The Real Facts on Water Fluoridation

Jenson Hagen

According to the CDC, Oregon has the 8th lowest incidence of tooth destruction due to “tooth decay or gum disease” when isolating the 65+ population despite only 27.4% of all Oregonians drinking fluoridated water. In fact, the states with the lowest rates of water fluoridation have the least amount of tooth destruction with a positive .52 correlation. Only 8.4% of Hawaii’s population receives fluoridated water, yet Hawaii has the lowest incidence of tooth destruction according to CDC’s own data.

Could there be an economic reason for this? I ran correlations on state GDP, water fluoridation, and tooth destruction, finding the data to be spurious. A state’s economic status did NOT bear a close relationship to water fluoridation levels or tooth destruction.

I did find high correlations between water fluoridation rates and tooth destruction, meaning the states with the highest fluoridation rates had the highest rates of tooth destruction—these are most of the states that meet the Healthy People 2010 goal of fluoridating 75% of the population’s water. The Brunelle and Carlos study of 1990 showed that cavity rates did not vary much in states with high water fluoridation rates because of the spillover effect from the transportation of fluoridated beverages to nonfluoridated areas. Although people in these states are being exposed to water fluoridation indirectly and directly, the rate of tooth destruction is higher for the entire state.

How can tooth destruction happen? Normal bone matrix is made with very strong hydroxyapatite. The inclusion of fluoride creates fluorohydroxyapatite, a substance more capable of resisting bacterial decay, but much weaker structurally. The American Dental Association in its fluoride fact paper cites that water fluoridation contributes to a 10% greater rate of fluorosis, which is considered the level where fluoridation is considered excessive. The Institute of Medicine Committee on the Scientific Evaluation of Dietary Reference Intakes’ review of water fluoridation led to the optimal range of .7 to 1.2 ppm. This range was formulated assuming that dietary fluoride would contribute an additional .5 ppm. Added together, 1.7 ppm was considered the optimal “safe” level of fluoride before the “threshold for a problem of public health significance.” This is also the highest rate considered safe for infants. It’s very easy for a person to consume more than 1.7 ppm of fluoride after drinking fluoridated water calibrated to a different area through the spillover effect, ingesting fluoridated dental care products (children) or fluoride supplements, or eating a nonaverage diet where the level of fluoride is greater than .5 ppm.

The Institute of Medicine also states: “Many studies conducted prior to availability of fluoride-containing dental products demonstrated that dietary fluoride exposure is beneficial, owing to its ability to inhibit the development of caries in both children and adults (Russell and Elgrove 1951). “ Well, let’s take a look at the Russell and Elgrove study.

The authors first studied a NY city where rates of 1 ppm showed a reduction of 8%, a barely statistically significant amount. An examination of a CO city with rates of 2.5 ppm, twice the recommended water fluoridation rate, resulted in a 14% decrease in dental events. The authors also concluded: “[The findings] are not adequate to support a hypothesis that use of a fluoride water results in improved health of periodontal tissue.”

The ADA claims that there are no credible studies that show a negative health effect of fluoride whereby they simply discredit any study that shows any negative effect. I found on PubMed several credible studies that showed fluoride increases the virulence of Strep mutans and increases risks for people with chronic kidney disease. The ADA claims that dialysis occurs with nonfluoridated water so it’s not a concern, but they ignore the fact that people with chronic kidney disease ingest water apart from dialysis. There are no studies referencing multiple myeloma except for the University of Tokyo study on cancer that the ADA dismisses as poorly designed. The problem with comparing nonfluoridated areas to fluoridated areas in time regression analysis, which CDC often cites, is the growing spillover effect from widespread beverage distribution.

The CDC claims that water fluoridation saves $38 for every $1 spent. This study used data from the 1980s using a discount rate of 4% despite inflation rates ranging from 12-16%. The study also assumes that one hour of wages is lost for every tooth cavity filled—5 cavities in total. This wage rate does not take into account people that can see a dentist on a day off or use paid days-off. Reading the study, the $38 figure represents a best-case scenario. The worst-case scenario shows a benefit of $3.52 using a discount rate of 8%. If we used real inflation rates from the 1980s, there would be no benefit under the worst-case scenario.

A Portland resident will spend $51.64 on water fluoridation over a 75-year lifespan using Portland’s budget estimates. Using this $38 cost-benefit claim, we would generate $1,962 in dental savings per person. If we assume that lost wages and dental costs average $170 (CDC study uses $72 in 1995 terms) to get a cavity filled, we would save enough to fill 11.54 cavities. A slight overestimation since the average person never gets 11.54 total cavities filled over their lifetime. Assuming that we fill 5 fewer cavities as the CDC study claims and a cavity costs $170 to fill, we save 16x in relation to what we invest under the best-case scenario. If we have cost overruns beyond budget estimates, we experience an increase in tooth destruction, or we experience less than a 5-cavity reduction, then this best-case scenario would not manifest.

The cost-benefit could be negative if we experience more tooth destruction from water fluoridation. If we ignore tooth destruction and we actually achieve optimal levels of cavity prevention, then the total we save on our overall dental care is only 3.4% at best using national dental statistics of $333 spent per person/year. We do not save money on more expensive procedures related to periodontal tissue or from extreme tooth decay caused by lack of access to dentists.

I will admit that reducing cavities is important because of toxic elements in fillings. However, if we experience an increase in tooth destruction, then the amount of metal placed in our mouths from caps will be much higher than what a few cavities would involve. The best preventative measure is access to dental care, better dental practices, and a proper diet. I would much rather invest in these measures, even if they cost more, because they are the only proven way of decreasing cavities, periodontal disease, tooth destruction, and myriad other health problems we face.

Comments

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    Fluoridation is not about making sure people in their 60s don't get cavities, I don't think.

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      Community water fluoridation prevents cavities on the exposed root surfaces of the elderly

      See: J Public Health Dent. 1989 Summer;49(3):138-41. Effect of residence in a fluoridated community on the incidence of coronal and root caries in an older adult population. Hunt RJ et al

      Adults benefit by saving 0.29 tooth surface for every year of fluoridated water consumed.

      S.O. Griffin et al J Dent Res 86(5):410-415, 2007, Effectiveness of Fluoride in Preventing Caries in Adults

      This just scratches the surface of a large literature.

      So, in fact the entire community benefits, including the children.

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        I've seen the studies attesting to cavity reduction. I agree with their conclusions. Have you seen the studies attesting to increased bone fractures in fluoridated areas? I would love to hear you try to debunk those which no one is able to do in this entire post.

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          Recent studies that optimal fluoride concentration to be safe for bone health.

          A very large multicenter prospective study on risk factors for osteoporosis & fractures concluded "Long term exposure to fluoridated drinking water does not increase the risk of fracture."

          BMJ. 2000 Oct 7;321:844-5 Community water fluoridation, bone mineral density, & fractures: prospective study of effects in older women. Phipps KR, et al

          Systematic reviews agree that overall the studies of bone fracture effects show small variations around the "no effect" mark.

          Li et al found more fractures occurring with both lower & higher concentrations than optimal.

          "A U-shaped pattern was detected for the relationship between the prevalence of bone fracture and water fluoride level. The prevalence of overall bone fracture was lowest in the population of 1.00 - 1.06 ppm fluoride in drinking water, which was significantly lower (p < 0.05) than that of the groups exposed to water fluoride levels >4.32 and <0.34 ppm."

          J Bone Miner Res. 2001 May;16(5):932-9. Effect of long-term exposure to fluoride in drinking water on risks of bone fractures. Li Y, et al

          An article coauthored by the antifluoridationist dental professor Hardy Limeback judged the Li paper conclusive. That paper found no significant differences in hip bone strength comparing life-long residents of non-fluoridated Montreal & fluoridated Toronto.

          J Dent Res. 2010 Nov;89(11):1219-23. The long-term effects of water fluoridation on the human skeleton. Chachra D, Limeback H, et al

          Summarizing:

          1. CWF with optimal fluoride is associated with FEWER fractures than both higher & lower
          2. Lifelong fluoridated water intake causes no measurable change in bone strength
    • (Show?)

      And guess what, most of those people in their 60s in Oregon were born outside the state and most likely drank fluoridated water growing up! (For the last century, a majority of Oregonians were born outside the state.)

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    Jenson, are you a dentist?

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    There's plenty of science to support both sides of the fluoridation question. None of us here will be able to resolve the conflicting research.

    The issue in Portland isn't about fluoride. It's about the fact that five people, two of them lame ducks, made the decision to put this particular chemical into everyone's bodies without asking. Three of decision makers announced their decision before hearing any input from the broad public. Pretty rude, if you ask me.

    It's not about fluoridation. It's about democracy.

    And sometimes democracy is about revenge at the polls against unresponsive office-holders. Here's how to take revenge for this miscarriage of democratic process:

    1) Sign the fluoridation referendum petition and vote for it in 2014 when it appears on the ballot.

    2) In November, vote against Commissioner Amanda Fritz, who could have sought an amendment for the Council to bring the question to a public vote, but didn't.

    3) Also vote against all of the Council's ballot proposals: Amendments to the city charter and also the new income tax for the arts. (School bonds are a different matter entirely -- the Council isn't involved.)

    4) Unfriend lame-duck Mayor Adams on Facebook, exit his Twitter feed and mark his email as spam.

    5) Remove lame-duck Commissioner Leonard from your Christmas card list.

    6) In 2014, vote against Commissioner Fish, who sponsored the fluoridation measure and made up his mind in advance of public input, and Commissioner Saltzman, who supported the measure and didn't ask for a popular vote or at the least more extensive public dialog.

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      7). Carry a sign at Pioneer Square opposing everyone and everything, except Mitch McConnell.

      8). Get off my lawn.

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      Yeah, we aren't going to be able to wade through the research. But, you know what? There are at least 6 expert committees who have already reviewed all the science. And, they have all concluded that fluoridation is safe and very effective at reducing tooth decay. See: http://www.cdc.gov/fluoridation/safety/systematic.htm

      It is hubris to think we can read a couple studies off the internet and think we know better than all the health authorities in the country.

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        No, I agree that it will reduce tooth decay. But it won't fill the cavities that children still get, and it will contribute to other health issues, namely systemic fluorosis.

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          disregarding the fluorosis argument, what's your point? That a good thing that doesn't take care of every single problem ought to be avoided?

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          All five of the expert committees in my previous link have concluded that there is no risk of systemic fluorosis or any other health impact from fluoridation at 0.7ppm. The only issue is a slight increase in mild fluorosis which is not a health issue, and is a very minor cosmetic issue. A significant reduction in cavities far outweighs a very minor cosmetic issue that can usually only be identified by a dentist.

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          Smoke alarms alone don't detect dangerous levels of carbon monoxide. Does that make them an invaluable addition to any home or apartment?

          Fluoridation helps prevent cavities, but like any disease, it requires a multipronged approach. Treatment of Type I diabetes is more than just taking insulin, but also must include diet and exercise.

          Fluorosis is NOT a disease, and anyone who has questionable, very mild, or mild fluorosis (barely noticeable by anyone other than a trained health professional, enjoys the protection afforded by water fluoridation.

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      The reason we have a city council is so that they make complex decisions based on evidence, not bad science. This is NOT about the process. City council makes LOTS of decisions without us having voted on them. I don't recall having a public vote when it was decided to add chlorine to our water.

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        Well, Michael, actually, the reason we have a city council is to represent us, as in representative democracy.

        Personally, I'm all for fluoridation. But a lot of people aren't. It's really unseemly to push this through with such haste and with so little public input. I mean, it has a big impact people, and the reasonable thing for elected officials to do is to educate and ask.

        Unless, of course, they're arrogant in their power. In that case, they can get up and say, along with Nick Fish, that they were elected to make the tough decisions, and then maybe sing a chorus or two of "Macho Man".

        Contrast the way fluoridation was handled with how the council handled the Portland Plan -- meetings all over the city, extensive citizen input. I was really proud of how our city government handled that.

        Fluoridation, not so much.

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      Dear Mr. Bovee: There is a good way to weigh the research on fluoridation. It's call the systematic review. Several of these have been done by scientific organizations and determined fluoridation to be safe and beneficial.

      The councilors were elected to make routine decisions such as fluoridation. You want to vote on everything that water engineers to do to provide good drinking water to your tap? Or would you want raw sewage delivered for you to treat yourself?

      Seriously, there are already fluoride ions in the water, just a few more, say the scientists, is of great benefit.

      This is simply an issue where a handful of deceptive anti-fluoridationists have created a public hysteria. These are the same people who make films about the nation being intentionally poisoned by airplane contrails and vaccination, and "End Times."

      Being anti-fluoridation is like being anti-calcium or anti-iron, which are two other minerals in all our drinking water.

      Your recommendations are not geared toward making a better community or democratic process. You are old enough to know that revenge is never satisfying and often a misguided emotional response. This is about micro-managing the city council.

      One question for you: There never would have been a petition drive if the councilors had voted with the fluorophobes on this issue, would there?

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        There never would have been a petition drive if the councilors had voted with the fluorophobes on this issue, would there?

        Certainly not, because very few citizens are enthusiastic about having the water supply fluoridated, while many oppose it strongly.

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      When the city councils of Calgary, AB, Juneau and Fairbanks, AK voted out fluoridation without a vote by the people, there wasn't a peep out of the opponents to fluoridation. Now, you are whining that you should be able to vote on the issue.

      We never voted on adding Vitamin A or D to foods. Both of these vitamins can be toxic. We never voted to add folic acid to bread products to protect neural tube defects.

      Regarding the 3 previous votes in Portland on fluoridation, opponents have omitted an important 4th vote. In November, 1978 (mid-term election), the registered voters of Portland voted in fluoridation. However, at that time three of the city council members were opposed to fluoridation, whom one of them was in charge of the water bureau.

      Although the fluoridation equipment was purchased, the 3 city council members helped delay implementation, allowing the opponents to gather signatures for the May, 1980 election, knowing that there would be a low turnout.

      With a whopping 19% of the registered voters turning up a their polling stations, and every opponent to fluoridation voting, fluoridation was never implemented.

      41 years ago, Seattle went through a fluoridation campaign, and the hysteria, personal freedom rants, and fear mongering was no different than I'm seeing today in Portland. Now, when I go up to visit my daughter, who lives in fluoridated Seattle, I smile when I see folks drinking fluoridated water in nice restaurants, drinking Starbuck's coffee made with fluoridated water, eating Ivar's clam chowder made with fluoridated water, drinking Manny's Pale Ale brewed with Seattle water, and no one having a second thought.

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    Dude, it's time to take off the tin foil hat.

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    Jenson, I'm all for DIY statistics so long as you're open to criticism.

    Why are you comparing current fluoridation rates to tooth decay in the elderly? Fluoridation practices were a lot different when someone over 65 today was growing up. Also, people tend to move, with fewer than half of those over 65 living in the state in which they were born.

    I think what you're picking up is noise.

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      Thanks for the great question. I'm looking at the 65+ because it shows totals for a person's lifetime. Tooth decay tends to occur somewhat constant so looking at this age group versus another does not matter a tremendous amount. Noise? Probably not with this level of correlation and distribution. The high states to low states is a 20% spread. People move? Yes, but you can see that regions are somewhat uniform, and that's supported by the Brunelle and Carlos study as well. People might move across states, but it's usually a close move like Oregon to Washington versus across country to Florida.

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        Oh and the 65+ community is better to look at because they wouldn't be as tainted from the spillover effect of beverage distribution when looking at their total lifetimes versus say a 7 year old.

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      How many are destroyed through fluorosis? That's really what I'd like to know.

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        The answer to that is none. Only severe fluorosis destroys teeth. In the Brunelle and Carlos data there were only a little over 400 cases nation wide. We have 60+ years of good data showing that if water fluoride is below 2 ppm severe fluorosis is prevented. The 2006 NRC news conference is a convenient reference for this: www.nap.edu/webcast/webcast_detail.php?webcast_id=325

        The fluorosis associated with 0.7 ppm is the type which in the vast majority of cases requires a professional examination to detect. New research shows that this type of fluorosis actually protects teeth from cavities.

        Here is the last sentence from that paper in which the author argues for less concern over this issue in considering water fluoridation policy.

        "The results highlight the need for those considering policies regarding reduction in fluoride exposure to take into consideration the caries-preventive benefits associated with milder forms of enamel fluorosis."

        J Am Dent Assoc. 2009 Jul;140(7):855-62. The association between enamel fluorosis and dental caries in U.S. schoolchildren. Iida H, Kumar JV. http://www.ncbi.nlm.nih.gov/pubmed/19571049

        The main cause of fluorosis in the US now are inappropriate tooth brushing in childhood and inappropriate supplement prescriptions. The dental profession has recognized this and the toothpaste label is as it is from their lobbying the FDA. There is evidence that promotion of proper brushing and prescribing practices will decrease dental fluorosis.

        see: JADA Continuing Education: The Risk of Enamel Fluorosis and Caries Among Norwegian Children: Implications for Norway and the United States Pendrys DG et al JADA April 2010 141(4): 401-414

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    It is overwhelmingly likely that the $38 estimate on fluoridation's return on investment is low.

    The author assumed that the only treatment used to maintain cavity restorations were amalgam (silver) fillings and extractions. None of the expenses of modern restorative and dental prosthetics were included - no root canals, no crowns, no bridges, no implants. Hopefully the study will soon be repeated with cost estimates which reflect the true lifetime costs of a cavity.

    The Delta Dental Insurance company analyzed actual bills and found that a molar cavity contracted as a 10 year old has a life time cost of $2,187 (2003 dollars). The life time operating costs of fluoridation per citizen you cite is only $52, very small in comparison.

    There are simply no data to support your hypothetical that 0.7 ppm fluoride causes more dental disease. The literature supporting fluoridation's effective is large and robust.

    If you search pub med for fluoride you get about 45,000 hits; for fluoridation about 6,000. It is obvious that with a literature of this size that selective citations will appear to make a case that community water fluoridation is both ineffective and dangerous. It is equally obvious that the medical, dental and public health experts with training and experience to judge the entire literature overwhelmingly recommend it.

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      The tiny percentage of individuals who get mild fluorosis aren't even aware they have this horrible affliction.

      The National Health and Nutrition Examination Survey (NHANES) program at the Centers for Disease Control (CDC) survey from 1999-2002 found an overall dental fluorosis rate of 32 percent among U.S. school children aged 6 to 19 years old (CDC 2005a, CDC 2005b).

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          Bones, as well as teeth, suffer fluorosis. It is considered a disease of the sleletal system. Fuorosis increases incidence of broken hips and vertebrae in the elderly,not a minor problem.

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      Paul, you've got to think before you comment. The 10% assumes kids are drinking optimally fluoridated water and nothing else. What do you know about fluoride and kids? Kids eat fluoridated toothpaste because it tastes good. They get way more than what the CDC and others consider "safe"

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        Jenson

        Are you or are you not claiming that there is a connection between mild fluorosis and tooth destruction?

        You've been corrected on the ADA report which you distorted in your posting. Chuck Haynie has cited additional reports. Yet you refuse to retract your misleading claim.

        I stand by the final line in my posting.

        <hr/>

        What do I know about fluoride and kids? I've raised five of them and none of them eat toothpaste. How many have you raised?

        Do you have any other hard data indicating there is a problem with children eating toothpaste, or is this like your claim that you know what's in everyone's refrigerator, something you are just making up?

        But I digress by citing an anecdote . Can we stick to facts, please, not stuff we just make up?

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      Mel, I thought you were intelligent until I read this comment. So are all Hawaiians about to die because of the high sodium content in the ocean. Ha!

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        Jenson,

        Please don't misquote my post.

        My main point is that you are ignoring all sorts of factors that would bias the results. That is why trained epidemiologists analyze the studies to assess affects. For example, in Mexico higher rates of smoking have actually been associated with lower rates of lung cancer. Does that mean that for Mexicans smoking actually prevents lung cancer? No! The reason is that most people in Mexico City don't smoke, but they are exposed to many air pollutants. That is why we need to control for other factors, and I mentioned three major factors that you are ignoring, but there are many more.

        In regards to Hawaii, I said "dietary" intake is higher for Hawaiians. Fish that comes from the ocean naturally has high levels of fluoride. In addition, volcanic soils are higher in fluoride, so all of these factors make the dietary intake of fluoride much higher in Hawaii than on the mainland. You can see in this table below that fish is among the highest sources of fluoride, and this doesn't even differentiate between ocean fish and fresh water fish. Ocean fish is higher.

        http://www.fortcollinscwa.org/pages/fluoride.htm

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    I came to this party thinking fluoridation was an obvious choice and the opponents were conspiracy theorists. So I got online and looked for research supporting the benefits of fluoridation. Couldn't really find much. There was a paper published in the UK around 2000 that was a survey of all the available studies at the time, that also rated the studies for the quality. Taking only the more reliable studies they ended up with fairly inconclusive results. - no clear benefit.

    So I'm not sure now this is such a hot idea. If we're going to do it, then I think OHSU should set up a really well designed study with good baseline data. In 6 years or so, we can look at the results and see if we want to continue the program.

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      John there is lots of data on the CDC web site.

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      Thank you John. We can go back and forth forever with all these studies floating out there. Let's review studies that are relevant to us and how we will benefit and not benefit. I fear that the potentially drawbacks are real and they need to be more closely addressed before dumping fluoride into everyone's water.

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      You should read and study the huge Louisiana study which showed that about 66% of the operations on little preschool kids for mouth fulls of cavities are prevented with community water fluoridation.

      http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4834a2.htm

      A very recent economic modeling study showed that fluoridation is by far the most cost effective of all the public health interventions available to address this problem.

      http://www.ncbi.nlm.nih.gov/pubmed/22380939

      Prev Chronic Dis. 2012 Mar;9: A simulation model for designing effective interventions in early childhood caries. Hirsch GB, et al

      If you are of a mind to find some non-USA information you might find the systematic review by the Australian Government useful:

      http://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/eh41_1.pdf

      Systematic reviews are the most valid scientific approach to large literatures surrounded by controversy.

      Then of course there is the very long list of professional medical, dental and public health organizations advocating fluoridation. It is kind of tough for me to understand how, for example, the American Academy of Pediatrics would recommend a worthless intervention.

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    I pretty much ignore any essay or article that is headed "The Real Facts..." about anything. Ditto "The True Facts...". Sorry but that in itself indicated fuzzy thinking.

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      Yet despite all their problems with cavities and no access to dentists, they have the lowest rate of tooth destruction per my first link. That's interesting that you brushed over the CDC's link.

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      There is an interesting contradiction here. While Hawaii children may have a high level of tooth decay, for some unexplained reason they are much more likely to keep their teeth when they get old compared to fluoridated states. The same thing seems to be happening in Oregon. I haven't seen the fluoridationists trying to explain this away so far. Have they?

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    If Portland refuses fluoridation – the greatest public health measure next to vaccination – this city will gain the reputation of being a scientific backwater. How many high tech companies do you think that's going to attract?

    Portland citizens should show that they understand and respect good science as guiding their public decisions...and appreciate councilors who are wise enough to do likewise.

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    In 9 years of actively promoting fluoridation's benefits I've changed exactly one person's mind about this . .she was a teacher who had to listen to my dental health lecture a number of years running. She finally decided her instance in water "her way" was self-centered and harmful to the community's greater good.

    An article titled "Can we stop lies from becoming facts?" in salon.com today clearly states the problem.

    Quoting

    "You have to be careful when you correct misinformation that you don't inadvertently strengthen it," says Stephan Lewandowsky, a psychologist at the University of Western Australia in Perth and one of the paper’s authors. "“If the issues go to the heart of people’s deeply held world views, they become more entrenched in their opinions if you try to update their thinking.:"

    Psychologists call this reaction belief perseverance: maintaining your original opinions in the face of overwhelming data that contradicts your beliefs. Everyone does it, but we are especially vulnerable when invalidated beliefs form a key part of how we narrate our lives.

    see: http://www.salon.com/2012/10/04/can_we_stop_lies_from_becoming_facts/

    The public health scientific literature includes an Australian article with a similar thesis.

    Risk perception and water fluoridation support and opposition in Australia,Armfield JM et al, Journal of Public Health Dentistry 144(2010) 58..66

    The Believing Brain is a popular book describing the tenacity with which people keep their political beliefs. The more intelligent, the more unshakable the beliefs.

    I believe the challenge for political progressives, whose core view must surely include concern for improving the general health and blunting socioeconomic disadvantage, is to find ways to decrease the outrage persons to who see fluoridation as a scheme by phosphate fertilizer corporations to bring an uninvited and unwanted chemical into their homes and bodies.

    These arguments over the science details do not reach the crux of the controversy.

    The Oregonian's Editorial opinion well stated a message which hopefully even the most offended Portlander can hear.

    To believe fluoridation's opponents one must belief "That state and federal health agencies are, for some mysterious reason, hiding the truth and helping to poison more than 200 million citizens, aided by the American Dental Association and, we guess, credulous editorial boards like The Oregonian's. While we don't consider any of these groups infallible, or even close, it's far more likely that fluoridation receives so much mainstream support because it does exactly what it's supposed to. It reduces the incidence of cavities."

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      On the American Dental Association:

      According to the Boston College Law School study, "A dentist who is found guilty of violating the ADA Code of Ethics can be sentenced, censured, suspended, or expelled from the ADA" and the "ADA forbids its dentists from suggesting mercury removal under threat of license suspension". The same study pointed out that state dental associations and disciplinary boards have "not only adopted the ADA's position as a matter of routine" in proceedings which have sanctioned anti-amalgam dentists or stripped them of their licenses in California, Maryland, Arizona, Colorado, and Minnesota, but in many cases "the board members themselves often belonged to the ADA as well". A 2002 article in the Atlanta Journal and Constitution reported allegations by anti-amalgamists that the ADA had effectively imposed gag rules which forbade them from discussing their positions with patients. The Boston College Law School study also cites proceedings in which an Arizona dentist, "is facing sanctions for advocating alternative materials", a California dentist lost his license, "for running an advertisement entitled: "Mercury Emission from Silver Filings Unsafe by Government Standards", and a Maryland dentist, "was sanctioned for writing an article on dental amalgam removal". More recently, the ADA has entered into litigation "aimed at defending its reputation and discouraging further lawsuits by patient-plaintiffs against dental amalgam".

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        If you don't like the message, attack the messenger.

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        This accusation commonly is made in the public discussion of fluoridation.

        In Philomath formal presentation of Dental ethics and fluoridation. was made to the City Council.

        There is absolutely no truth whatsoever to the idea that there are official sanctions against dentists who are silly enough to oppose fluoridation.

        These sorts of ideas go to the heart of the of the thesis in the Salon article noted above.

        Hopefully progressives accustomed to global warming deniers will identify similar baloney in the fluoride discussion.

        The community's better oral health is dependent on clear thinking especially about community values and responsibilities.

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          "A dentist who is found guilty of violating the ADA Code of Ethics can be sentenced, censured, suspended, or expelled from the ADA" and the "ADA forbids its dentists from suggesting mercury removal under threat of license suspension". The same study pointed out that state dental associations and disciplinary boards have "not only adopted the ADA's position as a matter of routine" in proceedings which have sanctioned anti-amalgam dentists or stripped them of their licenses in California, Maryland, Arizona, Colorado, and Minnesota, but in many cases "the board members themselves often belonged to the ADA as well".

          Chirba-Martin, Welshhans. "An Uncertain Risk and an Uncertain Future: Assessing the Legal Implications of Mercury Amalgram Fillings." Boston College Law School Faculty Papers, 2004

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          I think you will agree that in the past dentists who spoke out against fluoridation were sanctioned by dentists and dental organizations who were in favor of fluoridation. Pro -fluoridation dentists would try to get official bodies to sanction anti-fluoridation dentists.

          It's true we don't hear about those things these days. But it did happen in the past.

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    any story that claims to have the "real facts" i'm going to assume has anything but.

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