“Fluoridation is the single most important commitment a community can make to the oral health of its children and to future generations.” -C. Everett Koop

Most weekends, I take on a lighter topic, as a way of taking a break from the deep physics, astronomy, and science we share during the week. But every once in a while, there’s an important story that needs to be told. This weekend, I invite you to enjoy Tony Rice’s rendition of a fabulous Gordon Lightfoot story song,

Wreck of the Edmund Fitzgerald.

One of the most contentious issues going on in my city — Portland, OR — right now, is our upcoming vote this May on whether or not we should fluoridate our drinking water. Now, a little disclosure from me, first:

  • I am an astrophysicist, not a medical doctor, not a dentist, and not a professional in the medical sciences.
  • I’ve lived in eight different states during my life; I moved to Oregon in 2008, which is the only place I’ve lived that doesn’t fluoridate our drinking water.
  • My values on public health are that we, as a community, should maximize the good health of our citizens while minimizing any bad effects that may arise.
  • In other words, if fluoridating our drinking water will result in better overall health for our citizenry than not fluoridating, I’ll be in favor of it. And if not — if the risks/bad effects outweigh any benefits — I’ll be against it.

That said, I’m not an expert on this issue. But the experts aren’t deciding our public policy on this issue: we, the voters, are. So I’ve set out to try and separate the science facts from scams, polemics and fictions concerning fluoridated drinking water. What follows is the best I’ve been able — as a non-expert on short notice — to put together.

Image credit: Michael Dayah, of http://ptable.com/.

Image credit: Michael Dayah, of http://ptable.com/.

First off, some basic science. Fluoride is a chemical — an ion — that’s added to drinking water. Now, I don’t know what you think of when you hear the word chemical; a lot of people think of toxins, plenty also think of poisons. It’s true that chemicals can be toxic or poisonous, but when I think of chemicals, I immediately think of chemistry.

And the chemistry of fluoride — that’s an ion containing fluorine, the ninth element in the periodic table — is really interesting. For one, fluorine is the most electronegative element, and is excellent at helping the transport of many positive ions, including calcium. We all have a non-negligible amount of fluorine (the element) in our bodies, as well. If you were to separate our bodies into the individual atoms composing it, you’d find that about 0.004% of your body, by weight, was made up of fluorine.

Image credit: Ed Uthman, with data from The Elements, by John Emsley.

Image credit: Ed Uthman, with data from The Elements, by John Emsley.

Now, the first place I went was to my dentist, who told me the following:

  • The most effective use of fluoride is topically, along the teeth, and is a tremendous benefit for dental health.
  • When she says “dental health,” she means strengthening teeth and reducing caries/cavities.
  • Naturally, water has a huge variety of fluoride concentrations, from less than 0.1 ppm (milligrams-per-liter) to in excess of 8 ppm; ours has a little bit naturally (about 0.2-0.3 ppm), but this is less than half the minimum recommendation from the US Public Health Service.
  • In Portland, because we don’t have fluoridated water, I am at a significantly higher risk for developing cavities. So in addition to brushing and flossing, I should be doing a fluoride rinse (like ACT) twice a day, and should not eat or drink anything (even water) for half an hour after rinsing.
  • She wishes that we would fluoridate our drinking water, as even though toothpastes, modern dental hygiene and a fluoride rinse are great for dental health, fluoridating our drinking water at the recommended levels would help our city’s overall dental health tremendously.

And the next place I went was to the American Dental Association’s website, where I found out:

  • Water fluoridation continues to be effective in reducing tooth decay by 20 – 40%, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.
  • Fluoridation is one public health program that actually saves money. An individual can have a lifetime of fluoridated water for less than the cost of one dental filling. And,
  • Community water fluoridation is the single most effective public health measure to prevent tooth decay.

Which sounds pretty good! It makes sense, after all: if fluoride is good at transporting calcium, it can help strengthen your teeth. In fact, it’s very important, developmentally, for infants to get the right amount of fluoride during the first few years of their life, as too little fluoride can result in weak bones and weak teeth.

But, as I started hearing from a lot of people, there may be drawbacks. One of them — most prominently — was dental fluorosis.

Image credit: Fluoridation Forum Report 2002.

Image credit: Fluoridation Forum Report 2002.

Someone alerted me that 40% of people have this! Well, no one wants discolored teeth, especially not the severe, brown stains that you can see in the last panel.

So I went and looked it up, and guess what? 40% of people do have some form of dental fluorosis, but…

Image credit: CDC / NCHS.

Image credit: CDC / NCHS.

Only 0.1% have what would be considered severe dental fluorosis. The teeth in this case are not just discolored, but also weaker than healthy teeth. So I looked up what causes those brown teeth. Do you know where we first discovered it?

In Colorado Springs, Colorado! It turns out that the water there, naturally, has excessively high amounts of fluoride in it! And giving someone too much fluoride can result in this severe form of fluorosis. In other words, too much fluoride is bad for you. It’s bad for your teeth and it’s bad for your bones. In the 1940s, in Grand Rapids, Michigan, they discovered that fluoridating drinking water at certain levels actually strengthened tooth enamel, reduced cavities, and improved lifelong dental health, both in children and in adults. Today, fluoridating drinking water means regulating the amount of fluoride to be between about 0.7 and 1.2 ppm.

We don’t normally think about our teeth when we think about health, but poor oral health is linked to tooth pain (obviously), which in turn is linked to:

  • difficulty sleeping,
  • difficulty concentrating in school and at work,
  • decreased achievement of children in school,
  • and possibly linked to heart disease.

So fluoridating our drinking water at the recommended levels would definitely improve our dental health; the science is very clear on that. But are there other side effects? Someone pointed out the following to me.

Image credit: Huffington Post.

Image credit: Huffington Post.

Reduced IQ?! Because of fluoride?! So I went and looked into it.

So this is based on a few studies, like this big one in rural China, and this one from Iran. It’s true, again, sort of. Yes, high levels of fluoride are correlated with lowered IQ, by up to 10 points. But this effect — the lowered IQ — is only seen in places where fluoride concentrations are at least 250% what the maximum recommended US value is. In fact, there are places in the study where levels are eight times that value! So yes, fluoridated water is linked to lower IQ, but not at the levels we fluoridate our water at.

People also pointed out a link to be between fluoridated drinking water and bone fractures.

Image credit: Li et al., via Wiley Online Library.

Image credit: Li et al., via Wiley Online Library.

Again, there is a link between fluoride and fractures, but it isn’t nearly as scary as you might think.

What the research shows here is that, if your fluoride concentration rises above 2.5 ppm (and remember, fluoridated water in the U.S. is between 0.7 and 1.2 ppm), your risk of bone fractures begins increasing spectacularly; this is due to a condition known as skeletal fluorosis. What’s interesting, though, is that if your fluoride concentration is too low, as in, below 0.5 ppm, your risks of fractures also increases! The place where fractures are minimized? Between 0.6 and 1.2 ppm.

This is true for all types of fractures except hip fractures, which don’t increase at low fluoride levels but do increase in rate above 1.2 ppm.

I also looked a little farther into the causes of fluorosis.

Image credit: Centers for Disease Control and Prevention.

Image credit: Centers for Disease Control and Prevention.

It turns out that fluoridated drinking water, on its own, at the recommended levels, will not cause moderate or severe fluorosis. But there are four things that people really, really should be aware of, because these can cause fluorosis in children:

  1. Swallowing fluoride toothpaste. Children under the age of two should not use toothpaste, and you should supervise your children each time they brush their teeth with toothpaste until they’ve established that they never swallow toothpaste. It’s great for topical applications, but getting too much fluoride, especially all-at-once, can cause fluorosis in their permanent teeth.
  2. Fluoride-containing infant formula. Breastfeeding a young child is ideal for a number of reasons, but not everyone does it for a variety of reasons. If, for some reason, you use infant formula instead of breastfeeding, be aware that many infant formulas contain moderate-to-high levels of fluoride, and, if so, should only be reconstituted with distilled water, not with fluoridated tap water.
  3. Tea! Believe it or not, many types of tea leaves contain large amounts of fluoride, and there’s even a woman (linked here) who gave herself skeletal fluorosis as an adult by drinking 1-2 gallons of tea every day for decades, upping her average dose to over 5 ppm of fluoride.
  4. Fluoride-containing drops. Many doctors will prescribe fluoride drops for babies who live in areas with very low levels of fluoride. (Some doctors do it here.) Do not use these drops on your child unless your doctor prescribes them to you! I know someone with moderate dental fluorosis because her mother gave her these drops despite having fluoridated drinking water; listen to your doctor!

There are a whole host of fluoride studies out there that were pointed out to me, and there are a few things that I do have mild reservations about.

Image credit: Environmental Science and Policy, J.W. Hirzy et al.

Image credit: Environmental Science and Policy, J.W. Hirzy et al.

There are presently three different fluoridating agents used in the USA; it’s possible that sodium fluoride — which is about five times as expensive as hydrofluorosilicic acid — poses slightly fewer long-term health risks, such as arsenic poisoning. If we were willing to spend five times as much to fluoridate with NaF instead of H2SiF6, that might be a better option. I’m hopeful that, down the road, when the science comes in conclusively on this issue, we’ll make the decision that’s in the best interest of public health.

There’s also evidence that fluoride causes calcium deposits in the brain’s pineal gland. It is unclear what, if any, negative health effects come along with that. But again, it’s worth investigating.

As far as I’ve been able to tell, according to all the original sources I’ve been able to dig up, water fluoridation is a relatively cheap, very effective and remarkably safe way to improve the dental health of the public. This systematic review, of 77 different studies (from 2008) agrees, and says the following.

Image credit: Yeung CA. Evid Based Dent. 2008.

Image credit: Yeung CA. Evid Based Dent. 2008.

It’s also worth noting that the Tampa Bay Times’ editorial writing staff just won a pulitzer prize for editorial writing for debunking five myths associated with the anti-fluoride movement.

In summary, here’s what I’ve learned about fluoride: fluoridating our drinking water at the optimum level recommended by the US Public Health Service — around 1 ppm — strengthens teeth, reduces cavities/caries, and provides protection against many poor health outcomes associated with both too much and too little fluoride.

Image credit: this one's all me; can you tell?

Image credit: this one’s all me; can you tell?

This was the subject of a heated discussion on scienceblogs a few years back, with an anti-fluoride post by Coby and a scientific takedown of that post by Orac. Indeed many legitimate doctors have spoken out against the anti-fluoridation movement.

It’s important to recognize that just because something is natural doesn’t mean it’s good for you, and just because something’s artificial doesn’t mean it’s bad for you. It’s also important to realize that public health means doing what’s best both for most of us and for the least affluent among us. What should guide us in making decisions about public health? The science. In this case, the science says that fluoridation is safe, the side effects are pretty much solely cosmetic and minor, and the health benefits to society are tremendous. And that’s why I’m pro-fluoridation at this point in time. (It’s telling that the anti-fluoridation group in Portland advances these as their best arguments.) It’s possible that there are health problems associated with fluoridated drinking water that we haven’t yet discovered. If we discover them, and those problems outweigh the health benefits associated with the improved dental health, I would change my mind, and advocate that fluoride be removed from the water.

It’s very rare that we get an opportunity to actually make a large impact in our public health system. We might not have universal healthcare, we might not even have a society where everyone can afford to go to the dentist. But — for less than the cost of one bottle of fluoride mouthwash per year — we can fluoridate our drinking water at the levels that science shows to be optimal for dental health. This May 21st, for everyone in Multnomah County, the evidence has convinced me: vote yes for public health; vote yes to fluoridation!

Comments

  1. #1 Brian Shiro
    Hawaii
    April 21, 2013

    Ethan,

    Public health issues are important, and I applaud you for researching this one to be an informed voter. However, I think you overlooked one major part of the debate. There is a growing consensus in the medical/dental community that flouride has little – or even no – benefit when it comes to preventing dental cavities, and it is potentially very harmful to children, as you alluded to in the post. That’s why new brands of toothpaste and other products (like gum) containing xylitol instead of flouride are exploding on the shelves lately. Xylitol is much safer and more effective, as the linked article below explains (see also the peer-reviewed PDF linked in the article). By the way, there’s a reason the more progressive states (Hawaii, Oregon, Washington, California) do not flourinate much of their water. It’s just a waste of money and a possible health risk with no clear benefit.

  2. #3 Steve Morris
    UK
    April 22, 2013

    There are infographics flooding facebook on this issue, making heavy reference to fluorosilicic acid being a ” toxic industrial waste product”. You can understand why those kinds of scare tactics gain followers. Congratulations, Ethan, in finding and summarising the evidence.

  3. #4 Tom Sheft
    Portland, OR
    April 22, 2013

    Well, this is a reasoned and well, thought out article – mostly – but the author omits or ignores a number of important issues.

    One, the amount of water used for drinking, going to the tap for a glass of water, is a tiny percentage of water use. The vast majority of municipal water usage is for industrial and commercial purposes. Added fluoride is useless here, and for some industries, like computer chip manufacture, it’s a contaminant that has to be removed. Your lawn and garden do not need added fluoride, either. Added fluoride at this level is a waste of money.

    Second, much of that commercial, and home, use is for food preparation. A municipality may be very diligent at keeping added fluoride at 1 ppm, but once the water is boiled the fluoride concentrates at varying and uncontrolled levels. So how much fluoride is in your latté or your plate of spaghetti? The author mentions that baby formula should be diluted with distilled water to avoid feeding overly high levels of fluoride to an infant. Do you think everybody’s going to do that? Anybody think it’s a good idea to give ~any~ level of fluoride to an infant?

    Next, the author acknowledges that there are possible negative health effects of added fluoride, but he says well, we should go ahead and fluoridate the water supply anyway. Um, excuse me? Shouldn’t we understand the negative aspects of fluoridation first, say it’s effect on dialysis patients for instance, ~before~ we add this substance to our water?

    Which brings us to a core issue: Fluoride added to a water supply is indiscriminate mass medication. I would be medicated without my choice or consent.

    The proper and most effective place to receive fluoride as a medication is in a dentist’s office. The most effective way to have healthy teeth is: Good nutrition, diligent oral hygiene, regular dental care.

  4. #5 Sandra Assasnik
    Portland, OR/Afghanistan
    April 22, 2013

    From working in public health, I have seen the nasty consequences of not having access to fluoridation. Thank you for explaining this so eloquently!

  5. #6 Ld Elon
    Cosmos/Hell
    April 22, 2013

    one pro, lots of cons, hmm

  6. #7 eric
    April 22, 2013

    the author acknowledges that there are possible negative health effects of added fluoride, but he says well, we should go ahead and fluoridate the water supply anyway. Um, excuse me? Shouldn’t we understand the negative aspects of fluoridation first

    He acknowledges the possibility that there might be some,. This is quite different from implying we are largely ignorant of long-term effects; AFAIK, after 50+ years of giving this to hundreds of millions of people, there is no correlation between flouridation at the CDC suggested level and any long-term heath effects. If we’re missing something, it only kicks in after 50+ years of use, or its extremely subtle, or it only affects some very small amount of the population.

    All of life is decision-making under uncertainty. A small uncertainty that what looks like the bset response may not be the best response should not paralyze us from making the best decision we can.

    Regarding your other points about people not drinking tap water, gardens, etc. People in fact do average several cups of tap water a day. Richer people drink more bottled water on top of that, but you are wrong in thinking that, in terms of overall population, this is ineffective. And (ii) I generally prioritize human health above gardens and silicon chip manufacturing costs. You’d have to show me quite a big cost difference for the manufacturing effect to outweigh the human one, and with gigabyte thumb drives costing practically nothing and terabyte storage drives retailing for $100 or less, well…good luck showing that.

  7. #8 Wow
    April 22, 2013

    Or it’s not being looked for, eric.

    Hell, what if the increase in Autism is due to birth defects from mothers who have all their lives have drunk flouridated water?

    If that were the case, we’re not able to see it BECAUSE WE’RE LOOKING ELSEWHERE for the cause.

    What if the effects look like some other symptom? Hyperactivity disorder, for example.

    Especially since one result can be caused by many things, therefore we find one solid connection then keep looking to explain why the causative strength has to be that high to explain the correlation.

    Not saying these are in any way true, but “we’ve seen nothing” isn’t a response since we’ve not been looking. We’d looked to better dental hygene with flouridation, but that colours where we expect some troublesome downsides.

  8. #9 Marvin
    Long Island, NY
    April 22, 2013

    Since cavities are a non-infectious disease, and since some people have philosophical objections to being medicated, fluoridation should be left to the individual and not imposed on everyone.

  9. #10 bobh
    April 22, 2013

    @Wow
    Really? Wow

  10. #11 Artor
    April 22, 2013

    Thank you Ethan for researching & compiling this information. I’d like to add a caveat though.
    Although we have regulations in the US limiting the amount of fluoride in our water, often the oversight or quality control is severely lacking. I’ve seen tap water with enough chlorine that it wouldn’t be considered safe for a swimming pool. I and all my sisters have moderate to severe fluoridosis from growing up in areas too heavily fluoridated. We all have the distinctive chalky bands on our teeth, and I just had my one tooth with the big brown crater repaired at no small expense. It probably won’t last another 5 years.
    I’m all for putting fluoride in toothpaste & mouthwash, but I can’t envision any good reason to put it in drinking water. Sure, you get more widespread exposure, but there is nothing to be gained from drinking it once it’s past your teeth, and some potentially major problems from overdosing.
    If my city starts fluoridating the water, I hope my tap filter can take it back out.

  11. #12 eric
    April 22, 2013

    Wow:

    Or it’s not being looked for, eric.

    Hell, what if the increase in Autism is due to birth defects from mothers who have all their lives have drunk flouridated water?

    Ethan’s cites show that people have been looking for negative effects, and not found any for cases of low flouride amounts, though they have been found for larger chronic doses.

    Sure, its possible we’ve missed some correlation. That’s always possible; you could say the same thing about autism being caused by exposure to cell phones (30 years now) or nylon (70-80 years now). Our best understanding is that no such negative health correlations occur, for any of those three cases. IMO we should form social policy on that best understanding and not eliminate nylon. Or cell phones. Or flouridation.

    Having said all that, if Portland wants to continue to not have it, that’s their choice. I’d vote like Ethan, but if my side lost the vote, I probably wouldn’t gripe about it and I’d probably engage in zero post-vote pro-flouride social activism. People make lots of bad or silly decisions. I happen to think this is one of them. But I support their right to make it, and frankly, if this is the worst decision the Portland city population makes, they are in pretty good shape.

  12. #13 Mark
    April 22, 2013

    Good article Ethan. Careful not to get overrun by the cranks on this issue.

    @1 – Brian, there is not a growing consensus that fluoride is not helpful. Your claim is not substantiated by any reference to the literature, only a link to a single dentists blog who admits her views are contradictory to those of the ADA. Medical doctors still strongly support fluoridation, including me and the ADA. I don’t know how you can possibly make such a claim.

    @WoW, there probably is not an actual increase in autism, it’s an increase in diagnosis, as the disorder was first dismissed as mental retardation, until about the 40s when it was understood as a different disorder. Then the Freudians blamed the disorder on poor mothering. Until the 80s the diagnosis was underreported until in the late 80s and 90s we emerged from this dark period of Freudian idiocy and started providing services specifically for autistic children. Autism has probably always been with us, but only recognized as a separate disorder from retardation in the last 100 years or so. After all, before this last century our complexity of understanding neurodiversity was to crudely classify people as “idiots”, “imbeciles” or “morons”. Our understanding of different mental disorders has fortunately evolved.

    Finally Ethan, you say:

    It’s important to recognize that just because something is natural doesn’t mean it’s good for you, and just because something’s artificial doesn’t mean it’s bad for you. It’s also important to realize that public health means doing what’s best both for most of us and for the least affluent among us.

    How is fluoride not natural? Sure, the silicates might be considered unnatural (although there is no real evidence of toxicity from the cation), but if you used NaF as you suggested, I can think of nothing more natural than elemental medicine. Sodium, fluoride, hey that’s nature. The weird thing about all this is how people are still so weird about chemicals as you address up top. We’re all chemicals. Everything in the universe is just chemicals (and energy). Chemical fear should be laughed at as prima facie absurd.

    Anyway, I liked the article, good job. I like to see my anecdotal evidence that my parents, who have both had about 6-8 cavities, and I, growing up on fluoridated water, have had none, is backed up by the reality-based community.

  13. #14 Wow
    April 22, 2013

    “@WoW, there probably is not an actual increase in autism, it’s an increase in diagnosis,”

    You’re under the impression I agree with the MMR/Rubella stuff. I don’t. It may be even more about how many types of behaviour are being put down to autism too.

    About all I know about water treatment is where I am they seem to dump the entire months’ supply in one one day making ANYTHING made from that water taste effing HORRIBLE. Seriously, I’m not used to it, but for the first few years I would have to stop drinking coffee because I couldn’t choke the bloody stuff down when made with the water from the taps for several days each month.

    But “there’s no effect” is not proof of anything unless you’ve tested it, and then it’s only proof for the lack of what you tested for.

    And correcting eric on that point was mine.

  14. #15 Wow
    April 22, 2013

    And “How is flouride not natural” is also bollocks.

    Cyanide is natural.

    Go eat a teaspoon.

  15. #16 MandoZink
    Louisville, KY
    April 22, 2013

    @ Brian Shiro
    Your information is incorrect and misleading. Xylitol is NOT a substitue for fluoride. They perform different funtions. I visited the website you referenced and a red flag went up when I saw the comparison chart. ONLY the xylitol’s benefits were listed and ALL 6 of them were just variations of a single fact – xylitol does not feed tooth bacteria (primarily Streptococcus mutans) as sugars do.

    In reality, xylitol and fluoride are best used together. There are toothpastes which contain both, not xylitol as a substitute. A study from the Journal of Oral Science found that xylitol-enhanced fluoride toothpaste protects well against tooth decay. A dentist friend explained the benefits of both and the exact mechanisms of their functioning to me years ago. You should thank Ethan for being so thorough.

    @ Ethan
    Thanks for the article and the Tony Rice. Tony lived and played here in Louisville during the 70′s, but I do not remember hearing him play live until he teamed up with my first mentor, David Grisman. What a show.

    In the early 80′s, my roomate and I used a good tape deck to slow David Grisman Quintet songs to half-speed and tried to pick out the notes. To our surprise, Tony Rice’s guitar work was incredibly more difficult than David Grisman’s mandolin picking. Our living room was host to a lot of musicians in those days. I miss ‘em.

  16. #17 Carye Bye
    Portland
    April 22, 2013

    Thanks for taking your time to try to sift through all this.

    As a local Portlander I hadn’t even thought about the Fluroide issue at all until City Hall suddenly was taking about it behind closed doors and voting Fluoride in. It was then I started to pay attention and got involved in collecting signatures for a public vote — because I felt that due process was ignored, and if this fluroide in the water scheme is so good why such a shady introduction? We were successful in gathering signatures — over 40,000 — and the public vote was to happen in a year and half. Once again City Hall jumped in and moved the vote a year up. Which is not good because the 2012 Smile Study of Oregon doesn’t get to be part of this decision. The Oregonian just posted a story to say that our tooth decay has gone down in the last 5 years — this is without fluoride here in Portland mind you. What else is in this local survey? We may not get to know before the vote.

    I’ve been in this city over 12 years and not once has fluoride come up or talk of a dental crisis, but then again I don’t work in any medical fields. I have however been suffering my own dental crisis and spent 14 visits up at OHSU dental school — sadly the work isn’t done, I got into debt and was sick of being so poor. I still have $2000 more work left to get to, and by the time I get to that there will be more problems. As a low-income adult on OHP I have no access to truly affordable dental care in Portland. Fluroide isn’t really going to help adults. I would like to also note that I grew up in Minnesota and was over fluroidated — have fluorosis — which I thought I caused myself by not brushing well enough when I had braces. It wasn’t until this past Fall I found out the cause of the stains on my teeth. This was a deep source of embarrasment for me as teen. I guess you could say it isn’t bad overall, and now I don’t really care (though still don’t know if I will have more problems in the future from over-fluroidation), but we live in a very shallow/looks are important world and as a teen this stuff matters. Before age 18, I probably only had 2-3 small cavatives — but I also always had to have sealants put on my teeth because my teeth are so grooved. I also got fluoride treatments at the dentist and possibly had it in my toothpaste too. As soon as I was off my mom’s watch of brushing, and healthy foods, I got into a thing called soda — in just one year, my teeth got 13 cavaties between my teeth from drinking free soda at work.

    The kids in this state are now covered for dental on Healthy Kids program, not the same program as HKHP and as noted before , dental decay is going down in this state thanks to this program — that wasn’t always there.

    Anyway, here are some of the reasons I plan to vote NO.

    -It’s unethical to force a nonnatural chemical into everybodys’ water that can’t be filtered out easily. Many countries will not do this. Also as you mentioned, topically is still best use of fluoride according to dentists

    -Most countries do not fluoridate water. It’s popular in the states, but not in Europe where 97% does not. That’s really worth nothing and that they also use fluroidated salt and other means — I don’t know that much, but I know that many europeans have much stricter views on what will pass in food and drink than in the US where companies get to rule

    -I don’t like that the Pro-fluoride people will not, WILL NOT be upfront that the fluoride most often put into municipal water because it’s cheap is the byproduct of phosphate fertiler company — they keep saying it’s a natural mineral.. It is in colorado but it won’t be in our water. I don’t like this not owning up. They just say that we will choose when the time comes. I don’t really think we have a choice for the money they propose

    -I have been meeting all kinds of people who get sick from over fluroidation — they will be forced to buy bottled water or get expensive filter treatments. It’s worth noting that this isn’t a purely healthy choice for all.

    -What about an the animals? If 99% of the fluoridated water just goes back in the environment — shouldn’t we be considered. Sierra Club, Columbia River Keepers say NO as well. There’s a really good video circulating by a local juggler / water scientist (I think) about how our local fish aren’t used to high fluroide concentrations in the water, and already the Washington side which has fluroidation/and industry has disrupted salmon cycles and killed off some of the salmon.

    -I don’t buy it’s for the poor children — first of all infants who can’t breastfeed shouldn’t be getting any water with fluroide. It’s only “ok” when babies teeth start to grow — so any poor mom now has to first know, and then buy bottled water? (Nestle who would love this). And a lot of poorer familes can’t afford quality New Seasons or Co-op products, instead they are getting tons of corn syrups, and soda and sugary cheap food — this is what’s harming children’s teeth. No amount of fluoride in the world can solve this. It might be more expensive but more direct services and incentive programs would do more good I think. I think we need to work on food deserts/junk food in schools, etc…

    -I see Fluoride as a banaid that may or may not work. There really are just as many studies for as against, but honeslty what I’m finding out is both the pro and against side have pretty bogus data. As you concluded, there are tons of questions yet.. and you may change your mind if you learn more. I’ve heard the Iowa study is pretty good. But honestly most studies are being blocked or not allowed and data comparability isn’t so good. And you can’t really figure out all the variables which include each source of fluroide, what other procedures dentally — sealants etc.

    -Dosage — I don’t understant optimal dose — I already got a higher dose growing up and now since 40% are found to have fluorosis, the amount of fluoride has be lowered in water. And now this new recommendation is the optimal dose. — but like you said we get fluoride even in tea — and of course from toothpaste and probably some in beverage projects bottled with fluroide in the water. And we are different weights, drink different amounts of water. I don’t see how we can make this educated guess.

    -I feel like the US has no problems experimenting on it’s population. I think if there isn’t a high enough of good (I’d say somethign like 75% less cavities, and super minimum sickness or over exposure) – then it’s not worth doing at this point in history especially if data is already coming out that Portland may not really be in dental crisis after all — except for maybe all the folks not covered by dental who experience their own personal crisis in finances and health.

    It’s a huge topic to take on and while I see your sources are these “official” ones, I’d also challenge to find some more from nuetral studies. It’s hard for the mainstream health system to change their recommendations. There’s plently of health advocates who don’t agree with fluordation of the water as well. Maybe interview a few?

  17. #18 Skeptical
    April 22, 2013

    Read the book “The Fluoride Deception” by Christopher Bryson FREE at link below.

    http://www.docstoc.com/docs/70672845/Bryson—The-Fluoride-Deception-_history-of-water-flouridation-and-why-it-is-bad-for-your-health_

    You need to read the facts (both pro & con) before making a decision like this.

  18. #19 Tom
    April 22, 2013

    I plan to respond to some of Ethan’s points here soon, but I wanted to make some general points:

    First, a note about authority: I’m tired of dentists and MDs acting as if their degree makes them an expert on fluoride. I am an MD but am certainly no expert, though I have looked at some of the primary literature and evaluated results myself. It’s no surprise that Healthy Kids, Healthy Portland (a classic feel-good, meaningless PR agency-crafted name if I ever heard one) prominently displays logos of the ADA, AMA, WHO, etc. Certainly, we hope that authorities are right most of the time and are concerned only with the public’s best interests, but unfortunately that is not always the case. Because “they” say it does not mean it is true, or beyond debate.

    The evidence for water fluoridation is weak. Epidemiologic data from the WHO comparing countries that fluoridate to those that do not are not convincing. (http://www.fluoridealert.org/studies/caries01/) There is better evidence for topical fluoride in preventing caries, and of course toothpaste allows the dose to be controlled by the user. Ethan earlier stated that “…our tooth decay rates in Portland are something like 40% higher than they are in Seattle.” An open-and-shut case, then–as long as you don’t understand epidemiology. Correlation most certainly does not equal causation, especially in such a case with innumerable other variables. Such false inferences run rampant in the fluoride discussion.

    Countries that do not fluoridate tap water include Japan, Germany, France, Norway, Sweden, Austria, Belgium, Denmark, Finland, Greece, Iceland, Italy, Netherlands, Portugal, Scotland, and Switzerland. Their tooth decay rates are comparable to ours. Do you think these first world countries are just ignorant?
    http://en.wikipedia.org/wiki/Fluoridation_by_country

    Fluoride is a known toxin. Because it is not an essential nutrient, adding it to the water supply is tantamount to mass medication with uncontrolled dosage of a substance that accumulates in the body. The FDA considers it a drug. And removing fluoride from water is very difficult. The fluoride ion is not filtered by standard carbon filters; only reverse osmosis and other expensive purification methods can effectively remove F-. Thus, the vast majority of Americans are subjected to a de facto mandate to consume this substance. This is a tremendous ethical issue that fluoride proponents routinely ignore.

    Any analogy to chlorine is stunningly ignorant of the fundamental differences between it and fluoride: chlorine is a water treatment, not a human treatment, and it can be easily removed with a cheap filter (or even letting water stand for a few hours, as it will evaporate). It’s not as toxic, either.

    The toxicity of fluoride is readily visible, as 40% of US children have some degree of dental fluorosis. Most have only mild fluorosis, but what is going on in other tissues/organs in the body that we can’t see? Other known effects linked to fluoride include skeletal fluorosis and increased fracture risk, thyroid disease, kidney disease, and neurological problems. Infants and children are disproportionately at risk, as are minorities and the poor.

    Moreover, low income families are more vulnerable to the effects of toxins like fluoride given poor diet and environmental conditions. And there is dubious benefit: Detroit has been fluoridated since 1967, yet a 2006 study showed that 82% of low-income African Americans in Detroit had cavities (Burt et al.), and concluded “Our findings are that gingival plaque deposits and soft drinks are the major individual-level determinants of caries in this population.” Any small benefit from ingested fluoride cannot compensate for poor diet and dental care. The CDC has stated that the major benefits of fluoride are topical, not systemic.

    See “The Case Against Fluoride” by Connett, Beck, and Micklem for a thorough approach to the topic. It’s very well referenced, so you can read primary sources to your heart’s content. For more on the history of fluoridation and the industrial interests behind its promotion in the 20th century, see investigative journalist Christopher Bryson’s “The Fluoride Deception”. The history is quite fascinating (it’s connected to the Manhattan Project and involves plenty of conflicts of interest) and it helps explain the tremendous pressure to preserve mandatory water fluoridation from the ADA, the CDC, and other authorities even today.

  19. #20 eric
    April 22, 2013

    Dosage — I don’t understant optimal dose

    Think of it like sunlight. If you don’t get any, that’s unhealthy. If you get too much all at once, it can cause acute effects like sunburn. If you get too much spread out over a long period of time, it can cause chronic effects (for sunlight: skin cancer). “Optimal dose” refers to getting a amonut of stuff – whether its sunlight or something else – which is neither too little to be unhealthy or too much to be unhealthy.

    Another example, maybe more analogous to flouride for your teeth, would be vitamin A. If you don’t get enough, that’s bad for your health. If you get too much, that’s bad for your health too. There is an optimal dose for it.

  20. #21 MandoZink
    Louisville, KY
    April 22, 2013

    Sigh. It doesn’t seem to matter how much careful consideration of facts and evidence is presented. Someone will always say “But you didn’t read this article I found on a website!”. And suddenly dentists are not specialists in their field either.

    Soon we’ll be reading that there are excess fluorides in “chem-trails”.

  21. #22 Dunc
    April 23, 2013

    I’m curious as to how many of the opponents of fluoridation actually know what the naturally-occurring fluoride level in their water supply is, and how many actually consider this factor when deciding whether or not to move somewhere.

  22. #23 Wow
    April 23, 2013

    Dunc, do you know what the natural fluoride level is?

  23. #24 Wow
    April 23, 2013

    Heh, something to keep in mind when arguing “It’s only 1ppm!”, according to homeopathy, the more it is diluted, the stronger it is.

  24. #25 Dan
    Oregon City
    April 23, 2013

    Thanks for the article. That said, I wish you would delve deeper into the Harvard meta study on IQ. I have read that the authors of the study have urged voters in the United States not to consider it when deciding on water fluoridation (I’m not providing a link cause I don’t have time at the moment). Additionally, how credible can a meta study if the original research is questionable?

  25. #26 Juice
    April 23, 2013

    In places where 99.99% of people brush their teeth, usually with fluoride containing toothpaste, there is no need to add fluoride to the water supply. In the places where almost everyone brushes their teeth but they don’t fluoridate the water, there is no increased rate of tooth decay is there? Does Portland have higher than average cavity rates? I don’t think it does. It’s just not necessary in most places anymore.

  26. #27 CB
    April 23, 2013

    Wow:
    Yes, but also according to homeopathy, when you dilute something a bunch, it does the opposite of what the concentrated form does. So our 1ppm flouride should… cause cavities, but cure fluorosis?

  27. #28 Wow
    April 23, 2013

    Ah, only if you take the thing causing it and dilute it will it do it more.

    If you dilute the thing making a cure, it cures better.

    All I’m saying is that “It’s not much” isn’t going to cut the mustard any more.

  28. #29 jane
    April 23, 2013

    Arguing from nature, since humans suffer highly elevated cavity and fracture rates if deprived of any fluoride, we obviously evolved to consume and need some amount of it. Therefore, I see no problem with fluoridation to the low end of the recommended dose range.

    However, it is of concern that the increased fracture risk and lowered IQ with “high” doses begin at doses that are legal, if not recommended, in the U.S. The gap between 2.5 ppm and 1.2 ppm is not that great, making it rational to wonder whether some susceptible individuals might suffer harm at the federally recommended maximum level of artificial fluoridation. (Compare the American rhetoric on this to the American rhetoric regarding alcohol in pregnancy, for which there’s a rather broader gap between the proven-toxic dose and the proven-harmless dose.) If offered the chance to have had 20% fewer fillings at the cost of 5 IQ points – for whatever that measure is worth – I wouldn’t consider taking such a deal.

    If harm is not visible at recommended U.S. levels, we might reasonably assume that most people will not be harmed by those levels – but if anyone is, then you’re making a decision to harm some to benefit others. Unlike vaccinations for life-threatening diseases, it’s not so clear that the benefits outweigh the harms, since it would take more than a few avoided cavities to make up for an extra hip fracture or a lifetime with a duller mind.

  29. #30 CB
    April 23, 2013

    Wow:

    But in homeopathy, a cure is by definition the thing that causes a symptom outside of a homeopathic preparation (though not necessarily the cause of a specific instance to be treated) because water memory causes the opposite effect. The question, then, would be if 1ppm flouride counts as a homepathic preparation or not. If it is, then regular non-homeopathic fluoride should cause cavities and cure fluorosis.– clearly not the case. If it’s not , then a true homeopathic preparation would be what causes cavities and cures fluorosis.

    My point is that even jokes about homeopathy don’t properly reflect how retarded homeopathy is.

  30. #31 Douglas Watts
    April 23, 2013

    As a newspaper reporter in the 1980s and 1990s I always looked forward to City Council meetings about fluoridation because it brought on more concentrated crazy than the Apollo Moon Hoax and who shot JFK combined. And sure enough, the pattern is repeated here. Time Cube !!!

  31. #32 Narad
    April 23, 2013

    Countries that do not fluoridate tap water include Japan, Germany, France, Norway, Sweden, Austria, Belgium, Denmark, Finland, Greece, Iceland, Italy, Netherlands, Portugal, Scotland, and Switzerland. Their tooth decay rates are comparable to ours.

    As mentioned in passing by Carye, a number of these use fluoridated salt. I don’t have an overview, but for Germany at least, it constituted nearly 70% of the market share (PDF, Fig. 4).

    As an aside, I distinctly recall one entry from a crunchy mama at MDC who reported that she managed, by virtue of only using some sort of Magic Druidic Sea Salt for years, to actually give her kid a goiter. Score one for “indiscriminate mass medication.”

    Returning briefly to Dr. Ellie, her assertion that “the usefulness of fluoride is to promote tooth repair, after damage has been done” isn’t quite accurate, either, as fluoride can in fact inhibit S. mutans by more than one mechanism (e.g., PMID 7497353).

    I’m too tired to do the topical-versus-systemic issue, but one does need to address the time it takes for salivary fluoride to return to baseline after topical use (perhaps 1&ndash 2 hr); if the use of fluoridated water throughout the day can give a boost of ~0.02 ppm, it’s nothing to sneeze at.

    (And re Marvin @9, it turns out that yes, horizontal transmission occurs.)

  32. #33 G.
    April 24, 2013

    Since nobody has said this explicitly yet:

    Dr. Joseph Mercola is one of (fellow Scienceblogger) Orac’s paradigm cases of a quack who promotes all manner of antiscientific and pseudoscientific bullsh– to the public.

    And the Huffington Post, also known as Huff Poo, is also a huge promoter of medical quackery, pseudoscience, and dangerous bullsh– in its “health” columns.

    IMHO the solution to fluoridiosis is to provide those who have it in any noticeable way, with a lifetime of free cosmetic dentistry as needed to normalize the appearance of their teeth. This follows from the general principle that externalities are impermissible.

    If I’m not mistaken, Oregon also has an epidemic of anti-vaccination BS going around (thanks for the measles and whooping cough, arseholes!). Anyone who espouses anti-vax BS ought to be pre-emptively disqualified from further consideration for anything else they have to say about health issues.

  33. #34 Wow
    April 24, 2013

    Some remedies from homeopathy really do work, it’s the explanations of how (for at least the ones that get noised about: there will be a reporting bias, because science mags will want to show the nuttiest ones for a good laugh at someone’s expense) are, genteelly put, made up.

  34. #35 Alice
    Roanoke, VA
    April 24, 2013

    Ethan, I believe this is a well-researched article and I applaud you for presenting this information. I am a mother, a grandmother, a pediatrician, and a child advocate. While I agree with some of the readers who have noted that there should be personal choice, as a responsible society, we have to remember that not every family is able to make that personal choice. Many young children have no access to dental care, and are at serious risk of dental carries-a situation that has been much lessened by wide-scale availability of fluoridation programs. Some health departments and primary care physicians are offering fluoride varnishing, which is clearly the best way to stave off cavity development, but must be applied by trained individuals, and this is not universally available. I would urge your readers to support fluoridation as a cost effective, safe approach to improving dental health in the population.

  35. #36 skeith
    April 24, 2013

    A genuinely homeopathic preparation will contain 0 ppm of the active ingredient.

    They only “work” if your objective is to intake a bit of water or milk sugar, or if a placebo effect kicks in. The placebo (or it’s evil twin the nocebo) effect is real and powerful, but to say that some homeopathic preparations “really work” without mentioning it is … a strange assertion.

  36. #37 Hayley
    Portland, OR
    April 25, 2013

    Thank you so much for summarizing the evidence so concisely! I am ALWAYS engaged in debates with fellow Portlanders about “natural” vs. “good for you” — it’s such an important distinction that everyone has trouble with, but here especially, because so many of us care about purity of body and environment. I will pass this along to my friends.

  37. #38 Wow
    April 25, 2013

    “They only “work” if your objective is to intake a bit of water or milk sugar, or if a placebo effect kicks in.”

    Well, two things:

    1) See, it works. And, unlike ACTUAL medicine, no side effects. (NOTE: the reason why most medical treatments have as a side effect the effect they’re supposed to treat is because it might not work)
    2) That isn’t the only “treatment” that homeopathy does. It’s merely the easiest one to make fun of.

  38. #39 Wow
    April 25, 2013

    “Many young children have no access to dental care, and are at serious risk of dental carries”

    Universal healthcare.

    It makes healthcare a lot cheaper.

    Unless you allow the drug companies to force “free” treatment with their newest drugs. So one addendum you may wish to make is that any treatment drugs are either generics or produced at cost (everyone still gets their salary, so nobody is going to be made unemployed) before allowed to be part of the standard treatment that you get free.

  39. #40 G
    April 25, 2013

    I thought I already posted this but it didn’t show up:

    Mercola is a notorious quack, and Huff Poo’s “health” section is a notorious den of quackery. This according to Orac, who goes into many specific instances in his blog.

    I’m inclined to believe that fluoridation is a supportable public health measure, but not as strongly supportable as mandatory vaccination. The person who has not used fluoride is at most at risk of expensive dental work, but the person who has insisted on not getting vaccinated for “religious” or similar reasons (beliefs of whatever kind) is a direct threat to the lives and health of others.

    Now this gets me into an interesting logical bind: If we tolerate religious and equivalent exceptions to vaccination, we also have to tolerate such exceptions to fluoridation, which would lead to not fluoridating water supplies. However I would not tolerate religious exemptions to vaccination, and I would provide subsidized cosmetic dentistry for those who suffered staining of teeth due to a reaction to fluoride.

    Realistically, much suffering will be alleviated once we come up with genetic medicine to enable the regeneration of new natural teeth at any point in a person’s lifespan.

  40. #41 MobiusKlein
    April 25, 2013

    @Tom Sheft:
    “but once the water is boiled the fluoride concentrates at varying and uncontrolled levels. So how much fluoride is in your latté or your plate of spaghetti? ”
    Unless you are letting your pasta water boil so long, you vaporize half of the water, you won’t get out of the CDC recommended zone. Same for lattes. You don’t boil it so long in real life.

    More thinking, less fear mongering please.

  41. #42 skeith
    April 26, 2013

    “1) See, it works. And, unlike ACTUAL medicine, no side effects.”

    Untrue. A great many of the “side effects” listed for medications are nocebo effects. Nocebo is exactly like placebo but negative instead of positive. If you read the insert for medicines, you’ll notice certain trends: trouble sleeping, dry mouth, upset stomach. These are frequently (not always) nocebo. Treatments for chronic pain often run into both placebo and nocebo in clinical trials.

    People expect medicine to have side-effects, just as they expect medicine to have effects. It works both ways.

    Homeopathy is extremely dangerous, not in itself but because it deters people who believe in it from seeking real medical treatment for serious conditions. It’s important, IMHO, to not say “it works” without noting that it is the placebo effect (a real effect, but one that isn’t going to touch a condition like cancer).

  42. #43 Wow
    April 26, 2013

    ““1) See, it works. And, unlike ACTUAL medicine, no side effects.”

    Untrue.”

    Yes, your statement it is untrue is untrue.

    The pacebo effect works. It works better than non-treatment. And, since doesn’t have any active effect, it has no side effect.

    And though you’re right, you’re deliberately ignoring the hippo in the room that even yourself admit:

    Nocebo isn’t the only reason why medication fails on occasion.

    “Homeopathy is extremely dangerous”

    So is the treatment for dangerous illnesses. Homeopathy being extremely dangerous can only happen for illnesses that are dangerous themselves.

  43. #44 Kenric Ashe
    United States
    April 26, 2013

    Fluosilicic acid used in water fluoridation — human studies for which have NEVER BEEN CONDUCTED — is 100% soluble which results in nearly 67,000 times more fluorine ions dissolved into the water than natural calcium fluoride which is nearly insoluble. Fluorine is the most reactive element in the known universe so it combines with other toxic elements such as lead and aluminum. This is why we are seeing higher incidences of Alzheimer’s and dementia, which is why there is such a controversy about fluoridation now in Ireland. And there is no calcium in fluoridated water to counteract the toxicity. Fluoridation supporters need to stop pretending that it’s just the same as the natural fluoride.

    SCIENTIFIC DISSENSUS ON SAFETY OF FLUOSILICIC ACID

    Source: http://www.thehealthvine.net/index.php?option=com_content&view=article&id=36&Itemid=58

    Hexafluorosilicic acid or hydrofluorosilicic acid or H2SiF6.

    This substance is usually generated in the wet scubbing sytems of the phosphate fertilizer industry and shipped as a 23% solution to communities fluoridating their water. However, when it is diluted ( approximately 180,000 gallons to one) at the public water works the substance is attacked by the water and yields fluoride ion. To what extent this process goes to completion by the time the water reaches the consumer is under debate. Urnansky and Schock (2000) argue based upion theoretical assumptions that the process will be complete and that there will be no fluoride left aattached to silicon. Masters and Coplan argue based upon a Ph.D thesis from Germany (Westendorf, 1974) that at neutral pH two fluoride atoms are still attached to the silicon and moreover the hexafluorosilicate ion is more active biologically than the free fluoride ion. Masters and Coplan (1999, 2000) have also found an association between blood levels in children in both Massachusetts (1999) and New York (2000) and the use of the silicon fluorides (H2SiF6 and Na2SiF6) as fluoridating agents but not sodium fluoride. Thus, they have argued that it is some silcon fluoride complex which facilitates the uptake of lead (from other environmental sources) into children’s blood and not the free fluoride ion itself.

    FLUOSILICIC ACID IMPORTED FROM CHINA

    On top of all that the fluorine compound that’s coming from China has additional substances in it, some kind of sludge of unknown origin. And the CDC when bombarded by about 1,000 complaints about that, instead of investigating it they just shrug it off and repeat their stop-worrying-you-silly-conspiracy-theorists-it’s-totally-safe mantra. They have to keep supporting fluoridation because otherwise they’d be admitting they were wrong for so many decades and then everything else they do will be questioned and they’ll probably lose funding. They’re saving face at the expense of public health.

    TECHNICAL DETAILS

    The solubility of natural calcium fluoride in water (using 18 °C as a reference point) is 0.0015 g/100 mL = 15 ppm.

    15 ppm is how much of the calcium fluoride ionises into its separate Ca++ and F- ions, not to be confused with the concentration of F- ions in water or ppm of “fluoride” in water as many fluoridation supporters have erroneously stated. Remember for example that the World Health Organization references a level of 1.3 ppm of fluoride in seawater (they don’t specify which fluoride compound but presumably calcium fluoride since that is by far the most prevalent in nature). http://www.who.int/water_sanitation_health/dwq/chemicals/fluoride.pdf

    Or in layman’s terms, only 0.0015% of calcium fluoride actually dissolves in water.

    Fluosilicic acid in comparison is miscible = 100% soluble = 1,000,000 ppm. Therefore when fluosilicic acid ionises in water the end result is 66,667 times more F- ions compared to calcium fluoride ionization. And on top of that there is no accompanying calcium in the water to act as a mitigating factor to fluorine’s toxicity.

    Keep in mind fluorine is the most reactive element in the known universe so it has a very strong tendency to combine with other toxic elements such as aluminum and lead and the ability to breach the brain-blood barrier, thus resulting in dementia, Alzheimer’s, etc.

    Now if you really want to get into some very interesting details and severe implications of artificial fluoridation, check out this out:

    Fluoridation: Aspects of toxicity
    by MALCOLM HARRIS Ph.D. (Wales), B.Pharm. (Wales), FPS, FSS, FRSH.
    Originally printed in The Probe (October 1976)
    http://www.fluoridationfacts.com/science/papers/aspects_of_toxicity.htm

  44. #45 Kenric Ashe
    April 26, 2013

    The American Academy of Pediatric Dentistry does not support the use of prenatal fluoride supplements. Pregnant women with MS are even specifically instructed to avoid fluoridated water. The National Kidney Foundation no longer supports fluoridation because it’s bad for people with CKD (chronic kidney disease). Far more fluoride collects in the pineal gland (the extremely important connector of the brain and endocrine system) than teeth or bones. The National Research Council in 2006 stated that it might be a factor in early puberty and various other critical effects regulated by the pineal gland. Fluoride also has greater effects on those with poor nutrition and hypothyroidism. Some people are allergic to fluoride. There was also a coverup of a huge Harvard study on osteosarcoma. Fluosilicic acid is far more toxic than natural calcium fluoride because it is 100% soluble and all those free-floating ions of the most reactive element in the known universe readily combine with other toxins such as arsenic, lead, and aluminum, which oh by the way are also added to the water as part of the fluoridation process. Fluorine compounds are able to breach the blood-brain barrier and the placenta, which is a likely factor in Alzheimer’s and early onset dementia. And by the way, what is the toxicity level for a fetus? Oddly it’s not defined by the USDA, even though they have done so for newborn babies. Peer-reviewed placebo studies on the adverse health effects from fluosilicic acid have NEVER BEEN DONE. You want me to show you the NRC consensus report that proves the risks of so-called “optimal” fluoridation? No, YOU show me the NRC report that proves it is SAFE, because there is a preponderance of evidence indicating likely harm.

    Why is all of the science being ignored? The only conspiracy I truly believe in is that some people want to make a hell of a lot of money. CRAZY HUH?! The original fraudulent Grand Rapids “study” was sponsored by Alcoa. No conflict of interest was declared even though they converted toxic waste disposal expenses into profits. The ADA has a huge conflict of interest as well because they profit from their seal of approval on fluoridated products and they even sell their own co-branded fluoridated water at Wal-Mart. The Harvard professor who tried to cover up the osteosarcoma study works for Colgate.

    Fluoridation was sold to the American people by Edward Bernays, the same man who sold Lucky Strike cigarettes aka “Torches of Freedom” to a new generation of women demanding equal rights. He used his understanding of uncle Sigmund Freud’s psychology also to manipulate doctors into endorsing large quantities of bacon as a healthy breakfast. I know this sounds like an episode of Mad Men, but truth is stranger than fiction. Look it up if you don’t believe me. Bernays is known as “The Father of Public Relations”. One of his clients was United Fruit. Their profits were threatened by the democratically elected president of Guatemala, so Bernays convinced American politicians and the American public of a Communist threat. The U.S. overthrew their government and ignited a civil war in which 200,000 people died, and all those new family farms were lost. Bernays’ ad campaign for WWI was “we’re making Europe safe for democracy”. Does anyone still believe that?

    The ADA has been fighting Medicare/Medicaid since 1965, now the same with Obamacare, and they also fight midlevel practitioners which would greatly help people in rural and poor areas that don’t have enough dentists. The ADA is one of the main reasons people suffer from cavities. The EPA ignores its own scientists as well as the Safe Drinking Water Act and manipulated the NRC’s ability to have more of an impact on fluoridation policies. The EPA Union even sued the EPA and successfully got fluoride removed from their workplaces. The CDC ignored half of the NRC report in their summary. 68 years of fluoridation doesn’t prove it’s safe. TIME Magazine: “For nearly six decades, gasoline companies ignored the known dangers associated with lead to get rich.” SOUND FAMILIAR?

  45. #46 skeith
    April 26, 2013

    “The pacebo effect works. It works better than non-treatment. And, since doesn’t have any active effect, it has no side effect.”

    You’ve missed the point. Nocebo is a real effect, just like placebo, and is JUST AS LIKELY to kick in with homeopathic preparations as placebo.

    (technically, placebo and nocebo would be side-effects, and so to say it has no side-effects while simultaneously saying it has a placebo effect is an incoherent statement, but let’s ignore that since you seem to be operating from the point of view that the placebo is the intended effect)

    You seem to think that placebo is the only psychosomatic effect possible from an inactive treatment. Nocebo happens, it is real, and it can be prompted by homeopathy. Unless you’d like to claim that nocebo is not a side-effect but an intended effect, my negation of your statement, that it is untrue, remains.

    “So is the treatment for dangerous illnesses. Homeopathy being extremely dangerous can only happen for illnesses that are dangerous themselves.”

    I have no idea what kind of point you were trying to make here, so perhaps you’d like to rephrase it?

    In fact, I’d like to ask you to rephrase your entire position. It seems to me that you are arguing that homeopathic remedies are A-OK in all respects and have zero drawbacks. Is this really what you’re trying to say, or do I have it wrong somewhere?

  46. #47 Wow
    April 27, 2013

    “You’ve missed the point. Nocebo is a real effect, just like placebo”

    No, I entirely get that point. It doesn’t change the placebo effect, though.

    You seem to miss the point that the ncoebo effect isn’t the only deleterious effect of medication that has an effect. Nocebo effects exist on both sides. Therefore moot.

    I can accept that you’re placing the nocebo effect as an effect of the homeopathic “remedy”, but I’m not putting ANY effect in the homeopathic remedy, neither positive nor negative.

    But not medicating still can work.

  47. #48 Molly Moore
    Portland
    April 27, 2013

    I’m voting “no” on the Fluoridation Measure. Eric’s well-researched blog is appreciated, but the ultimate conclusion wasn’t enough to convince me otherwise.

    1) It’s an unnecessary expense for our City, whose resources could be used toward much more significant public health and environmental water needs.
    2) Personal anecdote: I raised my son on breast milk the first six months, then his formula was made with distilled water (distilled at home with a Pure Water system). He was 18 months when he gave up his bedtime bottle, then drank juices made with concentrate and distilled water, and drank distilled water in a glass … he had a nice set of shiny white teeth in his little head. Furthermore, his first filling was to fix a broken tooth from a roughhousing incident. He did not have a cavity until he was in his 20s !!! And that was because the punk wasn’t at home for me to nag to “brush your teeth”! He’s now 35, lives in Portland. I’m thinking all the fluoride he gets is in his chosen brand of toothpaste, which I haven’t checked for 15 years or so. He says he gets cavities once in a while.
    2) Personal anecdote: My husband had dental fluorosis. From the pictures Eric provided, it was in the moderate category. He was raised in Chicago and on Long Island before moving to Marin County when he was 8. Luckily his stellar personality kept people from noticing his teeth, which began to weaken and fall out in his late 40s. He has had dentures for 6 years (he’s 61).
    3) I was raised on well water from the Ogallala acquifer beneath Nebraska and used Crest all the time I was growing up. I still have my teeth, but nearly all molars have crowns. I’m a lousy flosser. I lack the exorbitant co-pays for root canals and crowns, so I have two gaps where a crowned tooth used to be. Such is the aging process (I am 62). I still have a pretty smile, naturally straight teeth.

    Anecdotal evidence vs. empirical evidence? Since the latter falls short of a convincing argument, I’m sticking with what I’ve experienced in my life: fluoridated water doesn’t make enough of an impact to warrant the expense of implementation and would have little to no effect on the adult population. (I’ve heard there are more dogs in Portland than children. I wonder, do dogs benefit from fluoride? My 14-year old dog has all her teeth and has never had a professional cleaning.)

    Concerned about Portland water issues? Let’s focus on the storm runoff problems into the Williamette and the Columbia first! Runoff water gardens are a good start, but such a tiny step forward.

    Better still, we could put the money to be spent toward implementing fluoridation into a free dental examination and family education program for pre-school children … seems like a no-brainer to me!

  48. #49 skeith
    April 27, 2013

    “Therefore moot.”

    It’s not moot if this:

    “And, unlike ACTUAL medicine, no side effects.”

    Is a hinge of your argument. Nocebo is a side-effect; nocebo kicks in with homeopathic preparations; therefore: the assertion that homeopathic preparations have no side-effects is false. Nocebo is a bad side-effect, too.

    “I’m not putting ANY effect in the homeopathic remedy, neither positive nor negative.”

    Then your statement:

    “The pacebo effect works. It works better than non-treatment. And, since doesn’t have any active effect, it has no side effect.”

    Is incoherent. If you acknowledge placebo as a side-effect (as opposed to an intended effect) then you can’t say a homeopathic preparation simultaneously has no side effects but does produce a side effect (placebo). I mean, this isn’t Shrodinger’s cat here, a and not-a are not compatible with one another in this instance.

    But this is splitting hairs and getting pedantic about logic, which is bad of me and I acknowledge that. Here is the real issue, from my point of view:

    http://whatstheharm.net/homeopathy.html

    Here are a few of the more heartbreaking:

    “A homeopath told her to give up her asthma medication. She later died of an asthma attack.”

    “Lucille concealed the diagnosis of breast cancer from her family. She secretly consulted a naturopath and took homeopathic remedies. She also used quack treatments like blood irradiation. Her cancer raged out of control and she died.”

    “Isabella was prescribed medications for her epilepsy. Instead of using them, her parents consulted an iridologist, an applied kinesiologist, a psychic and an osteopath. She was being treated purely with homeopathic medication when she died.”

    IMHO (and this is IMHO) it’s better to suffer physical side-effects from real asthma medication than to depend on the placebo effect of a homeopathic preparation and die. YMMV.

  49. #50 Wow
    April 28, 2013

    “It’s not moot if this:

    “And, unlike ACTUAL medicine, no side effects.”

    Is a hinge of your argument.”

    Yes it is moot.

    I ascribe NO ACTIONS to homeopathic remedies.

    That is the “hinge” of my argument.

  50. #51 skeith
    April 28, 2013

    “I ascribe NO ACTIONS to homeopathic remedies.”

    Then, again, your statement that it has no side effects is incoherent, as you are attempting to say that a and not-a are both true simultaneously.

    And this:

    “Yes, your statement it is untrue is untrue.”

    Was uncalled-for. “Homeopathic preparations have no side-effects” is not only untrue, it is self-contradictory and meaningless (i.e. incoherent).

    My purpose is not to critique your logic, but to be a contradictory voice against the smooth belief that so many people have that homeopathy is harmless and in fact may well be better than real medicine because: “No side effects!” Not only are there side effects (just nocebo and placebo, which is not nothing), but it is dangerous to promote or even stand in silence next to a system that claims it can cure practically anything but can cure nothing. Homeopathy represents a dysfunction of critical thinking in health care, and that can (and does) cause people to die.

  51. #52 JAMES THOMPSON
    April 30, 2013

    If fluoride worked, dentists would be out of business by now.
    I have taken excellent care of my teeth over the years and have used fluoride for the last two decades. I have had more cavities using the damned stuff than I did before using it.Fluoride does not prevent cavities.

  52. #53 Alissa
    Halifax, Canada
    May 1, 2013

    Is the high fluoride level found in all teas or just black tea?

  53. #54 Narad
    May 1, 2013

    If fluoride worked, dentists would be out of business by now.

    Nice Nirvana fallacy you’ve got there.

  54. #55 Wow
    May 2, 2013

    ““I ascribe NO ACTIONS to homeopathic remedies.”

    Then, again, your statement that it has no side effects is incoherent”

    Say that all you like. Just because you will not understand it doesn’t make it incoherent, just makes you unable to understand it.

  55. #56 Wow
    May 2, 2013

    ““Yes, your statement it is untrue is untrue.”

    Was uncalled-for”

    No, it was entirely called for. Your statement “untrue” on the statement that was made against was untrue.

    Are truths uncalled for in your world if they aren’t the truths you’d like to hear?

  56. #57 Hank Maglott
    May 7, 2013

    Very great site, this truly answered some of my questions. Thank you! If you have a moment please check out my website Oregon Strategist.

  57. #58 Karl Lembke
    Los Angeles, CA
    May 8, 2013

    Tom Sheft remarks that most of the water that would be fluoridated is never consumed, and therefore fluoridation is a waste of money.
    By the same reasoning, the work water utilities do to disinfect the water and kill of any disease causing organisms is also wasted. I’m acquainted with the processes the Los Angeles Department of Water and Power use to remove a number of contaminants from water, and since most of that water is never drunk, it’s also a waste of money.

  58. #59 Peeter Joot
    Markham, Ontario, Canada
    May 12, 2013

    The book “The case against Fluoride, How Hazardous Waste Ended Up in Our Drinking Water and the Bad Science and Powerful Politics That Keep In There”, by Paul Connett, James Beck, and H S Micklem, does a thorough job taking apart a lot of the standard arguments for Floridation, and enumerates a number of the other possible risks (many of which aren’t above). It, and it’s references are worth checking out.

  59. [...] not is something that I really can’t say anything about. If you, for example, take a look at this blog post about this issue with the following discussion in the comments section, you can see that it really [...]

  60. [...] A scienceBlogs dismantling of anti-fluoridation pseudoscience [...]

  61. #62 Lauren Ayers
    United States
    June 7, 2013

    This is a very helpful analysis, and great graphics. My one quibble causes me to go the exact other way from your conclusion, and I’m curious what your response would be. Namely, what about the Precautionary Principle?

    Well, there is another quibble: why not cut added sugar out of the school breakfast and lunch program. Sure, it’s so much easier to add a chemical to the water, but the actual cause of decay is too much junk food!

    Last, Ethan, can you see how paternalistic you sound when you decide what ‘low income families’ should do? It’s clear you are sincere and your brain is in top shape. But how would you feel if someone said, ‘We must do such-and-such for the astrophysicists among us’ because they aren’t smart enough to do it themselves.

    I wring my hands all the time about Americans not being smart enough to see how bad Coke and other sugary drinks are, but don’t you think it’s useless, for instance, try to ban Coke in stores? (Proclaiming, “No sodas on school campuses,” is different, it’s en loco parentis just as we say “No cigarettes or alcohol on campus.”)

  62. #63 Wow
    June 8, 2013

    Why is it paternalistic?

    Is it paternalistic for a doctor to tell someone to cut out smoking for their health?

    Is it maternalistic for a nurse to say you need to change your diet to avoid a repeat heart attack?

  63. #64 Richard
    June 16, 2013

    What if the doctor is female and the nurse is male?

  64. [...] and the scientific evidence for it. It is from Ethan Seigel’s blog Starts with a Bang (see Weekend Diversion: Fluoridated Water: Science, Scams and Society). The article itself is a good description of the issues involved in the current [...]

  65. [...] and the scientific evidence for it. It is from Ethan Seigel’s blog Starts with a Bang (see Weekend Diversion: Fluoridated Water: Science, Scams and Society). The article itself is a good description of the issues involved in the current [...]

  66. #67 Alan
    Australia
    June 30, 2013

    Our local municipal council recently voted to remove flouride from our water supply (after it was implemented in 2008) even though a nearby council has been adding flouride to the water supply since 1964 (their results are that children aged 5 to 12 have 45% less cavities than the same age group in non-flouridated areas) with no negative consequences.

    One irony of this decision, which was taken “in the interests of public health” is that our water supply is drawn from a river which drains areas of major agricultural production and receives “dump” water from a dozen major coal mines – but not one word from our good councillors about the obvious resulting salt (which salts they are we don’t know) content of our drinking water.

    The thing that struck me about the supporters of this move was that they were largely made up of the people who also campaign against: the theory of anthropomorphic global warming and childhood vaccinations. They were also notably “older’ than the general population.

  67. #68 Jeff
    Florida
    July 2, 2013

    The bottom line is this, if I want medication I should be the one to choose what I take. Not only that, when medication is given to people it needs to be monitored by a physician regularly. Who is to tell me that I have to ingest something just to possibly help my teeth look better. I can’t believe that a municipal company can do this to people without their consent.

  68. #69 Wow
    July 3, 2013

    Problem with that is that you do not live alone. Nor are your circumstances everyone’s cicrumstances.

    If you have medication then you have to buy it or it is given to you. In either case, you have to include it in your daily routine to collect. In the latter case, you have to employ many people to package and distribute the product, requiring expense from government. In the former, someone will want to add a profit on top of that expense.

    Which means in the former case that poor people cannot buy the drug and in the latter case, you’ll whine about how high taxes are and complain about the spongers.

    You may not want this drug, but you live in a society where you and your children (who do not get a choice if it is left to you) will be less healthy and require aid to become optimally healthy or remain a less-than-optimal worker (making businesses less efficient and reducing profitability) and again raise taxes to cover the remediation.

    And in cases where the medication is to halt a transmissable disease, you are going to be choosing whether the people around you are healthy, but why the hell do you get to choose THEIR health when demanding only YOU can choose YOUR health?

    Now when the medication costs a lot per dose, and especially when that medication isn’t needed for the majority of the populace, “get your own” may be entirely justified.

    When the medication is cheap (especially so if making it compulsory makes the production massively cheaper) and doubly so when the vast majority of people need it, then there is no point in leaving it up to individual choice.

    Therefore the case is that the benefits and costs need to be weighed up by experts and greater good (weighed against the greater harm) has to be decided by these experts for everyone.

    In some cases floridation isn’t needed because the water available is so pure that the risk of side effect is comparable to the risk of caries when not floridating (and the precautionary principle indicates therefore that the risk should be assessed as primary).

    In most places, the water is already fairly replete with byproducts and other chemicals, therefore the marginal extra risk is unimportant. Much like once you have a car, the marginal cost of using it to travel 2 miles to the shops is smaller than public transport, whereas the cost of running a car for a weekly shop is much higher than the cost of taking public transport.

    Now that you know this, do you believe that a municipal company can do this to people without their consent?

  69. #70 Wow
    July 3, 2013

    “What if the doctor is female and the nurse is male?”

    In which case the question is:

    Is it maternalistic for a doctor to tell someone to cut out smoking for their health?

    Is it paternalistic for a nurse to say you need to change your diet to avoid a repeat heart attack?

    So, now that is cleared up, can you answer them? Or was that just a pointless query of yours?

  70. #71 Kelly
    Texas
    July 8, 2013

    Don’t medicate my water. Period. All you brainwashed fluoride freaks can buy your own and add it to your own drinking water if you are such big fans.

  71. #72 Wow
    July 8, 2013

    Surely a period in your water is far worse than fluoridation?

    PS it isn’t your water.

  72. #73 Denice
    July 15, 2013

    No mention of connection between fluoride and thyroid disease, that I now have to deal with after a lifetime of exposure and no benefit to my oral cavity health or my grandchildrens and what they may face in their lifetime. I agree with Tom Sheft, Oregon: “Fluoride added to a water supply is indiscriminate mass medication. I would be medicated without my choice or consent. “

  73. #74 Wow
    July 16, 2013

    You also are enjoined from killing your fellow humans without your choice or consent.

    You don’t see a worry about that, do you.

    You are completely able to remove the option yourself, therefore you DO choose it because the alternatives are too much bother for you:
    1) Move to a different county
    2) Move to a different country
    3) Source your own water
    4) Buy bottled water without fluoride in it

    You choose not to partake of those alternatives, because you’re not actually worried about fluoridation of water, you’re just angry because there’s a government and it’s deciding stuff for you.

  74. #75 Howard Farran DDS, MBA
    United States
    July 20, 2013

    This is the single best community water fluoridation summary I have ever read. Howard Farran DDS, MBA

  75. #76 Lorry
    U.S.A.
    July 23, 2013

    With all that I am, I hope and pray you were sincere in doing your research and are in no way being paid-off by fluoride providers! I can tell you from first hand experience NO ONE should be using OR consuming any amounts of FLUORIDE! The rumor of fluoride being a, “Good thing” is over 70+ yrs. old. The, “Fluoride” that is being added to our water is actually HYDROFLUOSILICICACID and is a noxious poison. This chemical which has been and continues to be added to our M.U.D. and city water for decades must be cleaned-up by HAZMAT when spilled! It eats through concrete, stainless steel, the ground (sink holes) ; you name it! How in the world can anyone regulate how much tap water a person drinks on any given day? How can a gov’t determine how much poison won’t damage a person when they can’t possibly know who and how much we are each consuming, daily, weekly or annually??? I can tell you Fluoride makes one’s bones brittle, including the teeth and does cause dental fluorosis. It also causes ulcer-like burning in the stomach and painful gums. STOP using ALL FLUORIDE products, immediately and you will discover better health! Intake IODINE to offset the absorption of FLUORIDE into your bones & help prevent brittle bones/osteoporosis. Also, try purchasing a real water filter which remove toxins, as well as lime & calcium deposits. I did this, as well as stopped using ALL fluoride products and my stomach and gums no longer have a deep, severe pain after a day of using fluoride filled products! My children do not complain of stomachaches anymore, either! Fluoride may be found in nature (Fluorine), but I STROGLY recommend you ask someone else besides a dentist about this chemical – who said the dentists were told the TRUTH in college??? Please. Don’t listen to the, so called professionals; rather use you own brain and LOOK around. Look at the hypothyroidism fluoride mimics, the fluorosis, the low I.Q. of our students, the anti-depressant drugs, which cause passiveness. Oh, and don’t forget to look into how Hitler added fluoride to his Holocaust prisoners drinking water, too! Be smart, let the symptoms help you find the truth; not what those who benefit from selling this poison. Did you know that Hydrofluosilicicacid is a byproduct of aluminum smelting and phosphate fertilizer plants!!! Florida has a huge pond of it, hundred of acres wide! Bottom line: How can it be good to, “Medicate” an entire population when there is absolutely no way of being able to know each person’s age/weight at any given time; this is a CRIME being done around the world, but especially in the U.S.A. Corporations do NOT want to PAY $$$ to have their waste properly disposed of, b/c they would lose $$$ and have to close their doors, but regardless, we shouldn’t have to drink the noxious poisons they don’t want to take responsibility for, ever. How do dentists know fluoride is good for us – b/c they were TOLD it is – they are NOT chemists and have not paid attention to their clients teeth! I had fluoridated tap water my entire life and I had plenty of childhood cavities! If you want healthy teeth stay off the fluoride, cut the sugar, eat ORGANIC/NON-GMO fruits & vegetables and brush your teeth WITHOUT fluoride poison! You will thank me later!

  76. #77 Wow
    July 23, 2013

    “I can tell you from first hand experience NO ONE should be using OR consuming any amounts of FLUORIDE! ”

    This is the claim from the religious as “proof” for their version of The Great Sky Fairy.

    It doesn’t belong in a discussion of rational people.

    Please also note that CARBONIC ACID is produced by Carbon (which you breathe out!) and Hydrogen (in water).

    SO NEVER DRINK AN FLUID CONTAINING WATER IF YOU BREATHE!!!!

  77. #78 John Tomins
    United States
    October 7, 2013

    From Now I take care of my teeth I will brush not twice a day thrice a day

  78. […] Diagram from Ethan Seigel’s blog Starts with a Bang (see Weekend Diversion: Fluoridated Water: Science, Scams and Society). […]

  79. […] may come to regret the title of this post given the chemophobia and fear surrounding fluoride and water fluoridation, but recent research suggests that fluoride may help […]

  80. #81 Marion
    New Zealand
    February 28, 2014

    In May 2013 I had a fluoride blood test and it came at 5.0 umoI/L
    I was advised by the medical team analysing my blood to immediately stop drinking fluoridated water, drink no tea and take only brief showers
    By keeping to this over 8 months the fluoride level in my blood was down to 2.1umoI/L in January 2014 (Range 0.3 to 2.2 .
    Irish Scientist Declan Waugh so reported on my May 2014 blood test stating my 5.0 fluoride level last May “indicated a skeletal system saturated with fluoride”
    Since staying off fluoridated water I have after many years become pain free in my lower limbs/joints so delighted with that.
    We are continuing to try and get the fluoride removed from our Hastings water supply and ask that fluoride pills be made available as they once were for those that want them.

  81. #82 Wow
    March 3, 2014

    “We are continuing to try and get the fluoride removed from our Hastings water supply”

    How about just not drinking flouridated water?

    It’s a tiny fraction doing that or a massive overwhelming majority having to get pills.

    Which is the most equitable solution?

  82. #83 Marion
    New Zealand
    May 22, 2014

    I haven’t drunk fluoridated water since May 2013 but travel a round trip of 38 kms to collect unfluorided water from our sister city Napier that in a trial commenced in 1954 has never had it’s water fluoridated. That trial/study was quickly abandoned when dental studies undertaken in Napier found less cavities in samples of children teeth than the children drinking fluoridated water 12 miles away in Hastings.
    At present we are hopeful a case before the High Court in New Zealand may overturn the law that sees about a third of our towns and city water supplies fluoridated. I will install a reverse osmosis system should this High Court case fail.
    Apart from the fluoride in our Hastings water at times we have to cope with high levels of chloride treatment due to un explained bacteria getting into our water supply.

  83. […] Fluoridated Water – Science, Scams and Society – Starts With A Bang […]