Talk:Water fluoridation/Archive 5

"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. 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. .

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? Sandy Georgia  (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.  Sandy Georgia  (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 o f o rmation  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 is a direct quote from the reference. 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.
 * 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.

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.  Sandy Georgia  (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. Sandy Georgia  (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, 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 o f o rmation  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) 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...    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?    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?    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?    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.    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.    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-.    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.    03:30, 21 February 2013 (UTC) -- In fact the NHMRC source, current citation #10, which is on the second sentence, supports the first.    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.   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)