Water fluoridation controversy
Encyclopedia
The water fluoridation controversy arises from moral, ethical, and safety concerns regarding the fluoridation
of public water supplies
. The controversy occurs mainly in English-speaking countries, as Continental Europe
does not practice water fluoridation. Those opposed argue that water fluoridation imposes ethical issues, may cause serious health problems, is not effective enough to justify the costs, and has a dosage that cannot be precisely controlled.
The weight of the scientific evidence have found that at the dosage recommended for water fluoridation, the only clear adverse effect is dental fluorosis
, which can alter the appearance of children's teeth during tooth development
. This effect is mildly cosmetic and is unlikely to represent any real effect on public health. Despite opponents' concerns, water fluoridation has been effective at reducing cavities in both children and adults.
Opposition to fluoridation has existed since its initiation in the 1940s. During the 1950s and 1960s, some opponents of water fluoridation suggested that fluoridation was a communist plot to undermine public health.
. They argue that consent by all water consumers cannot be achieved, nor can water suppliers accurately control the exact levels of fluoride that individuals receive, nor monitor their response.
In the United Kingdom
the Green Party
refers to fluoride as a poison, claims that water fluoridation violates Article 35 of the European Charter of Fundamental Rights, is banned by the UK poisons act of 1972, violates Articles 3 and 8 of the Human Rights Act
and raises issues under the United Nations Convention on the Rights of the Child.
Water fluoridation has also been criticized by Cross and Carton for violating the Nuremberg Code
and the Council of Europe's Biomedical Convention of 1999. Dentistry professor David Locker and philosopher Howard Cohen argued that the moral status for advocating water fluoridation is "at best indeterminate" and could even be considered immoral because it infringes upon autonomy based on uncertain evidence, with possible negative effects.
A research article suggested applying the precautionary principle
to this controversy, which calls for public policy
to reflect a conservative approach to minimize risk in the setting where harm is possible (but not necessarily confirmed) and where the science is not settled.
, which can alter the appearance of children's teeth during tooth development
. This effect is mildly cosmetic and is unlikely to represent any real effect on public health. Fluoridation has little effect on risk of bone fracture
(broken bones); it may result in slightly lower fracture risk than either excessively high levels of fluoridation or no fluoridation. A major Australian study found no clear association between fluoridation and cancer
or deaths due to cancer, both for cancer in general and also specifically for bone cancer and osteosarcoma
, and other adverse effects lack sufficient evidence to reach a confident conclusion. Several studies cited by opponents of community fluoridation have found associations, consistently finding that osteosarcoma rates are significantly higher in male children with raised fluoride levels.
The WHO set a general guideline of 1.5 mg/L concentration of fluoride in drinking water to avoid adverse effects of higher concentrations including severe dental fluorosis and skeletal fluorosis
, as these effects were minimal at this concentration or lower. In 2006, a 12-person U.S. National Research Council (NRC) committee reviewed the health risks associated with fluoride in the water and unanimously concluded that the maximum contaminant level
of 4 mg/L should be lowered. Although it did not comment on water fluoridation's safety, three of the panel members, namely Robert Isaacson, Kathleen Thiessen and Hardy Limeback, expressed their opposition to water fluoridation after the study and the chair, John Doull, suggested that the issue should be reexamined.
Because water fluoridation provided is not individually controlled, opponents express concern for vulnerable populations such as children, nutritionally deficient individuals, and renally impaired individuals. The National Research Council states that children have a higher daily average intake than adults per kg of bodyweight. Those who perspire heavily or have kidney problems consume more water and thus also have a greater intake. A 2006 study found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not among females. A 2009 analysis by the United States Centers for Disease Control (CDC) stated that upon reviewing this and other similar studies, the weight of the evidence does not support a relationship. However, the CDC also calls for further research into this potential association to help support or refute the observation. A study performed as a doctoral thesis, which is described as the most rigorous yet by the Washington Post, found a relationship among young boys, but then the Harvard professor who advised the doctoral students determined that the results were not highly correlative enough to have evidentiary value; the professor then was investigated but exonerated by the federal government's Office of Research Integrity (ORI).
An epidemiological connection between silicofluorides, an industrial byproduct which is used to fluoridate much of the U.S. water, and lead uptake in children was observed in a 2000 study. A 2006 U.S. CDC-funded study was unable to replicate the results, which the original researchers responded to in a 2007 rebuttal. Aside from the lead connection, concerns are raised as to whether silicofluorides might have different effects on the body than sodium fluorides, and silicofluorides have not been rigorously tested for safety.
found that 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 to 4.4 teeth), which is roughly equivalent to preventing 40% of cavities. The review found that the evidence was of moderate quality: many studies did not attempt to reduce observer bias, control for confounding factors, report variance measures, or use appropriate analysis. The effect is largely due to the topical effect of fluoride ions in the mouth rather than the systemic effect of ingestion.
Fluoridation opponents have challenged the efficacy of fluoridation, although their arguments have been accused of bias. A large study of water fluoridation's efficacy was conducted by the National Institute of Dental Research in 1988, which officially found "20 percent fewer decayed tooth surfaces" corresponding to "less than one cavity per child". Arguing that the study had errors, the data was reanalyzed by fluoridation opponent John A. Yiamouyiannis, whose results indicated no statistically significant difference in tooth decay rates among children in fluoridated and nonfluoridated communities. Conversely, fluoridation proponents argued that Yiamouyiannis' work had errors.
In 1986 fluoridation opponent Mark Diesendorf
pointed out the substantial declines in tooth decay in nonfluoridated European countries. Although fluoridation may still be a relevant public health measure among the poor and disadvantaged, it may be unnecessary for preventing tooth decay, particularly in industrialized countries where tooth decay is rare.
, former United States Environmental Protection Agency
scientist Robert Carton claimed that "fluoridation is the greatest case of scientific fraud
of this century." The practice was described as the "longest running public health controversy in North America" in the broadcast.
In a presentation to the California Assembly Committee of Environmental Safety and Toxic Materials, Richard Foulkes, M.D., former special consultant to the Minister of Health of British Columbia
, revealed:
A 2001 study found that "fluoride, particularly in toothpastes, is a very important preventive agent against dental caries," but added that "additional fluoride to that currently available in toothpaste does not appear to be benefiting the teeth of the majority of people."
The International Chiropractor's Association
opposes mass water fluoridation, considering it "possibly harmful and deprivation of the rights of citizens to be free from unwelcome mass medication."
In the United States, the Sierra Club opposes mandatory water fluoridation. Some reasons cited include possible adverse health effects, harm to the environment, and risks involving sensitive populations.
Citing impacts on the environment, the economy and on health, the Green Party of Canada
seeks a ban on artificial fluoridation products. The Canadian Green Party considers water fluoridation to be unsustainable.
Sociologist Brian Martin states that sociologists have typically viewed opposition to water fluoridation as irrational, although critics of this position have argued that this rests on an uncritical attitude toward scientific knowledge.
(NKF) updated their position on fluoridation for the first time since 1981. Formerly an endorser of water fluoridation, the group is now neutral on the practice. The report states, “Individuals with CKD should be notified of the potential risk of fluoride exposure by providing information on the NKF website including a link to the report in brief of the NRC and the Kidney Health Australia position paper." Calling for additional research, the foundation's current position paper states, however, that there is insufficient evidence to recommend fluoride-free drinking water for patients with renal disease.
The American Dental Association calls water fluoridation "unquestionably one of the safest and most beneficial, cost-effective public health measures for preventing, controlling, and in some cases reversing, tooth decay."
Health Canada supports fluoridation, citing a number of international scientific reviews that indicate "there is no link between any adverse health effects and exposure to fluoride in drinking water at levels that are below the maximum acceptable concentration of 1.5 mg/L."
The World Health Organization says fluoridation is an effective way to prevent tooth decay in poor communities. "In some developed countries, the health and economic benefits of fluoridation may be small, but particularly important in deprived areas, where water fluoridation may be a key factor in reducing inequalities in dental health."
, United Kingdom, Ireland
, Canada
, and Australia
, and a handful of other countries. The following nations previously fluoridated their water, but stopped the practice, with the years when water fluoridation started and stopped in parentheses:
In 1986 the journal Nature
had a commentary, "Large temporal reductions in tooth decay, which cannot be attributed to fluoridation, have been observed in both unfluoridated and fluoridated areas of at least eight developed countries."
In areas with complex water sources, water fluoridation is more difficult and more costly. Alternative fluoridation methods have been proposed, and implemented in some parts of the world. The World Health Organization
(WHO) is currently assessing the effects of fluoridated toothpaste, milk fluoridation and salt fluoridation in Africa
, Asia
, and Europe
. The WHO supports fluoridation of water in some areas, and encourages removal of fluoride where fluoride content in water is too high.
" to describe mottling from consumption of 6 mg/L of fluoride prior to tooth eruption, a level of consumption not expected to occur under controlled fluoridation. When voted upon, the outcomes tend to be negative, and thus fluoridation has had a history of gaining through administrative orders in North America. Theories for why the public tends to reject fluoridation include "alienation from mainstream" society, but evidence for that is weak. Another interpretation is confusion introduced during the referendum. Some studies of the sociology of opposition to water fluoridation have been criticized for having an uncritical attitude toward scientific knowledge.
Outside of North America
, water fluoridation was adopted in European countries, but in the late 1970s and early 1980s, Denmark
and Sweden
banned fluoridation when government panels found insufficient evidence of safety, and the Netherlands
banned water fluoridation when "a group of medical practitioners presented evidence" that it caused negative effects in a percentage of the population.
Water fluoridation has frequently been the subject of conspiracy theories. During the "Red Scare
" in the United States during the late 1940s and 1950s, and to a lesser extent in the 1960s, activists on the far right
of American politics routinely asserted that fluoridation was part of a far-reaching plot to impose a socialist or communist regime. They also opposed other public health programs, notably mass vaccination
and mental health
services. Their views were influenced by opposition to a number of major social and political changes that had happened in recent years: the growth of internationalism, particularly the UN and its programs; the introduction of social welfare provisions, particularly the various programs established by the New Deal
; and government efforts to reduce perceived inequalities in the social structure of the United States
.
Some took the view that fluoridation was only the first stage of a plan to control the American people. Fluoridation, it was claimed, was merely a stepping-stone on the way to implementing more ambitious programs. Others asserted the existence of a plot by communists and the United Nations
to "deplete the brainpower and sap the strength of a generation of American children". Dr. Charles Bett, a prominent anti-fluoridationist, charged that fluoridation was "better THAN USING THE ATOM BOMB because the atom bomb has to be made, has to be transported to the place it is to be set off while POISONOUS FLUORINE has been placed right beside the water supplies by the Americans themselves ready to be dumped into the water mains whenever a Communist desires!" Similarly, a right-wing newsletter, the American Capsule News, claimed that "the Soviet General Staff is very happy about it. Anytime they get ready to strike, and their 5th column
takes over, there are tons and tons of this poison "standing by" municipal and military water systems ready to be poured in within 15 minutes."
This viewpoint led to major controversies over public health programs in the US, most notably in the case of the Alaska Mental Health Enabling Act
controversy of 1956. In the case of fluoridation, the controversy had a direct impact on local programs. During the 1950s and 1960s, referendums on introducing fluoridation were defeated in over a thousand Florida
communities. Although the opposition was overcome in time, it was not until as late as the 1990s that fluoridated water was drunk by the majority of the population of the United States.
The communist conspiracy argument declined in influence by the mid-1960s, becoming associated in the public mind with irrational fear and paranoia. It was portrayed in Stanley Kubrick
's 1964 film Dr. Strangelove, in which the character General Jack D. Ripper initiates a nuclear war in the hope of thwarting a communist plot to "sap and impurify" the "precious bodily fluids" of the American people with fluoridated water. Another satire appeared in the 1967 movie In Like Flint
, in which a character's fear of fluoridation is used to indicate that he is insane. Some anti-fluoridationists claimed that the conspiracy theories were damaging their goals; Dr. Frederick Exner, an anti-fluoridation campaigner in the early 1960s, told a conference: "most people are not prepared to believe that fluoridation is a communist plot, and if you say it is, you are successfully ridiculed by the promoters. It is being done, effectively, every day ... some of the people on our side are the fluoridators' 'fifth column'."
In 2004 on the television program Democracy Now, investigative journalist and author of the book The Fluoride Deception, Christopher Bryson stated that, “the post-war campaign to fluoridate drinking water was less a public health innovation than a public relations ploy sponsored by industrial users of fluoride–including the government’s nuclear weapons program.”
In Ryan v. Attorney General (1965), the Supreme Court of Ireland held that water fluoridation did not infringe the plaintiff's right to bodily integrity. However, the court found that such a right to bodily integrity did exist, despite the fact that it was not explicitly mentioned in the Constitution of Ireland
, thus establishing the doctrine of unenumerated rights
in Irish constitutional law.
wherein activists have sued municipalities, asserting that their rights to consent to medical treatment and due process
are infringed by mandatory water fluoridation. Individuals have sued municipalities for a number of illnesses that they believe were caused by fluoridation of the city's water supply. In most of these cases, the courts have held in favor of cities, finding no or only a tenuous connection between health problems and widespread water fluoridation. To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful.
Water fluoridation
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...
of public water supplies
Water supply
Water supply is the provision of water by public utilities, commercial organisations, community endeavours or by individuals, usually via a system of pumps and pipes...
. The controversy occurs mainly in English-speaking countries, as Continental Europe
Continental Europe
Continental Europe, also referred to as mainland Europe or simply the Continent, is the continent of Europe, explicitly excluding European islands....
does not practice water fluoridation. Those opposed argue that water fluoridation imposes ethical issues, may cause serious health problems, is not effective enough to justify the costs, and has a dosage that cannot be precisely controlled.
The weight of the scientific evidence have found that at the dosage recommended for water fluoridation, the only clear adverse effect is dental fluorosis
Dental fluorosis
Dental fluorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development. The risk of fluoride overexposure occurs between the ages of 3 months and 8 years. In its mild forms , fluorosis often appears as unnoticeable,...
, which can alter the appearance of children's teeth during tooth development
Tooth development
Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. Although many diverse species have teeth, non-human tooth development is largely the same as in humans...
. This effect is mildly cosmetic and is unlikely to represent any real effect on public health. Despite opponents' concerns, water fluoridation has been effective at reducing cavities in both children and adults.
Opposition to fluoridation has existed since its initiation in the 1940s. During the 1950s and 1960s, some opponents of water fluoridation suggested that fluoridation was a communist plot to undermine public health.
Ethics
Many who oppose water fluoridation consider it to be a form of compulsory mass medicationMedication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
. They argue that consent by all water consumers cannot be achieved, nor can water suppliers accurately control the exact levels of fluoride that individuals receive, nor monitor their response.
In the United Kingdom
United Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
the Green Party
Green Party of England and Wales
The Green Party of England and Wales is a political party in England and Wales which follows the traditions of Green politics and maintains a strong commitment to social progressivism. It is the largest Green party in the United Kingdom, containing within it various regional divisions including...
refers to fluoride as a poison, claims that water fluoridation violates Article 35 of the European Charter of Fundamental Rights, is banned by the UK poisons act of 1972, violates Articles 3 and 8 of the Human Rights Act
Human Rights Act
A human rights act is a statute that sets out individual rights and freedoms under the law. Many jurisdictions have bills of rights enshrined into law and called the "Human Rights Act". This naming convention is commonly used in Commonwealth nations...
and raises issues under the United Nations Convention on the Rights of the Child.
Water fluoridation has also been criticized by Cross and Carton for violating the Nuremberg Code
Nuremberg Code
The Nuremberg Code is a set of research ethics principles for human experimentation set as a result of the Subsequent Nuremberg Trials at the end of the Second World War.-Background:...
and the Council of Europe's Biomedical Convention of 1999. Dentistry professor David Locker and philosopher Howard Cohen argued that the moral status for advocating water fluoridation is "at best indeterminate" and could even be considered immoral because it infringes upon autonomy based on uncertain evidence, with possible negative effects.
A research article suggested applying the precautionary principle
Precautionary principle
The precautionary principle or precautionary approach states that if an action or policy has a suspected risk of causing harm to the public or to the environment, in the absence of scientific consensus that the action or policy is harmful, the burden of proof that it is not harmful falls on those...
to this controversy, which calls for public policy
Public policy
Public policy as government action is generally the principled guide to action taken by the administrative or executive branches of the state with regard to a class of issues in a manner consistent with law and institutional customs. In general, the foundation is the pertinent national and...
to reflect a conservative approach to minimize risk in the setting where harm is possible (but not necessarily confirmed) and where the science is not settled.
Safety
At the dosage recommended for water fluoridation, the only clear adverse effect is dental fluorosisDental fluorosis
Dental fluorosis is a developmental disturbance of dental enamel caused by excessive exposure to high concentrations of fluoride during tooth development. The risk of fluoride overexposure occurs between the ages of 3 months and 8 years. In its mild forms , fluorosis often appears as unnoticeable,...
, which can alter the appearance of children's teeth during tooth development
Tooth development
Tooth development or odontogenesis is the complex process by which teeth form from embryonic cells, grow, and erupt into the mouth. Although many diverse species have teeth, non-human tooth development is largely the same as in humans...
. This effect is mildly cosmetic and is unlikely to represent any real effect on public health. Fluoridation has little effect on risk of bone fracture
Bone fracture
A bone fracture is a medical condition in which there is a break in the continuity of the bone...
(broken bones); it may result in slightly lower fracture risk than either excessively high levels of fluoridation or no fluoridation. A major Australian study found no clear association between fluoridation and cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
or deaths due to cancer, both for cancer in general and also specifically for bone cancer and osteosarcoma
Osteosarcoma
Osteosarcoma is an aggressive cancerous neoplasm arising from primitive transformed cells of mesenchymal origin that exhibit osteoblastic differentiation and produce malignant osteoid...
, and other adverse effects lack sufficient evidence to reach a confident conclusion. Several studies cited by opponents of community fluoridation have found associations, consistently finding that osteosarcoma rates are significantly higher in male children with raised fluoride levels.
The WHO set a general guideline of 1.5 mg/L concentration of fluoride in drinking water to avoid adverse effects of higher concentrations including severe dental fluorosis and skeletal fluorosis
Skeletal fluorosis
Skeletal fluorosis is a bone disease caused by excessive consumption of fluoride. In advanced cases, skeletal fluorosis causes pain and damage to bones and joints.-Forms:...
, as these effects were minimal at this concentration or lower. In 2006, a 12-person U.S. National Research Council (NRC) committee reviewed the health risks associated with fluoride in the water and unanimously concluded that the maximum contaminant level
Maximum Contaminant Level
Maximum Contaminant Levels are standards that are set by the United States Environmental Protection Agency for drinking water quality. An MCL is the legal threshold limit on the amount of a substance that is allowed in public water systems under the Safe Drinking Water Act...
of 4 mg/L should be lowered. Although it did not comment on water fluoridation's safety, three of the panel members, namely Robert Isaacson, Kathleen Thiessen and Hardy Limeback, expressed their opposition to water fluoridation after the study and the chair, John Doull, suggested that the issue should be reexamined.
Because water fluoridation provided is not individually controlled, opponents express concern for vulnerable populations such as children, nutritionally deficient individuals, and renally impaired individuals. The National Research Council states that children have a higher daily average intake than adults per kg of bodyweight. Those who perspire heavily or have kidney problems consume more water and thus also have a greater intake. A 2006 study found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not among females. A 2009 analysis by the United States Centers for Disease Control (CDC) stated that upon reviewing this and other similar studies, the weight of the evidence does not support a relationship. However, the CDC also calls for further research into this potential association to help support or refute the observation. A study performed as a doctoral thesis, which is described as the most rigorous yet by the Washington Post, found a relationship among young boys, but then the Harvard professor who advised the doctoral students determined that the results were not highly correlative enough to have evidentiary value; the professor then was investigated but exonerated by the federal government's Office of Research Integrity (ORI).
An epidemiological connection between silicofluorides, an industrial byproduct which is used to fluoridate much of the U.S. water, and lead uptake in children was observed in a 2000 study. A 2006 U.S. CDC-funded study was unable to replicate the results, which the original researchers responded to in a 2007 rebuttal. Aside from the lead connection, concerns are raised as to whether silicofluorides might have different effects on the body than sodium fluorides, and silicofluorides have not been rigorously tested for safety.
Efficacy
The available evidence shows that water fluoridation is effective in reducing cavities (see effectiveness section of the main article). The most comprehensive systematic reviewSystematic review
A systematic review is a literature review focused on a research question that tries to identify, appraise, select and synthesize all high quality research evidence relevant to that question. Systematic reviews of high-quality randomized controlled trials are crucial to evidence-based medicine...
found that fluoridation was statistically associated
Association (statistics)
In statistics, an association is any relationship between two measured quantities that renders them statistically dependent. The term "association" refers broadly to any such relationship, whereas the narrower term "correlation" refers to a linear relationship between two quantities.There are many...
with a decreased proportion of children with cavities (the median
Median
In probability theory and statistics, a median is described as the numerical value separating the higher half of a sample, a population, or a probability distribution, from the lower half. The median of a finite list of numbers can be found by arranging all the observations from lowest value to...
of mean
Mean
In statistics, mean has two related meanings:* the arithmetic mean .* the expected value of a random variable, which is also called the population mean....
decreases was 14.6%, the range
Range (statistics)
In the descriptive statistics, the range is the length of the smallest interval which contains all the data. It is calculated by subtracting the smallest observation from the greatest and provides an indication of statistical dispersion.It is measured in the same units as the data...
−5 to 64%), and with a decrease in decayed, missing
Tooth loss
Tooth loss is when one or more teeth come loose and fall out. Tooth loss is normal for deciduous teeth , when they are replaced by a person's adult teeth. Otherwise, losing teeth is undesirable and is the result of injury or disease, such as mouth trauma, tooth injury, tooth decay, and gum disease...
, and filled
Dental restoration
A dental restoration or dental filling is a dental restorative material used to restore the function, integrity and morphology of missing tooth structure. The structural loss typically results from caries or external trauma. It is also lost intentionally during tooth preparation to improve the...
primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5 to 4.4 teeth), which is roughly equivalent to preventing 40% of cavities. The review found that the evidence was of moderate quality: many studies did not attempt to reduce observer bias, control for confounding factors, report variance measures, or use appropriate analysis. The effect is largely due to the topical effect of fluoride ions in the mouth rather than the systemic effect of ingestion.
Fluoridation opponents have challenged the efficacy of fluoridation, although their arguments have been accused of bias. A large study of water fluoridation's efficacy was conducted by the National Institute of Dental Research in 1988, which officially found "20 percent fewer decayed tooth surfaces" corresponding to "less than one cavity per child". Arguing that the study had errors, the data was reanalyzed by fluoridation opponent John A. Yiamouyiannis, whose results indicated no statistically significant difference in tooth decay rates among children in fluoridated and nonfluoridated communities. Conversely, fluoridation proponents argued that Yiamouyiannis' work had errors.
In 1986 fluoridation opponent Mark Diesendorf
Mark Diesendorf
Mark Diesendorf teaches Environmental Studies at the University of New South Wales, Australia. He was formerly Professor of Environmental Science at...
pointed out the substantial declines in tooth decay in nonfluoridated European countries. Although fluoridation may still be a relevant public health measure among the poor and disadvantaged, it may be unnecessary for preventing tooth decay, particularly in industrialized countries where tooth decay is rare.
Statements against
In 1992, speaking on the Canadian television program MarketplaceMarketplace (TV series)
Marketplace is a Canadian television series, broadcast on CBC Television. Launched in 1972, the series is a consumer advocacy newsmagazine, which shows investigative reports on issues such as product testing, health and safety, fraudulent business practices and other news issues of interest to...
, former United States Environmental Protection Agency
United States Environmental Protection Agency
The U.S. Environmental Protection Agency is an agency of the federal government of the United States charged with protecting human health and the environment, by writing and enforcing regulations based on laws passed by Congress...
scientist Robert Carton claimed that "fluoridation is the greatest case of scientific fraud
Fraud
In criminal law, a fraud is an intentional deception made for personal gain or to damage another individual; the related adjective is fraudulent. The specific legal definition varies by legal jurisdiction. Fraud is a crime, and also a civil law violation...
of this century." The practice was described as the "longest running public health controversy in North America" in the broadcast.
In a presentation to the California Assembly Committee of Environmental Safety and Toxic Materials, Richard Foulkes, M.D., former special consultant to the Minister of Health of British Columbia
British Columbia
British Columbia is the westernmost of Canada's provinces and is known for its natural beauty, as reflected in its Latin motto, Splendor sine occasu . Its name was chosen by Queen Victoria in 1858...
, revealed:
The [water fluoridation] studies that were presented to me were selected and showed only positive results. Studies that were in existence at that time that did not fit the concept that they were "selling," were either omitted or declared to be "bad science." The endorsements had been won by coercion and the self-interest of professional elites. Some of the basic "facts" presented to me were, I found out later, of dubious validity. We are brought up to respect these persons in whom we have placed our trust to safeguard the public interest. It is difficult for each of us to accept that these may be misplaced.
A 2001 study found that "fluoride, particularly in toothpastes, is a very important preventive agent against dental caries," but added that "additional fluoride to that currently available in toothpaste does not appear to be benefiting the teeth of the majority of people."
The International Chiropractor's Association
International Chiropractor's Association
The International Chiropractor's Association is the oldest chiropractic association, having been founded by B.J. Palmer in 1938 in Davenport, Iowa...
opposes mass water fluoridation, considering it "possibly harmful and deprivation of the rights of citizens to be free from unwelcome mass medication."
In the United States, the Sierra Club opposes mandatory water fluoridation. Some reasons cited include possible adverse health effects, harm to the environment, and risks involving sensitive populations.
Citing impacts on the environment, the economy and on health, the Green Party of Canada
Green Party of Canada
The Green Party of Canada is a Canadian federal political party founded in 1983 with 10,000–12,000 registered members as of October 2008. The Greens advance a broad multi-issue political platform that reflects its core values of ecological wisdom, social justice, grassroots democracy and...
seeks a ban on artificial fluoridation products. The Canadian Green Party considers water fluoridation to be unsustainable.
Sociologist Brian Martin states that sociologists have typically viewed opposition to water fluoridation as irrational, although critics of this position have argued that this rests on an uncritical attitude toward scientific knowledge.
Neutral Statement
On April 15, 2008, the United States National Kidney FoundationNational Kidney Foundation
The National Kidney Foundation, Inc. is a major voluntary health organization in the United States, headquartered in New York City...
(NKF) updated their position on fluoridation for the first time since 1981. Formerly an endorser of water fluoridation, the group is now neutral on the practice. The report states, “Individuals with CKD should be notified of the potential risk of fluoride exposure by providing information on the NKF website including a link to the report in brief of the NRC and the Kidney Health Australia position paper." Calling for additional research, the foundation's current position paper states, however, that there is insufficient evidence to recommend fluoride-free drinking water for patients with renal disease.
Statements for
The fluoridation of public water has been hailed by the U.S. Center for Disease Control as one of the top medical achievements of the 20th Century. It is ranked #9 on this list ahead of "Recognition of tobacco use as a health hazard."The American Dental Association calls water fluoridation "unquestionably one of the safest and most beneficial, cost-effective public health measures for preventing, controlling, and in some cases reversing, tooth decay."
Health Canada supports fluoridation, citing a number of international scientific reviews that indicate "there is no link between any adverse health effects and exposure to fluoride in drinking water at levels that are below the maximum acceptable concentration of 1.5 mg/L."
The World Health Organization says fluoridation is an effective way to prevent tooth decay in poor communities. "In some developed countries, the health and economic benefits of fluoridation may be small, but particularly important in deprived areas, where water fluoridation may be a key factor in reducing inequalities in dental health."
Use throughout the world
Water fluoridation is used in the United StatesUnited States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
, United Kingdom, Ireland
Ireland
Ireland is an island to the northwest of continental Europe. It is the third-largest island in Europe and the twentieth-largest island on Earth...
, Canada
Canada
Canada is a North American country consisting of ten provinces and three territories. Located in the northern part of the continent, it extends from the Atlantic Ocean in the east to the Pacific Ocean in the west, and northward into the Arctic Ocean...
, and Australia
Australia
Australia , officially the Commonwealth of Australia, is a country in the Southern Hemisphere comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands in the Indian and Pacific Oceans. It is the world's sixth-largest country by total area...
, and a handful of other countries. The following nations previously fluoridated their water, but stopped the practice, with the years when water fluoridation started and stopped in parentheses:
- Federal Republic of Germany (1952–1971)
- Sweden (1952–1971)
- Netherlands (1953–1976)
- Czechoslovakia (1955–1990)
- German Democratic Republic (1959–1990)
- Soviet Union (1960–1990)
- Finland (1959–1993)
- Japan (1952–1972)
In 1986 the journal Nature
Nature (journal)
Nature, first published on 4 November 1869, is ranked the world's most cited interdisciplinary scientific journal by the Science Edition of the 2010 Journal Citation Reports...
had a commentary, "Large temporal reductions in tooth decay, which cannot be attributed to fluoridation, have been observed in both unfluoridated and fluoridated areas of at least eight developed countries."
In areas with complex water sources, water fluoridation is more difficult and more costly. Alternative fluoridation methods have been proposed, and implemented in some parts of the world. The World Health Organization
World Health Organization
The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...
(WHO) is currently assessing the effects of fluoridated toothpaste, milk fluoridation and salt fluoridation in Africa
Africa
Africa is the world's second largest and second most populous continent, after Asia. At about 30.2 million km² including adjacent islands, it covers 6% of the Earth's total surface area and 20.4% of the total land area...
, Asia
Asia
Asia is the world's largest and most populous continent, located primarily in the eastern and northern hemispheres. It covers 8.7% of the Earth's total surface area and with approximately 3.879 billion people, it hosts 60% of the world's current human population...
, and Europe
Europe
Europe is, by convention, one of the world's seven continents. Comprising the westernmost peninsula of Eurasia, Europe is generally 'divided' from Asia to its east by the watershed divides of the Ural and Caucasus Mountains, the Ural River, the Caspian and Black Seas, and the waterways connecting...
. The WHO supports fluoridation of water in some areas, and encourages removal of fluoride where fluoride content in water is too high.
History
The first large fluoridation controversy occurred in Wisconsin in 1950. Fluoridation opponents questioned the ethics, safety, and efficacy of fluoridation. New Zealand was the second country to fluoridate, and similar controversies arose there. Fears about fluoride were likely exacerbated by the reputation of fluoride compounds as insect poisons and by early literature which tended to use terms such as "toxic" and "low grade chronic fluoride poisoningFluoride poisoning
In high concentrations, soluble fluoride salts are toxic and skin or eye contact with high concentrations of many fluoride salts is dangerous. Referring to a common salt of fluoride, sodium fluoride , the lethal dose for most adult humans is estimated at 5 to 10 g...
" to describe mottling from consumption of 6 mg/L of fluoride prior to tooth eruption, a level of consumption not expected to occur under controlled fluoridation. When voted upon, the outcomes tend to be negative, and thus fluoridation has had a history of gaining through administrative orders in North America. Theories for why the public tends to reject fluoridation include "alienation from mainstream" society, but evidence for that is weak. Another interpretation is confusion introduced during the referendum. Some studies of the sociology of opposition to water fluoridation have been criticized for having an uncritical attitude toward scientific knowledge.
Outside of North America
North America
North America is a continent wholly within the Northern Hemisphere and almost wholly within the Western Hemisphere. It is also considered a northern subcontinent of the Americas...
, water fluoridation was adopted in European countries, but in the late 1970s and early 1980s, Denmark
Denmark
Denmark is a Scandinavian country in Northern Europe. The countries of Denmark and Greenland, as well as the Faroe Islands, constitute the Kingdom of Denmark . It is the southernmost of the Nordic countries, southwest of Sweden and south of Norway, and bordered to the south by Germany. Denmark...
and Sweden
Sweden
Sweden , officially the Kingdom of Sweden , is a Nordic country on the Scandinavian Peninsula in Northern Europe. Sweden borders with Norway and Finland and is connected to Denmark by a bridge-tunnel across the Öresund....
banned fluoridation when government panels found insufficient evidence of safety, and the Netherlands
Netherlands
The Netherlands is a constituent country of the Kingdom of the Netherlands, located mainly in North-West Europe and with several islands in the Caribbean. Mainland Netherlands borders the North Sea to the north and west, Belgium to the south, and Germany to the east, and shares maritime borders...
banned water fluoridation when "a group of medical practitioners presented evidence" that it caused negative effects in a percentage of the population.
Conspiracy theories
Red Scare
Durrell Blackwell Durrell Blackwell The term Red Scare denotes two distinct periods of strong Anti-Communism in the United States: the First Red Scare, from 1919 to 1920, and the Second Red Scare, from 1947 to 1957. The First Red Scare was about worker revolution and...
" in the United States during the late 1940s and 1950s, and to a lesser extent in the 1960s, activists on the far right
Far right
Far-right, extreme right, hard right, radical right, and ultra-right are terms used to discuss the qualitative or quantitative position a group or person occupies within right-wing politics. Far-right politics may involve anti-immigration and anti-integration stances towards groups that are...
of American politics routinely asserted that fluoridation was part of a far-reaching plot to impose a socialist or communist regime. They also opposed other public health programs, notably mass vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
and mental health
Mental health
Mental health describes either a level of cognitive or emotional well-being or an absence of a mental disorder. From perspectives of the discipline of positive psychology or holism mental health may include an individual's ability to enjoy life and procure a balance between life activities and...
services. Their views were influenced by opposition to a number of major social and political changes that had happened in recent years: the growth of internationalism, particularly the UN and its programs; the introduction of social welfare provisions, particularly the various programs established by the New Deal
New Deal
The New Deal was a series of economic programs implemented in the United States between 1933 and 1936. They were passed by the U.S. Congress during the first term of President Franklin D. Roosevelt. The programs were Roosevelt's responses to the Great Depression, and focused on what historians call...
; and government efforts to reduce perceived inequalities in the social structure of the United States
Social structure of the United States
Social class is a controversial issue in the United States, having many competing definitions, models, and even disagreements over its very existence. Many Americans believe in a simple three-class model that includes the "rich", the "middle class", and the "poor"...
.
Some took the view that fluoridation was only the first stage of a plan to control the American people. Fluoridation, it was claimed, was merely a stepping-stone on the way to implementing more ambitious programs. Others asserted the existence of a plot by communists and the United Nations
United Nations
The United Nations is an international organization whose stated aims are facilitating cooperation in international law, international security, economic development, social progress, human rights, and achievement of world peace...
to "deplete the brainpower and sap the strength of a generation of American children". Dr. Charles Bett, a prominent anti-fluoridationist, charged that fluoridation was "better THAN USING THE ATOM BOMB because the atom bomb has to be made, has to be transported to the place it is to be set off while POISONOUS FLUORINE has been placed right beside the water supplies by the Americans themselves ready to be dumped into the water mains whenever a Communist desires!" Similarly, a right-wing newsletter, the American Capsule News, claimed that "the Soviet General Staff is very happy about it. Anytime they get ready to strike, and their 5th column
Fifth column
A fifth column is a group of people who clandestinely undermine a larger group such as a nation from within.-Origin:The term originated with a 1936 radio address by Emilio Mola, a Nationalist General during the 1936–39 Spanish Civil War...
takes over, there are tons and tons of this poison "standing by" municipal and military water systems ready to be poured in within 15 minutes."
This viewpoint led to major controversies over public health programs in the US, most notably in the case of the Alaska Mental Health Enabling Act
Alaska Mental Health Enabling Act
The Alaska Mental Health Enabling Act of 1956 was an Act of Congress passed to improve mental health care in the United States territory of Alaska. It became the focus of a major political controversy after opponents nicknamed it the "Siberia Bill" and denounced it as being part of a communist...
controversy of 1956. In the case of fluoridation, the controversy had a direct impact on local programs. During the 1950s and 1960s, referendums on introducing fluoridation were defeated in over a thousand Florida
Florida
Florida is a state in the southeastern United States, located on the nation's Atlantic and Gulf coasts. It is bordered to the west by the Gulf of Mexico, to the north by Alabama and Georgia and to the east by the Atlantic Ocean. With a population of 18,801,310 as measured by the 2010 census, it...
communities. Although the opposition was overcome in time, it was not until as late as the 1990s that fluoridated water was drunk by the majority of the population of the United States.
The communist conspiracy argument declined in influence by the mid-1960s, becoming associated in the public mind with irrational fear and paranoia. It was portrayed in Stanley Kubrick
Stanley Kubrick
Stanley Kubrick was an American film director, writer, producer, and photographer who lived in England during most of the last four decades of his career...
's 1964 film Dr. Strangelove, in which the character General Jack D. Ripper initiates a nuclear war in the hope of thwarting a communist plot to "sap and impurify" the "precious bodily fluids" of the American people with fluoridated water. Another satire appeared in the 1967 movie In Like Flint
In Like Flint
In Like Flint is a 1967 film directed by Gordon Douglas, the sequel to the parody spy film Our Man Flint . It posits an international feminist conspiracy to depose the ruling American patriarchy with a feminist matriarchy. To achieve and establish it, they kidnap and replace the U.S. President,...
, in which a character's fear of fluoridation is used to indicate that he is insane. Some anti-fluoridationists claimed that the conspiracy theories were damaging their goals; Dr. Frederick Exner, an anti-fluoridation campaigner in the early 1960s, told a conference: "most people are not prepared to believe that fluoridation is a communist plot, and if you say it is, you are successfully ridiculed by the promoters. It is being done, effectively, every day ... some of the people on our side are the fluoridators' 'fifth column'."
In 2004 on the television program Democracy Now, investigative journalist and author of the book The Fluoride Deception, Christopher Bryson stated that, “the post-war campaign to fluoridate drinking water was less a public health innovation than a public relations ploy sponsored by industrial users of fluoride–including the government’s nuclear weapons program.”
Europe
Water was fluoridated in large parts of the Netherlands from 1960 to 1973, when the Supreme Court of the Netherlands declared fluoridation of drinking water unauthorized. Dutch authorities had no legal basis for adding chemicals to drinking water if they did not improve the safety as such. The simple reason is that consumers cannot choose a different tap water provider. Drinking water has not been fluoridated in any part of the Netherlands since 1973.In Ryan v. Attorney General (1965), the Supreme Court of Ireland held that water fluoridation did not infringe the plaintiff's right to bodily integrity. However, the court found that such a right to bodily integrity did exist, despite the fact that it was not explicitly mentioned in the Constitution of Ireland
Constitution of Ireland
The Constitution of Ireland is the fundamental law of the Irish state. The constitution falls broadly within the liberal democratic tradition. It establishes an independent state based on a system of representative democracy and guarantees certain fundamental rights, along with a popularly elected...
, thus establishing the doctrine of unenumerated rights
Unenumerated rights
Unenumerated rights are sometimes defined as legal rights inferred from other legal rights that are officiated in a retrievable form codified by law institutions, such as in written constitutions, but are not themselves expressly coded or "enumerated" among the explicit writ of the law. ...
in Irish constitutional law.
United States
Fluoridation has been the subject of many court casesLegal case
A legal case is a dispute between opposing parties resolved by a court, or by some equivalent legal process. A legal case may be either civil or criminal...
wherein activists have sued municipalities, asserting that their rights to consent to medical treatment and due process
Due process
Due process is the legal code that the state must venerate all of the legal rights that are owed to a person under the principle. Due process balances the power of the state law of the land and thus protects individual persons from it...
are infringed by mandatory water fluoridation. Individuals have sued municipalities for a number of illnesses that they believe were caused by fluoridation of the city's water supply. In most of these cases, the courts have held in favor of cities, finding no or only a tenuous connection between health problems and widespread water fluoridation. To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful.