Actually, few things have been more studied in the public health arena than community water fluoridation. The number of research studies involving fluoride is probably closer to 30,000 than 3,200, with the efficacy and safety of community water fluoridation well established.

Regarding the “mottling” effect of teeth, the degree of fluorosis is key. What we see in the USA is very mild fluorosis, usually from children eating toothpaste or living in areas with private water wells. Mild to moderate fluorosis is a cosmetic condition, with mottling usually in the form of white patches that indicate strong teeth. (Please pass the mild fluorosis!) Only in severe fluorosis, seen for example in areas of India where there are high levels of fluoride in ground water, is there a weakening of teeth and bones.

In effect, fluoride is a *nutrient*, but needed only in trace amounts. Here’s the test of that: Without enough fluoride, the tiny bones in the ear will become malformed (a condition that can result in hearing loss), but is reversible by ingesting fluoride.

Community water fluoridation is merely the adjustment of the fluoride that already exists in drinking water so that it is at a beneficial dosage. Ongoing studies determine what is ideal, based on climate and intake of fluoride from other source.

I recommend these reviews:

Fluoride Technical Study Group Report
www.healthdistrict.org/fluoridereport/FTSG.htm

Institute of Medicine: Fluoride Technical Study Group Report on fluoride:
books.nap.edu/openbook.php?record_id=5776&page=288

CDC — Community Water Fluoridation
www.cdc.gov/fluoridation/

jdr.sagepub.com/cgi/reprint/31/6/761
Drinking Water Containing Fluoride
The Formation of Hydroxyfluor-Apatite in Tooth Enamel Under Influence of . . .

Fluorapatite however is even weaker, as the fluorine atoms are much too small for the crystalline structure.

However, if in our tooth enamel a proportion of the Calcium atoms are replaced by the much smaller fluorine atoms, then the crystalline structure becomes much stronger.

This is why fluoride ions ingested while the tooth enamel is FORMING can increase enamel strength in the teeth. That is before birth for the deciduous teeth and in early childhood for the permanent teeth.

Fluoride in toothpaste will do little, if anything, to increase enamel strength. It can only work on the4e teeth while present in solution in the mouth. And can only affect the very uppermost layer of the crystalline structure.

Too much fluorine/fluorine is much worse than not enough. Not only does it weaken the tooth enamel but it causes bone deformities.

But as far as I know, the only cases of fluorosis that have been reported are from areas where naturally occurring fluoride to very high.

As to putting it in drinking water — I’m all for it — it would be well nigh impossible to get a toxic dose from drinking water, at the level that it is added to reticulated drinking water in area with NO natural fluoride.

Obviously, you don’t just bung fluorine in the water — the water must be tested — for an average fluorine content over a period of time. Because, for example, after high rainfall events it is likely to be lower.)

Tablets on the other hand are easily overdosed on — the old “if a little is good, a lot must be better phenomenon — and an overdose that can be obtained from tablets can be fatal.

From my, admittedly limited, reading of the research it seems that the “anti-fluoridation” reports are coming from anti-fluoridation organisations. And they are seriously flawed — mostly studies done in areas with very high levels of natural fluoride present in the water, or on very small populations.

The “pro-fluoride” research seems to be usually done of very larger groups over longer periods.

And then I really can’t see why a Municipal Council or “Water authority” would be biased in favour of adding fluoride — after all it merely adds an extra expense to water provision.

The argument that you want to be in control,of what you eat/drink does not hold water either. There is already added chemicals, also with toxic potentiality, added to our water to “make it safe”.
Natural water can carry many disease causing organisms, as well as many different minerals. Depends on whether of not you are in a hard water area or a soft water area. Rainwater, especially in built up areas can contain many toxic minerals and depending on how you catch it, disease causing organisms.

Dental caries results when bacteria breed in mushy sweet food resulting in an acidic plaque contacting with the tooth.

Tooth enamel is 96% microcrystalline apatite, a mineral with the formula Ca5(PO4)3(OH,F,Cl).

At the surface of the tooth of an individual never exposed to fluoridation or F in toothpaste the ratio of OH:F:Cl is 90:0:10 This can resist acids down to pH5.5 If all the OH is replaced by F then an acid stronger than pH3.5 is needed. (The lower the pH, the stronger the acid).

The outer micrometre (thousandth of a millimetre) of teeth in fluoridated areas does contain a high concentration of F (up to 3wt% or 30000ppm). This drops to only 100ppm about 5 micrometres into the enamel.

Thus the benefits of fluoride result in its action from outside the tooth and there is no need to ingest fluorine.

These days the improved dental health of children in fluoridated areas amounts to about one less filling by the age of 10. This could be due to rinsing after brushing teeth. The fluorine in the rinsing water hangs around in saliva for several minutes.

The best way for all generations to look after their teeth is to brush with a fuoride toothpaste and have a good mouthwash with high, 10ppm F water. Stop if fluorosis appears.

Historical note: An epidemic of dental caries started when cheap refined sugar became available at the end of the 18th century. Because of the naval blockade by the UK of Europe and Napoleon’s “Continental System”, the epidemic was worst in the USA, UK and its colonies, i.e. the English speaking peoples. Caries reached its peak at the time of the first word war and, with the arrival of affordable dentistry and awareness of dental hygiene, declined thereafter. It just happened that fluoridation was introduced at a time when dental health was improving anyway.

Am I missing something?”

Apparently Yes. I simply do not want fluoride in my water. Full stop. (And no, I don’t agree with your summaries as to benefits and risks!)

[Bad science] Reviews, comments and acknowledgements… yeah all nice stuff done behind curtains and away from the public. We mainly only get to hear about decisions made afterwards…

Can this be oversome from an overindulgence in acidic, sugary drinks (Coke / Pepsi), absolutely.

The WHO, CDC, ADA, BDA, Irish Medical Board and others categorically endorse fluoridation for general health of the population. Poor Dental health can be more crippling to an individual than malnutrition in some instances. The increased routes for disease and infection and impact to quality of life can be devastating.

I would like someone to please submit a link to a set of peer reviewed studies contradicting the efficacy for fluoridation.

It’s been interesting to see the debate on what the ‘state’ should do to items such as water, or common foodtuffs, in order to combat possible health problems in the population. My preference is for the state to keep out of this unless absolutely firm evidence for strong health benefits is made. A case by case discussion point, though a clean water supply is a no-brainer.

The fluoridation of water and its benefits still seems to be ‘in the air’ in this context. Although there’s some debate on this here, it seems the evidence isn’t as strong as it should be for state intervention to be fully justifiable.

Where I am disappointed here is on info for evidence of fluoride in toothpaste in preventing decay. No one seems to think it as important as I do! Although I hate to bring the anecdotal stuff up in this column it just seems so clear to me because people of my generation and older had a mouthful of cavities in our teens despite regular brushing and less cheap confectionary as available today (though we did have the sugary drinks….). In contrast many of you younger folks (Ben included) presumably have pristine teeth despite a childhood of chocolate lunches. I would ascribe that generational difference primarily to fluoride toothpaste! Anyone disagree?

There is a good report on fluoridation using salt from Costa Rica. The original project to fluoridate the water failed due to the problems with infrastructure.

Personally, I think the focus should be on quality water supplies, elimination of parasites and malaria, globally.

to be honest, i was hoping for histrionic letters to the paper from DoH etc, fantasising moronically that i had said fluoridation is bad, but sadly no joy so far. still, they might be slow in getting their acts together.

The original work on which fluoridation policy was based is old – the landmark studies were done between the mid 1940s and mid 1950s, and fluoridation in the US was widespread by the late 50s, hence General Jack D Ripper in the film (1964). And by modern standards these studies have flaws, though at the time they were state-of-the-art.

Which doesn’t mean fluoridation is bad – it just means the evidence is lacking.

Anyway, for some reason I just can’t get all that worked up about whether they stick fluoride in my water or not. Must be the results of that mind-control stuff they’ve been putting in my tea.

*By the way countries such as France, Germany, Switzerland and Belgium use salt fluoridation instead. Reference – Elsevier

Ireland has a great website detailing their history of fluoridation. Given the isolation that nation, I think the data is pretty compelling.

I am disappointed with the appearance of ad hominem attacks in the postings, generally this site seems to be a refuge of clever, respectful debate. There seems to be an emotional component here in which arguments are magnified beyond the suggestion of the data available.

The first determination should be whether fluoridation is effective. This fact seems to be well established. The second determination should be whether the risks of fluoridation run counter to and outweigh its benefits. The determination here appears to be no.

The issue of public consent is a red herring as each implemented program has had a review, comment and acknowledgement period.

Am I missing something?