Talk:Water fluoridation/Archive 5

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"Fluoridation does not affect the appearance, taste, or smell of drinking water."

This is an odd statement and needs to be given some substance instead of being expressed as a fact. If it is true than it would be interesting to have a paragraph that explains the slightly different taste/freshness of tap water with respect to bottled and untreated (rain) water. — Preceding unsigned comment added by 79.132.253.195 (talk) 23:51, 13 April 2011

Why do you think it is an "odd statement"? Surely it is desirable that any water treatment has no noticable effect on the water? The statement cites a study where it was found that people could not tell if water was fluoridated or not. The issues regarding tap water taste vs rain or bottled water are propbably best discussed at bottled water and tap water. Colin°^Talk 07:43, 14 April 2011 (UTC)

Saying that fluoride does not affect the appearance, taste, or smell of drinking water is nonsense. Pure water has nothing in it and it is very clean and clear unlike water that has things added to it. You simply can not add things to water without affecting it's taste, appearance and smell and that is a fact. One would have to have clean water to compare the fluoridated water to see that difference. Statements like that are just nonsensical. — Preceding unsigned comment added by 212.124.103.204 (talk) 01:37, 28 May 2011 (UTC)

Effects on Iodine Absorption

Don't fluoride and bromine (not nutrients) compete in the body for iodine receptors, iodine being the heaviest element that is an essential nutrient? Reduced IQ, issues with bones, and many other of the corollaries that have, at least weakly, been found in studies of excessive fluoride exposure, seem to resemble iodine deficiency. 66.178.144.154 (talk) 07:45, 18 April 2011 (UTC)

F^- and I^- are very different in size, so their competition would be surprising. I have heard that perchlorate (ClO₄^-) competes with I^-, see Perchlorate#Biological functions. Usually in chemistry, F^- and hydroxide (OH^-) are more similar, as shown by the uptake of fluoride into apatite in the enamel. One need to be circumspect on this theme because there is a lot of wacky literature about the effects of fluoride, often written by undereducated conspiracy theorists.--Smokefoot (talk) 12:40, 18 April 2011 (UTC)

Bottled water typically has unknown fluoride levels, and some domestic water filters remove some or all fluoride.

I was looking at the citation to this claim and it doesn't seem to back up this claim. Hobson WL, Knochel ML, Byington CL, Young PC, Hoff CJ, Buchi KF. Bottled, filtered, and tap water use in Latino and non-Latino children. Arch Pediatr Adolesc Med. 2007;161(5):457–61. doi:10.1001/archpedi.161.5.457. PMID 17485621.

There is no mention of the amount of fluoride being removed by filters nor does it claim that bottled water typically has unknown fluoride levels. — Preceding unsigned comment added by Charbon (talk • contribs) 21:41, 25 May 2011 (UTC)

"The type of water filter used impacts the amount of fluoride and bacteria removed from the water. Faucet-mounted or pitcher filters only remove impurities, while under-the-sink filters, such as reverse osmosis and distillation filters, remove 65% to 95% and 100% of the fluoride, respectively." ... "However, 10.2% of our filter users use under-the-sink filters, such as reverse osmosis or distillation filters, that remove between 65% and 100% of fluoride4 and, therefore, did not receive adequately fluoridated water."

"A stud of drinking water in Cincinnati, Ohio, found that bacterial counts in bottled water were often higher than those in tap water and fluoride concentration was inconsistent." ... "The impact of always drinking bottled water on fluoride intake is uncertain because the regulations for bottled water do not require disclosure of fluoride content on the labels. Although it is likely that some bottled water contains some fluoride, physicians and families cannot quantify the fluoride consumption of their patients or children."

If this information was controversial, I'd probably want a better source than the discussion aspects of a primary research paper. But I'm not aware of any controversy in this regard. Colin°^Talk 21:52, 25 May 2011 (UTC)

U.S. Department of Health and Human Services (HHS)

The U.S. HHS has proposed to lower the water fluoridation levels in the U.S.

http://www.hhs.gov/news/press/2011pres/01/pre_pub_frn_fluoride.html

http://www.hhs.gov/news/press/2011pres/01/20110107a.html

That info says they would decide on the proposal by Spring 2011-- did they? SandyGeorgia (Talk) 01:38, 28 May 2011 (UTC)

I do not know what has been decided. If you would like to know more information about what the HHS is doing then call them and ask. Both sites have contact information.

That would be an interesting exercise, but a phone call from a Wiki editor to them would not be a source we would use on Wikipedia. Please sign your posts by entering four tildes ( ~~~~ ) after them. SandyGeorgia (Talk) 02:05, 28 May 2011 (UTC)

As I wrote in Talk:Water_fluoridation_controversy, this is not relevant until the proposal actually passes. Noformation (talk) 02:09, 28 May 2011 (UTC)

Edit request from Psnisbet, 27 July 2011

I wish to edit the statement that the UK applies water fluoridation. In fact, only a very small proportion of UK authorities do this, and the page should be edited to reflect this fact. The reference for this is:

http://dwi.defra.gov.uk/consumers/advice-leaflets/fluoridemap.pdf

Psnisbet (talk) 14:39, 27 July 2011 (UTC)

This article covers fluoridation worldwide (though the US is better covered because it is better covered by the sources). Very few countries have 100% fluoridated water. So the paragraph says "It has been introduced to varying degrees in many countries and territories outside the U.S., including ... the UK, ..." (my emphasis). I think this is appropriate and deals with the fact that only a portion of UK supply is fluoridated. For more detailed information, the reader is directed (via a hatnote) to Fluoridation by country. Colin°^Talk 15:02, 27 July 2011 (UTC)

IQ and levels of water fluoridation

I have a problem with the following snippet of text

"pposition 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. 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 anecdotally 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.[22]"

It falsely states that lower IQ is based on "antifluoridationist literature", this is simply not true, there are many peer reviewed articles from scientific journals which do in fact link lower IQs levels in young children who are exposed to water fluoridation that experience medium to severe levels of fluorosis.

Suggest that above snippet is corrected and also the section titled "Evidence basis" is updated with findings in the linked study, i would be more than happy to make the changes if given access, thanks. — Preceding unsigned comment added by Artonink (talk • contribs) 13:09, 29 August 2011 (UTC)

The journal Fluoride is not recognized as a credible source by PubMed: it was rejected as a publication with a biased, unscientific agenda. --Smokefoot (talk) 13:23, 29 August 2011 (UTC)

source updated http://www.ncbi.nlm.nih.gov/pubmed/18695947

please correct the article and clearly reference these studies or grant access, thanks

Now try this: WP:MEDRS. Basically that Wikipedia wants references for medical issues to come from reviews or books. Dont forget to sign.--Smokefoot (talk) 16:57, 29 August 2011 (UTC)

greetings smokefoot, below is a publication reviewing previous referenced studies and then some
http://www.nap.edu/catalog.php?record_id=11571

important to note, reference [22] of snippet above does not relate in any way to lower IQ, the author, Jason Armfield, also cites dubious consumer reports, magazines and articles to support his claims, considering that the article isn't even reviewed raises further questions of its credibility. Lets try and be a little consistent here.

I do appreciate that there is a lot of misinformation surrounding this subject and we should be cautious about what is published however the studies/research presented here are from recognised experts, most of which are directly contactable via email, who have a number of publications to their name from recognised academic institutions from around the world. I also appreciate there is a lot of "antifluoridationist literature" and am well aware of the associated conspiracy theories, my intention is to not degrade the subject to such lows but to ensure that there is a balanced review of the scientific literature, best regards Artonink (talk) 06:27, 30 August 2011 (UTC)

Could you provide us the text from this book that you wish to see reflected? Doc James (talk · contribs · email) 08:08, 30 August 2011 (UTC)

Greetings Doc James, hope you are well

I cited the above publication since a link to pubmed was not deemed credible, study can be found on page 205
http://www.nap.edu/openbook.php?record_id=11571&page=205 Artonink (talk) 08:21, 30 August 2011 (UTC)

Yes interesting studies. They appear to be looking at natural levels of fluoride in the water and the effect of these levels on IQ in China. The level of 2.47mg/L is more than twice what people add to the water in developed countries. Does not appear to be looking at the practice of "water fluoridation" Looks like they need water defluoridation. Would be an interesting page. Doc James (talk · contribs · email) 09:41, 30 August 2011 (UTC)

thanks Doc James, i'll keep that in mind Back to my original request, can you please fix the article, as established here the notion of lower iq related to water fluoridation is not a result of antifluoridationist literature as incorrectly described in the article.Artonink (talk) 07:19, 7 September 2011 (UTC)

I didn't read your source but if I'm interpreting what Doc James said above correctly, he's pointing out that since the study deals with natural levels of fluoride in the water and not specifically the practice of water fluoridation, it is not applicable here. Do I have that right, Doc? If that's the case, then the type of source you would need to change that would have to link the practice of water fluoridation itself to lower IQ. N^oformation ^Talk 08:38, 7 September 2011 (UTC)

lets not worry about the source, or even represent the findings of the various studies, lets just remove "low iq" from the article, as it stands the article incorrectly suggests the links of water fluoridation and low iq is baseless conjecture from antifluoridationists, this is clearly incorrect 60.240.216.167 (talk) 08:48, 7 September 2011 (UTC)

I've removed "anecdotally" from the sentence, as the source doesn't use it and it probably doesn't apply to all the links suggested in the literature. The link with low IQ may come from a variety of sources, some anedotal and some like the above based on studies of natural fluoride levels above those used for fluoridation. Whether those studies are relevant to fluoridation, or whether applying them to the fluoridation argument is "baseless conjecture" is a matter for our reliable sources to decide, not us. Colin°^Talk 10:11, 7 September 2011 (UTC)

thankj00 — Preceding unsigned comment added by 60.240.216.167 (talk) 10:34, 8 September 2011 (UTC)

Essential nutrient, Infectious disease

The mechanism section states:

• It has not been proven unequivocally that fluoride is an essential nutrient in the sense of being required to sustain life or growth in humans.

It is a direct quote from the reference Olivares M, Uauy R. Nutrients in Drinking Water. World Health Organization; 2005. ISBN 92-4-159398-9. Essential nutrients in drinking water [PDF]. p. 41–60.. It suggests that fluoride is very likely to be an Essential_nutrient, while in reality scientists agree it is not, unless one would redefine "essential" as anything that improves health. That same source lists a WHO guideline value of 1.5 mg/L (last page), contrary to the 2004 WHO expert committee advice of an absolute upper limit of 1.0 mg/L or even lower (ref 6, and the same advice is given in an advice from 1994, see section implementation). An indication perhaps that WHO guidelines should not be seen as reliable sources for expert opinions.
DS Belgium (talk) 19:34, 14 September 2011 (UTC)

I believe this is wrong...

"Water fluoridation is the controlled addition of fluoride to a public water supply"

So if I add fluoride to a 5 gallon jug of water for my private consumption, it would not be considered water fluoridation?

I propose eliminating "public" from the sentence.Gesellman (talk) 03:27, 29 October 2011 (UTC)

In the usual sense, water fluoridation means the addition of fluoride to public water supply because, although theoretically possible, no other entity is engaged in fluoridating water. In an effort to make definitions understandable to the majority of the readers, we inevitably make small sacrifices in precision. One could quibble about "controlled" since water could be fluoridated in an uncontrolled manner. One could quibble about the "addition of fluoride" since chemists can add reagents other than fluoride salts to release fluoride, etc. So to restrict the definition to any fluoridation of water would give undue weight to esoteric meanings (see WP:UNDUE, which means that the proposed change risks giving too much weight to a niche interpretation, misleading readers). At least from my perspective. --Smokefoot (talk) 03:57, 29 October 2011 (UTC)

Nice article, small crit

Nice article. I appreciate how it covers a controversial subject and gives appropriate weight (not much) to the kookier anit-F stuff.

Small crit: I felt like the sentence about females looking prettier and earning more money when fluoridated was a little too much. In another part of this article, it discusses poor quality or sketchiness of some research. And that thing about the females is a working paper (just a draft, really, a pdf on the net) not a published journal report. Plus it seems like a bit of a one off and prone to a lot of confounding factors.

TCO (Reviews needed) 03:35, 3 January 2012 (UTC)

I have watchlisted (but not kept up with entirely) this article since its main author departed Wikipedia. As far as I can tell, Eubulides switched out the original papers because he liked to use freely accessed sources. It doesn't appear that text should be deleted without accessing the original sources he used-- unfortunately, he's no longer around to ask, and I don't have journal access. I would worry about any text that has crept in since Eubulides departed, but he was very strong on sourcing, so text in the article before his departure is less suspect. SandyGeorgia (Talk) 16:19, 3 January 2012 (UTC)

It's no big deal to me, really. I'm just dropping the comment for others to consider. FYI, it was a working paper before also, not a journal report. And probably the way to do it right is to cite the journal and a separate link to the free working paper version with parens "draft" or "working paper version" in the event that there is a free draft, but not a pdf of the final version. In any case, I think the overall article does a great job of handling this touchy subject and coming down (appropriately) saying what the scientific consensus is and that the anti-F stuff is deprecated in the literature. I just felt this one report on the pro F side was a little "much" and sketchy on its own and not needed (kinda particular). It is too bad, E is not here, but I would make the same comment to him. It's just minor, constructive feedback on the talk page.TCO (Reviews needed) 17:13, 3 January 2012 (UTC)

The published paper is:

• Glied S, Neidell M. The Economic Value of Teeth. J. Human Resources March 1, 2010 vol. 45 no. 2 468-496.

Having quickly read the draft paper and this review that mentions it I think we should drop it. The authors are looking at historical data that they admit would probably not recur (due to fluoride being available from other sources too). This is a primary research paper, so not our best choice of source, though we could use the review I linked. However, that review repeats what the paper admits, that they were really researching the effect of oral health on labour market outcomes, not fluoridation. They simply chose that as a marker they could test. Lastly, our article uses the ambiguous phrase "earned significantly more" for a figure of 2-4%. That may be statistically significant, but isn't financially all that significant. Colin°^Talk 19:36, 3 January 2012 (UTC)

Thank you for digging it up, Colin ... ok, based on that, I agree, and since that makes three of us, I'll go remove it. SandyGeorgia (Talk) 19:39, 3 January 2012 (UTC)

IQ add by IP

Seems like the IQ stuff should go in a different section. I don't think (IANAD) that those journals linked are anti-F literature. Seems like they are decent journals.

Seems like they are talking more about the effect of actual damage from regions where there is too much fluoride (parts of China). Or perhaps that info should just be cut or put in some other article (not really about water fluoridation, but about exposure, much of it from coal burning).

TCO (Reviews needed) 22:59, 8 January 2012 (UTC)

I think that this information places WP:UNDUE weight on a perverse situation barely related to the ppm levels used in public waters. Separately, I had also thought about adding papers on the pervasiveness of fluoride in sea water, but considerations of WP:UNDUE weight held me back. Also I did not want to start a list of where fluoride occurs in water fluoridation.

The standards for WP:MEDRS are pretty stringent. I would check the citation and make sure that it is at least a reputable, big time journal vs the usual creepy stuff that the most virulent anti-fluoride groups usually rely on.

Should you decide to proceed, a more appropriate place is Fluoride toxicity#Chronic toxicity, where the fundamental problem for those poisoned is high fluoride from ground water. It's pretty serious problem globally, akin to the issue of arsenic contamination of groundwater.

Other editors might have useful views, so I would wait and see the community response to your idea.--Smokefoot (talk) 23:16, 8 January 2012 (UTC)

Yeah, that is the place for it. I don't know for sure those are decent journals, but there were two and one was a review. I think I will try it there. I lack the global knowledge to tell weight, but...well...had a review. I think it is worth a shot. I am on the pro-F side, don't worry.TCO (Reviews needed) 23:25, 8 January 2012 (UTC)

Well, I am not particularly pro-F or anti-F, and given the fluoridation of toothpaste and other things, it is kind of moot point I think cause we all have our fix. Back to the IQ thing, my guess is that any elemental deficiency or excess will cause an IQ problem and a host of others. Arsenic is apparently healthful in tiny doses, and, famously, selenium is an essential element, but a little too much is lethal. These are the nuanced complications of reality that the anti-fluoride groups just refuse to deal with. BTW, water fluoridation is viewed about 30000 times each month.--Smokefoot (talk) 23:43, 8 January 2012 (UTC)

What we have to watch for here is that we cite reliable secondary sources that are discussing water fluoridation: the controlled addition of floride to the water. The moment we start citing sources (and primary ones at that) that just discuss fluoride in water or fluoride and health in general, then we are taking the WP:OR step that we consider those facts to be relevant to water fluoridation. As Smokefoot says, we have other articles that discuss these other aspects (and I should note that they by and large are not watchlisted or cared for like this article so beware). Colin°^Talk 08:46, 9 January 2012 (UTC)

Violent agreement.TCO (Reviews needed) 17:01, 9 January 2012 (UTC)

IQ add by Cottegedream

Regarding this edit, just want to reiterate that correlation studies are good for nothing other than suggesting that more research is necessary. Correlation studies suggest that storks deliver babies N^oformation ^Talk 00:13, 9 January 2012 (UTC)

Concur with the caution and the suggestion that we not cite the paper on IQ. --Smokefoot (talk) 01:46, 9 January 2012 (UTC)

No adverse effects?

Water quality is something I've paid considerable attention to over the past 22 years. I want to raise question about the notion that fluoride in drinking water has no adverse effects except potentially leading to dental fluorosis. It is published in PubMed that fluoride accumulates in the pineal gland. According to this article is accumulates more readily in the pineal than in bone and teeth. Numerous other PubMed articles indicate effects of fluoride toxicity. Most (perhaps all) of these studies are using significantly higher levels of fluoride than the EPA recommended limit for drinking water, although many have the same or similar levels to fluoridated table salt (another issue, for another Wiki page on Salt Fluoridation). For instance, it was shown that sodium fluoride (at 200ppm) decreases the activity of important antioxidants, resulting in myocardial damage in rats . Just because they study was done at 200ppm, we can't conclude that lower dosages don't also have a negative impact on such antioxidant activity. Here is a study confirming the issue of fluoride increasing the uptake of lead in people exposed to both http://www.ncbi.nlm.nih.gov/pubmed/20188782. There are also links between fluoride intake and thyroid dysfunction . Again, most of these studies work with higher than what is likely from ingesting water with a maximum of 2ppm fluoride. Yet, it is faulty science to therefore conclude that at lower levels fluoridation of water is harmless or has no adverse effects.

While searching for the above studies, I came across this page: fluoridealert (dot) org / fluoride-facts.aspx (I see this link has been blocked, but for this disussion, I wish to refer editors to the material I am mentioning).

I have gone through the references cited by that article. Whilst some of the conclusions drawn by the author based on the references cited could be considered questionable (i.e. the studies are inconclusive at the levels commonly added to drinking water), I have to ask: Are the authors of this Wiki page dismissing all the points made in that article and all the cited references?

Please advise. Jonathan E. (talk) 16:33, 5 March 2012 (UTC)

Any points made at fluoridealert and in the literature it cites will have been discussed in other reliable secondary sources and either confirmed or dismissed there. Fluoridelert is an activist site and thus not useful for our purposes of a neutral encyclopedia. There is extensive 3rd-party literature to draw on instead. As for it being "faulty science" to draw the conclusion that there is no relation between toxic effects seen in gross doses and levels present in fluoridated water, that is your own presumption, one not shared by the scientific community, so it is that community you should seek to convince, not Wikipedia. Franamax (talk) 16:44, 5 March 2012 (UTC)

I am not a fan of this sentence in the article - By comparison, brushing with a nonfluoride toothpaste has little effect on cavities.[49] The link doesn't work either. It makes it sound like brushing your teeth with non-flouride toothpaste is worthless and that is wrong. I don't have any proof, but flouride in toothpastes is sort of new. They didn't have flouride in them when I was a teenager or young adult. My mother brushed her teeth with baking soda her whole life and her teeth were fine. Mylittlezach (talk) 23:08, 7 March 2012 (UTC)

Have a read of the source. It is freely available online (though the main URL didn't work for me this morning, I went via the DOI and the clicked on the PDF link). Search for "toothbrush" in the source article (both the lead/abstract and later on). It is explains well why toothbrushing doesn't affect caries (but does help with your gums) and why fluoride in the toothpaste is important. Your mother perhaps had a low-sugar diet. Yes, fluoride in toothpaste is relatively new but so is keeping your teeth all your adult life. Colin°^Talk 08:39, 8 March 2012 (UTC)

Appeal to ignorance[[1]]. All that needs to be done to prove that statement false is to find some evidence that brushing with anything other than fluoridated toothpaste can prevent dental caries.

"Search for 'toothbrush'", so you say. Yes, do that, and find the study copy'n'pasted a quote from some other guy. Classic fluoride science indeed. 67.169.93.56 (talk) 19:16, 5 August 2012 (UTC)

simple: please add an article link

i'd do it myself, but can't since the page is "semi-protected". under the Implementation section, there are 3 bullets which represent the 3 main compounds used in fluoridation. the first 2 bullets are links to their respective wikipedia articles, but the 3rd bullet is not a link, even though a wikipedia article does exist for it. can someone with the power please add the link for this third bullet? thanks in advance! feel free to delete this edit once it's done. Feugene (talk) 11:51, 25 April 2012 (UTC)

Done. Thanks. Colin°^Talk 12:10, 25 April 2012 (UTC)

On: Stating that a study supports a notion vs stating that a study proves a notion.

Hello all,

I am taking this discussion here to prevent an impending edit war. As I tried to state in my edit summaries, my edit, which was:

“ In July 2012, a study conducted by Harvard University was published in support of the notion that fluoride exposure can have adverse effects on the neurodevelopment of children. On July 20th, 2012, it was published online in a US National Institute of Environmental Health Sciences' journal called Environmental Health Perspectives. It found that "... children in high fluoride areas had significantly lower IQ than those who lived in low fluoride areas". ”

didn't use any primary research papers to verify information. What it did do, is use a reputable news website, marketwatch.com, to verify facts about a study. I did not use the study to make any claims, show any proofs regarding water fluoridation, or use it as a source; I am merely providing information about a study of water fluoridation. Gold Standard 20:48, 26 July 2012 (UTC)

First, please review WP:MEDRS. Next please note that the source is a re-print of a press release from a fringe anti-fluoridation group, not a news story, so that isn't a reliable source for much of anything. Even if it were a news story, that is not the type of source we should be using; we use high quality secondary sources such as review articles, graduate level textbooks, etc. Note that there are literally thousands of studies on fluoride, so we cannot include a discussion of all of them here, we rely on high quality medical secondary sources to tell us what information to include. That source falls far, far short. Yobol (talk) 20:54, 26 July 2012 (UTC)

"we use high quality secondary sources such as review articles" So if I use the review article itself is it ok? Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis Gold Standard 21:11, 26 July 2012 (UTC)

The actual text of the paper doesn't even seem to be available yet, but looking at the Supplemental Information, the underlying studies address fluoride levels far in excess of those in typical water fluoridation schemes. No-one disputes that if you eat lots and lots of fluorine (or anything else for that matter) it will become toxic - but that is not what this article is about. So no, it may be better to wait until a reliable second party says there is some connection between this "review" (actually it's a meta-analysis) and typical water fluoridation schemes. Franamax (talk) 21:48, 26 July 2012 (UTC)

Then why does it say, "having drinking water fluoride as the only exposure" in the abstract? Gold Standard 21:55, 26 July 2012 (UTC)

Perhaps because some/one of the studies related to coal-burning? If you can't tell the difference between naturally occurring (excess) fluoride in drinking water and controlled levels used in deliberate water fluoridation schemes, I suppose I can't help you. Franamax (talk) 22:08, 26 July 2012 (UTC)

Also, my edits state that "fluoride exposure" can have adverse effects, I never stated what levels. Regardless of the levels that were studied, I still believe this is relevant to the topic of water fluoridation since studies on fluoridated water were reviewed. Gold Standard 22:00, 26 July 2012 (UTC)

Which qualifies you as a user of weasel words. Unless you are just scaremongering, you would indeed specify the levels. So there is proof again that we need to wait for reliable secondary commentary before including this. Franamax (talk) 22:08, 26 July 2012 (UTC)

(e/c x 4) Meta-analyses like these, in general, are the type of source we should use. Delving into the details of the study, we see a few problems with using it right now: 1) "The exposed groups had access to drinking-water with fluoride concentrations up to 11.5 mg/L (Wang et al. 2007), thus in many cases concentrations were above the levels of 0.7-1.2 mg/L (HHS) and 4.0 mg/L (US EPA) considered acceptable in the US." These studies appear to be studying fluoride in water that is already naturally high in fluoride levels (as opposed to artificial government administered fluoridation of the water supply). The applicability of these results outside of China may be minimal. 2) "The estimated decrease in average IQ associated with fluoride exposure based on our analysis may seem small and may be within the measurement error of IQ testing." In other words, any effects they found may not mean anything anyways. 3) "Still, each of the articles reviewed had deficiencies, in some cases rather serious, which limit the conclusions that can be drawn." The studies which they draw their conclusions on are of poor quality, meaning no firm conclusions could be made (Garbage in, garbage out). And finally 4) their conclusion: "In conclusion, our results support the possibility of adverse effects of fluoride exposures on children’s neurodevelopment. Future research should formally evaluate dose-response relations based on individual-level measures of exposure over time, including more precise prenatal exposure assessment and more extensive standardized measures of neurobehavioral performance, in addition to improving assessment and control of potential confounders." In other words this is a hypothesis generating paper; it doesn't come to any specific conclusion, but suggests future avenues of study. Given the limitations, it's probably best to wait to get context from other more authoritative sources such as the FDA, CDC, or other secondary sources to give us context before including. Yobol (talk) 22:10, 26 July 2012 (UTC)

I have made changes that make it clear that the study compared normal levels of fluoride to abnormally high levels of flouride. Also, the National Institute of Health is a perfectly reliable source. Gold Standard 22:20, 26 July 2012 (UTC)

It is also clearly stated in the abstract that they found that "children in high fluoride areas had significantly lower IQ scores than those who lived in low fluoride areas". Gold Standard 22:25, 26 July 2012 (UTC)

"Significantly" as in Statistical significance - does not mean important or meaningful. As the authors themselves state, it means that more research may be needed. But it doesn't mean what the press release you are relying on to form your opinion thinks it does. This is why we wait for expert published commentary rather than galloping of in all directions with our own. Franamax (talk) 22:37, 26 July 2012 (UTC)

I am obviously no longer relying on that press release, that is why I found the analysis article. It is expert published commentary on various studies. Gold Standard 22:41, 26 July 2012 (UTC)

Please tell us what specific change you are now suggesting. TippyGoomba (talk) 23:41, 26 July 2012 (UTC)

This addition:

“ In July 2012, a review of various studies was conducted by Harvard University researchers and was published in support of the notion that increased fluoride exposure can have adverse effects on the neurodevelopment of children. The review compared the IQs of children in areas with abnormally high fluoride content to the IQs of children in areas with normal fluoride content, and found that "children in high fluoride areas had significantly lower IQ than those who lived in low fluoride areas". On July 20th, 2012, it was published online in a US National Institute of Environmental Health Sciences' journal called Environmental Health Perspectives. ”

Also, in response to your edit summary, Franamax, Harvard University researchers were the ones who conducted the study. See the initial link I provided. Gold Standard 22:28, 26 July 2012 (UTC)

Dispute resolution

Fyi, gold has posted to Wikipedia:Dispute_resolution_noticeboard#Water_fluoridation as well as violated WP:3R. TippyGoomba (talk) 00:42, 27 July 2012 (UTC)

I apologize for the WP:3R violation, but it has already been discussed. I also did notify the other two users of the dispute resolution. Gold Standard 00:47, 27 July 2012 (UTC)

Gold Standard has made a number of mistakes with the text/sources and they are common enough mistakes to be worth examining.

• Firstly, let's deal with the idea that MarketWatch is a "reputable news website". All news/journal publications contain mixture of content. Some may come under the term "journalism" and the quality of that journalism is associated with the quality of the journal. I suspect (but don't know) that MarketWatch take their market/financial news stories seriously but don't have journalists qualified to comment on anything else. However, this particular article isn't journalism. At the top of the page it quite clearly says "PRESS RELEASE" and at the bottom it states who issued it and when "NYS Coalition Opposed to Fluoridation, Inc" and the fact that this release came from (and may have been assembled by) PR Newswire, so is likely to be repeated verbatim on many news sites. So what we've got isn't actually a MarketWatch news story but merely a press release by a fringe group. That MarketWatch chose to run that press release tells you something about the kind of care they take about what they publish: very little. I suspect if some fringe group issued a press release that said the price of gold was going to collapse, then they'd think twice. See also Churnalism for why supposed journalism articles can also be practically verbatim press releases too.
• While we do want and need secondary sources to link this study with water fluoridation (the article subject), we need high quality sources. And for contentious subjects we need very high quality sources. I hope you can see that this fringe group is not really to be trusted to make that judgement.
• Surely "fluoride exposure" or "fluoride in drinking water" is the same thing as "water fluoridation"?? No, they aren't. The latter is controlled to a level that is intended to balance the benefit/harm. The former can in some parts of the world reach toxic levels.
• So is the meta-analysis a good source for our article. Open the full text PDF (a link on the top-right of web page noted above). Search for "fluoridation" (as opposed to "fluoride"). It is mentioned once, in the title of a reference. The word "fluoridating" is also mentioned once in a reference title. In other words, at no time does this paper comment on "water fluoridation" (as opposed to natural fluoride in drinking water, or indeed, harmfully high levels of natural fluoride in drinking water).
• Is "National Institute of Health a perfectly reliable source". It is more complex than that. I agree that's a trusted organisation. But when judging whether a source is reliable one must always do so in context with the proposed article text. This source simply doesn't deal with water fluoridation so isn't a source on the article topic at all. If the NIH published a statement, with evidence, that water fluoridation was harmful and should be banned, that would be appropriate.
• "studies on fluoridated water were reviewed". Actually they weren't. The meta-analysis looked at studies that were all (but one in Iran) from China. China does not fluoridate its water. This is naturally occurring (or industrially contaminated from coal burning) fluoride in the water, at levels much higher than fluoridation permits.
• It is also interesting to note that when the studies compared children in high fluoride areas with a "reference" area, the reference area often had fluoride levels around those aimed for by water fluoridation. In other words, the "unaffected" children were actually exposed to levels similar to children receiving fluoridated water.
• Apply a simple test. Ask yourself: if this study is so damning of water fluoridation that the public must be alerted immediately and our water supplies immediately cleansed of this toxin, why aren't the authorities or medical journals doing so? Perhaps they are slow to react. Well, we can wait for them to publish. We're a tertiary source, not a newspaper. Perhaps the paper triggers further research (seems a good thing, and what the paper itself encourages) and that further research will establish whether fluoridation is harmful to our IQ. Perhaps there's a conspiracy to keep silent and have us all dumbed down :-).
• Wrt the proposed text, WP is an encyclopaedia that contains facts. Not a newspaper that reports recent studies as news. So generally we should aim for article text that simply states facts and doesn't spend its time saying where the facts came from, who published those facts. Such wording is often indicative that someone is pushing a POV at trying to over emphasise the importance of the facts by basking in the halo of a prestigious organisation or journal. Sometimes, the facts aren't clear or different respected authorities have published conflicting figures over time. In those cases we need to be more specific about the source of any claims. But the proposed text really isn't appropriately worded for an encyclopaedia. Colin°^Talk 08:24, 27 July 2012 (UTC)

Aren't there arbcom cases that apply to this page? --Ronz (talk) 16:03, 27 July 2012 (UTC)

I already conceded at WP:DRN. Gold Standard 17:59, 27 July 2012 (UTC)

Simple request for reference and clarification

Hello everyone,

In the Evidence Basis section it states "Moderate-quality research exists as to water fluoridation's effectiveness and its potential association with cancer". A clear reference to a source for this statement is essential as it makes a statement of fact. Could this reference please be added?

Thank you. — Preceding unsigned comment added by Needleboy007 (talk • contribs) 09:03, 13 October 2012 (UTC)

User:Smokefoot has gone ahead and removed the unsourced statements. Thank you for your input. TippyGoomba (talk) 20:23, 13 October 2012 (UTC)

Biased article

Why is there absolutely no mention of the use of water fluoridation at concentration camps in Nazi Germany and Soviet Russia? It was used to make the inmates more docile and apathetic. Just asking why Wiki agents are hiding truths that contradict government propaganda. I'm glad my water company refuses to fluoridate water - https://www.affinitywater.co.uk/water-quality-fluoride.aspx — Preceding unsigned comment added by 2.29.204.253 (talk) 11:37, 6 November 2012 (UTC)

You are welcome to add such information but Wikipedia expects reliable sources. Websites are usually not good enough. --Smokefoot (talk) 12:11, 6 November 2012 (UTC)

@ 2.29.204.253. Whilst I can sympathise with your worries, yet there is no 'reliable' evidence that I have found that the Nazi’s used fluoridation of water for this purpose.

There is far more evidence that the Nazi's used and developed Chlorpromazine and Thalidomide but non, for fluoridation of water. Chronic hunger and malnutrition, can better explain the docile and apathetic behaviour of those inmates you refer to. They had so little food that they started to metabolize their own body mass. However strong the will, the body could not stand up against their oppressors under these conditions.--Aspro (talk) 20:36, 6 November 2012 (UTC)

Aspro, the intertwining of Nazi's and fluoridation is deep in the culture of many (most?) anti-fluoridationists. Go to their main organization - fluoride action network - and search "Nazi". You'll get pages of assertions (for amusement you can also search "pineal" - even more pages). Many antifluoridationist disagree with our definition of reliable source since, they suggest, conventional sourcces are involved in a conspiracy (to promote fluoride to (i) passivate society or (ii) dispose of toxic waste or, more calmly, (iii) to medicate when the costs outweigh the benefits). Since the antifluoride groups do not accept Wikipedia's idea of reliable sources, editors find themselves in a Catch-22. Wikipedia is implicated in the same conspiracy. You will also notice that with rare exception, those complaining on these pages (a) are unregistered, (b) have a single minded focus on fluoride, and (c) are inarticulate with science - these characteristics also complicate communications. --Smokefoot (talk) 23:50, 6 November 2012 (UTC)

Fluoridation of public water supplies

Please check the Center for Disease Control website on this topic. Unless I am misunderstanding, it indicates that the source of fluoride used in public water supplies is the the pollution-scrubbing devices of the phosphate fertilizer industry. I think the article should have mentioned that this is where the fluoride comes from. — Preceding unsigned comment added by 72.211.178.151 (talk) 20:24, 2 December 2012 (UTC)

I checked, here's what I found. No reference to "pollution-scrubbing devices", whatever that means. The site mentions phosphate fertilizer but doesn't explicitly say it's part of the supply chain. I don't see anything particularly interesting to add to the article. Got any other references we can take a look at? TippyGoomba (talk) 21:25, 2 December 2012 (UTC)

Oh 72.211.178.151 is referring to an old howler about how fluoride is obtained industrially. The idea is basically rubbish (IMHO) found in blogs written by people who do not understand how chemical industry operates. The basic idea is that phosphate rock is solubilized for eventual conversion to phosphate fertilizer by treatment with sulfuric acid. Phosphate salts needs to be soluble to be beneficial to plants. The phosphate rock contains substantial amounts of fluoroapatite (also a phosphate source) which reacts with the sulfuric acid to solubilizes/volatilzes any fluoride. My understanding is that the fluoride is liberated as gaseous hydrogen fluoride, which is captured and used to make fluorine compounds (drugs, Teflon, fluoride salts for water treatment, etc). My further understanding is that in some cases the HF is allowed to (or just does) react with silicaceous material (i.e., sand), which is a common impurity in phosphate rock. The reaction of HF and SiO₂ leads to hexafluorosilicic acid, which is also used in some water fluoridation facilities. Since the fertilizer is the main target of the phosphate rock plants, one could say that HF and hexafluorosilicic acid are waste products. The bloggers have concluded that that the evil-doers in these industries can't figure out a better way of disposing of their fluoride waste-stream than sticking it into drinking water (very dilute). The fundamental aspect that some folks cannot fathom is that many, many chemicals produced in industry are also impurities from another process. In a classic case, platinum is a common impurity in some nickel ores and the industry happily collects the platinum. Similarly gold and silver and germanium and rhenium, and on and on. The petrochemical industry generates all manner of niche compounds that are used in diverse apps. The case against fluoridation of public waters has various degrees of merit, but this line of reasoning comes from a chemically illiterate part of that group, hence my contemptuous comments. --Smokefoot (talk) 21:47, 2 December 2012 (UTC)

? Non of your comment makes sense Smokefoot. How does that equate to what in Europe we recognise as naturally occurring Calcium Fluoride.--Aspro (talk) 19:30, 3 December 2012 (UTC)

Smokefoot's comments make perfect sense to me - he explained the likely basis for the "pollution-scrubbing devices" concerns of the ip that started this discussion.

What does calcium fluoride have to do with anything written here? --Ronz (talk) 20:33, 3 December 2012 (UTC)

The OP is asking about the industrial source of fluoride used in water fluoridation. The addition of Hexafluorosilicic acid is a US thing. Several European countries have tried this approach, instead of calcium fluoride , only to find that the science is lacking and failed to provide the promised results. Thus, they discontinued the program. Would you sprinkle sodium chlorate on your fish 'n chips?--Aspro (talk) 23:05, 3 December 2012 (UTC)

You are probably correct that fluorite is used as the source of fluoride that goes into water treatment facilities. Relative to phosphate rock, fluorite is the more traditional commercial source of fluoride and fluorine. We would very much welcome articles or even policy statements from the EU concerning fluoride from fluorite vs phosphate rock or related topics. I think that fluoride is fluoride though, and there is probably not much written along the lines that seem to worry you. But maybe I misunderstand. If fluoride is bad for people (your assertion, I take it), it wont matter where it is coming from, fluoroapatite or fluorite. --Smokefoot (talk) 23:43, 3 December 2012 (UTC)

Example: Sodium is sodium & chloride is chloride and oxygen is oxygen. But if you take it in the form of sodium chlorate it is more toxic. So likewise: One has to consider the the form of the hexafluorosilicic acid additive after it has passed through the supply and comes out the tap. Then look at the dental health of the population before it was added and compare those studies to the dental health of the same cohort after introduction. The original studies were far to small to exclude conflation. The European introduction of this type of fluoridation exposed the short comings (methodical errors) of these early studies. Currently, it seems only Ireland in Europe that is still keen on this form of water fluoridation (being the most resent) and it is now finds itself far enough into the experiment, that the authorities are also now under pressure to discontinue it for the same reasons that it has been discontinued elsewhere. I.e., the original studies, judged by modern standards -was poor science.--Aspro (talk) 20:49, 5 December 2012 (UTC)

Staying on the topic (the charge that fluoride and hexafluorosilicic acid are "waste products"). We're cool that fluoride is fluoride (no conflation). We're also cool that chlorate is not chloride (that would be conflation). Fluoride and hexafluorosilicic acid are not the same. On the other hand "form of the hexafluorosilicic acid additive" means hexafluorosilicic acid. The main point of this conversation was to resolve the accusation that fluoridation involves disposing of wastes. --Smokefoot (talk) 14:20, 6 December 2012 (UTC)

That’s already established fact. The source of fluoride for water treatment (under current methods) utilises an unwanted industrial by-product. That is the definition of waste... Waiting now for the circular augment- but it does have use... - 'Water Fluoridation'. A fallacy that the Europe (and now Chines) experience, exposed for what it was. So by using this industrial by-product, it is a way of deposing of industrial waste that otherwise would have to be deposed of like other toxic waste. So this does answers the OP's question. i.e., It does constitute the disposal of toxic industrial waste.--Aspro (talk) 00:52, 7 December 2012 (UTC)

Sounds more like phosphate fertilizer is the "toxic industrial waste", you should go rant on that article as well. TippyGoomba (talk) 02:12, 7 December 2012 (UTC)

Phosphate fertilizer is the 'end product'. The industrial wast, is the by products that does not end up in the sack of fertilizer.--Aspro (talk) 20:19, 7 December 2012 (UTC)

Phosphate fertilizer and fluoride are the 'end product'. TippyGoomba (talk) 00:16, 8 December 2012 (UTC)

Using semantic gymnastics the sophists where able to prove black-was-really-white. So I'll be more specific: The intended and sort for end product of the process in other words, the the industry's raison d'être. Therefore, hexafluorosilicic acid is in the proper sense the by-product of this process. --Aspro (talk) 15:06, 8 December 2012 (UTC)

Is an edit being proposed? Alexbrn (talk) 06:34, 7 December 2012 (UTC)

I dont think so, we were just discussing whether fluoridation represents disposal of wastes or use of a chemical valued for water fluoridation and other applications.--Smokefoot (talk) 14:40, 7 December 2012 (UTC)

A better way of viewing it perhaps would be along the lines that there is no such thing as rubbish (waste); as rubbish (waste) is just something in the wrong place at the wrong time. Example: Small amounts of the nuclear industries radioactive 'waste' such as Strontium-90 has found useful applications. Yet it is obtained from the nuclear industries waste, which un-contained would pollute the environment. --Aspro (talk) 20:01, 7 December 2012 (UTC)

Edit request on 18 December 2012

This article is heavily biased regarding controversial issues. It dismisses people who are in opposition to water flouridation as non credible and "conspiracy theorists." Evidence is stated in this article that is in favor to flouridation, but none of the many studies regarding the dangers of flouridation is stated, take this for example. This article clearly has an agenda and needs more balance. 149.63.60.58 (talk) 23:16, 18 December 2012 (UTC) Josh

Citing an article that misrepresents research findings?! No, per MEDRS. --Ronz (talk) 00:44, 19 December 2012 (UTC)

Agreed, sources for the article need to meet our guideline on sourcing for medical content. Yobol (talk) 01:12, 19 December 2012 (UTC)

See below references to fluoride and cancer--

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/7679201

"Clastogenic activity of sodium fluoride in great ape cells"

"Conflicting evidence has been reported concerning the mutagenicity of sodium fluoride (NaF), especially clastogenicity at concentrations of more than 1 mM. NaF is known to induce chromosome aberrations at these concentrations in human cells, but not in most rodent cells. We considered that such species-specific difference in chromosomal sensitivity would be derived from the phylogenetic distance between rodents and man. To clarify the role of interspecies differences, we investigated the chromosomal sensitivity to NaF in cell lines from various primates, which diverged into many species, including rodent-like prosimians and human-like great apes. The results showed that the clastogenicity of NaF was limited to human and great ape cells." PMID: 7679201

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/9002384

"Relationship between fluoride concentration in drinking water and mortality rate from uterine cancer in Okinawa prefecture, Japan"

"The Okinawa Islands located in the southern-most part of Japan were under U.S. administration from 1945 to 1972. During that time, fluoride was added to the drinking water supplies in most regions. The relationship between fluoride concentration in drinking water and uterine cancer mortality rate was studied in 20 municipalities of Okinawa and the data were analyzed using correlation and multivariate statistics. A significant positive correlation was found between fluoride concentration in drinking water and uterine cancer mortality in 20 municipalities " PMID: 9002384

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/16596294

"Age-specific fluoride exposure in drinking water and osteosarcoma (United States)."

"We explored age-specific and gender-specific effects of fluoride level in drinking water and the incidence of osteosarcoma. ..."

"Our exploratory analysis found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females." PMID: 16596294

Also on PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/19812419

"Is there a need of extra fluoride in children?"

"Fluoride consumption by human beings increases the general cancer death rate, disrupts the synthesis of collagen and leads to the breakdown of collagen in bone, tendon, muscle, skin, cartilage, lungs, kidney and trachea, causing disruptive effect on tissues in the body. It inhibits antibody formation, disturbs immune system and makes the child prone to malignancy. Fluoride has been categorized as a protoplasmic poison..." PMID:19812419

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/11512573

"Regression analysis of cancer incidence rates and water fluoride in the U.S.A. based on WHO data..."

"...cancers of the oral cavity and pharynx, colon and rectum, hepato-biliary and urinary organs were positively associated with Fluoridated Drinking water (FD). This was also the case for bone cancers in male, in line with results of rat experiments. Brain tumors and T-cell system Hodgkin's disease, Non-Hodgkin lymphoma, multiple myeloma, melanoma of the skin and monocytic leukaemia were also correlated with Fluoridated Drinking water." PMID: 11512573

I was thinking that if it really did cause cancer, wouldn't that make it in violation of the Delaney Clause? "the Secretary of the Food and Drug Administration shall not approve for use in food any chemical additive found to induce cancer in man, or, after tests, found to induce cancer in animals.--"Merrill, Richard A. "Food Safety Regulation: Reforming the Delaney Clause" in Annual Review of Public Health, 1997, 18:313-40. This source includes a useful historical survey of prior food safety regulation. If fluoride is in water that goes into foods wouldn't it be in violation of this clause?

The following papers explain that some caries are due to high lead levels and fluoride doesn't help in these cases.

"Enamel biopsies taken from school children in a community where exposure to lead was a health hazard were analyzed for lead and fluoride. The children with high enamel lead had significantly higher caries scores than the children with low enamel lead, in spite of the fact that the high lead group also was higher in enamel fluoride. There was no increase in enamel lead with age. The lead in saliva was only a fraction of that in blood. Infants with lead poisoning showed higher saliva lead than a normal infant."

•"Lead in Enamel and Saliva, Dental Caries and the Use of Enamel Biopsies for Measuring Past Exposure to Lead" http://jdr.sagepub.com/content/56/10/1165.abstract The fluoride in their teeth did not prevent the caries.

Lead is passed on from mother to child. The child doesn't necessarily have to ingest the lead. It can be transferred by the mother to her offspring, just like fluoride.

See "Association of Dental Caries and Blood Lead Levels" in JAMA. http://jama.jamanetwork.com/article.aspx?articleid=190537

See "Blood lead level and dental caries in school-age children" http://www.ncbi.nlm.nih.gov/pubmed/12361944

"Mean blood lead level was significantly greater among the urban subgroup, as was the mean number of carious tooth surfaces. Blood lead level was positively associated with number of caries among urban children, even with adjustment for demographic and maternal factors and child dental practices."This study suggests that the fluoridation of water can lead to higher lead levels:

•"Association of silicofluoride treated water with elevated blood lead" PMID: 11233755 http://www.ncbi.nlm.nih.gov/pubmed/11233755

Chronic, low-level dosage of silicofluoride (SiF) has never been adequately tested for health effects in humans. We report here on a statistical study of 151,225 venous blood lead (VBL) tests taken from children ages 0-6 inclusive, living in 105 communities of populations from 15,000 to 75,000. For every age/race group, there was a consistently significant association of SiF treated community water and elevated blood lead. The highest likelihood of children having VBL> 10 microg/dL occurs when they are exposed to SiF treated water and subject to another risk factor known to be associated with high blood lead (e.g., old housing). "Abstract: Lead, a toxin that lowers dopamine function, has been associated with violent behavior as well as learning deficits. Hydrofluosilicic acid and sodium silicofluoride, which were substituted for sodium fluoride without testing as chemicals for public water treatment, increase absorption of lead from the environment and are associated with violent behavior. Given the costs of incarcerating violent criminals, these side-effects justify a moratorium on using silicofluorides for water treatment until they are shown to be safe."

http://oehha.ca.gov/prop65/public_meetings/052909coms/fluoride/RMasters.pdf — Preceding unsigned comment added by 99.61.178.14 (talk) 22:53, 27 December 2012 (UTC)

The request should be of the form please change sentence X to Y. Alternatively, you can create an account. TippyGoomba (talk) 01:03, 28 December 2012 (UTC)

Aren't there any better studies to cite?

The claim is made "Water fluoridation is effective at reducing cavities in both children and adults.[9]", but the paper linked to says in the abstract "While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality." It seems weak to make this claim without pointing out that the citation used to back it up is of studies that are generally moderate to low in quality. Isn't there a review based on good quality science? — Preceding unsigned comment added by 75.164.193.55 (talk) 04:18, 20 February 2013 (UTC)

That is the conundrum. There is not at present any good quality science to to review. That would require a large cohorts with checks to identify and mitigated social/economic/ecological effects that might conflate the data collected. That type of research requires a lot of money because of its scale. The only 'general' guide are those counties that introduced fluoridation of water, then abandoned it when the promised benefits did not appear in their population. Some European countries -for instance- provided either free or subsidized dental treatment for children, so they were more keen to objectively look at the results. "Severe" fluoridosis may be rare percentage-wise but when it starts to cost the government health care services so many thousand dollars per patent to venire (several times as the teeth grow) and correct, then the economic advantage of remedial dental work plus the cost of the fluoridation itself, moves to give a negative cost benefit. The only way to settle it for good would be a very large, world wide (and thus expensive) study. Conflation is an important issue, not only did Switzerland abandon fluoridation of water 'they did not abandon their very high gun ownership and yet have very little gun crime. A mere dribble compared -with say the US. So simplistic comparisons (poor quality studies) can be really misleading. Real world examples (rather than theory) suggest: Good Dental Health Care, Sensible Diets and Responsible Gun Ownership certainly seams better than the uniformed opinions reflected in countries like the US etc.--Aspro (talk) 17:21, 20 February 2013 (UTC)

Don't agree with Aspro, there are some good studies in the peer-reviewed literature that quantify the relationship between caries reduction and fluorosis (BMC Public Health. 2012 Dec 28;12:1122.) that account for socio-economic status as well. Also lots of cohort studies; the nature of the investigation would limit you to cohort studies. You may not find randomized controlled placebo controlled trials however, I think because you can't consent a population to randomization process in the case of water fluoridation. There are many RCTs where fluoride from other delivery vehicles is given and, in my mind, the caries reduction potential is well proven but their is the risk of fluorosis. I can find other references however, that a well matched cohort on a large sample is a very close approximation to randomization. Ian Furst (talk) 18:42, 20 February 2013 (UTC)

The reviews didn't find studies that in a scientific sense were good. Period. Don't disagree with me but with all those scientists that studied the available data. --Aspro (talk) 19:38, 20 February 2013 (UTC)

There's not much point arguing about it - let's see if we can find a meta-study or review that includes good quality research. Tilapidated (talk) 19:49, 20 February 2013 (UTC)

This is not an “argument”. That requires a logical process and sound evidence that productive 'argument' requires; which in this case is sorely lacking. That is the problem – good quality studies have yet not been done – so they is no hope of you finding them if the experts can’t find any because non have been conducted yet.--Aspro (talk) 21:35, 20 February 2013 (UTC)

What I mean is that there is no point arguing about this here - if what you say is true then we need solid academic sources who hold that opinion. Tilapidated (talk) 21:37, 20 February 2013 (UTC)

You might like to start here for solid academic sources who hold that opinion. A Systematic Review of Public Water Fluoridation 2000 A more complete meta study in its scope I don't know off – and I doubt if anybody else knows better. PS. don't be lazy and read others articles of what some want you you to believe this study came up with. Read the this original thoroughly. Some reviews have twisted the finding round to agree with their own POV hoping that no one will bother to read the actual study.--Aspro (talk) 22:00, 20 February 2013 (UTC)

I added a section on the York review to the article - I'm also looking for other good quality reviews. Tilapidated (talk) 22:10, 20 February 2013 (UTC)

Natural and artificial water fluoridation

Colin - it looks like you removed the reference to the WHO study on the hazards of over-floridated water - it's not clear to me why you think this article should only relate to artificial water fluoridation - water fluoridation is a natural process as well, and a huge amount of the fluoride that gets added to water is through natural processes - it seems to me that it's appropriate to deal with that here. Tilapidated (talk) 19:21, 20 February 2013 (UTC)

See the lead. "Water fluoridation" is controlled and artificial. "Fluoridated water" covers both but isn't the subject of the article. The difference is absolutely vital. Colin°^Talk 20:32, 20 February 2013 (UTC)

Not so sure - fluoridated water is water that has fluoride added to it, either naturally or by a human process. Fluoridation is the process of adding fluoride, be it human or geological processes at work. Why is the distinction vital? Many of the issues are intertwined, for example the recommended amounts to be added to municipal systems, or removed from consumption depend on natural fluoridation processes. BTW "Fluoridated water" redirects to this page.

The term is commonly used to refer to natural processes - for example this CDC pamphlet - "Fluoridation: nature’s way to prevent tooth decay", and this study in the bmj, "Objective: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for." http://www.bmj.com/content/315/7107/514Tilapidated (talk) 20:49, 20 February 2013 (UTC)

This paper refers to "Currently about 49 % of the U.S. population is artificially fluoridated (hydrofluorosilicic acid, sodium silicofluoride and sodium fluoride) and 7 % have natural water fluoridation" http://www.xxfluoride.com/Dr_Russell_statement.cfm

"The only area in Scotland which did have naturally fluoridated water at 1ppm was on the Moray coast" http://www.sdmag.co.uk/index.php/articles/pm_article/public_health/

"Muskegon [not fluoridated] and nearby Aurora [naturally fluoridated at 1.4ppm]) (Bellemare 1979)" https://www.ucalgary.ca/PHIRC/pdf/Synthesis_flouridation.pdf

etc etc. Tilapidated (talk) 21:01, 20 February 2013 (UTC)

Sorry about the glitch with the talk-page-revert earlier. I was trying to use my mobile phone and must have hit the wrong link. Won't do that again. The article's lead is sourced to the CDC which states "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.". Other people might use the term more liberally, but ultimately the scope of the term wrt this wikipedia article is the one reflected by the current lead: artificial and controlled. Many articles on Wikipedia cover terms where the scope can vary in practice but Wikipedia needs to pick one well defined scope in order to form a cohesive article topic. If you want to change the scope, you need to gain consensus. We don't do that in a hurry, especially for a featured article. Also, we simply can't add unsourced text to the article: it will just be removed per WP:V. The text you are adding about the York review is already covered by the article. Please note that if you quote text then you absolutely need to give a citation and here it would have been necessary to give a date -- which is 2003. So given that is 10 years ago, the statement is now very out-of-date and an update required.

This is a controversial subject and the text needs to reflect the best professional consensus on the topic. By conflating natural (and often toxic levels of) fluoride with fluoridation, the article will inevitably foul WP:SYN. Before you know it, the lead sentence will mention brain damage and government mind control and the lead image will be this one.

Please can you discuss edits to this FA before making significant changes. Anything you add must cite high quality sources per WP:MEDRS and be in proportion per WP:WEIGHT. Colin°^Talk 21:47, 20 February 2013 (UTC)

Colin - no worries on the revert - re the definition - I'm not sure why you would want to limit the definition to that CDC comment - any discussion of fluoride levels in water has to take into account natural and added fluoride, right? Common usage of the term is to include natural and artificial fluoridation. BTW - I'm not at all suggesting we 'conflate' them - we just need to be clear that fluoridation comes from a variety of sources. I'm going to presume that you're joking about mind control. The studies I added are the most thorough I could find, from the most mainstream science.

Re the York study - absolutely - I welcome your addition of more recent quality reviews, but the York study remains a major land-mark in the literature - I'd like to put together a section that includes the most important literature reviews and short summaries of their findings - I look forward to your contributions! What concerns me is that it seems that we are making statements that imply a consensus that I can't find in any serious reviews of the literature. Which more recent literature reviews are you most impressed by?

Tilapidated (talk) 21:56, 20 February 2013 (UTC)

Terminology

Given the common and technical uses of the term 'water fluoridation' include both natural water fluoridation and human water fluoridation, and given the importance of all sources of fluoride in water when discussing the topic, it seems prudent to adopt the standard language around this issue.

• Natural water fluoridation, to refer to the process of fluoridation of water by (usually) geological means.
• Community water fluoridation, to refer to the deliberate addition of fluoride for public health purposes.

Both of these are, prima facie water fluoridation, since they are processes by which water becomes fluoridated. In discussion above I listed examples of the use of this terminology in academic and public health settings. It is clear, unambiguous, neutral, and the normal language used by the community of experts dealing with this issue.

It's also important to consider all sources of fluoride when discussing the issue - the article currently does this already, which, without clarity on terms, risks ambiguity and confusion. Tilapidated (talk) 23:25, 20 February 2013 (UTC)

Water can be fluoridated, naturally, but it has not undergone fluoridation.CDC That is the terminology.Novangelis (talk) 23:48, 20 February 2013 (UTC)

I appreciate your thoughtful contribution (that link appears to be broken, so I can't check it), but on what basis do you think the CDC should be the reference for terminology? In fact the CDC themselves use the term - they also use the term 'community water fluoridation' - for example here - http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#4

This British Medical Journal article is an example of common usage of 'natural water fluoridation', and 'artificial water fluoridation' when used in a trial to assess the effectiveness of each. This article in the Scottish Dental Magazine likewise follows the same pattern.

I wonder whether you are taking a slightly US centric view in assuming that a US public health agency should be the final arbitrator of this, rather than common global academic and professional usage? http://www.bmj.com/content/315/7107/514 , http://www.sdmag.co.uk/index.php/articles/pm_article/public_health/

For more like this, see:

• Ziegelbecker R. Natural water Fluoridation: Multifactorial Influence on Dental Caries in 21 Cities Study. XVIIth Conference of the International Society for fluoride Research. Budapest (Hungary) June 22-25 1989.
• Here is a UK Royal College of Surgeons article that uses the term to make the important distinction. http://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/documents/discolor.pdf
• Although most examples I have found that use the term 'natural water fluoridation', it is very common in the US to refer to deliberate fluoridation for public health purposes by the term 'Community water fluoridation'. One among very many is this one from the American Journal of Preventive Medicine. http://thecommunityguide.org/oral/oral-ajpm-ev-rev.pdf. They Define 'Community water fluoridation (CWF) as adjusting and monitoring fluoride in public water supplies to reach optimal fluoride concentrations in community drinking water.'

I'm interested in what you want to re-name the geological process by which water becomes fluoridated, if you don't want to allow the community the term 'natural water fluoridation'?

Tilapidated (talk) 23:52, 20 February 2013 (UTC)

The CDC link works on my machine and goes to a simple HTML link, so the problem is your machine or firewall. It is an expert review, published in MMWR, and is a sound basis for defining the scope of the article. The NCI uses the same definition.[2] The York review uses fluoridated/fluoridation in the same manner, even if their glossary is woefully deficient on the central topic, so it is not a British vs. American English usage. I am not aware of any fringe groups that blame naturally occurring fluoride for their problems (although I would not be shocked if there was one which thought it was the action of evil nature spirits). A quibble in terminology is not a basis for changing the clearly defined scope of an article.Novangelis (talk) 00:47, 21 February 2013 (UTC)

I'm not sure that I follow your comments on 'fringe groups'. I don't have a 'quibble' - I've presented to you both a logical case for an improvement in clarity of meaning, and plenty of examples of this usage in academia and public health, and a question about why you think the CDC definition (which seems to be used inconsistently even by the CDC) should prevail even when it is confusing.

I'm not certain what your basis for objecting to this clarification could possibly be - perhaps you could outline any possible drawbacks you perceive to this clarification of terminology? Tilapidated (talk) 01:06, 21 February 2013 (UTC)

One option would be to have a 'definitions' section that outlines the major definitions, and who uses them - this would be clear, neutral, verifiable and sourced, and would avoid the problem of having to select one definition as the only one used in the article? I'm not hugely in favor of this, since you are the only person who seems to have a problem with the commonly used definitions. The CDC, while declaring that it is talking about community water fluoridation on its site, elsewhere uses the term natural water fluoridation when that is what it is talking about, and CWF is the mainstream term where both types are in place. Tilapidated (talk) 01:31, 21 February 2013 (UTC)

The point about fringe groups was that people with the critical reasoning skills of lint would have had no problems figuring out what this article had about before you edited. You made the article more confusing by changing the terminology to one that is inconsistent with the scope of the article, and was also inconsistent with the reference (which you obviously had not read). Adding a section that discusses alternate definitions in use might not be unreasonable assuming that formal, not inferred, definitions are used.Novangelis (talk) 02:08, 21 February 2013 (UTC)

Perhaps English isn't your first language, but I think I get the jist of your meaning. Unfortunately you didn't answer the bulk of the issues raised. I understand from your edits that you bring a strong point of view to this article, but please try to remain civil and focussed on the issue, which is that there is not one clear, official definition in use, and no clear reason to use the CDC one over any other (even the CDC mixes and matches). I'll work on a section discussing definitions. Tilapidated (talk) 02:20, 21 February 2013 (UTC)

Someone reverted my suggestion based on this discussion within 7 minutes of my making it without bothering to discuss, but I suppose you could go look in the change log. I have to say this is a surprisingly hostile page. Tilapidated (talk) 02:38, 21 February 2013 (UTC)

Please read/review WP:LEAD, the lead is the very last thing that gets updated. The lead summarizes what's in the article body, there should not be anything in the lead that isn't covered thoroughly in the article body. Changing the lead to redefine the scope of the article without having the content in the article body already in place is a serious WP:MOS problem. Please first get consensus here on the Talk page for your proposed changes (I do not see consensus here yet), then work on developing the content in the article body, and then the last thing to do is update the lead. The reverse approach, which you appear to be trying to take, will find lots of opposition. Zad68 02:44, 21 February 2013 (UTC)

I think you may be a little confused - the changes clarifying definitions used in the academic literature and public health agencies do not change the scope of the article. Recognizing the language that is actually used in the field to distinguish different sources of water fluoridation is not the same as suggesting that this article should include the geology and chemistry of natural water fluoridation, simply to explain that when discussing community water fluoridation, natural water fluoridation is often contrasted, and that the shorthand 'water fluoridation' is often used to mean exclusively 'community water fluoridation'. What changes to the body of the article could you be expecting on this basis? Tilapidated (talk) 02:48, 21 February 2013 (UTC)

It's possible I was reacting to what I was expecting vs. what the actual edit was, and I apologize for that. Give me a sec to try to improve the wording, though... Zad68 03:00, 21 February 2013 (UTC)

No problem - we all react in haste from time to time ;) Tilapidated (talk) 03:02, 21 February 2013 (UTC)

The issue that I'm seeing with the proposed edit:

Water fluoridation is the addition of fluoride to water. In public health, it refers to the controlled addition of fluoride to a public water supply to reduce tooth decay. Community water fluoridation is also used to mean the same thing, especially when used in contrast to 'natural water fluoridation', a (mainly) geological process.

is that it does indeed change the scope of the article from having F- added to water for the purpose of controlling tooth decay to the general topic of water having F- added to it for any reason. I think this is the point being raised elsewhere on this page and this edit is still running into that problem, can we work on it to maintain the article's scope to be the control of F- level in water for the purposes of controlling tooth decay? Zad68 03:10, 21 February 2013 (UTC)

Sure - there's no debate that this is about the public health application, it's just that 'water fluoridation' has a plain language meaning of 'processes that add fluoride to water', this comes out in the literature where you see papers and public health authorities distinguishing between community fluoridation and natural fluoridation. My edit is meant to make clear that, in this context, 'water fluoridation' is used as short hand for 'community water fluoridation'. Tilapidated (talk) 03:21, 21 February 2013 (UTC)

Glad we agree on that. So what exactly is missing from the current sentences:

Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride.

Aren't all the items covered: F- is controlled for the purposes of dental health, it may come naturally, it may be added. Is the only thing missing the mention of the term Community water fluoridation? We can do that by just changing the opening words to: "Community water fluoridation is..." and we're done? Zad68 03:42, 21 February 2013 (UTC)

Well the problem is that this is only true from a fairly specific perspective. People who are familiar with the term from a public health perspective are used to using the term 'water fluoridation' to mean 'community water fluoridation', for their purposes there are no other meanings. People who are used to the research around this are more used to carefully distinguishing between community water fluoridation and natural water fluoridation, for example when conducting comparison studies of communities who receive water fluoridation from natural sources. It's fine to declare that this article will use the term in a specific way, and changing the opening words as you suggest gets us most of the way there, but I'm not sure why you're opposed to recognizing that term 'natural water fluoridation' exists, or that water fluoridation is also a natural process, and that important studies examine the effects of community water fluoridation alongside natural water fluoridation, both of which are types of water fluoridation? Tilapidated (talk) 06:11, 21 February 2013 (UTC)

I want to make sure I understand your concern correctly: Regarding natural water fluoridation, are you saying that there's an encyclopedic topic regarding the study of the health effects of naturally fluoridated water on communities, and that those health effects being studied are things other than dental health?

If that's not your concern, and we're all still in agreement that the scope of this article is the control of the F- levels in water (whether the F- got there naturally or artificially) for the purposes of improving public dental health, then I'm still missing what the issue is. Is it just that the term natural water fluoridation should appear? I did searches on PubMed - "water fluoridation" is by far the most common term, "community water fluoridation" is used but much less frequently, and "natural water fluoridation" is relatively uncommon. The current lead does say "this can occur naturally" and, in my opinion, that's sufficient to cover it. Would adding a redirect from natural water fluoridation to this article cover this part of your concern? Zad68 14:35, 21 February 2013 (UTC)

I don't think we're in substantial disagreement. This page is about the addition of fluoride to water for public health reasons. As you point out, PubMed most commonly calls that 'water fluoridation', which isn't really shocking, because it's medical journal search tool. As you also point out 'community water fluoridation' is also used as a synonym in the public health literature.

Of course 'natural water fluoridation' isn't a common term in public health, because the process of adding fluoride to water through geological means is not something that public health researchers concern themselves with.

It seems clumsy to me to lead with a narrow and specific definition, which, while it it the most common, leads us to have to go back and explain its inadequacy later on. It's fine to use 'water fluoridation' in this context as a short-hand for community water fluoridation, knowing that our audience doesn't assume that we're meaning the sum of all water fluoridation processes, but I feel for the sake of correctness and clarity we should get the issue out of the way, define our terms correctly and declare that we're going to be using the terms in a particular way.

Not doing this means that we have to use an ambiguous term, and then scatter awkward explanatory statements throughout the article.

Rather than saying "a: Water fluoridation is the process of fluoridating water, by whatever means, b: Community water fluoridation is the deliberate public health application, frequently used synonymously, and c: natural water fluoridation is the geological process that is beyond the scope of this article." We have, instead to pretend that the narrow public health shorthand is the only valid definition of the term, rather than just the prevalent one. It leads us to "Water fluoridation is the deliberate public health application of fluoride, it also happens naturally" which leads me to ask - well what's it called when it happens naturally? When it comes up in the article the term 'naturally fluoridated water' is always used - how did it come to be 'naturally fluoridated'? One presumes that water fluoridation took place naturally, but are assured by the definition that the term only applies to artificial fluoridation.

I guess my concerns come down to: a) the current definition is very narrow in scope, and fails to recognize the terms broader meaning before settling into the common public health meaning, and that b) this leads to confusing asides throughout the article, and c) obscures the fact that natural water fluoridation is of concern to people studying optimal fluoride levels. Hope that makes sense. Tilapidated (talk) 15:09, 21 February 2013 (UTC)

We're not in substantial disagreement, good! I understand your points regarding the wording, and with them in mind, I read through the article paying special attention to the coverage of natural vs. artifical fluoridation. Personally, I don't think the article exhibits a tremendous problem with first describing fluoridation as the "controlled addition" of fluoride and then noting that due to natural fluoride levels, some water has to undergo defluoridation. The article's main focus is (correctly) the health effects of fluoridated water, and not how the fluoride got there, so this seems like not an overwhelmingly important issue. As you correctly point out, the normal public health view is that water has to have fluoride added to it. Because that's the normal view, it's perfectly appropriate for the article to approach it that way too, even though some water naturally has the right amount of fluoride, or has too much fluoride and needs to be defluoridated - these things are covered by the article just fine, in my opinion.

As we're writing articles for humans to read, developing them is only part science; it's in large part art, and often the choice of wording comes down to subjective choices over what sounds good. So, I understand what you're saying, but I don't think a change to the article is warranted. You are of course welcome to try develop a consensus of support from other editors for your proposed changes. Zad68 19:32, 21 February 2013 (UTC)

Your reply makes me think we're talking at crossed purposes. The issue I'm raising is the by defining 'water fluoridation' as 'community water fluoridation', we make the article inconsistent with studies that use the term 'water fluoridation' to mean both natural and community water fluoridation (all processes that add fluoride to water). That's all. Tilapidated (talk) 16:45, 22 February 2013 (UTC)

Nature and quality of scientific studies

A couple of users have reverted the addition of a section looking at the major academic reviews of community water fluoridation, and I'm struggling to understand their reasoning in doing this. The section as I inserted it is copied below, and consists of direct quotes from the most thorough peer reviewed literature reviews I have been able to find, all published from highly regarded research institutions in significant journals. I invite those reverting this information to kindly explain their reasoning, and am excited to see any other quality reviews that they feel are relevant. Tilapidated (talk) 23:31, 20 February 2013 (UTC)

The York Review

In 1999, the Department of Health commissioned CRD to conduct a systematic review into the efficacy and safety of the fluoridation of drinking water. The review was published on the CRD Fluoridation Review website and in the BMJ in October 2000. The authors stated in 2003: "We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth. The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable. Since the report was published in October 2000 there has been no other scientifically defensible review that would alter the findings of the York review."

University Dental School, Cork, Ireland

A report on systematic reviews and studies was conducted. Of the 59 publications identified, 3 systematic reviews and 3 guidelines were included. The paper states: "While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality."

Department of Public Health, National Health Service Lanarkshire, UK

A 2008 literature review was undertaken on English language publications from 1996 onwards. Of a total 5418 nonduplicate citations identified, 77 were included in the review. The review concluded "fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride."

The goal of Wikipedia is to create a cohesive article. Listing selected quotes from selected reviews is antithetical to this goal.Novangelis (talk) 00:51, 21 February 2013 (UTC)

I'm a little confused by your comment. The article already has a section entitled 'evidence basis'. I can't believe that you are seriously suggesting that the most significant reviews of the evidence basis should be excluded from this section? It's a little disturbing to me that you want to remove referenced descriptions of the best available science and replace them with unsupported claims. Tilapidated (talk) 01:01, 21 February 2013 (UTC)

Stop trying to argue to exhaustion by straw man (and ad hominem as above). We write in prose that follows sources.Novangelis (talk) 03:11, 21 February 2013 (UTC)

I don't understand your post at all I'm afraid. Let me re-phrase my question, in case I was not clear.

Currently, there is a section entitled 'Evidence basis'. It currently contains an entirely unsourced claim of effectiveness as an opening statement. I introduced an expanded section, giving more detail of the major literature reviews that address these issues.

I am a little perplexed that you want to remove well sourced references to the best science available and replace them with an unsourced statement. I understand you bring a strong point of view to this discussion, but it's my strong belief that the best way to resolve controversy is by reference to the science. I welcome you adding reviews and meta-studies that you think add to the debate, but am disturbed that you want to remove them. Tilapidated (talk) 03:18, 21 February 2013 (UTC)

That's not what he's saying. This is more a matter of style than anything else: Wikipedia articles that cite well-respected, very reliable sources like meta-analyses, literature reviews and statements from major medical organizations just state the results. We do not have to say "A review of this many studies by this organization said that F- reduces tooth decay." We just say, "F- reduces tooth decay" and cite the source. Zad68 03:24, 21 February 2013 (UTC)

Adding: I find this article's paragraph starting "A 2000 systematic review..." as pretty unusual, but the exception might be being made here because that 2000 review is historically significant and was very influential in driving the direction of the use of F-. Zad68 03:27, 21 February 2013 (UTC)

Adding again: The opening sentence of that section "Existing evidence strongly suggests that water fluoridation reduces tooth decay" is simply an overview or summary sentence to introduce the section. True there is no in-line cite for it, but that's because the entire section and the sources it cites support it. There isn't a need for a cite on that one sentence. Zad68 03:30, 21 February 2013 (UTC) -- In fact the NHMRC source, current citation #10, which is on the second sentence, supports the first. Zad68 03:32, 21 February 2013 (UTC)

There are 10 references used for the first time in the section and ~35 references (not necessarily unique) used in total. They include all three that you listed and (many) more.Novangelis (talk) 03:44, 21 February 2013 (UTC)

Exactly... it maybe just be Tilapidated was expecting see every sentence have a number in brackets after it, and just this one didn't. Zad68 03:47, 21 February 2013 (UTC)

Hi there - let's step back a minute - let me try to explain my concern with this section. It contains a number of different and conflicting statements about the effectiveness of fluoride for different purposes. This is quite confusing, and suggests that the evidence is strong, and unified in its findings. The final sentence references (among other things) the York study, and states that 'With regard to potential adverse effects, almost all research has been of low quality.[11]', what the York study says is that 'The quality of (ALL) studies was low to moderate.' They conclude that ' 214 studies; none was of evidence level A (high quality, bias unlikely).'

In the second paragraph we get into a relatively large section on the York Study "A 2000 systematic review found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth),[11]" . In a clarifying statement the study authors report 'We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth.' There is nothing in this section that gets to any of the nuance, methodological issues, study quality, and design issues that make the results of these studies as complex as they are.

With regard to the 10 / 35 references, I found the referencing confusing, with studies referenced that as far as I could see fairly clearly did not support the statements made. Also individual studies were cited alongside large scale reviews and meta studies. I think, given the contentious nature of this, and the generally mixed quality of the data and research, some discussion of the major landmark reviews of the literature, of the methodological issues, and of the problems interpreting the data would be helpful.

You rightly point out that current citation number 10 does support the opening statement, but the problem is that there is such a wide range of studies and reviews, concluding a wide range of findings, from strong support to weak support with some contrary findings. To pick one of them, without declaring the range of serious scientific work, and disagreement within the field, is problematic.

I do understand what I think is motivating you on this - you don't want to be seen to give any ground on the issue of certainty of belief in fluoride - but I hope you understand that being unwilling to critically examine the evidence actually undermines the claim to be scientifically driven. Tilapidated (talk) 06:32, 21 February 2013 (UTC)

The article reflects the complete lack of scientific descent on the issue. Your current objection is that the article loses some nuance as it summarizes a particular source. So far, it sounds like you're cherry picking. TippyGoomba (talk) 06:43, 21 February 2013 (UTC)

I'm not certain how you can suggest that there is a 'complete lack of scientific descent on the issue'. The article (not me) cites a literature review commissioned by the UK Chief Medical Officer of the Department of Health which involved “an up to date expert scientific review of fluoride and health”. It was published in the British Medical Journal and reviewed 214 studies. The authors state: "We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth."

I fail to see how that reflects either cherry picking on my part, or a 'complete lack of scientific descent on the issue'. I am simply pointing out that the evidence is complex and mixed in quality. Tilapidated (talk) 06:52, 21 February 2013 (UTC)

By descent I mean a quote along the lines of "it's bad for reasons XYZ" or "we could not disprove the null hypothesis to a high degree of certainty". Use whatever word you want. It's cherry picking because you picked one sentence form one source. TippyGoomba (talk) 07:42, 21 February 2013 (UTC)

I did refer to 'one source', the source that the paragraph in the article that we're talking about refers to. I fail to see how citing from the authors of the study that the article is talking about is 'cherry picking'. To cite from a different one would be irrelevant and misleading.

While the study (that the article, not me) chose to talk about is 'one source', it is one of the most significant peer reviewed literature reviews available, covering, as I pointed out, hundreds of studies, so while it is 'one source', its scope is enormous - that's why it's mentioned in the article. Not having the space to quote the whole text, I picked a sentence that summarizes the results of the study. Luckily, I don't have to pick a quote that could be unrepresentative, since the authors themselves summarize the study clearly. The statement on the Center for Reviews and Dissemination website is short and concise, and gives insight into the opinions of the authors http://www.york.ac.uk/inst/crd/fluoridnew.htm. I still struggle to understand your accusation of 'cherry-picking', and your claim that there is a 'complete lack of scientific descent on the issue'.

The current paragraph on the scientific research is inadequate and misleading. The most significant finding from the York review was not that they thought that the research supported or did not support fluoridation, but that the data was so poor in quality that it was difficult to be sure with any degree of certainty. Nothing in the current section indicates any such issues. Tilapidated (talk) 15:20, 21 February 2013 (UTC)

Edit request on 18 December 2012

This article is heavily biased regarding controversial issues. It dismisses people who are in opposition to water flouridation as non credible and "conspiracy theorists." Evidence is stated in this article that is in favor to flouridation, but none of the many studies regarding the dangers of flouridation is stated, take this for example. This article clearly has an agenda and needs more balance. 149.63.60.58 (talk) 23:16, 18 December 2012 (UTC) Josh

Citing an article that misrepresents research findings?! No, per MEDRS. --Ronz (talk) 00:44, 19 December 2012 (UTC)

Agreed, sources for the article need to meet our guideline on sourcing for medical content. Yobol (talk) 01:12, 19 December 2012 (UTC)

See below references to fluoride and cancer--

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/7679201

"Clastogenic activity of sodium fluoride in great ape cells"

"Conflicting evidence has been reported concerning the mutagenicity of sodium fluoride (NaF), especially clastogenicity at concentrations of more than 1 mM. NaF is known to induce chromosome aberrations at these concentrations in human cells, but not in most rodent cells. We considered that such species-specific difference in chromosomal sensitivity would be derived from the phylogenetic distance between rodents and man. To clarify the role of interspecies differences, we investigated the chromosomal sensitivity to NaF in cell lines from various primates, which diverged into many species, including rodent-like prosimians and human-like great apes. The results showed that the clastogenicity of NaF was limited to human and great ape cells." PMID: 7679201

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/9002384

"Relationship between fluoride concentration in drinking water and mortality rate from uterine cancer in Okinawa prefecture, Japan"

"The Okinawa Islands located in the southern-most part of Japan were under U.S. administration from 1945 to 1972. During that time, fluoride was added to the drinking water supplies in most regions. The relationship between fluoride concentration in drinking water and uterine cancer mortality rate was studied in 20 municipalities of Okinawa and the data were analyzed using correlation and multivariate statistics. A significant positive correlation was found between fluoride concentration in drinking water and uterine cancer mortality in 20 municipalities " PMID: 9002384

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/16596294

"Age-specific fluoride exposure in drinking water and osteosarcoma (United States)."

"We explored age-specific and gender-specific effects of fluoride level in drinking water and the incidence of osteosarcoma. ..."

"Our exploratory analysis found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females." PMID: 16596294

Also on PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/19812419

"Is there a need of extra fluoride in children?"

"Fluoride consumption by human beings increases the general cancer death rate, disrupts the synthesis of collagen and leads to the breakdown of collagen in bone, tendon, muscle, skin, cartilage, lungs, kidney and trachea, causing disruptive effect on tissues in the body. It inhibits antibody formation, disturbs immune system and makes the child prone to malignancy. Fluoride has been categorized as a protoplasmic poison..." PMID:19812419

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/11512573

"Regression analysis of cancer incidence rates and water fluoride in the U.S.A. based on WHO data..."

"...cancers of the oral cavity and pharynx, colon and rectum, hepato-biliary and urinary organs were positively associated with Fluoridated Drinking water (FD). This was also the case for bone cancers in male, in line with results of rat experiments. Brain tumors and T-cell system Hodgkin's disease, Non-Hodgkin lymphoma, multiple myeloma, melanoma of the skin and monocytic leukaemia were also correlated with Fluoridated Drinking water." PMID: 11512573

I was thinking that if it really did cause cancer, wouldn't that make it in violation of the Delaney Clause? "the Secretary of the Food and Drug Administration shall not approve for use in food any chemical additive found to induce cancer in man, or, after tests, found to induce cancer in animals.--"Merrill, Richard A. "Food Safety Regulation: Reforming the Delaney Clause" in Annual Review of Public Health, 1997, 18:313-40. This source includes a useful historical survey of prior food safety regulation. If fluoride is in water that goes into foods wouldn't it be in violation of this clause?

The following papers explain that some caries are due to high lead levels and fluoride doesn't help in these cases.

"Enamel biopsies taken from school children in a community where exposure to lead was a health hazard were analyzed for lead and fluoride. The children with high enamel lead had significantly higher caries scores than the children with low enamel lead, in spite of the fact that the high lead group also was higher in enamel fluoride. There was no increase in enamel lead with age. The lead in saliva was only a fraction of that in blood. Infants with lead poisoning showed higher saliva lead than a normal infant."

•"Lead in Enamel and Saliva, Dental Caries and the Use of Enamel Biopsies for Measuring Past Exposure to Lead" http://jdr.sagepub.com/content/56/10/1165.abstract The fluoride in their teeth did not prevent the caries.

Lead is passed on from mother to child. The child doesn't necessarily have to ingest the lead. It can be transferred by the mother to her offspring, just like fluoride.

See "Association of Dental Caries and Blood Lead Levels" in JAMA. http://jama.jamanetwork.com/article.aspx?articleid=190537

See "Blood lead level and dental caries in school-age children" http://www.ncbi.nlm.nih.gov/pubmed/12361944

"Mean blood lead level was significantly greater among the urban subgroup, as was the mean number of carious tooth surfaces. Blood lead level was positively associated with number of caries among urban children, even with adjustment for demographic and maternal factors and child dental practices."This study suggests that the fluoridation of water can lead to higher lead levels:

•"Association of silicofluoride treated water with elevated blood lead" PMID: 11233755 http://www.ncbi.nlm.nih.gov/pubmed/11233755

Chronic, low-level dosage of silicofluoride (SiF) has never been adequately tested for health effects in humans. We report here on a statistical study of 151,225 venous blood lead (VBL) tests taken from children ages 0-6 inclusive, living in 105 communities of populations from 15,000 to 75,000. For every age/race group, there was a consistently significant association of SiF treated community water and elevated blood lead. The highest likelihood of children having VBL> 10 microg/dL occurs when they are exposed to SiF treated water and subject to another risk factor known to be associated with high blood lead (e.g., old housing). "Abstract: Lead, a toxin that lowers dopamine function, has been associated with violent behavior as well as learning deficits. Hydrofluosilicic acid and sodium silicofluoride, which were substituted for sodium fluoride without testing as chemicals for public water treatment, increase absorption of lead from the environment and are associated with violent behavior. Given the costs of incarcerating violent criminals, these side-effects justify a moratorium on using silicofluorides for water treatment until they are shown to be safe."

http://oehha.ca.gov/prop65/public_meetings/052909coms/fluoride/RMasters.pdf — Preceding unsigned comment added by 99.61.178.14 (talk) 22:53, 27 December 2012 (UTC)

The request should be of the form please change sentence X to Y. Alternatively, you can create an account. TippyGoomba (talk) 01:03, 28 December 2012 (UTC)