Water fluoridation

Since its inception in the 1940s, the scientifically sound concept of fluoridating water has been a source of fear and suspicion in the minds of conspiracy theorists.
Water is fluoridated by adding a small quantity (up to 2 mg/l) of a fluoride salt of fluorine. Fluoride works by converting the outer layer of tooth enamel made of hydroxylapatite, Ca5(PO4)3OH, to fluoroapatite, Ca5(PO4)3F. The latter chemical is less soluble in acidic solutions. The three most commonly added fluoride chemicals are sodium fluoride (NaF), fluorosilicic acid ((H3O)2SiF6), and sodium fluorosilicate (Na2[SiF6]).Water Fluoridation: A Manual For Engineers and Technicians, CDC Fluorosilicic acid is a byproduct of phosphate fertilizer manufacture, a fact which fluoride opponents repeat ad absurdum in an attempt to scare you.Fluoride Action Network: Fluoridation Chemicals
In short: the issue has been extensively studied since the 1940s. As a result, every reputable public health organization endorses the benefits of fluoridation. To date, no such organizations have endorsed claims that fluoride is a secret communist mind-control plot — though we wait with bated breath.
==History of fluoridation==
There are three periods concerning the history of water fluoridation:
#Before 1933, the study of mottled tooth enamel, later known as fluorosis. Researchers noticed reduced dental caries in communities with naturally occurring fluoride in the drinking water, in places like Colorado and India.
#From 1933 to 1945, the study of the relationship between fluorine and tooth decay. (No, not in Nazi Germany.Truth about fluoride doesn't include Nazi myth, PolitiFact)
#From 1945 onward, which focused on deployment of water fluorides, creating pretty rainbows in garden sprinklers ... which definitely weren't there before and certainly are not caused by the refraction of light.
Since widespread community water fluoridation began in earnest in the 1940s in the United States, one last bastion of hope for modern anti-fluoridationists has been the city of Portland, Oregon. As of 2014, it is the last of the largest metropolitan cities in the United States to remain unfluoridated,Water Fluoridation Status of the 50 Largest Cities in the United States, Wisconsin Dental Association (San Jose, which ranks above Portland in population, was unfluoridated until 2012.) despite four popular vote attempts to add the *ahem* chemical.Why Portland Is Wrong About Water Fluoridation, Scientific American
In the United States, the Safe Drinking Water Act (SDWA) of 1974 confers the authority for ensuring the safety of public drinking water to the Environmental Protection Agency (EPA).Basic Information about Fluoride in Drinking Water, EPA
==Arguments for fluoridation==
Centralized fluoridation is a safe, simple, and effective way to improve the dental health of the population at large (especially children in the candy cavity-prone years). It is also extremely cost-effective: one study estimated that for every $1 a city invested in fluoridation it saved the average citizen (with a mean dental health cost) $38 on dental care.Do cities really save $38 for every $1 they spend on fluoridation?, PolitiFact The Centers for Disease Control and Prevention considers water fluoridation to be one of the top 10 public health advances of the 20th century.Here, here, here and here The American Dental Association "unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay."What the National and International Experts Say About Water Fluoridation, Ontario Dental Association The World Health Organization states that "fluoridation of water supplies, where possible, is the most effective public health measure for the prevention of dental decay."Water Fluoridation, WHO
Having been around for 70-odd years and having been the focus of much research, water fluoridation has been studied to death (the number of studies seems to have peaked around the late 1960s followed by a general declinePubMed has over six thousand citations to studies regarding water fluoridation, and this is by no means a complete registry of every study ever done.Centers for Disease Control and Prevention. Last Updated May 12, 2015. Scientific Reviews and Reports: Assessing the Evidence. Retrieved March 20, 2017.Yeung, Ca. PubMed. A systematic review of the efficacy and safety of fluoridation. Retrieved March 20, 2017. This is one systematic review on the many, many studies done.). Arguments along the lines of "the jury is out" or "the science is incomplete" are wrong. Thousands of studies and years of actual implementation have not upset the scientific consensus.
==Standard arguments against fluoridation==
Most of the arguments against fluoridation are based on ethical and moral issues, namely that water fluoridation is medicating large numbers of people without their explicit consent. Curiously, they don't typically complain about regulations that add "drugs" to other foods, like iodine added to salt, vitamin D added to milk, iron added to cereal, or folic acid added to flour.http://www.dietitians.ca/Dietitians-Views/Food-Regulation-and-Labelling/Food-Fortification.aspx 
Despite fluoride naturally occurring in food and water,Naturally occurring hazards: Fluoride, WHO a common argument against it is the appeal to nature. Most health effect arguments against water fluoridation (such as toxicity and mottled teeth) base their assumptions on much higher doses of fluoride than are allowed in municipal tap water and the excessive cherry-picking of studies. Additional studies on links between fluoride and cancer, and fluoride and bone fractures have been shown to be invalid.Review of Fluoride: Benefits and Risks, US Department of Health and Human Services Other arguments are based on the false assumption that if fluoridation worked, there would be no tooth decay. 
The favourite adverse effect of the anti-fluoride crowd, is a scary-sounding but rather benign condition in which the teeth become slightly stained. It is a purely cosmetic issue that does not lead to tooth decay, whereas removing fluoride from water does if individuals do not brush their teeth regularly. In all but the most severe cases, the mottling is barely noticeable, and it's only significant in children whose teeth have not finished developing. By comparison, drinking a lot of coffee or tea can also make your teeth yellow, though this is reversible. Dental fluorosis is a potential risk, but is not problematic if the dosage is controlled. Drinking water with fluoride above "safe dosages", such as that found in some natural ground water wells in developing countries or in brick teas exposed to excessively fluorinated water, can also cause a more serious condition called 
===="But the EPA opposes fluoridation!"====
Deniers will typically claim 1,500+ EPA scientists are opposed to fluoridation.http://www.fluoridation.com/epa2.htm Upon closer inspection, however, this "study" is actually just a grievance letter written in 1999 by J. William Hirzy, Ph.D. on the letterhead of his local National Treasury Employees Union Chapter 280. The letter — far from representing the views of 1,500 scientists (the union represents all employees, which includes non-scientists like lawyershttp://nteu280.org/history/) — is really the result of a poorly attended meeting of one local union chapter. With only 20 of said union chapter members in attendance, Hirzy and his followers were able to adopt a resolution opposing fluoridation. When it became obvious to the wider union that Hirzy and his local chapter were falsely presenting their fringe position as representing the view of the entire union, the chapter officers who actually represented the majority of the members rapidly disowned Hirzy's position.http://www.in.gov/isdh/24525.htm#Does_the_US_EPA_oppose_water_fluoridation After the above incident, Hirzy seems to have gone on to become the deniers' go-to guy.https://openparachute.wordpress.com/tag/hirzy/
===="But the National Research Council opposes fluoridation!"====
Deniers will hand wave to a 2006 500+ page report by the NRC's Committee Report on Fluoride in Drinking Water and claim that it opposes fluoridation, and of course claims will be accompanied by cherry-picked scare quotes.http://fluoridealert.org/researchers/nrc/ The study makes no claims against water fluoridation. The report merely reviews the evidence for safe levels. Science does that from time to time. Reappraises safe consumption levels given changes in technologies and lifestyles. The report gives no support to fluoridation deniers as it suggests 2.0 ppm is a safe level. Most public water is fluoridated at a 0.7 ppm level, a third of what the NRC determined was still a safe level. In response to the misuse of the report, the report's chairman has stated, "I do not believe there is any valid, scientific reason for fearing adverse health conditions from the consumption of water fluoridated at the optimal level."http://www.ilikemyteeth.org/wp-content/uploads/2013/03/Doull-Email-on-CWF-March-2013.pdf
===="But the World Health Organization opposes fluoridation!"====
Deniers will make various claims that the World Health Organization (WHO) opposes fluoridation. By way of evidence they will point to various WHO publications about the need to remove fluoride from water. Deniers miss that these guides are for people living in areas where there's a dangerous concentration in the local drinking water due to natural sources and a government unable to fund the technology to reduce it to a safe level. Deniers miss the notion that everything is poisonous in high enough concentrations. For example, vitamin A is critical to human health but a human (typically a child) can realistically poison himself/herself by consuming too much.http://www.ewg.org/research/how-much-is-too-much/up-to-half-of-young-children-get-too-much-vitamin-zinc-and-niacin The 2016 WHO report, Fluoride and Oral Health, clearly supports fluoridation for populations that would benefit from it. http://who.int/oral_health/publications/2016_fluoride_oral_health.pdf
===="But a bunch of western European countries oppose fluoridation!"====
Deniers will typically list nations that do not fluoridate their water.http://www.slweb.org/50reasons.html Mostly they're Western European nations which lends their position a gloss of respectability because, you know, apparently Western Europeans have their shit together. What they ignore is water fluoridation is a public health measure created to benefit the poorhttps://www.cda-adc.ca/jcda/vol-66/issue-11/592.html without means to access dentists. They typically list nations like Sweden, Finland, Denmark, etc. It goes without saying these nations provide excellent universal health care regardless of family income, including free access to dental care for children. Most of these nations have dental care and surveillance at the school level.http://www.fyidenmark.com/dentalcare.html Hilariously enough, even though water fluoridation is banned in these countries, conspiracy nuts nevertheless bring it up and call for it to be banned.https://www.adressit.com/fluori In addition to better access to childhood dental care, many of these nations — for example, Switzerland, Germany, and France — don't fluoridate their water because they fluoridate their salt.http://fluoridealert.org/studies/caries01/
===="But the freakin' Nazis fluoridated the water in their death camps!"====
This is one of those wonderful examples of an unsourced anecdote mentioned once that gets repeated as fact for decades. The suggestion is the Nazis fluoridated the water to pacify the death camp populations. Apparently soldiers with guns, and machine gun towers that would mow you down if you got too close to the fence were not enough to mollify the death camp population. They needed to drug them up. The claim is generally attributed to an early denier named Charles E. Perkins who wrote a book called The Truth about Water Fluoridation. The claim is that Perkins' source was a worker at a German chemical company that ostensibly supplied fluoride. However, Politifact casts some doubt on the Perkins origin.http://www.politifact.com/florida/statements/2011/oct/06/critics-water-fluoridation/truth-about-fluoride-doesnt-include-nazi-myth/ His actual book makes no mention of this. However, some allege he wrote a follow-on letter that made this claim.https://skepticalvegan.com/2013/03/07/water-fluoridation-a-communist-plot/ Suffice it to say there's zero documentation anywhere the Nazis ever used fluoride for mind control purposes. It may be connected with claims that the similar chemical potassium bromide (once used medically as a sedative) was added to British soldiers' rations to lower their libidos or for some other reason, although this also appears to be a myth, and fluoride doesn't have the same effect anyway.Potassium bromide, Chemistry World
===="I'm fine with fluoride on toothpaste, but fluoride shouldn't be ingested!"====
Just as how other denialist circles have soft and hard nuances, anti-fluoridation people have their share of softcore anti-fluoride opinions. According to them, fluoride is fine when applied topically (on toothpaste, for instance), but not when it is part of the water supply (systemic).Mercola says [http://articles.mercola.com/sites/articles/archive/2014/07/01/water-supply-fluoridation.aspx "Most dental authorities now agree that the predominant benefit of fluoride is topical, not systemic." The problem, particularly in the U.S., is that people, especially children, need more exposure to fluoride to appreciate the positive effects of decreasing cavities. In the U.S., fluoridated water is how most children are exposed to fluoride, since, compared to Europe, children do not have school-based dental care and do not visit the dentist regularly. Additionally, fluoride, when swallowed, can be distributed throughout the body, which includes being in the saliva that covers the teeth. Nevertheless, fluoridated water has been shown with more than enough evidence to improve the quality of teeth in humans compared to its risks, if any, and removing them in water will reduce those benefits. The main problem is that it goes against the heaps of evidence demonstrating the safety and benefits of drinking fluoridated water.
====The IQ studies====
*In 2006, the National Research Council (NRC) published a review of the EPA's drinking water standard for fluoride.Fluoride in Drinking Water: A Scientific Review of EPA's Standards, National Research Council The report noted potential negative effects due to fluoridation, including cognitive impairment, impaired thyroid functioning, and increases in bone fractures, in addition to the fluorosis of children's teeth. The NRC called for a reduction of the EPA's limit of 4.0 mg/L of fluoride in drinking water. This was a much higher standard than the recommended levels for water fluoridation (targeting levels from 0.7 to 1.2 mg/L).
*The Harvard IQ study: "Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis" evaluated the impact of highly elevated natural fluoride in Chinese water supplies on childhood development. (Read: They were studying fluoride poisoning.) In short, they concluded that their results can prove nothing about US intentional water fluoridation:
*In 2014, a study conducted in New Zealand examined the relationship between fluoridation and IQ directly on a cohort of people born in Dunedin in the 1970s. It found no statistically significant link. The authors suggest that the earlier Harvard study might have been affected by confounding variables, especially urban or rural status.Community Water Fluoridation and Intelligence: Prospective Study in New Zealand by Jonathan M. Broadbent et al., American Journal of Public Health Volume 105, Issue 1, 2015.
*In 2017, there is another study conducted in Mexico, published in Environmental Health Perspectives, determining the effects of high fluoridation and IQ scores called "Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico". It is shortened to the "Bashash study".Bashash et. al. (2017). Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico. Environmental Health Perspectives. Retrieved April 22, 2018. Despite being the largest long-term study and following standard protocal for measurements, it is still limited by a multitude of factors being lack of data for fluoride intake, the only recorded fluoride intake being salts and naturally occurring fluoride, a relatively small convenience sample, and a lack of factoring for confounding factors such as accounting for possible arsenic, thus making this study far from conclusive in determining the effects.American Dental Association. (November 27, 2017). Comments on a Study Published in Environmental Health Perspectives Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6-12 Years of Age in Mexico.
Perhaps we should be studying the IQ of the deniers, as it is most likely well below 100.
===="But, informed consent!"====
The pseudo-Libertarian argument concern trolling. The basic premise is that not everyone "agrees" to have their water fluoridated. This might be valid logic in magical sunshine land where the unicorns fart dollar bills, but unfortunately we do not live in such a world. Giving everyone the ability to choose whether or not their water was fluoridated would effectively mean that every single house would have its own fluoridation unit which could be turned on or off, meaning it's prohibitively expensive to install, let alone maintain. Instead, everyone "consents" in the sense that in a democracy, every town/municipality has elected people who chose to fluoridate the water. If such a thing was tyranny, then having any municipal water system at all would equally be tyranny, since you also didn't consent to having your water chlorinated, either.
====Conspiracy theories====
Water fluoridation as a commie plot started among the wingnut paranoids during the Cold War, most notably the John Birch Society — the "dark age" claims of which were being debunked in public at least as early as 1962.https://news.google.com/newspapers?nid=1891&dat=19620321&id=M54fAAAAIBAJ&sjid=qNUEAAAAIBAJ&pg=694,2464316&hl=en The conspiracy theory gained currency among far-left moonbats after it mutated in the early 1990s into a plot by the aluminum industry to dispose of their fluoride wastes by dumping them into the water supply for profit.Fluoridation of water, The Skeptic's Dictionary The implication that Big Pharma is out to poison you and that the scientific consensus is proof of a massive world-wide conspiracy of scientists/dentists makes reasoning with conspiracy theorists particularly difficult. Then again, reasoning with conspiracy theorists is almost always a waste of time.
Another popular claim is that fluoridation is a method of nuclear waste disposal.Fluoride, Teeth, and the Atomic Bomb, fluoridation.com (crank site) It is true that gaseous fluorine was first used during the Manhattan Project in the process of uranium enrichment, which involves the conversion of uranium oxide to uranium hexafluoride. However, this is irrelevant, because fluoridation uses fluoride (i.e., soluble salts that contain fluorine) rather than fluorine (a gas so corrosive that it violently reacts with water). Furthermore, uranium enrichment does not involve any nuclear reactions, so no radioactivity or nuclear waste is generated in this process. Finally, this is actually a niche use of fluorine compounds. They are mainly used in steelmaking, aluminum smelting, and the production of specialty plastics (such as PTFE, also known as Teflon) and pharmaceuticals. Cranks apparently find these uses much less interesting.
Prominent commie Mao Zedong's refusal to brush his teeth is not only definitive proof that the commies were indeed behind US fluoride use all along; his aversion to fluoride also helps to explain his super-appalling dental hygiene.http://www.people.com/people/archive/article/0,,20104202,00.html The cranks agree — resist world communism by not listening to scientists, instead following the Dear Leader's example.
==The end is nigh?==
Robert F. Kennedy Jr., realizing that his 2024 presidential campaign was doomed, he instead joined team MAGA. After Trump won the 2024 election, RFK was promised a leadership post at the Department of Health and Human Services, where of confirmed by the US Senate, he could direct government policy about two of his favorite dangerously kooky ideas, antivax and banning fluoride supplementation of municipal water supplies. In November 2024, before election day, RFK claimed that Trump would "advise all U.S​. water systems to remove fluoride from public water",On January 20, the Trump White House will advise all U.S​. water systems to remove fluoride from public water. Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease. President ​@realDonaldTrump and First Lady @MELANIATRUMP want to Make America Healthy Again.​ @michaelpconnett by Robert F. Kennedy Jr. (8:36 PM · Nov 2, 2024) Twitter (archived from 2 Nov 2024 22:45:46 UTC). making previously debunked claims about the dangers of fluoridation.Fluoridated Water National Cancer Institute.Which states mandate fluoride in drinking water: RFK Jr. wants fluoride out of water but about a dozen states require it. Here’s what the federal government can do. by Hannah Recht (December 17, 2024 at 6:00 a.m. EST) The Washington Post. Despite RFK's misguided desires to eliminate all water fluoridation in the US, there are several US states that mandate water fluoridation, primarily in municipal or urban water supplies (Arkansas, California, Connecticut, Delaware, Georgia, Illinois, Kentucky, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, Ohio and South Dakota. So such a presidential directive, might have much less effect than RFK would anticipate.
==The cream of the anti-fluoridation crap==
*Alex Jones — Possibly the most vocal opponent to fluoridation today.https://www.google.com/search?q=site:infowars.com+flouride&ie=utf-8&oe=utf-8&gws_rd=cr&ei=RxVSVrmBG4K5swHtmZ_4AQ#q=site:infowars.com+fluoride He's even put it on a t-shirt.http://store.infowars.com/Fluoride-In-The-Tap-Water--Blue-Shirt_p_453.html
*David Icke — Exposing the reptilian side to this vast fluoridation conspiracy.http://www.davidicke.com/headlines/tag/fluoride/
*Jedi Mind Tricks — semi-underground hip-hop artist, conspiracy theorist, and homophobe. Clearly an academic worthy of your time.
*John Yiamouyiannis — AIDS denialist quack and "science director" for the anti-vaccine, phony cancer cure-pushing National Health Federation.
*Joseph Mercola — quack internet doctor and supplement peddler. You know you're an asshole when InfoWars quotes you.http://www.infowars.com/the-fluoride-deception-whats-added-to-your-water-supply/
* most famous for showing viruses can cause cancers in animals, also believed that fluoridation was "an insidious poison, harmful, toxic and cumulative in its effect, even when ingested in minimal amounts."Ludwik Gross, a Trailblazer in Cancer Research, Dies at 94, The New York Times
*Mike Adams — operator/editor of NaturalNews, an infamous alternative medicine website. Claims that proponents of water fluoridation are "psychopathic criminals," "mad scientists," and "some of the most life hating people you'll ever meet.""Water fluoridation DEFEATED in Portland"
*Paul Connett — executive director of the Fluoride Action Network (an anti-fluoridation activist group).
*Ralph Nader — consumer advocate."Ralph Nader on Water Fluoridation" (Sigh)
* — American legal clerk and environmental activist."Erin Brockovich on Water Fluoridation" Actually refers to it as "Fluoridegate".https://groups.yahoo.com/neo/groups/FluoridePoisoning/conversations/topics/12181
* — American actor and environmentalist. https://www.youtube.com/watch?v=bRUjjyD21OY
*Richard A. Passwater — American megavitamin therapy kook
*Paul Saladino — Conspiracy theorist and opponent of fluoride in toothpaste, promotes an expensive "animal-based diet" with fruit.
==Trivia==
*A word of advice — if you're the type of person who freaks out about the fluoride in the water supply, it is advised that you never drink tea; this is because the tea plant — both black and green — is exceptionally good at soaking up fluoride in its soil.Do fluoride levels in cheap tea pose a health risk?, NHS If you're sane, then well, drinking tea without sugar is a good way to improve your dental hygiene because of its high fluoride concentration. People in China commonly used to brush their teeth with tea as an alternative, though their teeth were still significantly worse off than those of the modern toothpaste user.Concerns over China's teeth, BBC
*Due to a pressing need among cranks to rationalize away why your average person won't just run along with any zany Internet theory accept the facts as provided by truthers, the term "fluoride stare" has actually been popularized in the fringe. This term denotes the embarassed glance of non-judgemental (though, palpable) disbelief given by those whose first reaction to having been dragged through a lecture on Obama being a reptilian isn't "YES!! IT ALL FITS!". 
==In a nutshell==
==See also==
*American Academy of Environmental Medicine, a pro-pseudoscience group of physicians.
*Dental woo
*Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis - a commonly miscited study by the anti-fluoridation group.
*Water woo
*Chemophobia
*Fluoride Stare
*Water chlorination
==External links==
*A Systematic Review of Public Water Fluoridation (2000), University of York
*Quackwatch on Water Fluoridation
*Is fluoride in water a good thing or a danger?, The Straight Dope
==References==
Category:Biology
Category:Conspiracy theories
Category:Dental woo
Category:Science
 
Category:Water woo