Debunking Anti-Fluoride Woofuckery and Pseudoscience

A guest post by Ron Johnson from The New Horsemen, edited by Daniel Ryan. Part 15 of The New Horsemens FAQ woofuckery collection.

Since its inception in the 1940s, the idea of fluoridating water has given rise to fear and suspicion with claims ranging from evil Nazi/Commie/government mind control conspiracies to cancer causation to decreased IQ and a cheap way to dispose of toxic waste (http://www.skepdic.com/fluoridation). The implication that Big Pharma is out to poison you and that the scientific consensus is proof of a massive worldwide conspiracy of scientists/dentists makes reasoning with conspiracy theorists particularly difficult. But as we always do in The New Horsemen we’ll let the science decide what is “true” and what is “woo”!

What Is Fluoride?

(http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm)
Fluoride compounds are salts that form when the element, fluorine, combines with minerals in soil or rocks. Fluoride is widely distributed in the lithosphere mainly as fluorspar, fluorapatite and cryolite, and is recognised as the thirteenth most common element in the earth’s crust. It is found in seawater at a concentration of around 1.2 – 1.4 mg/litre, in ground waters at concentrations up to 67 mg/litre, and in most surface waters at concentrations less than 0.1 mg/litre. Fluoride is also found in foods particularly fish and tea (http://www.who.int/water_sanitation_health/dwq/nutrientschap14.pdf)

While almost all foodstuffs contain at least traces of fluoride, water and non-dairy beverages are the main sources of ingested fluoride, accounting for 66 to 80% of fluoride intake in US adults according to the concentration of fluoride in the public drinking water. Other significant sources of ingested fluoride are toothpaste in very young children (who tend to swallow most of their toothpaste), tea in tea-drinking communities, and inhaled fluoride in some communities in China where coal containing very high levels fluoride is burned indoors. Absorption of ingested fluoride is via the stomach and small intestine (http://apps.who.int/iris/bitstream/10665/42415/1/WHO_EHC_227.pdf).

Fluoride works by converting the outer layer of tooth enamel made of hydroxylapatite, Ca5(PO4)3OH, to fluoroapatite, Ca5(PO4)3F. The latter chemical is less soluble in acidic solutions. The three most commonly added fluoride chemicals are sodium fluoride, fluorosilicic acid, and sodium fluorosilicate (http://stacks.cdc.gov/view/cdc/13103).

History Of Fluoridation
(http://www.quackwatch.org/03HealthPromotion/fluoride.html)

The history of fluoridation in the United States underlines its unique standing as a public health measure copied from a natural phenomenon. In the early 1900s, Dr. Frederick S. McKay began an almost 30-year search for the cause of the staining of teeth that was prevalent in Colorado, where he practiced dentistry. In his investigation, McKay found the condition common in other states, including Texas, where it was known as “Texas teeth.” By 1916 he had identified excessive amounts of fluoride occurring naturally in water supplies as the cause of the dental staining. In 1928, he concluded that such teeth, although stained, showed “a singular absence of decay,” and that both the staining and the decay resistance were caused by something in the water. In 1931, the “something” was identified as fluoride. Soon, scientific data from thirteen countries confirmed these findings.

In 1945, the U.S. Public Health Service began four  studies, testing the hypothesis that artificial fluoridation to 1.0 ppm would produce healthier teeth without causing mottling. By 1950, the experiment was declared a success. The communities with fluoridated water supplies had 50% fewer cavities. The recommendation was made that communities without naturally occurring fluoride add it to their water supplies at a concentration of 1.0 ppm. The American Dental Association, the American Medical Association, the American Association of Public Health Dentists, and the National Research Council concurred with the recommendation (not a mandatory governmental requirement).

There are three periods concerning the history of water fluoridation (http://rationalwiki.org/wiki/Water_fluoridation):

1. Before 1933, the study of mottled tooth enamel, later known as fluorosis. (https://en.wikipedia.org/wiki/History_of_water_fluoridation)
2. From 1933 to 1945, the study of the relationship between fluoride and tooth decay.
3. From 1945 onward, which focused on deployment of water fluorides

In the United States, the Safe Drinking Water Act (SDWA) of 1974 confers the authority for ensuring the safety of public drinking water to the Environmental Protection Agency.( http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm )

What Are Fluoride’s Potential Health Effects?

Exposure to EXCESSIVE consumption of fluoride over a lifetime may lead to increased likelihood of bone fractures in adults, and may result in effects on bone leading to pain and tenderness. Children aged 8 years and younger exposed to excessive amounts of fluoride have an increased chance of developing pits in the tooth enamel, along with a range of cosmetic effects to teeth.

Like many things in our water supply, chlorine for example, the amount determines whether it is safe or harmful (the dose makes the poison!). For that reason, the EPA recommends that the amount of fluoride in a water supply not rise above certain levels. The Centers for Disease Control and Prevention (CDC) provides recommendations for the optimal levels of fluoride in drinking water in order to prevent tooth decay.

In January 2011, the U.S. Department of Health and Human Services proposed to change its recommended limit for fluoride to 0.7 mg/L, replacing the current recommended range of 0.7 to 1.2 mg/L. (Parts per million, ppm, and milligrams per liter, mg/L, are nearly equivalent. E.g., 1.2 mg/L = 1.201370764 ppm) The U.S. Environmental Protection Agency simultaneously announced that it will take a fresh look at the maximum allowable level, currently set at 4 mg/L, for fluoride that occurs naturally in drinking water (http://www.skepdic.com/fluoridation).

How Does Fluoride Get Into My Drinking Water?

Some fluoride compounds, such as sodium fluoride and fluorosilicates, dissolve easily into ground water as it moves through gaps and pore spaces between rocks. Most water supplies contain some naturally occurring fluoride. Fluoride also enters drinking water in discharge from fertilizer or aluminum factories. Also, many communities add fluoride to their drinking water to promote dental health.

How Can Fluoride Be Removed From My Drinking Water?

The following treatment method(s) have proven to be effective for removing fluoride to below 4.0 mg/L or 4.0 ppm: distillation or reverse osmosis. There are several independent American National Standards Institute (ANSI) certified organizations that test and certify home water treatment units. More information about these organizations and other issues related to your water safety can be found at http://water.epa.gov/aboutow/ogwdw/upload/2005_11_17_faq_fs_healthseries_filtration.pdf

Arguments For Fluoridation

Reasons Why Fluoride in Water is Good for Communities
(http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/5-reasons-why-fluoride-in-water-is-good-for-communities) (http://www.cdc.gov/fluoridation/basics/index.htm)

1. Prevents tooth decay. Fluoride in water is the most efficient way to prevent one of the most common childhood diseases – tooth decay. An estimated 51 million school hours and 164 million work hours are lost each year due to dental-related illness. Community water fluoridation is so effective at preventing tooth decay that the Centers for Disease Control and Prevention named it one of 10 great public health achievements of the 20th century.
2. Protects all ages against cavities. Studies show that fluoride in community water systems prevents at least 25 percent of tooth decay in children and adults, even in an era with widespread availability of fluoride from other sources, such as fluoride toothpaste.
3. Safe and effective. For 70 years, the best available scientific evidence consistently indicates that community water fluoridation is safe and effective. It has been endorsed by numerous U.S. Surgeons General, and more than 100 health organizations recognize the health benefits of water fluoridation for preventing dental decay, including the Centers for Disease Control and Prevention, the American Medical Association, the World Health Organization, the American Dental Association, and the American Academy of Pediatrics.
4. Saves money. The average lifetime cost per person to fluoridate a water supply is less than the cost of one dental filling. For most cities, every $1 invested in water fluoridation saves $38 in dental treatment costs. Another study found the estimated return on investment for community water fluoridation (including productivity losses) ranged from $4 in small communities of 5,000 people or less, to $27 in large communities of 200,000 people or more (http://www.cdc.gov/fluoridation/pdf/griffin.pdf).
5. It’s “natural”. Fluoride is naturally present in groundwater and the oceans. Water fluoridation is the adjustment of fluoride to a recommended level for preventing tooth decay (http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/ada-applauds-hhs-final-recommendation-on-optimal-fluoride-level-in-drinking-water). It’s similar to fortifying other foods and beverages, like fortifying salt with iodine, milk with vitamin D, orange juice with calcium and bread with folic acid.

Centralised fluoridation is a safe, simple, and effective way to improve the dental health of the population at large (especially children in the candy cavity-prone years). It is also extremely cost-effective: one study estimated that for every $1 a city invested in fluoridation it saved the average citizen (with a mean dental health cost) $38 on dental care (http://www.politifact.com/oregon/statements/2012/aug/23/nick-fish/do-cities-really-save-38-every-1-they-spend-fluori/) (http://www.fairbanksalaska.us/wp-content/uploads/2011/07/20010000Griffin-Econ-Eval-Fluoridation.pdf)

The Centers for Disease Control and Prevention considers water fluoridation to be one of the top 10 public health advances of the 20th century (http://www.cdc.gov/about/history/tengpha.htm) (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm) and the American Dental Association “unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay.” (http://www.oda.on.ca/personal-oral-care/fluoride-in-your-tap-water). The World Health Organization states that “fluoridation of water supplies, where possible, is the most effective public health measure for the prevention of dental decay.” (http://ilikemyteeth.org/fluoridation/health-experts-on-fluoride/)

Having been around for 70+ years and having been the focus of much research, water fluoridation has been studied extensively (the number of studies seems to peak around the late 1960s followed by a general decline http://www.ncbi.nlm.nih.gov/pubmed/?term=water+fluoridation). Arguments along the lines of “the jury is out” or “the science is incomplete” are wrong. Thousands of studies and years of actual implementation have not upset the scientific consensus.

Arguments Against Fluoridation

Many of the arguments against fluoridation are based on ethical and moral issues, namely that water fluoridation is medicating large numbers of people without their explicit consent (even though fluoride is a naturally occurring substance and not technically a medicine). The freedom issue, however, has become muddled because freedom to choose is pointless if people can’t get truthful, straightforward information about what it is they are making a choice. Getting truthful information about fluoridation is about as straightforward as getting truthful information about vaccinations and electromagnetic radiation ( http://www.skepdic.com/fluoridation).

1) Appeal To Nature. Despite fluoride naturally occurring in food and water (http://ilikemyteeth.org/fluoridation/health-experts-on-fluoride/), a common argument against it is the appeal to nature. Fluoride is widely distributed in the lithosphere mainly as fluorspar, fluorapatite and cryolite, and is recognised as the thirteenth most common element in the earth’s crust. It is found in seawater, groundwater, and in most surface waters. Fluoride is also found in foods particularly fish and tea (http://www.who.int/water_sanitation_health/dwq/nutrientschap14.pdf).

2) Cancer: In the mid-1970s, John Yiamouyiannis, PhD (http://www.quackwatch.org/11Ind/yiamouyiannis.html) began issuing a series of reports claiming that fluoridation causes cancer. Experts concluded that these reports were based on a misinterpretation of government statistics. They had compared cancer death rates in fluoridated and non-fluoridated cities but failed to consider various factors in each city (such as industrial pollution) that are known to raise the cancer death rate. By 1977, independent investigations by eight of the leading medical and scientific organisations in the English-speaking world had refuted the claims, but they still surface today in many communities that consider fluoridation.

In 1990, the cancer charge was raised again following an unauthorised release of data from an experiment in which rats and mice were exposed to high dosages of fluoride. The experiment was conducted by the National Toxicology Program, a branch of the National Institute of Environmental Health Sciences. The agency’s final report stated that there was no evidence of cancer-causing activity in female rats or in male and female mice and only “equivocal evidence” in male rats. A subsequent review by a U.S. Public Health Service panel concluded that the data were insignificant and that fluoridation posed no risk of cancer or any other disease. 50 epidemiological studies done in different populations at different times have failed to demonstrate an association. These studies were done by the United States, Japan, the UK, Canada and Australia. (http://www.dentalwatch.org/fl/phs_1991.pdf)

Studies done on the toxicity of fluoride have also been done (http://health.skepticproject.com/articles/health/fluoride/). Two animal studies were conducted by the National Toxicology Program of the National Institute of Environmental Health Sciences and The Proctor and Gamble Company. (http://www.ncbi.nlm.nih.gov/pubmed/2071234) (http://jnci.oxfordjournals.org/content/82/13/1118.short) There were eight groups of animals each with its own sex and species. The animals were given 25, 75 and 175 ppm of fluoride respectively. The studies concluded that “Taken together the two animal studies fail to establish an association between fluoride and cancer.” Additional studies on links between fluoride and cancer and fluoride and bone fractures have been shown to be invalid (http://health.gov/environment/ReviewofFluoride/default.htm).

3) Fluoridated Water Causes Osteosclerosis And Other Bone Altering Illnesses: This claim is true but misleading. In a survey of 170,000 people’s x-rays from Texas and Oklahoma, who had lived in communities whose water supply contained 4 ppm – 8 ppm of fluoride, only 23 cases of osteosclerosis had been found. Not one case of the more severe skeletal fluorosis. (Stevenson CA, Watson AR. Fluoride osteosclerosis. American Journal of Roentgenology, Radium Therapy and Nuclear medicine 1957; 78 (1) 13-18) Other studies have determined that toxicity may occur 10 years after exposure to HIGH levels. (over 5 ppm) (http://www.ncbi.nlm.nih.gov/books/NBK109825/) Note that this is much higher than the optimal safety guidelines. The reason that there are still communities today with more than 5 ppm in their water supply is due mainly to the fact that they use natural water supplies (rivers, lakes).

4) The US IQ Average Has Dropped In The Past 50 Years: According to most IQ researchers, the national IQ has actually been rising since the 1930’s. This increase has been observed all around the world, and not just with IQ tests but with episodic and semantic memory tests. (http://www.americanscientist.org/issues/feature/rising-scores-on-intelligence-tests/1) This observation has been called the “Flynn effect”. Some explanations for the “Flynn effect” are improved nutrition and better education. This claim is closely related to…

5) The 2012 Harvard Study: In 2012, some news organisations transmitted a press release by the “NYS Coalition Opposed to Fluoridation, Inc.” which suggested that a 2012 Harvard meta-study of studies on the effects of water fluoridation and child IQs found “significantly lower IQ” in children. However, if you actually read the paper (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/) and look at Table 1, the study compared children in areas with recommended levels of fluoride in water — the same levels that are introduced in the process of water fluoridation (0.5 to 1.5 mg/L) — to children in areas with high fluoride levels (above 1.5 mg/L). In other words, and yet again, this paper documents the risks of chronic fluoride toxicity, not water fluoridation.

In 2014, a study conducted in New Zealand examined the relationship between fluoridation and IQ directly on a cohort of people born in Dunedin in the 1970s. It found no statistically significant link. The authors suggest that the earlier Harvard study might have been affected by confounding variables, especially urban or rural status (http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301857). This leads into…

6) Chinese Studies Indicate That High Levels Of Fluoride Can Lower IQ
(http://health.skepticproject.com/articles/health/fluoride/): This claim is partially true, but misleading. There have been about a dozen studies done in China that may show a potential link. But China’s water supply was not very safe to begin with, as its contains high levels of fluoride.

“Drinking water with high levels of fluoride is widespread in China and has been seen in all provinces, municipalities and autonomous regions with the exception of Shanghai, and it has been estimated that there are over 1,200 counties and almost 150,000 villages affected by fluorosis (including coal pollution derived fluorosis).”
Dental fluorosis in China has been recognised for some time (http://jdr.sagepub.com/content/12/4/591.extract).” (http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf)

China has also had high rates of fluorosis, a clear sign that their citizens are consuming too much fluoride. “It has been estimated that over 26 million people in China suffer from dental fluorosis due to elevated fluoride in their drinking water, with a further 16.5 million cases of dental fluorosis resulting from coal smoke pollution (Liang et al., 1997).” (http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf)

China does not fluoridate its water, so they get their water from natural sources. It’s also worth mentioning that the lower IQ link may be from fluoride gases coming from coal/clay pollution, or from arsenic which is also in the water supply. (http://www.scidev.net/en/news/fluoride-poisoning-in-china-due-to-clay-not-coal.html) (http://phys.org/news/2008-01-alarmed-mercury-arsenic-chinese-freshwater.html)

In conclusion, the claim that high levels of fluoride cause a decline in IQ is inconclusive. The Chinese water supply is very different than the US water supply and contains other toxic elements that correlate with the cognitive decline. This is likely considering the studies done on rats indicated that cognitive decline required up to 75 times the EPA limit. When you look at the totality of the evidence on water fluoridation safety, a link between lowered IQ and fluoridated water becomes unlikely.

7) Dental Fluorosis: Dental fluorosis is a scary-sounding but rather a benign condition in which the teeth become slightly stained. It is a cosmetic issue that does not lead to tooth decay, whereas removing fluoride from water does if individuals do not brush their teeth regularly. In all but the most severe cases, the mottling is barely noticeable, and it’s only significant in children whose teeth have not finished developing. (By comparison, drinking a lot of coffee or tea can also make your teeth yellow, though this is reversible.)

Fluoridation opponents like to cite CDC statistics showing that the incidence of fluorosis(http://www.dentalwatch.org/fl/fluorosis.html) among adolescents aged 12-15 rose from 22.6% in 1986-87 to 40.7% in 1999-2004 (http://www.cdc.gov/nchs/data/databriefs/db53.pdf). Taken by itself, that statement is factual but misleading. As stated questionable, very mild, and mild fluorosis and most cases of moderate fluorosis are barely visible and pose no problem whatsoever. In addition, it’s been shown that teeth with fluorosis are more resistant to decay than teeth without fluorosis. The teeth may appear whiter than otherwise, but they are neither unattractive nor structurally damaged. Severe fluorosis that adversely affects both appearance and function is close to zero among people who drink water that is optimally fluoridated.

Some Prominent Figures Against Fluoridation

• John Yiamouyiannis – until his death in 2000.
• Paul Connett – executive director of the Fluoride Action Network (an anti-fluoridation activist group).
• Joseph Mercola – quack internet doctor and supplement peddler.
• Ralph Nader – consumer advocate
• Jedi Mind Tricks – semi-underground hip-hop artist, conspiracy theorist, and homophobe.
• Mike Adams – operator/editor of Natural News, an infamous alternative medicine website. Claims that proponents of water fluoridation are “psychopathic criminals,” “mad scientists,” and “some of the most life hating people you’ll ever meet.”
• Ludwik Gross, most famous for showing viruses can cause cancers in animals, also believed that fluoridation was “an insidious poison, harmful, toxic and cumulative in its effect, even when ingested in minimal amounts.”
• Yolanda Whyte, M.D. – Yolanda M. Whyte, M.D. has been actively opposing fluoridation during the past few years. She speaks at community meetings, has testified at legislative hearings, and is currently appearing in a video sponsored by the Fluoride Action Network (FAN), the primary U.S. antifluoridation organization. This article dissects some of her views and indicates why they should be disregarded.

MORE INFORMATION

Excellent blog about fluoride myths: https://openparachute.wordpress.com/fluoridation/

Questions And Answers On Fluoride
This fact sheet provides information on community water fluoridation as well as current federal activities to update guidance and regulations concerning community water fluoridation. The Department of Health and Human Services (HHS) oversees the national water fluoridation program.
http://water.epa.gov/lawsregs/rulesregs/regulatingcontaminants/sixyearreview/upload/2011_Fluoride_QuestionsAnswers.pdf

How Fluoride In Water Helps Prevent Tooth Decay
The most effective way to prevent tooth decay is delivered to most Australian homes every day through their water pipes. It is, of course, fluoride distributed via the water supply.
https://theconversation.com/how-fluoride-in-water-helps-prevent-tooth-decay-6933

American Dental Association: Fluoridation Facts
Fluoridation Facts is the ADA’s premier resource on community water fluoridation. This 71-page booklet is a comprehensive encyclopaedia of fluoridation facts taken from over 350 scientific references. Fluoridation Facts includes information from scientific research in an easy to use question and answer format on the topics of effectiveness, safety, practice and cost-effectiveness of fluoridation.
http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/fluoridation-facts

More than 125 “National and International Organizations That Recognise the Public Health Benefits of Community Water Fluoridation for Preventing Dental Decay.”
http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/fluoridation-facts/fluoridation-facts-compendium

Medical Testimonials About Fluoridation
http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/medical-testimonials-about-fluoridation

Cochrane Review Of Water Fluoridation To Prevent Tooth Decay
Tooth decay is a worldwide problem affecting most adults and children. Untreated decay may cause pain and lead to teeth having to be removed.
http://www.cochrane.org/CD010856/ORAL_water-fluoridation-prevent-tooth-decay

Review Of Cochrane Review On Community Water Fluoridation
A new systematic review from the Cochrane Collaboration was recently released, its goal being “to assess the effects of water fluoridation (artificial or natural) for the prevention of tooth decay. It also evaluates the effects of fluoride in water on the white or brown marks on the tooth enamel that can be caused by too much fluoride (dental fluorosis).”
https://www.sciencebasedmedicine.org/cochrane-review-on-your-precious-bodily-fluids-community-water-fluoridation/

Fluoride: Still Not Poisoning Your Precious Bodily Fluids!
We, dentists, are an evil group of sociopaths. When we’re not trying to kill you or give you chronic diseases such as multiple sclerosis with our toxic mercury saturated fillings, we are advocating for the placement of rat poison/industrial waste (i.e. fluoride) in your water supply by our governmental overlords. What is up with us?
https://www.sciencebasedmedicine.org/fluoride-still-not-poisoning-your-precious-fluids/

Preventing Tooth Decay in Kids: Fluoride and the Role of Non-Dentist Health Care Providers
https://www.sciencebasedmedicine.org/preventing-tooth-decay-in-kids-fluoride-and-the-role-of-non-dentist-health-care-providers/

EPA and HHS Announce New Scientific Assessments and Actions on Fluoride / Agencies working together to maintain benefits of preventing tooth decay while preventing excessive exposure
The U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) today are announcing important steps to ensure that standards and guidelines on fluoride in drinking water continue to provide the maximum protection to the American people to support good dental health, especially in children. HHS is proposing that the recommended level of fluoride in drinking water can be set at the lowest end of the current optimal range to prevent tooth decay, and EPA is initiating a review of the maximum amount of fluoride allowed in drinking water.
http://yosemite.epa.gov/opa/admpress.nsf/d0cf6618525a9efb85257359003fb69d/86964af577c37ab285257811005a8417!OpenDocument

New Fluoride Risk Assessment And Relative Source Contribution Documents
EPA has completed and peer-reviewed a quantitative dose-response assessment based on the available data for severe dental fluorosis as recommended by NRC. Additional research will be necessary to obtain dose-response data amenable to a quantitative risk assessment for Stage II skeletal fluorosis and/or skeletal fractures. The dose-response assessment provides a reference dose based on the critical health effect of pitting of the enamel in severe dental fluorosis.
http://water.epa.gov/action/advisories/drinking/upload/fluoridefactsheet.pdf

U.S. Public Health Service Recommendation For Fluoride Concentration In Drinking Water for the Prevention of Dental Caries
Through this recommendation, the U.S. Public Health Service (PHS) updates and replaces it’s 1962 Drinking Water Standards related to community water fluoridation—the controlled addition of a fluoride compound to a community water supply to achieve a concentration optimal for dental caries prevention.
http://www.publichealthreports.org/documents/PHS_2015_Fluoride_Guidelines.pdf

Surgeon General’s Perspectives
Based on this comprehensive, multi-year assessment, PHS now recommends that community water systems use a single concentration of 0.7 mg/L of fluoride in drinking water to maintain cavity prevention bene ts and reduce the risk of dental fluorosis. This new recommendation revises and replaces the previously recommended range of 0.7–1.2 mg/L.
http://www.publichealthreports.org/documents/Surgeon_General_Perspective_FG.pdf

THE DEBATE OVER FLUORIDATED WATER
The debate over fluoridation goes back roughly 70 years to when communities began fluoridating water to prevent tooth decay. The issue: Is fluoridated water better for your health or not?
http://ilikemyteeth.org/fluoridation/

IN THEIR OWN WORDS: What Respected Organizations Say About the Safety And Effectiveness Of Community Water Fluoridation
http://ilikemyteeth.org/wp-content/uploads/2011/03/RespectedOrgs-noPics_v2a.pdf

CDC. 2012 Water Fluoridation Statistics Website
http://www.cdc.gov/fluoridation/statistics/2012stats.htm

Is Fluoride In Water A Good Thing Or A Danger?
http://www.straightdope.com/columns/read/2692/is-fluoride-in-water-a-good-thing-or-a-danger

Oral Health In America: A Report Of The Surgeon General
http://profiles.nlm.nih.gov/ps/access/NNBBJT.pdf

American Cancer Society: Water Fluoridation And Cancer Risk
Many decades after fluoride was first added to drinking water in some parts of the United States, there is still controversy about the possible health effects of drinking water fluoridation.
http://www.cancer.org/cancer/cancercauses/othercarcinogens/athome/water-fluoridation-and-cancer-risk

National Cancer Institute: Fluoridated Water
A possible relationship between fluoridated water and cancer risk has been debated for years. The debate resurfaced in 1990 when a study by the National Toxicology Program, part of the National Institute of Environmental Health Sciences, showed an increased number of osteosarcomas (bone tumours) in male rats given water high in fluoride for 2 years. However, other studies in humans and in animals have not shown an association between fluoridated water and cancer.
http://www.cancer.gov/about-cancer/causes-prevention/risk/myths/fluoridated-water-fact-sheet

Cancer Council Of Wester Australia, Cancer myth: Fluoride And Cancer
Fluoridation is considered by many to be a major public health success. The addition of fluoride to drinking water has led to a significant reduction in dental caries. There is no consistent evidence of fluoride from drinking water increasing cancer risk. At very high doses – much higher than in drinking water – fluoride can have some adverse health effects on teeth and bones.
https://www.cancerwa.asn.au/resources/cancermyths/fluoride-cancer-myth/

Anti-fluoride Activists Should Put Their Tinfoil Hat Theories To Rest
Politics and religion are the classic topics to avoid if you want to enjoy a dinner party. In Australia, you can now add water fluoridation to that list.
http://www.theguardian.com/commentisfree/2013/sep/19/anti-fluoride-science-australia

Fluoridation: Don’t Let the Poisonmongers Scare You
Fluoride is a mineral that occurs naturally in most water supplies. Fluoridation is the adjustment of the natural fluoride concentration to about one part of fluoride to one million parts of water. Although fluoridation is safe and effective in preventing tooth decay, the scare tactics of misguided poisonmongers have deprived many communities of its benefits.
http://www.quackwatch.org/03HealthPromotion/fluoride.html

THE RESEARCH

Over 2000 Peer Reviewed Studies On Water Fluoridation
http://www.ncbi.nlm.nih.gov/pubmed/?term=water+fluoridation

The York Review – A Systematic Review of Public Water Fluoridation: A Commentary
The best available evidence (from studies that met inclusion criteria) suggests that fluoridation of drinking water supplies reduces caries (decay and crumbling of a tooth or bone) prevalence but is associated with dental fluorosis. The balance of the evidence did not show an association between any fractures and water fluoridation. No associations between water fluoridation and human cancer were found.
http://www.nature.com/bdj/journal/v192/n9/abs/4801410a.html

NHS Centre For Reviews And Dissemination. A Systematic Review Of Water Fluoridation.
http://www.nhs.uk/conditions/fluoride/documents/crdreport18.pdf

Systematic Review Of Water Fluoridation
http://www.ncbi.nlm.nih.gov/pubmed/11021861

Effectiveness Of Fluoride in Preventing Caries In Adults
Abstract: To date, no systematic reviews have found fluoride to be effective in preventing dental caries in adults. The objective of this meta-analysis was to examine the effectiveness of self and professionally applied fluoride and water fluoridation among adults. We used a random-effects model to estimate the effect size of fluoride (absolute difference in annual caries increment or relative risk ratio) for all adults aged 20+ years and for adults aged 40+ years. Twenty studies were included in the final body of evidence. Among studies published after/during 1980, any fluoride (self and professionally applied or water fluoridation) annually averted 0.29 (95%CI: 0.16-0.42) carious coronal and 0.22 (95%CI: 0.08-0.37) carious root surfaces. The prevented fraction for water fluoridation was 27% (95%CI: 19%-34%). These findings suggest that fluoride prevents caries among adults of all ages.
http://www.ncbi.nlm.nih.gov/pubmed/17452559

The Community Preventive Services Task Force, Preventing Dental Caries: Community Water Fluoridation, 2000, 2013
The Community Preventive Services Task Force recommends community water fluoridation based on strong evidence of effectiveness in reducing dental caries across populations. Evidence shows the prevalence of caries is substantially lower in communities with CWF. In addition, there is no evidence that CWF results in severe dental fluorosis.
http://www.thecommunityguide.org/oral/fluoridation.html

National Research Council, Fluoride in Drinking Water: A Scientific Review of EPA’s Standards, 2006
That review focused only on potential unwanted effects of naturally occurring fluoride at concentrations of 2–4 mg/L, much higher than 0.7 mg/liter, the new recommendation for community water fluoridation. Even at these higher concentrations, the NRC panel found substantial evidence only for an increased likelihood of severe dental fluorosis and noted that severe fluorosis remains near zero in communities where the level of fluoride in drinking water is less than 2 mg/L.
http://www.nap.edu/catalog/11571/fluoride-in-drinking-water-a-scientific-review-of-epas-standards

DRI DIETARY REFERENCE INTAKES FOR Calcium, Phosphorus, Magnesium, Vitamin D, and Fluoride
These guidelines describe the dietary reference intakes for specific nutrients known to be beneficial to health, including fluoride.
http://www.nap.edu/read/5776/chapter/1

NHMRC Public Statement: Efficacy and Safety of Fluoridation
Fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride. It is recommended that water be fluoridated in the target range of 0.6 to 1.1 mg/L, depending on climate, to balance reduction of dental caries and occurrence of dental fluorosis.
http://www.nhmrc.gov.au/guidelines-publications/eh41

CDC STATEMENT ON THE EVIDENCE SUPPORTING THE SAFETY AND EFFECTIVENESS OF COMMUNITY WATER FLUORIDATION
In the seminal report, Oral Health in America: A Report of the Surgeon General, Surgeon General David Satcher observed a “‘silent epidemic’ of dental and oral diseases […] with those suffering the most found among the poor of all ages.”1 The report affirms that community water fluoridation is “an inexpensive means of improving oral health that benefits all residents of a community, young and old, rich and poor alike.” Because of its contribution to the dramatic decline in tooth decay over the past 70 years, CDC named community water fluoridation 1 of 10 great public health achievements of the 20th century.
https://www.nidcr.nih.gov/DataStatistics/SurgeonGeneral/Documents/[email protected]

Effects of Fluoridated Drinking Water on Dental Caries in Australian Adults
Systematic reviews produce conflicting conclusions regarding dental caries-preventive effects of water fluoridation in adults. The authors investigated the relationship using data from the nationally representative 2004−2006 Australian National Survey of Adult Oral Health. Effects were compared between the pre-fluoridation cohort born before 1960 (n = 2,270) and the cohort born between 1960 and 1990 (n = 1,509), when widespread implementation of fluoridation increased population coverage from < 1% to 67%. Residential history questionnaires determined the percentage of each person’s lifetime exposed to fluoridated water. Examiners recorded decayed, missing, and filled teeth (DMF-Teeth) and decayed and filled tooth surfaces (DF-Surfaces). Socio-demographic and preventive dental behaviors were included in multivariable least-squares regression models adjusted for potential confounding. In fully adjusted models, > 75% of lifetime exposure to fluoridation relative to < 25% of lifetime exposure was associated with 11% and 10% fewer DMF-Teeth in the pre-1960 (p < .0001) and 1960–1990 cohorts (p = .018), respectively. Corresponding reductions in DF-Surfaces were 30% (p < .001) and 21% (p < .001). Findings for intermediate fluoridation exposure suggested a dose-response relationship. Results were consistent in sensitivity analyses accounting for missing data. In this nationally representative sample of Australian adults, caries-preventive effects of water fluoridation were at least as great in adults born before widespread implementation of fluoridation as after widespread implementation of fluoridation.
http://www.ncbi.nlm.nih.gov/pubmed/23456704

Results And Conclusions Of The National Toxicology Program’s rodent carcinogenicity studies with sodium fluoride.
Abstract: The US National Toxicology Program (NTP) has conducted toxicity and carcinogenicity studies with sodium fluoride administered in the drinking water to F344/N rats and B6C3F1 mice. The drinking water concentrations used in the 2-year studies were 0, 25, 100, or 175 ppm sodium fluoride (equivalent to 0, 11, 45 or 79 ppm fluoride). Survival and weight gains of rats and mice were not affected by fluoride treatment. Animals receiving sodium fluoride developed effects typical of dental fluorosis, and female rats given 175 ppm had increased osteosclerosis. There were no increases in neoplasms in female rats or in male or female mice that were attributed to sodium fluoride administration. There was equivocal evidence of carcinogenic activity of sodium fluoride in male rats based on the occurrence of a small number of osteosarcomas in treated animals.
http://www.ncbi.nlm.nih.gov/pubmed/2071234

Two-Year Carcinogenicity Study of Sodium Fluoride in Rats
Abstract: To determine the carcinogenic potential of sodium fluoride (NaF), we fed Sprague-Dawley rats a diet containing NaF for up to 99 weeks. Rats receiving NaF at a dose of 4,10, or 25 mg/kg per day added to a low-fluoride diet were compared with controls receiving either a low-fluoride diet or laboratory chow. Each treatment group consisted of 70 rats of each sex. A 30% decrement in weight gain occurred at an NaF dose of 25 mg/kg per day. Evidence of fluoride toxicity was seen in the teeth, bones, and stomach, and the incidence and severity of these changes were related to the dose of NaF and the duration of exposure. Despite clear evidence of toxicity, NaF did not alter the incidence of preneoplastic and neoplastic lesions at any site in rats of either sex. Results from this study indicate that NaF is not carcinogenic in Sprague-Dawley rats.
http://jnci.oxfordjournals.org/content/82/13/1118.short

National Research Council. Carcinogenicity of fluoride. In: Subcommittee on Health Effects of Ingested Fluoride
The National Academy of Sciences, conducted an extensive literature review concerning the association between fluoridated drinking water and increased cancer risk. The review included data from more than 50 human epidemiological studies and six animal studies. The Subcommittee concluded that none of the data demonstrated an association between fluoridated drinking water and cancer.
http://www.nap.edu/read/2204/chapter/2#10

Fluoride-Related Skeletal Effects: Evaluations of Key Studies
At low intake levels, fluoride has been shown to have therapeutic value in the prevention of dental caries; however, slightly higher levels, particularly in children during the period of enamel development can lead to dental fluorosis, a condition in which the enamel covering of the teeth fails to crystallize properly. Possible resulting problems include enamel defects ranging from barely discernable markings to brown stains and surface pitting. Prolonged high intake of fluoride, at any age, can result in skeletal fluorosis, a condition which may increase bone brittleness, and in a potential increase in risk of bone fracture. In high-dose cases, severe bone abnormalities can develop, crippling the affected individual.
http://water.epa.gov/action/advisories/drinking/upload/Fluoride_dose_response.pdf

An Assessment of Bone Fluoride and Osteosarcoma
Abstract: The association between fluoride and risk for osteosarcoma is controversial. The purpose of this study was to determine if bone fluoride levels are higher in individuals with osteosarcoma. Incident cases of osteosarcoma (N = 137) and tumor controls (N = 51) were identified by orthopedic physicians, and segments of tumor-adjacent bone and iliac crest bone were analyzed for fluoride content. Logistic regression adjusted for age and sex and potential confounders of osteosarcoma was used to estimate odds ratios (OR) and 95% confidence intervals (CI). There was no significant difference in bone fluoride levels between cases and controls. The OR adjusted for age, gender, and a history of broken bones was 1.33 (95% CI: 0.56-3.15). No significant association between bone fluoride levels and osteosarcoma risk was detected in our case-control study, based on controls with other tumor diagnoses.
http://jdr.sagepub.com/content/90/10/1171.abstract

Fluoride In Drinking Water And Osteosarcoma Incidence Rates In The Continental United States Among Children And Adolescents
Conclusion: Our ecological analysis suggests that the water fluoridation status in the continental U.S. has no influence on
osteosarcoma incidence rates during childhood and adolescence.
https://www.ncbi.nlm.nih.gov/pubmed/22189446

Drinking Water Fluoridation And Osteosarcoma Incidence On The Island Of Ireland.
Abstract: The incidence of osteosarcoma in Northern Ireland was compared with that in the Republic of Ireland to establish if differences in incidence between the two regions could be related to their different drinking water fluoridation policies. Data from the Northern Ireland Cancer Registry (NICR) and the National Cancer Registry of Ireland (NCRI) on osteosarcoma incidence in the respective populations were used to estimate the age-standardised and age-specific incidence rates in areas with and without drinking water fluoridation. One hundred and eighty-three osteosarcoma cases were recorded on the island of Ireland between 1994 and 2006. No significant differences were observed between fluoridated and non-fluoridated areas in either age-specific or age-standardised incidence rates of osteosarcoma. The results of this study do not support the hypothesis that osteosarcoma incidence in the island of Ireland is significantly related to public water fluoridation. However, this conclusion must be qualified, in view of the relative rarity of the cancer and the correspondingly wide confidence intervals of the relative risk estimates.
http://www.ncbi.nlm.nih.gov/pubmed?term=Drinking%20water%20fluoridation%20and%20osteosarcoma%20incidence%20on%20the%20island%20of%20Ireland

Age-specific fluoride exposure in drinking water and osteosarcoma (United States).
CONCLUSIONS: Our exploratory analysis found an association between (higher) fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females. Further research is required to confirm or refute this observation.
http://www.ncbi.nlm.nih.gov/pubmed?term=Age-specific%20fluoride%20exposure%20in%20drinking%20water%20and%20osteosarcoma%20