Talk:Water fluoridation/Archive 6

Proposal to add some material on the scientific research to the 'science basis' section
Currently the article refers to the York Review explicitly, but does not deal with it in any systematic way. I propose a short section that outlines the largest and most significant reviews of research in this area, with a summary of their findings, which are typically much more nuanced than the statements in the article right now. Currently the article does not do justice to the methodological issues, data and analysis quality, and types of study. I feel that the three major studies proposed above would be a good start, but am very open to discussion about which ones are the most significant and scientifically rigorous. Tilapidated (talk) 16:28, 21 February 2013 (UTC)


 * The York report is from 2000, states "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence" and the evidence quality is described as "moderate". We also have multiple, other newer analyses and statements from major medical organization.  In particular we have a newer (NHMRC 2007) analysis from the Australian government, and after reviewing basically the same data, it states "The existing body of evidence strongly suggests that water fluoridation is beneficial at reducing dental caries".   This Australian NHMRC study specifically talks about the York analysis (McDonagh 2000).  We generally prefer the findings of the most up-to-date secondary sources.  Any changes proposed to the article in this area would have to based not only on McDonagh 2000 but also NHMRC 2007 and the several other newer reviews and meta-analyses available.  I cannot find any compelling reason to have the article feature McDonagh 2000 over the several other, newer sources we have.    20:10, 21 February 2013 (UTC)
 * The quote you mention is referenced in the article to a number of studies, including the York study, which clearly does not support it.
 * The article already does feature McDonagh 2000 over other newer reviews, and the authors' statement is from 2003. It also mentions the NHMRC, although gives it less text real-estate, then goes back to talk about a 2002 study. What I am proposing is that we update this to feature the various major literature reviews and their findings systematically, rather than in the rather haphazard way it is done now. I think the NHMRC review is significant, partly because it follows the same inclusion methodology as the York study, so it is directly comparable, although disapointingly it only adds one study to the York dataset. While many are referenced, pulling this one out in the text, and then misrepresenting what it says, seems odd. It sounds like you are agreeing with me? Tilapidated (talk) 22:54, 21 February 2013 (UTC)


 * Eubulides, the main author of this article till 2010 was fastidious about using the best and most up-to-date sources, and sticking closely to what they said. Hence the "strongly suggests" phrase comes exactly from the NHMRC 2007 source. As noted further up, the best encyclopaedic style is for us to state facts rather than argue the case in front of the reader. The reader has links to the sources of those facts if they wish to examine the reviews and studies in detail. It may be that we personally disagree with those sources or feel we could do a better review of the primary literature, but that is not our job and as Wikipedians we have limitations that don't exist in other publications. Where there are high quality reports or reviews published since 2010, then I would think they are worth examining. Such as the US lowering of the recommended levels in 2011. On a personal note, I've been struck down with a cold and my brain has turned to cotton wool -- so I may not be up to much for the next few days. Colin°Talk 21:17, 21 February 2013 (UTC)
 * Colin, the issue isn't whether any of us personally agree or disagree, but about presenting the range of findings in the serious literature. I find it strange that you would want to throw out literature reviews done before 2010, that certainly isn't normal practice, and Eubulides certainly didn't do that. Indeed some of the most useful research in this area comes from the 50s and 60s. The change over time of findings, interpretation, and methodologies is useful in understanding how policy has changed over time. The York dataset is essentially the same (with one fewer study) so the differences in findings language seems interesting. The fact that two respected groups can come up with reviews of essentially the same studies, and come up with completely different results is very significant. To obscure that is to mislead the reader into thinking that the science is uniformly interpreted. Tilapidated (talk) 22:54, 21 February 2013 (UTC)
 * I agree with Colin about the style of the presentation. IMHO, "a short section that outlines the largest and most significant reviews of research in this area" would be unwise because we get into cherry picking of "significant reviews" and of phrases from those reviews. I also think that as an encyclopedia, Wikipedia has useful scholarly inertia, it does not report the latest review ([{WP:NOTNEWS]]) especially in an area where there are virulent fringe groups (like the infamous Fluoride Action Network).  And I worry about taking advice from new, single issue editors.  What is lacking in this article are citations to mainline dental textbooks. But I am jumping into a long conversation, I can see.  --Smokefoot (talk) 23:28, 21 February 2013 (UTC)
 * Hi there Smokefoot - I'd encourage you to try to set aside your prejudices and think instead about the issue. I'm a little disturbed by your comments - we already have the section that you think is unwise, it's just that currently is rambling and does not really do justice to any of the reviews it cites, cherry-picking, as you warn against. The section is really not a news report - the latest review that is significant is a couple of years old as far as I can see. I don't think anyone is mentioning campaign groups, we're talking about peer reviewed scholarship in mainstream journals. I don't really see any dispute here about the type of study that would qualify for such as section. Hope that clarifies! Tilapidated (talk) 00:02, 22 February 2013 (UTC)
 * Tilapidated, where have I said I "want to throw out literature reviews done before 2010". We will not make progress with such nonsense misinterpretations. Slow down. Read the whole article. Read the existing sources. Read what other people are actually saying. I'm saying this article is almost certainly good wrt any sources published up to 2010 but may be lacking in newer sources. Therefore my priority is to consider if there is anything new to report because I'm very doubtful that rehashing reports from 2000, no matter how important they may be, will bring new light. Colin°Talk 14:09, 22 February 2013 (UTC)
 * Hi Colin - it was you saying that you wanted to use only the most up-to date sources, and that 'Where there are high quality reports or reviews published since 2010, then I would think they are worth examining.' that led me to believe you were not interested in sources pre 2010. I'm glad I misunderstood you! I'm not sure what you mean by 'rehashing', but as you most likely know, research is iterative. Eubulides referenced the York study (I imagine) because it remains one of the most significant reviews. Subsequent studies have often adopted the same inclusion methodology, and draw heavily from it. The MHMRC study reanalyses (rehashes, if you will) largely the same dataset. ;) Tilapidated (talk) 16:50, 22 February 2013 (UTC)

Changes to the effectiveness section
I made some minor edits to split paragraphs, and removed a sentence from the section on the York review that was in direct contradiction to the text of the review. I removed:
 * which is roughly equivalent to preventing 40% of cavities.

because the text of the York Review (page xii) says 'The degree to which caries is reduced, however, is not clear from the data available.' The quote refers to topical fluorides, and is original research in direct contradiction of the study in question.

It appears that TippyGoomba reverted the change within four minutes of my making it, of course without commenting here, claiming that there is no consensus for the change. So - I guess the question is - is there a consensus that clear factual errors in citation remain on the page? Thanks.Tilapidated (talk) 02:14, 22 February 2013 (UTC)


 * OK Tippy - that's now twice you've reverted without discussion in the same few minutes. Since you posted a link to the BRD, please do explain your commitment to keeping errors of fact in the article. Thanks, Tilapidated (talk) 02:47, 22 February 2013 (UTC)


 * I'm not Tippy but here's my observation - The edit under discussion made this change:"...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), which is roughly equivalent to preventing 40% of cavities., but found that the degree to which caries were reduced was not clear from the data available."I agree with the revert of this change, because it appears to make the article self-contradictory. The previous sentence explained the degree to which caries were reduced, and so it's incongruous to follow that up with a statement that the degree to which caries were reduced wasn't determinable.  The statement that the York report "found that the degree to which caries were reduced was not clear" isn't an accurate representation of the source.  I don't find a problem with the use of .   02:48, 22 February 2013 (UTC)


 * So Zad - I have a couple of questions for you: in what respect is "the degree to which caries were reduced was not clear from the data available." (my summary) not an accurate representation of the source text "'The degree to which caries is reduced, however, is not clear from the data available."?
 * I think there is confusion around the stated ranges of observations in the studies with the degree of claimed reductions in caries that the analysis supports. While they report the observations, the data quality and ranges make it impossible for the study authors to specify the real reductions. They say this clearly in the review. To splice in our own analysis from another study is not only original research, it's poor quality original research.
 * The statements are not contradictory - one statement reports values, the other conclusions that can be drawn from them. We can't remove the conclusions that the original authors came to and replace them with our own because we don't like the original ones. Tilapidated (talk) 02:55, 22 February 2013 (UTC)


 * Here - to be clear, is the whole original quote from the study (page xii) "The studies were of moderate quality (level B), but of limited quantity. The degree to which caries is reduced, however, is not clear from the data available. The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%)." The two statements are not contradictory, and are taken directly from the source. Tilapidated (talk) 03:04, 22 February 2013 (UTC)
 * Again with the cherry picking. TippyGoomba (talk) 04:10, 22 February 2013 (UTC)
 * I think perhaps that term doesn't mean what you think it means. That is the whole of the relevant quote from the original study that is referenced in the article. Perhaps you could show me where in the review there is more context that changes the meaning of the statement "The degree to which caries is reduced, however, is not clear from the data available.'? Tilapidated (talk) 04:13, 22 February 2013 (UTC)
 * You are reading the sources for quotes which serve your agenda. That's cherry picking. Now you're asking me to cherry pick my own quotes. Cute game, shall we play for shots? TippyGoomba (talk) 04:18, 22 February 2013 (UTC)
 * I'm sorry - I'm not able to understand you at all. The article version that you reverted to takes a quote from the York Review "The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%)", then cuts in a completely different claim about the number of carries that is reduced, referencing a topical fluoride study. That is what 'cherry picking' refers to - taking the pieces that you want from two different studies, and pasting them together to form a meaning not found in the original. The complete quote from the original study is what I included - that is the opposite of cherry picking. Tilapidated (talk) 04:22, 22 February 2013 (UTC)
 * Regarding the York study results, I think what I'm trying to get at is that we need to re-present the technical information the study gives us in a way that's accurate but also meaningful to a layperson, our intended audience. The lack of clarity (I would say precision) in the York summary is expressed in the large ranges of the means, and this is faithfully represented in our article, and then a layperson-friendly equivalent is given.  The "roughly 40%" isn't out of line with what other reputable sources say, for example the ADA says "Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20 – 40%", this large study from Australia found about a 30% reduction.  It's reasonable to take the study's description of the effects as imprecise, put the ranges in the article, and use language that expresses that level of impreciseness in providing a lay-friendly interpretation.  P.S.  The Princess Bride was one of my favorite movies!   04:20, 22 February 2013 (UTC)
 * The way that the paragraph reads right now implies that the York Review shows 40%. If you want to put another paragraph in about another study that shows a 40% reduction that's great, but what I was correcting is the addition of a comment to the findings of the York Study, the authors of which specifically say in the same paragraph in which they report the ranges, that the degree of reduction of caries is impossible to report from their data set. It's not lay-friendly to replace their conclusion with someone elses - it's in direct contradiction of their conclusion. Tilapidated (talk) 04:27, 22 February 2013 (UTC)


 * You missed my zoidberg :P TippyGoomba (talk) 04:25, 22 February 2013 (UTC)
 * How did a Futurama ref blow by me?? Must be bedtime...   04:28, 22 February 2013 (UTC)


 * OK - lets try this - does anyone dispute that the original review says 'The degree to which caries is reduced, however, is not clear from the data available.", and that they are talking about the ranges they report?
 * If so, that's pretty easy to fix. If not, please explain why it's ok to remove their conclusion, and replace another one from a completely different study? Tilapidated (talk) 04:30, 22 February 2013 (UTC)

The source text "The degree to which caries is reduced, however, is not clear from the data available" is not a "conclusion" but an introductory clause to their more detailed figures of the range/median etc. The words "not clear" are unhelpful imo. I can see what they are saying but the reader will too easily confuse that with "might be nonsense" -- scientists fall over themselves to clarify the uncertainties in their research, and this is often interpreted by the public as them not really having a clue or changing their minds all the time (is red wine good or bad for me this week?). As Zad notes, it is lack of precision that upsets the York authors, not whether there is a reduction at all. We already give (almost too much) detail on the statistics. I propose our version of this clause says "although the degree to which caries was reduced varied considerably in the studies examined." This is imo a fine introduction and lay summary of the rather complex statistics that follow. Colin°Talk 14:57, 22 February 2013 (UTC)


 * Hi Colin - I understand that you don't like the conclusions that the York Review authors came to, I just think it's not appropriate to change their conclusions, and substitute ones we prefer. When they use 'not clear' they are expressing uncertainty about the ability to specify a reduction in caries based on the available data. It's not simply a lack of precision, some of the studies show an increase in caries from fluoridated water (-5.0 to 64%) so it's not simply that there is a problem about specifying degree of reduction. It's really important to try to understand the difference between a reported range (which is what the numbers are) and conclusions that are drawn from that. The York team are explicit that they cannot make any claim about the degree to which caries are reduced based on their data.
 * Perhaps you want more evidence that this is not simply an obtuse reading of the paper? Let's go to their statement, three years later, where they clarify their findings. "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." http://www.york.ac.uk/inst/crd/fluoridnew.htm
 * I would propose that statement as a clear, layman's explanation of what they found. Tilapidated (talk) 16:59, 22 February 2013 (UTC)

Worthington
Colin - for clarity I created a new section here - I hope you don't mind me splitting your post - let me know if you do and I will restore it. Tilapidated (talk) 17:01, 22 February 2013 (UTC)
 * Wrt to the 40% figure from Worthington2003:
 * "Other researchers claim that fluoridation results in a reduction of 40% in cavities. "

Does anyone here have access to that paper? Although it is ostensibly about topical fluoride, I can only assume that the 40% figure is those authors' interpretation of the York review data, otherwise it wouldn't have been spliced into that paragraph. Or perhaps they cite yet another source for that figure. We need to get to the bottom of that. Btw, we should avoid using the word "claim" for results coming from reliable secondary sources because it implies we may not believe them. That word should be used with caution and only where we are talking about "facts" stated by unreliable sources. For example, Wakefield's claims about autism. Therefore I propose we remove that sentence/source from the article text until someone with access to it can convince us of why it should be included. Colin°Talk 14:57, 22 February 2013 (UTC)
 * I have no idea why a reference to a study about topical fluoride was added, I can only assume, as you do, that it was citing the York study, but that's not clear. Either way, what's important to me is that we make clear who is making what claim.
 * I take your point on the word 'claim', and am happy to remove it - I certainly believe them, and put it in because I felt you did not. Consider that the term has a technical usage too that may be appropriate here as we deal with several different studies that assert different things. We're not doubting any of the studies, simply dealing with the fact that different researchers find different results and draw different conclusions. Tilapidated (talk) 17:05, 22 February 2013 (UTC)
 * I have found another source based on Worthington here page 6. The 40% figure is a calculation based on York's 2.25 teeth median figure. Therefore it is valid expert interpretation of the York data and quite acceptable to be spliced into that paragraph. Colin°Talk 17:36, 22 February 2013 (UTC)
 * Colin, that's completely disingenuous. It's fine to have a sentence saying that some other researcher chosen to draw different conclusions than the authors of the study, but cherry picking the beginning and ending of the sentence from different places, directly contradicting the meaning of the original author is ridiculous. Tilapidated (talk) 17:47, 22 February 2013 (UTC)
 * I'm going to see if I get hold of Worthington. Until one of us has actually read it, please hold your tongue. Colin°Talk 17:54, 22 February 2013 (UTC)

STOP
Can I request that everyone stop editing this article right now. It is clear that recent changes reflect a misunderstanding of the sources used and that the original text was absolutely fine. In light of this we need to discuss changes before editing the article any further. Colin°Talk 17:36, 22 February 2013 (UTC)
 * Page is fully protected for one week. I will add consensus changes if developed here. Doc James  (talk · contribs · email) (if I write on your page reply on mine) 17:55, 22 February 2013 (UTC)


 * It's not remotely clear that the original text was fine - in fact its blindingly obvious that the original text is a gross misrepresentation. I get that you're passionately invested in this issue, but taking the conclusions of a serious study, and replacing them with those of a pamphlet put out by the British Fluoridation Society that better fits your point of view is ridiculous.
 * The authors of the York Review say ""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." http://www.york.ac.uk/inst/crd/fluoridnew.htm
 * I am honestly baffled that you think it is ok to represent in the same sentence as reporting their numbers that it is "is roughly equivalent to preventing 40% of cavities." It's directly contradicting their reported findings. Tilapidated (talk) 17:57, 22 February 2013 (UTC)

recommended changes to lede
I made what I thought were a few minor wording changes in the lede that were reverted, so I am bringing it here for consensus. The changes I recommend in the final paragraph are shown in bold below, with justification to follow.

The final paragraph states "The goal of water fluoridation is to prevent a chronic disease whose burdens particularly fall on children and on the poor.[19] Its use presents a potentialconflict between the common good and individual rights.[20] It is controversial,[21] and opposition to it has been based on the grounds of perceived ethical, legal, safety, and efficacy issues. (deleted "grounds").[22] Health and dental organizations worldwide have endorsed its safety and effectiveness.[3] Its use began in 1945, following studies of children in a region where higher levels of fluoride occur naturally in the water.[23] Researchers discovered that moderate fluoridation prevents tooth decay,[24] and as of 2004 about 400 million people worldwide received fluoridated water.[18]"

The intent was to recognize that there are a multitude of sources and opinions on the topic, as represented within the body of the article. Stating that there is a conflicr between common good and individual rights is a subjective opinion espoused by some factions. Some factions believe there is not conflict there. Whether or not there is a conflict between two social constructs is not a measurable thing or a universal; it is an opinion. One I happen to agree with, but one which remains an opinion. I think it best to simply add "potential" to indicate that there is debate about this, as represented by the sources and discussion in the article. Similarly, the sentence about opposition gives what I assume is an unintended implication that opposition has been based on the grounds of actual ethical, legal, safety and efficacy problems. Again, since different factions have different takes on this, I think it best to indicate that opposition is based on what the opponents view as those factors instead of stating that those issues universally and objectively exist. Another alternative for the latter sentence would simply be to say "...opposition to it has been based on arguments concerning...etc etc etc". IN that way it's clear we're indicating the position of the opposition, and not implying that the grounds are universally held to be true things.I don't want to argue about whether fluoridation is good or is not...that's not the purpose of this page, though I know it's a touch issue. I'm just trying to make a minor change to improve neutrality.Jbower47 (talk) 21:17, 22 February 2013 (UTC)


 * I don't think that either change is an improvement. Watering down statements with unnecessary qualifiers is not a move towards neutrality. Public health always involves a balance between the community good and the individual, not just potentially. Courts do not rule on "grounds of perceived... issues".Novangelis (talk) 21:35, 22 February 2013 (UTC)
 * I don't agree that that;s a universal. As reflected in the varying viewpoints in the article, the community good/individual rights issue is not recognized universally as an issue for this topic. It's inherently a subjective opinion. When we say that there is "conflict" we are lending creedence to one viewpoint over another. If there are better ways to word either, I'm certainly up for hearing them. I just would like to see us veer away, as we have done in other areas, from anything that implies, intentionally or not, that there is validity or invalidity of subjective opinions held by either faction in the discussion. It's not intended as watering down; it's intended to recognize the complexity of the issue and avoid endorsing any given view of it. Saying the opposition sees a conflict between public good and individual rights is decidedly different than saying there IS a conflict. One is recognizing an opinion exists; the other is endorsing that opinion as universal fact.Jbower47 (talk) 21:55, 22 February 2013 (UTC)


 * I agree with that the addition of mitigating or viewpoint language, (which can less charitably be viewed as weasel words) does not add significantly to the article, and in fact detracts from it. -- [ UseTheCommandLine ~/talk ] #_ 22:04, 22 February 2013 (UTC)


 * In that case, can you recommend a way that would be mutually agreeable to deal with the "conflict" sentence at least? The latter change is somewhat negligible, so I'm not too concerned about it. But stating there IS a conflict between public good and individual rights is a viewpoint not held universally. I think something as simple as saying that "opponents believe that..." would make it a much more verifiable statement. Again, it's the difference between saying there is a conflict, and saying that opponents feel there is. The former is advocating that belief, that latter simply recognizes that it is there. I think that might be a simple way to make the statement more neutral.Jbower47 (talk) 22:18, 22 February 2013 (UTC)
 * Is it a big enough issue to be mentioned in the lead section more than it already is (why do these conversations always seem to be about changes to the lead section? in my experience anyway) without being WP:UNDUE? mention of ethical/political conflict/controversy has been in the lead section for some time. Would additional language actually achieve anything? -- [ UseTheCommandLine ~/talk ] #_ 22:43, 22 February 2013 (UTC)


 * Thank-you for proposing this change here for discussion. I see the earlier edit was reverted by Zad68 here with the comment "sources cited do not limit these ethical concepts to opponents only, advocates and critics draw different conclusions but they both deal with the ethical issues". I agree with his comment. I'm not convinced that one side thinks there are ethical problems and the other side thinks there are none. Even if fluoridation was completely without potential side-effects, there would be ethical considerations about adding it to the water supply. But all sides accept there is a potential for side-effects. There will be some children who have excellent oral health, use fluoride toothpaste, eat a healthy diet and develop mild fluorosis because of fluoridation yet wouldn't have suffered cavities without fluoridation. Is there anyone who doesn't think that is the case at all? There will be other children who develop no or fewer cavities because of fluoridation. And there will be others whose minds are taken over by the government in an evil scheme in collaboration with the nuclear and fertilizer industry. Ok perhaps not that bit. Therefore the "common good and individual rights" issue raises its head and must be dealt with. Lots of things involve a balance of risk and only work at the collective-statistics level. An individual might drive faster with the reassurance of wearing a seatbelt, and then lose control at a sharp corner and crash into a bus shelter -- killing the occupants of the bus shelter but his seatbelt prevents him flying through the window so he survives with minor chest bruising. So essentially I'm happy with saying there is conflict and there are ethical issues. The difference between the sides is the conclusion one comes to when dealing with these. -- Colin°Talk 22:51, 22 February 2013 (UTC)

Pinellas County, Florida recently did away with fluoridation
Per community pressure and vote of County Commission. See: Pinellas county commission votes to stop putting fluoride in water supply Star767 (talk) 02:17, 24 February 2013 (UTC)
 * That was a year ago. -- Orange Mike &#x007C;  Talk  02:15, 5 March 2013 (UTC)

But they return it amongst some bitter feelings. See Pinellas county commission voes 6-1 to return fluoride to drinking water Star767 (talk) 02:29, 24 February 2013 (UTC)

CLAIMED: article does not reference relevant facts
Attempts to correct false statements in this article have been strongly resisted by parties that are unknown. The article promotes the infusion into public water supplies of diluted industrial hazardous waste fluorosilicic acid simply because it contains some fluoride. Adding waste or any proposed medicament into public water supplies and then recommending that people consume it is a violation of the intent of the Safe Drinking Water Act, the Water Pollution Control Act and the Food Drug and Cosmetic Act. Indeed no controlled clinical trials in human volunteers even exist for this material or for sodium fluoride. The article is promoting quackery since the science is compelling and complete indicating that industrial fluoride (rather than the nontoxic calcium fluoride) is a cumulative substance that causes harm, is present in saliva to bathe teeth at only 0.02 ppm which is 75,000 times less concentrated than in toothpaste,and is unable to influence teeth caries. If you don't do your own hand-on research, you have no right to force your opinions in an article such as this. It destroys the credibility of Wikipedia and makes a mockery out of a source that some perceive as a credible reference.The article cannot be repaired and should be completely re-written, this time with facts such as summarized in lay terms by the NRC 2006 Report, the 2013 monographs by Declan Waugh for fluoridated Southern Ireland, and the text by Connett, The Case Against Fluoride, 2010. — Preceding unsigned comment added by 72.199.234.172 (talk) 16:50, 3 March 2013 (UTC)
 * Actually, the "parties" that write these "false statements" are rather well known, we are registered editors at Wikipedia, generally with elaborate user pages. It is those that disagree that rant from behind anonymous IP addresses and never join the rest of us in writing this encyclopedia.  --Smokefoot (talk) 18:32, 3 March 2013 (UTC)
 * That's perhaps overbroad, Smokes: I'm sure that some of the anti-fluoridation folks who bombard this article have contributed useful edits on other topics. They just don't do it here, since they have The Truth™® and thus are impervious to mere scientific consensus. -- Orange Mike &#x007C;  Talk  02:11, 5 March 2013 (UTC)

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


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


 * Don't agree with Aspro, there are some good studies in the peer-reviewed literature that quantify the relationship between caries reduction and fluorosis (BMC Public Health. 2012 Dec 28;12:1122.) that account for socio-economic status as well. Also lots of cohort studies; the nature of the investigation would limit you to cohort studies. You may not find randomized controlled placebo controlled trials however, I think because you can't consent a population to randomization process in the case of water fluoridation.  There are many RCTs where fluoride from other delivery vehicles is given and, in my mind, the caries reduction potential is well proven but their is the risk of fluorosis.  I can find other references however, that a well matched cohort on a large sample is a very close approximation to randomization. Ian Furst (talk) 18:42, 20 February 2013 (UTC)
 * The reviews didn't find studies that in a scientific sense were good. Period. Don't disagree with me but with all those scientists that studied the available data.  --Aspro (talk) 19:38, 20 February 2013 (UTC)
 * There's not much point arguing about it - let's see if we can find a meta-study or review that includes good quality research. Tilapidated (talk) 19:49, 20 February 2013 (UTC)


 * This is not an “argument”. That requires a logical process and sound evidence that productive 'argument' requires; which in this case is sorely lacking.  That is the problem – good quality studies have yet not been done – so they is no hope of you finding them if the experts can’t find any because non have been conducted yet.--Aspro (talk) 21:35, 20 February 2013 (UTC)
 * What I mean is that there is no point arguing about this here - if what you say is true then we need solid academic sources who hold that opinion. Tilapidated (talk) 21:37, 20 February 2013 (UTC)


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

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

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


 * See the lead. "Water fluoridation" is controlled and artificial. "Fluoridated water" covers both but isn't the subject of the article. The difference is absolutely vital. Colin°Talk 20:32, 20 February 2013 (UTC)
 * Not so sure - fluoridated water is water that has fluoride added to it, either naturally or by a human process. Fluoridation is the process of adding fluoride, be it human or geological processes at work. Why is the distinction vital? Many of the issues are intertwined, for example the recommended amounts to be added to municipal systems, or removed from consumption depend on natural fluoridation processes. BTW "Fluoridated water" redirects to this page.
 * The term is commonly used to refer to natural processes - for example this CDC pamphlet - "Fluoridation: nature’s way to prevent tooth decay", and this study in the bmj, "Objective: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for." http://www.bmj.com/content/315/7107/514Tilapidated (talk) 20:49, 20 February 2013 (UTC)

This paper refers to "Currently about 49 % of the U.S. population is artificially fluoridated (hydrofluorosilicic acid, sodium silicofluoride and sodium fluoride) and 7 % have natural water fluoridation" http://www.xxfluoride.com/Dr_Russell_statement.cfm
 * "The only area in Scotland which did have naturally fluoridated water at 1ppm was on the Moray coast" http://www.sdmag.co.uk/index.php/articles/pm_article/public_health/
 * "Muskegon [not fluoridated] and nearby Aurora [naturally fluoridated at 1.4ppm]) (Bellemare 1979)" https://www.ucalgary.ca/PHIRC/pdf/Synthesis_flouridation.pdf
 * etc etc. Tilapidated (talk) 21:01, 20 February 2013 (UTC)


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


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


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


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


 * Re the York study - absolutely - I welcome your addition of more recent quality reviews, but the York study remains a major land-mark in the literature - I'd like to put together a section that includes the most important literature reviews and short summaries of their findings - I look forward to your contributions! What concerns me is that it seems that we are making statements that imply a consensus that I can't find in any serious reviews of the literature. Which more recent literature reviews are you most impressed by?
 * Tilapidated (talk) 21:56, 20 February 2013 (UTC)

Terminology
Given the common and technical uses of the term 'water fluoridation' include both natural water fluoridation and human water fluoridation, and given the importance of all sources of fluoride in water when discussing the topic, it seems prudent to adopt the standard language around this issue.
 * Natural water fluoridation, to refer to the process of fluoridation of water by (usually) geological means.
 * Community water fluoridation, to refer to the deliberate addition of fluoride for public health purposes.

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

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


 * Water can be fluoridated, naturally, but it has not undergone fluoridation.CDC That is the terminology.Novangelis (talk) 23:48, 20 February 2013 (UTC)
 * I appreciate your thoughtful contribution (that link appears to be broken, so I can't check it), but on what basis do you think the CDC should be the reference for terminology? In fact the CDC themselves use the term - they also use the term 'community water fluoridation' - for example here - http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#4
 * This British Medical Journal article is an example of common usage of 'natural water fluoridation', and 'artificial water fluoridation' when used in a trial to assess the effectiveness of each. This article in the Scottish Dental Magazine likewise follows the same pattern.
 * I wonder whether you are taking a slightly US centric view in assuming that a US public health agency should be the final arbitrator of this, rather than common global academic and professional usage? http://www.bmj.com/content/315/7107/514, http://www.sdmag.co.uk/index.php/articles/pm_article/public_health/
 * For more like this, see:
 * Ziegelbecker R. Natural water Fluoridation: Multifactorial Influence on Dental Caries in 21 Cities Study. XVIIth Conference of the International Society for fluoride Research. Budapest (Hungary) June 22-25 1989.
 * Here is a UK Royal College of Surgeons article that uses the term to make the important distinction. http://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/documents/discolor.pdf
 * Although most examples I have found that use the term 'natural water fluoridation', it is very common in the US to refer to deliberate fluoridation for public health purposes by the term 'Community water fluoridation'. One among very many is this one from the American Journal of Preventive Medicine. http://thecommunityguide.org/oral/oral-ajpm-ev-rev.pdf. They Define 'Community water fluoridation (CWF) as adjusting and monitoring fluoride in public water supplies to reach optimal fluoride concentrations in community drinking water.'
 * I'm interested in what you want to re-name the geological process by which water becomes fluoridated, if you don't want to allow the community the term 'natural water fluoridation'?
 * Tilapidated (talk) 23:52, 20 February 2013 (UTC)


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


 * I'm not sure that I follow your comments on 'fringe groups'. I don't have a 'quibble' - I've presented to you both a logical case for an improvement in clarity of meaning, and plenty of examples of this usage in academia and public health, and a question about why you think the CDC definition (which seems to be used inconsistently even by the CDC) should prevail even when it is confusing.
 * I'm not certain what your basis for objecting to this clarification could possibly be - perhaps you could outline any possible drawbacks you perceive to this clarification of terminology? Tilapidated (talk) 01:06, 21 February 2013 (UTC)


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


 * The point about fringe groups was that people with the critical reasoning skills of lint would have had no problems figuring out what this article had about before you edited. You made the article more confusing by changing the terminology to one that is inconsistent with the scope of the article, and was also inconsistent with the reference (which you obviously had not read). Adding a section that discusses alternate definitions in use might not be unreasonable assuming that formal, not inferred, definitions are used.Novangelis (talk) 02:08, 21 February 2013 (UTC)
 * Perhaps English isn't your first language, but I think I get the jist of your meaning. Unfortunately you didn't answer the bulk of the issues raised. I understand from your edits that you bring a strong point of view to this article, but please try to remain civil and focussed on the issue, which is that there is not one clear, official definition in use, and no clear reason to use the CDC one over any other (even the CDC mixes and matches). I'll work on a section discussing definitions. Tilapidated (talk) 02:20, 21 February 2013 (UTC)
 * Someone reverted my suggestion based on this discussion within 7 minutes of my making it without bothering to discuss, but I suppose you could go look in the change log. I have to say this is a surprisingly hostile page. Tilapidated (talk) 02:38, 21 February 2013 (UTC)
 * Please read/review WP:LEAD, the lead is the very last thing that gets updated. The lead summarizes what's in the article body, there should not be anything in the lead that isn't covered thoroughly in the article body.  Changing the lead to redefine the scope of the article without having the content in the article body already in place is a serious WP:MOS problem.  Please first get consensus here on the Talk page for your proposed changes (I do not see consensus here yet), then work on developing the content in the article body, and then the last thing to do is update the lead.  The reverse approach, which you appear to be trying to take, will find lots of opposition.    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)

Proposal to add some material on the scientific research to the 'science basis' section
Currently the article refers to the York Review explicitly, but does not deal with it in any systematic way. I propose a short section that outlines the largest and most significant reviews of research in this area, with a summary of their findings, which are typically much more nuanced than the statements in the article right now. Currently the article does not do justice to the methodological issues, data and analysis quality, and types of study. I feel that the three major studies proposed above would be a good start, but am very open to discussion about which ones are the most significant and scientifically rigorous. Tilapidated (talk) 16:28, 21 February 2013 (UTC)


 * The York report is from 2000, states "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence" and the evidence quality is described as "moderate". We also have multiple, other newer analyses and statements from major medical organization.  In particular we have a newer (NHMRC 2007) analysis from the Australian government, and after reviewing basically the same data, it states "The existing body of evidence strongly suggests that water fluoridation is beneficial at reducing dental caries".   This Australian NHMRC study specifically talks about the York analysis (McDonagh 2000).  We generally prefer the findings of the most up-to-date secondary sources.  Any changes proposed to the article in this area would have to based not only on McDonagh 2000 but also NHMRC 2007 and the several other newer reviews and meta-analyses available.  I cannot find any compelling reason to have the article feature McDonagh 2000 over the several other, newer sources we have.    20:10, 21 February 2013 (UTC)
 * The quote you mention is referenced in the article to a number of studies, including the York study, which clearly does not support it.
 * The article already does feature McDonagh 2000 over other newer reviews, and the authors' statement is from 2003. It also mentions the NHMRC, although gives it less text real-estate, then goes back to talk about a 2002 study. What I am proposing is that we update this to feature the various major literature reviews and their findings systematically, rather than in the rather haphazard way it is done now. I think the NHMRC review is significant, partly because it follows the same inclusion methodology as the York study, so it is directly comparable, although disapointingly it only adds one study to the York dataset. While many are referenced, pulling this one out in the text, and then misrepresenting what it says, seems odd. It sounds like you are agreeing with me? Tilapidated (talk) 22:54, 21 February 2013 (UTC)


 * Eubulides, the main author of this article till 2010 was fastidious about using the best and most up-to-date sources, and sticking closely to what they said. Hence the "strongly suggests" phrase comes exactly from the NHMRC 2007 source. As noted further up, the best encyclopaedic style is for us to state facts rather than argue the case in front of the reader. The reader has links to the sources of those facts if they wish to examine the reviews and studies in detail. It may be that we personally disagree with those sources or feel we could do a better review of the primary literature, but that is not our job and as Wikipedians we have limitations that don't exist in other publications. Where there are high quality reports or reviews published since 2010, then I would think they are worth examining. Such as the US lowering of the recommended levels in 2011. On a personal note, I've been struck down with a cold and my brain has turned to cotton wool -- so I may not be up to much for the next few days. Colin°Talk 21:17, 21 February 2013 (UTC)
 * Colin, the issue isn't whether any of us personally agree or disagree, but about presenting the range of findings in the serious literature. I find it strange that you would want to throw out literature reviews done before 2010, that certainly isn't normal practice, and Eubulides certainly didn't do that. Indeed some of the most useful research in this area comes from the 50s and 60s. The change over time of findings, interpretation, and methodologies is useful in understanding how policy has changed over time. The York dataset is essentially the same (with one fewer study) so the differences in findings language seems interesting. The fact that two respected groups can come up with reviews of essentially the same studies, and come up with completely different results is very significant. To obscure that is to mislead the reader into thinking that the science is uniformly interpreted. Tilapidated (talk) 22:54, 21 February 2013 (UTC)
 * I agree with Colin about the style of the presentation. IMHO, "a short section that outlines the largest and most significant reviews of research in this area" would be unwise because we get into cherry picking of "significant reviews" and of phrases from those reviews. I also think that as an encyclopedia, Wikipedia has useful scholarly inertia, it does not report the latest review ([{WP:NOTNEWS]]) especially in an area where there are virulent fringe groups (like the infamous Fluoride Action Network).  And I worry about taking advice from new, single issue editors.  What is lacking in this article are citations to mainline dental textbooks. But I am jumping into a long conversation, I can see.  --Smokefoot (talk) 23:28, 21 February 2013 (UTC)
 * Hi there Smokefoot - I'd encourage you to try to set aside your prejudices and think instead about the issue. I'm a little disturbed by your comments - we already have the section that you think is unwise, it's just that currently is rambling and does not really do justice to any of the reviews it cites, cherry-picking, as you warn against. The section is really not a news report - the latest review that is significant is a couple of years old as far as I can see. I don't think anyone is mentioning campaign groups, we're talking about peer reviewed scholarship in mainstream journals. I don't really see any dispute here about the type of study that would qualify for such as section. Hope that clarifies! Tilapidated (talk) 00:02, 22 February 2013 (UTC)
 * Tilapidated, where have I said I "want to throw out literature reviews done before 2010". We will not make progress with such nonsense misinterpretations. Slow down. Read the whole article. Read the existing sources. Read what other people are actually saying. I'm saying this article is almost certainly good wrt any sources published up to 2010 but may be lacking in newer sources. Therefore my priority is to consider if there is anything new to report because I'm very doubtful that rehashing reports from 2000, no matter how important they may be, will bring new light. Colin°Talk 14:09, 22 February 2013 (UTC)
 * Hi Colin - it was you saying that you wanted to use only the most up-to date sources, and that 'Where there are high quality reports or reviews published since 2010, then I would think they are worth examining.' that led me to believe you were not interested in sources pre 2010. I'm glad I misunderstood you! I'm not sure what you mean by 'rehashing', but as you most likely know, research is iterative. Eubulides referenced the York study (I imagine) because it remains one of the most significant reviews. Subsequent studies have often adopted the same inclusion methodology, and draw heavily from it. The MHMRC study reanalyses (rehashes, if you will) largely the same dataset. ;) Tilapidated (talk) 16:50, 22 February 2013 (UTC)

Changes to the effectiveness section
I made some minor edits to split paragraphs, and removed a sentence from the section on the York review that was in direct contradiction to the text of the review. I removed:
 * which is roughly equivalent to preventing 40% of cavities.

because the text of the York Review (page xii) says 'The degree to which caries is reduced, however, is not clear from the data available.' The quote refers to topical fluorides, and is original research in direct contradiction of the study in question.

It appears that TippyGoomba reverted the change within four minutes of my making it, of course without commenting here, claiming that there is no consensus for the change. So - I guess the question is - is there a consensus that clear factual errors in citation remain on the page? Thanks.Tilapidated (talk) 02:14, 22 February 2013 (UTC)


 * OK Tippy - that's now twice you've reverted without discussion in the same few minutes. Since you posted a link to the BRD, please do explain your commitment to keeping errors of fact in the article. Thanks, Tilapidated (talk) 02:47, 22 February 2013 (UTC)


 * I'm not Tippy but here's my observation - The edit under discussion made this change:"...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), which is roughly equivalent to preventing 40% of cavities., but found that the degree to which caries were reduced was not clear from the data available."I agree with the revert of this change, because it appears to make the article self-contradictory. The previous sentence explained the degree to which caries were reduced, and so it's incongruous to follow that up with a statement that the degree to which caries were reduced wasn't determinable.  The statement that the York report "found that the degree to which caries were reduced was not clear" isn't an accurate representation of the source.  I don't find a problem with the use of .   02:48, 22 February 2013 (UTC)


 * So Zad - I have a couple of questions for you: in what respect is "the degree to which caries were reduced was not clear from the data available." (my summary) not an accurate representation of the source text "'The degree to which caries is reduced, however, is not clear from the data available."?
 * I think there is confusion around the stated ranges of observations in the studies with the degree of claimed reductions in caries that the analysis supports. While they report the observations, the data quality and ranges make it impossible for the study authors to specify the real reductions. They say this clearly in the review. To splice in our own analysis from another study is not only original research, it's poor quality original research.
 * The statements are not contradictory - one statement reports values, the other conclusions that can be drawn from them. We can't remove the conclusions that the original authors came to and replace them with our own because we don't like the original ones. Tilapidated (talk) 02:55, 22 February 2013 (UTC)


 * Here - to be clear, is the whole original quote from the study (page xii) "The studies were of moderate quality (level B), but of limited quantity. The degree to which caries is reduced, however, is not clear from the data available. The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%)." The two statements are not contradictory, and are taken directly from the source. Tilapidated (talk) 03:04, 22 February 2013 (UTC)
 * Again with the cherry picking. TippyGoomba (talk) 04:10, 22 February 2013 (UTC)
 * I think perhaps that term doesn't mean what you think it means. That is the whole of the relevant quote from the original study that is referenced in the article. Perhaps you could show me where in the review there is more context that changes the meaning of the statement "The degree to which caries is reduced, however, is not clear from the data available.'? Tilapidated (talk) 04:13, 22 February 2013 (UTC)
 * You are reading the sources for quotes which serve your agenda. That's cherry picking. Now you're asking me to cherry pick my own quotes. Cute game, shall we play for shots? TippyGoomba (talk) 04:18, 22 February 2013 (UTC)
 * I'm sorry - I'm not able to understand you at all. The article version that you reverted to takes a quote from the York Review "The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%)", then cuts in a completely different claim about the number of carries that is reduced, referencing a topical fluoride study. That is what 'cherry picking' refers to - taking the pieces that you want from two different studies, and pasting them together to form a meaning not found in the original. The complete quote from the original study is what I included - that is the opposite of cherry picking. Tilapidated (talk) 04:22, 22 February 2013 (UTC)
 * Regarding the York study results, I think what I'm trying to get at is that we need to re-present the technical information the study gives us in a way that's accurate but also meaningful to a layperson, our intended audience. The lack of clarity (I would say precision) in the York summary is expressed in the large ranges of the means, and this is faithfully represented in our article, and then a layperson-friendly equivalent is given.  The "roughly 40%" isn't out of line with what other reputable sources say, for example the ADA says "Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20 – 40%", this large study from Australia found about a 30% reduction.  It's reasonable to take the study's description of the effects as imprecise, put the ranges in the article, and use language that expresses that level of impreciseness in providing a lay-friendly interpretation.  P.S.  The Princess Bride was one of my favorite movies!   04:20, 22 February 2013 (UTC)
 * The way that the paragraph reads right now implies that the York Review shows 40%. If you want to put another paragraph in about another study that shows a 40% reduction that's great, but what I was correcting is the addition of a comment to the findings of the York Study, the authors of which specifically say in the same paragraph in which they report the ranges, that the degree of reduction of caries is impossible to report from their data set. It's not lay-friendly to replace their conclusion with someone elses - it's in direct contradiction of their conclusion. Tilapidated (talk) 04:27, 22 February 2013 (UTC)


 * You missed my zoidberg :P TippyGoomba (talk) 04:25, 22 February 2013 (UTC)
 * How did a Futurama ref blow by me?? Must be bedtime...   04:28, 22 February 2013 (UTC)


 * OK - lets try this - does anyone dispute that the original review says 'The degree to which caries is reduced, however, is not clear from the data available.", and that they are talking about the ranges they report?
 * If so, that's pretty easy to fix. If not, please explain why it's ok to remove their conclusion, and replace another one from a completely different study? Tilapidated (talk) 04:30, 22 February 2013 (UTC)

The source text "The degree to which caries is reduced, however, is not clear from the data available" is not a "conclusion" but an introductory clause to their more detailed figures of the range/median etc. The words "not clear" are unhelpful imo. I can see what they are saying but the reader will too easily confuse that with "might be nonsense" -- scientists fall over themselves to clarify the uncertainties in their research, and this is often interpreted by the public as them not really having a clue or changing their minds all the time (is red wine good or bad for me this week?). As Zad notes, it is lack of precision that upsets the York authors, not whether there is a reduction at all. We already give (almost too much) detail on the statistics. I propose our version of this clause says "although the degree to which caries was reduced varied considerably in the studies examined." This is imo a fine introduction and lay summary of the rather complex statistics that follow. Colin°Talk 14:57, 22 February 2013 (UTC)


 * Hi Colin - I understand that you don't like the conclusions that the York Review authors came to, I just think it's not appropriate to change their conclusions, and substitute ones we prefer. When they use 'not clear' they are expressing uncertainty about the ability to specify a reduction in caries based on the available data. It's not simply a lack of precision, some of the studies show an increase in caries from fluoridated water (-5.0 to 64%) so it's not simply that there is a problem about specifying degree of reduction. It's really important to try to understand the difference between a reported range (which is what the numbers are) and conclusions that are drawn from that. The York team are explicit that they cannot make any claim about the degree to which caries are reduced based on their data.
 * Perhaps you want more evidence that this is not simply an obtuse reading of the paper? Let's go to their statement, three years later, where they clarify their findings. "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." http://www.york.ac.uk/inst/crd/fluoridnew.htm
 * I would propose that statement as a clear, layman's explanation of what they found. Tilapidated (talk) 16:59, 22 February 2013 (UTC)

Worthington
Colin - for clarity I created a new section here - I hope you don't mind me splitting your post - let me know if you do and I will restore it. Tilapidated (talk) 17:01, 22 February 2013 (UTC)
 * Wrt to the 40% figure from Worthington2003:
 * "Other researchers claim that fluoridation results in a reduction of 40% in cavities. "

Does anyone here have access to that paper? Although it is ostensibly about topical fluoride, I can only assume that the 40% figure is those authors' interpretation of the York review data, otherwise it wouldn't have been spliced into that paragraph. Or perhaps they cite yet another source for that figure. We need to get to the bottom of that. Btw, we should avoid using the word "claim" for results coming from reliable secondary sources because it implies we may not believe them. That word should be used with caution and only where we are talking about "facts" stated by unreliable sources. For example, Wakefield's claims about autism. Therefore I propose we remove that sentence/source from the article text until someone with access to it can convince us of why it should be included. Colin°Talk 14:57, 22 February 2013 (UTC)
 * I have no idea why a reference to a study about topical fluoride was added, I can only assume, as you do, that it was citing the York study, but that's not clear. Either way, what's important to me is that we make clear who is making what claim.
 * I take your point on the word 'claim', and am happy to remove it - I certainly believe them, and put it in because I felt you did not. Consider that the term has a technical usage too that may be appropriate here as we deal with several different studies that assert different things. We're not doubting any of the studies, simply dealing with the fact that different researchers find different results and draw different conclusions. Tilapidated (talk) 17:05, 22 February 2013 (UTC)
 * I have found another source based on Worthington here page 6. The 40% figure is a calculation based on York's 2.25 teeth median figure. Therefore it is valid expert interpretation of the York data and quite acceptable to be spliced into that paragraph. Colin°Talk 17:36, 22 February 2013 (UTC)
 * Colin, that's completely disingenuous. It's fine to have a sentence saying that some other researcher chosen to draw different conclusions than the authors of the study, but cherry picking the beginning and ending of the sentence from different places, directly contradicting the meaning of the original author is ridiculous. Tilapidated (talk) 17:47, 22 February 2013 (UTC)
 * I'm going to see if I get hold of Worthington. Until one of us has actually read it, please hold your tongue. Colin°Talk 17:54, 22 February 2013 (UTC)