much of the public, and activists have capitalized on their ignorance in order to promote their agenda. What it does highlight is the importance of regular dental visits which, of course, is an ongoing issue even for those who have adequate dental coverage. If a dentist notices the onset of fluorosis, they will advise the patient to reduce their usage of fluoride products.

    Now, the argument that water is being fluoridated and consumers more or less “forced” to drink it is a different subject altogether, and depending on peoples’ opinions and political leanings, may be a legitimate issue. However, conflating that with erroneous health concerns is little more than fear-mongering intended to scare people into compliance rather than argue the merits of libertarian points, and that is the basis for many fallacious talking points by activists for any number of subjects, anywhere from GMOs to fluoridation. THIS is why skeptics argue against people like yourself who try to uphold incorrect information as facts. It distracts from actual meaningful conversations that unfortunately often go unaddressed because we’re constantly having to correct mis/disinformation made by activists, and all that does is impede progress.

    What is seems to be happening in those instances is that activists want to outright ban the things they disagree with, and not consider that either A) they are just wrong in their conclusions, or B) there may be alternatives which address their concerns but doesn’t necessarily preclude the use of what they’re fighting against. It is the activists who are close-minded, not the skeptics or the proponents. Decisions should be made case-by-case on the best and strongest evidence possible, not on misinformation, fear, and appeals to emotion.

  44. Mlemaon 02 Jun 2014 at 10:56 pm

    “If a dentist notices the onset of fluorosis, they will advise the patient to reduce their usage of fluoride products.”

    You really don’t understand too much about this.

    I don’t think you or BBBlue has done a good job of justifying fluoridation, or of justifying the harm and expense that befalls many individuals when people who form their opinions for reasons other than evidence have control over things that negatively affect other people.

  45. Mlemaon 02 Jun 2014 at 11:05 pm

    Can we at least agree that citizens ought to be informed on the fluoride content of their water? After all, even the CDC recommends use of an alternative source of water for children aged 8 years and younger if their primary drinking water contains greater than 2 mg/L of fluoride. How can this happen if parents don’t know that their water has that much fluoride? And how will people afford alternative water sources? They’re already paying to get public water – shouldn’t they be able to drink that?

  46. rezistnzisfutlon 02 Jun 2014 at 11:16 pm

    “You really don’t understand too much about this.”

    I would say the same about you. You have presented weak and cherry-picked evidence, or evidence that is either inconclusive or doesn’t really support your position.

    Wanting freedom from ingesting a substance in your water is a different argument than making baseless claims about the safety or efficacy of the substance. While you’re free to argue the merits of each, we’re free to point out the fallacy of conflating the subjects as well as the evidence you present, especially given that you have yet to demonstrate that fluoridating water poses any real health risks that cannot be mitigated or outweighs the benefits.

    With your kind of argument, any number of water treatments should be banned because some people may not like it, for whatever reason they can come up with, even though there are legitimate reasons why water is treated with various chemicals. It is you who doesn’t seem to understand risk vs. reward, toxicity, educating people, and best use practices. If a person chooses to swish with gallons of mouthwash and toothpaste all day long because they have some pathological obsession with clean teeth, that’s their problem.

    “…or of justifying the harm and expense that befalls many individuals..”

    This is it, you haven’t made any argument demonstrating the harm you claim exists. I have had more than enough exposure (no pun intended) to this debate to know quite well what anti-fluoridationists have to say about it. Until you can show strong evidence that contradicts the already strong evidence for the safety and efficacy of fluoridation, we’ll remain unconvinced and critical of your claims. If you can provide strong evidence and argumentation regarding some libertarian aspect against water fluoridation, that is a separate issue. You try to make them the same issue, which is a fallacy.

    At this point, what you post is, to me, dubious and not worth poring over. For me, the fact that there dozens, if not hundreds, of published peer-review studies in legitimate journals as well as ALL of the regulatory agencies and scientific bodies that support the safety and efficacy of water fluoridation, that by far trumps the kind of weak and spurious evidence anti-fluoridation proponents like yourself push. Your “freedom from a substance” argument isn’t convincing as well.

  47. rezistnzisfutlon 02 Jun 2014 at 11:33 pm

    Can we at least agree that citizens ought to be informed on the fluoride content of their water?”

    Sure. it’s not a state secret. That information is readily available at any municipal water agency and legally required information for private wells for anyone who is interested. There are limits that must be adhered to.

    NATIONAL GUIDELINES FOR FLUORIDE USE (CDC)

    PHS recommendations for fluoride use include an optimally adjusted concentration of fluoride in community drinking water to maximize caries prevention and limit enamel fluorosis. This concentration ranges from 0.7 ppm to 1.2 ppm depending on the average maximum daily air temperature of the area (66–68). In 1991, PHS also issued policy and research recommendations for fluoride use (8). The U.S. Environmental Protection Agency (EPA), which is responsible for the safety and quality of drinking water in the United States, sets a maximum allowable limit for fluoride in community drinking water at 4 ppm and a secondary limit (i.e., nonenforceable guideline) at 2 ppm (69,70). The U.S. Food and Drug Administration (FDA) is responsible for approving prescription and over-the-counter fluoride products marketed in the United States and for setting standards for labeling bottled water (71) and over-the-counter fluoride products (e.g., toothpaste and mouthrinse) (72).

    Most municipal supplies are below 0.5 ml/day. The ones that are above are due to natural fluoride in the water supply.

  48. rezistnzisfutlon 02 Jun 2014 at 11:39 pm

    After all, even the CDC recommends use of an alternative source of water for children aged 8 years and younger if their primary drinking water contains greater than 2 mg/L of fluoride.

    As a suggestion, it would be helpful if you provided a link to factual statements like this. Not that I’m saying you’re incorrect, but that it’s good to know where you’re getting your information.

  49. rezistnzisfutlon 03 Jun 2014 at 12:21 am

    Just some background on myself, I’m a practicing hydrogeologist with training in groundwater contamination, environmental engineering, and civil engineering. This happens to be my area of expertise. So, to claim that I don’t know much about the topic is woefully misrepresentative. That would be like saying that Dr. Novella doesn’t know squat about neuroscience, or BBBlue doesn’t know anything about agriculture.

  50. Mlemaon 04 Jun 2014 at 2:33 am

    “…we’re free to point out the fallacy of conflating the subjects…”
    “…we’ll remain unconvinced…”

    I love it when people use the royal “we”. :)

    “With your kind of argument, any number of water treatments should be banned because some people may not like it, for whatever reason they can come up with, even though there are legitimate reasons why water is treated with various chemicals.”

    That’s just silly. Fluoride is the only medical treatment we distribute through our public water supply. That’s enough reason to oppose it. No dosage control. No pre-dosing health assessment. Unwanted side effects. Accidental overdose. Why would you say nutritional supplementation is unnecessary and nutrients should be gained through food, but then support adding a toxin to the public water supply because you believe it reduces cavities if you drink it? This is outdated reasoning that doesn’t reflect our current scientific understanding. There’s no verified benefit before age 8 and benefits after that age are from topical application. The most fluoridated water can do is keep a certain amount of fluoride in your saliva if you drink it throughout the day. But since drinking it poses other problems (it’s a toxin) – why wouldn’t you just brush your teeth and spit it out? I predict that over time the allowed maximum, and the “optimal” fluoride level, will continue to decrease.

    “…you haven’t made any argument demonstrating the harm you claim exists.”

    Fluorosis? In 1986-1987, 22.6% of adolescents aged 12-15 had dental fluorosis, whereas in 1999-2004, 40.7% of adolescents aged 12-15 had dental fluorosis.
    http://www.cdc.gov/nchs/data/databriefs/db53_fig3.png

    “Until you can show strong evidence that contradicts the already strong evidence for the safety and efficacy of fluoridation”

    Here’s a metastudy from 2000 you might find interesting (some of the responses are interesting too):
    Systematic review of water fluoridation
    http://www.bmj.com/content/321/7265/855
    “Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken.”
    “We included 214 studies; none was of evidence level A (high quality, bias unlikely).”

    I offer it to help explain why it’s meaningless to say:
    “For me, the fact that there dozens, if not hundreds, of published peer-review studies in legitimate journals as well as ALL of the regulatory agencies and scientific bodies that support the safety and efficacy of water fluoridation, that by far trumps the kind of weak and spurious evidence anti-fluoridation proponents like yourself push.”

    Besides, you still have it backwards. I don’t have to prove anything except that fluoride is a toxin. You have to prove that there’s a benefit that outweighs the harm. The harm has been demonstrated in fluorosis (which is only the most evident sign of toxicity – scientists are still studying how fluoride affects other enzymes besides those negatively impacted by fluoride pre-eruption of the tooth.)

    “Your “freedom from a substance” argument isn’t convincing as well.”

    I have to forgive you for saying that because you don’t really know what you’re talking about. If you did, it would be a horrible thing to say.

    “If a dentist notices the onset of fluorosis, they will advise the patient to reduce their usage of fluoride products.”

    Everything you’ve said shows me you don’t know what you’re taking about. You don’t know what causes fluorosis and how to prevent it, or what’s required to treat it. You don’t understand that there are people who not only shouldn’t drink fluoridated water, but that those people aren’t duly informed that they shouldn’t be drinking fluoridated water, or whether or not their water contains fluoride. Yes, the info is available. But a person has to be aware that they’re at risk. The greatest harm of fluoridation happens in populations least likely to be aware they’re drinking fluoridated water and least able to afford to prevent or mitigate harm.

    There are reasons I don’t want water fluoridated. I’ve provided those reasons. You have yet to provide any reasons why i should want to drink fluoridated water. Tell me why I should want to drink fluoridated water? You already know more about me than any community knows about the age and health status of any one individual in its population who drinks its water. You know I’m not an infant. Do you think indigent mothers with infants know that it’s inadvisable to prepare formula with fluoridated water? What about the CDC’s recommendation to use an alternative source of water for children aged 8 years and younger if their primary drinking water contains greater than 2 mg/L of fluoride? How many people with children under 8 know this information? How many of them can well afford to buy fluoride-free water to give to their children under 8?

    “As a suggestion, it would be helpful if you provided a link to factual statements like this. Not that I’m saying you’re incorrect, but that it’s good to know where you’re getting your information.”

    When I say it’s a CDC recommendation, it means it’s recommended by the CDC. You should save your hot air for a balloon ride.
    http://www.cdc.gov/fluoridation/faqs/dental_fluorosis/

    Also, I am dismayed that Dr. Novella would use the research on IQ to name his post “New Study shows fluoride is safe” It’s just a way to put a belief out there. There’s no study that shows “fluoride is safe”. He was probably trying to attract anti-fluoride activists for a hoot n holler, but all he got was me. (not an activist outside this page) :)
    I think there are some problems with the IQ prospective study. I’d like to see a critical assessment by the skeptical community. (why do I doubt that will happen?)

    “Most municipal supplies are below 0.5 ml/day. The ones that are above are due to natural fluoride in the water supply.”

    Source?

  51. Scepticonon 04 Jun 2014 at 6:54 pm

    As it happens I was sent this PR release on the paper:
    http://www.prnewswire.com/news-releases/study-claiming-fluoride-does-not-lower-iq-is-flawed-260752731.html

    The claims are coming from the anti-fluoride side so it’s to be expected they will have a problem with the study but is anyone in a position to determine if the objections have any merit?

  52. Mlemaon 05 Jun 2014 at 3:24 pm

    Scepticon, thank you for providing that link. It would be nice to have one of our resident scientists take a look at it.

  53. zganaon 15 Jun 2014 at 6:20 pm

    This is my first comment on this blog, which I have visited rarely before if ever. First off, despite the occasional snarkiness, the comments here have been impressively civil. Maybe I’ll find myself coming back.

    The most important finding listed in any of the comments here is that there are many studies on fluoridation, and none of them are quality science.

    http://www.bmj.com/content/321/7265/855

    This paper finds comparable associations of water fluoridation with dental caries and with fluorosis, with unclear results on other effects. I think this makes it clear that fluoridation proponents unjustifiably discount individuals’ rights to personalize the cost-benefit analysis involved in consuming fluoride.

    Mlema: props for sticking around and doing battle with people who do not understand burden of proof.

    Scepticon: I tried but did not succeed at obtaining the full text of Broadbent’s IQ study, but the shortcomings listed in the article look pretty damning to me (a soon-to-be-PhD physicist who does statistical analysis in multimessenger astrophysics). This objection is the most serious:

    The study’s small sample size of non-water-fluoridated subjects (99 compared to 891 water-fluoridated subjects) means it has low ability to detect an effect. Even worse, 139 subjects took fluoride tablets, but Broadbent does not say which. Since fluoride tablets are only recommended for children living in non-water-fluoridated areas, there may have been little difference in total fluoride intake between his comparison groups. Broadbent’s failure to consider total fluoride exposure may thus explain why he found “no effect”.

    So not only is the OP making a logical error by conflating a lack of IQ effect with overall safety; it also relies on a study of dubious quality (just like all other fluoridation research, as we have seen).

  54. Mlemaon 26 Jun 2014 at 11:42 pm

    Zgana, I appreciate your comment. If you start visiting often you’ll come to realize that, in many cases (not all) this site is less about skepticism and more about supporting whatever is the apparent institutional or industry consensus. The fact that the CDC has called fluoridation “one of the ten greatest public health achievements of the 20th century” means there will be no skepticism here regarding continued promotion of fluoridation, despite what many scientists are now saying – and despite the effects on, and wishes of, individual citizens. There is still input at the community level though – for individuals who have the time and will to invest in such a battle. Although some states have mandated fluoridation.

  55. grabulaon 27 Jun 2014 at 1:33 am

    @zgana

    I suspect you’re a wolf in sheeps clothing. You’re here posting for the first time innocently asking questions and later it’ll turn out your as off course as mlema is. On the off chance this isn’t true you need to go back through the data, there are plenty of quality studies on flouride that show it’s beneficial. The unfortunate thing is that a while back someone hit on the idea of government mind control or whatnot through our water and the fringe has continued to cling to flouride as the devils work.

    Mlema is as usual off:

    ” If you start visiting often you’ll come to realize that, in many cases (not all) this site is less about skepticism and more about supporting whatever is the apparent institutional or industry consensus. ”

    Most of us are true, dyed in the wool open minded skeptics, but we have little tolerance for the shenanigans of Mlema and his ilk. After being wrong so many times it’s easier for them to paint us as being schills and so on but it’s an ad hominem and undeserving. If you aren’t what I think you are, stick around, enjoy the conversation and learn something.

  56. Mlemaon 27 Jun 2014 at 10:05 pm

    grabula – What questions did zgana ask?

    Also – I think you mean undeserved, as in not deserved. Undeserving means not worthy.

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