Talk:Water fluoridation/Archive 3

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Professional Perspectives on Water Fluoridation

Youtube video - Professional Perspectives on Water Fluoridation Tremello22 (talk) 19:21, 21 May 2009 (UTC)

Eckardt vs. Erhardt, and 19th century fluoride research

As reference to early supplements containing potassium fluoride, a "Dr. Eckardt" is mentioned in the article. In fact, the paper cited gives that name as the author; but that certainly is a typo, for several related papers have been written by Dr. Erhardt, who was a public health officer of Emmendingen, near Freiburg, Germany. Dr. Carl Erhardt (1813-1875) had a famous brother, Dr. Wolfgang Erhardt, who worked as a physician for the German embassy at Rome, Italy, and who "endorsed" his brother' s pills, as cited by dentist Georg von Langsdorff in 1875.

There's even more in the early fluoride history than just a few recommendations. The issue was under heavy discussion since the beginning of the 19th century! For details see http://www.fluoride-history.de/fteeth1.htm . Of course, that part doesn'nt please the fluoridistas. They prefer to cite just one side, pro, of the issue. --Tren (talk) 10:55, 24 May 2009 (UTC)

Thanks for the correction. Do you have a full citation to the 1954 JADA paper, in the style already used in Water fluoridation? That is, can you fill in the blanks in the following use of the {{cite journal}} template?

• {{cite journal |author= ???, ???, ??? |title= Potassium fluoride as a caries preventive: a report published 80 years ago |journal= J Am Dent Assoc |volume=49 |issue=? |pages=385–??? |year=1954}}

I confess that I don't see the relevance of the 19th-century history to the modern debate about the benefits and drawbacks of water fluoridation. Water fluoridation has space limitations and it cannot delve all that deeply into topics that aren't directly related to water fluoridation. However, the 19th-century fluoride research could be covered in somewhat greater detail in History of water fluoridation, and the pastilles etc. of the 19th century could be summarized in Fluoride therapy (which greatly needs a History section). Eubulides (talk) 18:57, 24 May 2009 (UTC)

No author of the short article, a translation of a paper by Erhardt, is given. It's just one page, p.385, in the September 1954 issue of the JADA. --Tren (talk) 19:21, 24 May 2009 (UTC)

Thanks; in that case we should probably cite the original too, so I've restored that. Is there a brief introduction to the translation that supports Water fluoridation's claim that Erhardt was a public health officer and that his name was misspelled in the original publication? Is the translator listed in that article? Was the September issue the 9th issue of volume 49 of that journal? Eubulides (talk) 19:42, 24 May 2009 (UTC)

The JADA article is a translation of another paper by Erhardt on the same topic. The original paper was published in "Memorabilien. Monatshefte für rationelle Ärzte" Vol. 19 (November, 1874) pp.359-360. Title: "Kali fluoratum zur Erhaltung der Zähne". The article was reported to the ADA by Eduard G. Friedrich of Chicago; there is no mention if the same person did the translation. Also a paper by Georg von Langsdorff (Dtsch. Vierteljahrsschrift für Zahnheilkunde 15 (1875) 430-9) refers to the public health officer ("Bezirksarzt") Dr. Erhardt. I did some research on Erhardt and was informed by the State Archive that he was a former spa doctor and was employed by the State since 1860, first at Gernsbach; worked since 1872 at Emmendingen, near Freiburg; died 1875 during a cure at Karlsruhe. As Erhardt himself wrote in a paper in 1851, a "Amtsarzt" or "Bezirksarzt" was employed and paid by the State to treat the poor. --Tren (talk) 17:07, 25 May 2009 (UTC)

Thanks again. I was unaware that there were two 1874 publications by Erhardt on the topic. Water fluoridation currently cites the March 1874 publication in Der praktische Arzt (which Google Books has digitized; I searched books.google.com for the string "Kali fluoratum zur Erhaltung der Zähne", in quotes, and it was the 1st of the 5 matches). Is this similar to (perhaps an earlier version of?) the identically titled November 1874 paper published in Memorabilien. Monatshefte für rationelle Ärzte, or are they quite different papers? Since the March 1874 paper identifies Erhardt as a "Bezirksarzt" that's a good enough source for us. Eubulides (talk) 18:26, 25 May 2009 (UTC)

Erhardt spread his stuff through several journals at the same time, in somewhat different wording. The November article cites more explicitly his alleged experiment on dogs. --Tren (talk) 18:45, 25 May 2009 (UTC)

You "don't see the relevance of the 19th-century history to the modern debate about the benefits and drawbacks of water fluoridation." The 19th century quotes cited in this article as well as in some pro-fluoridation papers, selectively quote the "pro" arguments, as if it was well known already then that fluoride was good for teeth. The opposing arguments are disregarded. Dentists and chemists(Wrampelmeyer, Michel, Gabriel) reported that theý found no difference in the fluoride content of sound vs. carious teeth. Berzelius, in his "Jahresberichte" of 1840, wrote that the low amounts of fluoride usually found in teeth are to be considered just accidental components. Gabriel, Harms and others made it perfectly clear that the amounts of fluoride found in teeth and bones with newer and more reliable methods are too low to form fluoroapatite at any significant rate. And they were actually supported by x-ray diffraction studies done in the 1930's. Yet, the fluoridistas still refer just to the purely speculative, unscientific, and unfounded claims of Crichton-Browne, Erhardt, Deninger, and (sometimes) a few others. This exactly is the relevance to the modern debate. "Opponents" are simply treated in an unfair way! Why not state that in the 19th century, the possible benefits of fluoride were subject of (sometimes heated) discussions. Many references for this are cited at the fluoride-history site given above. _That_ would be a fair statement. --Tren (talk) 18:32, 25 May 2009 (UTC)

Well, for starters, we don't have a reliable source saying there were heated discussions, so Water fluoridation can't say that. We also have to be cautious of sources devoted to fluoride in general, as opposed to water fluoridation in particular, as they may not have proper WP:WEIGHT from the water-fluoridation point of view. I do take your point that it's not right just to cite Erhardt 1874 and Crichton-Browne 1892; we need a broader overview of 19th-century fluoride research if we're going to mention it at all. I looked for a bit for one, found Cox 1952, installed a change that gives just a higher-level view of 19th-century fluoride research (citing Cox), and moved the excessive details to History of water fluoridation. I would like a more-recent reliable review of the 19th-century history, from a water-fluoridation viewpoint, but I don't have one. For example, I don't have ready access to Kargul et al. 2003 (PMID 12739679), or to Kumar & Moss 2008 (PMID 18329450). Anyway, hope this change helps. Eubulides (talk) 08:39, 26 May 2009 (UTC)

Cautious wording in Truman et al.

A recent edit made this change (italics are insertions):

"A 2002 systematic review found data seeming to support the conclusion that starting water fluoridation reduces tooth decay in the community by 30–50% overall, and that stopping it leads to an 18% increase when other fluoride sources are inadequate."

However, the cited source, Truman et al. 2002 (PMID 12091093), says this:

"Although we could not quantitatively combine effect measures from groups A and B, both seem to support the conclusion that community water fluoridation reduces dental caries by 30% to 50% of what could be expected for people not consuming fluoridated water. In addition, stopping CWF may lead to the median 17.9% increase in caries described above, in situations in which alternative sources of fluoride are inadequate."

The cited source uses phrases like "seem to support the conclusion" and "may lead", which is considerably more cautious than the new text in Water fluoridation which confidently asserts that starting CWF reduces caries such-and-such and stopping it increases it 18%. Perhaps the old wording was too wishy-washy, but the new wording is too confident. While we're in the neighborhood, the source talks about a "median" 18% increase and that info can easily be reflected in the text, and "in the community" is redundant with "overall". So I installed the following edit to try to further improve the text:

"A 2002 systematic review found that starting water fluoridation seems to reduces tooth decay in the community by 30–50% overall, and that stopping it may leads to an median 18% increase when other fluoride sources are inadequate."

Eubulides (talk) 21:25, 1 June 2009 (UTC)

I've read the paper closer than before. Perhaps there's a cultural difference in the use of "seem". To me it implies two things:

1. The authors are guessing and we all know the gut has no place in scientific evaluation.
2. The conclusion is an illusion that the authors are about to point out.

Neither meaning has a place in an encyclopaedia IMO. In addition "may" does not mean "is likely to" but rather "could possibly", which combined with the source figure of "17.9%" strikes me as a ridiculous combination of precision and indecision. Their conclusions is a solid "strong evidence shows that CWF is effective in reducing the cumulative experience of dental caries within communities." but their attempts to combine the study data to produce some figures fail IMO. Our readers could interpret those words as meaning "we are so unsure that it is also quite possible that starting water fluoridation would lead to an increase in caries or that stopping it would be beneficial".

I'm really not convinced it is worth repeating those numbers if there's no science or maths behind their creation. Looking at the charts in the paper, I'm left with the impression that there are so many variables at play, that the effect of introducing or ending a CWF scheme on a given community cannot be predicted accurately. This has implications for determining in advance if the side-effects or cost of introducing a scheme will make it worthwhile (though both could be measured afterwards and the scheme abandoned if necessary).

Lastly, I'm puzzled about the qualifying statement "when other fluoride sources are inadequate". Do they mean "inadequate" to a sizeable sub-population (fluoride toothpaste available, but high levels of non-usage) or absolutely (fluoride toothpaste generally unaffordable in the community, and water supply has inadequate fluoride). Surely the degree of "inadequacy" is proportional to the increase in caries experienced when one source of fluoride is removed. This further makes a nonsense of the "17.9%" figure IMO. Colin°^Talk 22:46, 1 June 2009 (UTC)

This is being a bit hard on Truman et al., I think. They're just being very cautious in their wording. They are referring to a 17.9% figure that is precise for a reason (it's the median result of 5 studies) but I agree that pulling that figure out of context gives an impression of precision that is unwarranted. The "when other fluoride sources are inadequate" comment is talking, I think, about all other sources of fluoride; this includes not only toothpaste, but also rinses, varnishes, etc., plus halo-effect beverages; see p. 25 column 1 last paragraph. I do agree that the overall Truman numbers are presented confusingly in Water fluoridation. If you have access to Kumar 2008 (PMID 18694870), its table 1 (p. 9) has a much better summary of Truman et al. than we did, but it's fairly terse and including it here would require a lot of elaboration. I'm not sure it's worth it. So for now I removed the poorly-explained numbers and substituted Truman et al.'s conclusion, as follows:

"A 2002 systematic review found strong evidence that starting water fluoridation seems to reduce is effective at reducing overall tooth decay in communities the community by 30–50%, and that stopping it may lead to a median 18% increase when other fluoride sources are inadequate."

I hope this sentence is a useful summary of the the paragraph that it terminates, as it talks about communities as a whole, whereas the previously sentences in that paragraph are each individually limited either to children, or to adults. Eubulides (talk) 06:15, 2 June 2009 (UTC)

Yes, that's fine. I stick by my view that the 30-50% figure is just a hand-wavy opinion, which they are entitled to offer but needs context before it becomes repeatable here and sticks out compared to all the other stats that have confidence intervals, etc. The 17.9% figure is just silly and what they said is different to what was reproduced here. They said "stopping CWF may lead to the median 17.9% increase in caries described above" (i.e., you might get a result just like the median of the results in this analysis) whereas we said that "stopping CWF may lead to a median 18% increase", which (because "median" only makes sense within a sample) says "if several communities stopped CWF, the median of their increase may be 18%", which is too precise. But even thought they say "you may get this figure", it is worthless without some idea of how likely that "may" is. If you fill a 1 litre bucket with pebbles at a beach, you may get 243 pebbles. And you may not. Colin°^Talk 08:22, 2 June 2009 (UTC)

Unreliable sources added to the lead

A recent edit added this text:

"though certain side effects have been suggested[1], such as calcification of the pineal gland[2], elevation of blood lead level[3], effects on thyroid activity[4], osteosarcoma [5], bone fractures[6], and decreased fertility[7]."

There are a couple of problem with this change.

• The main problem is that it introduced several primary sources in order to dispute the conclusions of the reliable secondary sources cited in this article. This is contrary to WP:PSTS and of WP:MEDRS, which say that Wikipedia articles (particularly for medical facts and figures) should rely mainly on secondary sources such as reviews, and should not use primary sources to overturn the conclusions of secondary sources.
• The sources cited by this new text are either irrelevant, or unreliable primary sources, or both:

1. Paul Connetta Report of meeting and commentary: US National Research Council Subcommittee on Fluoride in Drinking Water Fluoride Vol. 36 No. 4 280-289 2003 [1]

   This is a personal report of one meeting of the U.S. NRC project that eventually produced a report that is explicitly not about water fluoridation. So not only is this source not reliable, it's about a different topic.

2. Luke, Jennifer. "Fluoride Deposition in the Aged Human Pineal Gland". Caries Res. 2991 (35): 125–28. Retrieved 2009-05-20. {{cite journal}}: Cite has empty unknown parameters: |laysource=, |laydate=, |laysummary=, and |month= (help)

   This primary study presents zero evidence of adverse effects. The claim that it reports adverse effects is one of many unsupported claims that fluoridation is linked to "poisonings and various accidents, allergies, brain dysfunctions such as Alzheimer's disease, hyperactivity, low intelligence, arthritis, bone diseases including hip fractures and osteosarcomas, cancers, dental fluorosis, gastrointestinal problems, diseases of the kidney, pineal gland and thyroid gland, reproductive issues, AIDS, and even with increased tooth decay" (this list is from Armfield 2007, PMID 18067684, a reliable source on such claims). Water fluoridation already mentions some of these claims, which are not supported by the scientific evidence. I don't see any evidence that the pineal-gland claim is any more notable than the rest.

3. Roger D. Masters; Myron J. Coplan. Water treatment with silicofluorides and lead toxicity International Journal of Environmental Studies, 1029-0400, Volume 56, Issue 4, 1999, Pages 435 – 449

   This primary study is reviewed by Pollick 2004 (PMID 15473093), already cited in the article. As per WP:MEDRS the article should not use primary studies to dispute reliable reviews.

4. Galletti P, Joyet G. Effect of fluorine on thyroidal iodine metabolism in hyperthyroidism J Clin Endocrinol 1958;18:1102-10

   This is a 1958 (!) primary study. If it is not summarized in recent reliable reviews, it is not notable. As per WP:MEDRS it should not be cited directly.

5. Cohn PD. A brief report on the association of drinking water fluoridation and the incidence of osteosarcoma among young males New Jersey Department of Health, November 8, 1992.

   This is a 1992 (also old!) primary study on osteosarcoma. Water fluoridation is citing a reliable review on osteosarcoma (NHMRC 2007) and should not be attempting to undermine the conclusions of this review with an old primary study.

6. Li Y, Liang C, Slemenda CW, Ji R, Sun S, Cao J, et al. Effect of long-term exposure to fluoride in drinking water on risks of bone fractures. J Bone Miner Res 2001;16:932-9.

   This primary study reports that the risk of bone fracture is lower in water fluoridated to recommended levels. However, regardless of whether it is evidence for or against fluoridation, this shouldn't be cited directly; instead, the article should cite a reliable review of this study, which it already does (NHMRC 2007).

7. Freni SC. Exposure to high fluoride concentrations in drinking water is associated with decreased birth rates. J Toxicol Environ Health 1994;42:109-21.

   This primary study is about fluoridation to well above recommended levels, and is thus not directly relevant to water fluoridation. Again, reliable reviews should be cited instead of this old primary study.

• One other problem with the change: it altered the lead so that it no longer summarized the body, but instead contradicts the body. As per WP:LEAD, the lead is supposed to summarize the body.
• With all these problems, the simplest thing was to revert the change, which I've done. I don't see any topic here that is worth mentioning in the article (certainly not in the lead), but perhaps something could be salvaged, and further comments are welcome.

Eubulides (talk) 05:57, 30 June 2009 (UTC)

I think it's ridiculous that you're removing my edit. Primary sources ARE acceptable, just not preferable. Look at any medical/scientific article on wikipedia. Even though secondary (review) sources are preferable in general, I'd say that wikipedia policy prefers many primary sources to few review sources. In the scientific community, no one would ever rely on a SINGLE review article, because even the authors of review articles can have a bias.

Regardless, I think it's absolutely foolish and POV to say "there is no clear evidence of any adverse effects" unless you're using some opinionated definition of "adverse." Look at some side-by-side X-rays of human brains, and you'll see that the pineal gland is invisible in people with a low fluoride intake and it is a bright (i.e., hardened with calcium) spot in people with fluoride in their drinking water. Fluoride in drinking water changes the pineal gland's composition and appearance, which probably changes its functioning, and though I'm sure no neurobiologist would say that's clearly adverse or beneficial, I think obvious side effects on the human brain shouldn't be marginalized.

I would just add an image of side-by-side brain x-rays and notate the calcified pineal gland, and since wikipedia's rules on images are more lenient, that probably would remain on the page. However, I don't have noncopyrighted images like that. I'd appreciate if somebody could post something like that, and I'd be happy to annotate it.

Either way, this article should NOT ignore the effects of fluoridated water on the pineal gland, so I'm going to add that one bit back in. I don't want to rewrite the entire article, so I'm just going to put it in the header. Inasilentway (talk) 14:46, 30 June 2009 (UTC)

I moved discussion of the pineal gland from the lead (where it definitely does not belong) into the body, and cited a reliable secondary source (a review) rather than a primary source directly. It's true that primary sources are acceptable on occasion, but they cannot be used to dispute reliable mainstream opinion, which is what was happening here. Please see WP:PSTS for details on this Wikipedia policy. Eubulides (talk) 20:56, 30 June 2009 (UTC)

I really think this article (or one or more of its authors) has hidden POV, and its featured article status should immediately be reviewed. I truly believe that it is unencyclopedic and biased--in the header it admits "Moderate-quality studies have investigated effectiveness; studies on adverse effects have been mostly of low quality" and yet it cites numerous review articles of the available research. I think that: 1)these secondary sources could not be reliable without adequate primary evidence, which is admittedly lacking 2)if it's true that the information is lacking, then it's probably more enlightening and manageable to refer to primary sources rather than equally uninformed secondary sources 3)specifics on primary evidence could easily and should be presented. Therefore, I think primary sources, such as the ones that were deleted from my first edit, should be allowed on this page.

I made my argument about x-ray evidence of human pineal gland calcification due to fluoride in drinking water earlier in this discussion. You can refer to pineal gland if you want confirmation. Granted, calcification of a gland of the brain is not a clear "adverse effect," but it is an obvious side effect. Yet even a mere reference to that fact was only grudgingly allowed to be included in the article after reverting my first TWO attempts at including it, and even then, it was inserted right next to the conspiracy theories section with a citation to a paper with only one reference to the pineal gland in the entire article in the section "Fear Mongering."

Maybe we need moderation/arbitration on this. The article probably should not be a featured article. My edits are being aggressively deleted and I think it's unfair and causes this article to push an unbalanced viewpoint. Maybe this is a reflection of a larger cultural bias in favor of water fluoridation, but I really do think this article, even subtleties of its wording, organization, and punctuation, is far too supportive of water fluoridation in light of the admittedly lacking research on its effects.Inasilentway (talk) 06:07, 1 July 2009 (UTC)

Please see #Numerous review articles below. Eubulides (talk) 07:51, 1 July 2009 (UTC)

Numerous review articles

• "in the header it admits "Moderate-quality studies have investigated effectiveness; studies on adverse effects have been mostly of low quality" and yet it cites numerous review articles of the available research" And the very sentence quoted is supported by one of those review articles, namely the York review (2000). The York review, like the other reviews, summarizes primary studies of varying quality. There is nothing wrong with citing review articles; on the contrary, it's preferred (see WP:MEDRS). What's wrong, from a Wikipedia point of view, is to pick and choose some of the primary studies in order to dispute the reviews (see WP:PSTS for more on this).
• "these secondary sources could not be reliable without adequate primary evidence" Secondary sources can certainly be reliable even in the presence of unreliable primary sources. They can say what is unreliable about the primary sources and why, and can give the consensus view on what the primary sources actually mean. For example, all currently-available reliable secondary sources agree that water fluoridation reduces cavities, even though the primary sources establishing this result are not high quality by today's standards.
• "if it's true that the information is lacking, then it's probably more enlightening and manageable to refer to primary sources rather than equally uninformed secondary sources" No, the secondary sources are not "equally uninformed". They are written by published experts in the field. It would be against Wikipedia policy for us to second guess the experts. Again, please see WP:PSTS.
• "specifics on primary evidence could easily and should be presented" No, because that's far too prone to abuse. Please see WP:MEDRS for why. For example, a Wikipedia editor could easily use primary sources to "prove" that water fluoridation causes AIDS. Another one could just as easily use them to "prove" that water fluoridation causes cavities. None of these "proofs" would pass muster in any serious scientific journal, and Wikipedia should not be passing along misinformation like this. The way to avoid this sort of problem is to rely on the best reviews available from mainstream scientific and medical sources.
• "You can refer to pineal gland if you want confirmation." We cannot rely on other Wikipedia articles for confirmation of medical facts and figures. For obvious reasons we must rely on external reliable sources. There is no scientific evidence that water fluoridation adversely affects the pineal gland (or the thyroid, or the kidneys, etc.), and Water fluoridation should not say or imply otherwise. Dental fluorosis is the only adverse effect for which there is scientific evidence (admittedly low-quality evidence), and the topic of dental fluorosis is amply covered in Water fluoridation.
• "Maybe this is a reflection of a larger cultural bias in favor of water fluoridation" Possibly so, but in that case Water fluoridation must faithfully reflect mainstream views. Wikipedia is not the place to conduct original research that proves the mainstream wrong.
• To avoid reinventing the wheel on this subject, it might help to review the January good article review, the February peer review, the March featured-article candidacy, and the June featured-article candidacy.

Eubulides (talk) 07:51, 1 July 2009 (UTC)

Text deleted from the lead

A recent series of edits deleted significant text from the lead, causing the lead to be a less-than-faithful summary of the body as required by WP:SUMMARY. Here are the two chunks of text that were deleted (I'm rendering the citations inline in this copy):

• "Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride.(CDC 2001, PMID 11521913) Fluoridated water operates on tooth surfaces: in the mouth it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities.(Pizzo et al. 2007, PMID 17333303) Typically a fluoridated compound is added to drinking water, a process that costs an average of about $1.32 per person-year in the U.S.;(CDC 2001, PMID 11521913; Minn Fed 2009) defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits.(Taricska et al. 2006, doi:10.1007/978-1-59745-029-4_9). A 1994 World Health Organization expert committee suggested a level of fluoride from 0.5 to 1.0 mg/L (milligrams per liter), depending on climate.(WHO 1994)"

• This text summarizes the Implementation and Mechanism sections, and these sections need to be summarized in the lead.

• "Dental cavities remain a major public health concern in most industrialized countries, affecting 60–90% of schoolchildren and the vast majority of adults,(Petersen & Lennon 2004, PMID 15341615) and costing society more to treat than any other disease.(Sheiham 2001, PMID 11683551)"

• This text summarizes the Goal section, another section that needs summarization in the lead.

The edits also made this change:

• "Water fluoridation is the controlled addition of fluoride to a public water supply to reduce under the premise of reducing tooth decay."

But the cited source (CDC 2001, PMID 11521913) does not say anything about a "premise"; it states, for example, "Community water fluoridation is a safe, effective, and inexpensive way to prevent dental caries." with no mention of a "premise". So this alteration is not supported by the cited source.

Some of the edit summaries that justified these changes seemed to be based on obsolete information (e.g., "misleading as implies topical effect, when the majority is systemic"); other edit summaries are debatable, but in any event I suggest any problems with the lead be discussed here before making such wholesale changes. I see that while writing up the above, another editor reverted these deletions, which was a good thing to do for now. Eubulides (talk) 21:53, 11 July 2009 (UTC)

"one of 10 greatest achievements... 20th century"

Mentioned twice....annoying, and repetitive...

Or is it just me? Is it possible to unify this? —Preceding unsigned comment added by 98.21.61.161 (talk) 04:10, 21 July 2009 (UTC)

One occurrence is in the lead and one in the body. The lead is supposed to summarize the body; see WP:LEAD. If there weren't repetition between the lead and the body, something would be wrong. Eubulides (talk) 04:13, 21 July 2009 (UTC)

consensus

14 Nobel Prize winners jointly stating fluoride is dangerous--is a conspiracy?? [www.nofluoride.com/presentations/Nobel%20Prize%20Winners.pdf]

210.50.176.57 (talk) 01:02, 1 August 2009 (UTC)

Who knows - could it be called an Appeal to Authority? Shot info (talk) 02:18, 1 August 2009 (UTC)

There is no such joint statement. There is an unsupported list floating around antifluoridation websites. For example, this list mentions Hans von Euler-Chelpin (Chemistry, 1929) as being one of 14 Nobelists who "have opposed or expressed reservations about fluoridation"; however, the website cites no sources and is not itself a reliable source. Euler-Chelpin died in 1964 and his opinion about fluoridation (whatever it was) is no longer relevant to this article, except possibly to the History section. Eubulides (talk) 05:22, 1 August 2009 (UTC)

210.50.176.57, if you can provide a better source (after all, "Nofluoride" probably doesn't qualify as a reliable source for encyclopedic content) then it can be evaluated. But I agree with Eubulides, there is no way that this document can be independantly verified if it's actually correct, or misrepresenting the position of those 14 NP winners. This is a problem about sourcing material from poor sources, mainly as one cannot have a high confidence in the validity of their material. But if you have a good source, with the pertinent info, by all means submit it. Shot info (talk) 22:57, 5 August 2009 (UTC)

As a public policy decision

The following text was recently added to the lead by an IP address:

As a public policy decision, the most important issue -- too often ignored -- is the choice of compound for this purpose. Whereas sodium fluoride (NaF) dissociates into its component elements and has little if any negative side effect, silicofluorides -- fluorosilicic acid (H2SiF6) or sodium silicofluoride (Na2SiF6) -- are toxins that do NOT dissociate totally (as shown by the German chemist Westendorf in 1975). Evidence of harmful effects of the residual (an oligomer of silicic acid) have been extensively documented in work by Coplan and Masters (see <www.dartmouth.edu/~rmasters). Since sodium fluoride was tested before use and is without known harmful side effects, it should be used for water fluoridation; silicofluorides were nominated for testing in 2002 by the National Toxicology Program of the U.S. (on the grounds that their "toxicology" was not adequately known), and without such testing claims of benefit need to consider apparent harmful side-effects (higher rates of learning disabilities, substance abuse and violent crime, each of which is plausibly due to greater impulsiveness in users due to the effects on the neurotransmitter acetylcholinesterase that were found by Westendorf).

There are several problems with this material:

• It obviously advocates for the minority viewpoint that the choice of fluoridating compound has a significant health effect, violating WP:NPOV.
• It puts material in the lead that does not summarize anything in the body, contrary to WP:LEAD.
• It contains much material that is not sourced, contrary to WP:V.
• The sources that it uses are primary sources. As per WP:MEDRS the article should use reliable secondary sources on the topic of silicofluorides, and should not use primary sources in an attempt to undermine the secondary sources.
• This topic is already well covered in Water fluoridation # Safety, which cites both Pollick 2004 (PMID 15473093) and Macek et al. 2006 (PMID 16393670) on the topic, sources that are much stronger.

For this reason I moved the material into this talk page section, where it can be further discussed with the above points in mind. Eubulides (talk) 04:56, 11 August 2009 (UTC)

Posted by John Chalos

Posted by John Chalos August 24, 2009 john.chalos@gmail.com

Okay. It seems someone removed my post (based on an article I co-wrote with my father for the local newspaper and not otherwise copyrighted) saying it was copyrighted material. I'd like to make a plea for you to ignore the "regard" some have shown for this prize-winning entry to your encyclopedia. Popularity (especially, among those with vested interest) shouldn't be a motivating factor when determining how we educate our society. I think eleven EPA unions protesting water fluoridation before congress in 2005 and the National Academy of Sciences objecting to it in 2006 reflects credible dissent. I'd like the article to reflect those documented events. They were covered by many news sources but I guess posting links, quotes or excerpts would get this deleted since my post might contain some copyrighted material. Geez. Come on, this is censorship. For links to viable news sources, see the following pages: www.slweb.org, www.fluoridealert.org, www.nofluoride.com. —Preceding unsigned comment added by 9chambers (talk • contribs) 22:46, 24 August 2009 (UTC)

• Yes, that material was removed because it was a duplicate of a 2006 copyrighted opinion piece signed by Pete Chalos in the Terre Haute Tribune-Star. Wikipedia cannot accept copyrighted material like that.
• The above comments mischaracterize the 2006 National Academy of Sciences report, which explictly "does not examine the health risks or benefits of the artificially fluoridated water that millions of Americans drink".[2]
• Fringe sites like fluoridealert.org are not reliable sources for medical facts and figures; see WP:MEDRS.
• The letter from the EPA union does not appear to be notable, as nothing came of it. It was, if memory serves, led by a single antifluoridation member of the Washington DC local. However, if we can find reliable third-party sources establishing this letter's notability, it might be suitable for the Opposition to water fluoridation article.

Eubulides (talk) 23:12, 24 August 2009 (UTC)

Posted by John Chalos August 25, 2009 john.chalos@gmail.com

The 2005 congressional hearing was sparked by the objections of no less than eleven EPA unions representing 7,000 qualified professionals. The "leader" happened to be Dr. J. William Hirzy, Senior Vice-President and a chief toxicologist at the EPA. Nothing came of it but it was a significant protest. I appreciate you linking the NAS statement; I do think the article makes it clear that some in this country are being over-exposed to fluoride (in part) due to water fluoridation. I feel you're neglecting much of the information but you do seem to address some concerns in your "Opposition to water fluoridation" article. Lastly, I'd like to encourage you to take a moment to review the short video on the main page at www.fluoridealert.org. Thank you for listening and responding. —Preceding unsigned comment added by 66.64.210.50 (talk) 05:58, 25 August 2009 (UTC)

If you have a reference or citation to that 2005 congressional hearing, that would be worth adding to the Opposition to water fluoridation article. The NAS study was entirely about water naturally fluoridated to levels well above those recommended for fluoridated water, and the study itself explicitly rejected the claim that the study was about water fluoridation; see, for example, page 20 of the study, which said "The committee is aware that some readers expect this report to make a determination about whether public drinking-water supplies should be fluoridated. That expectation goes beyond the committee’s charge. As noted above, the MCLG and SMCL are guidelines for areas where fluoride concentrations are naturally high."[3] Eubulides (talk) 14:22, 25 August 2009 (UTC)

Like the person above

Like the person above, all my posts have been deleted from this discussion by someone. Again, diabetic people consume more water than normal, and daily as much fluoride from 1 ppm fluoride water as normal people on 2 ppm fluoride water. This disproves the extreme claim in 'fluoridation' that fluoridation does not increase risk of bone fractures. Consensus agreement exists that 2 ppm fluoride daily uptake for lifetime exposures reach thousands of mg/kg bone fluoride that increases bone fracture risk.

Will this post also be deleted? —Preceding unsigned comment added by 72.220.56.10 (talk) 04:07, 1 September 2009 (UTC)

• The previous comment was evidently made by Rsauerheber (talk · contribs) without logging in. I'm not sure who its phrase "the person above" refers to. Rsauerheber, perhaps you could clarify? It would help to log in before posting, so that this sort of confusion could be avoided.
• The point about diabetics is evidently original research, and by policy can't appear in Wikipedia articles.
• Also, please read the policy page Wikipedia:What Wikipedia is not, particularly its section Wikipedia is not a soapbox. Following its device will help keep this thread on track. This talk page is for improving the article, not for serving as a general forum about water fluoridation. Off-topic threads are routinely deleted.

Eubulides (talk) 04:24, 1 September 2009 (UTC)

Understood.

1) Diabetic consumption data were published, reviewed by the National Research Council and re-published; it is not my original research.

2) There is total consensus that fluoride is NOT an essential element, because there is NO deficiency state that is reversed by the element alone that has ever been induced (The Merck Manual, 7th ed., 'Fluorine') This directly disproves the claim in 'fluoridation' that fluoride is added in a manner similar to that for iodide to reduce goiter. Such a claim is that of an extreme fringe minority who remain grossly mis-informed. If Wikipedia is interested in improving the article 'fluoridation', then at the very least could this false statement be deleted?

3) All artificial fluorides are listed on all poisons registries as rat poisons and insecticides (such as The Merck Manual 6th Ed., p. 2694; The Merck Index, 1976, etc.) while natural calcium fluoride is not listed on any poisons registry because its lethal dose is 30 times higher and is incapable of generating corrosive hydrofluoric acid HF in drinking water. The overfeed mentioned in 'fluoridation' used artificial sodium fluoride, which is 3,000 times more soluble (4.3 grams per 100 milliliters of water) than natural calcium fluoride (0.0015 grams per 100 milliliters). The poisoning of 300 people could not have happened if natural calcium fluoride (not a toxic compound below 5,000 grams per kg) were used for 'fluoridation' at 1 ppm. Natural calcium fluoride solubility prevents fluoride levels above 7 ppm fluoride in drinking water. Sodium fluoride and sodium fluorosilicate have lethal doses of a mere 0.125 grams per kg in tested animals, which compares to the lethality of arsenic.

The consensus viewpoint of the American people is against the artificial fluoride chemicals listed in the article 'fluoridation' that are injected into natural drinking waters, and in fact the people have voted more often than not against artificial fluoridation of water with these substances. They are widely used by water districts with support by city officials, rather than any perceived support of the people. (Nebraska state referendum voting data are on the public record, as are San Diego city voting data, but in most cases citizens are forbidden from voting on the procedure).

4) Teeth mottling according to scientific consensus is evidence of "consumption of too much fluoride" (Webster's 7th New Collegiate Dictionary), which is not a mineral nutrient in the first place (comment #2 above). Zipkin's studies published 1958 and recently reviewed proved that incorporation of fluoride sufficient to cause mottling of teeth already also caused incorporation of fluoride into bone that is irreversible (because calcium fluoride is so grossly insoluble) to thousands of times that above the level in fluoride water that caused such mottling. Accumulation progresses for the lifespan of the individual and the voting public should be given balanced credit for the choice and votes they have made. The article 'fluoridation' distorts the above 4 points of accepted fact.--Rsauerheber (talk) 05:41, 1 September 2009 (UTC)

For starters, please stop using spaces prior to your paragraphs - use the "Show Preview" button to see how your edits will turn out.

Secondly - exactly what changes do you propose to the article. All your paragraphs above are soapboxing and not helping the article.

Thirdly - the article states, The U.S. specifies the optimal level of fluoride to range from 0.7 to 1.2 mg/L (milligrams per liter, equivalent to parts per million), depending on the average maximum daily air temperature; the optimal level is lower in warmer climates, where people drink more water, and is higher in cooler climates.[31] The U.S. standard, adopted in 1962, is not appropriate for all parts of the world and is based on assumptions that have become obsolete with the rise of air conditioning and increased use of soft drinks, processed food, and other sources of fluorides. In 1994 a World Health Organization expert committee on fluoride use stated that 1.0 mg/L should be an absolute upper bound, even in cold climates, and that 0.5 mg/L may be an appropriate lower limit.[6] A 2007 Australian systematic review recommended a range from 0.6 to 1.1 mg - so your numbers are largely irrelevant in an article about Water Fluoridation and the dangers thereof.

Please cease with the soapboxing - start proposing where and what sections in the article you want changed, and your proposed changes. Shot info (talk) 05:51, 1 September 2009 (UTC)

I second this. Please propose specific changes to the article. What words would you change/add/remove and cite which reliable sources back up those changes. All the above is just soapboxing, wastes our time and will be deleted. Colin°^Talk 09:02, 1 September 2009 (UTC)

#1 'fluoridation' statement-- 'fluoride can occur naturally in water in concentrations well above recommended levels, which can have several long-term adverse effects, including severe dental fluorosis, skeletal fluorosis, and weakened bones.[42] The World Health Organization recommends a guideline maximum fluoride value of 1.5 mg/L as a level at which fluorosis should be minimal.[50]' Proposed addition: This guideline however does not take into account the high volume of water necesary for subgroups of people, such as with diabetes who consume the same fluoride daily dose from 1 ppm water as non-diabetic individualse drinking 2 ppm fluoride water. [note to editor: diabetic subgroups (and others with health conditions requiring high volume water consumption) were not identified and were instead merely averaged among populations examined in reviews such as that of York]. This fact also applies to the statement that fluoride does not affect bone strength and to the statement that if has no other adverse effects. These claims do no and have never applied to diabetics and other high water volume consumers. This is because biologic effects depend on the total amount consumed, not simply the 1 ppm concentration, as noted in a separate statement in 'fluoridation'].

T #2 statement-- 'the recommended level should not be below 0.5 ppm fluoride' correctly describes the decision made by the WHO, but it renders the false conclusion that water supplies with 0.2 ppm are somehow then deficient, and also that fluoride ia somehow a necessary mineral nutrient, when (as stated in the earlier post) it is not. The U.S. FDA and NRC both recognize that no condition (including dental disease) is associated with complete absence of fluoride. A qualifier is thus necessary to avoid presuming the WHO are alone experts on this topic. Millions of people have zero cavities for lifetimes in areas with water fluoride below 0.5 ppm. —Preceding unsigned comment added by 205.153.156.222 (talk) 19:56, 1 September 2009 (UTC)

#1 proposes text that does not cite any reliable sources, and thus fails the verifiability policy. #2 does not propose any specific change to the article. Eubulides (talk) 23:53, 1 September 2009 (UTC)

#1 references are numerous but one is: Greenburg, L., Nelsen, C. and Kramer, N., Pediatrics 54:320, 1974. is one of many references on the subject. These authors also recommended that diabetes insipidus, renal medullary disease, nephropathy patients, and most with solute diuresis are associated with such large water volume consumption that fluoride water levels considered acceptable for normal individuals would be sufficient to cause fluorosis symptoms over long term drinking. In studies with only 2 ppm fluoride for chronic periods suchindividuals defeloped abnormal bone X-rays due to incorporated fluoride.

The change I propose for #2 is a statement that 'fluoride is not a mineral nutrient, and no pathologic condition of any kind is associated with the absence of fluoride intake. The complete absence of fluoride in a human being is not an abnormal condition. Fluoridation of a human being is not a physiologic requirement for human health. The absence of fluoride does not cause dental caries. Caries are caused by consumption of sugary foods and not cleaing teeth afterward. [note: many references to these effects were already deleted from earlier posts]. Either fluoridation is explained well with proper context from both sides (knowledgable opponents vs. others who want it) or it will simply remain as is, with inferences a reader will make that are not true. —Preceding unsigned comment added by 205.153.156.222 (talk) 00:33, 2 September 2009 (UTC)

• Greenberg et al. 1974 (PMID 4414789) cannot possibly support #1, as #1 begins "This guideline ...", referring to the 2006 WHO guideline; and a 1974 paper of course cannot possibly make any statement about the 2006 WHO guideline. And, at any rate, there is no reason for the Water fluoridation article to cite a case report, a very low quality primary source, when far better sources are available. The Wikipedia guideline on medical sources says that case reports "are a form of anecdote and generally fall below the minimum requirements of reliable medical sources".
• No reliable sources have been given for #2.

Eubulides (talk) 03:53, 2 September 2009 (UTC)

If the better source mentioned (which is not referenced in the post) claims that people with diabetes insipidus drinking 1 ppm fluoride do not compare to people drinking 2 ppm, then that source, not matter how reliable Wikipedia considers it, is wrong.

Since 'fluoridation' is not going to make the corrections required, then the article cannot be recomended for any of my students, family or friends because it implies that all bone cancers in victims drinking 1 ppm water as source of fluoride were not caused by that fluoride; and that the U.S. FDA is incorrect in its position that fluoride is not a mineral nutrient and is uncontrolled use of a drug. Water fluoridation has never been approved by the FDA in spite of recommendations by the WHO. The FDA, not the WHO, is correct in their assessment.

It is unethical for anyone to presume the right to control an entry called 'fluoridation' in a public encyclopledia as though their written statements are all correct, and yet this is exactly what is being done under the auspices of Wikipedia. Good luck to you. --205.153.156.222 (talk) 23:19, 2 September 2009 (UTC)

The ariticle is only controlled (limited, if you will) by what can be backed up by published reliable sources. It may well be that we lack good quality sources on some of these issues and consequently the article suffers -- but that is the consequence of Wikipedia's policies. If the article was written by a named authority on the subject, and reviewed by other named authorities, such as might occur on Britannica, then we could leave it to those experts to judge whether to include one aspect or another, and whether to give a particlar case report or opinion weight or not. As Wikipedia can be written anonymously by anyone, we require all facts to be sourced elsewhere -- not to Wikipedian's own opinions, whether those opinions seem reasonable or not.

The issue that certain groups of people with illnesses that lead them to consume large quantities of water, and consequently are at greater risk of fluorosis, is a valid one. It is similar to the issues of setting the levels of fluoridation in hot countries vs temperate countries. If a reliable source can be found for this aspect it could be mentioned, but it must not be specified in a way that criticises the WHO guideline limits unless the reliable source also criticised the WHO guideline limits.

A statement something like "Fluoride is not an essential mineral nutrient and the absense of fluoride does not cause dental caries" seems a reasonable addition, provided a reliable source can be found for this. I think it would be useful to clarify that fluoride is not like certain other minerals that we require in our diet. However the statement "no pathologic condition of any kind is associated with the absence of fluoride intake" is not true -- caries is associated with lower/no fluoride intake, just not caused by it. The other points you suggest to add merely labour the point, and the causes of caries are more complex than just sugary snacks and insufficient brushing.

Colin°^Talk 14:31, 3 September 2009 (UTC)

Thanks for those helpful comments. Please see #Diabetes and #Essential nutrient below. Eubulides (talk) 19:16, 3 September 2009 (UTC)

Diabetes

For the topic of diabetes and water fluoridation, I searched the three best reviews we have on the safety of water fluoridation (the 2007 Australian review, Truman et al. 2002 (PMID 12091093), and the 2000 York review), and found no mention of diabetes or diabetics. This suggests that any concern about the effects on diabetics are not given much weight by mainstream medicine and science. Any other reliable sources in this area would be welcome; I did a brief Google Scholar search for recent sources and came up dry, though. Eubulides (talk) 19:16, 3 September 2009 (UTC)

Dietary Reference Intake

The material about Dietary Reference Intake mentioned in the previous thread should be added, since this provides important context for the existing treatment of daily intake of fluoride. To do this, in Mechanism, just before the sentence that begins "A rough estimate is that an adult in a temperate climate consumes 0.6 mg/day of fluoride without fluoridation", I propose that we insert the following text:

"The U.S. Institute of Medicine has established Dietary Reference Intakes for fluoride: Adequate Intake values range from 0.01 mg/day for infants aged 6 months or less, to 4 mg/day for men aged 19 years and up; and the Tolerable Upper Intake Level is 0.10 mg/kg/day for infants and children through age 8 years, and 10 mg/day thereafter."

citing:

Institute of Medicine (1997). "Fluoride". Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride. National Academy Press. pp. 288–313. ISBN 0-309-06350-7. {{cite book}}: External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)

Eubulides (talk) 08:05, 6 September 2009 (UTC)

Yes, a useful addition. Colin°^Talk 00:03, 9 September 2009 (UTC)

Several controversial edits recently installed

This recent series of edits by Petergkeyes (talk · contribs), which follows on the similar edit made a few minutes earlier by 71.140.3.164 (talk · contribs · WHOIS), installs obviously-controversial material into the article without any previous discussion. These changes should be reverted, and the matter discussed first on the talk page, as the top of this talk page says. Eubulides (talk) 23:28, 8 September 2009 (UTC)

I've reverted the changes, which removed cited text. Please discuss what is wrong with the text you wish to remove. Colin°^Talk 23:58, 8 September 2009 (UTC)

it is a chemical. the natural stuff is not, "adjusted," as sometimes erroneously claimed.

The stuff that is used to fluoridate drinking water is a chemical. This is irrefutable, and is not up for debate. Petergkeyes (talk) 23:38, 8 September 2009 (UTC)

Water is a chemical, for goodness sake. A serious encyclopaedia doesn't adopt dumbed-down Daily Mail language. The insertion of "chemical" is clearly an attempt to introduce POV via the lay assumption that "chemicals" are nasty and to be avoided. Colin°^Talk 23:58, 8 September 2009 (UTC)

Fluoride is simply an element. The material added to the water is not simply an element. It is a compound chemical. I prefer the word chemical, but will settle for compound as a second choice. Petergkeyes (talk) 00:34, 9 September 2009 (UTC)

Why does this word need to be added? Shot info (talk) 00:38, 9 September 2009 (UTC)

Actually Peter, the location you have added it into is not needed. If you continue reading the paragraph you will see how the "addition of fluoride" is achieved. Likewise in the body of the article it is articulated more fully. The starting sentence how it was prior to your edit makes a nice neat summary of what "Water Fluoridation" actually is which is "Fluoridation of Water" by adding "fluoride" to "water". Shot info (talk) 00:43, 9 September 2009 (UTC)

For those who do not continue reading the paragraph, the first sentence is more accurate with the material identified. "Fluoride" is only a portion of what is added. It increases the accuracy to note the additive used, not just its targeted element. Petergkeyes (talk) 00:54, 9 September 2009 (UTC)

? Huh - increases accuracy? The first sentence is 100% accurate about Water Fluoridation prior to your edit - as the article is about ensuring fluoride is at a certain level in water - hence Water Fluoridation. BTW - have you read compound yet? Shot info (talk) 01:10, 9 September 2009 (UTC)

What is your argument, Shot? All of the additives used to fluoridate public water supplies are compound chemicals. Do we agree on that? 01:26, 9 September 2009 (UTC) —Preceding unsigned comment added by Petergkeyes (talk • contribs)

It's pretty easy to read what my argument - the article is about ensuring fluoride is at a certain level in water - hence Water Fluoridation. Shot info (talk) 03:22, 9 September 2009 (UTC)

• The cited source, CDC 2001 (PMID 11521913), uses "fluoride" (not "fluoride chemical" or "fluoride compound") to define water fluoridation. Here's the quote: "Fluoridated drinking water contains a fluoride concentration effective for preventing dental caries; this concentration can occur naturally or be reached through water fluoridation, which is the controlled addition of fluoride to a public water supply." Generally speaking, all the reliable sources consistently focus on the fluoride, not the far-less-important detail of which compounds were used. Inserting "compound" or "chemical" in the lead sentence is de facto advocacy of the minority view that criticizes fluoride "chemicals" (or "compounds"), violating WP:NPOV. Let's stick with the established terminology used by reliable mainstream sources on the subject.
• I again ask that potentially-controversial changes like these be proposed on the talk page first, not inserted unilaterally without discussion, as this change and this change were in the past three hours or so. Please see the top of this talk page.

Eubulides (talk) 03:53, 9 September 2009 (UTC)

Economics

I did a bit of reading to see what's new in water fluoridation, and found a couple of new papers on the economics that raise worthy issues that are not discussed in this article. First, water fluoridation results in less employment for dentists (this is a no-brainer, but I have not before seen a reliable source on this). Second, U.S. chidren who grow up in fluoridated areas earn more than those who do not; this effect is almost all in girls from poorer families, suggesting that it's due to a beauty premium when those girls grow up. I added a brief discussion of these topics and renamed Cost to Economics to reflect the now-broader topic of that section.

Eubulides (talk) 18:50, 31 August 2009 (UTC)

Can you prove that brushing their teeth didn't prevent the cavities instead? People who drink fluoridated water but don't brush their teeth get cavities, while those who brush their teeth and drink bottled or distilled water do not. Dream Focus 16:22, 10 September 2009 (UTC)

The source in question (Glied & Neidell 2008 [PDF]) states that because the study is based on data from a time before fluoridated toothpaste and sealants became popular, its results can be ascribed to water fluoridation as opposed to fluoridated toothpaste or sealants. Fluoridation #Economics does mention that the data were from 1957–1964; do you think that it should also mention that this predates fluoridated toothpaste and sealants? Eubulides (talk) 17:40, 10 September 2009 (UTC)

Essential nutrient

I investigated the topic of whether fluoride is considered to be an essential nutrient, and found that modern reliable sources do consider it to be one. Here is a quote explaining the situation:

"Furthermore, the actual function of an essential nutrient can vary categorically in at least two important ways. First, and most often, a nutrient is required as either a precursor, e.g., amino acids, or as a cofactor, e.g., B group vitamins, within a defined metabolic pathway.... The second metabolic action of an essential nutrient exists through its countering the deleterious action of an independent biological process. Here, the nutrient prevents a secondary biological process that would be harmful to the organism. For example, fluoride acts to prevent dental cavities by interfering with the action of microbial destruction of tooth enamel. Both oral cavity microbes and sugar are considered a part of a contemporary lifestyle; as such, dental cavities fall into the normal physiological arena. Where diets contain less sugar, the need for fluoride ceases." The authors give dietary fiber as another example of an essential nutrient in the second category. The source: Jones PJ, Varady KA (2008). "Are functional foods redefining nutritional requirements?" (PDF). Appl Physiol Nutr Metab. 33 (1): 118–23. PMID 18347661.

Several other recent and reliable sources list fluoride as an essential nutrient, including:

• Bergman C, Gray-Scott D, Chen JJ, Meacham S (2009). "What is next for the Dietary Reference Intakes for bone metabolism related nutrients beyond calcium: phosphorus, magnesium, vitamin D, and fluoride?". Crit Rev Food Sci Nutr. 49 (2): 136–44. doi:10.1080/10408390701764468. PMID 18989832.{{cite journal}}: CS1 maint: multiple names: authors list (link)
• Lichtenstein AH, Russell RM (2005). "Essential nutrients: food or supplements? Where should the emphasis be?". JAMA. 294 (3): 351–8. PMID 16030280.

I did not find any recent sources disputing the classification of fluoride as an essential nutrient in typical Western diet. I did find a dispute in a much older paper: "There is some reluctance to classify fluoride as an essential nutrient." in Hartles & Slack 1959 (doi:10.1079/PNS19590020). However, this 50-year-old paper obviously does not reflect current thinking.

Given all the above, I propose appending the following sentences to the Mechanism section:

"Fluoride is an essential nutrient, but not in the most common sense as a precursor or cofactor of a metabolic pathway. Instead, like dietary fiber, fluoride prevents a harmful biological process. In fluoride's case the harm comes from a modern lifestyle involving sugar and oral microbes, and diets lower in sugar remove the need for fluoride."

citing Jones & Varady 2008. Eubulides (talk) 19:16, 3 September 2009 (UTC)

Eh, no. Fluoride has always been classified by nutritional science as "beneficial", not essential. To say otherwise is to misrepresent modern nutritional science and its classification scheme. For example, see the 2004 WHO draft paper on essential minerals in drinking water, page 12 (http://www.who.int/water_sanitation_health/dwq/en/nutoverview.pdf) which states that "the essentiality of fluoride for humans has not been proven unequivocally". I can also bring up my recent undergrad nutrition textbook, which states the exact same thing. Your research apparently completely missed the most key papers on this topic such as Tao and Suttie 1973. This is briefly reviewed in NRC 1989, which states that "these contradictory results do not justify a classification of fluoride as an essential nutrient". You say that these articles say that fluoride is essential - but you've got no quotes which say that exactly. Even your first quote is a roundabout way of proposing a nonmainstream (and highly illogical) view of what an essential nutrient is. Dietary fiber is not considered an essential nutrient either. II | (t - c) 19:53, 3 September 2009 (UTC)

I'm afraid that the sources listed in the previous comment are either out of date or not for citation.

• Tao & Suttie 1976 (PMID 939992) is a 33-year-old primary source and is not reliable for the question as to whether fluoride is considered to be an essential nutrient now. Its contents make it clear that it's investigating whether fluoride is essential in the first (precursor-or-cofactor) way discussed by Jones & Varady, not whether fluoride is essential in the second (countering-deleterious-action) way. The proposed text addresses this point, by saying that fluoride is not essential in the first way.
• The NRC 1989 report is a reasonable source for how fluoride was considered twenty years ago, but the old notion of Recommended Dietary Allowance (RDA) has been superseded by the newer notion of Dietary Reference Intake (DRI). I just now checked the USDA website and the latest tables (dated 1997) generated by the NRC do list fluoride requirements. Bergman et al. 2009 summarizes the work of the Food and Nutrition Board’s DRI committee, which has been reviewing this standard, and makes it clear that fluoride requirements will also be in the next version of the standard.
• Given the above, I suspect that your nutrition textbook is relying on obsolete information; it wouldn't be the first time. But we could check this if you could supply the citation and quote from it, in particular, the sources that it cites to support its claims.
• That 2004 WHO draft is explicitly not for citation; do you have something else recent from the WHO that can be cited?
• "You say that these articles say that fluoride is essential - but you've got no quotes which say that exactly". Sure I do. The extended quote from Jones & Varady says "Furthermore, the actual function of an essential nutrient can vary categorically in at least two important ways. First,.... The second metabolic action of an essential nutrient exists through its countering the deleterious action of an independent biological process.... For example, fluoride acts to prevent dental cavities by interfering with the action of microbial destruction of tooth enamel." This clearly gives fluoride as an example of the 2nd category of essential nutrients.
• "Even your first quote is a roundabout way of proposing a nonmainstream (and highly illogical) view of what an essential nutrient is." Nope, it's the current mainstream. And there's nothing illogical about it.
• "Dietary fiber is not considered an essential nutrient either." It wasn't considered to be essential three decades ago, but it is now. For example, please see Gordon 2009, whose abstract begins, matter-of-factly, "Dietary fiber (DF) is an undefined nutrient, but an essential nutrient." That's just from a quick Google Scholar search of recent sources, but I'm sure more sources can be supplied.

Eubulides (talk) 20:55, 3 September 2009 (UTC)

The final citation to Olivares & Uauy is here. It says "the essentiality of fluoride for humans has not been proven unequivocally" (in fact, the weight is against it). Let's be clear about Jones & Varady: this is a speculative paper which proposes that plant sterols be considered essential because they are beneficial in reducing cholesterol. One could say the same about statins. There are tons of nonessential substances which are well-tolerated and beneficial. Such a position would probably be characterized by Quackwatch as a CAM hype. It essentially ignores the traditional distinction between essential and beneficial nutrients, and its proposal will most likely be ignored because so many nonessential substances are beneficial. As you note, the NRC 1997 committee did come up with DRIs for fluoride (similar recommendations for fiber exist). A letter was mailed to the NAS about the lack of clarification. The response [4], by the President of the NAS and the President of the IOM, said "nowhere in the report is it stated that fluoride is an essential nutrient. If any speaker or panel member at the September 23rd workshop referred to fluoride as such, they misspoke. As was stated in Recommended Dietary Allowances 10th Edition, which we published in 1989: "These contradictory results do not justify a classification of fluoride as an essential element, according to accepted standards". Sometimes paper authors (even writing "reviews" OMG!) are able to sneak in opinions which don't really reflect mainstream "accepted standards". Sure, one can find numerous sources hyping dietary fiber who say it is an essential nutrient. But it's still not a traditional essential nutrient, and there are tons of Americans who live fairly happy lives on very little fiber. On the other hand, it's more like an essential nutrient than fluoride - one can be cavity-free quite easily without fluoride, whereas one will always be uncomfortable on the toilet without fiber. The old, traditional standards of nutrition are what should be used. And if an authority has not revised its statement, its original statement applies (as in the case of the NRC 1989). II | (t - c) 21:57, 3 September 2009 (UTC)

• Thanks for the citation to Olivares & Uauy 2005. I agree that it is a better source.
• Although Jones & Varady is explicitly speculative about plant sterols, it is explicitly not speculative about fluoride or dietary fiber: it gives them as examples of essential nutrients of the "countering the deleterious action" type.
• Jones & Varady are not the only modern sources that use the more-expansive version of "essential" to mean "needed to promote optimum health" as opposed to "needed to survive". However, I agree that this use of the term is controversial among reliable sources, and that we should give greater weight to the consensus position. I'll propose a new draft in #Essential nutrient 2 below.

Eubulides (talk) 08:05, 6 September 2009 (UTC)

It is never as simple as you first think

Hmm. It is never as simple as you first think. I agree that undergrad textbooks aren't the best source for up-to-date knowledge/consensus. We do need to be careful we are classifying fluoride based on widespread consensus, otherwise we would need to say that it is a controversial topic. The classification of fluoride as an essential or as a beneficial nutrient is, I think, within the scope of this article. I'm glad to see ImperfectlyInformed and Eubulides conducting the sort of source-based discussion we should have on these talk pages. That's healthy. Colin°^Talk 21:33, 3 September 2009 (UTC)

• I did some more reading into the subject. It's quite a zoo. I looked for recent Google Scholar sources saying "fluoride is an essential nutrient" and found just one:
  • "Fluoride is an essential nutrient for the human body at low concentrations." (Tang et al. 2009, doi:10.1016/j.jhazmat.2009.06.079). This cites Kumar & Moss 2008 (PMID 18329450), a source I lack ready access to.
• Widening the search to the past twenty years found some lower-quality sources not worth mentioning, along with one moderated discussion, namely Fürst P (moderator) (2000). "Moderated discussion". Am J Clin Nutr. 71 (6 Suppl): 1688S–90S. PMID 10837317. It has this illuminating exchange:

Dr Harper

... What about fluoride? Is it a nutrient? A functional food? Is it just a natural product? We are not quite sure. Nevertheless, it is a substance that has an obvious and well-established beneficial health effect. I would separate the health effect from the pharmacologic effect. Thus, I might put protection of fluoride against tooth decay as a nonpharmacologic, but beneficial, health effect, and its effects at higher levels, in staining teeth or causing bone deterioration, as pharmacologic effects.

Dr Fernstrom

If it is not a nutrient per se, then that definition is not valid.

Dr Harper

That's the debate. We are not going to resolve it today, but some of us are not convinced that fluoride is an essential nutrient, yet we are convinced that it has a health effect.

Dr Fernstrom

Would you then call this, by definition, a pharmacologic effect?

Dr Hathcock

From a scientific viewpoint, it may not make much difference what we call it, but from a regulatory viewpoint, it is critically important. The definition can determine whether there is free access to a product or whether access will be by prescription only.

I also found another extremely dated source that talks about the controversy: Hegsted DM (1975). "Summary of the Conference on Nutrition in the Causation of Cancer". Cancer Res. 35: 3541–3. It says:

"There has been a long and continuing argument over whether fluoride is an essential nutrient, i.e., essential for life. This is a rather unproductive argument since the effect of fluoride on dental decay is obvious and its use in public health has nothing to do with our usual definition of essentiality. The fact is that it is essential for the maintenance of good dental health even though dental cavities might be avoided on low-fluoride diets if we could be nourished by by-passing the mouth."

This last comment essentially mirrors what Jones & Varady 2008 say in substance, even if it uses a different interpretation of the phrase "essential nutrient".

• I searched for "fluoride is not an essential nutrient" among recent articles, and found only two sources, both quite unreliable. Widening the search to the last 20 years found no more such sources.
• After further reading I'm inclined to think the following. First, the field of nutrition has to some extent (but certainly not completely) moved past debates about whether a nutrient is essential for survival, and toward more-complicated questions about whether a nutrient is needed for optimal health. Second, it'll take too much space to do this overall topic justice here, and any full details be in a different article. However, a brief summary would be helpful and I'll propose one in #Essential nutrient 2 below.

Eubulides (talk) 08:05, 6 September 2009 (UTC)

Essential nutrient 2

Here's a new version of the proposed material to be appended to Mechanism, updated in the list of the above discussion.

"Like dietary fiber, fluoride is a nutrient that acts against a harmful biological process; in fluoride's case the harm comes from a modern lifestyle involving sugar and oral microbes, and diets lower in sugar remove this need for fluoride.^[1] It has not been proven unequivocally whether fluoride is an essential nutrient, in the sense of being required to sustain life or growth in humans.^[2]"

References

1. Jones PJ, Varady KA (2008). "Are functional foods redefining nutritional requirements?" (PDF). Appl Physiol Nutr Metab. 33 (1): 118–23. PMID 18347661.
2. Olivares M, Uauy R (2005). "Essential nutrients in drinking water". Nutrients in Drinking Water. World Health Organization. pp. 41–60. ISBN 92-4-159398-9. {{cite book}}: |access-date= requires |url= (help); |format= requires |url= (help); External link in |chapterurl= (help); Unknown parameter |chapterurl= ignored (|chapter-url= suggested) (help)

Eubulides (talk) 08:05, 6 September 2009 (UTC)

Changed "prevents" to "acts against" as per discussion below. Eubulides (talk) 21:05, 9 September 2009 (UTC)

Looks good to me. Colin°^Talk 00:03, 9 September 2009 (UTC)

Fluoride doesn't fit the standard definition of a nutrient. The undergrad textbook I mentioned, Understanding Nutrition by Whitney & Rolfes (10th edition, 2005) defines nutrients as "chemical substances obtained from food and used in the body to provide energy, structural materials, and regulating agents to support growth, maintenance, and repair of the body's tissues ..." - on the same page (p. 6) they discuss "nonnutrients" which includes "fibers, phytochemicals, pigments, additives, alcohols, and others". The textbook definition is the one which most people intuitively believe, and it is also used in other scientific contexts (eg, the algal bloom was caused by excess nutrients). It is the one used in the lead of Wikipedia's nutrient article ("A nutrient is a chemical that an organism needs to live and grow or a substance used in an organism's metabolism which must be taken in from its environment"). If one defines a nutrient as anything which prevents a harmful biological process, all preventive drugs would be nutrients. Even devices could be defined as nutrients. Latex could be a nutrient for promiscuous young men; "in latex's case the harm comes from a modern lifestyle involving sex and genital microbes; monogamy reduces the need due to reduced promiscuity" (ingestion is not necessary for nutrient status - note vitamin D). Caffeine is nutrient that prevents the "harm coming from a modern lifestyle involving little sleep", and statins are the nutrient which prevents the "harm coming from the modern lifestyle involving too many cheeseburgers". Anyway, I don't like it and I think it's illogical, but I don't have a source stating my position. Obviously there are a lot of people who call fluoride a nutrient, so I guess I won't oppose the above couple sentences.

I will see about finding out what the graduate level textbook [http://www.amazon.com/Advanced-Nutrition-Human-Metabolism-James/dp/0534555217 Advanced Nutrition and Human Metabolism] says about the topic. It's a better source than a speculative 2009 Current Opinion paper proposing that functional foods be defined as essential nutrients, based on the already controversial and problematic precedent of fluoride and fiber. II | (t - c) 06:52, 9 September 2009 (UTC)

Although I agree that there is controversy among reliable sources whether fluoride is an essential nutrient, I don't see the same controversy over whether fluoride is a nutrient. Here are two examples I found with a quick search for "fluoride nutrient" in PubMed:

• "Food intake provides the necessary components for adequate metabolic functions in bone. Calcium, phosphorus, vitamin D, magnesium, proteins, and fluoride are some of the most important nutrients in this regard." —Vicente-Rodríguez et al. 2008 (PMID 18758899)
• "The set of updated standards is now called Recommended Energy and Nutrient Intakes (RENIs), defined as levels of intakes of energy and nutrients ... The desirable proportions of protein, fats, carbohydrates as well as fiber are also provided, in addition to information on recommended intake levels for selenium, magnesium, manganese, fluoride, cobalamin, and vitamin K." —Barba & Cabrera 2008 (PMID 18460438)

These are not speculative papers. Certainly fluoride falls into the category of substances that are "regulating agents to support growth, maintenance, and repair of the body's tissues" (in this case, dental enamel in the presence of sugar and microbes). Eubulides (talk) 07:15, 9 September 2009 (UTC)

Perhaps this is an area where a language-change is occurring wrt to the word "nutrient". Driven by the experts but the rest of us haven't caught up. I share II's gut feeling that it isn't a "proper" nutrient like we learned when I was at school :-). Colin°^Talk 19:36, 9 September 2009 (UTC)

No doubt it depends on which school you went to.... As this seems to be an argument about terminology rather than about the physical processes, how about if we make it clearer in the text that we are using the word "nutrient" in a particular sense? I modified the text as follows: "fluoride is a nutrient in the sense that it prevents a harmful biological process". I hope this helps to allay the concerns expressed above. Eubulides (talk) 19:52, 9 September 2009 (UTC)

No, don't do that. Do the sources say it is a "nutrient" but only in one sense? The article says fluoride repairs demineralisation with a tough veneer. That isn't just "prevents a harmful biological process" is it? If the expert consensus is that "nutrient" can be used wrt fluoride, without restriction/clarification, then we should be able to follow, even if some of our guts are unhapppy. Colin°^Talk 20:12, 9 September 2009 (UTC)

The source (which is the first quote in #Essential nutrient above) says that there are two categories of essential nutrients, and that fluoride is a nutrient in the second category. This is what I tried (apparently unsuccessfully) to render with the phrase "in the sense of". I agree with your gut reaction about terminology shift; that was why I tried to make it clear in the text that we are using the word "nutrient" in the sense that the source uses it. For now, though, I've reverted that change to the draft. Perhaps, now that you've seen the source, you can suggest better wording (or maybe that wording was OK)? Eubulides (talk) 20:20, 9 September 2009 (UTC)

The source says "counters the deletrious action of an independent biological process". "counters" isn't the same as "prevents" as the former includes repair. I'm struggling to come up with a replacement word for "prevents", however I'm less worried about the current text than the "in the sense that" text because the latter made "prevention" the only reason it was called a "nutrient". Currently, "prevention" is just an example of how it is "nutritious". Colin°^Talk 20:51, 9 September 2009 (UTC)

Thanks for catching both points. I changed "prevents" to "acts against"; that's a better synonym for "counters". Perhaps it's better to leave well enough alone about the "in the sense that" issue, as the following sentence makes it pretty clear that there is more than one nutrient category. Eubulides (talk) 21:05, 9 September 2009 (UTC)

As I mentioned, I'm not going to oppose the addition even though I don't agree with calling fluoride and fiber nutrients. So feel free to add it. II | (t - c) 22:57, 9 September 2009 (UTC)

EPA definition

The 2001 CDC description of what fluoridation is has been replaced by a 2006 definition by EPA. In the United States of America, EPA regulates fluoride in drinking water. Petergkeyes (talk) 11:55, 10 September 2009 (UTC)

I addressed this point in #More controversial edits recently installed below. The EPA's regulations are about water naturally fluoridated to levels far above those recommended for dental health, and have little to do with Water fluoridation. They should be (and are) discussed in Fluoride poisoning instead. Eubulides (talk) 15:56, 10 September 2009 (UTC)

More controversial edits recently installed

Another recent series of edits recently installed, again without discussion, removed several items of text that are well-supported by reliable sources:

• "it [tooth decay] is expected to increase in several countries there due to changing diet and inadequate fluoride exposure" (supported by Petersen & Lennon 2004, PMID 15341615)
• "the actual number [of people drinking naturally fluoridated water] is unknown and is likely to be much higher" (supported by "British Fluoridation Society et al. 2004")
• "but sometimes the need for water fluoridation was met by alternative strategies" (supported by the same source)
• It also substituted an enormously inferior source, cited only in the lead, to define water fluoridation. The CDC's definition (CDC 2001, PMID 11521913) is a consensus document written by a large committee of experts; the EPA glossary is a one-line definition in an unsigned random website. Please keep Wikipedia:Reliable sources (medicine-related articles) in mind when selecting sources for this article.

For now I reverted the change. One more time: please discuss possibly-controversial changes like this on the talk page first, before installing. Continuing to install controversial changes like this, without discussion, is counterproductive towards improving the encyclopedia. Eubulides (talk) 14:55, 10 September 2009 (UTC)

CDC definition is inferior because it comes from a biased source. CDC is a longtime promoter of water fluoridation, and its definition reflects its bias. EPA (notwithstanding its labor unions) does not take a position on fluoridation, therefore its dictionary-style definition is superior to CDC's. Also, the 2006 EPA definition is more up to date than the 2001 CDC promo. EPA's definition also clearly provides more information that CDC's, without the sentence being intrusively large.

No matter what the British Fluoridation Society, or Petersen and Lennon say, that does not make their statements encyclopedic. All three statements you reprinted with bullet points are POV, not facts. The first two don't even particularly say anything. They say, "we don't know, maybe this..." They are superfluous, they do not contribute to the article, and they should be re-removed. I explained each change on the history page. Please address my comments, rather than complaining that there has been, "no discussion." Petergkeyes (talk) 04:51, 11 September 2009 (UTC)

• The CDC definition (CDC 2001, PMID 11521913) was written by the Fluoride Recommendations Work Group, a distinguished group of 11 dental experts, and was reviewed by 23 equally distinguished reviewers, all listed at the start of the report. It represents a consensus and peer-reviewed secondary source, which places it atop the list of reliable sources listed in Wikipedia:Reliable sources (medicine-related articles).
• In contrast, the EPA source is an unsigned web page. Its definition of fluoridation is taken unchanged from page 24 of the 1997 EPA Terms of Environment (EPA 175-B-97-2001), which is an unsigned report that shows no signs of peer review. As the introduction to that 1997 document states, "The definitions do not constitute the Agency's official use of terms and phrases for regulatory purposes, and nothing in this document should be construed to alter or supplant any other federal document." So, not only is this source extremely weak by the standards of Wikipedia:Reliable sources (medicine-related articles), the source itself states that the definition has nothing to do with EPA's regulatory duties and should not be construed to alter or supplant the CDC's document.
• "CDC definition is inferior because it comes from a biased source." The CDC position is obviously the mainstream position. WP:NPOV does not mean to omit all bias: it means to present all viewpoints in fair proportion to what they say, emphasizing the mainstream position. The EPA is not an expert on water fluoridation, and explicitly says that its definition of fluoridation is not authoritative; its glossary is a far inferior source.
• "the 2006 EPA definition is more up to date than the 2001 CDC promo." No, as shown above, the EPA definition is from 1997, not that this is particularly relevant.
• "EPA's definition also clearly provides more information that CDC's" The only difference in information is that the EPA's definition says "chemical", a word that fluoridation opponents prefer because (as Colin noted above) it scares people. It's easy to search through websites and find documents where "fluoridation" and "chemical" are close to each other. But that is not the best way to find reliable sources on the subject. The best way is to read the peer-reviewed literature, which is what the CDC definition is.
• "All three statements you reprinted with bullet points are POV, not facts" All three statements are verified by reliable sources. They are all factual statements. There is no controversy among reliable sources about these matters. A Wikipedia editor's disagreement with reliable sources does not matter. What matters is what reliable sources say.
• "The first two don't even particularly say anything." Sure they do. They contain valuable information about how changing dietary habits in less-industrialized countries, when combined with inadequate fluoride exposure, is expected to lead to increased tooth decay, and about the uncertainty of our knowledge of how many people drink naturally fluoridated water.
• 'I explained each change on the history page. Please address my comments, rather than complaining that there has been, "no discussion."' I have addressed your comments. As for procedure: the top of this talk page makes clear that the procedure is to discuss potentially controversial changes to the article, and to gain consensus, before making the changes. Comments in edit summaries are not that kind of discussion.

In the light of the above comments I have reverted the changes. Please don't continue to attempt to make these changes without consensus, as continued efforts along these lines will hurt the encyclopedia.

Eubulides (talk) 06:12, 11 September 2009 (UTC)

Why not list exactly what it cost each year?

The article currently reads Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $0.92 per person-year. Over 300 million Americans, so does that mean we are spending hundreds of millions of dollars each year on it? When you look at how much money the government spends on other things, it usually shows a number, not that number divided by the number of people currently living in the country. Dream Focus 16:24, 10 September 2009 (UTC)

The cited source does not make this computation, and it would be original research for us to do the computation, so we can't include an overall figure here. Certainly it would be incorrect to multiply by 300 million, as only about 60% of the U.S. population receives artificially fluoridated water (2006 statistics). Similarly, it would be original research for us to compute the total sum saved by water fluoridation due to spending less money on dental treatments. Eubulides (talk) 17:40, 10 September 2009 (UTC)

Article order

Small question, why is the History section at the very bottom? Wouldn't it make stylistic sense to have that up top? Staxringold _talk^contribs 02:15, 12 October 2009 (UTC)

It's common in many technical articles to put History later in the article, using the idea that most readers are interested in the current state of a subject more than in historical aspects. See, for example, Autism, Asperger syndrome, Saffron (all featured articles). Eubulides (talk) 04:13, 12 October 2009 (UTC)

Secondary article on Opposition should be merged

Why is there a second article on fluoride opposition? It seems to duplicate several sections of this article. Criticism has been moved to a different article where it can still be countered without admitting it has the validity of the main article. Valid criticisms should be included in this article. If any one section of this article was deserving of a separate section, that would make sense, but a separate article that tracks several sections is just leading to a silence of criticism and duplicate information. —Preceding unsigned comment added by Gregwebs (talk • contribs) 04:29, 12 October 2009 (UTC)

It is common for articles that would otherwise be too long to split off subarticles for particular subtopics, and I expect that is what has happened here. Water fluoridation is a featured article and covers the entire subject; its Ethics and politics section briefly covers the controversy neutrally and at a high level. The subarticle Opposition to water fluoridation goes into considerably more detail. Unfortunately the subarticle has serious NPOV and reliability problems, some of which are noted by its tags. Among other things, the subarticle's very title is wrong: it should be Water fluoridation controversy and it should present all sides of the controversy neutrally, which it currently does not. But at any rate, these are problems with the subarticle, not with Water fluoridation itself. Eubulides (talk) 04:48, 12 October 2009 (UTC)

Yes, but that article is not a subarticle. It is a listing of critiques across various sections of the main article. It is a problem with this article that proper criticism is being placed on a separate page instead of being addressed. Gregwebs (talk) 06:20, 12 October 2009 (UTC)

It is true that the opposition article is poorly written and organized, but the point is that the criticism is summarized and addressed here. This is not the place to list in detail every argument against water fluoridation, just as the Cancer article isn not the place to list every treatment against cancer. It suffices here to briefly summarize the arguments, in proportion to the weight given them by reliable sources. Eubulides (talk) 07:16, 12 October 2009 (UTC)

Satire

This article needs a picture from Dr Strangelove. lol 58.167.41.154 (talk) 09:00, 12 October 2009 (UTC)

Which Green parties?

A recent edit replaced "Green Party" with "New Zealand Green Party". However, the cited source (Nordlinger 2003) mentions the Green Parties of both New Zealand and the United Kingdom. Shouldn't the phrase be replaced instead with something like "New Zealand and UK Green parties"? Eubulides (talk) 00:59, 12 October 2009 (UTC)

There is no UK Green party. If you can find a source as to whether it was the Green Party of England and Wales, the Scottish Green Party, or the Green Party in Northern Ireland, then by all means add it. jnestorius^(talk) 01:15, 12 October 2009 (UTC)

I can easily find reliable sources showing that all three of those Green parties oppose water fluoridation. However, this article is not the place to publish a list of Green party organizations that oppose water fluoridation. Rather than list individual organizations I'm inclined to rewrite the text to say something like "Green parties in the UK and New Zealand", which (1) is correct (if I've got the wording/punctuation right) and (2) is directly supported by the cited source. How does that sound? Eubulides (talk) 04:35, 12 October 2009 (UTC)

That's fine. I didn't like the unqualified link to Green party, as not all such parties oppose fluoridation. jnestorius^(talk) 13:13, 12 October 2009 (UTC)

OK, thanks, I did that. Eubulides (talk) 07:03, 13 October 2009 (UTC)

NPOV: Missing philosophical argument and citing weakest opponents (straw man fallacy)

Dr. Strangelove's character and the extreme right- and left-wing groups may indeed be opposed to fluoridation, but that movie was clearly intended to ridicule opponents of fluoridation, among other targets. Although some mention is made of medical treatment without informed consent, what's missing is the philosophical debate on whether Government should force medical treatment on an entire population. For example, isn't global overpopulation an even more pressing issue than tooth decay? Ergo (per the ideology that supports fluoridation), put birth-control medications in drinking water globally, until the population is reduced to sustainable levels. Sound silly? Substitute "birth-control medication" for "fluoride" in almost every one of the "pro" arguments. Yes, silly indeed.

Mass forced medication smacks of the comparison we're not allowed to use here (the dreaded H- and N-words, of course). This is the strongest philosophical argument -- the right of individual choice -- but the sources cited seem to focus on the least attractive opponents, namely, a movie intended as slapstick satire, though with a message indeed, and those screaming of Communist plots. The Cold War is over, and fluoride is still here.

I'm not a reliable source to advance this argument, and no, I haven't time to be bold, do the research, source it properly, and edit the article myself. I just came here to look up something else, saw the FA, and... surprised it made it to FA with this notorious example of the Straw man fallacy of logic. Cheers. Unimaginative Username (talk) 05:26, 12 October 2009 (UTC)

Shii (tock) 05:36, 12 October 2009 (UTC)

As the Ethics and politics section says, there are important ethical arguments on both sides of the question. The main point made in the above comment seems to be that the phrase "mass medication" is missing from that section. It would be reasonable to add that phrase, supported by a reliable source. However, if you aren't willing to propose specific wording or to do any research, adding a tag to the whole article would seem to be an instance of driveby tagging, a practice that is strongly discouraged on Wikipedia. Eubulides (talk) 05:40, 12 October 2009 (UTC)

Since Unimaginative Username admits to not having done the research, I have removed the POV tag s/he placed. SandyGeorgia (Talk) 05:42, 12 October 2009 (UTC)

And also keep edit-conflicting me from responding. I didn't say I haven't done the research in the past, just that I haven't time to collate sources and get it done, not only before FA changes, but before bedtime. A legitimate question has been raised and I invite legitimate opposing comments. Or leave the slanted article up -- this is how you lose formerly active editors like myself, (no threat, statement of past event), impair credibility, and discourage even trying.

For an ordinary article, I can understand that policy -- very reasonable. However, this is FA on the Main Page. By the time I were to do all the research necessary, prepare, and edit, it would no longer be FA, and the effect of disputing it, and my reasons for doing so, are lost to all but a fraction of those who will see it while it is Main Page. I think the arguments, which I was enhancing but ran into an edit conflict, speak for themselves, and certainly opposing comments can be added.

"if you aren't willing to propose specific wording" .... doing so without reliable sources is original research, no? Cheers. Unimaginative Username (talk) 05:52, 12 October 2009 (UTC)

• Edit, after edit conflict: Edit: As more evidence that the article is slanted "pro", consider the picture caption: "Fluoridation does not affect the appearance, taste, or smell of drinking water.[1]" So? Many known poisons are tasteless, odorless, and colorless. This is hardly an argument in favor of fluoridation or its safety, only the answer to a much more trivial argument, whether the water tastes, smells, or looks different. Cf. the fairly recent disclosures by US Environmental Protection Agency finding 50-odd prescription drugs in the drinking water of many US cities -- tranquilizers, anti-depressants, sleeping pills, aforementioned birth control pills, antibiotics, etc, presumably via said drugs being eliminated in urine, and the resultant sewage not being treated sufficiently to eliminate them before being recycled back into tap water. Apparently, none of those affected taste, smell, or color enough for users to gasp, nor to shrink from drinking it. One more example of trivial arguments in favor, the false dichotomy of "public good vs. individual rights" (without individual rights, no public good, nor any other, is possible. You're in a totalitarian slave state, and the possibility of fewer cavities is a ludicrously small compensation), and the presentation of the weakest arguments by the least respected opponents. Unimaginative Username (talk) 05:52, 12 October 2009 (UTC)

• As you mention, the statement "Fluoridation does not affect the appearance, taste, or smell of drinking water." is not an argument in favor of fluoridation or its safety. So I'm puzzled why you are objecting to it. This is an article about water fluoridation in general: it is not particularly an article about whether water fluoridation should or should not be done. When covering the general topic, one of the obvious areas to cover is how fluoridation affects water's taste etc. This is completely independent of whether fluoridation is safe. The lead sentence of Carbon monoxide says that CO is "colorless, odorless, and tasteless", but that doesn't mean we should slap a POV tag on that article. Eubulides (talk) 06:27, 12 October 2009 (UTC)

wow isn't it ironic that this article doesn't mention how hitler, stalin, AND mussolini all fluoridated their population's water to pacify them? lol isn't it ironic dont u think, wikipedia is neutral (LMFAO) —Preceding unsigned comment added by 75.1.48.21 (talk) 06:09, 12 October 2009 (UTC)

The Ethics and politics section does cover the theory that water fluoridation was designed to make people submissive to those in power. No reliable sources support the claim that Hitler, Stalin, and Mussolini all fluoridated their population's water to pacify them, but the topic is notable enough to be briefly summarized in that section. Eubulides (talk) 06:27, 12 October 2009 (UTC)

I agree that NPOV is missing from this article. Take a look at the cited study "Community water fluoridation and caries prevention: a critical review" doi:10.1007/s00784-007-0111-6. PMID 17333303. It is very harsh on water fluoridation, and yet it seems to be used only to point out that water fluoridation is safe. Given all the previous discussions about problems with this article and the doppelganger opposition article, it was very suprising to see this article on the front page of Wikipedia. Gregwebs (talk) 06:43, 12 October 2009 (UTC)

The previous comment is completely incorrect. The study in question, Pizzo et al. 2007 (PMID 17333303), is cited ten times in the article, to support many claims that are critical of water fluoridation, including questions of violations of ethical and legal rules, issues of informed consent, legal issues, the claim that water fluoridation may not be needed at all, the claim that toothpaste is a better way to prevent cavities, the claim that the main reason for the decline in tooth decay is toothpaste, the claim that there is only limited evidence that fluoridation reduces oral health inequalities, the claim that most countries of Europe have experienced decline in dental caries without using water fluoridation, and the claim that all fluoridation methods (including toothpaste) work about the same way. Eubulides (talk) 07:16, 12 October 2009 (UTC)

Ok, good point, but the problem still remains that much of the point of that review has been put into the alternatives section, instead of the effectiveness section, and that it is being countered by weak evidence about inequalities in the U.S. Overall this article maintains a dispassionate tone and abides by the rules Wikipedia has layed out, but it has managed to make fluoridation appear to be a godsend, when this, many other sources, and the history of Europe have made an extremely strong case that it is unneeded in the modern world. —Preceding unsigned comment added by Gregwebs (talk • contribs) 15:36, 12 October 2009 (UTC)

From the point of view of someone who supports fluoridation, the article gives a too-heavy coverage to opponents. From the point of view of someone who opposes it, the article gives a too-heavy coverage to proponents. In no sense does the article make fluoridation appear to be a "godsend". It extensively covers the evidence from Europe that fluoridation is not needed in industrialized countries, and mentions this in the lead. It also mentions, both in the lead and in the body, that the evidence in favor of fluoridation is not of high quality, and that the practice is controversial. This is not to say that the article is perfect (far from it!), and specific suggestions for improvement are welcome, but please bear in mind that the article is supposed reflect what reliable sources say about fluoridation, roughly in proportion to the weight that they say it, regardless of one's own personal opinion about fluoridation. Eubulides (talk) 19:42, 12 October 2009 (UTC)

Removal of CDC material from body of article

This edit removed from the body the claim "Water fluoridation has been listed as one of the ten great public health achievements of the 20th century in the U.S." (leaving it only in the lead), and removed from the article entirely the point that this was "alongside vaccination, family planning, recognition of the dangers of smoking, and other achievements." The first deletion violates WP:LEAD, which says that the lead should summarize the body: it's not right for the lead to make a claim that is not also in the body. The second deletion removes valuable context, in that it gives the reader a better feeling for how important the CDC thinks water fluoridation is. Regardless of whether one agrees with the CDC, this context should be presented. I suggest that the edit be reverted. Perhaps the material should be moved or reworded, but it shouldn't be deleted entirely.

Also, I'd like to suggest that in the future, possibly-controversial edits like this should be discussed first on the talk page, before being installed. Eubulides (talk) 07:16, 12 October 2009 (UTC)

I have reverted this change. This text has been thoroughly discussed and reviewed. There's WP:BOLD and there's taking a scythe to an article on the main page. Controversial articles should be edited delicately and after discussion reaches consensus. The article will still be here tomorrow. Colin°^Talk 07:48, 12 October 2009 (UTC)

Sorry, I didn't think this edit could possibly be controversial. Making someone's top-ten list has nothing do with evidence basis of effectiveness. Please move this text to an appropriate section (history?) of the article. Gregwebs (talk) 14:10, 12 October 2009 (UTC)

That is a reasonable proposal. I suggest that we move the top-ten material to the 2nd paragraph of Ethics and politics. (But not right now, as the article is being munged too much while it's on the main page, and anyway other editors may want to chime in here first.) Eubulides (talk) 19:42, 12 October 2009 (UTC)

Even when its about health and from the CDC? 173.22.123.35 (talk) 22:04, 12 October 2009 (UTC)

It is partly a health statement, and partly a political statement. There are valid arguments for putting it in Evidence basis, and valid arguments for putting it in Ethics and politics. I would be interested to hear what other editors think on the subject. Eubulides (talk) 23:41, 12 October 2009 (UTC)

No further comment, so I moved it as suggested above. Eubulides (talk) 20:01, 16 October 2009 (UTC)

Thank you. —Preceding unsigned comment added by Gregwebs (talk • contribs) 02:44, 17 October 2009 (UTC)

Article praise

I like this article, it's quite a nice one to be featured. One question, is a see also section with one point really worth it? Either expand it (perhaps with an article on water contamination rates per country, or something like that, or incorporate the existing link into the prose and remove the section? Good work. SGGH ^ping! 11:51, 12 October 2009 (UTC)

Good catch, thanks! SandyGeorgia (Talk) 14:09, 12 October 2009 (UTC)

Rephrase of last para in lead

This edit ("edited last paragraph of lead for style and accuracy") introduced a POV style where the previous text was neutral. The "but" and the "although" set sentences in opposition to each other where none is required. Also the change from "It is controversial..." to "Treatment of the public water supply is controversial..." is incorrect. The previous "it" referred to water fluoridation whereas treatment of the water supply (in general, for example to clean it and add chlorine) is not a controversial subject.

The other changes made the prose wordier and added unnecessary detail for the lead.

The change to the last sentence paragraph I'm not sure about. It previously said "it is now used by 5.7% of people worldwide." but now says "some 5.7% of people worldwide now receive water containing fluoride to around 1 mg/L". The latter includes naturally fluoridated water. Which is correct?

I've reversed the edit for now. Colin°^Talk 16:05, 12 October 2009 (UTC)

Thanks. I agree with the reversal. Eubulides (talk) 19:42, 12 October 2009 (UTC)

The reason why I changed the wording was that the construction of the paragraph was not good with short sentences and too many "its". I accept that the bit about treatment of water was not the best wording but I was trying to make it less repetitive. The bit in last sentence "5.7% of people worldwide now receive water containing fluoride to around 1 mg/L" is what the reference says - it's on line you can check it yourself. The bit about flouridation preventing cavities is complete nonsense - it reduces the incidence of them. I changed cavities to dental caries as that's the correct term and it's what they are called in the reference. By all means change what you don't like but don't throw out the baby with the bathwater. Richerman (talk) 19:57, 12 October 2009 (UTC)

You are right about the 5.7 bit, sorry about that. The prose might not have been perfect but the changes were worse as they introduced POV. I've removed the "now" as it isn't in the source and the word best avoided on WP. The "preventing cavities" isn't nonsense -- only if you take it as 100% effective as preventing cavities. Vaccines and washing your hands both prevent disease -- there's no "may prevent" about it. The point is that saying "may help prevent" introduces doubt as to whether it has any preventative action, which isn't the case. Colin°^Talk 22:23, 12 October 2009 (UTC)

Colin's right about "may prevent" being wrong; the first paragraph of the source talks about fluoridation being a "method of caries prevention", with no "may" in sight. The phrase "reduces the incidence of dental caries" is too technical for the lead; as per WP:LEAD and WP:MEDMOS the lead should prefer widely-accessible language to technically-correct but hard-to-understand language. There's no reason to wikilink to dental caries here, since the lead has already wikilinked to tooth decay, an easier-to-understand redirect to dental caries. It's better to be consistent in using simpler terminology in the lead, so I changed "reduces the incidence of dental caries" back to the simpler "prevents tooth decay". The "now" was in the text to provide linkage from the 1st half of the sentence, which talks about events in the 1950s; that same edit inserted "as of 2004" to restore this linkage and to reflect the date of the estimate. Eubulides (talk) 06:33, 13 October 2009 (UTC)

5.7% bit

The source for the 5.7% is an article in the BMJ. Good. It says "Worldwide, about 5.7% of people receive water containing fluoride to around 1 mg/l." This is slightly different to our current lead text which says "about 5.7% of people worldwide receive water fluoridated to around 1mg/L." It is ambiguous whether "fluoridated" implies human intervention but on balance it probably would read that way in an article on the human intervention. So perhaps this should be fixed. However, the BMJ's source for this is National Public Health Service for Wales Briefing paper on fluoridation and the implications of the Water Act 2003. This contains the text "Worldwide over 360 million people drink fluoridated water -- either naturally occurring or adjusted to the optimum level of fluoride to reduce tooth decay." It doesn't mention 5.7 and it doesn't include 1mg/l in that sentence (though earlier it does say the optimum level is 1mg/l). The sentence doesn't indicate the level of fluoride in the naturally-occurring water. I wonder if the BMJ is not only using a sub-optimal source but is also reading too much into the source in order to do its maths. The National Public Health Service for Wales must have got its data from somewhere better. Can we find it? Colin°^Talk 22:45, 12 October 2009 (UTC)

I remember following the exact same reference trail that you did, and ended up with "moderate fluoridation prevents cavities, and it is now used by 5.7% of people worldwide." being the best summary of the original source (while also agreeing with the cited source). I'll see if I can reconstruct that when I have a bit more time. Eubulides (talk) 23:41, 12 October 2009 (UTC)

The Wales briefing paper got its data from an earlier edition of "One in a million", whose latest (2004) edition (PDF) estimates about 400 million people worldwide drink fluoridated water; this includes about 50 million who drink water that is naturally fluoridated to a value around optimal. (These figures are rounded, by the source, from more-precise figures.) Given that we now have later figures, we should consistently cite the newer figures instead of the older ones, and I installed an edit to do that. Eubulides (talk) 06:33, 13 October 2009 (UTC)

Ethics and Politics section & note 81

A passage immediately after note 80 and before note 81 reads:

Many people do not know that fluoridation is meant to prevent tooth decay, or that natural or bottled water can contain fluoride

Is the source for note 81 being cited for this claim, or only for the sentence following, the one beginning, "A 2009 survey of Australians..."? Only an abstract of the source article is available to non-subscribers, so perhaps someone with access can confirm that the source makes a claim about the prevalence of knowledge about the purpose or fluoridation or the presence of fluoride in bottled water. If it doesn't, this claim is unsourced and ought to be removed. --Rrburke^(talk) 16:37, 12 October 2009 (UTC)

Thank you for catching that error. The source for that claim is actually Griffin et al. 2008 (PMID 18333872), which says (p. 100) "However, many had a poor understanding of the benefits and costs associated with fluoridation. They seemed unaware that water could naturally contain fluoride or that some bottled mineral waters actually have a very high fluoride content. Studies in the USA and South Africa have shown that many people did not know water fluoridation was intended to prevent tooth decay, although that knowledge was better in higher educated groups and among older people." The claim was properly sourced when it was originally inserted, but became separated from its source in a later edit. I fixed the problem by adding a named ref to the source. Eubulides (talk) 19:42, 12 October 2009 (UTC)

But since it is apparent that there is indeed disagreement as to whether there are or are not benefits associated with the use of fluoride and fluoridation, isn't this a rather poor source? The statement "many had a poor understanding of the benefits . . ." actually means, "a lot of people disagreed with this estemmed group of scientists and social engineers." If this had been an anti-fluoride source, wouldn't it have read, "many seemed to naturally sense the harmful affects of forced fluoridation"? The poor quality of the source is further indicated by the use of "very high" as a precise measurement of some approximation. It doesn't matter what side you pick, but the sources ought to be good sources. 67.172.153.122 (talk) 20:24, 12 October 2009 (UTC)

There's nothing wrong with the sentence or the use of the source to support it. It provides support for people being unaware that fluoridation is intended to prevent caries, and that people are unaware that bottled water may contain fluoride. Fences&Windows 21:44, 12 October 2009 (UTC)

I agre with Fences and windows here. Also, the word "benefits" does not appear in the Water fluoridation passage in question, so I don't see why it's important to focus on that word in this thread. Eubulides (talk) 23:41, 12 October 2009 (UTC)

What?

I edited this page, saying that flouride was different than flourine. Later, the administrator deleted it and sent me a message saying I needed to cite the source. I'm sorry, but I think that pretty common knowledge. Sdeas (talk) 23:22, 12 October 2009 (UTC)Sdeas

Indeed, it is such common knowledge that it doesn't need to be stated in an article about Water fluoridation, and that's the reason why your edit was removed (three times). Thank you for taking the time to discuss this here, but unless you can show that there exists some confusion between fluoride and fluorine (using reliable sources), then the statement really is unnecessary in this featured article. Hope that helps --RexxS (talk) 23:33, 12 October 2009 (UTC)

The change did not say that fluoride is different from fluorine; it said that fluoride is not to be confused with fluorine. It's not clear that such a statement is important to be in the lead. Is there a reliable source saying that such confusion is common and is notable in the context of water fluoridation? If not, I suggest moving the point to Fluoride, where it's more relevant. Eubulides (talk) 23:41, 12 October 2009 (UTC)

Western Europe Comparison

A fairly large number of western european countries do not have any form of water flouridation and have the same, if not lower, levels of dental problems. - Dr. Joseph Diamond, Dimensio —Preceding unsigned comment added by Dimensio (talk • contribs) 23:11, 12 October 2009 (UTC)

The article says Most countries in Europe have experienced substantial declines in cavities without the use of water fluoridation. - citing

• Pizzo G, Piscopo MR, Pizzo I, Giuliana G (2007). "Community water fluoridation and caries prevention: a critical review". Clin Oral Investig. 11 (3): 189–93. doi:10.1007/s00784-007-0111-6. PMID 17333303.{{cite journal}}: CS1 maint: multiple names: authors list (link)

Are you suggesting a different wording, and if so, what is your source? --RexxS (talk) 23:26, 12 October 2009 (UTC)

The comment "A fairly large number of western european countries do not have any form of water flouridation and have the same, if not lower, levels of dental problems." is surely well intentioned, but it glosses over a complex aspect. There are many countries in western europe and thus many modalities have come and gone in these countries, in some cases with variations province by province. As explained in the article, among the many modalities are salt fluoridation and milk fluoridation. Concurrently, fluoridated toothpaste became widely used as did the use of topical fluoride gels during dental check-ups. So Europe and other parts of the 1st world have experienced a broad multifaceted exposure to fluoridation. Would-be correlations of dental caries rates require an assessment of the total fluoride exposure. With many fluoridation modalities in place, the fluoridation of public waters would have less impact on dental health.--Smokefoot (talk) 02:45, 13 October 2009 (UTC)

Linking common units

Any thoughts on whether the links in milligrams per liter serve any purpose at all? (The second one crept in yesterday.) I know that WP:LINK#What generally should not be linked qualifies its recommendation not to link common units with a suggestion to provide conversions, but here there isn't an appropriate conversion - unless somewhere in the backwoods they're measuring fluoridation levels as 0.0001 ounces per gallon? Would anyone unfamiliar with these units gain a better understanding of the concentration of fluoride by reading where those links take them? I seriously doubt it, and would strongly suggest removing those links in this case. --RexxS (talk) 12:39, 13 October 2009 (UTC)

Recent edits

While some of Bitcloud1 (talk · contribs)'s recent edits may be helpful, I recommend that most of them be reverted because improper sources are being used, and it seems s/he may be using abstracts rather than relying on full articles. I also left Bitcloud a WP:3RR reminder, as the account was registered right after I reverted 118.208.108.188 (talk · contribs · WHOIS) twice, and is making similar edits. Hopefully the notification will suffice, and a checkuser won't be needed. SandyGeorgia (Talk) 14:31, 15 October 2009 (UTC)

I don't recommend we blanket revert edits. These are all legitimate, unbiased edits backed up by legitimate citations. If anyone would like to modify citations to point to full articles rather than abstracts, they are welcome to do so. I will try to correct this minor administrative technicality as well.

Meta: I made two edits before logging in. My old account is attached to my old email address, so i was forced to create a new account when I noticed the omissions on this article. (though I really feel that this is irrelevant. The edits are legitimate and are cited.)

Please discuss any issues with any of the changes in discussions.

Bitcloud1 (talk) 14:53, 15 October 2009 (UTC)

Then please be aware that 3RR applies to all of your edits; you may have already violated it. If you have, you can avoid being blocked by reverting your edits post-haste. SandyGeorgia (Talk) 15:04, 15 October 2009 (UTC)

I'm assuming you're talking about the "and costing society more to treat than any other disease." section. This citation is inaccurate and misleading by anyone's account. I can't revert this because it is an inaccurate statement. If anyone feels this to not be the case, the topic is "Highest disease cost uncited." in discussions. Let's add it back in if information comes to light suggesting tooth decay to be the highest societal cost amongst diseases.

Re: 3RR. I have made two reverts, the second after comprehensively citing sources for the edit I originally made. The other revision was flagged as an "undo" (because i entered the edit through the "undo" link), but was a simple edit/rewrite removing the specific aspects you objected to. I hope you understand, this was not a "war" revision. It was simple collaborative editing. Bitcloud1 (talk) 15:29, 15 October 2009 (UTC)

The cited source, Sheiham 2001 (PMID 11683551), clearly supports the claim that dental caries costs society more to treat than any other disease. It says, for example, "Caries is indeed the most expensive human disease in terms of direct costs." (p. 569). I don't know what the phrase '"Highest disease cost uncited." in discussions' is referring to. Eubulides (talk) 20:53, 15 October 2009 (UTC)

This is incorrect. The discussions clearly discusses the costs of diseases. Heart disease is listed as the highest by many sources, including the WHO. "direct costs" are not "societal costs". Please revert this deletion. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

I don't know what "discussions" are being referred to. The phrase "societal costs" does not appear in Water fluoridation. The cited source, Sheiham 2001 (PMID 11683551), gives the direct costs of caries treatment and cardiovascular disease, with the former being significantly greater. No reliable source disagreeing with this claim has been given in this thread. Eubulides (talk) 07:47, 16 October 2009 (UTC)

I have undone this edit. I can't make sense of the edit summary ("removed reference to animals and "weasle words") as the edit didn't remove anything and added words rather than fixing "weasel words".

No, this edit reduced the sentence (paraphrased) "similarly there is an increase in levels of fluoride in the blood, and..." to "Similarly there is an increase in levels of fluoride in the blood.". Where there is mention of fluoridated water increasing levels of fluoride in the body, if a specific body area (saliva) is mentioned, then other specific body areas should also be mentioned. If no specific areas are mentioned, it should read "increased levels in the body". Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The previous comment incorrectly characterizes the edit in question. The edit didn't "reduce" the sentence: it inserted the sentence into the lead. The sentence does not summarize anything in the body (violating WP:LEAD) and is supported by a poor-quality source. The edit also inserted some phrases not supported by the cited sources. Eubulides (talk) 07:47, 16 October 2009 (UTC)

• The text introduced "maximum safe" into the "level of fluoride". This is not supported by the source, which says: "The optimum water fluoride concentration will normally be within the range 0.5-1.0 mg/l."
• The text introduced "in an attempt" wrt reducing tooth decay. Those words imply a belief that is not proven to be substantiated. This is false and not supported by the source which clearly says water fluoridation is effective at preventing caries.

The assumption is that it by default will reduce tooth decay. Vaccines are used in an attempt to immunise against disease. Police speed checks are used in an attempt to reduce road fatalities. Water fluoridation can only ever be "in an attempt" to reduce tooth decay. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The introduction of "in an attempt" is an editorial comment that undermines what the cited source says. Let's stick with what the reliable source says. Eubulides (talk) 07:47, 16 October 2009 (UTC)

• The text removed "naturally occurring" wrt defluoridation. That was not helpful.

This article isn't about "naturally occurring" fluoridation. De-fluoridation has also been needed in non-naturally occurring water supplies. This should be corrected. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The cited source talks about defluoridation as "the lowering of the naturally occurring fluoride level in drinking water to prevent dental fluorosis". Water defluoridation is highly relevant to water fluoridation, as they have similar goals. Eubulides (talk) 07:47, 16 October 2009 (UTC)

• The text introduced the sentence "Similarly, it creates an increased level of fluoride in the blood." into the lead, sourced to a primary research paper. The WP article does talk about fluoride being absorbed into the blood and indeed deposited in the bones. It uses a better source. I don't quite know what "Similarly" is meant to imply as there's nothing similar about it. If we are going to cover systemic absorption of fluoride in the lead, we should use better sources and revise the wording and possibly position within the lead. For example, it is not clear to the reader why this should be relevant at this point. I think Eubulides should be able to suggest something here.

Colin°^Talk 16:28, 15 October 2009 (UTC)

I have undone this edit, which had the summary "Removed weasle words and restored impartiality to the section regarding "dental fluorosis"".

• The text removed the qualification on fluorosis: "most of this is mild and usually not considered to be of aesthetic or public-health concern". This qualification is supported by the source, which says "the majority of this fluorosis was mild and would not be considered to be of aesthetic concern." The "most" is not a weasel word here as it is equivalent to "majority of". The aesthetic concerns (or lack of) are not the opinions of pro-fluoride writers -- they are a result of questioning people (e.g. teenagers) on whether they regard the effects as of any aesthetic concern. One can't "restore impartiality" by removing bits of the text one doesn't like. If our sources say it generally isn't of aesthetic concern, then this can and should be reflected in our text.

Colin°^Talk 16:41, 15 October 2009 (UTC)

This uses biased, subjective language. Perhaps better wording would be "Surveys conducted suggest that most of this is mild and usually not considered to be of aesthetic or public-health concern" Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The cited source does not use this sort of qualification ("Surveys conducted suggest") and neither should this article. The word "considered" suffices in the source to indicate the obvious point that the esthetic judgment is subjective, and that wording suffices in this article too. Eubulides (talk) 07:47, 16 October 2009 (UTC)

I have undone this edit, which had the summary "Clarified the statement "has substantial advantages". Now specifically addresses the advantages.".

• The text replaced "Water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk." with "Water fluoridation, when feasible and culturally acceptable, can lead to a substantial decrease in tooth decay, especially for subgroups at high risk." This is not the point of the sentence. The point of the sentence, is that it has advantages over the other means of delivering fluoride or improving dental health, and those advantages are particularly seen in certain subgroups at high risk. Nobody needs reminding, at this stage, what the aim is ("a substantial decrease in tooth decay"). Colin°^Talk 18:22, 15 October 2009 (UTC)

This needs to be clarified in this case. It's ambiguous in its current wording. We should replace "has substantial advantages" with "has substantial advantages over other fluoridation methods".

The cited source, Petersen et al. 2004 (PMID 15341615) does not say "substantial advantages over other fluoridation methods"; it merely says "substantial advantages". In the context of the cited source it's clear that it is talking about other fluoride methods; that same context is present here, as the text in question is following the discussion of other fluoride methods. There's no need to add "over other fluoridation methods" here, just as there is no need in the source. 07:47, 16 October 2009 (UTC)

Colin, as Sandy has pointed out, there is a WP:3RR rule. You might need to address this. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

WP:3RR says "A series of consecutive saved revert edits by one user with no intervening edits by another user counts as one revert." I chose to revert those changes bit-by-bit rather than revert back to an earlier version of the article. That was because I wanted to review and discuss each edit rather than just say "it was all bad". BTW: I follow a one-revert-rule. Colin°^Talk 08:13, 16 October 2009 (UTC)

(update) Hmm, I'd always understood WP:3RR as warring against one party (or group of editors) over an issue. But the policy page doesn't restrict the reverts in that way, so several IP/newbie editors come along and add different sorts of nonsense (such as this poison-nerve-agent theory), I'm limited after the first revert. Oh, well. I guess we need more eyes on this article. Colin°^Talk 11:02, 16 October 2009 (UTC)

I undid this edit, which added material supported by a news article about a fluoride overfeed in Australia. This overfeed isn't particularly notable compared to the ones already mentioned (no injuries were reported, as opposed to the incidents already noted, which included many injuries and one fatality). It's better to use reliable secondary sources for material like this, to avoid problems with WP:WEIGHT and WP:RECENTISM; see WP:PSTS and WP:MEDRS. I also removed the insertion of the phrase "maximum safe" when talking about WHO suggestions; that WHO document is talking about recommended levels, not maximum safe levels. I removed a couple of insertion of "in humans" as the surrounding text is clearly already about humans (and the sources don't say "in humans", for the same reason, so we shouldn't either). And I changed an "effective" back to a "justified" because the cited source says "justified", not "effective" (see Talk:Water fluoridation/GA1 #Europe and Canada). I suggest that future edits that are likely to be controversial be discussed on the talk page first, to save us all some time and effort. Eubulides (talk) 20:53, 15 October 2009 (UTC)

I disagree with a 20 times over the limit fluoridation news article not being notable. Please revert this edit, or include this information in another way. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

I respectfully but firmly disagree. There are countless public water supply systems in the world and some small percentage are almost always botching something. In my area we see spikes in chlorination. The acute toxicity of fluoride indicates that it is grams per liter is when things get dangerous, not milligrams. The LD50 for sodium fluorosilicate in rats is 125 mg/kg (that's a big rat!, but seriously...) for a 50 kg person that LD50 translates to several grams per liter. So the incident in Brisbane is a non-event for most neutral readers (i.e., those neither for or against fluoridation). In fact, the absence of anything particularly bad happening with a spike in fluoride if anything, undermines some of the alarmist rhetoric on this page. --Smokefoot (talk) 00:01, 16 October 2009 (UTC)

Perhaps a subpage or subcategory of "incidents of accidental over fluoridation" should be made rather than just ignoring these news items. It was a national news item. Your comments lead me to believe that it may be a commonly reported occurrence, in which case it definitely needs to be addressed. If the other illnesses are a result of negligence in fluoridation, then all incidences of negligence are notable. Bitcloud1 (talk) 02:02, 16 October 2009 (UTC)

That sort of material would be original research in this article, and can't appear here. Eubulides (talk) 07:47, 16 October 2009 (UTC)

Wikipedia is an encyclopaedia, not a collection of bad-news stories. It is a very poor and unfair way of conducting an argument to list all the bad things one can find. Naturally, the press covers bad news. Nobody writes/reads news stories like "Wee Jonny went to the dentist for a checkup and didn't require any fillings." So such an article or set of articles would be perceived as a WP:POVFORK and foul WP:NPOV by seeking to cast a topic solely in a bad light. Colin°^Talk 08:13, 16 October 2009 (UTC)

"justified" section. Why does this belong in the lead? Citation is a subjective work, and includes the subjective terms "may be". I don't feel this is appropriate for the lead. Bitcloud1 (talk) 23:36, 15 October 2009 (UTC)

The cited source, Burt & Tomar 2007 (ISBN 0195150694), is high-quality expert opinion, and the opinion is properly qualified with a "may be" here. The sentence in question is extremely helpful in the lead, as it ties together the previous sentences' coverages of alternative fluoride methods and of different experiences in U.S. and Europe. No reliable sources disagree with the claim in question. Eubulides (talk) 07:47, 16 October 2009 (UTC)

Weapons grade uranium etc.

A recent edit by the new user Roger Masters (talk · contribs), whose user name suggests that of the antifluoridation activist Roger Masters, inserted a large quantity of material that was original research, had serious WP:WEIGHT issues, and promoted WP:FRINGE theories (e.g., "waste products from processing weapons grade uranium"). I reverted the edit. Normally I would copy the material in question to the talk page for further discussion, but this insertion is fairly long and appears to contain copyrighted material that is reproduced without permission, so I'm not going to do that here. The main issue that the inserted material discussed, namely the safety of silicofluorides, is already covered in the 4th paragraph Water fluoridation #Safety, citing sources that are far more reliable than what was in the inserted text. Eubulides (talk) 07:47, 16 October 2009 (UTC)

Yiamouyiannis and other low-quality sources

A recent edit inserted the following text:

"Even though it it widely endorsed, various scientific studies have found fluoridation to have a detrimental effect or no effect at best."

citing the following sources:

• Yiamouyiannis, J (1990). "Water Fluoridation and Tooth Decay: Results From the 1986-1987 National Survey of U.S. Schoolchildren". Journal of The International Society for Fluoride Research. 23 (2): 55–67.
• Ziegelbecker RC, Ziegelbecker R (1993). "WHO data on dental caries and natural water fluoride levels". Fluoride. 26: 263–266.
• Diesendorf M (1986). "The mystery of declining tooth decay". Nature. 322: 125–129.

These sources do not support the claim in question: they do not say "Even though it it widely endorsed, various scientific studies have found". The claim in question is therefore original research. Furthemore, the first two sources are WP:FRINGE sources. For example, Yiamouyiannis was a notorious laetrile and fluoridation activist, and his work is discreded; see, for example, Horowitz 2000 (PMID 10929563), who writes

"Yiamouyiannis has repeatedly obtained data from government sources and then analyzed them to show damaging effects from community water fluoridation. His spurious analysis–based on crude mortality data unadjusted for age, sex, or race, showing that persons in fluoridated communities die from cancer more than do persons in non-fluoridated communities–has been fully discredited by the National Cancer Institute of NIH."

Ziegelbecker & Ziegelbecker 1993 has similar problems: it is also fringe. The third source, Diesendorf 1986, was a reasonable source in the middle 1980s when it was published, but its point is that dental caries has been reduced even in areas that do not practice water fluoridation, which is quite a different matter (and one that is already covered by the lead, with much better and more-recent reviews). Even if the first two sources were reliable, which they are not, they are primary sources, and as per Wikipedia policy and guidelines they should not be used to attack or undermine reliable secondary sources. The third source is far too old and does not support the claim in question. Please see WP:PSTS and WP:MEDRS for the Wikipedia policy and guidelines that are clearly violated by this insertion. For now, I've reverted the change. I suggest that further discussion on this topic be done on this talk page first, before attempting to make obviously-contradictory changes like this. Eubulides (talk) 16:36, 16 October 2009 (UTC)

Remove improperly cited vague sentence leading the Effectiveness section

"Fluoride has contributed to the dental health of children and adults worldwide."

This sentence leading the Effectiveness section is vague to the point of being useless and just looks like fluoride promotion. The statement is not event supported by its citation. —Preceding unsigned comment added by Gregwebs (talk • contribs) 02:58, 14 October 2009 (UTC)

It looks like a straightforward statement of fact to me, particularly as the introductory sentence to a section on "Effectiveness". The source cited states:

Widespread use of fluoride has been a major factor in the decline in the prevalence and severity of dental caries (i.e., tooth decay) in the United States and other economically developed countries. When used appropriately, fluoride is both safe and effective in preventing and controlling dental caries.

Perhaps it would be helpful if you could indicate which part(s) of the sentence you have problems with?

• Fluoride's contribution to dental health?
• The contribution to children's dental health?
• The contribution to adults' dental health?
• The contribution to dental health in many countries?

I think that when you define your objections, you'll see that the sources in the article actually do support the sentence. --RexxS (talk) 03:34, 14 October 2009 (UTC)

Objections: WP:WEASEL, WP:NPOV, mixes concepts

• The statement is about "Fluoride" instead of "Water fluoridation"
• The vagueness of "worldwide"
• The vagueness of "has contributed"
• The interjection of the word "children"
• The statement being made factual instead of attributed

This section is supposed to be about the effectiveness of water fluoridation, not about how wonderful fluoride is for our children. —Preceding unsigned comment added by Gregwebs (talk • contribs) 03:58, 14 October 2009 (UTC)

The section does need a lead; we can't simply remove the sentence and leave a gap. It would make sense to make the sentence more specific about water fluoridation. How about replacing the lead with "Water fluoridation reduces tooth decay in children and adults."? That's short and sweet and summarizes the section nicely. The cited source makes a clear distinction between children and adults, so our text should too. The sentence should be attributed in the usual way with a footnote, not with in-text attribution, because in-text attribution would incorrectly convey to the reader the impression that the claim is controversial among reliable sources. Eubulides (talk) 06:22, 14 October 2009 (UTC)

Indeed, this lead sentence would be more useful if it specified "water fluoridation" vs just "fluoride." Other sentences in the same paragraph also could be improved as indicated by my {inserts}: "Moderate-quality research {sounds like an attempt to placate a complaining group}} exists as to water fluoridation's effectiveness {for what?, dental health one assumes, isn't that the point of the whole article and the reason that the US CDC lists fluoridation of water as a top ten advance?}"--Smokefoot (talk) 12:54, 14 October 2009 (UTC)

The suggested intro is better, but still not specific enough. "Water fluoridation reduces tooth decay in those whose teeth do not regularly come in contact with fluoride." Gregwebs (talk) 15:31, 14 October 2009 (UTC)

That's circular. With water fluoridation their teeth will regularly come in contact with fluoride. Colin°^Talk 15:37, 14 October 2009 (UTC)

"... teeth do not *otherwise* regularly ...". Reliable sources used in this article show that in Europe, where there is no water fluoridation, they have reduced tooth decay. These sources attribute it in large part to other sources of fluoride, such as fluoridated toothpaste. Water Fluoridation would have been of little benefit to them, just as it is of little benefit to anyone who already has adequate fluoride exposure. —Preceding unsigned comment added by Gregwebs (talk • contribs) 16:00, 14 October 2009 (UTC)

The claim "Water fluoridation reduces tooth decay in those whose teeth do not otherwise regularly come in contact with fluoride." is not directly supported by the cited source, so we can't use that wording. Furthermore, the wording clearly implies that fluoridation does not reduce tooth decay in those who brush with fluoride toothpaste regularly, an implication that is incorrect. Let's leave the topic sentence short, sweet, and a summary of the section, rather than introduce unsupported (and incorrect) editorial opinion. Eubulides (talk) 06:50, 15 October 2009 (UTC)

This is directly supported by citations in the article "Community water fluoridation and caries prevention: a critical review" PubMed 17333303: "...the caries reduction directly attributable to water fluoridation have declined in the last decades as the use of topical fluoride had become more widespread... studies conducted in fluoridated and nonfluoridated communities suggested that this method of delivering fluoride may be unnecessary for caries prevention particularly in the industrialized countries where the caries level has became low."

This major point about the effectiveness of water fluoridation should be in the introductory statements to maintain accuracy and a NPOV. —Preceding unsigned comment added by Gregwebs (talk • contribs) 03:55, 17 October 2009 (UTC)

"This is directly supported by citations in the article" No, those quotes from Pizzo et al. 2007 (PMID 17333303) do not establish that water fluoridation does not reduce tooth decay in those who brush with fluoride toothpaste regularly. On the contrary, they say that water fluoridation has less of an effect (not "no effect") on regular tooth-brushers, and that in an industrialized society willing to tolerate a somewhat-higher level of caries than would obtain with water fluoridation + fluoride toothpaste (perhaps because dental treatments are free or low-cost) the water fluoridation may be unnecessary. The implication is that, in a society where dental treatments are unavailable or are too expensive for the poor, society might not be willing to tolerate this somewhat-higher level of caries, and water fluoridation would then still be necessary. This point is currently made in the lead in the last sentence of the 2nd paragraph, citing Burt & Tomar 2007. The opinion of Pizzo et al. 2007 is already featured quite prominently in the lead compared to the weight given their arguments by other reliable sources; there would be a WP:WEIGHT problem in featuring them much more than they're already featured. But perhaps, if you think this part of their argument is crucial, it could replace some of the existing text. Eubulides (talk) 06:27, 17 October 2009 (UTC)

I do think for this section titled "effectiveness" the fact that the effectiveness greatly varies if there are other methods of fluoride exposure needs to be clearly stated and reflected in the introductory remarks. —Preceding unsigned comment added by Gregwebs (talk • contribs) 20:16, 17 October 2009 (UTC)

The Effectiveness section already does what you're requesting. Its second sentence says the effectiveness of water fluoridation has gone down significantly with time, likely due to the introduction of fluoride toothpaste, plus the halo effect. Eubulides (talk) 07:37, 19 October 2009 (UTC)

Ok, I was in the mindframe of only thinking about an intro sentence, not an intro paragraph. If we remove the first sentence that doesn't add useful information, then we will have a good intro paragraph that goes over the historical effectiveness of water fluoridation and makes very specific statements with useful information. Gregwebs (talk) 23:52, 19 October 2009 (UTC)

Essential Nutrient

The previous discussions on this subject were interesting, but based on original research of what an essential nutrient is. None of the cited sources state that fluoride is an essential nutrient. WP does not list it as essential nutrient. There is no need to quote (and not show that we are quoting) their ridiculous wordplay on Wikipedia to give the impression that it could be essential when there is no evidence to back up those statements. Speculation should be explicitly labeled as such. —Preceding unsigned comment added by Gregwebs (talk • contribs) 04:52, 12 October 2009 (UTC)

The coverage that's currently in Water fluoridation is directly supported by the cited sources, and is not original research. The first cited source, Olivares and Uauy 2005 (PDF), says "The essentiality of fluoride for humans has not been proven unequivocally", which is pretty much what Water fluoridation currently says. The same source goes on to say "However, this element has beneficial effects on the prevention of dental caries" which is pretty much the same point that all reliable sources on this topic say: namely, that fluoride has a beneficial effect even if it's not an essential nutrient. This point is elaborated further by the second source, Jones & Varady 2008 (PMID 18347661), which provide dietary fiber as helpful example of another nutrient that has beneficial effects but is not essential. This discussion is highly relevant to fluoride and is well supported by reliable sources, with no serious dispute about it in reliable sources; I see no reason to remove the discussion, though of course there is always room for improvement in the coverage of any topic. Eubulides (talk) 05:06, 12 October 2009 (UTC)

The current material is being directly quoted (and not shown as such). So if you are going to continue to revert my edits which are consistent with Wikipedia's guidelines, an alternative that does not violate those guidelines should be provided. Gregwebs (talk) 06:14, 12 October 2009 (UTC)

It's not supposed to be a direct quote: it's supposed to be a close paraphrase. In a controversial area like this, it's wise to not stray too far from the sources. If there is any real objection to it based on direct quotation, please specify the objectionable words. Wording we can fix. Eubulides (talk) 07:16, 12 October 2009 (UTC)

I don't think a discussion about the definition of an essential nutrient belongs on this page, it belongs on the essential nutrient page. A citation of someone proposing a new definition of essential nutrient that could possibly include fluoride just proves that point. I don't see why we need to make this speculation part of this page without labeling it as such. Gregwebs (talk) 06:14, 12 October 2009 (UTC)

The article text in question does not propose a new definition of essential nutrient; it uses the traditional definition. We cannot expect the typical reader to know the distinction between a nutrient and an essential nutrient (which is the main distinction here). The question of whether fluoride is an essential nutrient or just a nutrient is an important one, supported by many reliable sources (not just the sources listed here). It's inappropriate to unilaterally remove this longstanding material over reasonable objections. Please restore it while we thrash out the wording on the talk page. Eubulides (talk) 07:16, 12 October 2009 (UTC)

My suggestion is to avoid copying pro-fluoride speculation and to state the facts: "Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans. A diet low in sugar removes the need for fluoride." Gregwebs (talk) 15:17, 12 October 2009 (UTC)

The existing article text in question does not contain speculation, either pro- or anti-fluoride. And the existing text states all the facts given in your proposal. No valid reason has been given to remove the material in question, which is well-supported by reliable sources. Eubulides (talk) 19:42, 12 October 2009 (UTC)

The text "It has not been proven unequivocally whether fluoride is an essential nutrient" contains quoted weasel words with the goal of making it sound like fluoride is probably an essential nutrient. Keeping this obtuse wording is not required for an accurate summary of the facts at hand. Gregwebs (talk) 19:59, 12 October 2009 (UTC)

The cited source (Olivares and Uauy 2005) says "The essentiality of fluoride for humans has not been proven unequivocally". It would be misleading to summarize this source by writing "Fluoride is not considered an essential nutrient ...". It would be OK to summarize it as "It is not known whether fluoride is an essential nutrient ...", or something like that. Furthermore, the previous comment doesn't address the point that the example of dietary fiber helps explain to the reader the distinction between a nutrient and an essential nutrient, which is clearly an important distinction to make in this context. No reason has been given for removing this example, which is well supported by a reliable source. Eubulides (talk) 23:41, 12 October 2009 (UTC)

The goal here is not to repeat the weasel words of one paper, but to summarize the facts at hand and make proper attributions. I would prefer not to explain by analogy, particularly with fiber. If someone wants to more deeply understand the concept they can click on the wiki link to essential nutrient. One sentence of explanation should be able to suffice.

"Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans since a diet low in sugar removes the need for fluoride. Scientists have proposed that in modern high sugar diets fluoride should be considered an essential nutrient.[citations]"

Gregwebs (talk) 04:07, 14 October 2009 (UTC)

• "Fluoride is not considered an essential nutrient" Again, that is not what the cited source says. The cited source (Olivares and Uauy 2005) says that it's not known whether fluoride is an essential nutrient. Sources can certainly be cited saying tht fluoride is an essential nutrient (e.g., Tang et al. 2009, doi:10.1016/j.jhazmat.2009.06.079, Chipponi et al. 1982, PMID 6805293). Other sources say that fluoride is not an essential nutrient, with Jones & Varady 2008 (PMID 18347661) being one of those sources. In an uncertain area like this, the Wikipedia article cannot take sides; the science is genuinely unsettled.
• "Scientists have proposed that" Those are weasel words, no? And they are not in the source.
• "I would prefer not to explain by analogy" Some sort of explanation is needed, because the topic of whether fluoride is an essential nutrient or just a nutrient is directly relevant to the topic of water fluoridation. Several sources say that fluoride is an essential nutrient (see the previous bullet), while several (less-reliable) sources deny that fluoride is a nutrient at all (e.g., "The FDA states specifically that fluoride is not a nutrient"[5]). It's clearly a topic worth covering, so we shouldn't remove all discussion of fluoride as a (inessential) nutrient. The explanation by analogy is a good one, because it conveys to the reader the distinction between an essential and a merely beneficial nutrient far more clearly than a dry definition would. The analogy is not original research, as it's taken straight from the cited source.
• "The goal here is not to repeat the weasel words of one paper, but to summarize the facts at hand and make proper attributions." No weasel words are in this part of the article text now, and the facts are being summarized and properly attributed.

Eubulides (talk) 06:22, 14 October 2009 (UTC)

"Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans- a diet low in sugar removes the need for fluoride. However, in the typical modern high sugar diets fluoride could be considered an essential nutrient."

Again, it is absolutely ridiculous to state "it has not been unequivocally proven", since we are not (and should not be) quoting the article. If that stays here, we should insert it in every other sentence in the article. If you cannot yield on this point, there is no point in continuing this discussion. Gregwebs (talk) 15:51, 14 October 2009 (UTC)

This new version removes the "Scientists have reported that" weasel words, which addressed the least important of my objections, but the other objections remain. First, the distinction between essential and beneficial nutrients should be made. Second, the science is not settled as to the essentiality of fluoride as a nutrient, and the text shouldn't say or imply otherwise. Eubulides (talk) 06:50, 15 October 2009 (UTC)

"Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans- a diet low in sugar removes the need for fluoride. However, in the a modern high sugar diet fluoride acts as a nutrient against tooth decay and could be considered an essential nutrient."

If something is being proposed as a potential nutrient, then that means it is not considered to *be* an essential nutrient, and the text needs to reflect this fact, instead of implying through weasel words that fluoride is an essential nutrient. The statement about fiber also should be removed until it can be reworded or cited- as it stands the "harmful biological process" it acts against is unknown. Gregwebs (talk) 03:12, 17 October 2009 (UTC)

Please see #Essential nutrient 2 below. Eubulides (talk) 06:27, 17 October 2009 (UTC)

Essential nutrient 2

• "If something is being proposed as a potential nutrient" But that's not what's happening. The cited source (Jones & Varady 2008, PMID 18347661) doesn't say that it is proposing that fluoride is an essential nutrient: it is saying that fluoride is an essential nutrient, using the more-modern definition of essential nutrient. The article's proposal is not about fluoride at all: it is a proposal that plant sterols and omega-3 fatty acids should be considered to be essential nutrients in this more-modern sense.
• "instead of implying through weasel words that fluoride is an essential nutrient" The current text does not imply that fluoride is an essential nutrient. It says only that we don't have conclusive proof that it is essential (in the traditional sense of "essential"). There is some evidence that fluoride is essential (in the traditional sense), but the evidence is too weak to draw such a conclusion unequivocally.
• "The statement about fiber also should be removed until it can be reworded or cited" The statement is cited. It's sourced to Jones & Varady 2008, who compare fluoride to "dietary fiber in its capacity to slow or restrict glucose and bile acid absorption."
• "in the a modern high sugar diet fluoride acts as a nutrient against tooth decay" This isn't quite right; as Jones & Varady write, the modern lifestyle involves both sugar and oral microbes, and it would suffice to remove either. It may become practical to vaccinate against the microbes, for example.
• 'as it stands the "harmful biological process" it acts against is unknown' I don't see the need for this article to go into the details about dietary fiber's action against glucose and bile acid absorption. The point is that fluoride is not alone in being a nutrient that works in a negative way, and mentioning dietary fiber suffices to make that point. Anybody curious about the details can click on the wikilink to Dietary fiber.

Eubulides (talk) 06:27, 17 October 2009 (UTC)

Part of the problem is clicking on the link to the dietary fiber page doesn't give the details as to what the harmful process is. On that page, and in popular knowledge, fiber does not so much "act against a harmful biological process", but instead it is supposed to provide various benefits. The claims for fiber are varied, whereas the claim for fluoride is it helps one specific biological pathway. If instead it stated "like fiber, fluoride is only beneficial under certain dietary circumstances", that would be more to the point.

as per microbes, I thought the logic for stopping cavities is an OR, not an AND- eliminating either one of the two stops cavities (but I assume the practical idea is to somehow reduce microbes to reduce cavities, not elimination) —Preceding unsigned comment added by Gregwebs (talk • contribs) 20:52, 17 October 2009 (UTC)

• 'On that page, and in popular knowledge, fiber does not so much "act against a harmful biological process", but instead it is supposed to provide various benefits.' Many of those benefits accrue not because fiber is an essential nutrient in the traditional sense: they accrue because fiber interferes with other processes. I've added a new section Dietary fiber #Mechanism to try to cover this issue better.
• "I thought the logic for stopping cavities is an OR, not an AND" Yes, that's right. The point is that the text should mention both arms of the OR. And you are correct that the vaccines would not eliminate all microbes, just as dietary intervention would not eliminate all sugar.
• "like fiber, fluoride is only beneficial under certain dietary circumstances" That wouldn't be quite right, as dietary fiber is beneficial pretty much everywhere, whereas fluoride isn't needed in locations where people practice low-sugar (and low-starch) diets.

Eubulides (talk) 07:37, 19 October 2009 (UTC)

The point still remains that the claims for fiber are varied and complex (not to mention made with weak evidence), which means this comparison can introduce confusion instead of clarity, particularly if there are no specifics with fiber.

There are well-documented examples of cultures that have had great teeth and great health and no need for fluoride or fiber (Eskimos are the first that come to mind). So to the best of scientific knowledge, flouride and fiber are only useful under certain dietary circumstances, and have never been shown to be useful for everyone, everywhere. But while the statement I made was accurate, you and others will still read it with confusion about its accuracy, which is why this article would be better off without the fiber reference.

Gregwebs (talk) 19:00, 19 October 2009 (UTC)

You are correct about fluoride (and that point is made in the Water fluoridation article), but incorrect about dietary fiber. Although the traditional Eskimo diet was significantly lower in dietary fiber than (say) the traditional western European diet, it did contain dietary fiber derived from animals (nondigestible aminopolysaccharides). I don't know of any human diet that was essentially fiber-free. Furthermore the "great health" of the traditional Inuit was actually not that good by modern standards, and although of course there are no reliable health statistics for the Inuit before European contact, more-recent statistics include higher rates of some diseases, such as gallbladder cancer, that are associated with low-fiber diets. Anyway, we are starting to diverge from the subject of this talk page. I'm a bit lost about which statement is meant by "the statement I made was accurate", so I can't follow the last sentence in the previous comment. Eubulides (talk) 20:45, 19 October 2009 (UTC)

Do you have any more information about dietary fiber from animals? I am interested in this information, and it should be added to the dietary fiber page when you have time. The only information I can find is that connective tissue could be considered fiber. Recent studies of the Inuit also show diabetes and alcoholism, and are quite useless for determining pre-contact health. The only information I have come across so far (observational or archeological) seems to show good health, including an absence of dental caries.

We digress. But the above points that there are multiple claimed mechanisms of fiber for different processes in the body, with varying degrees of effectiveness that are generally based on low quality research means that making a non-specific comparison to dietary fiber is a source of confusion and should be removed. —Preceding unsigned comment added by Gregwebs (talk • contribs) 23:37, 19 October 2009 (UTC)

Why was this edit done?

Why was this edit (which removed the "Like dietary fiber" clause) done? What I see above is an original-research discussion on whether the analogy is appropriate. That's fine to a degree but since it appears to have reached a stalemate, the casting vote should really go to our sources, which use the analogy. Or have I've missed something, and Eubulides has conceded the analogy is not appropriate? I think the analogy has some merit but like all analogies, can be shown to be not exactly 1:1. Colin°^Talk 08:34, 26 October 2009 (UTC)

AFAIK Eubulides has not conceded, but he has stopped discussing. I propose to removing the reference to fiber until it is defended. The issue is less one of original-research and more one of: is the analogy appropriate considering the complex multiple mechanisms by which fiber is explained to work, and the lack of explanation following the wiki link. What sources are using a direct analogy? This article explains the specific biological pathway and condition that can be improved for flouride. If the fiber reference is maintained, I think it should make a specific statement about either a biological pathway or a condition it can improve. —Preceding unsigned comment added by Gregwebs (talk • contribs) 14:25, 26 October 2009 (UTC)

That would be OK; I inserted something along the lines of this suggestion. Eubulides (talk) 15:48, 26 October 2009 (UTC)

The source doesn't just say "slow bile acid absorption" it says "slow or restrict glucose and bile acid absorption". I'm absolutely no expert here but the dietary fiber article particularly mentions the reduction in bile acid absorption rather than slowing (the reduction lowers cholesterol levels in the blood, apparently). The slowing seems more applicable to the glucose absorption, which smooths out variance in blood glucose levels. Why don't we just keep the whole phrase? Colin°^Talk 16:56, 26 October 2009 (UTC)

I'm no expert either, but when it comes to the gut my impression is that there's not a sharp line between slowing and restricting. That being said, it's OK to mention both, and to mention glucose too, so I added that as well. I hope it's OK that my change substituted the plainer-language but less-precise "sugar" for the scientific "glucose". Looking back on my change now, this material is starting to become a digression, and I wouldn't object if it got trimmed back to something shorter. Do we really need to mention both bile acid and glucose? Surely one's enough here. Eubulides (talk) 17:08, 26 October 2009 (UTC)

I like the changes. Probably only 1 mechanism is necessary for comparison purposes. Note that "the harmful biological process" has still not been stated for fiber. The grammar seems incorrect. "Just as dietary fiber can slow sugar absorption to act against the harmful process of (insulin spikes?) ..." Gregwebs (talk) 17:27, 26 October 2009 (UTC)

I interpret "restriction" as actually limiting or reducing the amount absorbed whereas "slowing" may not limit or reduce the amount at all. If we want to just mention one, the problem might be picking the appropriate combination. This is the problem I had with "slow bile acid absoption" in that I think the wrong combination was picked. I'm not sure we can give details of the benefit of either of these effects without including another source. I think the current text is fine and doesn't need to be shortened or give more detail on any one of the effects. Colin°^Talk 17:47, 26 October 2009 (UTC)

Really, to bring the analogy full circle we need something like this: "Just as dietary fiber can act as a nutrient to aid in slowing the digestion of sugar, fluoride can act as a nutrient in a diet high in sugar to prevent tooth decay. A diet low in sugar removes the need for fluoride." Gregwebs (talk) 20:03, 26 October 2009 (UTC)

Where does the "high in sugar" == needed / "low in sugar" not needed rule come from? And the reader is going to think the connection is "sugar" and not "sort of a nutrient". Colin°^Talk 22:38, 26 October 2009 (UTC)

The point that needs to be made is that both are conditionally essential. If we can't come up with a good way to state that fiber is conditionally essential, then it should be removed altogether. Gregwebs (talk) 17:23, 27 October 2009 (UTC)

Please see #Conditionally essential below. Eubulides (talk) 17:45, 27 October 2009 (UTC)

Conditionally essential

"The point that needs to be made is that both are conditionally essential." No, the cited source doesn't say that. The source (Jones & Varady 2008, PMID 18347661) likens dietary fiber to fluoride not on the grounds of conditional essentiality, but on the grounds that both are counter-permissive nutrients, i.e., both have beneficial nutritional effects that occur because they counter an adverse action of some other biological process. The current text in Water fluoridation captures this, in that it says that fluoride is like dietary fiber in that it "acts against a harmful biological process". The text goes on to say that fluoride's benefit is conditional, but it (correctly) does not claim that the same thing is true for dietary fiber. Eubulides (talk) 17:45, 27 October 2009 (UTC)

Ok, but the "harmful biological process" that fiber acts against is still not stated. —Preceding unsigned comment added by Gregwebs (talk • contribs) 00:59, 29 October 2009 (UTC)

Repeated removal of discussion of nutrient status

Gregwebs (talk · contribs) is repeatedly removing material discussing fluoride as a nutrient (first time, second time). The material is directly supported by high-quality sources, is not controversial among reliable sources, and was carefully reviewed as part of the featured-article process. Please don't simply remove such material without consensus. I suggest that the section be restored to its stable version and that further changes be discussed here. Eubulides (talk) 05:15, 12 October 2009 (UTC)

I started the discussion of the topic on this page, so it is odd for you accuse me of edit warring. I am all for consensus instead of one person owning this page. Gregwebs (talk) 06:21, 12 October 2009 (UTC)

You started this thread only after your second revert of well-sourced material, and only after I informed you of the 3RR rule. You are continuing to install obviously-controversial edits into a stable featured article without discussion and without consensus, for example, this edit. These actions are inconsistent with a claim to be all for consensus instead of one person owning the article. I suggest that these changes be reverted and that we discuss them on the talk page. Eubulides (talk) 07:16, 12 October 2009 (UTC)

I started discussion of the edit in question before I was "informed" of the 3RR rule that I have not violated, and before my first undo. Gregwebs (talk) 14:53, 12 October 2009 (UTC)

Gregwebs, a reminder to unestablished users to be aware of WP:3RR is not intended as an accusation. Please be aware of 3RR and refrain from reinserting text that does not have consensus; discuss first. SandyGeorgia (Talk)

For the benefit of editors new to the article, it may be useful to review Talk:Water fluoridation/Archive 3#Essential nutrient, which contains a detailed discussion of the sources and the consensus that was reached, before making changes to the text related to essential nutrients. --RexxS (talk) 17:06, 12 October 2009 (UTC)

Fluoride toothpaste is widely used

A recent deletion by 71.235.238.78 (talk · contribs · WHOIS) (which has been reverted twice, and then reinstated twice by the same IP address) removed the sentence, talking about fluoride toothpaste, that "It is widely used, but less so among the underprivileged.". with edit summaries like "again, that part of the sentence sounded like it was advertising fluoride toothpaste, or in some way promoting its use".

The cited source, Jones et al. 2005 (PMID 16211158), directly supports the sentence. The source says "Probably the most widespread and significant vehicle used for fluoride has been toothpastes.... Uptake and use has not been uniform and is less likely among underprivileged groups." This is not an advertisement: it is a public-health paper published in the Bulletin of the World Health Organization, with a wide variety of dental and public-health coauthors. Because the sentence is well-sourced and relevant, I've restored it. I suggest to the IP address to please discuss the matter here rather than continuing to remove the material against consensus. Eubulides (talk) 03:31, 31 October 2009 (UTC)

Mainly because

A recent edit added the text:

"mainly because addition of fluoride does not improve the safety of drinking water as such (legal reason) and because of the availability of alternatives."

However, the cited source, Martin 1989 (doi:10.1111/j.1533-8525.1989.tb01511.x), does not support this newly added text. That source does not come to any conclusions about the main reasons for the administrative decisions in Europe. The source gives just one example, in Denmark, and this example does not talk about improving the safety of drinking water, or about legal reasons, or about the availability of alternatives. As the change is not at all supported, I have reverted it for now. Eubulides (talk) 19:41, 4 November 2009 (UTC)

• I agree that there is no link between the reference and my added text. I added a modified text with reference. E.J.Hoekstra (talk) 21:03, 4 November 2009 (UTC)

Missing Opposition?

I used to be all for Fluoridation, but much of the opposition, starting as early as the '50's, was evidence of lowered test scores. This is not addressed; it is only "glazed over" by: "lack of evidence of harmful effects". There IS evidence. I ask this point be included in "Opposition".68.231.189.108 (talk) 12:59, 12 October 2009 (UTC)

Agree. Such prominent opponents of water fluoridation have included Dr. Bronner, who was arrested for his activities to protest water pluoridation in the 1950s. Drinking water sources have been a convenient source for the disposal of fluoride waste under the reasoning of, "fluoride prevents tooth decay." Meanwhile many brands of natural toothpaste now boast that they do not contain fluoride because of health concerns. This article, as it stands today as Wikipedia's featured article, reads as propaganda for water fluoridation, not presenting a neutral view of the subject as is befitting of Wikipedia's standards. —Morganfitzp (talk) 13:23, 12 October 2009 (UTC)

These arguments should be based on reliable sources that are peer-reviewed and recent. Opposition is well covered, and included in the lead. SandyGeorgia (Talk) 13:45, 12 October 2009 (UTC)

I'd object to putting pluride in water; is it a form of plutonium? Sounds nasty. In order to avoid accusations of being off topic, I agree with Sandy, and we have a different article for these sorts of things too (which also requires RS). Verbal chat 14:01, 12 October 2009 (UTC)

There is no reliable evidence that water fluoridation lowers test scores or IQ, or that it causes Down's syndrome, senile dementia, goiter, etc. The article is relying on recent reliable reviews of fluoridation (some pro-fluoridation, and some anti-); none of them say that there is any evidence along these lines. The only clear adverse effect is dental fluorosis, and this is covered at some length in the Safety section and mentioned in the lead. Eubulides (talk) 19:42, 12 October 2009 (UTC)

I don't have any axe to grind on this topic but I agree that the opposition argument is not well covered at all and this article doesn't present a balanced view. If I can quote from the opening paragraphs of article used for reference no. 79:

For eons now, liberals have teased conservatives about one thing (well, many things, but I'm thinking of one in particular): the fluoridation of water fluoridation of water

Addition of fluoride compounds to water (see fluorine) at one part per million to reduce dental caries (cavities). This practice is based on the lower rates of caries seen in areas with moderate natural fluoridation of water and on studies ..... Click the link for more information.. "Oh, you work at National Review? What do you do, write editorials denouncing the fluoridation fluoridation (flr'ĭdā`shən), process of adding a fluoride to the water supply of a community to preserve the teeth of the inhabitants. of the water supply?" Ha, ha, ha. (Actually, we spend our time advocating separate lunch counters for Negroes.) In many quarters, "fluoridation of water" is a code word for right-wing kookery.

Well, imagine my surprise -- and delight -- when I was talking recently with a dentist friend of mine and the subject of water fluoridation came up: "We still have to fight on that, all over the country," he said. "What," I said, "you mean the Birchers are still at it?" "Oh, no," he replied. "It's the Left. The opposition comes from the environmentalist environmentalist

a person with an interest and knowledge about the interaction of humans and animals with the environment. , earthy-crunchy, sandal-wearing Left."

Well, well, well. Who's laughin' now, baby?

Is this what passes for a reliable source that is peer-reviewed and recent?

Then there is a passage in the wikipedia article that says:

Media reporters are often poorly equipped to explain the scientific issues, and are motivated to present controversy regardless of the underlying scientific merits. Internet websites, which are increasingly used by the public for health information, contain a wide range of material about fluoridation ranging from factual to fraudulent, with a disproportionate percentage opposed to fluoridation. Antifluoridationist literature links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid.

I think it would be much better to preface this with something like " a critical examination of antifluoridationist literature published in 2007 argued that" rather than present these arguments as a statement of facts. Richerman (talk) 15:10, 12 October 2009 (UTC)

• The first source mentioned above, Nordlinger 2003, is cited only on the politics of water fluoridation, not about its medical or technical aspects. I agree that it would be better to cite a peer-reviewed source on the topic, preferably something more recent, but in the meantime this source is adequate to support the entirely non-controversial claim that opposition to fluoridation has come from right wing groups such as the John Birch Society, and more recently from left-wing groups such as some Green parties.
• The second source mentioned above, Armfield 2007 (PMID 18067684), is a reliable peer-reviewed source, and none of the article text that it supports is controversial among reliable sources. There is no need for in-text attribution for claims that are not controversial among reliable sources.

Eubulides (talk) 19:42, 12 October 2009 (UTC)

The "balance" is given by WP:UNDUE and WP:FRINGE covers the minority view that fluoride in water is dangerous. Verbal chat 15:14, 12 October 2009 (UTC)

Have you read WP:FRINGE?. Almost all of the mainstream pro-fluoride review articles acknowledges the opposition arguments. That alone is enough to show it is not fringe. —Preceding unsigned comment added by Gregwebs (talk • contribs) 15:45, 12 October 2009 (UTC)

The statement of supporting arguments as facts (when all opposing must be qualified) may be the main problem with this article. This may be a violation of WP:ATTRIBUTEPOV Gregwebs (talk) 16:31, 12 October 2009 (UTC)

Generally speaking, the article uses in-text attribution only when discussing topics that are disputed among reliable sources. For example, reliable sources do not agree that fluoridation is one of the top-ten public health achievements of the 20th century, so it's appropriate for an in-text attribution of this opinion to the CDC. However, where reliable sources agree on a topic, it would be misleading to use in-text attribution for that topic, as it would incorrectly suggest to the reader that the topic is controversial among reliable sources. So, for example, reliable sources agree that the goal of fluoridation is to prevent tooth decay, so it would be misleading for the Goal section to begin with something like "The Centers for Disease Control says that water fluoridation's goal is to prevent tooth decay", as this would suggest to the reader that other reliable sources say that fluoridation's goal is actually something else; here, it more accurate simply to give a footnoted attribution in the usual way. This style is standard in Wikipedia, and you'll see it used in many other high-quality articles that discuss controversial subjects. Eubulides (talk) 19:42, 12 October 2009 (UTC)

Of course I am not arguing against the sample you gave. I take issue mostly with statements like "Fluoride has contributed to the dental health of children and adults worldwide." in the evidence section. Besides lacking attribution to POV, it is also vague to the point that it is simply promotional. Gregwebs (talk) 20:18, 12 October 2009 (UTC)

But there is no dispute among reliable sources that fluoride has contributed to the dental health of children and adults worldwide. Fluoride does have disadvantages, which are also discussed. It is not POV or promotional to list its advantages as well as its disadvantages. Eubulides (talk) 23:41, 12 October 2009 (UTC)

I'm not asking that you give them more weight - just that they aren't dismissed out of hand. Although the reference I mentioned is pretty poor for a citation as it's not peer reviewed as far as I can see, the writer does make some valid points. To quote:

Still, the mainstreamers can be awfully high-handed when it comes to the anti-fluoridationists. Paul Connett complains, "Promoters of fluoridation refuse to recognize that there is any scientific debate on this issue." That's largely true. Connett points out that a leading fluoridation proponent has said, "Debates give the illusion that a scientific controversy exists when no credible people support the fluorophobics' view." That is patently untrue. Many dentists -- unorthodox, to be sure -- oppose fluoridation, and the "fluorophobics" can boast some heavy-hitters, like Arvid Carlsson, winner of the 2000 Nobel prize Nobel Prize, award given for outstanding achievement in physics, chemistry, physiology or medicine, peace, or literature. The awards were established by the will of Alfred Nobel, who left a fund to provide annual prizes in the five areas listed above. ..... Click the link for more information. in medicine. And yet many of the mainstreamers persist in treating every anti-fluoridationist like a street-corner quack. Indeed, there are anti-anti-fluoridationist whacks at QuackWatch.org. This site contains an article -- generally informative and persuasive -- that says, "The anti-fluoridationists' basic technique is the big lie. Made infamous by Hitler, it is simple to use, yet surprisingly effective." This is perhaps not the best way to win an argument, especially with serious-minded people. The anti-fluoridationists complain that the mainstreamers are afraid to debate them, relying on dogma, tradition, and prejudice instead of scientific fact.

Richerman (talk) 15:28, 12 October 2009 (UTC)

The previous comment is a reasonable request. However, Water fluoridation does not dismiss antifluoridationist arguments out of hand. It describes them prominently, and mentions them in the lead, giving them the approximate weight that reliable sources do. The article should not say or imply that there is no scientific debate on this issue, and it should not say or imply that all antifluoridationist arguments are street-corner quackery. If there's any specific place in Water fluoridation where it mistakenly dismisses antifluoridationist arguments, please let us know, ideally with suggestions for improved wording. Eubulides (talk) 19:42, 12 October 2009 (UTC)

First of all I think that labelling the The John Birch Society and Greenpeace as right wing and left wing, although probably somthing many would agree with, is POV and sounds rather dismissive of their views. Secondly I think the sentence I mentioned earlier needs some qualification and would suggest that it should read "Proponents argue that media reporters are often poorly equipped to explain the scientific issues......etc." When I say about dismissing the arguments out of hand, maybe that's a bit strong, but what I mean is coming down too heavily on the side of proponents. So saying "Opposition campaigns involve newspaper articles, talk radio, and public forums. Media reporters are often poorly equipped to explain the scientific issues..." Is implying that the proponents are right and the "antis" are obviously wrong, and that's not neutral enough. Richerman (talk) 10:02, 13 October 2009 (UTC)

My sense on reading this report is that it approaches over-legitimizing the opposition to the fluoridation of water. The practical problem arises as to when and how it is appropriate to be dismissive. The opposition is diverse organizationally and highly vocal, but the opposition is represented by no large scientific organization on the scale and with the legitimacy of the AMA, WHO, CDC, National Academy, Royal Society. Instead, the opposition is more commonly represented by single issue books or organizations such as the Fluoride Action Network. A related practical problem is that so much energy is focused on subtly rebalancing this article, yet parallel care is not diected at the Wiki articles that have been created to cater to the opposition. These articles lose their legitimacy because they come across as less balanced and in some cases almost strident. In the perfect world the POV aspect would be discussed in the content of the collection of articles on fluoridation. But the topic is too hot emotionally to handle cooly.--Smokefoot (talk) 12:56, 13 October 2009 (UTC)

The article says that Organized political opposition has come from right-wing groups ... and more recently from left-wing groups ... - both John Birch Society and Greenpeace are given merely as examples. The point is, surely, that both sides of the political spectrum have provided organised political opposition? (rather than "these groups can be dismissed because they are labelled X or Y".) Also, I cannot see how you draw your implication on the second point. Opposition campaigns involve newspaper articles, talk radio, and public forums. Media reporters are often poorly equipped to explain the scientific issues, and are motivated to present controversy regardless of the underlying scientific merits implies nothing more than the vehicle chosen for the campaign is not good at explaining the science, but instead will convey that campaign for other reasons. It makes no comment on the underlying rightness of the opposition's campaign. That's as neutral as anyone could reasonably expect. --RexxS (talk) 13:13, 13 October 2009 (UTC)

In answer to the point above about other articles on this subject, I'm interested in this one because it's a featured article that was on the front page and as such is supposed to be the best that wikipedia can produce and should stand on its own merits. I presume the others you're talking about are not featured articles for the reasons you've mentioned. As I said I have no strong opinions on this subject either way and was merely acting as devil's advocate trying to see how someone from the "anti" side would see the way the arguments were presented. I notice no-one has seen fit to comment on what I said about the quality of reference 79. However, I know when I'm flogging a dead horse so, if you're happy with the article, by all means leave it as it is. Richerman (talk) 14:34, 13 October 2009 (UTC)

It's hard to follow this entire discussion

It's hard to follow this entire discussion, but I'd like to note briefly that I've noticed the same thing as the original poster. The section on "safety" uses several paragraphs to present water fluoridation as essentially safe, containing only a small link named "several long-term adverse effects" detailing possible adverse effects of excessive fluoride intake. Meanwhile, arguments against fluoridation are relegated to the section "Ethics and politics", which presents the issue as a complete fiction without any basis in fact, with no attempt being made to examine what specific claims are being made or what documentation may be available to support those claims. It's one thing to take controversial claims with a grain of salt, but to maintain an article so biased that it reads like a pro-fluoridation activism site is a bit much.

(On a related note, the section also links to an additional article, Opposition to water fluoridation, whose "Potential health risks" section simply links back to the previous section again in a circular manner, with neither containing much information on the topic.)

On the other hand, some anti-fluoridationists go to great lengths to document their claims with references to scientific literature, for instance the so called "Fluoride Action Network": [HEALTH EFFECTS: Bibliography of Papers Cited by FAN] [23 published studies report an association of reduced IQ with high fluoride exposure]. If Wikipedia continues to misrepresent the issue as nonexistent, anyone able to Google their way to one of these pages will have to doubt Wikipedia's credibility as a source.

Rōnin (talk) 15:27, 12 November 2009 (UTC)

• "arguments against fluoridation are relegated to the section "Ethics and politics"" No, they're presented in many sections. For example, the lead section talks about dental fluorosis, about other adverse effects, about the low quality of safety studies, about the fact that European countries seem to be doing just fine without water fluoridation, about the conflict between individual rights and the common good, about the controversy, and about ethical, legal, safety, and effectiveness arguments against fluoridation. Each of these comments in the lead section are followed up in multiple sections in the body. For example, the Implementation section says that the U.S. standard for fluoridation has become obsolete; the Mechanism section says that it's not known whether fluoride is an essential nutrient; the Evidence basis says that there's consistent evidence that fluoridation causes dental fluorosis and that research into most potential adverse effects has been almost all of low quality; the Alternatives section says that toothpaste is more widely used and more rigorously evaluated; the Economics section says there's little high-quality research on cost-effectiveness and that fluoridation harms the income of dentists; the Use around the world section that many communities have discontinued fluoridation, due not only to political opposition but also by alternative strategies; and the History section says that pioneering studies of fluoride were crude and gives more examples of discontinuance of fluoridation. This is just a summary of some of the arguments against fluoridation presented in these sections: I have not enumerated them all.
• "the section "Ethics and politics", which presents the issue as a complete fiction without any basis in fact" The Ethics and politics section focuses on ethics and politics; by design, the science and medicine topics are discussed in Evidence basis and it would be repetition to re-discuss them in Ethics and politics. The same holds for pro-fluoridation arguments, of course: the science behind them is not discussed in Ethics and politics, because it's already covered in Evidence basis.
• "to maintain an article so biased that it reads like a pro-fluoridation activism site is a bit much." From the point of view of an anti-fluoridationist, this article no doubt appears to be pro-fluoridation. Similarly, pro-fluoridationists probably view this article as being anti-fluoridation, because it gives so much space to anti-fluoridation sources. For example, the two most-commonly cited sources in this article are Pizzo et al. 2007 (PMID 17333303), which is anti-fluoridation, and NHMRC 2007, which is pro-fluoridation. You would never see that in pro-fluoridation website. Instead, you'd see language like "Fluoridation is the perfect public health intervention."[6] That's not language that you see here. (Of course, you'd never see all those citations to a pro-fluoridation review in an anti-fluoridationist summary either.)
• "the section also links to an additional article, Opposition to water fluoridation, whose "Potential health risks" section simply links back to the previous section again in a circular manner" That is a problem, but it's really a problem with Opposition to water fluoridation (a much lower-quality article), and should be fixed there.
• "the so called "Fluoride Action Network" The Fluoride Action Network is a partisan source that does not follow established scientific principles of peer review. As a questionable source it cannot be used in Wikipedia articles to support claims about fluoridation. We need reliable sources to support such claims. Please see Wikipedia:Reliable sources (medicine-related articles) for guidelines on reliable sources on medical topics.

Eubulides (talk) 21:07, 12 November 2009 (UTC)

No mention of blood concentration of fluoride?

There is no mention of fluoride levels found in blood. This needs to be resolved. There is also evidence suggesting that animals will suffer kidney and liver function damage due to water fluoridation. This is important information for this article: http://www.ncbi.nlm.nih.gov/pubmed/16834990 —Preceding unsigned comment added by Bitcloud1 (talk • contribs) 12:38, 15 October 2009 (UTC)

Highest disease cost uncited.

The reference to "and costing society more to treat than any other disease." is unsupported by the reference given. Forbes calls "Heart Disease" the highest: http://www.forbes.com/2005/04/14/cx_mh_0414healthcosts.html though I don't know who they are citing.

This claim needs to be investigated before it goes on the article. —Preceding unsigned comment added by Bitcloud1 (talk • contribs) 12:41, 15 October 2009 (UTC)

The cited source says "Dental diseases, particularly dental caries, are the most expensive part of the body to treat. Caries is indeed the most expensive human disease in terms of direct costs. For example, the direct costs of caries treatment in Germany was 20.2 billion, CVD 15.4 billion DM, diabetes 2.3 billion DM.4. In West Germany, the cost of dental care was 10.3% of the health budget in 1994." (my emphasis) I suspect Forbes either forgot that caries was a disease, or asked a bunch of doctors and forgot to ask the dentists too. Colin°^Talk 12:52, 15 October 2009 (UTC)

Thanks for the citation. A little extra research yeilds this from WHO: "Moreover, traditional treatment of oral disease is extremely costly, the fourth most expensive disease to treat in most industrialized countries." http://www.who.int/oral_health/disease_burden/global/en/index.html

This journal agrees with Forbes as "Heart Disease" being the most expensive in the UK: http://www.accessmylibrary.com/coms2/summary_0286-2712108_ITM

This article puts heart disease in Australia at $5.924 billion/year, while oral care was $5.305 billion: http://www.aihw.gov.au/publications/cvd/hcecd04-05/hcecd04-05.pdf

This appears to be the article cited by Forbes (for the US figures 2002) http://www.ahrq.gov/research/ria19/expendria.htm#diff4

The originally cited article does specifically state "Caries is indeed the most expensive human disease in terms of direct costs.". The phrase "and costing society more to treat than any other disease" isn't indicative of direct costs, and incorrectly suggests broader societal costs. I don't think direct costs are appropriate for an encyclopaedia article, and we should only cite this if there is evidence that tooth decay is actually the highest costing disease. (the WHO appraisal doesn't seem to support this) Bitcloud1 (talk) 13:39, 15 October 2009 (UTC)

Thanks for those sources. They are more recent than Sheiham 2001 (PMID 11683551), the source we had cited as saying that dental caries was #1. I found another WHO source, Petersen 2008 (PMID 18630105) which the article is already citing, agreeing with the "fourth most expensive" claim. Looking further, I even found a 2005 editorial by Sheiham (PMID 16211151) agreeing with the "fourth most expensive", so it appears that the claim about being #1 is dated at best. I switched to saying it's #4, citing the 2008 WHO source. Sorry about taking so long to look into this: I lost this thread in the main-page flurry of comments. Eubulides (talk) 08:39, 7 November 2009 (UTC)

Hoge Raad der Nederlanden

A recent edit reinserted material about a 1973 decision by the Hoge Raad der Nederlanden. This level of detail is inappropriate for Water fluoridation. There must be hundreds of court decisions all over the world about fluoridation, and there's no particular reason to emphasize this one here. When similar material was added earlier, it was promptly and properly moved to Fluoridation by country #Netherlands; that is a much better place for that sort of detail. Please don't continue to reinsert this material without proper discussion and consensus. Eubulides (talk) 21:23, 4 November 2009 (UTC)

I reverted my edit on The High Council of The Netherlands in The Netherlands forbid fluoridation since addition of fluoride does not improve the safety of drinking water as such and water suppliers go beyond their legal task as requested by Eubulides on my talk. In my opinion my contribution is important because the present section on Ethics and politics seem to me a little unbalanced towards Anglo-Saxon countries. This is most probably due to the fact that in continental Europe there is almost no discussion on water fluoridation. The section just addresses Europe in half a sentence. However, Europe exists of many countries, all with there own approach. Martin states that most public administrations in continental Europe has taken the decision not to fluoridise, however, without giving a reference. This means not all of them used governmental decisions. In my opinion it is informative to mention in this section more background why there is little discussion in continental Europe. This is not addressed in this section. My contribution, although maybe not perfect, was a first try.

Eubulides states that we should use reliable reviews of the topic, rather than citing court decisions directly. The article currently cites several reviews of water fluoridation (including negative opinion) and as far as I know none of these reviews mention this 1973 court case. As per WP:WEIGHT, we can't assign far more weight to this subtopic than reliable sources do, nor should we be citing primary sources directly when we have substantial secondary sources available Although I agree that reviews should have preference over specific papers, the references on water fluoridation are mainly primary sources and even some gray literature. That the Dutch Supreme Court case is not mentioned in reviews may have several reasons. First, the Dutch language is not well accessible for non-speakers and second, court cases in general are not easy to access. This problem is also valid for other European languages. So my conclusion is that due to the absence of substantial secondary sources, primary sources can be used. However, what disturbed me most is the fact that Eubulides’ statement implicitly marginalises the reference I used as unreliable.

In order to balance the section on ethics and politics I propose elements of the following text. Martin gives three main grounds for against fluoridation. First, opponents claim the benefits are exaggerated or not established. Second, there are claims of health risks to some members of the population; the Danish government seems to have followed this line. Third, fluoridation is thought to be an infringement on individual rights because it is compulsory medication of all members of a community, as opposed to chlorination, which is treatment of the water. This line was more or less followed by the High Council of The Netherlands that forbid fluoridation based on the judgement that addition of fluoride does not improve the safety of drinking water as such and water suppliers go beyond their legal task. The prohibition of fluoridation by the High Council due to the lack of a legal basis stopped the whole discussion in The Netherlands in 1973 (see also nl:drinkwater#Het drinkwaterfluorideringsdebat). Sweden followed similar route as The Netherlands.

E.J.Hoekstra (talk) 23:39, 6 November 2009 (UTC)

Thanks for your thoughtful comments. Please see #European views below. Eubulides (talk) 06:32, 7 November 2009 (UTC)

European views

• "in continental Europe there is almost no discussion on water fluoridation" I expect there's not that much discussion anywhere. Most people have more-important things to worry about. I agree that the topic comes up even more rarely in Europe, because water fluoridation is more-rarely practiced there.
• "it is informative to mention in this section more background why there is little discussion in continental Europe" But we'd need a reliable source to make that point, no? I.e., we'd need a source making the point that there is little discussion in continental Europe because fluoridation is rarely practiced there. Although that point is probably true, we can't make it without a good source.
• "The section just addresses Europe in half a sentence." Not true. The Ethics and politics section specifically mentions the European Academy of Paediatric Dentistry, a German chemical company, the Green party in the UK, a 2003 study of focus groups from 16 European countries, and a 1999 survey in Sheffield, UK, in addition to the administrative decisions you noted. Also, that section cites European sources heavily. It cites:

• Pizzo et al. 2007 (PMID 17333303; cited twice),
• British Fluoridation Society et al. 2004,
• Petersen & Lennon 2004 (PMID 15341615),
• Petersen 2008 (PMID 18630105),
• the European Academy Of Paediatric Dentistry 2009 (PMID 19772841),
• Griffin et al. 2008 (PMID 18333872),
• Dixon & Shackley 1999 (PMID 10226722),
• Calman 2009 (PMID 19135693), and
• Cheng et al. 2007 (PMID 17916854).

That's ten citations to European sources, compared to (by my count) 13 citations to U.S. sources and 9 citations to sources that are neither U.S. nor European. There is certainly no bias against European views here; on the contrary, given the relatively small amount of literature on the subject generated in Europe, one could argue that there's a slight bias for European sources.

• "due to the absence of substantial secondary sources, primary sources can be used" But there is no such absence. As I mentioned in the previous bullet, that section already cites 10 European sources. Other sections cite many European sources as well. These are by and large secondary sources, which is better for Wikipedia.
• "Europe exists of many countries, all with there own approach" Yes, and it's beyond the scope of this article to discuss each country's approach: we need to draw a relatively-broad brush here, just as the coverage of North America does not discuss individual U.S. states or Canadian provinces (which have very different practices). That sort of detail is appropriate for Fluoridation by country, but is far too much detail for the more-general article.
• "the references on water fluoridation are mainly primary sources and even some gray literature" The references on almost any topic are mainly primary sources and/or gray literature. But Wikipedia articles should avoid these references: it should use reliable reviews (see WP:PSTS and WP:MEDRS). Water fluoridation relies mostly on secondary sources for its conclusions, and there's no reason to lower its standards on this particular point.
• "That the Dutch Supreme Court case is not mentioned in reviews may have several reasons." Yes, and in addition to the reasons given, it may not be mentioned because it's dated and limited in scope. There have been many court decisions all over the world about water fluoridation, and they're all based on legal principles and arguments about safety, rights, the law, etc. The text of the Dutch decision itself does not provide any evidence that the decision is still important enough to mention here.
• "In order to balance the section on ethics and politics" That section already gives a bit more space to opponents of fluoridation than it does to proponents. Giving even more weight to opponents would present obvious WP:WEIGHT issues. This is not to say that we can't change the section, but the section is already overlong, and any additions should be balanced with deletions (which can be moved into the see-also article).
• "Martin gives three main grounds for against fluoridation." Yes, and those three grounds are already covered in Ethics and politics:

• "First, opponents claim the benefits are exaggerated or not established." The article text currently says "Since fluoridation's inception, proponents have argued for scientific optimism and faith in experts, while opponents have drawn on distrust of experts and unease about medicine and science. Controversies include disputes over fluoridation's benefits and the strength of the evidence basis for these benefits,"
• "Second, there are claims of health risks to some members of the population" The article text currently talks about "the difficulty of identifying harms" and goes not to say, "Antifluoridationist literature links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid."
• "Third, fluoridation is thought to be an infringement on individual rights because it is compulsory medication of all members of a community, as opposed to chlorination, which is treatment of the water." The article text currently says "Fluoridation can be viewed as a violation of ethical or legal rules that prohibit medical treatment without medical supervision or informed consent, and that prohibit administration of unlicensed medical substances." and later, discusses "legal issues over whether water fluoridation is a medicine, and the ethics of mass intervention."

Perhaps the abovementioned wording could be improved without making it longer and causing weight problems: do you have specific suggestions? Eubulides (talk) 06:32, 7 November 2009 (UTC)

Calcium-fluoro-phosphate

A recent edit by an IP address added (without comment) the following material to the lead:

"It is important to note that calcium-fluoro-phosphate - a bone and teeth strengthening organic chemical - is NOT soluble in water[7]. Sodium flouride and hydrofluosilicic acid are used to fluoridate water and are not organic."

The first sentence relies on an unreliable source "Fluoride – The Lunatic Drug". The second sentence is unsourced. This insertion is therefore weak.

This material is already covered in the lead (which talks about "a fluoridated compound" and "Fluoridated water operates on tooth surfaces: in the mouth it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities.") and the material is discussed in great detail in the body, which makes it clear that sodium flouride and hydrofluosilicic acid are not the only two compounds used for fluoridation.

The change also added this paragraph to the lead:

"See Opposition to water fluoridation."

That sort of "See" is not appropriate in the lead; the Manual of Style says that it should be in a See also section, but if it's already referred to in the body (which it is, as a hatnote for the Ethics and politics section) then there's no need for it in a See also section.

For now I reverted the change, and suggest that further discussion about it be placed here. Eubulides (talk) 08:49, 8 November 2009 (UTC)

Please note that the Merck Index (Rahway, N.J.) is a very good source, not a 'weak' one, by listing the solubilities and lethal doses for calcium fluoride (8 ppm fluoride maximum solubility; 5,000 ppm lethal acute dose) verses fluosilicic acid (massive solubility; 125 ppm acute lethal dose). Water fluoridation as the article points out was based on natural fluoride water (containing by the way calcium as high as 500 ppm or more), preventing any possible acute lethality, and yet the artificial procedure injects mostly fluosilicic acid. The calcium to fluoride ratio is always lowered by this injection, even though the OHD at CDC prefers to claim it 'is natural' anyway. Oly soft water cities can have acute lethal poisonings (as during an overfeed)(Gessner, New Eng. J. Med., 1994). 1 ppm artificial fluoride in soft water cities leads to higher blood fluoride levels (0.21 ppm fluoride, NRC, 2006) and incorporates into bone (at thousands of times that in the water in only 1-2 years) in a linear, non-saturable, irreversible manner (NR, 2006) proving it is a pathologic, not a physiologic, process. Old recommendations by the WHO, or OHD at CDC, that do not consider the intrinsic water calcium level (in view of the hard Merck data) requires this inclusion to avoid pro-fluoride bias. And note that the FDA, Dept. of Agriculture, EPA and NRC oppose or do not support artificial fluoridation and are as significant as the WHO, ADA and others listed above. --Rsauerheber (talk) 03:37, 30 November 2009 (UTC)

The previous comment is not responsive. The proposed addition to the article does not cite the Merck Index; it cites a fringe web site. The other arguments in the previous comment are either based on unreliable sources, or discuss topics (such as overfeed) that are already well-covered in Water fluoridation. I am sure that the U.S. Department of Transportation also does not take an official position supporting water fluoridation but this is not relevant to the article. Eubulides (talk) 04:00, 30 November 2009 (UTC)

The NRC in the 1950's presumed fluoride was a mineral nutrient, but now that we have reliable data disproving that, the NRC now recognizes officially it is not a mineral nutrient. The FDA was never fooled and still labels all artificial fluorides as unregulated drugs with no nutritive value. The Dept. of Agriculture opposes artificial fluoride inejections because of known effects on fish. The NRC 2006 reference is not 'unreliable' in that it does contain some facts. The most unreliable references in the article is that to the work of McKay (and Dean and Heard) who first misunderstood that the whitened teeth with decreased cavities in natural water in the Southwest was due to calcium levels being higher in the water, not due to the fluoride. Labeling the NRC reference as 'unreliable' while the other as 'reliable' fails to indicate to the reader that Dr. Heard and

Dr. Dean both later retracted their original mistaken opinions. --Rsauerheber (talk) 20:19, 30 November 2009 (UTC)

The Water fluoridation article already discusses claims that fluoride is a nutrient, citing recent reliable sources, and the article says that it's not been proven that fluoride is an essential nutrient, so it would appear that the article agrees with that part of your comment. The U.S. Dept. of Agriculture does not oppose water fluoridation, and claims to the contrary are sheer misinformation (similarly for FDA, EPA and NRC). No reliable source supports the claim that studies were mistaken in attributing reduction of cavities to fluoride rather than to calcium. This talk page is supposed to be about improving the article; it is not a forum for disseminating fringe theories. Eubulides (talk) 20:36, 30 November 2009 (UTC)

The DOT has not to my knowledge investigated water fluoridaiton in detail, as have the FDA, NRC and Dept. of Agriculture, who because of that will not agree to promote it.

All this still ignores the fact that no mention in the article is made to identify fluosilicic acid fluoridation as an unnatural procedure because of its extreme high solubility, lower lethal dose than natural calcium fluoride, and it increases the ratio of fluoride to endogenous calcium level in the water which affects relative assimilation of the ion. Yes, the fluoride ion in hard water is identical to the ion in soft water, but its activity and biologic effectiveness are completely different in the two cases. Since this fact is omitted, the article cannot be considered of a quality to recommend being read.

One statement actually claims that fluoridated water (that is known to accumulate fluoride in bone irreversibly to thousands of times that in the water over lifetime drinking) does not increase bone fracture rates. This is challenged by the NRC Report 2006, an American review of water fluoride which indeed made this correct claim. The NRC also states that current allowed levels of fluoride in drinking water are not protective of health for the American consumer. The claim in the article that the NRC is 'unreliable', while the English York review article is top-notch and without bias, reflects bias in the writer of the article. Indeed, the article is not peer reviewed, is obviously not written by a practicing toxicological scientist and is itself of very low quality.

There are no prospective clinical trials on the biological side effects of artificial fluoridated water consumption in humans, and because of this the FDA cannot approve its use as a drug, and as well, the claims of safety in the article are unjustified. Anecdotal articles and reviews of such articles do not constitute proof of safety, no matter how cleverly written are such articles that have no controlled clinical data to back up such claims. The best we have unfortunately are animal studies that are prospective to use as a guide, and human studies after-the-fact that are not well-controlled. Rationality dictates that since only fluoride consumption can lead to fluoride incorporation into bone, that even without controlled trials it is clear fluoride consumption in the U.S. is routinely out of control, based on levels now being found in deceased individuals reported in the NRC study, that the author continues to claim without proof is 'unreliable'.--Rsauerheber (talk) 05:03, 1 December 2009 (UTC)

• The FDA, NRC and Dept. of Agriculture have not "investigated water fluoridation in detail", and they have not come out in opposition of it. It is not their job to oversee water fluoridation, so one would not expect them to have an official position on it, any more than one would expect the CDC to have an official position on how to grow corn. It is completely incorrect to imply, as your comments have, that these organizations oppose water fluoridation: they do not.
• Claims about "unnatural procedures", calcium, and suchlike are supported only by WP:FRINGE sources.
• It is completely incorrect to claim that the NRC 2006 report said that water fluoridation increases bone fracture rates. The NRC 2006 report made no such claim. It is not about water fluoridation at all: it explicitly excludes water fluoridation from its subject matter. The NRC 2006 report is about water that is naturally fluoridated to levels well above those recommended for water fluoridation.
• "The claim in the article that the NRC is 'unreliable'" There is no such claim in Water fluoridation.
• "English York review article is ... is not peer reviewed, is obviously not written by a practicing toxicological scientist and is itself of very low quality." The York review is by consensus the highest-quality review of its time. It was not itself published in a peer-reviewed journal, but the report itself was extensively peer reviewed, and its summary (McDonagh et al. 2000, PMID 11021861) and commentary (Treasure et al. 2002, PMID 12047121) were published in peer-reviewed journals. Later reliable reviews, such as the NHMRC review summarized in Yeung 2008 (PMID 18584000), give considerable weight to the York review. The claim that the York review is of low quality is completely implausible.
• Again, please remember that this talk page is not intended to be a soapbox; see WP:SOAPBOX.

Eubulides (talk) 05:28, 1 December 2009 (UTC)

Emphasis on adverse effects

A recent edit introduced several changes at once, introducing some clear POV.

I'm sorry you thought it was POV, but the changes were to attempt to address the existing POV in the article. In future I'll try to introduce small changes at a time. Deeperthinker (talk) 16:36, 7 January 2010 (UTC)

Small changes would be good, thanks. Also, it might help to review the Wikipedia POV policy. In Wikipedia, "NPOV" does not mean "no point of view": it means "neutral point of view", that is, an article should fairly represent viewpoints in proportion to their prominence in reliable sources. Eubulides (talk) 20:31, 7 January 2010 (UTC)

• The edit introduced the following changes to the lead:

  "There is no clear evidence of other adverse effects. Moderate-quality research exists as to water fluoridation's effectiveness and its potential association with cancer; research into other potential adverse effects has been almost all of low quality. Little high-quality research has been performed. Some evidence suggests that fluoride at the levels used in water fluoridation could impair thyroid function or cause osteosarcoma. However, there is not enough high-quality research to form a definite conclusion.

  This rephrasing substantially departs from what the cited sources themselves choose to emphasize, by playing up evidence of osteocarcoma etc. even when the reliable sources say that there is no clear evidence. We should be summarizing the reviews in ways that the reviews themselves do, rather than reaching down into them and emphasizing negative aspects that the reviews themselves do not emphasize. (The reviews in question are the 2000 York review and the 2007 NHMRC review.)

The intention was not to play up the evidence for osteosarcoma more than the preceding version. The preceding wording was a bit odd, since it was mentioning effectiveness in the section on safety (and saying that there is only moderate-quality research). Also, the question of thyroid function should be at least mentioned here, since it is the other main question. Deeperthinker (talk) 16:36, 7 January 2010 (UTC)

There must be some confusion here, as my previous comment is talking about a change to the lead, not to the Safety section. The lead summarizes all the sections, and it's reasonable for the lead (in interest of brevity, and putting most-important-stuff first) to talk about effectiveness, then about safety, and then about quality of effectiveness and safety studies. According to the cited sources, the main question about safety is dental fluorosis, not thyroid or osteosarcoma. Eubulides (talk) 20:31, 7 January 2010 (UTC)

I meant the changes in the lead. It just seemed strange to mention effectiveness, then safety, then mention effectiveness and cancer in the same sentence. The main idea there was to try to improve the flow of the paragraph. Osteosarcoma is just the cancer mentioned in the summary of the NHMRC report. I have no objection to leaving this part as it is. Deeperthinker (talk) 23:02, 8 January 2010 (UTC)

• The edit removed the following from Effectiveness:

  "Water fluoridation is the most effective means of achieving community-wide exposure to fluoride's effects in preventing tooth decay."

  This statement is well-supported by the cited source (the 2007 NHMRC review) and is a good summary of the effectiveness section; there's no good reason to remove it.

This is the most POV sentence in the article, and is the wording used in promoting fluoridation. It should be substantially reworded or deleted. Deeperthinker (talk) 16:36, 7 January 2010 (UTC)

The point is well-supported by the cited source. Perhaps you could suggest a wording that would fix the problem that you perceive in its POV (in the Wikipedia sense of POV)? Can you cite reliable sources that disagree with it? Eubulides (talk) 20:31, 7 January 2010 (UTC)

The problem is that this wording is very similar to that used in promoting fluoridation. Also, I would not say that it is accurate, because fluoride toothpaste seems to be more effective. One of the references in this article mentioned other means that are as effective or more effective than fluoridation, but it will take a while to find it again. It would be far less controversial to lead the subsection with something about the magnitude of the reduction in decay attributed to water fluoridation. Would you object to that? Deeperthinker (talk) 23:02, 8 January 2010 (UTC)

• "fluoride toothpaste seems to be more effective" No reliable source claims that fluoride toothpaste is more effective than water fluoridation. Even Pizzo et al. 2007 (PMID 17333303), which is highly critical of water fluoridation and which promotes fluoride toothpaste, does not claim that fluoride toothpaste is more effective. Furthermore, the wording in question does not say that water fluoridation is the most effective full stop. It says that water fluoridation "is the most effective means of achieving community-wide exposure to fluoride's effects in preventing tooth decay". The "community-wide" is a key part of this wording. As Water fluoridation #Alternatives points out, fluoride toothpaste relies on individual behavior and is less likely to be used by the poor, so fluoride toothpaste is not as effective at achieving community-wide exposure. Perhaps the point could be worded more clearly, but the point itself is not controversial among reliable sources.
• "It would be far less controversial to lead the subsection with something about the magnitude of the reduction in decay attributed to water fluoridation. Would you object to that?" Yes, for two reasons. First, the point in question is not controversial among reliable sources. Second, the proposal to lead with a magnitude-reduction sentence is essentially a proposal to remove the lead sentence (as the 2nd sentence is already about magnitude reduction). But the lead sentence summarizes the Effectiveness section much better than a dry recitation of some statistics.
• "The problem is that this wording is very similar to that used in promoting fluoridation." The exact wording doesn't matter that much; it's the substance that matters, not the wording. Can you propose a different wording that would remove the promotional aspect that you perceive, without removing the substance?

Eubulides (talk) 06:17, 9 January 2010 (UTC)

The claim here seems to be that water fluoridation is more effective than any other alternative, whereas this section seems to be about the effectiveness of water fluoridation itself. The comparison with alternatives is in another section entirely. It would summarise the section better if it were just to say that water fluoridation is an effective means, rather than the most effective means. Then this sentence would not be making a stronger claim than is made in the rest of the section. Would you agree? Deeperthinker (talk) 02:31, 10 January 2010 (UTC)

That is a good suggestion, and I changed the lead sentence of Effectiveness to say merely "Water fluoridation is effective at reducing cavities in both children and adults", moving the comparison of fluoridation to alternatives into the Alternatives section. Eubulides (talk) 09:23, 10 January 2010 (UTC)

That is an improvement, thanks. Deeperthinker (talk) 15:39, 10 January 2010 (UTC)

• The edit made this change:

  "Fluoridation may be more justified effective in the U.S. because unlike most European countries, the U.S. does not have school-based dental care, many children do not visit a dentist regularly, and for many U.S. children water fluoridation is the prime source of exposure to fluoride."

  The cited source (Burt & Tomar 2007, p. 315) says that water fluoridation is "needed" in the U.S., not that it is "effective". "Justified" is close in meaning to "needed" ("effective" is not); "necessary" is even closer, so let's use that.

The problem was that the word "justified" is POV because it implies that fluoridation is justified. The wording "necessary" is also questionable, because it is again an opinion. The word "effective" is the least POV word I can think of. It may be further in meaning from the wording used in the cited source, but the source itself has strong POV in its wording. Deeperthinker (talk) 16:36, 7 January 2010 (UTC)

The containing sentence already has a "may" ("Fluoridation may be more necessary in the U.S....") in it, which sufficiently qualifies it as a possibility and not a definite fact. We cannot take a point that is well-supported by the source, and then change its words to make it say something significantly different from what the source says, simply because we disagree with the source. We have to stick closely to what the sources say. In this case the source is written by two published experts in the field and no reliable source disputes it, so there's no justification for altering its conclusions. I tried another edit, this time using "needed" since that's the exact word of the source. Eubulides (talk) 20:31, 7 January 2010 (UTC)

There are two issues there, whether fluoridation is more effective in the US than in Europe, and whether if it is effective it is needed. The question of whether it is effective is a scientific question, so it is appropriate to preface the sentence with "may" to indicate that this is a scientific possibility. The question of whether it is necessary is a political and ethical question, and is therefore far more controversial. The word "may" is not really an appropriate qualifying word for an opinion on this subject. For example, if you were citing a source that said that Democrats are better than the Republicans, it would not be appropriate to say that Democrats may be better than the Republicans. Would you object to rewording this sentence to simply say that it is an opinion? Deeperthinker (talk) 23:02, 8 January 2010 (UTC)

This reads too much into the word "needed". The word "needed" doesn't mean "required" or "mandatory" or "obligated" (those would be political or ethical terms); it's simply a statement that water fluoridation is more useful in environments where dental care is of lower quality. Hmm, now that I've written the previous sentence, how about saying "useful" instead of "needed"? Would that do? Articles should avoid Simon-says style prose (in-text attribution) when the material is not controversial among reliable sources, which is the case here. Eubulides (talk) 06:17, 9 January 2010 (UTC)

Yes, certainly "useful" would make a lot of sense. Deeperthinker (talk) 02:31, 10 January 2010 (UTC)

OK, thanks, done. Eubulides (talk) 09:23, 10 January 2010 (UTC)

• The edit introduced the following material at the start of Safety:

  "Water fluoridation can cause side effects, though these are normally minor. The most significant adverse health effects are in the case of accidents. In rare cases malfunctions of water fluoridation equipment can result in overfluoridation that causes acute fluoride poisoning, with symptoms that include nausea, vomiting, and diarrhea. Seventeen such incidents were reported in the U.S. between 1972 and 2002, with fluoride concentrations as high as 220 mg/L. For example, in a 1992 accident in Alaska, 262 people became ill and one person died."

  First, the cited source (Balbus & Lang 2001, PMID 11579665) does not support this material: it nowhere talks about "Seventeen such incidents", and it nowhere says that accidents are "the most significant" adverse effects. Second, placing this material here introduces editorial POV by emphasizing accidents, even though reliable reviews on water fluoridation invariably focus on dental fluorosis as the most important adverse effect.

The wording "the most significant" was only intended to mean that it is only in the case of accidents that there are severe adverse effects. There are seventeen cases of accidents, so only mentioning three greatly underestimates the number of accidents. I do not know of a published source that lists all seventeen, but can find sources for those individually. Reviews on water fluoridation are only concerned with the possible health effects when water fluoridation equipment is functioning correctly, not with the case of accidents, so they do not mention accidents at all. It needs to be mentioned in a complete section on safety, but it is a separate issue to that of safety when the equipment is functioning correctly. It should at least be placed in a separate paragraph. Deeperthinker (talk) 16:36, 7 January 2010 (UTC)

This is substituting our opinion and evidence for that of the high-quality sources that form the basis for this article. We cannot go through the literature and find individual cases ourselves: that's original research, which should be published elsewhere, not on Wikipedia. If the "17 events" list is widely promoted among fringe sites, it might be good to summarize it in the controversy page, but it doesn't belong here without reliable sources to back it up. Reliable reviews of the broader aspects of fluoridation do not put overfeeds first: on the contrary, they also put dental fluorosis first (since it's well documented and is the most important safety effect) and use words like "infrequent" to talk about overfeeds (Mazur A (2001). "Looking back at fluoridation". Risk Health Saf Environ. 12 (1–2): 59–65.).

Perhaps you are reading more into what I said than what I meant. The linking sentence was only intended to mean that there are not severe problems unless there is an accident. I would have thought that was a fairly uncontroversial statement that is well supported by the source. The figure of 17 accidents was listed on Wikipedia until about a year ago, but it only seems to appear on anti-fluoridation sites otherwise. After checking this more carefully there don't seem to be reliable sources for all 17 accidents. Actually, the rate of accidents in the reference currently cited is about the same as the rate in the claim of 17 accidents (since that is over a period of 30 years). Therefore the material as it currently stands would seem to represent the rate reasonably accurately, even if the claim of 17 accidents is correct.

Regarding the issue of where the material on accidents should be placed, in my response above I said that it should be placed in a separate paragraph, not that it should be placed at the beginning. My concern is that the information about accidents is placed at the end of a paragraph of material that is otherwise only loosely related. This overly obscures the information, and would be the equivalent of a longer review putting material about accidents at the end of a section where the section title doesn't mention accidents. (I am unable to find the reference you cite, though. It doesn't list it in the journal index.) Do you object to putting this material in a separate paragraph? Deeperthinker (talk) 03:28, 9 January 2010 (UTC)

No objection to that. I took a stab at it by reparagraphing the material to put the overfeed material in a separate paragraph. This edit altered content only by inserting a paragraph boundary. Mazur 2001 is not cited in the article; I suppose it could be, but it's not as strong a source as the reviews we're currently citing. (Among other things, it's just one author.) Eubulides (talk) 06:17, 9 January 2010 (UTC)

Good, thanks. Deeperthinker (talk) 02:31, 10 January 2010 (UTC)

• The edit introduced a large section of material that cited sources that are not about water fluoridation, but are about fluoride in general, or are about fluoride in concentrations well in excess of recommended levels. This material might be suitable for articles such as Fluorosis but they are not that relevant here. For example, the newly-introduced material placed heavy emphasis on the 2006 NRC report, even though that report explicitly says that it is not about water fluoridation: this is clear abuse of the source.

The 2006 NRC report is highly relevant, because it is the most comprehensive review on the health effects of fluoride, and includes much information that is omitted from the York and NHMRC reports. It is not a report specifically to evaluate the safety of water fluoridation, but it contains much material that is relevant to water fluoridation, so it is highly relevant to this article.

In the case of thyroid effects the relevant dosage is at the concentrations used in water fluoridation. It is not accurate to say that this is just about "fluoride in general" and is not relevant to water fluoridation.

In addition, the cancer test on rats mentioned is also highly relevant. It was the biggest experiment intended to determine if fluoride is carcinogenic. The fact that it used fluoride "in concentrations well in excess of recommended levels" is not relevant, because this is standard procedure in cancer testing. This is because carcinogens do not cease to become carcinogenic at lower doses, they just cause a lower rate of cancers. The NRC report discusses this experiment, but the York and NHMRC reports do not, because they do not include animal testing.

The current discussion of cancer: "There is no clear association between fluoridation and cancer or deaths due to cancer, both for cancer in general and also specifically for bone cancer and osteosarcoma." is entirely inadequate. The reference cited does not make that conclusion. It states that the York review made that conclusion, then additionally mentions the Bassin study (see pages 11 and 12). The article should also mention this study for completeness. Deeperthinker (talk) 16:36, 7 January 2010 (UTC)

Please see #Discussion of cancer etc. below. Eubulides (talk) 20:31, 7 January 2010 (UTC)

To try to address the above issues, I edited the article to revert most of the edits, keeping the edits that did not cause POV problems. Further discussion is welcome. Eubulides (talk) 23:54, 6 January 2010 (UTC)

Discussion of cancer etc.

• "The current discussion of cancer: "There is no clear association between fluoridation and cancer or deaths due to cancer, both for cancer in general and also specifically for bone cancer and osteosarcoma." is entirely inadequate. The reference cited does not make that conclusion." Yes, the NHMRC review does largely defer to the York review on this issue: the NMHRC review does discuss later studies, which don't change this conclusion. In the light of this, we should cite both reviews: the York review for the main conclusion, and the NHMRC review for the followup. I have tried out an edit to do that. The York review's conclusions (p. 58) supports the current article's wording; the York review says (p. 58) "There is no clear picture of association between water fluoridation and overall cancer incidence and mortality", which directly supports the first half of the sentence quoted in the previous comment, and it also says "While a broad number of cancers were represented in the included studies, osteosarcoma, bone/joint and thyroid cancers were of particular concern due to fluoride uptake by bone and thyroid. Again, no clear association between water fluoridation and increased incidence or mortality was apparent.", which directly supports the second half of the sentence.
• "The 2006 NRC report is highly relevant, because it is the most comprehensive review on the health effects of fluoride" The 2006 NRC report may well be the most comprehensive review on the health effects of fluoride at concentrations well above recommended levels. However, it explicitly does not review health effects of fluoride at the concentrations used for water fluoridation. Using its conclusions to support arguments against water fluoridation is original research, which Wikipedia articles cannot do.
• "In the case of thyroid effects the relevant dosage is at the concentrations used in water fluoridation.... the cancer test on rats ..." The thyroid and cancer issues have been reviewed thoroughly in our sources, and we should not be substituting our own opinions for those of the sources. We should certainly not be disputing the opinions of reviews by reaching down into the primary literature. We have high-quality reviews that have reviewed material about whether fluoride causes cancer, or causes thyroid effects, and Water fluoridation should be respecting these reviews rather than diving into primary sources in order to undermine the reviews. Please see Wikipedia:No original research #Primary, secondary and tertiary sources and Wikipedia:Reliable sources (medicine-related articles) #Respect secondary sources.
• "the York and NHMRC reports do not, because they do not include animal testing" And they do so for good reason. For example, page 1 of the York review states:

"The history of health technology development shows that there have been numerous new interventions that were promising (or harmful) in animal and laboratory studies that turned out to be ineffective (or safe) when tested in humans. One example would be the drug omeprazole (Losec®) which caused gastric tumours in pre-clinical animal studies. However, such tumours have not been documented in humans, even in patients with conditions that require continuous treatment for many years. In general, when human data are available, animal or laboratory data provide far less reliable estimates of effect and, as such, do not bear significant weight on decisions about interventions. Such data will not be considered in this review."

We should not be substituting our opinion for that of expert reviewers who have explicitly considered and rejected animal-based evidence as being far less reliable.

Eubulides (talk) 20:31, 7 January 2010 (UTC)

This seems to be the most contentious issue. First of all I should emphasise that I am not trying to say that these issues should be presented as having convincing evidence. It is just that these are issues where there is some scientific debate. The issues I was bringing up are just those that are discussed in the Scientific American (January 2008) article. Perhaps a better approach would be to mention that there is some controversy, and cite the Scientific American article (which isn't otherwise cited).

Regarding animal testing, I would agree that animal tests should not be relied on entirely, but it seems very odd to omit them entirely (especially when they were commissioned by Congress to test fluoride safety). This is a minor point, though, which I don't wish to argue.

With the NRC report, it should still be cited somewhere, because it is a very significant report regarding the health effects of fluoride. Currently it is not cited anywhere in the article.

I still believe a brief mention of the osteosarcoma study should be made, because it has been so high-profile and controversial. The current text singles out osteosarcoma for specific mention, but without that context it does not make sense.

Here is my effort at writing some text incorporating these ideas:

"There are medium-quality studies into cancer, and no clear association with water fluoridation has been found[York,NHMRC]. There has been controversy over a 2006 study into osteosarcoma[Bassin,SA], though there is not clear evidence in that case either [NHMRC,NRC]. For other health effects there are only low-quality studies, and the interpretation of the evidence is contentious [SA]."

Is this a reasonable compromise? Deeperthinker (talk) 04:58, 10 January 2010 (UTC)

• "I still believe a brief mention of the osteosarcoma study should be made, because it has been so high-profile and controversial." It hasn't been that high profile, except among unreliable sources. I'll discuss it further below.
• "The current text singles out osteosarcoma for specific mention, but without that context it does not make sense." The Bassin study is only a small part of the osteosarcoma context, and merely mentioning the study doesn't really say anything about the context. It's not clear why further context would be helpful here, anyway, as the hypothesized mechanism for why fluoride might cause osteosarcoma is not all that relevant to water fluoridation per se. From a water fluoridation viewpoint, surely all that matters is that osteosarcoma has been investigated and there's no clear association. Similarly for other bone cancer, for other cancer, and for fractures; the article simply doesn't have space to discuss all the hypotheses and all the contexts, not without violating WP:WEIGHT constraints.
• It's not clear from the previous comment where the proposed text is intended to go. For now, I'll assume this would be added to the Safety section.
• "There are medium-quality studies into cancer ..." This duplicates the existing "Moderate-quality research exists as to water fluoridation's effectiveness and its potential association with cancer".
• "... and no clear association with water fluoridation has been found" This duplicates the existing "There is no clear association between fluoridation and cancer or deaths due to cancer".
• "There has been controversy over a 2006 study into osteosarcoma[Bassin,SA]" The Scientific American piece (Fagin 2008, PMID 18225698) is a poor source for the technical or scientific aspects of water fluoridation; as the Wikipedia guideline on medical sources says, "The popular press is generally not a reliable source for science and medicine information in articles." Among other things, Fagin's misuse of the 2006 NRC report was rightly criticized in a followup letter from American Dental Association president published in Scientific American; see Feldman M. Fluoride findings. Sci Am. 2008;298(5):12. The Water fluoridation article should not use Fagin's dubious precedent as an excuse to cite the NRC report as having anything to do with water fluoridation, because the NRC report itself says that it has nothing to do with water fluoridation. The Bassin study was criticized by its own research group, is contradicted by other data generated by that group, has not been replicated, and (most importantly as far as Wikipedia goes) is not given this much prominence by reliable reviews of water fluoridation; emphasizing the Bassin report in Safety would be contrary to the Wikipedia policy on primary sources and the Wikipedia guideline on medical sources.
• "For other health effects there are only low-quality studies... " This duplicates the existing "research into other potential adverse effects has been almost all of low quality".
• '"... and the interpretation of the evidence is contentious" There is certainly a lot of contention about the evidence! See the Ethics and politics section for more. However, reliable secondary sources agree that there is no clear evidence of harm, other than dental fluorosis, and the article should not imply otherwise.
• "Perhaps a better approach would be to mention that there is some controversy, and cite the Scientific American article (which isn't otherwise cited)." "With the NRC report, it should still be cited somewhere," OK, how about the following proposal instead? Let's append the following to the third paragraph of the Ethics and politics section:

"U.S. opponents of fluoridation were heartened by a 2006 National Research Council report about hazards of water naturally fluoridated to high levels;[citing Fagin 2008, PMID 18225698] the report recommended lowering the U.S. maximum limit of 4 mg/L for fluoride in drinking water.[citing National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: National Academies Press; 2006. ISBN 0-309-10128-X.].

Eubulides (talk) 09:23, 10 January 2010 (UTC)

I was suggesting the material to go in the safety section, in which case the sentence about cancer would just replace the previous sentence about cancer. It is probably more appropriate to mention the controversy in the "Ethics and politics" section, though. I agree that the article should not say that there is clear evidence of harm other than dental fluorosis.

I was not saying that the Scientific American article should be used as a source for the technical or scientific aspects of fluoridation, only for the controversy.

I see your point about the Bassin study. There certainly isn't room to discuss all the hypotheses and all the contexts, but the current text singles out bone cancer and osteosarcoma for specific mention, without an explanation why. Perhaps it would be better to split the sentence in two, and say something like:

"There is no clear association between fluoridation and cancer or deaths due to cancer[11][12]. Bone cancer and osteosarcoma in particular have been examined, as fluoride accumulates in bone, but no clear association has been found.[11][12]"

That lengthens it only slightly, so I don't think it violates WP:WEIGHT constraints.

I think the material you suggested for the controversy section should be fine. I am not convinced that the NRC report should be entirely ignored in the safety section, though. The fact that it is not specifically about water fluoridation means that it should be given less weight, but not ignored entirely. In my previous response I was suggesting citing it for there not being a clear association between fluoride and cancer. (That is, to support the conclusions of the other reviews, not dispute them.) Do you object to that? Deeperthinker (talk) 15:39, 10 January 2010 (UTC)

• "I was suggesting the material to go in the safety section, in which case the sentence about cancer would just replace the previous sentence about cancer." I'm still not quite clear about what the proposed change to Safety is. Is it this?

"There is no clear association between fluoridation and cancer or deaths due to cancer, both for cancer in general and also specifically for bone cancer and osteosarcoma. Bone cancer and osteosarcoma in particular have been examined, as fluoride accumulates in bone, but no clear association has been found." (citing NHMRC 2007 and the 2000 York review)

If so, this change still has some problems. First, it muddies the previously-clear information that there is no clear association between fluoridation and deaths due to bone cancer in general or due to osteosarcoma in particular. Second, there is too much repetition between the proposed text and the existing "Moderate-quality research exists as to water fluoridation's effectiveness and its potential association with cancer; research into other potential adverse effects has been almost all of low quality. Little high-quality research has been performed." in Evidence basis. Third, the phrase "no clear association" is unnecessarily repeated. Fourth Third, and most important, neither of the cited sources directly supports the claim "as fluoride accumulates in bone", and there is a weight problem for the text to discuss mechanism here (where it is discussing an unsupported claim of an adverse effect) when it does not discuss mechanism anywhere else in the section. The fact that fluoride accumulates in bone is discussed in Mechanism, and surely there is little need to repeat and emphasize it here.

• "In my previous response I was suggesting citing it [the NRC report] for there not being a clear association between fluoride and cancer." I don't see how that's appropriate. The NRC report is explicitly about fluoride at concentrations well above recommended levels rather than being about water fluoridation, so when it says that there's not a clear association between cancer and fluoride it is talking about something other than water fluoridation, and it would take some original research for us to apply its conclusion here, research that may be obvious to an expert but which we cannot do. We have multiple high-quality reviews that are directly on point, so why cite a source that is explicitly not about water fluoridation?

Eubulides (talk) 05:12, 12 January 2010 (UTC)

PS. I just now realized that part of my previous comment was wrong: it was about an earlier proposal, not the latest one. I struck that part. Eubulides (talk) 06:51, 12 January 2010 (UTC)

POV problems with article

This article has severe POV problems. Some years ago it was biased against fluoridation, which was since corrected, but in the past year or so it has swung too far in the opposite direction. I previously spent an entire day trying to correct the most egregious problems, but my changes were reverted in about an hour, and has led to the lengthy discussion above. I therefore propose putting a disputed neutrality flag on this article. I will put give responses to the above discussion shortly. Deeperthinker (talk) 21:16, 8 January 2010 (UTC)

Per WP:NPOVD, you need to list "specific issues that are actionable within the content policies". Remember that WP:NPOV requires neutral coverage of the positions held by our best reliable sources, not the position that any one editor personally believes to be neutral or fair to all sides, or a position halfway between mainstream and fringe. Similarly, the WP:WEIGHT given to issues such as adverse effects, risk of serious illness or industrial accidents should be in proportion to the weight given by reliable sources to the issues. Colin°^Talk 12:08, 9 January 2010 (UTC)

Please see above for the list of the specific issues. Most of them are resolved now. Deeperthinker (talk) 05:03, 10 January 2010 (UTC)

I have just removed the POV tag because the main issues have been resolved. There is still some ongoing discussion, though. Deeperthinker (talk) 13:52, 10 January 2010 (UTC)

Recent edits introduced non-neutral POV

A recent series of edits introduced a strong point of view against water fluoridation that is not supported the sources cited. It inserted the following into the lead:

"There has been considerable opposition to the practice within the medical community, due to the adverse effects of dental fluorosis, and links to cancer" (citing [8])

But the article does not support this claim: it does not talk about "considerable" opposition, and the lead already covers the adverse effects and cites much more reliable sources than a newspaper article about fluoride opponents. The edits also modified Evidence basis, completely rewriting the sense of the lead in a way that undermined and contradicted the sources, and promoting a single primary study to overturn reliable reviews, in contradiction of Wikipedia:Reliable sources (medicine-related articles) #Respect secondary sources. I reverted almost all the edits. Eubulides (talk) 18:35, 23 January 2010 (UTC)

The account in question has now been blocked as it is a suspected sockpuppet of User:Hereherer. --Ckatz^chat_spy 23:48, 23 January 2010 (UTC)

Page loading efficiency and style

This page takes a long time to load, and part of this is due to the use of the standard Wikipedia citation templates such as {{cite journal}}. Recently developed faster & smaller Vancouver system templates such as {{vcite journal}} would make the page much faster to generate (roughly by a factor of two in my tests) as well as significantly smaller in terms of the HTML generated (a savings of 34% in my tests). Let's use them here; they're already in use in several other articles, and have resulted in major savings both for time and for the size of the generated HTML. Eubulides (talk) 09:49, 15 February 2010 (UTC)

Image text

This edit changed the lead image text from "Fluoridation does not affect the appearance, taste or smell of drinking water." to "Fluoridation can not be seen, tasted or smelled in drinking water." with the comment "changing slightly POV image text". I don't see what was POV (in either direction) with the previous wording but the new wording sounds like the description of an undetectable poison so I'd argue it was POV. In addition, it is gramatically wrong -- it would need to lead with "Fluoride can not..". The problem with just mentioning one substance in water that is invisible, tasteless and odourless is that the same is true for most of the minerals and other chemicals in water that are tiny in amount. It might be a different story if there were grams of a substance dissolved in a glass of water and it still remained undetectable. The key point is that "Fluoridation" (the controlled act of adding a tiny amount of fluoride) ensures it is not noticed. I suggest the edit is reverted. Colin°^Talk 08:24, 8 March 2010 (UTC)

You're right about the grammar, as well as about the POV. Furthermore, it's not true that "fluoride can not be seen, tasted, or smelled": fluoride can be tasted, if there's enough of it. The point is that water fluoridation (which uses low concentrations) doesn't affect the taste. I reverted the change. Eubulides (talk) 17:01, 8 March 2010 (UTC)

Poisonous to the stomach

A recent edit deleted some well-sourced text from the Goal section, and added the following text:

"The problem is the evidence that it is effective at such low amounts is contentious within the scientific community, and indeed that it is not poisonous to the stomach, bones, teeth and harmful to mental development. The history of water fluoridation remains mired in controversy."

First, this material is not appropriate for Goal: it's relevant to Effectiveness, Safety, and History, but not to Goal. Second, this claim is unsourced and is unlikely to be supported by reliable sources. I've reverted it for now; further comments are welcome. Eubulides (talk) 00:42, 9 March 2010 (UTC)

someone needs to dispute the neutrality of this article, sounds like it written by someone in the flouride selling business.

Has anyone investigated the references? All the information I've read lately about flouride indicates that it is much more dangerous and toxic than has been let on previously. Some would argue it has no benefits and is just a toxin that has been given psuedo crudentials to justify poisioning our water supplies, and making us pay for that poision, as opposed to the manufacturs having to pay to dispose of it as toxic waste. —Preceding unsigned comment added by 66.209.81.2 (talk) 05:54, 16 February 2010 (UTC)

I agree. This article reads like marketing material. The fluoridation of water is a highly controversial subject and this article doesn't represent that in any way. The fluoridation of water is banned is several countries, including China, Austria, Belgium, Finland, Germany, Denmark, Norway, Sweden, The Netherlands, Hungary, and Japan, for various reasons. Also, the history section of this article is a complete whitewash. In the "implementation" section, it claims, and contains references, that a "by-product" (which, in this case, is a euphemism for "pollution") from the manufacture of phosphate fertilizers produces a fluoride that is used in water fluoridation, but the history section doesn't cover this, and this FACT is paradoxically labeled as a "conspiracy theory" later in the article. This article contains far too much propaganda and far too little objective research. There isn't a single mention of the Fluorine Lawyers Committee, Kettering Laboratory, or any of the industries and organizations that produced fluoride pollution or represented those that did or lobbied to allow fluoride into the drinking water. This article is absolutely shameful. 71.168.94.71 (talk) 01:00, 10 March 2010 (UTC)

The article does have an Ethics and politics that goes into some detail in these areas, including countries that have discontinued fluoride. "By-product" is the term used by the source, and it sounds accurate: the process's goal is not to produce fluoride, but fluoride is produced as a byproduct. I installed a this edit to make it clear that the conspiracy theory alleges that water fluoridation is promoted behind the scenes by the industries in question, a claim that is well supported by the source (Armfield 2007, PMID 18067684). That same change adds a mention of the Kettering Laboratory, supported by a reliable source. I could not find any reliable source about the Fluorine Lawyers Committee. Eubulides (talk) 08:57, 11 March 2010 (UTC)

Yes, the references have been investigated. The claims you mention about poison and manufacturers are discussed in the 4th paragraph of the Ethics and politics section, a paragraph that cites Armfield 2007 (PMID 18067684) and Newbrun 1996 (PMID 9034969). Eubulides (talk) 06:07, 16 February 2010 (UTC)

Anonymous editor -- if you wish to do more research, and improve the article this would be a good place to start: A Bibliography of Scientific Literature on Fluoride -- Jrtayloriv (talk) 04:50, 18 February 2010 (UTC)

Eubulides, why are the "claims" about "poison" not mentioned under the "Safety" heading? Putting this in the "Ethics and Politics" section is like putting it in a hiding place. Secondly, this "claim" can be easily verified. The upper lethal limit for humans is less that a teaspoon. Kangaroos die when they drink water with the levels used in Australian municipalities. Fluoride containers are marked with a skull and crossbones for goodness sake. The fact that this most controversial of articles is given the "featured article" status for "neutrality" is absurd. Why is the conspiracy section made to look like a joke? The "fluoride detractors" are painted as raving lunatics. Is it really Wikipedia's job to editorialize this issue? No. The political cartoon's caption says the author is commenting on fluoride being a "communist plot". This is a clear attempt to trivialize the issue as communism has nothing to do with the cartoon. —Preceding unsigned comment added by 173.73.165.8 (talk) 06:24, 15 March 2010 (UTC)

The claim I was talking about is "Some would argue it has no benefits and is just a toxin that has been given psuedo crudentials to justify poisioning our water supplies, and making us pay for that poision, as opposed to the manufacturs having to pay to dispose of it as toxic waste." This claim is a conspiracy theory and belongs in the discussion of conspiracy theories, not in the safety section. The safety section already discusses fluoride poisoning, and wikilinks to Fluoride poisoning, and discusses illnesses and one death due to overfluoridation, all supported by reliable sources. Eubulides (talk) 08:00, 15 March 2010 (UTC)

P.S. The cartoon is clearly about communism, as can be seen from the accompanying text in the flier containing the cartoon. The text says, among other things, "FIGHT COMMUNISTIC WORLD GOVERNMENT by destroying THE UNHOLY THREE!!!" Eubulides (talk) 08:49, 15 March 2010 (UTC)

We're going to need something more solid than that this article disagrees with "All the information I've read lately" in order to support the NPOV tag just added. Yes the references have been checked, by editors involved in the Medicine Wikiproject and by editors at the Featured Article review process. I suspect you've been reading too much junk Internet conspiracy websites (and the one listed by Jrtayloriv is an example). Perhaps you should read some of the references listed by this article -- those whose titles are hyperlinks will be free to read online without subscription. Colin°^Talk 16:28, 20 February 2010 (UTC)

The tags have been removed. -- Brangifer (talk) 17:40, 20 February 2010 (UTC)

"Scare image"

A severe case of dental fluorosis in a white adult male due to medical overexposure to fluoride as a child to succesfully prevent dental caries

I'd like to note that Eubulides has removed this picture by calling it a "scare image".

Pictured on the right is the result of a daily fluoride dosis way below 220mg/L administered for a few months (not more than 6) around the age of 5 years, where the child encountered no signs of fluoride poisoning such as nausea or even vomiting due to the low dosage. It's this level of color deviance that is euphemized as "aesthetic concern in about 1 of every 22 people" exposed to fluoride in the Safety section. In fact this pictured case is considered as mild in the professional dentist community that the individual "due to neglectibility" was denied any color affecting treatments by a number of dentists for years when seeking treatment as a teenager throughout the 1990s, whereas fluoride was always diagnosed as the cause at first sight, and was told more than once that the acquired immunity to cavities would more than make up for the "slight aberration" in color. This picture was not taken in a developing country with poor standards of living and hygiene; individual grew up in an upper middle-class (though single-parent) household in a First World nation in Western Europe, with a level of healthcare available superior to that, for instance, in the United States.

Another IP above has already commented upon how much this whole article reeks like whitewash by the industrial fluoridation lobby, and the fact the picture was removed doesn't do much to dispel that concern already voiced. Just why do you think that the colloquial term for dental fluoridosis happens to be "Colorado brown stain"? --79.193.38.159 (talk) 00:34, 3 March 2010 (UTC)

A mild case of dental fluorosis, visible as white streaks on the subject's upper right central incisor.

The historical Colorado Brown Stain came from water naturally fluoridated to levels well above recommended levels. Yes, one can get severe dental fluorosis with sufficient exposure to fluoride, but the level of exposure evidenced in the scary image is much higher than what one would get with water fluoridation. The previous comment says that it came via exposure to fluoride at a level 220 mg/L for months, a level that would normally cause acute fluoride poisoning; in contrast, the maximum level for water fluoridation is 1.2 mg/L. The current article already has an image of dental fluorosis that could result from water fluoridation: see the image at right. Adding the scary image would be greatly misleading. Eubulides (talk) 02:16, 3 March 2010 (UTC)

Clearly wrong reading of the first comment. It says "WAY BELOW 220mg/L", as the dosage was so low not even nausea was present (and you'd need AT LEAST 220mg/L for vomiting to occur), it's just that the exact dosage (in standardized pill form manufactured and prescribed expressedly for the standard prevention of cavities in permanent teeth to toddlers losing their first teeth) administered by certified dentists cannot be reconstructed after 20 years.

Again, how can the colloquial name for the most common type refer to the color "brown" even today if the second picture is supposed to be anything like a common case, and how can a number of dentists refer to the first picture as a "neglectible" and "mild" case, immediately recognizing the cause as a common 1980s practice of prescribing legal, i. e. certifiedly low dosages of fluoride, if the common form does not look like [9] and the first picture above? Back during the late 1980s, these pills were not even classified as prescription-only medication as the amount of fluoride with them was so low. The removed picture looks a lot more like the one at the professional link, and the picture still in the article looks like a questionable case, at best.

More pictures and websites on the common form being yellow to brown from even just 5 minutes of googling for fluorosis: [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22]. --79.193.38.159 (talk) 02:44, 3 March 2010 (UTC)

If the scary image is from an unknown level of fluoride, then it's not appropriate for Water fluoridation. Whatever the level was, it was evidently much higher than that recommended for water fluoridation. No reputable dentist would call the scary image a "negligible" or "mild" case. The "most common type" of fluorosis is the mild type, not Colorado brown stain. There are many web sites posting misinformation about fluoride (for more on this please see Armfield 2007, PMID 18067684), but the Water fluoridation article, like all Wikipedia articles, should be based on reliable sources. Eubulides (talk) 03:21, 3 March 2010 (UTC)

So Oralhealtheducation.com, TheFreeDictionary's Medical dictionary (main sources The American Heritage® Stedman's Medical Dictionary, Second Edition and Dorland's Medical Dictionary for Health Care Consumers), Dr. Kamsiah Gulam Haider (also see [23]) are "unreliable sources"? All of those report yellow to brown teeth as primarily due to industrial water fluoridation. You might call the other links biased misinformation I guess, as no matter how many peer-reviewed studies they're quoting, they're communal public health campaigns educated by the existing professional literature in print. And could non-prescription doses of fluoride legal for and expressedly measured for daily toddler consumption in a Western country be that much higher than in water? These pills were even commonly advertized as substituting water fluoridation in areas where it was not available, and the exposure in the pictured "severe case" was even extremely short compared to lifelong intake from water and other dietary standards. --79.193.38.159 (talk) 03:34, 3 March 2010 (UTC)

Since this nearly-identical comment is occurring both here and in Talk:Dental fluorosis #"Most-typical"?, I've continue it there. No sense duplicating the thread. Eubulides (talk) 05:46, 3 March 2010 (UTC)

I agree with Eubulides -- the "extreme" image shown above is not at all representative of the effects of water fluoridation. Putting it into the article for water fluoridation would be extremely misleading. There is plenty of scientific evidence about the harmful effects of water fluoridation -- no need to resort to dishonest scare tactics. Jrtayloriv (talk) 07:10, 3 March 2010 (UTC)

"There is plenty of scientific evidence about the harmful effects of water fluoridation" - Not if you're surfing wikipedia. Furthermore, the whitewashed image, at the default resolution, shows the smile of what looks to be a model from a toothpaste commercial. That's not dishonest? It seem an easy solution would be to have a picture that shows clearly a "mild" case of fluorosis, a picture where white staining AND worn edges are clearly visible. —Preceding unsigned comment added by 173.73.165.8 (talk) 06:43, 15 March 2010 (UTC)

File:MildFluorosis02-24-09.jpg shows a mild case of fluorosis, and shows white staining over about a third of a tooth. "Worn edges" are not a symptom of mild fluorosis. Eubulides (talk) 08:00, 15 March 2010 (UTC)

Eubulides, please respond to the comment in full. I made several points. A: The picture is the smile of a tooth model. B: The wiki resolution is too low for one to see the "fluorosis". C: I noted that a more moderate picture could satisfy everyone. As for what you DID choose to comment on, that worn edges are not a symptom of fluorosis, this is manifestly false. It's there in your own picture!

Edward Bernays

Regarding this edit, I've restored it. It is a claim widely made, appearing on Sourcewatch, as well as the Wikipedia article on Edward Bernays. It needs a reliable source (I presume Sourcewatch isn't), but it hardly seems a conspiracy theory that he was involved in a PR campaign introducing water fluoridation. The wording can be improved, but see no need to remove it. Greenman (talk) 21:02, 7 March 2010 (UTC)

The Sourcewatch page is a clone of the Wikipedia page. It is one thing for a newbie to add POV unsourced material. I shouldn't have to remind an editor of five years experience that adding or restoring "Any material challenged or likely to be challenged" requires a source, not to mention the other policies this poor wording violates. Colin°^Talk 22:20, 7 March 2010 (UTC)

Eubulides (and others), can you be specific about the objection? To say that's it's a "conspiracy theory", or "likely to be challenged" is unsatisfactory, as many projects of this type make use of PR campaigns. I understand that the insertion as it was is POV, with its underlying tone of special interest groups pulling the wool over the public, and that the claim is usually made in a conspirational manner. However, is there an objection to simply mentioning his involvement (or otherwise, if sources say otherwise?). I think it's important, as "conspiracy theories" are inundated with this claim, so it's a good reason to address it. For example, the aspartame and aspartame controversy articles deal with various widely-propogated misunderstandings and untruths by attempting to address them. Simply ignoring it leaves the field open to conspiracy - Wikipedia needs to own this fact, contextualising it properly. There's also the matter of consistency, since the claim is repeated on the Edward Bernays page. Greenman (talk) 19:53, 9 March 2010 (UTC)

The main objection (aside from total lack of sources) is that of WP:WEIGHT. There are many theories about fluoridation that are unconventional and not supported by mainstream sources. Why focus on this particular one? Why mention Freud, for example? That's pretty far afield. The Water fluoridation article already discusses this particular theory briefly, when it talks about "claims that fluoridation was motivated by protecting the U.S. atomic bomb program from litigation" and claims "that it is backed by the sugar or aluminum or phosphate industries". Why go into more details? Eubulides (talk) 20:01, 9 March 2010 (UTC)

The Edward Bernays page has this claim but it is unsourced there too. It might be notable to mention in his article a campaign that was significant in his life but is it a notable part of the global story of water fluoridation? Is it an accurate commentary on what occured? Perhaps Water fluoridation in the United States might cover how fluoridation was promoted and mention Bernays if that is appropriate. But we'd need reliable sources in order to determine that. Colin°^Talk 20:34, 9 March 2010 (UTC)

I agree any mention of Freud is completely unnecessary. And with the concerns about WP:WEIGHT. However, take a look at Aspartame_controversy#Methanol_and_formaldehyde, particularly the part beginning "Some opponents of aspartame have falsely claimed...". I believe the approach is a good model to follow. There's a widely-held view that seems to be incorrect. Rather than ignore it, it's addressed and explained. Stepping back, the purpose of a Wikipedia article is to inform readers. Many readers believe Bernays was involved (and they probably believe maliciously) in a PR campaign to garner support for fluoridation. If he wasn't, that's important to highlight, as it corrects a widely-held view. If he was, it's worth mentioning, but in a context that's not overwhelmingly POV. And why this one? It's a start. Other claims can follow. Until there are reliable sources claiming one or the other however, I'm happy to leave it out for now. But I believe it should be investigated. False claims need to be addressed, otherwise the ground is conceded and the unreliable websites out there are seen as more complete. Greenman (talk) 20:40, 9 March 2010 (UTC)

We also have Opposition to water fluoridation, which could go into details about any incorrect claims made by opponents. This is a general article on water fluoridation and part of an encyclopedia. It is just as much not an advocacy site for the scientific-point-of-view as it is not a dumping ground giving every consipiracy theory free webpace on a top-10 Internet website. What do reliable sources say about Bernays? If they don't give the issue any column inches then we can't either, even if there are hundreds of Internet conspiracy sites mentioning it. Colin°^Talk 20:59, 9 March 2010 (UTC)

Aspartame controversy is a reasonable place to talk about incorrect claims about aspartame, but Aspartame itself (rightly) gives such claims short shrift. Although the Bernays-related fluoridation-is-a-conspiracy claim is suitable for a controversy article, it's not clear that it's significant enough to deserve more coverage in Water fluoridation than it already has. That being said, I'll see if I can find a newer source on these non-mainstream theories, since our current sources (Armfield 2007, PMID 18067684; Newbrun 1996, PMID 9034969) are a bit dated. By the way, shouldn't the controversy page be called Water fluoridation controversy rather than the more-POV Opposition to water fluoridation? I added a thread Talk:Opposition to water fluoridation #Article title should say "controversy" rather than "opposition" about this. Eubulides (talk) 21:20, 9 March 2010 (UTC)

I reacquired a copy of Freeze & Lehr 2009 (ISBN 978-0-470-44833-5), an extensive and recent reliable source on the fluoride controversy. It devotes one of 13 chapters to the conspiracy theory involving Bernays, so I suppose that's good enough excuse to mention the Bernays theory in our paragraph on conspiracy theories. I made this edit as a first cut at that. Hope this helps. Eubulides (talk) 08:57, 11 March 2010 (UTC)

Looks good. I'm not sure about the word "gimmick". What about "ruse" or "stratagem" or similar? Colin°^Talk 09:11, 11 March 2010 (UTC)

Thanks. "Ruse" sounds good, so I switched to that. Eubulides (talk) 09:36, 11 March 2010 (UTC)

Arsenic and high fluoride levels

A recent edit added the following to Safety:

"Recently, studies have concluded that high levels of fluoride found in the drinking water of certain communities in China and Mexico are associated with significantly reduced IQ." (citing Rocha-Amador et al. 2007, PMID 18038039; and Wang et al. 2007, PMID 17450237)

Neither of the cited studies are about water fluoridation. They are both about exposure to arsenic in combination with levels of fluoride well above those recommended for water fluoridation. Since they're not about water fluoridation, I reverted the change. Eubulides (talk) 06:08, 13 March 2010 (UTC)

Curse those naturally occuring elements *shakes fist a the sky*. Shot info (talk) 08:10, 14 March 2010 (UTC)

Two lobbies

A recent edit removed the following sourced text:

"Many people do not know that fluoridation is meant to prevent tooth decay, or that natural or bottled water can contain fluoride; as the general public does not have a particular view on fluoridation, the debate may reflect an argument between two relatively small lobbies." (citing Griffin et al. 2008, PMID 18333872)

with the edit summary "Vague/false. Who are the "two small lobbies"? http://www.fluoridealert.org/communities.htm says people DO have an anti-fluoride bend, whereas government overwhelmingly is pro-fluoride." The two small lobbies in question are the pro-fluoridation and the anti-fluoridation lobbies. Notice that the comment is talking about lobbies here: very few people lobby the government on either side of the question. The fluoridealert.org web site is not a reliable source on fluoridation. Griffin et al. is reliable and directly supports the text in question; for example, for lobbies it says (p. 101):

"The debate around fluoride has lasted for over 50 years.... The debate remains polarized, although the apparent vehemence in the debate may reflect arguments between a relatively small number of lobbyists on either side. Holloway commented in 1977 that because the general public does not have a particular view on fluoridation 'decision makers would have little guidance except for the activities of the pressure groups involved'. He suggested that both pro- and antifluoridation groups 'adopt similar strategies in that they communicate with those members of the community who are likely to influence decisions on water fluoridation', but that antifluoridation groups were more likely to use the media to influence the public directly. Lobbying strategies do not seem to have changed significantly over time."

To help clear up any confusion about the lobbies, I restored the text in question, appending the phrase "for and against fluoridation" to try to clarify who the two lobbies are. Eubulides (talk) 08:00, 15 March 2010 (UTC)

"for and against fluoridation" does not clarify the issue. Who is the anti-fluoride lobby? Who is the pro-fluoride lobby? Is the pro-fluoride lobby actually "small"? The "source" you cite does not say what your wiki sentence says. The source you cite is a representation of an opinion stated by a man named Holloway. Your wiki sentence does not reflect this.

How is fluoridealert.org not a reliable source?

Please sign your comments. For what is a reliable source in Wikipedia, please read WP:RS. 07:11, 30 April 2010 (UTC)

No mention of the Nazis?

Water Fluoridation was implemented by the Nazis for use in their concentration camps. The stated purpose for this was to sterilize the inmates. This exact information is mentioned elsewhere on Wikipedia. This information is pertinent here. Will someone add it? I'm not too familiar with how to write in Wikipedia style.

Source? Shot info (talk) 07:26, 30 April 2010 (UTC)

Iodine competes with Fluorine/Bromine/Chlorine

Of the four, Iodine is an essential nutrient. Fluoride, like the other three, is not. Fluorine ingestion (through water fluoridation) inhibits Iodine absorption. This is well established and not controversial. There is no mention of it in this "Featured Article". A quick search reveals http://www.ncbi.nlm.nih.gov/pubmed/4088985?dopt=Abstract. Establishment "accepts" this "drawback" just as it "accepts" fluorosis. Therefore a section should be given to this topic here. It might also be written that in spite of this evidence, government organizations provide no recourse for iodine deficient citizens, and forced medication continues.

Do you have a teritary source stating the above? Shot info (talk) 07:28, 30 April 2010 (UTC)

Clear Bias

This article is clearly biased. All research indicating potential health concerns has been removed or minimized (eg labelling it as "low quality research").

Article needs significant editing to bring it to a neutral pov. —Preceding unsigned comment added by 121.73.170.183 (talk) 12:49, 2 June 2010 (UTC)

Please can you indicate which health concerns are missing or wrongly worded, along with high quality reliable sources. You may want to check the talk page archives for earlier discussions. Colin°^Talk 13:15, 2 June 2010 (UTC)

Wow. I cannot believe this article was ever featured. It is one of the most biased articles I have ever encountered on Wikipedia. Nobody can dispute that this is a controversial topic, yet that controversy is glossed over and one side is consistently belittled throughout this piece. The tone is extremely one sided. Coolgreycity (talk) 01:18, 15 June 2010 (UTC)— Coolgreycity (talk • contribs) has made few or no other edits outside this topic.

I agree any article that does not share the alex jones opinion must be biased. — Preceding unsigned comment added by 96.255.111.236 (talk)

Clearly the safety section needs improvement

The article suggests that the only clear side effect of fluoridation is dental fluorosis, while there have been many studies showing the long-term toxic effects of fluoride.

For example: http://www.fluoridealert.org/idd.htm "suggesting that a low iodine intake coupled with high fluoride intake exacerbates the central nervous lesions and the somatic developmental disturbance of iodine deficiency."

Average IQ of children in this study in a "high" fluoride area (.88mg/L, which is LESS than what the suggested 1mg/L from fluoridation in the United States) with low iodine levels was 71, while the IQ of children in a normal (.33mg/L) fluoride area with low iodine was 77, and the IQ of children in a normal fluoride area with high iodine from supplementation was 96.

These results are statistically significant and were reported in 1991. That's almost 20 years ago. Most Americans are deficient in iodine. And ingested fluorine is ineffective in promoting healthy teeth - only topical use is effective, albeit unnecessary as there are far safer, less toxic alternatives.Jayhammers (talk) 22:04, 14 June 2010 (UTC)

I believe the writer used "statistically significant" wrong. This happens all too often when somebody is trying support facts with words and not actual statistics. When something is statistically significant it is p<.05 or p<.01. When p is less than .05 we can be 95% confident that the results are not due by chance. When we say that p is less that .01 we can be 99% confident that the results are not due to chance. This person does not list what p is so we have know idea if the results are "statistically significant". —Preceding unsigned comment added by 76.88.50.213 (talk) 16:08, 23 June 2010 (UTC)

Regardless if the writer used statistically significant right or wrong, he makes a good point about the research that was done on the subject in question, which is the iq levels of children being in variation due to the fluoride use. It is a view point based on fact which is not represented in the original water fluoridation page, which would suggest a bias to the dental uses of fluoride in water. It is obvious the article isn't neutral....excuse me i have to cough. *propoganda*