The 39 reviews and studies listed below, published since 2000, have unanimously agreed with the scientific consensus that community water fluoridation (CWF) reduces dental decay. None of these reviews reported any health risks from drinking optimally fluoridated water, only a slightly increased risk of very mild to mild dental fluorosis.
Because the scientific evidence –– as evaluated by relevant experts worldwide –– overwhelmingly supports fluoridation, the World Health Organization and over 100 other major science and health organizations worldwide (and their hundreds of thousands of members) continue to publicly support fluoridation as a safe and effective public health measure to reduce dental decay –– and NO major science/health organizations support the opinions of fluoridation opponents. In fact, fluoridation opposition only comes from: a very small minority of those with relevant science/health training/experience, a handful of alternative 'health' organizations like the IAOMT, alternative-health marketing proponents like Joseph Mercola, vocal activist groups like FAN and the CHD (with an anti-vax agenda) and a number of conspiracy theory proponents like Alex Jones [INFOWARS], David Icke [Son of the Godhead] and Mike Adams [Natural News]
https://www.cyber-nook.com/water/WHOSupportsCWF.html
https://www.cyber-nook.com/water/CWF-Opposition.html
It
is important to not only provide information
that supports the scientific consensus, it is critical
to help those who care about the accurate evaluation and
presentation of
scientific evidence as it relates to public health
policy understand how studies can be designed, conducted
and presented to create unsupported concern about public
health measures. Findings from these studies are
then further exaggerated by anti-science activists -- in
this case to fuel unjustified concerns about fluoridated
water and IQ.
One of the more troubling
examples of how scientific evidence can become tangled
up in anti-science activism is a draft monograph
published September 2019. The National Toxicology
Program (NTP) was approached by a long-time
anti-fluoridation activist group, FAN, to review studies
they provided and determine if fluoride exposure might
impact neurodevelopment. In September 2019 the NTP
"released a draft monograph concluding that 'fluoride is presumed to be a cognitive neurodevelopmental hazard to humans.' Before finalizing its monograph, NTP asked a committee of the National Academies of Sciences, Engineering and Medicine to review its conclusion and decide whether it is supported by the scientific evidence. In a new report, the Committee finds that NTP's monograph failed to provide adequate support for its conclusion."
Not only did the review team find evidence the NTP
conclusion was not supported by
legitimate scientific evidence, it uncovered a number of
tactics employed in the NTP evaluation process that
seemed designed to misrepresent the studies that were
presented.
- NTP's Conclusion about Fluoride Is Not Backed by Science
-
Study: Evidence does not support classifying fluoride as cognitive neurodevelopmental hazard
- Why voters and elected officials should support CWF:
Summary,
Full Discussion
-
Excellent description of anti-F tactics
Anti-F Associations
A
NTP update: A revised draft of the initial NTP Monograph was published
9/2021, and it included an important change to the Conclusion: “When focusing on findings from studies with exposures in ranges typically found in drinking water in the United States... that can be evaluated for dose response,
effects on cognitive neurodevelopment are inconsistent, and therefore unclear.” (p. 2) In February, 2021 the NASEM released its review of the second revision of the draft NTP Monograph and stated, “
the [NTP] monograph cannot be used to draw conclusions regarding low fluoride exposure concentrations (less than 1.5 mg/L), including those typically associated with drinking water fluoridation.”
Additional discussions about the misuse of evidence
used by fluoridation opponents:
- Gish Gallop & Argumentum ad nauseam anti-F tactics
Description and
Examples
- if you already understand the concepts
-
Serious problems with the 2019 Green, et al. fluoride/IQ
study
- AADR Comment on
Prenatal Fluoride Exposure Study in Mexico
-
Maternal urinary fluoride/IQ study – an update
- Additional Resources
39 reviews/studies that support the safety
and effectiveness of CWF include:
-
The
National Toxicology Program (NTP) Monograph on the
Systematic Review of Fluoride Exposure and
Neurodevelopmental and Cognitive Health Effects
-
On 9/16/2020 a revised
draft of the draft NTP
Monograph was published, and it included an
important change to the Conclusion: “When
focusing on findings
from studies with exposures in ranges typically
found in drinking water in
the United States (0.7 mg/L for optimally
fluoridated community water systems) that can be
evaluated for dose response, effects
on cognitive neurodevelopment are inconsistent,
and therefore unclear.” (p.
2) ADA
comments
-
In February, 2021 the
NASEM released its review
of the second revision of the draft NTP
Monograph and stated,
“Even though the evidence provided appears
to show consistent indications of an association
between exposure to high fluoride concentrations
and cognitive deficits in children, the
monograph falls short of providing a clear and
convincing argument that supports its
assessment. It also needs to emphasize that much
of the evidence presented comes from studies
that involve relatively high fluoride
concentrations and that the
monograph cannot be used to draw conclusions
regarding low fluoride exposure concentrations
(less than 1.5 mg/L), including those typically
associated with drinking water fluoridation.”
(p.14) Comments, AFS, NASEM
Additional Information:
https://www.cyber-nook.com/water/Anti-F_Arguments.html
https://openparachute.wordpress.com/tag/ntp/
-
The 2019 CADTH report: Community Water Fluoridation Programs: A Health Technology Assessment:
"There is consistent evidence that CWF protects against dental caries in children and adults and leads to improved oral health outcomes with very uncommon and minor side effects, and that CWF programs are cost saving from a societal perspective."
Seven documents:
— Highlighting the Evidence – summary (6 pages)
— Budget Impact Analysis (77 pages)
— Review of Dental Caries and Other Health Outcomes (478 pages)
— Environmental Assessment (32 pages)
— Ethical Considerations (42 pages)
— Implementation Issues Analysis (36 pages)
— A Health Technology Assessment Protocol (56 pages)
https://cadth.ca/community-water-fluoridation-programs-health-technology-assessment
-
the 2019 FDI World
Dental Federation statement, Safe water supplies help contribute to better oral health outcomes:
"Water fluoridation is an effective public health measure for the prevention of tooth decay in children and adults; it is particularly impactful in populations with a moderate to high risk of tooth decay. It can contribute to better overall health and reduce disparities in the rates of poor oral health within communities."
(FDI World Dental Federation serves as the principal representative body for more than one million dentists worldwide...)
https://www.fdiworlddental.org/news/20190305/calling-for-safe-access-to-fluoridated-water-on-world-water-day
-
the 2018 National Toxicity Program
fluoride study, An Evaluation of Neurotoxicity Following
Fluoride Exposure from Gestational Through Adult Ages in
Long-Evans Hooded Rats: At these exposure levels, we observed no exposure-related differences in
motor, sensory, or learning and memory performance
on running wheel, open-field activity, light/dark
place preference, elevated plus maze, pre-pulse
startle inhibition, passive avoidance, hot-plate
latency, Morris water maze acquisition, probe test,
reversal learning, and Y-maze. T3, T4, and TSH
levels were not altered as a function of 10 or 20
ppm F- in the drinking water. No exposure-related
pathology was observed in the heart, liver, kidney,
testes, seminal vesicles, or epididymides. Mild
inflammation in the prostate gland was observed at
20 ppm F-. No evidence of neuronal death or glial
activation was observed in the hippocampus at 20 ppm
F-. (McPherson, et al., Neurotox Res. 2018)
https://www.ncbi.nlm.nih.gov/pubmed/29404855
-
the 2018 study, Water Fluoridation
and Dental Caries in U.S. Children and Adolescents:
These findings confirm a substantial caries-preventive benefit of CWF for U.S. children and that the benefit is most pronounced in primary teeth. (Slade, et al., J Dent Res. 2018)
http://journals.sagepub.com/doi/abs/10.1177/0022034518774331
- the
2018 Water Fluoridation Health
Monitoring Report for England:
Dental health:
-
Five-year-olds in areas with water fluoridation schemes were much less likely to experience tooth decay, and less likely to experience more severe decay than in areas without schemes
-
The chances of having a tooth/teeth removed in hospital because of decay were also much lower in areas with water fluoridation schemes
-
Children from both affluent and deprived areas benefitted from fluoridation, but children from relatively deprived areas benefitted the most.
-
Dental fluorosis, at a level that may effect the appearance of teeth, was observed in 10% of children/young people examined in fluoridated cities. However, there was no difference between children and young people surveyed in fluoridated and nonfluoridated cities when asked about their opinion on the appearance of their teeth, taking into account concerns which have resulted from any cause (eg poor alignment, decay, trauma or fluorosis).
Non-dental health outcomes:
Taken alongside the existing wider research, our results do not provide convincing evidence of higher rates of hip fracture, Down’s syndrome, kidney stones, bladder cancer, or osteosarcoma (a cancer of the bone) due to fluoridation schemes.
Conclusion:
The findings of this report agree with the view that water fluoridation is an effective and safe public health measure to reduce the frequency and severity of dental decay, and narrow differences in dental health between more and less deprived children and young people.
https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2018
-
the 2018 study, Contemporary evidence on the
effectiveness of water fluoridation in the
prevention of childhood caries – Australia:
Analysis of contemporary data representative of the Australian child population found consistent associations between %LEFW and childhood caries, which persisted when socioeconomic differences were adjusted across exposure groups, supporting the continued effectiveness of water fluoridation.
(Spencer, et al., Community Dent Oral Epidemiol. 2018)
https://onlinelibrary.wiley.com/doi/abs/10.1111/cdoe.12384
-
the 2018 Food Safety Authority of
Ireland Fluoride Report: Based on the results of this study, the FSAI Scientific Committee concluded that there is currently no scientific basis for concerns about the safety of children and adults in Ireland from exposure to fluoride from foods and beverages.
https://www.fsai.ie/news_centre/tds_fluoride_30042018.html
-
the 2018 CDC
Statement on the Evidence Supporting the Safety and
Effectiveness of Community Water Fluoridation: Water fluoridation is beneficial for reducing and controlling tooth decay and promoting oral health across the lifespan. Evidence shows that water fluoridation prevents tooth decay by providing frequent and consistent contact with low levels of fluoride, ultimately reducing tooth decay by 25% in children and adults. Additional evidence shows that schoolchildren living in communities where water is fluoridated have, on average, 2.25 fewer decayed teeth compared to similar children not living in fluoridated communities.
The safety and benefits of fluoride are well documented and have been reviewed comprehensively by several scientific and public health organizations. The U.S. Public Health Service; the United Kingdom’s National Institute for Health Research, Centre for Reviews and Dissemination, at the University of York; and the National Health and Medical Research Council, Australia have all conducted scientific reviews by expert panels and concluded that community water fluoridation is a safe and effective way to promote good oral health and prevent decay. The U.S. Community Preventive Services Task Force, on the basis of systematic reviews of scientific literature, issued a strong recommendation in 2001 and again in 2013, for community water fluoridation for the prevention and control of tooth decay
https://www.cdc.gov/fluoridation/guidelines/cdc-statement-on-community-water-fluoridation.html
-
the 2018 Evidence Review for Adverse Health Effects of Drinking Optimally Fluoridated Water (2010-2017):
This report is a summary of the evidence published since the 2010 Health Canada fluoride document to
May 10, 2017 about the adverse health effects of optimally controlled fluoridated water, including the
effects when mixed with infant formula.
Overall, the existing literature suggests that at an optimal concentration of water fluoridation, the only
adverse health consequence observed is a mild form of dental fluorosis.
https://www.publichealthontario.ca/-/media/documents/e/2018/evidence-review-health-affects-fluoridated-water.pdf?sc_lang=en
-
the 2017 Swedish report, Effects of Fluoride in the Drinking Water:
Taking all together, we investigate and confirm the long-established positive relationship between fluoride and dental health. Second, we fnd precisely estimated zero-effects on cognitive ability, non-cognitive ability and math test scores for fluoride levels in Swedish drinking water. Third, we find that fluoride improves later labor market outcomes, which indicates that good dental health is a positive factor on the labor market.
https://www.ifau.se/globalassets/pdf/se/2017/wp2017-20-the-effects-of-fluoride-in-the-drinking-water.pdf
-
the 2017 National Health and
Medical Research Council Public Statement –
Water Fluoridation and Human Health in Australia +
Questions & Answers: There is reliable evidence that community
water fluoridation helps to prevent tooth decay.
The consequences of tooth decay are considerable:
dental pain, concern about appearance, costs due to time
off school and work, and costs of dental treatment.
There is no reliable evidence of an association between
community water fluoridation at current Australian levels
and any health problems.
In Australia, community water fluoridation programs are
a safe, effective and ethical way of reducing tooth decay
across the population.
https://nhmrc.gov.au/about-us/publications/2017-public-statement-water-fluoridation-and-human-health
-
the
2017 EPA
Response: Fluoride Chemicals in Drinking Water; TSCA Section 21 Petition:
On November 23, 2016, a TSCA section 21 petition was submitted by the Fluoride Action Network [and 10 other organizations and individuals]. The general object of the petition
was to urge EPA “to protect the public and susceptible subpopulations from the neurotoxic risks of fluoride by banning the addition of fluoridation chemicals to water”
On February 17, 2017, "after careful consideration, EPA denied the TSCA section 21 petition, primarily because EPA concluded that the petition has not set forth a scientifically defensible basis to conclude that any persons have suffered neurotoxic harm as a result of exposure to fluoride in the U.S. through the purposeful addition of fluoridation chemicals to drinking water or otherwise from fluoride exposure in the U.S."
https://www.federalregister.gov/documents/2017/02/27/2017-03829/fluoride-chemicals-in-drinking-water-tsca-section-21-petition-reasons-for-agency-response
- the
2017 history of public health use of fluorides in caries prevention:
We systematically searched the PubMed database on
the preventive role of fluorides in public health,
published from 1984 to 2014. ... The role of fluorides in public health prevention has changed in accordance with the knowledge about the fluoride cariostatic mechanism. Previously the most important pre-eruptive effect of fluorides was supplemented by the post eruptive effect. Abundant evidence exists to show the effectiveness of systemic and topical fluorides.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5329778/
-
the 2016 World Health Organization
report: Fluoride and Oral Health:
—> Fluoride is
effective at controlling caries because it acts in
several different ways. When present in dental
plaque and saliva, it delays the demineralization
and promotes the remineralization of incipient
enamel lesions, a healing process before cavities
become established. Fluoride also interferes with
glycolysis, the process by which cariogenic bacteria
metabolize sugars to produce acid. In higher
concentrations, it has a bactericidal action on
cariogenic and other bacteria. Studies suggest that,
when fluoride is ingested during the period of tooth
development, it makes teeth more resistant to
subsequent caries development. Fluoridated water
also has a significant topical effect in addition to
its systemic effect (Hardwick et al., 1982). It is
well known that salivary and plaque fluoride (F)
concentrations are directly related to the F
concentration in drinking water. This versatility of
action adds to fluoride’s value in caries
prevention. Aiding remineralization is likely to be
fluoride’s most important action.
—> Studies from many different
countries over the past 60 years are remarkably
consistent in demonstrating substantial reductions
in caries prevalence as a result of water
fluoridation. One hundred and thirteen studies into
the effectiveness of artificial water fluoridation in
23 countries conducted before 1990, recorded a modal
percent caries reduction of 40 to 50% in primary
teeth and 50 to 60% in permanent.
—> More recently, systematic
reviews summarizing these extensive databases have
confirmed that water fluoridation substantially
reduces the prevalence and incidence of dental
caries in primary and permanent teeth. Although
percent caries reductions recorded have been
slightly lower in 59 post-1990 studies compared with
the pre-1990 studies, the reductions are still
substantial.
—>
The question of possible
adverse general health effects caused by exposure to
fluorides taken in optimal concentrations throughout
life has been the object of thorough medical
investigations which have failed to show any
impairment of general health.
This present publication is a revision of the
original 1994 document, again using the expertise of
researchers from the extensive fi elds of knowledge
required to successfully implement complex
interventions such as the use of fl uorides to
improve dental and oral health.
https://pubmed.ncbi.nlm.nih.gov/27352462/
-
the 2016
(update) Best Practice Approach - Community Water
Fluoridation - Association of State and
Territorial Dental Directors: Community water fluoridation remains an effective public health strategy for delivering fluoride
to prevent tooth decay and is the most feasible and cost-effective strategy for reaching entire
communities.
https://www.astdd.org/bestpractices/BPAFluoridation.pdf
-
the 2016 systematic review of published studies: Does cessation of
community water fluoridation lead to an increase in
tooth decay? We identified 15 instances of CWF cessation (‘intervention’) in 13 countries, which covered a broad time frame (1956–2003) and diverse geographical and political/economic contexts. Overall, results were mixed, but pointed more to an increase in caries postcessation than otherwise. For example,
of the 9 studies with at least moderate methodological quality based on criteria we developed for this review,
5 showed an increase in caries postcessation. 3 studies
[in Finland, E. Germany & Cuba] did not show an increase in caries postcessation; however, important postcessation changes (eg, implementation of alternative fluoride delivery programmes) and/or large-scale social change may have contributed to those effects. Importantly, in all three interventions, there were other factors which could have contributed to findings observed. In
Finland,18 the CWF-cessation community started to provide fluoride tablets to children postcessation. In
East Germany,26 postcessation fissure sealants were paid for by statutory health funds. In
Cuba,27 postcessation, all children received fluoride mouth rinses fortnightly, and children aged 2–5 years received 1–2 fluoride varnish applications annually. Those initiatives could have offset an impact of cessation on dental caries.
https://jech.bmj.com/content/70/9/934
-
the 2016 Economic Evaluation of Community Water Fluoridation: Recent evidence continues to indicate that the economic benefit of community water
fluoridation exceeds the intervention cost. Further, the benefit–cost ratio increases with the
community population size.
https://www.thecommunityguide.org/sites/default/files/publications/oral-ajpm-econ-fluoridation_0.pdf
-
the 2015 Manual of Dental
Practices, Council of European Dentists:
Approximately 6 million people in the UK receive water in which
the fluoride content has been adjusted to the optimum level for
dental health of around one part of fluoride per million parts of
water, or that has a naturally occurring fluoride level of around
this level. This means that around one in ten of the total
population of the UK is currently receiving water with a fluoride
level that is capable of providing protection against tooth decay.
https://cedentists.eu/library/eu-manual.html
-
the 2015 U.S. Public Health Service
Recommendation for Fluoride Concentration in Drinking
Water for the Prevention of Dental Caries: The
article demonstrates
how the scientific consensus changes based on legitimate
evidence – not fear mongering.
Systematic reviews of the scientific evidence
related to fluoride have concluded that community
water fluoridation is effective in decreasing dental
caries prevalence and severity. Effects included significant increases in the proportion of children who were caries-free and significant reductions in the number of teeth or tooth surfaces with caries in both children and adults. When analyses were limited to studies conducted after the introduction of other sources of fluoride, especially fluoride toothpaste, beneficial effects across the lifespan from community water fluoridation were still apparent.
Fluoride in saliva and dental plaque works to prevent dental caries primarily through topical -remineralization of tooth surfaces. Consuming fluoridated water and beverages, and foods prepared or processed with fluoridated water, throughout the day maintains a low concentration of fluoride in saliva and plaque that enhances remineralization. Although other fluoride-containing products are available and contribute to the prevention and control of dental caries, community water fluoridation has been identified as the most cost-effective method of delivering fluoride to all members of the community regardless of age, educational attainment, or income level.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547570/
-
the 2015 Cochrane Water Fluoridation Review:
Fluoride is a mineral that prevents tooth decay. It occurs naturally in water at varying levels. Our review found that water fluoridation is effective at reducing levels of tooth decay among children. The introduction of water fluoridation resulted in children having 35% fewer decayed, missing and filled baby teeth and 26% fewer decayed, missing and filled permanent teeth. We also found that fluoridation led to a 15% increase in children with no decay in their baby teeth and a 14% increase in children with no decay in their permanent teeth. These results are based predominantly on old studies and may not be applicable today.
The Cochrane
review is often cited by fluoridation opponents as
supporting their agenda
because of its complexity and the fact that
restrictive criteria
for selecting studies to review resulted in the
rejection of the majority of relevant studies.
It is important to understand the review limitations
- some of which are discussed in the critique below.
https://ww.cochrane.org/CD010856/ORAL_water-fluoridation-prevent-tooth-decay
- the
2016
Critique of the review of 'Water fluoridation
for the prevention of dental caries' published
by the Cochrane Collaboration: The Cochrane
Review maintained that the RCT would be the best
design for evaluating the effectiveness of
water fluoridation, while simultaneously
acknowledging its impracticability in this
instance. Although RCTs are the method of
choice for evaluating the effectiveness of
medicines and some clinical interventions,
literature published during the past 20 years
has indicated that they are inappropriate for
evaluating public health preventive programmes
and other complex interventions. ... While the overall conclusion that water fluoridation is effective in caries prevention is consistent with previous reviews, many important public health questions could not be answered by the Cochrane Review because of the restrictive inclusion criteria used to judge adequacy of study design and risk of bias. The potential benefits of using wider criteria in order to achieve a fuller understanding of the effectiveness of water fluoridation are discussed.
http://eprints.whiterose.ac.uk/98365/
-
the
2015
Health Effects of water Fluoridation - An Evidence
Review. Ireland Health Research Board: In summary the literature found no strong evidence that CWF is definitively associated with negative health effects.
http://www.hrb.ie/fileadmin/publications_files/Health_Effects_of_Water_Fluoridation.pdf
-
the 2015 review, Fluoridation of water: a literature review of risks or
benefits for the population in Ireland exposed to
the current levels – including a European policy
examination of water fluoridation practices:
To date epidemiological studies suggest water fluoridation is
effective in lowering dental caries through inhibiting demineralization and promoting re
mineralization making teeth stronger and more resistant to decay. As a community wide public
health measure fluoridation is accessible to all regardless of socio-economic status, educatioal
attainment or other social variables. ... At levels of 1 mg/L of fluoride in drinking water, no effects have been established, either positively
or negatively on disease or death rates. No differences in nephritis, coronary illness, allergic
reactions or cirrhosis and includes: Downs Syndrome, senile dementia, nephrolithiasis, stillbirths and
congenital abnormalities.
https://www.dcu.ie/sites/default/files/research/literature_review_on_fluoridation_study_-_ann_reilly.pdf
-
the
2015 Denver Water Board review of its 62 year fluoride
policy: In 2015 anti-F activists attempted to “persuade” the Denver Water Board to discontinue fluoridation. Fortunately, the Denver Water Board was able to evaluate the evidence from a scientific perspective.
The resolution the Denver Water Board Commissioners adopted at its August 26, 2015 meeting stated:
Nothing has been presented to the Board or learned in our research [Including the testimony of
anti-F activist, Paul Connett, who flew in for a presentation] that would justify ignoring the advice of these public health agencies and medical and community organizations, or deviating from the thoroughly researched and documented recommendation of the U.S. Public Health Service.
https://www.denverwater.org/sites/default/files/fluoride-board-resolution-august-2015.pdf
-
the
2014 American Academy of Pediatrics Clinical Report: Fluoride Use in Caries Prevention in the
Primary Care Setting: Dental caries is the most common chronic disease of childhood, with 59% of 12- to 19-year-olds having at least 1 documented cavity.
Caries is the “silent epidemic” that
disproportionately affects poor, young, and minority
populations. ... Community water fluoridation is a safe, efficient, and cost-effective way to prevent tooth decay and has been shown to reduce tooth decay by 29%. It prevents tooth decay through the provision of low levels of fluoride exposure to the teeth over time and provides both topical and systemic exposure.
http://pediatrics.aappublications.org/content/134/3/626
-
the 2014 Royal Society of New Zealand,
Health effects of water fluoridation: There is compelling evidence that fluoridation of water at the established and recommended levels produces broad benefits for the dental health of New Zealanders. In this context it is worth noting that dental health remains a major issue for much of the New Zealand population, and that economically and from the equity perspective fluoridation remains the safest and most appropriate approach for promoting dental public health.
The only side effect of fluoridation at levels used in NZ is minimal fluorosis, and this is not of major cosmetic significance. There are no reported cases of disfiguring fluorosis associated with levels used for fluoridating water supplies in New Zealand. ... We conclude that the scientific issues raised by those opposed to fluoridation are not supported by the evidence.
http://www.pmcsa.org.nz/wp-content/uploads/Health-effects-of-water-fluoridation-Aug2014.pdf
-
the 2013 European
Food Safety Authority review,
Scientific Opinion on Dietary Reference Values for fluoride:
Fluoride has no known essential function in human growth and development and no signs of fluoride deficiency have been identified. Though fluoride is not essential for tooth development, exposure to fluoride leads to incorporation into the hydroxyapatite of the developing tooth enamel and dentin. The resulting fluorohydroxyapatite is more resistant to acids than hydroxyapatite. Thus, teeth which contain fluoroapatite are less likely to develop caries. Apart from incorporation of fluoride into the dentin and enamel of teeth before eruption, dietary fluoride exerts an anticaries effect on erupted teeth through contact with enamel during consumption, excretion into saliva and uptake into biofilms on teeth. In addition, fluoride interferes with the metabolism of oral microbial cells, by directly inhibiting, for example, glycolytic enzymes and cell membrane-associated H+ ATPases in microbial cells after entry of hydrofluoric acid into their cytoplasm. (Summary, page 2)
-
the 2013
Community Guide Systematic Review, Dental Caries
(Cavities): Community Water Fluoridation: The Community Preventive Services Task Force (CPSTF) recommends community water fluoridation to reduce dental caries (tooth decay). Major Findings:
-
After water fluoridation began, communities saw a median increase of 15 percentage points (based on 11 studies) in the percentage of caries-free children compared to communities without water fluoridation.
-
When community water fluoridation was
discontinued, an increase in dental caries
occurred.
-
A systematic review of the economic evidence found that the economic benefit of community water fluoridation is greater than the cost
https://www.thecommunityguide.org/findings/dental-caries-cavities-community-water-fluoridation
-
the 2011 SCHER Critical review of any new evidence on the hazard
profile, health effects, and human exposure to fluoride
and the fluoridating agents of drinking water: Conclusions:
-
Fluoridation chemicals – In the pH-range and at the concentrations of hexafluorosilicates/fluoride relevant for drinking water, hydrolysis of hexafluorosilicates to fluoride was rapid and the release of the fluoride ion was essentially complete. Residual fluorosilicate intermediates were not observed by sensitive F-NMR. These calculated concentrations [of impurities in fluoridation chemicals] are at least two orders of magnitude below drinking water guideline values for these metals established by WHO and other organizations, and therefore are not regarded as an additional health risk. Based on the available chemistry of fluoride in solution, the chemistry of lead and lead ions, and the concentrations of fluoride in tap water, it is highly unlikely that there would be an increased release of lead from pipes due to hexafluorosilicic acid.
-
Genotoxicity and Carcinogenicity – SCHER agrees that epidemiological studies do not indicate a clear link between fluoride in drinking water, and osteosarcoma and cancer in general. There is no evidence from animal studies to support the link, thus fluoride cannot be classified as carcinogenic.
-
Neurotoxicity – SCHER agrees that there is not enough evidence to conclude that fluoride in drinking water at concentrations permitted in the EU may impair the IQ of children. SCHER also agrees that a biological plausibility for the link between fluoridated water and IQ has not been established.
-
Reproductive and developmental effects – SCHER concludes that fluoride at concentrations in drinking water permitted in the EU does not influence the reproductive capacity.
-
Summary – Fluoride, either naturally present or intentionally added to water, food and consumer products, e.g. toothpaste, is generally considered beneficial to prevent dental caries. Considering previous opinions from EFSA and SCCP, SCHER has reviewed the newest information in the area on risk and benefit of using fluoridated drinking water and intake of fluoride from all sources.
https://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_139.pdf
-
Review Summary
-
the
2011
Guidelines for Canadian Drinking Water Quality:
Guideline Technical Document – Fluoride: Health Canada's Chief Dental Officer has reviewed the available science on dental effects of fluoride, and sought external expert advice from the scientific dental community. Experts provided a recommendation on the optimal level, which was accepted by Health Canada's Chief Dental Officer. As a result, the optimal concentration of fluoride in drinking water for dental health has been determined to be 0.7 mg/L for communities who wish to fluoridate. This concentration provides optimal dental health benefits and is well below the MAC to protect against adverse effects. The weight of evidence from all currently available studies does not support a link between exposure to fluoride in drinking water at 1.5 mg/L and any adverse health effects, including those related to cancer, immunotoxicity, reproductive/developmental toxicity, genotoxicity and/or neurotoxicity. It also does not support a link between fluoride exposure and intelligence quotient deficit, as there are significant concerns regarding the relevant studies, including quality, credibility, and methodological weaknesses.
https://www.canada.ca/en/health-canada/services/publications/healthy-living/guidelines-canadian-drinking-water-quality-guideline-technical-document-fluoride.html
-
the 2008 Systematic review of the efficacy and safety of fluoridation
– Australian NHMRC:
RESULTS: In total, 5418 nonduplicate citations were identified. After applying the inclusion and exclusion criteria, 408 citations were considered potentially eligible for inclusion in the review. After the review of the full papers of potentially eligible articles, 77 citations were included in the review. The summary of findings was presented in the context of the research questions (Table 3).
RECOMMENDATIONS: Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride.
-
the 2007 Dutch Ministry of Health and Welfare and Sports: Economic
evaluation of prevention: further evidence: Fluoridation of drinking water in the Netherlands would probably be cost-saving as the costs
of fluoridation will be outweighed by the savings due to reduction of caries. However, people
would also run the risk of fluorosis (of aesthetic concern). Although practically feasible, the
many objections against fluoridation of drinking water make its implementation rather
improbable.
https://www.rivm.nl/bibliotheek/rapporten/270091004.pdf
-
the 2007 Findings and Recommendations of the Fluoride Expert Panel –
Health Canada: Community drinking water fluoridation is still an effective public health method
to reduce the prevalence of dental caries in the Canadian population.
http://www.simcoemuskokahealth.org/docs/default-source/topic-oralhealth/2008_HealthCan-expert_panel
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the 2007 Institut National de Santé Publique du Québec report, Water Fluoridation - An Analysis of the Health Benefits and Risks:
Overall, the scientific data currently available does not show that water fluoridation at concentrations deemed beneficial to dental health is harmful to humans. Nor have environmental studies revealed any harmful ecosystemic effects of fluoridation.
... Water fluoridation is the safest, most effective and most economical public health measure for preventing and reducing dental caries. It benefits all citizens, regardless of their level of education, socio-economic status, age or ethnic background. Everyone can benefit from water fluoridation, especially the most vulnerable members of our society.
https://www.inspq.qc.ca/pdf/publications/705-WaterFluoration.pdf
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the 2006 NRC Scientific Review of EPA’s Standards -
Fluoride In Drinking Water: The twelve
member committee “was asked to evaluate independently the scientific basis of EPA’s MCLG of 4 mg/L and SMCL of 2 mg/L in drinking water and the adequacy of those guidelines to protect children and others from adverse health effects."
The ONLY reasons provided in the report for lowering the MCL from 4 ppm (nearly six times higher than optimally fluoridated water) were extremely specific. The report states,
Lowering the MCLG will prevent children from developing severe enamel fluorosis and will reduce the lifetime accumulation of fluoride into bone that the majority of the committee concluded is likely to put individuals at increased risk of bone fracture and possibly skeletal fluorosis, which are particular concerns for subpopulations that are prone to accumulating fluoride in their bone.
The committee made no recommendation to lower the SMCL below 2.0 ppm (nearly three times the fluoride level of optimally fluoridated water) for any reason. If there were any health concerns from drinking water with a fluoride content of 2.0 ppm, those concerns would have been mentioned.
Quotes that allege the committee concluded drinking
water fluoridation caused harm are taken from
out-of-context discussions of specific studies.
https://www.nap.edu/catalog/11571/fluoride-in-drinking-water-a-scientific-review-of-epas-standards-
the 2003 Update on Fluorides and Fluorosis (Steven M. Levy, Journal of
the Canadian Dental Association):
Water fluoridation and use of fluoride dentifrice are the most efficient
and cost-effective ways to prevent dental caries; other
modalities should be targeted toward high-risk
individuals.
http://www.cda-adc.ca/jcda/vol-69/issue-5/286.pdf
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the 2003
Fluoride Technical Study Group Report, Fort Collins, CO:
https://www.fcgov.com/utilities/what-we-do/water/water-treatment/treated-drinking-water/drinking-water-fluoridation/fluoride-technical-study-group-report
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the 2000 York, Systematic review of
water fluoridation:
https://www.bmj.com/content/321/7265/855.full.print
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the 2000 Community Preventive Services
Task Force, Preventing Dental Caries: Community Water
Fluoridation:
https://www.thecommunityguide.org/sites/default/files/Oral-Health-Fluoridation-Archive.pdf
Additional Resources
Supporting
Community Water
Fluoridation: