Revision as of 04:16, 30 April 2016 view sourceBigbaby23 (talk | contribs)Extended confirmed users2,119 edits revert yobol lede edit. Nuffield has weight .I will elaborate in talk page← Previous edit | Revision as of 15:20, 30 April 2016 view source Bigbaby23 (talk | contribs)Extended confirmed users2,119 edits My try of trimming the lede to 4 paragraphs.Next edit → | ||
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The '''water fluoridation controversy''' arises from a ] debate concerning the science and public policy of the ] of public ]. It involves scientific issues, such as the question of ] It also involves ] and political issues, such as the question of the common good against individual rights, and the question of how the decision to fluoridate is made; ] or via ].<ref name=Scott>{{cite journal|last1=Scott|first1=P.|last2=Richards|first2=E.|last3=Martin|first3=B.|title=Captives of Controversy: The Myth of the Neutral Social Researcher in Contemporary Scientific Controversies|journal=Science, Technology & Human Values|volume=15|issue=4|pages=474–494|doi=10.1177/016224399001500406|url=http://m.sth.sagepub.com/content/15/4/474.abstract|accessdate=30 April 2016}}</ref> The controversy is propelled by a significant public opposition supported by a minority of professionals.<ref name="ReferenceA">{{cite journal |vauthors=Martin B |title=Analyzing the fluoridation controversy: resources and structures |journal=Soc Stud Sci |volume=18 |issue=2 |pages=331–63 |year=1988 |pmid=11621556 |doi= |url=}}</ref> Those opposed argue that water fluoridation has no or little ] benefits, may cause serious health problems, is not effective enough to justify the costs, and ] obsolete.<ref name=Thiessen>{{cite journal|last1=Ko|first1=Lee|last2=Thiessen|first2=Kathleen M.|title=A critique of recent economic evaluations of community water fluoridation|journal=International Journal of Occupational and Environmental Health|date=3 December 2014|volume=21|issue=2|pages=91–120|doi=10.1179/2049396714Y.0000000093|accessdate=21 April 2016}}</ref><ref name=Hileman>Hileman, Bette (November 4, 2006) Vol 84, Num 36 PP. 34-37, ], Retrieved April 14, 2016</ref><ref name=Kaminsky>], Book review (August 16, 2004) , Volume 82, Number 33, pp. 35-36 ], Retrieved April 19, 2016</ref> | |||
{{Lead too long|date=April 2016}} | |||
The '''water fluoridation controversy''' arises from political, moral, ethical,economic, and safety concerns regarding the ] of public ]. Those opposed argue that water fluoridation has no or little ] benefits, may cause serious health problems, is not effective enough to justify the costs, and ] obsolete.<ref name=FRWG/><ref name=Thiessen>{{cite journal|last1=Ko|first1=Lee|last2=Thiessen|first2=Kathleen M.|title=A critique of recent economic evaluations of community water fluoridation|journal=International Journal of Occupational and Environmental Health|date=3 December 2014|volume=21|issue=2|pages=91–120|doi=10.1179/2049396714Y.0000000093|accessdate=21 April 2016}}</ref><ref name=Hileman>Hileman, Bette (November 4, 2006) Vol 84, Num 36 PP. 34-37, ], Retrieved April 14, 2016</ref><ref name=Kaminsky>], Book review (August 16, 2004) , Volume 82, Number 33, pp. 35-36 ], Retrieved April 19, 2016</ref> | |||
] authorities throughout the world find a ] that water fluoridation at appropriate levels is a safe and effective means to prevent ].<ref name=Pizzo/> The authorities views on the most effective ] for community prevention of tooth decay are mixed; some state water fluoridation is most effective while others see no special advantage and prefer topical application strategies.<ref name=NHMRC/><ref name=EU2011/> | |||
Opposition to fluoridation has existed since its initiation in the 1940s.<ref name=Martin1989/> During the 1950s and 1960s, ] claimed that fluoridation was a ] plot to undermine American public health.<ref name="Johnston">{{cite book | last = Johnston | first = Robert D | title = The Politics of Healing | publisher = Routledge | year = 2004 | isbn = 0-415-93339-0| page = 136}}</ref> In recent years water fluoridation has become a prevalent health and political issue in many countries, resulting in some countries and communities discontinuing it's use while others have expanded it.<ref name=Scher2011>{{cite web|title=Introduction to the SCHER opinion on Fluoridation|url=http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/l-3/1.htm#0|publisher=European Commission Scientific Committee on Health and Environmental Risks (SCHER)|accessdate=18 April 2016|date=2011}}</ref><ref name="fas.org">Tiemann, Mary (April 5, 2013) (pdf) ], pages 1-2, 4, Retrieved April 13, 2016</ref> As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated <ref name=extent2012>{{vcite book |chapter=The extent of water fluoridation |chapterurl=http://bfsweb.org/onemillion/09%20One%20in%20a%20Million%20-%20The%20Extent%20of%20Fluoridation.pdf |url=http://bfsweb.org/onemillion/onemillion.htm |title=One in a Million: The facts about water fluoridation |edition=3rd |year=2012 |author=The British Fluoridation Society; The UK Public Health Association; The British Dental Association; The Faculty of Public Health |isbn=0-9547684-0-X |pages=55–80 |publisher=British Fluoridation Society |location=Manchester |chapterformat=PDF }}</ref> | |||
With regard to ], a 2007 ] report concluded that good evidence for or against water fluoridation is lacking, therefore local and regional democratic procedures are the most appropriate way to decide whether to fluoridate.<ref name=nuffield>{{vcite journal |author=Calman K |title=Beyond the 'nanny state': stewardship and public health |journal=Public Health |volume=123 |issue=1 |pages=e6–e10 |year=2009 |pmid=19135693 |doi=10.1016/j.puhe.2008.10.025 |laysummary=http://www.nuffieldbioethics.org/fileLibrary/pdf/One_page_summary_public_health.pdf |laysource=Nuffield Council on Bioethics |laydate=2007-11-13 }}</ref><ref name=Nuffieldfull/> Water fluoridation pits the common good against individual rights. Some say the common good overrides individual rights, and equate it to ] and ].<ref name=ethics> | |||
* {{vcite journal |author=McNally M, Downie J |title=The ethics of water fluoridation |journal=J Can Dent Assoc |volume=66 |issue=11 |pages=592–3 |year=2000 |pmid=11253350 |url=http://cda-adc.ca/jcda/vol-66/issue-11/592.html }} | |||
* {{vcite journal |author=Cohen H, Locker D |title=The science and ethics of water fluoridation |journal=J Can Dent Assoc |volume=67 |issue=10 |pages=578–80 |year=2001 |pmid=11737979 |url=http://cda-adc.ca/jcda/vol-67/issue-10/578.html }} | |||
</ref><ref name=Cross2003>{{cite journal |author=Cross DW, Carton RJ |title=Fluoridation: a violation of medical ethics and human rights |journal=Int. J. Occup. Environ. Health |volume=9 |issue=1 |pages=24–9 |year=2003 |pmid=12749628 |url= |doi=10.1179/107735203800328830}}</ref> Others say that individual rights override the common good, and say that individuals have no choice in the water that they drink, unless they drink more expensive bottled water,<ref name=Coggon>{{cite journal|last1=Coggon|first1=David|last2=Cooper|first2=Cyrus|title=Fluoridation of water supplies|journal=BMJ : British Medical Journal|date=31 July 1999|volume=319|issue=7205|pages=269–270|url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1126914/|accessdate=21 April 2016|issn=0959-8138}}</ref> and some argue unequivocally, that it does not stand up to scrutiny relative to medical ethics.<ref name=Cross>{{cite journal|last1=Cross|first1=Douglas W.|last2=Carton|first2=Robert J.|title=Fluoridation: a violation of medical ethics and human rights|journal=International Journal of Occupational and Environmental Health|date=1 March 2003|volume=9|issue=1|pages=24–29|doi=10.1179/107735203800328830|url=http://www.ncbi.nlm.nih.gov/pubmed/12749628|accessdate=21 April 2016|issn=1077-3525}}</ref> | |||
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively.<ref name=cheng>National Center for Biotechnology Information , BMJ. 2007 Oct 6; 335(7622): 699–702. Retrieved on 12 April 2016</ref><ref name=yorkcrd/> ]s have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled.<ref name=Scher2011/><ref name=yorkcrd>Centre for Reviews and Dissemination , ], York, United Kingdom. Originally released : 28 October 2003. Retrieved on 12 April 2016</ref><ref name=Ih2015>{{cite journal|last1=Iheozor-Ejiofor|first1=Z|last2=Worthington|first2=HV|last3=Walsh|first3=T|last4=O'Malley|first4=L|last5=Clarkson|first5=JE|last6=Macey|first6=R|last7=Alam|first7=R|last8=Tugwell|first8=P|last9=Welch|first9=V|last10=Glenny|first10=AM|title=Water fluoridation for the prevention of dental caries.|journal=The Cochrane database of systematic reviews|date=18 June 2015|volume=6|pages=CD010856|pmid=26092033}}</ref> Researchers who oppose the practice state this as well.<ref name="Book Reviews 2011">{{cite journal|last1=Peckham|first1=Stephen|title=Book Reviews: The case against fluoride: how hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there, by Paul Connett, James Beck, and H Spedding Micklem|journal=Critical Public Health|volume=22|issue=1|year=2012|pages=113–114|issn=0958-1596|doi=10.1080/09581596.2011.593350}}</ref> According to a 2013 ] report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.<ref name="fas.org">Tiemann, Mary (April 5, 2013) (pdf) ], pages 1-2, 4, Retrieved April 13, 2016</ref> | |||
Opposition to fluoridation has existed since its initiation in the 1940s.<ref name=Martin1989/> During the 1950s and 1960s, ] claimed that fluoridation was a ] plot to undermine American public health.<ref name="Johnston">{{cite book | last = Johnston | first = Robert D | title = The Politics of Healing | publisher = Routledge | year = 2004 | isbn = 0-415-93339-0| page = 136}}</ref> In recent years water fluoridation has become a prevalent health and political issue in many countries, resulting in some countries and communities discontinuing it's use while others have expanded it.<ref name=Scher2011>{{cite web|title=Introduction to the SCHER opinion on Fluoridation|url=http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/l-3/1.htm#0|publisher=European Commission Scientific Committee on Health and Environmental Risks (SCHER)|accessdate=18 April 2016|date=2011}}</ref><ref name="fas.org">Tiemann, Mary (April 5, 2013) (pdf) ], pages 1-2, 4, Retrieved April 13, 2016</ref> The controversy is propelled by a significant public opposition supported by a minority of professionals,<ref name="ReferenceA">{{cite journal |vauthors=Martin B |title=Analyzing the fluoridation controversy: resources and structures |journal=Soc Stud Sci |volume=18 |issue=2 |pages=331–63 |year=1988 |pmid=11621556 |doi= |url=}}</ref> which include researchers, dental and medical professionals, alternative medical practitioners, health food enthusiasts, a few religious groups (mostly ] in the U.S.), and occasionally consumer groups and environmentalists.<ref name=Reilly>{{vcite book |author=Reilly GA |chapter=The task is a political one: the promotion of fluoridation |pages=323–42 |title=Silent Victories: The History and Practice of Public Health in Twentieth-century America |editor=Ward JW, Warren C |publisher=Oxford University Press |year=2007 |isbn=0-19-515069-4 }}</ref> Organized political opposition has come from ],<ref name=Dehnbase>{{vcite web |url=http://www.dehnbase.org/lpus/library/platform/cp.html|title=Consumer protection |publisher=Libertarian Party |accessdate= June 28, 2010}}</ref> the ],<ref name=Birch>{{vcite book |author=Freeze RA, Lehr JH |title=The Fluoride Wars: How a Modest Public Health Measure Became America's Longest-Running Political Melodrama |publisher=Wiley |year=2009 |isbn=978-0-470-44833-5 |page=62}}</ref> and from groups like the Green parties in the UK and New Zealand.<ref name=Greenwars>{{vcite news |author=Nordlinger J |title=Water fights: believe it or not, the fluoridation war still rages—with a twist you may like |work=Natl Rev |date=2003-06-30 |url=http://www.thefreelibrary.com/Water+Fights%3a+Believe+it+or+not%2c+the+fluoridation+war+still+rages+--...-a0103135852 }}</ref> | |||
== Medical consensus == | |||
National and international health agencies and dental associations throughout the world have endorsed water fluoridation as safe and effective.<ref name=Pizzo>{{vcite journal |author=Pizzo G, Piscopo MR, Pizzo I, Giuliana G |title=Community water fluoridation and caries prevention: a critical review |journal=Clin Oral Investig |volume=11 |issue=3 |pages=189–93 |year=2007 |pmid=17333303 |doi=10.1007/s00784-007-0111-6 }}</ref><ref name=ADAorgs>{{vcite web |url=http://www.ada.org/en/public-programs/advocating-for-the-public/fluoride-and-fluoridation/fluoridation-facts/fluoridation-facts-compendium|author=|publisher=American Dental Association |title=National and International Organizations That Recognize the Public Health Benefits of Community Water Fluoridation for Preventing Dental Decay |date= |accessdate=2016-04-19 |archiveurl=https://web.archive.org/web/20080607092909/http://ada.org/public/topics/fluoride/facts/compendium.asp |archivedate=2008-06-07 }}</ref> | |||
The views on the most effective method for community prevention of tooth decay are mixed. The Australian government states that water fluoridation is the most effective means of achieving fluoride exposure that is community-wide.<ref name=NHMRC/> The World Health Organization states water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk,<ref name=Petersen-2004>{{vcite journal |author=Petersen PE, Lennon MA |title=Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach |journal=Community Dent Oral Epidemiol |volume=32 |issue=5 |pages=319–21 |year=2004 |pmid=15341615 |doi=10.1111/j.1600-0528.2004.00175.x |url=http://www.who.int/oral_health/media/en/orh_cdoe_319to321.pdf |format=PDF }}</ref> while the ] finds no advantage to water fluoridation compared with topical use.<ref name=EU2011/> | |||
] supports water fluoridation as safe and effective.<ref>{{cite web|title=Support for Water Fluoridation|url=http://www.bfsweb.org/onemillion/11%20One%20in%20a%20Million%20-%20Support%20for%20Fluoridation.pdf|website=British Fluoridation Society|accessdate=19 April 2016|date=2012}}</ref> the European Academy of Paediatric Dentistry,<ref>{{vcite journal |journal=Eur Arch Paediatr Dent |year=2009 |volume=10 |issue=3 |pages=129–35 |title=Guidelines on the use of fluoride in children: an EAPD policy document |author=European Academy Of Paediatric Dentistry|pmid=19772841 |doi=10.1007/bf03262673}}</ref> and the national dental associations of Australia,<ref>{{vcite web |url=http://www.ada.org.au/News-Media/Issues-at-a-Glance/Fluoride |accessdate=2016-04-19 |date= |title= Issues at a Glance Fluoride |author=] }}</ref> Canada,<ref>{{vcite web |url=http://www.cda-adc.ca/_files/position_statements/fluoride.pdf |format=PDF |accessdate=2016-04-19|date=March 2003|update=March 2012 |title=CDA position on use of fluorides in caries prevention |author=] }}</ref> and the U.S.<ref>{{vcite web |url=http://ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf |format=PDF |accessdate=2008-12-22 |date=2005 |author=ADA Council on Access, Prevention and Interprofessional Relations |publisher=] |title=Fluoridation facts |archiveurl=https://web.archive.org/web/20080723125738/http://ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf |archivedate=2008-07-23 }}</ref> The American Dental Association calls water fluoridation "one of the safest and most beneficial, cost-effective public health measures for preventing, controlling, and in some cases reversing, tooth decay."<ref>American Dental Association. . 2005. Quote is from .</ref> | |||
In the English speaking nations, who practice fluoridation; the United States, Canada, UK, Australia and New Zealand, many medical associations and authorities have published position statements and endorsed water fluoridation, exaples include: | |||
The ],<ref>Vivek H. Murthy, MD, MBA, Surgeon General of the United States. . Public Health Reports. July–August 2015. Volume 130:1-3.</ref> the ],<ref>{{vcite web |url=http://apha.org/news-and-media/news-releases/apha-news-releases/apha-reaffirms-its-support-for-community-water-fluoridation |accessdate=2016-04-19 |date=2011 |title=APHA Reaffirms Its Support for Community Water Fluoridation |author=American Public Health Association }}</ref> the ],<ref>{{cite book|title=Royal Commission on the NHS Chapter 9|date=July 1979|publisher=HMSO|isbn=0-10-176150-3|url=http://www.sochealth.co.uk/national-health-service/royal-commission-on-the-national-health-service-contents/royal-commission-on-the-nhs-chapter-9/|accessdate=19 May 2015}}</ref> ],<ref>{{cite web|author=Australian Government Department of Health and Ageing|title=Fluoridation of drinking water|url=http://www.health.gov.au/internet/main/publishing.nsf/Content/dentalfluoridation|website=www.health.gov.au|accessdate=22 April 2016|language=en}}</ref> ],<ref>{{cite web|title=Questions and answers | Fluoride facts|url=http://www.fluoridefacts.govt.nz/questions-and-answers-0|website=www.fluoridefacts.govt.nz|accessdate=22 April 2016}}</ref> ] 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."<ref>{{cite web|url=http://www.hc-sc.gc.ca/ewh-semt/water-eau/drink-potab/health-sante/faq_fluoride-fluorure-eng.php |title=Fluoride in Drinking Water |publisher=]}}</ref> The ] listed water fluoridation as one of the ten great public health achievements of the 20th century in the U.S.,<ref name=CDC-1999>{{vcite journal |author=Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC |title=Achievements in public health, 1900–1999: Fluoridation of drinking water to prevent dental caries |journal=MMWR Morb Mortal Wkly Rep |volume=48 |issue=41 |pages=933–40 |year=1999 |pmid= |url=http://cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm }} Contains in: {{vcite journal |journal=JAMA |volume=283 |issue=10 |pages=1283–6 |year=2000 |doi=10.1001/jama.283.10.1283 |pmid=10714718 |title=<!-- pacify citation bot --> |author=<!-- pacify citation bot --> }}</ref> along with ], ], recognition of the ], and other achievements.<ref name=CDC-1999/> | |||
In ]; the Israeli Association of Public Health Physicians, the Israel Pediatric Association, and the Israel Dental Association, support fluoridation.<ref>{{cite web|title=Restoration of Fluoridation to Drinking Water, Ministry of Health|url=http://www.health.gov.il/English/Topics/Dental_Health/information/Pages/flouride-2015.aspx|website=www.health.gov.il|accessdate=23 April 2016}}</ref> | |||
The ], looking at global public health, identifies fluoride as one of a few chemicals (along with the ] and ], and to a lesser extent lead, selenium and uranium) that are found in excessive levels in many parts of the world and cause negative health effects; for fluoride this is especially true in large regions of India, China, Central Africa and South America, and locally in many parts of the world. Only for fluoride does it recommend adjusting the level in places where the chemical is low to reach a threshold; this is because there is clear evidence that low concentrations provide protection against cavities, both in children and in adults.<ref>{{cite web |url=http://www.who.int/water_sanitation_health/oralhealth/en/index2.html |title=Water fluoridation |work=World Water Day 2001: Oral health |publisher=]}}</ref><ref name=WHO2011> WHO, 2011. ISBN 9789241548151. Page 168, 175, 372 and see also pp 370-73. See also J. Fawell, et al . WHO, 2006. Page 32. Quote: "Concentrations in drinking-water of about 1 mg l–1 are associated with a lower incidence of dental caries, particularly in children, whereas excess intake of fluoride can result in dental fluorosis. In severe cases this can result in erosion of enamel. The margin between the beneficial effects of fluoride and the occurrence of dental fluorosis is small and public health programmes seek to retain a suitable balance between the two"</ref> | |||
===Minority scientific view=== | |||
The scientists or doctors who oppose water fluoridation argue that it has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and is pharmacologically obsolete.<ref name=Thiessen>{{cite journal|last1=Ko|first1=Lee|last2=Thiessen|first2=Kathleen M.|title=A critique of recent economic evaluations of community water fluoridation|journal=International Journal of Occupational and Environmental Health|date=3 December 2014|volume=21|issue=2|pages=91–120|doi=10.1179/2049396714Y.0000000093|accessdate=21 April 2016}}</ref><ref name=Hileman>Hileman, Bette (November 4, 2006) Vol 84, Num 36 PP. 34-37, ], Retrieved April 14, 2016</ref><ref name=Kaminsky>], Book review (August 16, 2004) , Volume 82, Number 33, pp. 35-36 ], Retrieved April 19, 2016</ref> ] has argued that fluoridation viiolates modern ] and doesn't take into account individual variations in response, which can be considerable even when the dosage is fixed.<ref name=Kaminsky/><ref>{{cite book | last = Bryson | first = Christopher | title = The fluoride deception (page 240) | publisher = Seven Stories Press | location = New York | year = 2004 | isbn = 9781609800086 }}</ref> | |||
==Evidence== | |||
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively.<ref name=cheng>National Center for Biotechnology Information , BMJ. 2007 Oct 6; 335(7622): 699–702. Retrieved on 12 April 2016</ref><ref name=yorkcrd/> Systematic reviews have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled.<ref name=Scher2011/><ref name=yorkcrd>Centre for Reviews and Dissemination , ], York, United Kingdom. Originally released : 28 October 2003. Retrieved on 12 April 2016</ref><ref name=Ih2015>{{cite journal|last1=Iheozor-Ejiofor|first1=Z|last2=Worthington|first2=HV|last3=Walsh|first3=T|last4=O'Malley|first4=L|last5=Clarkson|first5=JE|last6=Macey|first6=R|last7=Alam|first7=R|last8=Tugwell|first8=P|last9=Welch|first9=V|last10=Glenny|first10=AM|title=Water fluoridation for the prevention of dental caries.|journal=The Cochrane database of systematic reviews|date=18 June 2015|volume=6|pages=CD010856|pmid=26092033}}</ref> A 2007 ] report concluded that good evidence for or against water fluoridation is lacking.<ref name=nuffield/> Researchers who oppose the practice state this as well.<ref name="Book Reviews 2011"/> According to a 2013 ] report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.<ref name="fas.org"/> The Chair of the 2006 ] committee report on fluoride in drinking water, John Doull has stated a similar conclusion regarding the source of the controversy: "In the scientific community, people tend to think that its settled, I mean. when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this has been going on. I think that’s why fluoridation is still being challenged so many years after it began, In the face of ignorance, controversy is rampant."<ref>{{cite journal|last1=Barnett-Rose|first1=Rita|title=Compulsory Water Fluoridation: Justifiable Public Health Benefit or Human Experimental Research Without Informed Consent?|journal=William & Mary Environmental Law and Policy Review|date=December 2014|volume= 39|issue= 1|page=225|url=http://scholarship.law.wm.edu/wmelpr/vol39/iss1/7/|accessdate=21 April 2016}}</ref><ref>{{cite journal|last1=Fagin|first1=Dan|title=Second Thoughts about Fluoride|journal=Scientific American|date=1 January 2008|volume=298|issue=1|pages=74–81|doi=10.1038/scientificamerican0108-74|url=http://www.nature.com/scientificamerican/journal/v298/n1/full/scientificamerican0108-74.html|accessdate=21 April 2016|language=en}}</ref> | |||
===Safety === | |||
{{Main|Water fluoridation#Safety}} | |||
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] can occur naturally in water in concentrations well above recommended levels, which can have ], including severe dental fluorosis, ], and weakened bones.<ref name="Hhe">{{vcite book |chapter=Human health effects |title=Fluoride in Drinking-water |author=Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y |publisher=World Health Organization |isbn=92-4-156319-2 |year=2006 |url=http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf |format=PDF |pages=29–36 }}</ref> In 1984 the World Health Organization recommended a guideline maximum fluoride value of 1.5 mg/L as a level at which fluorosis should be minimal, reaffirming it in 2006.<ref>{{vcite book |chapter=Guidelines and standards |title=Fluoride in Drinking-water |author=Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y |publisher=World Health Organization |isbn=92-4-156319-2 |year=2006 |url=http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf |format=PDF |pages=37–9 }}</ref> | |||
Fluoridation has little effect on risk of ] (broken bones); it may result in slightly lower fracture risk than either excessively high levels of fluoridation or no fluoridation.<ref name="NHMRC">{{vcite book |url=http://nhmrc.gov.au/_files_nhmrc/file/publications/synopses/Eh41_Flouridation_PART_A.pdf |format=PDF |accessdate=2009-10-13 |year=2007 |title=A systematic review of the efficacy and safety of fluoridation |author=National Health and Medical Research Council (Australia) |isbn=1-86496-415-4 }} Summary: {{vcite journal |author=Yeung CA |title=A systematic review of the efficacy and safety of fluoridation |journal=Evid Based Dent |volume=9 |issue=2 |pages=39–43 |year=2008 |pmid=18584000 |doi=10.1038/sj.ebd.6400578 |laysummary=http://nhmrc.gov.au/_files_nhmrc/file/media/media/rel07/Fluoride_Flyer.pdf |laydate=2007 |laysource=NHMRC }}</ref> There is no clear association between fluoridation and ] or deaths due to cancer, both for cancer in general and also specifically for ] and ].<ref name="NHMRC" /><ref name="YorkReview2000">{{vcite web |author=McDonagh M, Whiting P, Bradley M ''et al.'' |author.= |title=A systematic review of public water fluoridation |url=http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport18.pdf |format=PDF |year=2000 }} Report website: {{vcite web |title=Fluoridation of drinking water: a systematic review of its efficacy and safety |publisher=NHS Centre for Reviews and Dissemination |date=2000 |url=http://www.york.ac.uk/inst/crd/fluorid.htm |accessdate=2009-05-26 }} Authors' summary: {{vcite journal |author=McDonagh MS, Whiting PF, Wilson PM ''et al.'' |title=Systematic review of water fluoridation |journal=BMJ |volume=321 |issue=7265 |pages=855–9 |year=2000 |doi=10.1136/bmj.321.7265.855 |pmid=11021861 |pmc=27492 |url=http://www.bmj.com/cgi/reprint/321/7265/855.pdf |format=PDF }} Authors' commentary: {{vcite journal |author=Treasure ET, Chestnutt IG, Whiting P, McDonagh M, Wilson P, Kleijnen J |title=The York review—a systematic review of public water fluoridation: a commentary |journal=Br Dent J |volume=192 |issue=9 |pages=495–7 |year=2002 |pmid=12047121 |doi=10.1038/sj.bdj.4801410a |url=http://www.nature.com/bdj/journal/v192/n9/full/4801410a.html }}</ref> | |||
In rare cases improper implementation of water fluoridation can result in overfluoridation that causes outbreaks of acute ], with symptoms that include ], ], and ]. Three such outbreaks were reported in the U.S. between 1991 and 1998, caused by fluoride concentrations as high as 220 mg/L; in the 1992 Alaska outbreak, 262 people became ill and one person died.<ref>{{vcite journal |author=Balbus JM, Lang ME |title=Is the water safe for my baby? |journal=Pediatr Clin North Am |volume=48 |issue=5 |pages=1<!DOCTYPE html> | |||
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<h1 id="firstHeading" class="firstHeading" lang="en">Editing Water fluoridation controversy</h1> | |||
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<div lang="en" dir="ltr" class="mw-content-ltr"><p>The <b>water fluoridation controversy</b> arises from a <a href="//en.wiktionary.org/vociferous" class="extiw" title="wikt:vociferous">vociferous</a> debate concerning the science and public policy of the <a href="/Water_fluoridation" title="Water fluoridation">fluoridation</a> of public <a href="/Water_supply" title="Water supply">water supplies</a>. It involves scientific issues, such as the question of <a href="/Risk%E2%80%93benefit_ratio" title="Risk–benefit ratio">Risk–benefit ratio</a> It also involves <a href="/Medical_ethics" title="Medical ethics">Medical ethics</a> and political issues, such as the question of the common good against individual rights, and the question of how the decision to fluoridate is made; <a href="/Administration_(government)" title="Administration (government)">Administratively</a> or via <a href="/Referendum" title="Referendum">Referendum</a>.<sup id="cite_ref-Scott_1-0" class="reference"><a href="#cite_note-Scott-1"></a></sup> The controversy is propelled by a significant public opposition supported by a minority of professionals.<sup id="cite_ref-ReferenceA_2-0" class="reference"><a href="#cite_note-ReferenceA-2"></a></sup> Those opposed argue that water fluoridation has no or little <a href="/Dental_caries#Prevention" title="Dental caries">cariostatic</a> benefits, may cause serious health problems, is not effective enough to justify the costs, and <a href="/Clinical_pharmacology" title="Clinical pharmacology">pharmacologically</a> obsolete.<sup id="cite_ref-Thiessen_3-0" class="reference"><a href="#cite_note-Thiessen-3"></a></sup><sup id="cite_ref-Hileman_4-0" class="reference"><a href="#cite_note-Hileman-4"></a></sup><sup id="cite_ref-Kaminsky_5-0" class="reference"><a href="#cite_note-Kaminsky-5"></a></sup></p> | |||
<p><a href="/Public_health" title="Public health">Public health</a> authorities throughout the world find a <a href="/Medical_consensus" title="Medical consensus">medical consensus</a> that water fluoridation at appropriate levels is a safe and effective means to prevent <a href="/Dental_caries" title="Dental caries">Dental caries</a>.<sup id="cite_ref-Pizzo_6-0" class="reference"><a href="#cite_note-Pizzo-6"></a></sup> The authorities views on the most effective <a href="/Fluoride_therapy" title="Fluoride therapy">Fluoride therapy</a> for community prevention of tooth decay are mixed; some state water fluoridation is most effective while others see no special advantage and prefer topical application strategies.<sup id="cite_ref-NHMRC_7-0" class="reference"><a href="#cite_note-NHMRC-7"></a></sup><sup id="cite_ref-EU2011_8-0" class="reference"><a href="#cite_note-EU2011-8"></a></sup></p> | |||
<p>Opposition to fluoridation has existed since its initiation in the 1940s.<sup id="cite_ref-Martin1989_9-0" class="reference"><a href="#cite_note-Martin1989-9"></a></sup> During the 1950s and 1960s, <a href="/Conspiracy_theorists" title="Conspiracy theorists" class="mw-redirect">conspiracy theorists</a> claimed that fluoridation was a <a href="/Communist" title="Communist" class="mw-redirect">communist</a> plot to undermine American public health.<sup id="cite_ref-Johnston_10-0" class="reference"><a href="#cite_note-Johnston-10"></a></sup> In recent years water fluoridation has become a prevalent health and political issue in many countries, resulting in some countries and communities discontinuing it's use while others have expanded it.<sup id="cite_ref-Scher2011_11-0" class="reference"><a href="#cite_note-Scher2011-11"></a></sup><sup id="cite_ref-fas.org_12-0" class="reference"><a href="#cite_note-fas.org-12"></a></sup> As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated <sup id="cite_ref-extent2012_13-0" class="reference"><a href="#cite_note-extent2012-13"></a></sup></p> | |||
<p>Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively.<sup id="cite_ref-cheng_14-0" class="reference"><a href="#cite_note-cheng-14"></a></sup><sup id="cite_ref-yorkcrd_15-0" class="reference"><a href="#cite_note-yorkcrd-15"></a></sup> <a href="/Systematic_review" title="Systematic review">Systematic reviews</a> have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled.<sup id="cite_ref-Scher2011_11-1" class="reference"><a href="#cite_note-Scher2011-11"></a></sup><sup id="cite_ref-yorkcrd_15-1" class="reference"><a href="#cite_note-yorkcrd-15"></a></sup><sup id="cite_ref-Ih2015_16-0" class="reference"><a href="#cite_note-Ih2015-16"></a></sup> Researchers who oppose the practice state this as well.<sup id="cite_ref-Book_Reviews_2011_17-0" class="reference"><a href="#cite_note-Book_Reviews_2011-17"></a></sup> According to a 2013 <a href="/Congressional_Research_Service" title="Congressional Research Service">Congressional Research Service</a> report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.<sup id="cite_ref-fas.org_12-1" class="reference"><a href="#cite_note-fas.org-12"></a></sup></p> | |||
<p></p> | |||
<div id="toc" class="toc"> | |||
<div id="toctitle"> | |||
<h2>Contents</h2> | |||
</div> | |||
<ul> | |||
<li class="toclevel-1 tocsection-1"><a href="#Medical_consensus"><span class="tocnumber">1</span> <span class="toctext">Medical consensus</span></a> | |||
<ul> | |||
<li class="toclevel-2 tocsection-2"><a href="#Minority_scientific_view"><span class="tocnumber">1.1</span> <span class="toctext">Minority scientific view</span></a></li> | |||
</ul> | |||
</li> | |||
<li class="toclevel-1 tocsection-3"><a href="#Evidence"><span class="tocnumber">2</span> <span class="toctext">Evidence</span></a> | |||
<ul> | |||
<li class="toclevel-2 tocsection-4"><a href="#Safety"><span class="tocnumber">2.1</span> <span class="toctext">Safety</span></a></li> | |||
<li class="toclevel-2 tocsection-5"><a href="#Efficacy"><span class="tocnumber">2.2</span> <span class="toctext">Efficacy</span></a></li> | |||
</ul> | |||
</li> | |||
<li class="toclevel-1 tocsection-6"><a href="#Ethics"><span class="tocnumber">3</span> <span class="toctext">Ethics</span></a></li> | |||
<li class="toclevel-1 tocsection-7"><a href="#Opposition_groups_and_campaigns"><span class="tocnumber">4</span> <span class="toctext">Opposition groups and campaigns</span></a></li> | |||
<li class="toclevel-1 tocsection-8"><a href="#Public_opinion"><span class="tocnumber">5</span> <span class="toctext">Public opinion</span></a></li> | |||
<li class="toclevel-1 tocsection-9"><a href="#Use_throughout_the_world"><span class="tocnumber">6</span> <span class="toctext">Use throughout the world</span></a></li> | |||
<li class="toclevel-1 tocsection-10"><a href="#History"><span class="tocnumber">7</span> <span class="toctext">History</span></a> | |||
<ul> | |||
<li class="toclevel-2 tocsection-11"><a href="#Communist_conspiracy_theory_.281940s.E2.80.931960s.29"><span class="tocnumber">7.1</span> <span class="toctext">Communist conspiracy theory (1940s–1960s)</span></a></li> | |||
<li class="toclevel-2 tocsection-12"><a href="#Later_conspiracy_theories"><span class="tocnumber">7.2</span> <span class="toctext">Later conspiracy theories</span></a></li> | |||
<li class="toclevel-2 tocsection-13"><a href="#2006_US_NRC_report"><span class="tocnumber">7.3</span> <span class="toctext">2006 US NRC report</span></a></li> | |||
</ul> | |||
</li> | |||
<li class="toclevel-1 tocsection-14"><a href="#Court_cases"><span class="tocnumber">8</span> <span class="toctext">Court cases</span></a> | |||
<ul> | |||
<li class="toclevel-2 tocsection-15"><a href="#Europe"><span class="tocnumber">8.1</span> <span class="toctext">Europe</span></a></li> | |||
<li class="toclevel-2 tocsection-16"><a href="#United_States"><span class="tocnumber">8.2</span> <span class="toctext">United States</span></a></li> | |||
</ul> | |||
</li> | |||
<li class="toclevel-1 tocsection-17"><a href="#See_also"><span class="tocnumber">9</span> <span class="toctext">See also</span></a></li> | |||
<li class="toclevel-1 tocsection-18"><a href="#References"><span class="tocnumber">10</span> <span class="toctext">References</span></a></li> | |||
<li class="toclevel-1 tocsection-19"><a href="#Further_reading"><span class="tocnumber">11</span> <span class="toctext">Further reading</span></a></li> | |||
<li class="toclevel-1 tocsection-20"><a href="#External_links"><span class="tocnumber">12</span> <span class="toctext">External links</span></a></li> | |||
</ul> | |||
</div> | |||
<p></p> | |||
<h2><span class="mw-headline" id="Medical_consensus">Medical consensus</span></h2> | |||
<p>National and international health agencies and dental associations throughout the world have endorsed water fluoridation as safe and effective.<sup id="cite_ref-Pizzo_6-1" class="reference"><a href="#cite_note-Pizzo-6"></a></sup><sup id="cite_ref-ADAorgs_18-0" class="reference"><a href="#cite_note-ADAorgs-18"></a></sup></p> | |||
<p>The views on the most effective method for community prevention of tooth decay are mixed. The Australian government states that water fluoridation is the most effective means of achieving fluoride exposure that is community-wide.<sup id="cite_ref-NHMRC_7-1" class="reference"><a href="#cite_note-NHMRC-7"></a></sup> The World Health Organization states water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk,<sup id="cite_ref-Petersen-2004_19-0" class="reference"><a href="#cite_note-Petersen-2004-19"></a></sup> while the <a href="/European_Commission" title="European Commission">European Commission</a> finds no advantage to water fluoridation compared with topical use.<sup id="cite_ref-EU2011_8-1" class="reference"><a href="#cite_note-EU2011-8"></a></sup></p> | |||
<p><a href="/FDI_World_Dental_Federation" title="FDI World Dental Federation">FDI World Dental Federation</a> supports water fluoridation as safe and effective.<sup id="cite_ref-20" class="reference"><a href="#cite_note-20"></a></sup> the European Academy of Paediatric Dentistry,<sup id="cite_ref-21" class="reference"><a href="#cite_note-21"></a></sup> and the national dental associations of Australia,<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"></a></sup> Canada,<sup id="cite_ref-23" class="reference"><a href="#cite_note-23"></a></sup> and the U.S.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"></a></sup> The American Dental Association calls water fluoridation "one of the safest and most beneficial, cost-effective public health measures for preventing, controlling, and in some cases reversing, tooth decay."<sup id="cite_ref-25" class="reference"><a href="#cite_note-25"></a></sup></p> | |||
<p>In the English speaking nations, who practice fluoridation; the United States, Canada, UK, Australia and New Zealand, many medical associations and authorities have published position statements and endorsed water fluoridation, exaples include:</p> | |||
<p>The <a href="/U.S._Surgeon_General" title="U.S. Surgeon General" class="mw-redirect">U.S. Surgeon General</a>,<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"></a></sup> the <a href="/American_Public_Health_Association" title="American Public Health Association">American Public Health Association</a>,<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"></a></sup> the <a href="/Royal_Commission_on_the_National_Health_Service" title="Royal Commission on the National Health Service">Royal Commission on the National Health Service</a>,<sup id="cite_ref-28" class="reference"><a href="#cite_note-28"></a></sup> <a href="/Australian_Medical_Association" title="Australian Medical Association">Australian Medical Association</a>,<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"></a></sup> <a href="/New_Zealand_Medical_Association" title="New Zealand Medical Association">New Zealand Medical Association</a>,<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"></a></sup> <a href="/Health_Canada" title="Health Canada">Health Canada</a> 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."<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"></a></sup> The <a href="/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a> listed water fluoridation as one of the ten great public health achievements of the 20th century in the U.S.,<sup id="cite_ref-CDC-1999_32-0" class="reference"><a href="#cite_note-CDC-1999-32"></a></sup> along with <a href="/Vaccination" title="Vaccination">vaccination</a>, <a href="/Family_planning" title="Family planning">family planning</a>, recognition of the <a href="/Dangers_of_smoking" title="Dangers of smoking" class="mw-redirect">dangers of smoking</a>, and other achievements.<sup id="cite_ref-CDC-1999_32-1" class="reference"><a href="#cite_note-CDC-1999-32"></a></sup></p> | |||
<p>In <a href="/Israel" title="Israel">Israel</a>; the Israeli Association of Public Health Physicians, the Israel Pediatric Association, and the Israel Dental Association, support fluoridation.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"></a></sup></p> | |||
<p>The <a href="/World_Health_Organization" title="World Health Organization">World Health Organization</a>, looking at global public health, identifies fluoride as one of a few chemicals (along with the <a href="/Arsenic" title="Arsenic">arsenic</a> and <a href="/Nitrate" title="Nitrate">nitrate</a>, and to a lesser extent lead, selenium and uranium) that are found in excessive levels in many parts of the world and cause negative health effects; for fluoride this is especially true in large regions of India, China, Central Africa and South America, and locally in many parts of the world. Only for fluoride does it recommend adjusting the level in places where the chemical is low to reach a threshold; this is because there is clear evidence that low concentrations provide protection against cavities, both in children and in adults.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"></a></sup><sup id="cite_ref-WHO2011_35-0" class="reference"><a href="#cite_note-WHO2011-35"></a></sup></p> | |||
<h3><span class="mw-headline" id="Minority_scientific_view">Minority scientific view</span></h3> | |||
<p>The scientists or doctors who oppose water fluoridation argue that it has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and is pharmacologically obsolete.<sup id="cite_ref-Thiessen_3-1" class="reference"><a href="#cite_note-Thiessen-3"></a></sup><sup id="cite_ref-Hileman_4-1" class="reference"><a href="#cite_note-Hileman-4"></a></sup><sup id="cite_ref-Kaminsky_5-1" class="reference"><a href="#cite_note-Kaminsky-5"></a></sup> <a href="/Arvid_Carlsson" title="Arvid Carlsson">Arvid Carlsson</a> has argued that fluoridation viiolates modern <a href="/Clinical_pharmacology" title="Clinical pharmacology">pharmacological principles</a> and doesn't take into account individual variations in response, which can be considerable even when the dosage is fixed.<sup id="cite_ref-Kaminsky_5-2" class="reference"><a href="#cite_note-Kaminsky-5"></a></sup><sup id="cite_ref-36" class="reference"><a href="#cite_note-36"></a></sup></p> | |||
<h2><span class="mw-headline" id="Evidence">Evidence</span></h2> | |||
<p>Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively.<sup id="cite_ref-cheng_14-1" class="reference"><a href="#cite_note-cheng-14"></a></sup><sup id="cite_ref-yorkcrd_15-2" class="reference"><a href="#cite_note-yorkcrd-15"></a></sup> Systematic reviews have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled.<sup id="cite_ref-Scher2011_11-2" class="reference"><a href="#cite_note-Scher2011-11"></a></sup><sup id="cite_ref-yorkcrd_15-3" class="reference"><a href="#cite_note-yorkcrd-15"></a></sup><sup id="cite_ref-Ih2015_16-1" class="reference"><a href="#cite_note-Ih2015-16"></a></sup> A 2007 <a href="/Nuffield_Council_on_Bioethics" title="Nuffield Council on Bioethics">Nuffield Council on Bioethics</a> report concluded that good evidence for or against water fluoridation is lacking.<sup id="cite_ref-nuffield_37-0" class="reference"><a href="#cite_note-nuffield-37"></a></sup> Researchers who oppose the practice state this as well.<sup id="cite_ref-Book_Reviews_2011_17-1" class="reference"><a href="#cite_note-Book_Reviews_2011-17"></a></sup> According to a 2013 <a href="/Congressional_Research_Service" title="Congressional Research Service">Congressional Research Service</a> report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.<sup id="cite_ref-fas.org_12-2" class="reference"><a href="#cite_note-fas.org-12"></a></sup> The Chair of the 2006 <a href="/National_Research_Council_(United_States)" title="National Research Council (United States)">National Research Council</a> committee report on fluoride in drinking water, John Doull has stated a similar conclusion regarding the source of the controversy: "In the scientific community, people tend to think that its settled, I mean. when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this has been going on. I think that’s why fluoridation is still being challenged so many years after it began, In the face of ignorance, controversy is rampant."<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"></a></sup><sup id="cite_ref-39" class="reference"><a href="#cite_note-39"></a></sup></p> | |||
<h3><span class="mw-headline" id="Safety">Safety</span></h3> | |||
<div role="note" class="hatnote relarticle mainarticle">Main article: <a href="/Water_fluoridation#Safety" title="Water fluoridation">Water fluoridation § Safety</a></div> | |||
<p><a href="/Calcium_fluoride" title="Calcium fluoride">Calcium fluoride</a> can occur naturally in water in concentrations well above recommended levels, which can have <a href="/Fluoride_poisoning#Chronic_toxicity" title="Fluoride poisoning" class="mw-redirect">several long-term adverse effects</a>, including severe dental fluorosis, <a href="/Skeletal_fluorosis" title="Skeletal fluorosis">skeletal fluorosis</a>, and weakened bones.<sup id="cite_ref-Hhe_40-0" class="reference"><a href="#cite_note-Hhe-40"></a></sup> In 1984 the World Health Organization recommended a guideline maximum fluoride value of 1.5 mg/L as a level at which fluorosis should be minimal, reaffirming it in 2006.<sup id="cite_ref-41" class="reference"><a href="#cite_note-41"></a></sup></p> | |||
<p>Fluoridation has little effect on risk of <a href="/Bone_fracture" title="Bone fracture">bone fracture</a> (broken bones); it may result in slightly lower fracture risk than either excessively high levels of fluoridation or no fluoridation.<sup id="cite_ref-NHMRC_7-2" class="reference"><a href="#cite_note-NHMRC-7"></a></sup> There is no clear association between fluoridation and <a href="/Cancer" title="Cancer">cancer</a> or deaths due to cancer, both for cancer in general and also specifically for <a href="/Bone_cancer" title="Bone cancer" class="mw-redirect">bone cancer</a> and <a href="/Osteosarcoma" title="Osteosarcoma">osteosarcoma</a>.<sup id="cite_ref-NHMRC_7-3" class="reference"><a href="#cite_note-NHMRC-7"></a></sup><sup id="cite_ref-YorkReview2000_42-0" class="reference"><a href="#cite_note-YorkReview2000-42"></a></sup></p> | |||
<p>In rare cases improper implementation of water fluoridation can result in overfluoridation that causes outbreaks of acute <a href="/Fluoride_poisoning" title="Fluoride poisoning" class="mw-redirect">fluoride poisoning</a>, with symptoms that include <a href="/Nausea" title="Nausea">nausea</a>, <a href="/Vomiting" title="Vomiting">vomiting</a>, and <a href="/Diarrhea" title="Diarrhea">diarrhea</a>. Three such outbreaks were reported in the U.S. between 1991 and 1998, caused by fluoride concentrations as high as 220 mg/L; in the 1992 Alaska outbreak, 262 people became ill and one person died.<sup id="cite_ref-43" class="reference"><a href="#cite_note-43"></a></sup> In 2010, approximately 60 gallons of fluoride were released into the water supply in <a href="/Asheboro,_North_Carolina" title="Asheboro, North Carolina">Asheboro, North Carolina</a> in 90 minutes—an amount that was intended to be released in a 24-hour period.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"></a></sup></p> | |||
<p>Like other common water additives such as <a href="/Water_chlorination" title="Water chlorination">chlorine</a>, hydrofluosilicic acid and sodium silicofluoride decrease pH and cause a small increase of <a href="/Corrosivity" title="Corrosivity" class="mw-redirect">corrosivity</a>, but this problem is easily addressed by increasing the pH.<sup id="cite_ref-Pollick_45-0" class="reference"><a href="#cite_note-Pollick-45"></a></sup> Although it has been hypothesized that hydrofluosilicic acid and sodium silicofluoride might increase human <a href="/Lead" title="Lead">lead</a> uptake from water, a 2006 statistical analysis did not support concerns that these chemicals cause higher blood lead concentrations in children.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"></a></sup> Trace levels of <a href="/Arsenic" title="Arsenic">arsenic</a> and lead may be present in fluoride compounds added to water; however, <a href="/Concentration" title="Concentration">concentrations</a> are below measurement limits.<sup id="cite_ref-Pollick_45-1" class="reference"><a href="#cite_note-Pollick-45"></a></sup></p> | |||
<p>The effect of water fluoridation on the natural environment has been investigated, and no adverse effects have been established. Issues studied have included fluoride concentrations in groundwater and downstream rivers; lawns, gardens, and plants; consumption of plants grown in fluoridated water; air emissions; and equipment noise.<sup id="cite_ref-Pollick_45-2" class="reference"><a href="#cite_note-Pollick-45"></a></sup></p> | |||
<h3><span class="mw-headline" id="Efficacy">Efficacy</span></h3> | |||
<div role="note" class="hatnote relarticle mainarticle">Main article: <a href="/Water_fluoridation#Effectiveness" title="Water fluoridation">Water fluoridation § Effectiveness</a></div> | |||
<p>Reviews have shown that water fluoridation reduces cavities in children.<sup id="cite_ref-EU2011_8-2" class="reference"><a href="#cite_note-EU2011-8"></a></sup><sup id="cite_ref-Ih2015_16-2" class="reference"><a href="#cite_note-Ih2015-16"></a></sup><sup id="cite_ref-Parnell_47-0" class="reference"><a href="#cite_note-Parnell-47"></a></sup> A conclusion for the efficacy in adults is less clear with some reviews finding benefit and others not.<sup id="cite_ref-Ih2015_16-3" class="reference"><a href="#cite_note-Ih2015-16"></a></sup><sup id="cite_ref-Parnell_47-1" class="reference"><a href="#cite_note-Parnell-47"></a></sup> Studies in the U.S. in the 1950s and 1960s showed that water fluoridation reduced childhood cavities by fifty to sixty percent, while studies in 1989 and 1990 showed lower reductions (40% and 18% respectively), likely due to increasing use of fluoride from other sources, notably toothpaste, and also the 'halo effect' of food and drink that is made in fluoridated areas and consumed in unfluoridated ones.<sup id="cite_ref-FRWG_48-0" class="reference"><a href="#cite_note-FRWG-48"></a></sup></p> | |||
<p>A 2000 UK <a href="/Systematic_review" title="Systematic review">systematic review</a> (York) found that water fluoridation was <a href="/Association_(statistics)" title="Association (statistics)">associated</a> with a decreased proportion of children with cavities of 15% and with a decrease in decayed, <a href="/Tooth_loss" title="Tooth loss">missing</a>, and <a href="/Dental_restoration" title="Dental restoration">filled</a> <a href="/Primary_teeth" title="Primary teeth" class="mw-redirect">primary teeth</a> (average decreases was 2.25 teeth). The review found that the evidence was of moderate quality: few studies attempted to reduce <a href="/Observer_bias" title="Observer bias" class="mw-redirect">observer bias</a>, control for <a href="/Confounding_factor" title="Confounding factor" class="mw-redirect">confounding factors</a>, report variance measures, or use appropriate analysis. Although no major differences between natural and artificial fluoridation were apparent, the evidence was inadequate for a conclusion about any differences.<sup id="cite_ref-YorkReview2000_42-1" class="reference"><a href="#cite_note-YorkReview2000-42"></a></sup> A 2002 systematic review found strong evidence that water fluoridation is effective at reducing overall tooth decay in communities.<sup id="cite_ref-Truman_49-0" class="reference"><a href="#cite_note-Truman-49"></a></sup> A 2015 Cochrane review also found benefit in children.<sup id="cite_ref-Ih2015_16-4" class="reference"><a href="#cite_note-Ih2015-16"></a></sup></p> | |||
<p>Fluoride may also prevent cavities in adults of all ages. A 2007 <a href="/Meta-analysis" title="Meta-analysis">meta-analysis</a> by CDC researchers found that water fluoridation prevented an estimated 27% of cavities in adults, about the same fraction as prevented by exposure to any delivery method of fluoride (29% average).<sup id="cite_ref-Griffin_50-0" class="reference"><a href="#cite_note-Griffin-50"></a></sup> A 2011 European Commission review found that the benefits of water fluoridation for adult in terms of reductions in decay are limited.<sup id="cite_ref-EU2011_8-3" class="reference"><a href="#cite_note-EU2011-8"></a></sup> 2015 Cochrane review found no conclusive research in adults.<sup id="cite_ref-Ih2015_16-5" class="reference"><a href="#cite_note-Ih2015-16"></a></sup></p> | |||
<p>Most countries in Europe have experienced substantial declines in cavities without the use of water fluoridation.<sup id="cite_ref-Pizzo_6-2" class="reference"><a href="#cite_note-Pizzo-6"></a></sup> For example, in Finland and Germany, tooth decay rates remained stable or continued to decline after water fluoridation stopped. Fluoridation may be useful in the U.S. because unlike most European countries, the U.S. does not have school-based dental care, many children do not visit a dentist regularly, and for many U.S. children water fluoridation is the prime source of exposure to fluoride.<sup id="cite_ref-Burt_51-0" class="reference"><a href="#cite_note-Burt-51"></a></sup> The effectiveness of water fluoridation can vary according to circumstances such as whether preventive dental care is free to all children.<sup id="cite_ref-52" class="reference"><a href="#cite_note-52"></a></sup></p> | |||
<h2><span class="mw-headline" id="Ethics">Ethics</span></h2> | |||
<p>Water fluoridation pits the common good against individual rights. Some say the common good overrides individual rights, and equate it to <a href="/Vaccination" title="Vaccination">vaccination</a> and <a href="/Food_fortification" title="Food fortification">food fortification</a>.<sup id="cite_ref-ethics_53-0" class="reference"><a href="#cite_note-ethics-53"></a></sup><sup id="cite_ref-Cross2003_54-0" class="reference"><a href="#cite_note-Cross2003-54"></a></sup> Others say that individual rights override the common good, and say that individuals have no choice in the water that they drink, unless they drink more expensive bottled water,<sup id="cite_ref-Coggon_55-0" class="reference"><a href="#cite_note-Coggon-55"></a></sup> and some argue unequivocally, that it does not stand up to scrutiny relative to the Nuremberg Code and other codes of medical ethics.<sup id="cite_ref-Cross_56-0" class="reference"><a href="#cite_note-Cross-56"></a></sup></p> | |||
<p>Those who emphasize the public good emphasize the <a href="/Water_fluoridation_controversy#Medical_consensus" title="Water fluoridation controversy">medical consensus</a> that appropriate levels of water fluoridation are safe and effective to prevent cavities and see it as a <a href="/Public_health" title="Public health">public health</a> intervention, replicating the benefits of naturally fluoridated water, which can free people from the misery and expense of tooth decay and <a href="/Toothache" title="Toothache">toothache</a>, with the greatest benefit accruing to those least able to help themselves. This perspective suggests it would be unethical to withhold such treatment.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"></a></sup> In her book <i>50 Health Scares That Fizzled</i>, <a href="/Joan_Callahan" title="Joan Callahan">Joan Callahan</a> writes that, "For lower-income people with no insurance, fluoridated water (like enriched flour and fortified milk) looks more like a free preventative health measure that a few elitists are trying to take away."<sup id="cite_ref-58" class="reference"><a href="#cite_note-58"></a></sup></p> | |||
<p>Those who emphasize individual or local choice, may view fluoridation as a violation of <a href="/Medical_ethics" title="Medical ethics">ethical</a> or legal rules that prohibit medical treatment without medical supervision or informed consent, and that prohibit administration of unlicensed medical substances,<sup id="cite_ref-Pizzo_6-3" class="reference"><a href="#cite_note-Pizzo-6"></a></sup><sup id="cite_ref-LockerCohen2001_59-0" class="reference"><a href="#cite_note-LockerCohen2001-59"></a></sup> view it as "mass medication",<sup id="cite_ref-GreenUK2003_60-0" class="reference"><a href="#cite_note-GreenUK2003-60"></a></sup> or may even characterize it as a violation of the <a href="/Nuremberg_Code" title="Nuremberg Code">Nuremberg Code</a> and the Council of Europe's Biomedical Convention of 1999.<sup id="cite_ref-Cross2003_54-1" class="reference"><a href="#cite_note-Cross2003-54"></a></sup><sup id="cite_ref-Tienman2013_61-0" class="reference"><a href="#cite_note-Tienman2013-61"></a></sup><sup id="cite_ref-ChengChalmers2007_62-0" class="reference"><a href="#cite_note-ChengChalmers2007-62"></a></sup> Another journal article suggested applying the <a href="/Precautionary_principle" title="Precautionary principle">precautionary principle</a> to this controversy, which calls for <a href="/Public_policy" title="Public policy">public policy</a> 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.<sup id="cite_ref-Tickner_63-0" class="reference"><a href="#cite_note-Tickner-63"></a></sup> Others have opposed it on the grounds of potential financial conflicts of interest driven by the chemical industry.<sup id="cite_ref-GreenUK2015_64-0" class="reference"><a href="#cite_note-GreenUK2015-64"></a></sup></p> | |||
<p>A 2007 <a href="/Nuffield_Council_on_Bioethics" title="Nuffield Council on Bioethics">Nuffield Council on Bioethics</a> report reached a conclusion mainly on three points, stating that :</p> | |||
<ul> | |||
<li>The balance of benefit to risk ratio - is unclear due to the lack of good evidence for or against water fluoridation.</li> | |||
<li>Alternatives to the practice exist - topical fluoride therapy (toothbrushing etc)</li> | |||
<li>The role of consent- It gets priority when there are potential harms.</li> | |||
</ul> | |||
<p>The report therefore concluded that local and regional democratic procedures are the most appropriate way to decide whether to fluoridate.<sup id="cite_ref-nuffield_37-1" class="reference"><a href="#cite_note-nuffield-37"></a></sup><sup id="cite_ref-Nuffieldfull_65-0" class="reference"><a href="#cite_note-Nuffieldfull-65"></a></sup></p> | |||
<h2><span class="mw-headline" id="Opposition_groups_and_campaigns">Opposition groups and campaigns</span></h2> | |||
<p>The controversy is propelled by a significant public opposition supported by a minority of professionals,<sup id="cite_ref-ReferenceA_2-1" class="reference"><a href="#cite_note-ReferenceA-2"></a></sup> including researchers, dental and medical professionals, alternative medical practitioners such as <a href="/Chiropractors" title="Chiropractors" class="mw-redirect">chiropractors</a>, health food enthusiasts, a few religious groups (mostly <a href="/Christian_Scientists" title="Christian Scientists" class="mw-redirect">Christian Scientists</a> in the U.S.), and occasionally consumer groups and environmentalists.<sup id="cite_ref-Reilly_66-0" class="reference"><a href="#cite_note-Reilly-66"></a></sup> Organized political opposition has come from <a href="/Libertarians" title="Libertarians" class="mw-redirect">libertarians</a>,<sup id="cite_ref-Dehnbase_67-0" class="reference"><a href="#cite_note-Dehnbase-67"></a></sup> the <a href="/John_Birch_Society" title="John Birch Society">John Birch Society</a>,<sup id="cite_ref-Birch_68-0" class="reference"><a href="#cite_note-Birch-68"></a></sup> and from groups like the Green parties in the UK and New Zealand.<sup id="cite_ref-Greenwars_69-0" class="reference"><a href="#cite_note-Greenwars-69"></a></sup><sup id="cite_ref-GreenUK2015_64-1" class="reference"><a href="#cite_note-GreenUK2015-64"></a></sup><sup id="cite_ref-70" class="reference"><a href="#cite_note-70"></a></sup></p> | |||
<p>Opposition campaigns involve newspaper articles, talk radio, and public forums. Media reporters are often poorly equipped to explain the scientific issues, and are motivated to present controversy regardless of the underlying scientific merits. Websites, which are increasingly used by the public for health information, contain a wide range of material about fluoridation ranging from factual to fraudulent, with a disproportionate percentage opposed to fluoridation. Antifluoridationist literature links fluoride exposure to a wide variety of effects, including <a href="/AIDS" title="AIDS" class="mw-redirect">AIDS</a>, <a href="/Allergy" title="Allergy">allergy</a>, <a href="/Alzheimer%27s_disease" title="Alzheimer's disease">Alzheimer's disease</a>, <a href="/Arthritis" title="Arthritis">arthritis</a>, <a href="/Cancer" title="Cancer">cancer</a>, and low <a href="/IQ" title="IQ" class="mw-redirect">IQ</a>, along with diseases of the <a href="/Gastrointestinal_tract" title="Gastrointestinal tract">gastrointestinal tract</a>, <a href="/Kidney" title="Kidney">kidney</a>, <a href="/Pineal_gland" title="Pineal gland">pineal gland</a>, and <a href="/Thyroid" title="Thyroid">thyroid</a>.<sup id="cite_ref-Armfield_71-0" class="reference"><a href="#cite_note-Armfield-71"></a></sup></p> | |||
<h2><span class="mw-headline" id="Public_opinion">Public opinion</span></h2> | |||
<p>Many people do not know that fluoridation is meant to prevent tooth decay, or that natural or bottled water can contain fluoride. As fluoridation does not appear to be an important issue for the general public in the U.S., the debate may reflect an argument between two relatively small <a href="/Lobbying" title="Lobbying">lobbies</a> for and against fluoridation.<sup id="cite_ref-Griffin-opinions_72-0" class="reference"><a href="#cite_note-Griffin-opinions-72"></a></sup></p> | |||
<p>A 2009 survey of Australians found that 70% supported and 15% opposed fluoridation. Those opposed were much more likely to score higher on <a href="/Outrage_factor" title="Outrage factor">outrage factors</a> such as "unclear benefits".<sup id="cite_ref-73" class="reference"><a href="#cite_note-73"></a></sup></p> | |||
<p>A 2003 study of focus groups from 16 European countries found that fluoridation was opposed by a majority of focus group members in most of the countries, including France, Germany, and the UK.<sup id="cite_ref-Griffin-opinions_72-1" class="reference"><a href="#cite_note-Griffin-opinions-72"></a></sup></p> | |||
<p>A 1999 survey in <a href="/Sheffield" title="Sheffield">Sheffield</a>, UK found that while a 62% majority favored water fluoridation in the city, the 31% who were opposed <a href="/Willingness_to_pay" title="Willingness to pay">expressed their preference</a> with greater intensity than supporters.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"></a></sup></p> | |||
<p>Every year in the U.S., pro- and anti-fluoridationists face off in <a href="/Referenda" title="Referenda" class="mw-redirect">referenda</a> or other public decision-making processes: in most of them, fluoridation is rejected.<sup id="cite_ref-Reilly_66-1" class="reference"><a href="#cite_note-Reilly-66"></a></sup></p> | |||
<h2><span class="mw-headline" id="Use_throughout_the_world">Use throughout the world</span></h2> | |||
<div role="note" class="hatnote relarticle mainarticle">Main article: <a href="/Fluoridation_by_country" title="Fluoridation by country">Fluoridation by country</a></div> | |||
<p>Despite support by public health organizations and authorities, the practice is controversial as a public health measure; some countries and communities have discontinued it, while others have expanded it.<sup id="cite_ref-Scher2011_11-3" class="reference"><a href="#cite_note-Scher2011-11"></a></sup><sup id="cite_ref-fas.org_12-3" class="reference"><a href="#cite_note-fas.org-12"></a></sup></p> | |||
<p>In the U.S., rejection in state and local communities is more likely when the decision is made by a public referendum; in Europe, most decisions against fluoridation have been made administratively.<sup id="cite_ref-Martin1989_9-1" class="reference"><a href="#cite_note-Martin1989-9"></a></sup> Neither side of the dispute appears to be weakening or willing to concede.<sup id="cite_ref-Reilly_66-2" class="reference"><a href="#cite_note-Reilly-66"></a></sup></p> | |||
<p>Water fluoridation is used in the United States, 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:</p> | |||
<ul> | |||
<li>Federal Republic of Germany (1952–1971)</li> | |||
<li>Sweden (1952–1971)</li> | |||
<li>Netherlands (1953–1976)</li> | |||
<li>Czechoslovakia (1955–1990)</li> | |||
<li>German Democratic Republic (1959–1990)</li> | |||
<li>Soviet Union (1960–1990)</li> | |||
<li>Finland (1959–1993)</li> | |||
<li>Japan (1952–1972)<sup id="cite_ref-75" class="reference"><a href="#cite_note-75"></a></sup></li> | |||
<li>Israel (1981–2014) *Mandatory by law since 2002.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"></a></sup><sup id="cite_ref-77" class="reference"><a href="#cite_note-77"></a></sup></li> | |||
</ul> | |||
<p>In the United Kingdom a <a href="/Strategic_health_authority" title="Strategic health authority">strategic health authority</a> can direct a water company to fluoridate the water supply in an area if it is technically possible. The strategic health authority must consult with the local community and businesses in the affected area. The water company will act as a contractor in any new schemes and cannot refuse to fluoridate the supply.<sup id="cite_ref-78" class="reference"><a href="#cite_note-78"></a></sup></p> | |||
<p>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 <a href="/World_Health_Organization" title="World Health Organization">World Health Organization</a> (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.<sup id="cite_ref-79" class="reference"><a href="#cite_note-79"></a></sup> In some other countries, <a href="/Sodium_fluoride" title="Sodium fluoride">sodium fluoride</a> is added to table salt.<sup id="cite_ref-80" class="reference"><a href="#cite_note-80"></a></sup></p> | |||
<p>As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated water. A further 28 countries have water that is naturally fluoridated, though in many of them the fluoride is above the recommended safe level.<sup id="cite_ref-extent2012_13-1" class="reference"><a href="#cite_note-extent2012-13"></a></sup> As of 2012 about 435 million people worldwide received water fluoridated at the recommended level (i.e., about 5.4% of the global population).<sup id="cite_ref-extent2012_13-2" class="reference"><a href="#cite_note-extent2012-13"></a></sup> About 214 million of them living in the United States.<sup id="cite_ref-US-CDC-WF-Stats-2012_81-0" class="reference"><a href="#cite_note-US-CDC-WF-Stats-2012-81"></a></sup></p> | |||
<h2><span class="mw-headline" id="History">History</span></h2> | |||
<div role="note" class="hatnote relarticle mainarticle">Main article: <a href="/History_of_water_fluoridation" title="History of water fluoridation" class="mw-redirect">History of water fluoridation</a></div> | |||
<p>Fluoridation began during a time of great optimism and faith in science and experts (the 1950s and 1960s), but even then, the public frequently objected. Opponents drew on distrust of experts and unease about medicine and science.<sup id="cite_ref-82" class="reference"><a href="#cite_note-82"></a></sup> Controversies include disputes over fluoridation's benefits and the strength of the evidence basis for these benefits, the difficulty of identifying harms, legal issues over whether water fluoride is a medicine, and the ethics of mass intervention.<sup id="cite_ref-Cheng2007_83-0" class="reference"><a href="#cite_note-Cheng2007-83"></a></sup></p> | |||
<p>The first large fluoridation controversy occurred in Wisconsin in 1950. Fluoridation opponents questioned the ethics, safety, and efficacy of fluoridation.<sup id="cite_ref-Musto_84-0" class="reference"><a href="#cite_note-Musto-84"></a></sup> New Zealand was the second country to fluoridate, and similar controversies arose there.<sup id="cite_ref-Wrapson_85-0" class="reference"><a href="#cite_note-Wrapson-85"></a></sup> 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 <a href="/Fluoride_poisoning" title="Fluoride poisoning" class="mw-redirect">fluoride poisoning</a>" 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.<sup id="cite_ref-86" class="reference"><a href="#cite_note-86"></a></sup> When voted upon, the outcomes tend to be negative, and thus fluoridation has had a history of gaining through administrative orders in North America.<sup id="cite_ref-Musto_84-1" class="reference"><a href="#cite_note-Musto-84"></a></sup></p> | |||
<p><a href="/Conspiracy_theory" title="Conspiracy theory">Conspiracy theories</a> involving fluoridation are common, and include claims that fluoridation was motivated by protecting the U.S. atomic bomb program from litigation, that (as famously parodied in the film <i><a href="/Dr._Strangelove" title="Dr. Strangelove">Dr. Strangelove</a>,</i> where a deranged U.S. Army general claimed that it would "sap and impurify all of our precious bodily fluids") it is part of a <a href="/Communist" title="Communist" class="mw-redirect">Communist</a> or <a href="/New_World_Order_(conspiracy_theory)" title="New World Order (conspiracy theory)">New World Order</a> plot to take over the world, that it was pioneered by a German chemical company to make people submissive to those in power, that behind the scenes it is promoted by the sugary food or phosphate fertilizer or aluminium industries, or that it is a smokescreen to cover failure to provide dental care to the poor.<sup id="cite_ref-Armfield_71-1" class="reference"><a href="#cite_note-Armfield-71"></a></sup> One such theory is that fluoridation was a <a href="/Public-relations" title="Public-relations" class="mw-redirect">public-relations</a> ruse sponsored by fluoride polluters such as the aluminium maker <a href="/Alcoa" title="Alcoa">Alcoa</a> and the <a href="/Manhattan_Project" title="Manhattan Project">Manhattan Project</a>, with conspirators that included industrialist <a href="/Andrew_Mellon" title="Andrew Mellon">Andrew Mellon</a> and the <a href="/Mellon_Institute" title="Mellon Institute" class="mw-redirect">Mellon Institute</a>'s researcher Gerald J. Cox, the Kettering Laboratory of the <a href="/University_of_Cincinnati" title="University of Cincinnati">University of Cincinnati</a>, the <a href="/Federal_Security_Agency" title="Federal Security Agency">Federal Security Agency</a>'s administrator Oscar R. Ewing, and public-relations strategist <a href="/Edward_Bernays" title="Edward Bernays">Edward Bernays</a>.<sup id="cite_ref-87" class="reference"><a href="#cite_note-87"></a></sup> Specific antifluoridation arguments change to match the spirit of the time.<sup id="cite_ref-88" class="reference"><a href="#cite_note-88"></a></sup></p> | |||
<div class="thumb tright"> | |||
<div class="thumbinner" style="width:222px;"><a href="/File:Unholy_three_cropped.png" class="image"><img alt="Black-and-white political cartoon of a leering skull menacing a doll-holding little girl whose back is supported by an arm tagged "UNINFORMED PUBLIC". Nearby bones hold three large balls labeled "FLUORIDATED WATER", "POLIO MONKEY SERUMS", and "MENTAL HYGIENE etc." The cartoon is entitled "At the Sign of THE UNHOLY THREE", signed "B. SMART", and captioned "Are you willing to PUT IN PAWN to the UNHOLY THREE all of the material, mental, and spiritual resources of this GREAT REPUBLIC?"" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Unholy_three_cropped.png/220px-Unholy_three_cropped.png" width="220" height="199" class="thumbimage" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Unholy_three_cropped.png/330px-Unholy_three_cropped.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/5d/Unholy_three_cropped.png/440px-Unholy_three_cropped.png 2x" data-file-width="590" data-file-height="535" /></a> | |||
<div class="thumbcaption"> | |||
<div class="magnify"><a href="/File:Unholy_three_cropped.png" class="internal" title="Enlarge"></a></div> | |||
Illustration in <a href="/File:Unholy_three.png" title="File:Unholy three.png">a 1955 flier</a> by the Keep America Committee, alleging that fluoridation was a Communist plot.</div> | |||
</div> | |||
</div> | |||
<p>Outside North America, water fluoridation was adopted in some 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.</p> | |||
<h3><span class="mw-headline" id="Communist_conspiracy_theory_.281940s.E2.80.931960s.29">Communist conspiracy theory (1940s–1960s)</span></h3> | |||
<p>Water fluoridation has frequently been the subject of conspiracy theories. During the "<a href="/Red_Scare" title="Red Scare">Red Scare</a>" 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. These opponents believed it was "another aspect of President <a href="/Harry_Truman" title="Harry Truman" class="mw-redirect">Truman</a>'s drive to socialize medicine."<sup id="cite_ref-Henigbook1996_89-0" class="reference"><a href="#cite_note-Henigbook1996-89"></a></sup> They also opposed other public health programs, notably mass <a href="/Vaccination" title="Vaccination">vaccination</a> and <a href="/Mental_health" title="Mental health">mental health</a> services.<sup id="cite_ref-Henig_90-0" class="reference"><a href="#cite_note-Henig-90"></a></sup> 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 <a href="/Social_welfare_provision" title="Social welfare provision" class="mw-redirect">social welfare provisions</a>, particularly the various programs established by the <a href="/New_Deal" title="New Deal">New Deal</a>; and government efforts to reduce perceived inequalities in the <a href="/Social_structure_of_the_United_States" title="Social structure of the United States" class="mw-redirect">social structure of the United States</a>.<sup id="cite_ref-Rovere_91-0" class="reference"><a href="#cite_note-Rovere-91"></a></sup></p> | |||
<p>Others asserted the existence of "a Communist plot to deplete the brainpower and sap the strength of a generation of American children".<sup id="cite_ref-Henigbook1996_89-1" class="reference"><a href="#cite_note-Henigbook1996-89"></a></sup> 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 <i>American Capsule News</i>, claimed that "the Soviet General Staff is very happy about it. Anytime they get ready to strike, and their <a href="/Fifth_column" title="Fifth column">5th column</a> 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."<sup id="cite_ref-Johnston_10-1" class="reference"><a href="#cite_note-Johnston-10"></a></sup></p> | |||
<p>This controversy had a direct impact on local program during the 1950s and 1960s, where referendums on introducing fluoridation were defeated in over a thousand Florida communities. It was not until as late as the 1990s that fluoridated water was consumed by the majority of the population of the United States.<sup id="cite_ref-Henig_90-1" class="reference"><a href="#cite_note-Henig-90"></a></sup></p> | |||
<p>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 <a href="/Stanley_Kubrick" title="Stanley Kubrick">Stanley Kubrick</a>'s 1964 film <i><a href="/Dr._Strangelove" title="Dr. Strangelove">Dr. Strangelove</a></i>, 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 <i><a href="/In_Like_Flint" title="In Like Flint">In Like Flint</a></i>, in which a character's fear of fluoridation is used to indicate that he is insane.</p> | |||
<p>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'."<sup id="cite_ref-Johnston_10-2" class="reference"><a href="#cite_note-Johnston-10"></a></sup></p> | |||
<h3><span class="mw-headline" id="Later_conspiracy_theories">Later conspiracy theories</span></h3> | |||
<p>In 1987, Ian E. Stephens authored a self-published booklet, an extract of which was published in the Australian <a href="/New_Age" title="New Age">New Age</a> publication <a href="/Nexus_Magazine" title="Nexus Magazine" class="mw-redirect">Nexus Magazine</a> in 1995. In it he claimed he was told by "Charles Elliot Perkins" that: "Repeated doses of infinitesimal amounts of fluoride will in time reduce an individual's power to resist domination by slowly poisoning and narcotising a certain area of the brain and will thus make him submissive to the will of those who wish to govern him ... Both the Germans and the Russians added sodium fluoride to the drinking water of prisoners of war to make them stupid and docile." These statements have been dismissed by reputable <a href="/Holocaust" title="Holocaust" class="mw-redirect">Holocaust</a> historians as untrue, but they are regularly repeated to the present day in conspiracy publications and websites.<sup id="cite_ref-92" class="reference"><a href="#cite_note-92"></a></sup></p> | |||
<p>In 2004, on the U.S. television program <i><a href="/Democracy_Now" title="Democracy Now" class="mw-redirect">Democracy Now</a></i>, investigative journalist and author of the book <i>The Fluoride Deception</i>, <a href="/search/?title=Christopher_Bryson&action=edit&redlink=1" class="new" title="Christopher Bryson (page does not exist)">Christopher Bryson</a> claimed 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."<sup id="cite_ref-93" class="reference"><a href="#cite_note-93"></a></sup></p> | |||
<h3><span class="mw-headline" id="2006_US_NRC_report">2006 US NRC report</span></h3> | |||
<p>U.S. opponents of fluoridation were heartened by a 2006 <a href="/United_States_National_Research_Council" title="United States National Research Council" class="mw-redirect">National Research Council</a> report about hazards of water naturally fluoridated to high levels;<sup id="cite_ref-94" class="reference"><a href="#cite_note-94"></a></sup> the report recommended lowering the U.S. maximum limit of 4 mg/L for fluoride in drinking water.<sup id="cite_ref-95" class="reference"><a href="#cite_note-95"></a></sup></p> | |||
<h2><span class="mw-headline" id="Court_cases">Court cases</span></h2> | |||
<h3><span class="mw-headline" id="Europe">Europe</span></h3> | |||
<p>Water was fluoridated in large parts of the Netherlands from 1960 to 1973, at which point the <a href="/Supreme_Court_of_the_Netherlands" title="Supreme Court of the Netherlands">Supreme Court of the Netherlands</a> declared fluoridation of drinking water unauthorized.<sup id="cite_ref-96" class="reference"><a href="#cite_note-96"></a></sup> The Dutch Court decided that authorities had no legal basis for adding chemicals to drinking water if they did not also improve safety. It was also stated as support that consumers cannot choose a different tap water provider.<sup id="cite_ref-97" class="reference"><a href="#cite_note-97"></a></sup> Drinking water has not been fluoridated in any part of the Netherlands since 1973.</p> | |||
<p>In <i>Ryan v. Attorney General</i> (1965), the <a href="/Supreme_Court_of_Ireland" title="Supreme Court of Ireland">Supreme Court of Ireland</a> held that water fluoridation did not infringe the plaintiff's right to bodily integrity.<sup id="cite_ref-98" class="reference"><a href="#cite_note-98"></a></sup> The court found that such a right to bodily integrity did exist, despite the fact that it was not explicitly mentioned in the <a href="/Constitution_of_Ireland" title="Constitution of Ireland">Constitution of Ireland</a>, thus establishing the doctrine of <a href="/Unenumerated_rights" title="Unenumerated rights">unenumerated rights</a> in Irish constitutional law.</p> | |||
<h3><span class="mw-headline" id="United_States">United States</span></h3> | |||
<div role="note" class="hatnote">See also: <a href="/Water_fluoridation_in_the_United_States" title="Water fluoridation in the United States">Water fluoridation in the United States</a></div> | |||
<p>Fluoridation has been the subject of many <a href="/Legal_case" title="Legal case">court cases</a> wherein activists have sued municipalities, asserting that their rights to consent to medical treatment and <a href="/Due_process" title="Due process">due process</a> are infringed by mandatory water fluoridation.<sup id="cite_ref-Cross2003_54-2" class="reference"><a href="#cite_note-Cross2003-54"></a></sup> 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.<sup id="cite_ref-beck_99-0" class="reference"><a href="#cite_note-beck-99"></a></sup> To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful.<sup id="cite_ref-100" class="reference"><a href="#cite_note-100"></a></sup></p> | |||
<h2><span class="mw-headline" id="See_also">See also</span></h2> | |||
<ul> | |||
<li><a href="/Fluoride_therapy" title="Fluoride therapy">Fluoride therapy</a></li> | |||
<li><a href="/Fluoride_toxicity" title="Fluoride toxicity">Fluoride toxicity</a></li> | |||
<li><a href="/Hexafluorosilicic_acid" title="Hexafluorosilicic acid">Hexafluorosilicic acid</a></li> | |||
<li><a href="/Sodium_monofluorophosphate" title="Sodium monofluorophosphate">Sodium monofluorophosphate</a></li> | |||
</ul> | |||
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<h2><span class="mw-headline" id="References">References</span></h2> | |||
<div class="reflist columns references-column-count references-column-count-2" style="-moz-column-count: 2; -webkit-column-count: 2; column-count: 2; list-style-type: decimal;"> | |||
<ol class="references"> | |||
<li id="cite_note-Scott-1"><span class="mw-cite-backlink"><b><a href="#cite_ref-Scott_1-0">^</a></b></span> <span class="reference-text"><cite class="citation journal">Scott, P.; Richards, E.; Martin, B. <a rel="nofollow" class="external text" href="http://m.sth.sagepub.com/content/15/4/474.abstract">"Captives of Controversy: The Myth of the Neutral Social Researcher in Contemporary Scientific Controversies"</a>. <i>Science, Technology & Human Values</i> <b>15</b> (4): 474–494. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="//dx.doi.org/10.1177%2F016224399001500406">10.1177/016224399001500406</a><span class="reference-accessdate">. Retrieved <span class="nowrap">30 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Captives+of+Controversy%3A+The+Myth+of+the+Neutral+Social+Researcher+in+Contemporary+Scientific+Controversies&rft.aufirst=P.&rft.aulast=Scott&rft.au=Martin%2C+B.&rft.au=Richards%2C+E.&rft.genre=article&rft_id=http%3A%2F%2Fm.sth.sagepub.com%2Fcontent%2F15%2F4%2F474.abstract&rft_id=info%3Adoi%2F10.1177%2F016224399001500406&rft.issue=4&rft.jtitle=Science%2C+Technology+%26+Human+Values&rft.pages=474-494&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=15" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
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<li id="cite_note-Thiessen-3"><span class="mw-cite-backlink">^ <a href="#cite_ref-Thiessen_3-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Thiessen_3-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><cite class="citation journal">Ko, Lee; Thiessen, Kathleen M. (3 December 2014). "A critique of recent economic evaluations of community water fluoridation". <i>International Journal of Occupational and Environmental Health</i> <b>21</b> (2): 91–120. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="//dx.doi.org/10.1179%2F2049396714Y.0000000093">10.1179/2049396714Y.0000000093</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=A+critique+of+recent+economic+evaluations+of+community+water+fluoridation&rft.aufirst=Lee&rft.aulast=Ko&rft.au=Thiessen%2C+Kathleen+M.&rft.date=2014-12-03&rft.genre=article&rft_id=info%3Adoi%2F10.1179%2F2049396714Y.0000000093&rft.issue=2&rft.jtitle=International+Journal+of+Occupational+and+Environmental+Health&rft.pages=91-120&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=21" class="Z3988"><span style="display:none;"> </span></span> <span style="display:none;font-size:100%" class="error citation-comment"><code style="color:inherit; border:inherit; padding:inherit;">|access-date=</code> requires <code style="color:inherit; border:inherit; padding:inherit;">|url=</code> (<a href="/Help:CS1_errors#accessdate_missing_url" title="Help:CS1 errors">help</a>)</span></span></li> | |||
<li id="cite_note-Hileman-4"><span class="mw-cite-backlink">^ <a href="#cite_ref-Hileman_4-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Hileman_4-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text">Hileman, Bette (November 4, 2006) <a rel="nofollow" class="external text" href="http://pubs.acs.org/email/cen/html/090506090615.html">Fluoride Risks Are Still A Challenge</a> Vol 84, Num 36 PP. 34-37, <a href="/Chemical_%26_Engineering_News" title="Chemical & Engineering News">Chemical & Engineering News</a>, Retrieved April 14, 2016</span></li> | |||
<li id="cite_note-Kaminsky-5"><span class="mw-cite-backlink">^ <a href="#cite_ref-Kaminsky_5-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Kaminsky_5-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Kaminsky_5-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><a href="/Sheldon_Krimsky" title="Sheldon Krimsky">Sheldon Krimsky</a>, Book review (August 16, 2004) <a rel="nofollow" class="external text" href="http://pubs.acs.org/cen/books/8233/8233books.html">Is Fluoride Really All That Safe?</a>, Volume 82, Number 33, pp. 35-36 <a href="/Chemical_%26_Engineering_News" title="Chemical & Engineering News">Chemical & Engineering News</a>, Retrieved April 19, 2016</span></li> | |||
<li id="cite_note-Pizzo-6"><span class="mw-cite-backlink">^ <a href="#cite_ref-Pizzo_6-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Pizzo_6-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Pizzo_6-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-Pizzo_6-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><span class="citation">Pizzo G, Piscopo MR, Pizzo I, Giuliana G. Community water fluoridation and caries prevention: a critical review. <i>Clin Oral Investig</i>. 2007;11(3):189–93. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1007%2Fs00784-007-0111-6">10.1007/s00784-007-0111-6</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/17333303?dopt=Abstract">PMID 17333303</a>.</span></span></li> | |||
<li id="cite_note-NHMRC-7"><span class="mw-cite-backlink">^ <a href="#cite_ref-NHMRC_7-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-NHMRC_7-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-NHMRC_7-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-NHMRC_7-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><span class="citation">National Health and Medical Research Council (Australia). <i><a rel="nofollow" class="external text" href="http://nhmrc.gov.au/_files_nhmrc/file/publications/synopses/Eh41_Flouridation_PART_A.pdf">A systematic review of the efficacy and safety of fluoridation</a></i> . 2007 . <a href="/Special:BookSources/1864964154" class="internal mw-magiclink-isbn">ISBN 1-86496-415-4</a>.</span> Summary: <span class="citation">Yeung CA. A systematic review of the efficacy and safety of fluoridation. <i>Evid Based Dent</i>. 2008;9(2):39–43. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1038%2Fsj.ebd.6400578">10.1038/sj.ebd.6400578</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/18584000?dopt=Abstract">PMID 18584000</a>. <a rel="nofollow" class="external text" href="http://nhmrc.gov.au/_files_nhmrc/file/media/media/rel07/Fluoride_Flyer.pdf">Lay summary</a>: <i>NHMRC</i>, 2007.</span></span></li> | |||
<li id="cite_note-EU2011-8"><span class="mw-cite-backlink">^ <a href="#cite_ref-EU2011_8-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-EU2011_8-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-EU2011_8-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-EU2011_8-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><cite class="citation web"><a rel="nofollow" class="external text" href="http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/l-3/5.htm#0">"What role does fluoride play in preventing tooth decay?"</a>. 2011<span class="reference-accessdate">. Retrieved <span class="nowrap">18 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.btitle=What+role+does+fluoride+play+in+preventing+tooth+decay%3F&rft.date=2011&rft.genre=unknown&rft_id=http%3A%2F%2Fec.europa.eu%2Fhealth%2Fscientific_committees%2Fopinions_layman%2Ffluoridation%2Fen%2Fl-3%2F5.htm%230&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-Martin1989-9"><span class="mw-cite-backlink">^ <a href="#cite_ref-Martin1989_9-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Martin1989_9-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><span class="citation">Martin B. <a rel="nofollow" class="external text" href="http://www.uow.edu.au/~bmartin/pubs/89sq.html">The sociology of the fluoridation controversy: a reexamination</a>. <i>Sociol Q</i>. 1989;30(1):59–76. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1111%2Fj.1533-8525.1989.tb01511.x">10.1111/j.1533-8525.1989.tb01511.x</a>.</span></span></li> | |||
<li id="cite_note-Johnston-10"><span class="mw-cite-backlink">^ <a href="#cite_ref-Johnston_10-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Johnston_10-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Johnston_10-2"><sup><i><b>c</b></i></sup></a></span> <span class="reference-text"><cite class="citation book">Johnston, Robert D (2004). <i>The Politics of Healing</i>. Routledge. p. 136. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/0-415-93339-0" title="Special:BookSources/0-415-93339-0">0-415-93339-0</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.aufirst=Robert+D&rft.aulast=Johnston&rft.btitle=The+Politics+of+Healing&rft.date=2004&rft.genre=book&rft.isbn=0-415-93339-0&rft.pages=136&rft.pub=Routledge&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
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<li id="cite_note-fas.org-12"><span class="mw-cite-backlink">^ <a href="#cite_ref-fas.org_12-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-fas.org_12-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-fas.org_12-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-fas.org_12-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text">Tiemann, Mary (April 5, 2013)<a rel="nofollow" class="external text" href="https://www.fas.org/sgp/crs/misc/RL33280.pdf">Fluoride in Drinking Water: A Review of Fluoridation and Regulation Issues - Federation Of American Scientists</a> (pdf) <a href="/Federation_of_American_Scientists" title="Federation of American Scientists">Federation of American Scientists</a>, pages 1-2, 4, Retrieved April 13, 2016</span></li> | |||
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<li id="cite_note-Book_Reviews_2011-17"><span class="mw-cite-backlink">^ <a href="#cite_ref-Book_Reviews_2011_17-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Book_Reviews_2011_17-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><cite class="citation journal">Peckham, Stephen (2012). "Book Reviews: The case against fluoride: how hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there, by Paul Connett, James Beck, and H Spedding Micklem". <i>Critical Public Health</i> <b>22</b> (1): 113–114. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="//dx.doi.org/10.1080%2F09581596.2011.593350">10.1080/09581596.2011.593350</a>. <a href="/International_Standard_Serial_Number" title="International Standard Serial Number">ISSN</a> <a rel="nofollow" class="external text" href="//www.worldcat.org/issn/0958-1596">0958-1596</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Book+Reviews%3A+The+case+against+fluoride%3A+how+hazardous+waste+ended+up+in+our+drinking+water+and+the+bad+science+and+powerful+politics+that+keep+it+there%2C+by+Paul+Connett%2C+James+Beck%2C+and+H+Spedding+Micklem&rft.aufirst=Stephen&rft.aulast=Peckham&rft.date=2012&rft.genre=article&rft_id=info%3Adoi%2F10.1080%2F09581596.2011.593350&rft.issn=0958-1596&rft.issue=1&rft.jtitle=Critical+Public+Health&rft.pages=113-114&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=22" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
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<li id="cite_note-21"><span class="mw-cite-backlink"><b><a href="#cite_ref-21">^</a></b></span> <span class="reference-text"><span class="citation">European Academy Of Paediatric Dentistry. Guidelines on the use of fluoride in children: an EAPD policy document. <i>Eur Arch Paediatr Dent</i>. 2009;10(3):129–35. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1007%2Fbf03262673">10.1007/bf03262673</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/19772841?dopt=Abstract">PMID 19772841</a>.</span></span></li> | |||
<li id="cite_note-22"><span class="mw-cite-backlink"><b><a href="#cite_ref-22">^</a></b></span> <span class="reference-text"><span class="citation"><a href="/Australian_Dental_Association" title="Australian Dental Association">Australian Dental Association</a>. <a rel="nofollow" class="external text" href="http://www.ada.org.au/News-Media/Issues-at-a-Glance/Fluoride">Issues at a Glance Fluoride</a> .</span></span></li> | |||
<li id="cite_note-23"><span class="mw-cite-backlink"><b><a href="#cite_ref-23">^</a></b></span> <span class="reference-text"><span class="citation"><a href="/Canadian_Dental_Association" title="Canadian Dental Association">Canadian Dental Association</a>. <a rel="nofollow" class="external text" href="http://www.cda-adc.ca/_files/position_statements/fluoride.pdf">CDA position on use of fluorides in caries prevention</a> ; March 2003 .</span></span></li> | |||
<li id="cite_note-24"><span class="mw-cite-backlink"><b><a href="#cite_ref-24">^</a></b></span> <span class="reference-text"><span class="citation">ADA Council on Access, Prevention and Interprofessional Relations. <a href="/American_Dental_Association" title="American Dental Association">American Dental Association</a>. <a rel="nofollow" class="external text" href="http://ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf">Fluoridation facts</a> ; 2005 .</span></span></li> | |||
<li id="cite_note-25"><span class="mw-cite-backlink"><b><a href="#cite_ref-25">^</a></b></span> <span class="reference-text">American Dental Association. <a rel="nofollow" class="external text" href="http://www.ada.org/~/media/ADA/Member%20Center/FIles/fluoridation_facts.pdf">Fluoridation Facts</a>. 2005. Quote is from <a rel="nofollow" class="external text" href="http://www.ada.org/en/press-room/press-kits/water-fluoridation-press-kit">Water Fluoridation Press Kit</a>.</span></li> | |||
<li id="cite_note-26"><span class="mw-cite-backlink"><b><a href="#cite_ref-26">^</a></b></span> <span class="reference-text">Vivek H. Murthy, MD, MBA, Surgeon General of the United States. <a rel="nofollow" class="external text" href="http://www.publichealthreports.org/documents/Surgeon_General_Perspective_FG.pdf">Surgeon General’s Perspectives: Community Water Fluoridation - One of CDC’s “10 Great Public Health Achievements of the 20th Century</a>. Public Health Reports. July–August 2015. Volume 130:1-3.</span></li> | |||
<li id="cite_note-27"><span class="mw-cite-backlink"><b><a href="#cite_ref-27">^</a></b></span> <span class="reference-text"><span class="citation">American Public Health Association. <a rel="nofollow" class="external text" href="http://apha.org/news-and-media/news-releases/apha-news-releases/apha-reaffirms-its-support-for-community-water-fluoridation">APHA Reaffirms Its Support for Community Water Fluoridation</a>; 2011 .</span></span></li> | |||
<li id="cite_note-28"><span class="mw-cite-backlink"><b><a href="#cite_ref-28">^</a></b></span> <span class="reference-text"><cite class="citation book"><a rel="nofollow" class="external text" href="http://www.sochealth.co.uk/national-health-service/royal-commission-on-the-national-health-service-contents/royal-commission-on-the-nhs-chapter-9/"><i>Royal Commission on the NHS Chapter 9</i></a>. HMSO. July 1979. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/0-10-176150-3" title="Special:BookSources/0-10-176150-3">0-10-176150-3</a><span class="reference-accessdate">. Retrieved <span class="nowrap">19 May</span> 2015</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.btitle=Royal+Commission+on+the+NHS+Chapter+9&rft.date=1979-07&rft.genre=book&rft_id=http%3A%2F%2Fwww.sochealth.co.uk%2Fnational-health-service%2Froyal-commission-on-the-national-health-service-contents%2Froyal-commission-on-the-nhs-chapter-9%2F&rft.isbn=0-10-176150-3&rft.pub=HMSO&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-29"><span class="mw-cite-backlink"><b><a href="#cite_ref-29">^</a></b></span> <span class="reference-text"><cite class="citation web">Australian Government Department of Health and Ageing. <a rel="nofollow" class="external text" href="http://www.health.gov.au/internet/main/publishing.nsf/Content/dentalfluoridation">"Fluoridation of drinking water"</a>. <i>www.health.gov.au</i><span class="reference-accessdate">. Retrieved <span class="nowrap">22 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Fluoridation+of+drinking+water&rft.au=Australian+Government+Department+of+Health+and+Ageing&rft.genre=unknown&rft_id=http%3A%2F%2Fwww.health.gov.au%2Finternet%2Fmain%2Fpublishing.nsf%2FContent%2Fdentalfluoridation&rft.jtitle=www.health.gov.au&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-30"><span class="mw-cite-backlink"><b><a href="#cite_ref-30">^</a></b></span> <span class="reference-text"><cite class="citation web"><a rel="nofollow" class="external text" href="http://www.fluoridefacts.govt.nz/questions-and-answers-0">"Questions and answers | Fluoride facts"</a>. <i>www.fluoridefacts.govt.nz</i><span class="reference-accessdate">. Retrieved <span class="nowrap">22 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Questions+and+answers+%26%23124%3B+Fluoride+facts&rft.genre=unknown&rft_id=http%3A%2F%2Fwww.fluoridefacts.govt.nz%2Fquestions-and-answers-0&rft.jtitle=www.fluoridefacts.govt.nz&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-31"><span class="mw-cite-backlink"><b><a href="#cite_ref-31">^</a></b></span> <span class="reference-text"><cite class="citation web"><a rel="nofollow" class="external text" href="http://www.hc-sc.gc.ca/ewh-semt/water-eau/drink-potab/health-sante/faq_fluoride-fluorure-eng.php">"Fluoride in Drinking Water"</a>. <a href="/Health_Canada" title="Health Canada">Health Canada</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.btitle=Fluoride+in+Drinking+Water&rft.genre=unknown&rft_id=http%3A%2F%2Fwww.hc-sc.gc.ca%2Fewh-semt%2Fwater-eau%2Fdrink-potab%2Fhealth-sante%2Ffaq_fluoride-fluorure-eng.php&rft.pub=Health+Canada&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-CDC-1999-32"><span class="mw-cite-backlink">^ <a href="#cite_ref-CDC-1999_32-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-CDC-1999_32-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><span class="citation">Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. <a rel="nofollow" class="external text" href="http://cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm">Achievements in public health, 1900–1999: Fluoridation of drinking water to prevent dental caries</a>. <i>MMWR Morb Mortal Wkly Rep</i>. 1999;48(41):933–40.</span> Contains <a rel="nofollow" class="external text" href="http://cdc.gov/mmwr/preview/mmwrhtml/mm4841bx.htm">H. Trendley Dean, D.D.S.</a> <a rel="nofollow" class="external text" href="http://jama.ama-assn.org/cgi/content/full/283/10/1283">Reprinted</a> in: <span class="citation"><i>JAMA</i>. 2000;283(10):1283–6. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1001%2Fjama.283.10.1283">10.1001/jama.283.10.1283</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/10714718?dopt=Abstract">PMID 10714718</a>.</span></span></li> | |||
<li id="cite_note-33"><span class="mw-cite-backlink"><b><a href="#cite_ref-33">^</a></b></span> <span class="reference-text"><cite class="citation web"><a rel="nofollow" class="external text" href="http://www.health.gov.il/English/Topics/Dental_Health/information/Pages/flouride-2015.aspx">"Restoration of Fluoridation to Drinking Water, Ministry of Health"</a>. <i>www.health.gov.il</i><span class="reference-accessdate">. Retrieved <span class="nowrap">23 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Restoration+of+Fluoridation+to+Drinking+Water%2C+Ministry+of+Health&rft.genre=unknown&rft_id=http%3A%2F%2Fwww.health.gov.il%2FEnglish%2FTopics%2FDental_Health%2Finformation%2FPages%2Fflouride-2015.aspx&rft.jtitle=www.health.gov.il&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-34"><span class="mw-cite-backlink"><b><a href="#cite_ref-34">^</a></b></span> <span class="reference-text"><cite class="citation web"><a rel="nofollow" class="external text" href="http://www.who.int/water_sanitation_health/oralhealth/en/index2.html">"Water fluoridation"</a>. <i>World Water Day 2001: Oral health</i>. <a href="/World_Health_Organization" title="World Health Organization">World Health Organization</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Water+fluoridation&rft.genre=unknown&rft_id=http%3A%2F%2Fwww.who.int%2Fwater_sanitation_health%2Foralhealth%2Fen%2Findex2.html&rft.jtitle=World+Water+Day+2001%3A+Oral+health&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-WHO2011-35"><span class="mw-cite-backlink"><b><a href="#cite_ref-WHO2011_35-0">^</a></b></span> <span class="reference-text"><a rel="nofollow" class="external text" href="http://apps.who.int/iris/bitstream/10665/44584/1/9789241548151_eng.pdf">Guidelines for Drinking-water Quality, 4th Edition</a> WHO, 2011. <a href="/Special:BookSources/9789241548151" class="internal mw-magiclink-isbn">ISBN 9789241548151</a>. Page 168, 175, 372 and see also pp 370-73. See also J. Fawell, et al <a rel="nofollow" class="external text" href="http://apps.who.int/iris/bitstream/10665/43514/1/9241563192_eng.pdf?ua=1">Fluoride in Drinking-water</a>. WHO, 2006. Page 32. Quote: "Concentrations in drinking-water of about 1 mg l–1 are associated with a lower incidence of dental caries, particularly in children, whereas excess intake of fluoride can result in dental fluorosis. In severe cases this can result in erosion of enamel. The margin between the beneficial effects of fluoride and the occurrence of dental fluorosis is small and public health programmes seek to retain a suitable balance between the two"</span></li> | |||
<li id="cite_note-36"><span class="mw-cite-backlink"><b><a href="#cite_ref-36">^</a></b></span> <span class="reference-text"><cite class="citation book">Bryson, Christopher (2004). <i>The fluoride deception (page 240)</i>. New York: Seven Stories Press. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/9781609800086" title="Special:BookSources/9781609800086">9781609800086</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.aufirst=Christopher&rft.aulast=Bryson&rft.btitle=The+fluoride+deception+%28page+240%29&rft.date=2004&rft.genre=book&rft.isbn=9781609800086&rft.place=New+York&rft.pub=Seven+Stories+Press&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-nuffield-37"><span class="mw-cite-backlink">^ <a href="#cite_ref-nuffield_37-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-nuffield_37-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><span class="citation">Calman K. Beyond the 'nanny state': stewardship and public health. <i>Public Health</i>. 2009;123(1):e6–e10. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1016%2Fj.puhe.2008.10.025">10.1016/j.puhe.2008.10.025</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/19135693?dopt=Abstract">PMID 19135693</a>. <a rel="nofollow" class="external text" href="http://www.nuffieldbioethics.org/fileLibrary/pdf/One_page_summary_public_health.pdf">Lay summary</a>: <i>Nuffield Council on Bioethics</i>, 2007-11-13.</span></span></li> | |||
<li id="cite_note-38"><span class="mw-cite-backlink"><b><a href="#cite_ref-38">^</a></b></span> <span class="reference-text"><cite class="citation journal">Barnett-Rose, Rita (December 2014). <a rel="nofollow" class="external text" href="http://scholarship.law.wm.edu/wmelpr/vol39/iss1/7/">"Compulsory Water Fluoridation: Justifiable Public Health Benefit or Human Experimental Research Without Informed Consent?"</a>. <i>William & Mary Environmental Law and Policy Review</i> <b>39</b> (1): 225<span class="reference-accessdate">. Retrieved <span class="nowrap">21 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Compulsory+Water+Fluoridation%3A+Justifiable+Public+Health+Benefit+or+Human+Experimental+Research+Without+Informed+Consent%3F&rft.aufirst=Rita&rft.aulast=Barnett-Rose&rft.date=2014-12&rft.genre=article&rft_id=http%3A%2F%2Fscholarship.law.wm.edu%2Fwmelpr%2Fvol39%2Fiss1%2F7%2F&rft.issue=1&rft.jtitle=William+%26+Mary+Environmental+Law+and+Policy+Review&rft.pages=225&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=39" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-39"><span class="mw-cite-backlink"><b><a href="#cite_ref-39">^</a></b></span> <span class="reference-text"><cite class="citation journal">Fagin, Dan (1 January 2008). <a rel="nofollow" class="external text" href="http://www.nature.com/scientificamerican/journal/v298/n1/full/scientificamerican0108-74.html">"Second Thoughts about Fluoride"</a>. <i>Scientific American</i> <b>298</b> (1): 74–81. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="//dx.doi.org/10.1038%2Fscientificamerican0108-74">10.1038/scientificamerican0108-74</a><span class="reference-accessdate">. Retrieved <span class="nowrap">21 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Second+Thoughts+about+Fluoride&rft.aufirst=Dan&rft.aulast=Fagin&rft.date=2008-01-01&rft.genre=article&rft_id=http%3A%2F%2Fwww.nature.com%2Fscientificamerican%2Fjournal%2Fv298%2Fn1%2Ffull%2Fscientificamerican0108-74.html&rft_id=info%3Adoi%2F10.1038%2Fscientificamerican0108-74&rft.issue=1&rft.jtitle=Scientific+American&rft.pages=74-81&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=298" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-Hhe-40"><span class="mw-cite-backlink"><b><a href="#cite_ref-Hhe_40-0">^</a></b></span> <span class="reference-text"><span class="citation">Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y. <i><a rel="nofollow" class="external text" href="http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf">Fluoride in Drinking-water</a></i> . World Health Organization; 2006. <a href="/Special:BookSources/9241563192" class="internal mw-magiclink-isbn">ISBN 92-4-156319-2</a>. Human health effects. p. 29–36.</span></span></li> | |||
<li id="cite_note-41"><span class="mw-cite-backlink"><b><a href="#cite_ref-41">^</a></b></span> <span class="reference-text"><span class="citation">Fawell J, Bailey K, Chilton J, Dahi E, Fewtrell L, Magara Y. <i><a rel="nofollow" class="external text" href="http://www.who.int/water_sanitation_health/publications/fluoride_drinking_water_full.pdf">Fluoride in Drinking-water</a></i> . World Health Organization; 2006. <a href="/Special:BookSources/9241563192" class="internal mw-magiclink-isbn">ISBN 92-4-156319-2</a>. Guidelines and standards. p. 37–9.</span></span></li> | |||
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<li id="cite_note-Truman-49"><span class="mw-cite-backlink"><b><a href="#cite_ref-Truman_49-0">^</a></b></span> <span class="reference-text"><span class="citation">Truman BI, Gooch BF, Sulemana I <i>et al.</i>. <a rel="nofollow" class="external text" href="http://thecommunityguide.org/oral/oral-ajpm-ev-rev.pdf">Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries</a> . <i>Am J Prev Med</i>. 2002;23(1 Suppl):21–54. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1016%2FS0749-3797%2802%2900449-X">10.1016/S0749-3797(02)00449-X</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/12091093?dopt=Abstract">PMID 12091093</a>.</span></span></li> | |||
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<li id="cite_note-Nuffieldfull-65"><span class="mw-cite-backlink"><b><a href="#cite_ref-Nuffieldfull_65-0">^</a></b></span> <span class="reference-text"><cite class="citation book"><a rel="nofollow" class="external text" href="http://nuffieldbioethics.org/report/public-health-2/water-fluoridation/"><i>Public health : ethical issues (Chapter 7 - Fluoridation of water)</i></a>. London: <a href="/Nuffield_Council_on_Bioethics" title="Nuffield Council on Bioethics">Nuffield Council on Bioethics</a>. 2007. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/978-1-904384-17-5" title="Special:BookSources/978-1-904384-17-5">978-1-904384-17-5</a><span class="reference-accessdate">. Retrieved <span class="nowrap">25 April</span> 2016</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.btitle=Public+health+%3A+ethical+issues+%28Chapter+7+-+Fluoridation+of+water%29&rft.date=2007&rft.genre=book&rft_id=http%3A%2F%2Fnuffieldbioethics.org%2Freport%2Fpublic-health-2%2Fwater-fluoridation%2F&rft.isbn=978-1-904384-17-5&rft.place=London&rft.pub=Nuffield+Council+on+Bioethics&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-Reilly-66"><span class="mw-cite-backlink">^ <a href="#cite_ref-Reilly_66-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Reilly_66-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-Reilly_66-2"><sup><i><b>c</b></i></sup></a></span> <span class="error mw-ext-cite-error">Cite error: The named reference <code>Reilly</code> was invoked but never defined (see the <a href="/Help:Cite_errors/Cite_error_references_no_text" title="Help:Cite errors/Cite error references no text">help page</a>).</span></li> | |||
<li id="cite_note-Dehnbase-67"><span class="mw-cite-backlink"><b><a href="#cite_ref-Dehnbase_67-0">^</a></b></span> <span class="error mw-ext-cite-error">Cite error: The named reference <code>Dehnbase</code> was invoked but never defined (see the <a href="/Help:Cite_errors/Cite_error_references_no_text" title="Help:Cite errors/Cite error references no text">help page</a>).</span></li> | |||
<li id="cite_note-Birch-68"><span class="mw-cite-backlink"><b><a href="#cite_ref-Birch_68-0">^</a></b></span> <span class="error mw-ext-cite-error">Cite error: The named reference <code>Birch</code> was invoked but never defined (see the <a href="/Help:Cite_errors/Cite_error_references_no_text" title="Help:Cite errors/Cite error references no text">help page</a>).</span></li> | |||
<li id="cite_note-Greenwars-69"><span class="mw-cite-backlink"><b><a href="#cite_ref-Greenwars_69-0">^</a></b></span> <span class="error mw-ext-cite-error">Cite error: The named reference <code>Greenwars</code> was invoked but never defined (see the <a href="/Help:Cite_errors/Cite_error_references_no_text" title="Help:Cite errors/Cite error references no text">help page</a>).</span></li> | |||
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<li id="cite_note-77"><span class="mw-cite-backlink"><b><a href="#cite_ref-77">^</a></b></span> <span class="reference-text">Main, Douglas (29 August 2014) <a rel="nofollow" class="external text" href="http://www.newsweek.com/israel-has-officially-banned-fluoridation-its-drinking-water-267411">Israel Has Officially Banned Fluoridation of Its Drinking Water</a>, <a href="/Newsweek" title="Newsweek">Newsweek</a> Retrieved 2 September 2014</span></li> | |||
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<li id="cite_note-Musto-84"><span class="mw-cite-backlink">^ <a href="#cite_ref-Musto_84-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Musto_84-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><cite class="citation journal">Musto RJ (October 1987). <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pmc/articles/PMC1267306">"Fluoridation: why is it not more widely adopted?"</a>. <i>CMAJ</i> <b>137</b> (8): 705–8. <a href="/PubMed_Central" title="PubMed Central">PMC</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pmc/articles/PMC1267306">1267306</a>. <a href="/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/3651941">3651941</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Fluoridation%3A+why+is+it+not+more+widely+adopted%3F&rft.au=Musto+RJ&rft.date=1987-10&rft.genre=article&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1267306&rft_id=%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC1267306&rft_id=info%3Apmid%2F3651941&rft.issue=8&rft.jtitle=CMAJ&rft.pages=705-8&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=137" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-Wrapson-85"><span class="mw-cite-backlink"><b><a href="#cite_ref-Wrapson_85-0">^</a></b></span> <span class="reference-text"><cite class="citation journal">Wrapson J (2005). <a rel="nofollow" class="external text" href="http://www.historycooperative.org/journals/hah/7.2/wrapson.html">"Fluoridation of Public Water Supplies in New Zealand:'Magic Bullet,'Rat Poison, or Communist Plot?"</a>. <i>Health and History</i> <b>7</b> (2): 17–29. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="//dx.doi.org/10.2307%2F40111610">10.2307/40111610</a>. <a href="/JSTOR" title="JSTOR">JSTOR</a> <a rel="nofollow" class="external text" href="//www.jstor.org/stable/40111610">40111610</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Fluoridation+of+Public+Water+Supplies+in+New+Zealand%3A%27Magic+Bullet%2C%27Rat+Poison%2C+or+Communist+Plot%3F&rft.au=Wrapson+J&rft.date=2005&rft.genre=article&rft_id=%2F%2Fwww.jstor.org%2Fstable%2F40111610&rft_id=http%3A%2F%2Fwww.historycooperative.org%2Fjournals%2Fhah%2F7.2%2Fwrapson.html&rft_id=info%3Adoi%2F10.2307%2F40111610&rft.issue=2&rft.jtitle=Health+and+History&rft.pages=17-29&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=7" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-86"><span class="mw-cite-backlink"><b><a href="#cite_ref-86">^</a></b></span> <span class="reference-text"><cite class="citation journal">Richmond VL (January 1985). <a rel="nofollow" class="external text" href="http://www.ajcn.org/cgi/pmidlookup?view=long&pmid=3917599">"Thirty years of fluoridation: a review"</a>. <i>Am. J. Clin. Nutr.</i> <b>41</b> (1): 129–38. <a href="/PubMed_Identifier" title="PubMed Identifier" class="mw-redirect">PMID</a> <a rel="nofollow" class="external text" href="//www.ncbi.nlm.nih.gov/pubmed/3917599">3917599</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Thirty+years+of+fluoridation%3A+a+review&rft.au=Richmond+VL&rft.date=1985-01&rft.genre=article&rft_id=http%3A%2F%2Fwww.ajcn.org%2Fcgi%2Fpmidlookup%3Fview%3Dlong%26pmid%3D3917599&rft_id=info%3Apmid%2F3917599&rft.issue=1&rft.jtitle=Am.+J.+Clin.+Nutr.&rft.pages=129-38&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=41" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-87"><span class="mw-cite-backlink"><b><a href="#cite_ref-87">^</a></b></span> <span class="reference-text"><span class="citation" id="Fluoride-Wars">Freeze RA, Lehr JH. <i>The Fluoride Wars: How a Modest Public Health Measure Became America's Longest-Running Political Melodrama</i>. Wiley; 2009. <a href="/Special:BookSources/9780470448335" class="internal mw-magiclink-isbn">ISBN 978-0-470-44833-5</a>.</span> <span class="citation">Fluorophobia. p. 127–69.</span></span></li> | |||
<li id="cite_note-88"><span class="mw-cite-backlink"><b><a href="#cite_ref-88">^</a></b></span> <span class="reference-text"><span class="citation">Newbrun E. The fluoridation war: a scientific dispute or a religious argument?. <i>J Public Health Dent</i>. 1996;56(5 Spec No):246–52. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1111%2Fj.1752-7325.1996.tb02447.x">10.1111/j.1752-7325.1996.tb02447.x</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/9034969?dopt=Abstract">PMID 9034969</a>.</span></span></li> | |||
<li id="cite_note-Henigbook1996-89"><span class="mw-cite-backlink">^ <a href="#cite_ref-Henigbook1996_89-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Henigbook1996_89-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><cite class="citation book">Henig, Robin Marantz; book, A Joseph Henry Press (1996-11-04). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=bM1TAgAAQBAJ"><i>The People's Health:: A Memoir of Public Health and Its Evolution at Harvard</i></a>. Joseph Henry Press. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/9780309054928" title="Special:BookSources/9780309054928">9780309054928</a><span class="reference-accessdate">. Retrieved <span class="nowrap">10 September</span> 2014</span>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.au=book%2C+A+Joseph+Henry+Press&rft.aufirst=Robin+Marantz&rft.aulast=Henig&rft.btitle=The+People%27s+Health%3A%3A+A+Memoir+of+Public+Health+and+Its+Evolution+at+Harvard&rft.date=1996-11-04&rft.genre=book&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3DbM1TAgAAQBAJ&rft.isbn=9780309054928&rft.pub=Joseph+Henry+Press&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-Henig-90"><span class="mw-cite-backlink">^ <a href="#cite_ref-Henig_90-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-Henig_90-1"><sup><i><b>b</b></i></sup></a></span> <span class="reference-text"><cite class="citation book">Henig, Robin Marantz (1997). <i>The People's Health</i>. Joseph Henry Press. p. 85. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/0-309-05492-3" title="Special:BookSources/0-309-05492-3">0-309-05492-3</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.aufirst=Robin+Marantz&rft.aulast=Henig&rft.btitle=The+People%27s+Health&rft.date=1997&rft.genre=book&rft.isbn=0-309-05492-3&rft.pages=85&rft.pub=Joseph+Henry+Press&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-Rovere-91"><span class="mw-cite-backlink"><b><a href="#cite_ref-Rovere_91-0">^</a></b></span> <span class="reference-text"><cite class="citation book">Rovere, Richard H. (1959). <i>Senator Joe McCarthy</i>. University of California Press. pp. 21–22. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/0-520-20472-7" title="Special:BookSources/0-520-20472-7">0-520-20472-7</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.aufirst=Richard+H.&rft.aulast=Rovere&rft.btitle=Senator+Joe+McCarthy&rft.date=1959&rft.genre=book&rft.isbn=0-520-20472-7&rft.pages=21-22&rft.pub=University+of+California+Press&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-92"><span class="mw-cite-backlink"><b><a href="#cite_ref-92">^</a></b></span> <span class="reference-text">Politifact Florida <a rel="nofollow" class="external text" href="http://www.politifact.com/florida/statements/2011/oct/06/critics-water-fluoridation/truth-about-fluoride-doesnt-include-nazi-myth/">"Say water fluoridation started in Nazi Germany ghettos and death camps to pacify the Jews."</a> Politifact Florida accessed on 27 March 2014</span></li> | |||
<li id="cite_note-93"><span class="mw-cite-backlink"><b><a href="#cite_ref-93">^</a></b></span> <span class="reference-text">Bryson, Christopher. <a rel="nofollow" class="external text" href="http://www.democracynow.org/2004/6/17/the_fluoride_deception_how_a_nuclear">"The Fluoride Deception: How a Nuclear Waste Made its Way Into the Nation's Drinking Water"</a>, <i>Democracy Now</i>, 17 June 2004</span></li> | |||
<li id="cite_note-94"><span class="mw-cite-backlink"><b><a href="#cite_ref-94">^</a></b></span> <span class="reference-text"><span class="citation">Fagin D. Second thoughts about fluoride. <i>Sci Am</i>. 2008;298(1):74–81. <a href="/Digital_object_identifier" title="Digital object identifier">doi</a>:<a rel="nofollow" class="external text" href="http://dx.doi.org/10.1038%2Fscientificamerican0108-74">10.1038/scientificamerican0108-74</a>. <a class="external mw-magiclink-pmid" rel="nofollow" href="//www.ncbi.nlm.nih.gov/pubmed/18225698?dopt=Abstract">PMID 18225698</a>.</span></span></li> | |||
<li id="cite_note-95"><span class="mw-cite-backlink"><b><a href="#cite_ref-95">^</a></b></span> <span class="reference-text"><span class="citation">National Research Council. <i><a rel="nofollow" class="external text" href="http://books.nap.edu/catalog.php?record_id=11571">Fluoride in Drinking Water: A Scientific Review of EPA's Standards</a></i>. Washington, DC: National Academies Press; 2006. <a href="/Special:BookSources/030910128X" class="internal mw-magiclink-isbn">ISBN 0-309-10128-X</a>. <a rel="nofollow" class="external text" href="http://dels.nas.edu/dels/rpt_briefs/fluoride_brief_final.pdf">Lay summary</a>: <i>NRC</i>, 2006.</span></span></li> | |||
<li id="cite_note-96"><span class="mw-cite-backlink"><b><a href="#cite_ref-96">^</a></b></span> <span class="reference-text"><cite class="citation journal">Bram van der Lek (1976). <a rel="nofollow" class="external text" href="https://books.google.com/books?id=3UoZAAAAIAAJ&pg=PA487&lpg=PA487&dq=fluoridering+nederland&source=web&ots=gBeB1umWcI&sig=w-iamuX7EZ4PBcwWbRPObOnTQHM&hl=en&sa=X&oi=book_result&resnum=6&ct=result#PPA488,M1">"De strijd tegen fluoridering"</a>. <i>De Gids</i> <b>139</b> (2).</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=De+strijd+tegen+fluoridering&rft.au=Bram+van+der+Lek&rft.date=1976&rft.genre=article&rft_id=https%3A%2F%2Fbooks.google.com%2Fbooks%3Fid%3D3UoZAAAAIAAJ%26pg%3DPA487%26lpg%3DPA487%26dq%3Dfluoridering%2Bnederland%26source%3Dweb%26ots%3DgBeB1umWcI%26sig%3Dw-iamuX7EZ4PBcwWbRPObOnTQHM%26hl%3Den%26sa%3DX%26oi%3Dbook_result%26resnum%3D6%26ct%3Dresult%23PPA488%2CM1&rft.issue=2&rft.jtitle=De+Gids&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.volume=139" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-97"><span class="mw-cite-backlink"><b><a href="#cite_ref-97">^</a></b></span> <span class="reference-text"><cite class="citation book">Leonardus Johannes Antonius Damen, Peter Nicolaï, J.L. Boxum, K.J. de Graaf, J.H. Jans, A.P. Klap, A.T. Marseille, A.R. Neerhof, B.K. Olivier, B.J. Schueler, F.R. Vermeer, R.L. Vucsán (2005). "Deel 1: systeem, bevoegdheid, bevoegdheidsuitoefening, handhaving". <i>Bestuursrecht</i> . Boom juridische studieboeken (in Dutch). Boom Juridische uitgevers. pp. 54–55. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/978-90-5454-537-8" title="Special:BookSources/978-90-5454-537-8">978-90-5454-537-8</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.atitle=Deel+1%3A+systeem%2C+bevoegdheid%2C+bevoegdheidsuitoefening%2C+handhaving&rft.au=Leonardus+Johannes+Antonius+Damen%2C+Peter+Nicola%C3%AF%2C+J.L.+Boxum%2C+K.J.+de+Graaf%2C+J.H.+Jans%2C+A.P.+Klap%2C+A.T.+Marseille%2C+A.R.+Neerhof%2C+B.K.+Olivier%2C+B.J.+Schueler%2C+F.R.+Vermeer%2C+R.L.+Vucs%C3%A1n&rft.btitle=Bestuursrecht&rft.date=2005&rft.genre=bookitem&rft.isbn=978-90-5454-537-8&rft.pages=54-55&rft.pub=Boom+Juridische+uitgevers&rft.series=Boom+juridische+studieboeken&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span> <span class="citation-comment" style="display:none; color:#33aa33">CS1 maint: Multiple names: authors list (<a href="/Category:CS1_maint:_Multiple_names:_authors_list" title="Category:CS1 maint: Multiple names: authors list">link</a>)</span></span></li> | |||
<li id="cite_note-98"><span class="mw-cite-backlink"><b><a href="#cite_ref-98">^</a></b></span> <span class="reference-text"><cite class="citation web"><a rel="nofollow" class="external text" href="http://www.bailii.org/ie/cases/IESC/1965/1.html">"Ryan v. A.G. IESC 1; IR 294 (3 July, 1965)"</a>. Irish Supreme Court.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.btitle=Ryan+v.+A.G.+IESC+1%3B+IR+294+%283+July%2C+1965%29&rft.genre=unknown&rft_id=http%3A%2F%2Fwww.bailii.org%2Fie%2Fcases%2FIESC%2F1965%2F1.html&rft.pub=Irish+Supreme+Court&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></span></li> | |||
<li id="cite_note-beck-99"><span class="mw-cite-backlink"><b><a href="#cite_ref-beck_99-0">^</a></b></span> <span class="reference-text">Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) ("Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question." (citations omitted)).</span></li> | |||
<li id="cite_note-100"><span class="mw-cite-backlink"><b><a href="#cite_ref-100">^</a></b></span> <span class="reference-text">Pratt, Edwin, Raymond D. Rawson & Mark Rubin, <i>Fluoridation at Fifty: What Have We Learned</i>, 30 J.L. Med. & Ethics 117, 119 (Fall 2002)</span></li> | |||
</ol> | |||
</div> | |||
<h2><span class="mw-headline" id="Further_reading">Further reading</span></h2> | |||
<ul> | |||
<li><cite class="citation book">Connett, Paul; Beck, James; Micklem, H. Spedding (2010). <i>The case against fluoride; how hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there</i>. White River Junction, Vermont: Chelsea Green Publishing. p. 384. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/978-1-60358-287-2" title="Special:BookSources/978-1-60358-287-2">978-1-60358-287-2</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.au=Beck%2C+James&rft.aufirst=Paul&rft.aulast=Connett&rft.au=Micklem%2C+H.+Spedding&rft.btitle=The+case+against+fluoride%3B+how+hazardous+waste+ended+up+in+our+drinking+water+and+the+bad+science+and+powerful+politics+that+keep+it+there&rft.date=2010&rft.genre=book&rft.isbn=978-1-60358-287-2&rft.pages=384&rft.place=White+River+Junction%2C+Vermont&rft.pub=Chelsea+Green+Publishing&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></li> | |||
<li><cite class="citation book">Fawell, John Wesley (2006). <i>Fluoride in drinking-water</i>. Geneva: World Health Organization. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/92-4-156319-2" title="Special:BookSources/92-4-156319-2">92-4-156319-2</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.aufirst=John+Wesley&rft.aulast=Fawell&rft.btitle=Fluoride+in+drinking-water&rft.date=2006&rft.genre=book&rft.isbn=92-4-156319-2&rft.place=Geneva&rft.pub=World+Health+Organization&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></li> | |||
<li><cite class="citation book">Freeze RA, Lehr JH (2009). <i>The fluoride wars: how a modest public health measure became America's longest-running political melodrama</i>. Hoboken: Wiley. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/0-470-44833-4" title="Special:BookSources/0-470-44833-4">0-470-44833-4</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.aufirst=RA&rft.aulast=Freeze&rft.au=Lehr%2C+JH&rft.btitle=The+fluoride+wars%3A+how+a+modest+public+health+measure+became+America%27s+longest-running+political+melodrama&rft.date=2009&rft.genre=book&rft.isbn=0-470-44833-4&rft.place=Hoboken&rft.pub=Wiley&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></li> | |||
<li><cite class="citation book"><a href="/Brian_Martin_(social_scientist)" title="Brian Martin (social scientist)">Martin, Brian</a> (1991). <a rel="nofollow" class="external text" href="http://www.bmartin.cc/pubs/91skic.html"><i>Scientific knowledge in controversy: the social dynamics of the fluoridation debate</i></a>. Albany: State University of New York Press. <a href="/International_Standard_Book_Number" title="International Standard Book Number">ISBN</a> <a href="/Special:BookSources/0-7914-0538-9" title="Special:BookSources/0-7914-0538-9">0-7914-0538-9</a>.</cite><span title="ctx_ver=Z39.88-2004&rfr_id=info%3Asid%2Fen.wikipedia.org%3AWater+fluoridation+controversy&rft.aufirst=Brian&rft.aulast=Martin&rft.btitle=Scientific+knowledge+in+controversy%3A+the+social+dynamics+of+the+fluoridation+debate&rft.date=1991&rft.genre=book&rft_id=http%3A%2F%2Fwww.bmartin.cc%2Fpubs%2F91skic.html&rft.isbn=0-7914-0538-9&rft.place=Albany&rft.pub=State+University+of+New+York+Press&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook" class="Z3988"><span style="display:none;"> </span></span></li> | |||
<li><a href="/Brian_Martin_(social_scientist)" title="Brian Martin (social scientist)">Martin, Brian</a>, <i><a rel="nofollow" class="external text" href="http://www.bmartin.cc/pubs/14cm/14cm.pdf">The Controversy Manual</a></i> (Sparsnäs, Sweden: Irene Publishing, 2014).</li> | |||
</ul> | |||
<h2><span class="mw-headline" id="External_links">External links</span></h2> | |||
<ul> | |||
<li><a rel="nofollow" class="external text" href="https://www.dmoz.org/Society/Issues/Health/Water_Treatment/Fluoridation/">Water fluoridation</a> at <a href="/DMOZ" title="DMOZ">DMOZ</a></li> | |||
</ul> | |||
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The '''water fluoridation controversy''' arises from a ] debate concerning the science and public policy of the ] of public ]. It involves scientific issues, such as the question of ] It also involves ] and political issues, such as the question of the common good against individual rights, and the question of how the decision to fluoridate is made; ] or via ].<ref name=Scott>{{cite journal|last1=Scott|first1=P.|last2=Richards|first2=E.|last3=Martin|first3=B.|title=Captives of Controversy: The Myth of the Neutral Social Researcher in Contemporary Scientific Controversies|journal=Science, Technology & Human Values|volume=15|issue=4|pages=474–494|doi=10.1177/016224399001500406|url=http://m.sth.sagepub.com/content/15/4/474.abstract|accessdate=30 April 2016}}</ref> The controversy is propelled by a significant public opposition supported by a minority of professionals.<ref name="ReferenceA">{{cite journal |vauthors=Martin B |title=Analyzing the fluoridation controversy: resources and structures |journal=Soc Stud Sci |volume=18 |issue=2 |pages=331–63 |year=1988 |pmid=11621556 |doi= |url=}}</ref> Those opposed argue that water fluoridation has no or little ] benefits, may cause serious health problems, is not effective enough to justify the costs, and ] obsolete.<ref name=Thiessen>{{cite journal|last1=Ko|first1=Lee|last2=Thiessen|first2=Kathleen M.|title=A critique of recent economic evaluations of community water fluoridation|journal=International Journal of Occupational and Environmental Health|date=3 December 2014|volume=21|issue=2|pages=91–120|doi=10.1179/2049396714Y.0000000093|accessdate=21 April 2016}}</ref><ref name=Hileman>Hileman, Bette (November 4, 2006) Vol 84, Num 36 PP. 34-37, ], Retrieved April 14, 2016</ref><ref name=Kaminsky>], Book review (August 16, 2004) , Volume 82, Number 33, pp. 35-36 ], Retrieved April 19, 2016</ref> | |||
] authorities throughout the world find a ] that water fluoridation at appropriate levels is a safe and effective means to prevent ].<ref name=Pizzo/> The authorities views on the most effective ] for community prevention of tooth decay are mixed; some state water fluoridation is most effective while others see no special advantage and prefer topical application strategies.<ref name=NHMRC/><ref name=EU2011/> | ] authorities throughout the world find a ] that water fluoridation at appropriate levels is a safe and effective means to prevent ].<ref name=Pizzo/> The authorities views on the most effective ] for community prevention of tooth decay are mixed; some state water fluoridation is most effective while others see no special advantage and prefer topical application strategies.<ref name=NHMRC/><ref name=EU2011/> | ||
Opposition to fluoridation has existed since its initiation in the 1940s.<ref name=Martin1989/> During the 1950s and 1960s, ] claimed that fluoridation was a ] plot to undermine American public health.<ref name="Johnston">{{cite book | last = Johnston | first = Robert D | title = The Politics of Healing | publisher = Routledge | year = 2004 | isbn = 0-415-93339-0| page = 136}}</ref> In recent years water fluoridation has become a prevalent health and political issue in many countries, resulting in some countries and communities discontinuing it's use while others have expanded it.<ref name=Scher2011>{{cite web|title=Introduction to the SCHER opinion on Fluoridation|url=http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/l-3/1.htm#0|publisher=European Commission Scientific Committee on Health and Environmental Risks (SCHER)|accessdate=18 April 2016|date=2011}}</ref><ref name="fas.org">Tiemann, Mary (April 5, 2013) (pdf) ], pages 1-2, 4, Retrieved April 13, 2016</ref> As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated <ref name=extent2012>{{vcite book |chapter=The extent of water fluoridation |chapterurl=http://bfsweb.org/onemillion/09%20One%20in%20a%20Million%20-%20The%20Extent%20of%20Fluoridation.pdf |url=http://bfsweb.org/onemillion/onemillion.htm |title=One in a Million: The facts about water fluoridation |edition=3rd |year=2012 |author=The British Fluoridation Society; The UK Public Health Association; The British Dental Association; The Faculty of Public Health |isbn=0-9547684-0-X |pages=55–80 |publisher=British Fluoridation Society |location=Manchester |chapterformat=PDF }}</ref> | |||
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively.<ref name=cheng>National Center for Biotechnology Information , BMJ. 2007 Oct 6; 335(7622): 699–702. Retrieved on 12 April 2016</ref><ref name=yorkcrd/> ]s have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled.<ref name=Scher2011/><ref name=yorkcrd>Centre for Reviews and Dissemination , ], York, United Kingdom. Originally released : 28 October 2003. Retrieved on 12 April 2016</ref><ref name=Ih2015>{{cite journal|last1=Iheozor-Ejiofor|first1=Z|last2=Worthington|first2=HV|last3=Walsh|first3=T|last4=O'Malley|first4=L|last5=Clarkson|first5=JE|last6=Macey|first6=R|last7=Alam|first7=R|last8=Tugwell|first8=P|last9=Welch|first9=V|last10=Glenny|first10=AM|title=Water fluoridation for the prevention of dental caries.|journal=The Cochrane database of systematic reviews|date=18 June 2015|volume=6|pages=CD010856|pmid=26092033}}</ref> Researchers who oppose the practice state this as well.<ref name="Book Reviews 2011">{{cite journal|last1=Peckham|first1=Stephen|title=Book Reviews: The case against fluoride: how hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there, by Paul Connett, James Beck, and H Spedding Micklem|journal=Critical Public Health|volume=22|issue=1|year=2012|pages=113–114|issn=0958-1596|doi=10.1080/09581596.2011.593350}}</ref> According to a 2013 ] report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.<ref name="fas.org">Tiemann, Mary (April 5, 2013) (pdf) ], pages 1-2, 4, Retrieved April 13, 2016</ref> | |||
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively.<ref name=cheng>National Center for Biotechnology Information , BMJ. 2007 Oct 6; 335(7622): 699–702. Retrieved on 12 April 2016</ref><ref name=yorkcrd/> ]s have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled.<ref name=Scher2011/><ref name=yorkcrd>Centre for Reviews and Dissemination , ], York, United Kingdom. Originally released : 28 October 2003. Retrieved on 12 April 2016</ref><ref name=Ih2015>{{cite journal|last1=Iheozor-Ejiofor|first1=Z|last2=Worthington|first2=HV|last3=Walsh|first3=T|last4=O'Malley|first4=L|last5=Clarkson|first5=JE|last6=Macey|first6=R|last7=Alam|first7=R|last8=Tugwell|first8=P|last9=Welch|first9=V|last10=Glenny|first10=AM|title=Water fluoridation for the prevention of dental caries.|journal=The Cochrane database of systematic reviews|date=18 June 2015|volume=6|pages=CD010856|pmid=26092033}}</ref> Researchers who oppose the practice state this as well.<ref name="Book Reviews 2011">{{cite journal|last1=Peckham|first1=Stephen|title=Book Reviews: The case against fluoride: how hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there, by Paul Connett, James Beck, and H Spedding Micklem|journal=Critical Public Health|volume=22|issue=1|year=2012|pages=113–114|issn=0958-1596|doi=10.1080/09581596.2011.593350}}</ref> According to a 2013 ] report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.<ref name="fas.org">Tiemann, Mary (April 5, 2013) (pdf) ], pages 1-2, 4, Retrieved April 13, 2016</ref> | |||
Public water fluoridation was first practiced in 1945, in the U.S.. As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated water. A further 28 countries have water that is naturally fluoridated, though in many of them the fluoride is above the recommended safe level.<ref name=extent2012>{{vcite book |chapter=The extent of water fluoridation |chapterurl=http://bfsweb.org/onemillion/09%20One%20in%20a%20Million%20-%20The%20Extent%20of%20Fluoridation.pdf |url=http://bfsweb.org/onemillion/onemillion.htm |title=One in a Million: The facts about water fluoridation |edition=3rd |year=2012 |author=The British Fluoridation Society; The UK Public Health Association; The British Dental Association; The Faculty of Public Health |isbn=0-9547684-0-X |pages=55–80 |publisher=British Fluoridation Society |location=Manchester |chapterformat=PDF }}</ref> As of 2012 about 435 million people worldwide received water fluoridated at the recommended level (i.e., about 5.4% of the global population).<ref name=extent2012/><!-- Page 56 --> About 214 million of them living in the United States.<ref name=US-CDC-WF-Stats-2012>{{cite web |url=http://www.cdc.gov/fluoridation/statistics/2014stats.htm |title=Community Water Fluoridation --- 2014 Water Fluoridation Statistics |work=www.cdc.gov |accessdate=April 19, 2016}}</ref> | |||
== Medical consensus == | == Medical consensus == |
Revision as of 15:20, 30 April 2016
The water fluoridation controversy arises from a vociferous debate concerning the science and public policy of the fluoridation of public water supplies. It involves scientific issues, such as the question of Risk–benefit ratio It also involves Medical ethics and political issues, such as the question of the common good against individual rights, and the question of how the decision to fluoridate is made; Administratively or via Referendum. The controversy is propelled by a significant public opposition supported by a minority of professionals. Those opposed argue that water fluoridation has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and pharmacologically obsolete.
Public health authorities throughout the world find a medical consensus that water fluoridation at appropriate levels is a safe and effective means to prevent Dental caries. The authorities views on the most effective Fluoride therapy for community prevention of tooth decay are mixed; some state water fluoridation is most effective while others see no special advantage and prefer topical application strategies.
Opposition to fluoridation has existed since its initiation in the 1940s. During the 1950s and 1960s, conspiracy theorists claimed that fluoridation was a communist plot to undermine American public health. In recent years water fluoridation has become a prevalent health and political issue in many countries, resulting in some countries and communities discontinuing it's use while others have expanded it. As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively. Systematic reviews have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled. Researchers who oppose the practice state this as well. According to a 2013 Congressional Research Service report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.
Medical consensus
National and international health agencies and dental associations throughout the world have endorsed water fluoridation as safe and effective.
The views on the most effective method for community prevention of tooth decay are mixed. The Australian government states that water fluoridation is the most effective means of achieving fluoride exposure that is community-wide. The World Health Organization states water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk, while the European Commission finds no advantage to water fluoridation compared with topical use.
FDI World Dental Federation supports water fluoridation as safe and effective. the European Academy of Paediatric Dentistry, and the national dental associations of Australia, Canada, and the U.S. The American Dental Association calls water fluoridation "one of the safest and most beneficial, cost-effective public health measures for preventing, controlling, and in some cases reversing, tooth decay."
In the English speaking nations, who practice fluoridation; the United States, Canada, UK, Australia and New Zealand, many medical associations and authorities have published position statements and endorsed water fluoridation, exaples include:
The U.S. Surgeon General, the American Public Health Association, the Royal Commission on the National Health Service, Australian Medical Association, New Zealand Medical Association, 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 Centers for Disease Control and Prevention listed water fluoridation as one of the ten great public health achievements of the 20th century in the U.S., along with vaccination, family planning, recognition of the dangers of smoking, and other achievements.
In Israel; the Israeli Association of Public Health Physicians, the Israel Pediatric Association, and the Israel Dental Association, support fluoridation.
The World Health Organization, looking at global public health, identifies fluoride as one of a few chemicals (along with the arsenic and nitrate, and to a lesser extent lead, selenium and uranium) that are found in excessive levels in many parts of the world and cause negative health effects; for fluoride this is especially true in large regions of India, China, Central Africa and South America, and locally in many parts of the world. Only for fluoride does it recommend adjusting the level in places where the chemical is low to reach a threshold; this is because there is clear evidence that low concentrations provide protection against cavities, both in children and in adults.
Minority scientific view
The scientists or doctors who oppose water fluoridation argue that it has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and is pharmacologically obsolete. Arvid Carlsson has argued that fluoridation viiolates modern pharmacological principles and doesn't take into account individual variations in response, which can be considerable even when the dosage is fixed.
Evidence
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively. Systematic reviews have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled. A 2007 Nuffield Council on Bioethics report concluded that good evidence for or against water fluoridation is lacking. Researchers who oppose the practice state this as well. According to a 2013 Congressional Research Service report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy. The Chair of the 2006 National Research Council committee report on fluoride in drinking water, John Doull has stated a similar conclusion regarding the source of the controversy: "In the scientific community, people tend to think that its settled, I mean. when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this has been going on. I think that’s why fluoridation is still being challenged so many years after it began, In the face of ignorance, controversy is rampant."
Safety
Main article: Water fluoridation § SafetyCalcium fluoride can occur naturally in water in concentrations well above recommended levels, which can have several long-term adverse effects, including severe dental fluorosis, skeletal fluorosis, and weakened bones. In 1984 the World Health Organization recommended a guideline maximum fluoride value of 1.5 mg/L as a level at which fluorosis should be minimal, reaffirming it in 2006.
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. There is 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.
In rare cases improper implementation of water fluoridation can result in overfluoridation that causes outbreaks of acute fluoride poisoning, with symptoms that include nausea, vomiting, and diarrhea. Three such outbreaks were reported in the U.S. between 1991 and 1998, caused by fluoride concentrations as high as 220 mg/L; in the 1992 Alaska outbreak, 262 people became ill and one person died.Cite error: A <ref>
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(see the help page). The controversy is propelled by a significant public opposition supported by a minority of professionals. Those opposed argue that water fluoridation has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and pharmacologically obsolete.
Public health authorities throughout the world find a medical consensus that water fluoridation at appropriate levels is a safe and effective means to prevent Dental caries. The authorities views on the most effective Fluoride therapy for community prevention of tooth decay are mixed; some state water fluoridation is most effective while others see no special advantage and prefer topical application strategies.
Opposition to fluoridation has existed since its initiation in the 1940s. During the 1950s and 1960s, conspiracy theorists claimed that fluoridation was a communist plot to undermine American public health. In recent years water fluoridation has become a prevalent health and political issue in many countries, resulting in some countries and communities discontinuing it's use while others have expanded it. As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively. Systematic reviews have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled. Researchers who oppose the practice state this as well. According to a 2013 Congressional Research Service report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy.
Medical consensus
National and international health agencies and dental associations throughout the world have endorsed water fluoridation as safe and effective.
The views on the most effective method for community prevention of tooth decay are mixed. The Australian government states that water fluoridation is the most effective means of achieving fluoride exposure that is community-wide. The World Health Organization states water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk, while the European Commission finds no advantage to water fluoridation compared with topical use.
FDI World Dental Federation supports water fluoridation as safe and effective. the European Academy of Paediatric Dentistry, and the national dental associations of Australia, Canada, and the U.S. The American Dental Association calls water fluoridation "one of the safest and most beneficial, cost-effective public health measures for preventing, controlling, and in some cases reversing, tooth decay."
In the English speaking nations, who practice fluoridation; the United States, Canada, UK, Australia and New Zealand, many medical associations and authorities have published position statements and endorsed water fluoridation, exaples include:
The U.S. Surgeon General, the American Public Health Association, the Royal Commission on the National Health Service, Australian Medical Association, New Zealand Medical Association, 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 Centers for Disease Control and Prevention listed water fluoridation as one of the ten great public health achievements of the 20th century in the U.S., along with vaccination, family planning, recognition of the dangers of smoking, and other achievements.
In Israel; the Israeli Association of Public Health Physicians, the Israel Pediatric Association, and the Israel Dental Association, support fluoridation.
The World Health Organization, looking at global public health, identifies fluoride as one of a few chemicals (along with the arsenic and nitrate, and to a lesser extent lead, selenium and uranium) that are found in excessive levels in many parts of the world and cause negative health effects; for fluoride this is especially true in large regions of India, China, Central Africa and South America, and locally in many parts of the world. Only for fluoride does it recommend adjusting the level in places where the chemical is low to reach a threshold; this is because there is clear evidence that low concentrations provide protection against cavities, both in children and in adults.
Minority scientific view
The scientists or doctors who oppose water fluoridation argue that it has no or little cariostatic benefits, may cause serious health problems, is not effective enough to justify the costs, and is pharmacologically obsolete. Arvid Carlsson has argued that fluoridation viiolates modern pharmacological principles and doesn't take into account individual variations in response, which can be considerable even when the dosage is fixed.
Evidence
Proponents and opponents have been both criticized for overstating the benefits or overstating the risks, and understating the other, respectively. Systematic reviews have cited the lack of high quality research for the benefits and risks of water fluoridation and questions that are still unsettled. A 2007 Nuffield Council on Bioethics report concluded that good evidence for or against water fluoridation is lacking. Researchers who oppose the practice state this as well. According to a 2013 Congressional Research Service report on fluoride in drinking water, these gaps in the fluoridation scientific literature fuel the controversy. The Chair of the 2006 National Research Council committee report on fluoride in drinking water, John Doull has stated a similar conclusion regarding the source of the controversy: "In the scientific community, people tend to think that its settled, I mean. when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this has been going on. I think that’s why fluoridation is still being challenged so many years after it began, In the face of ignorance, controversy is rampant."
Safety
Main article: Water fluoridation § SafetyCalcium fluoride can occur naturally in water in concentrations well above recommended levels, which can have several long-term adverse effects, including severe dental fluorosis, skeletal fluorosis, and weakened bones. In 1984 the World Health Organization recommended a guideline maximum fluoride value of 1.5 mg/L as a level at which fluorosis should be minimal, reaffirming it in 2006.
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. There is 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.
In rare cases improper implementation of water fluoridation can result in overfluoridation that causes outbreaks of acute fluoride poisoning, with symptoms that include nausea, vomiting, and diarrhea. Three such outbreaks were reported in the U.S. between 1991 and 1998, caused by fluoride concentrations as high as 220 mg/L; in the 1992 Alaska outbreak, 262 people became ill and one person died. In 2010, approximately 60 gallons of fluoride were released into the water supply in Asheboro, North Carolina in 90 minutes—an amount that was intended to be released in a 24-hour period.
Like other common water additives such as chlorine, hydrofluosilicic acid and sodium silicofluoride decrease pH and cause a small increase of corrosivity, but this problem is easily addressed by increasing the pH. Although it has been hypothesized that hydrofluosilicic acid and sodium silicofluoride might increase human lead uptake from water, a 2006 statistical analysis did not support concerns that these chemicals cause higher blood lead concentrations in children. Trace levels of arsenic and lead may be present in fluoride compounds added to water; however, concentrations are below measurement limits.
The effect of water fluoridation on the natural environment has been investigated, and no adverse effects have been established. Issues studied have included fluoride concentrations in groundwater and downstream rivers; lawns, gardens, and plants; consumption of plants grown in fluoridated water; air emissions; and equipment noise.
Efficacy
Main article: Water fluoridation § EffectivenessReviews have shown that water fluoridation reduces cavities in children. A conclusion for the efficacy in adults is less clear with some reviews finding benefit and others not. Studies in the U.S. in the 1950s and 1960s showed that water fluoridation reduced childhood cavities by fifty to sixty percent, while studies in 1989 and 1990 showed lower reductions (40% and 18% respectively), likely due to increasing use of fluoride from other sources, notably toothpaste, and also the 'halo effect' of food and drink that is made in fluoridated areas and consumed in unfluoridated ones.
A 2000 UK systematic review (York) found that water fluoridation was associated with a decreased proportion of children with cavities of 15% and with a decrease in decayed, missing, and filled primary teeth (average decreases was 2.25 teeth). The review found that the evidence was of moderate quality: few studies attempted to reduce observer bias, control for confounding factors, report variance measures, or use appropriate analysis. Although no major differences between natural and artificial fluoridation were apparent, the evidence was inadequate for a conclusion about any differences. A 2002 systematic review found strong evidence that water fluoridation is effective at reducing overall tooth decay in communities. A 2015 Cochrane review also found benefit in children.
Fluoride may also prevent cavities in adults of all ages. A 2007 meta-analysis by CDC researchers found that water fluoridation prevented an estimated 27% of cavities in adults, about the same fraction as prevented by exposure to any delivery method of fluoride (29% average). A 2011 European Commission review found that the benefits of water fluoridation for adult in terms of reductions in decay are limited. 2015 Cochrane review found no conclusive research in adults.
Most countries in Europe have experienced substantial declines in cavities without the use of water fluoridation. For example, in Finland and Germany, tooth decay rates remained stable or continued to decline after water fluoridation stopped. Fluoridation may be useful in the U.S. because unlike most European countries, the U.S. does not have school-based dental care, many children do not visit a dentist regularly, and for many U.S. children water fluoridation is the prime source of exposure to fluoride. The effectiveness of water fluoridation can vary according to circumstances such as whether preventive dental care is free to all children.
Ethics
Water fluoridation pits the common good against individual rights. Some say the common good overrides individual rights, and equate it to vaccination and food fortification. Others say that individual rights override the common good, and say that individuals have no choice in the water that they drink, unless they drink more expensive bottled water, and some argue unequivocally, that it does not stand up to scrutiny relative to the Nuremberg Code and other codes of medical ethics.
Those who emphasize the public good emphasize the medical consensus that appropriate levels of water fluoridation are safe and effective to prevent cavities and see it as a public health intervention, replicating the benefits of naturally fluoridated water, which can free people from the misery and expense of tooth decay and toothache, with the greatest benefit accruing to those least able to help themselves. This perspective suggests it would be unethical to withhold such treatment. In her book 50 Health Scares That Fizzled, Joan Callahan writes that, "For lower-income people with no insurance, fluoridated water (like enriched flour and fortified milk) looks more like a free preventative health measure that a few elitists are trying to take away."
Those who emphasize individual or local choice, may view fluoridation as a violation of ethical or legal rules that prohibit medical treatment without medical supervision or informed consent, and that prohibit administration of unlicensed medical substances, view it as "mass medication", or may even characterize it as a violation of the Nuremberg Code and the Council of Europe's Biomedical Convention of 1999. Another journal 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. Others have opposed it on the grounds of potential financial conflicts of interest driven by the chemical industry.
A 2007 Nuffield Council on Bioethics report reached a conclusion mainly on three points, stating that :
- The balance of benefit to risk ratio - is unclear due to the lack of good evidence for or against water fluoridation.
- Alternatives to the practice exist - topical fluoride therapy (toothbrushing etc)
- The role of consent- It gets priority when there are potential harms.
The report therefore concluded that local and regional democratic procedures are the most appropriate way to decide whether to fluoridate.
Opposition groups and campaigns
The controversy is propelled by a significant public opposition supported by a minority of professionals, including researchers, dental and medical professionals, alternative medical practitioners such as chiropractors, health food enthusiasts, a few religious groups (mostly Christian Scientists in the U.S.), and occasionally consumer groups and environmentalists. Organized political opposition has come from libertarians, the John Birch Society, and from groups like the Green parties in the UK and New Zealand.
Opposition campaigns involve newspaper articles, talk radio, and public forums. Media reporters are often poorly equipped to explain the scientific issues, and are motivated to present controversy regardless of the underlying scientific merits. Websites, which are increasingly used by the public for health information, contain a wide range of material about fluoridation ranging from factual to fraudulent, with a disproportionate percentage opposed to fluoridation. Antifluoridationist literature links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's disease, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid.
Public opinion
Many people do not know that fluoridation is meant to prevent tooth decay, or that natural or bottled water can contain fluoride. As fluoridation does not appear to be an important issue for the general public in the U.S., the debate may reflect an argument between two relatively small lobbies for and against fluoridation.
A 2009 survey of Australians found that 70% supported and 15% opposed fluoridation. Those opposed were much more likely to score higher on outrage factors such as "unclear benefits".
A 2003 study of focus groups from 16 European countries found that fluoridation was opposed by a majority of focus group members in most of the countries, including France, Germany, and the UK.
A 1999 survey in Sheffield, UK found that while a 62% majority favored water fluoridation in the city, the 31% who were opposed expressed their preference with greater intensity than supporters.
Every year in the U.S., pro- and anti-fluoridationists face off in referenda or other public decision-making processes: in most of them, fluoridation is rejected.
Use throughout the world
Main article: Fluoridation by countryDespite support by public health organizations and authorities, the practice is controversial as a public health measure; some countries and communities have discontinued it, while others have expanded it.
In the U.S., rejection in state and local communities is more likely when the decision is made by a public referendum; in Europe, most decisions against fluoridation have been made administratively. Neither side of the dispute appears to be weakening or willing to concede.
Water fluoridation is used in the United States, 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:
- 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)
- Israel (1981–2014) *Mandatory by law since 2002.
In the United Kingdom a strategic health authority can direct a water company to fluoridate the water supply in an area if it is technically possible. The strategic health authority must consult with the local community and businesses in the affected area. The water company will act as a contractor in any new schemes and cannot refuse to fluoridate the supply.
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. In some other countries, sodium fluoride is added to table salt.
As of 2012, 25 countries have artificial water fluoridation to varying degrees, 11 of them have more than 50% of their population drinking fluoridated water. A further 28 countries have water that is naturally fluoridated, though in many of them the fluoride is above the recommended safe level. As of 2012 about 435 million people worldwide received water fluoridated at the recommended level (i.e., about 5.4% of the global population). About 214 million of them living in the United States.
History
Main article: History of water fluoridationFluoridation began during a time of great optimism and faith in science and experts (the 1950s and 1960s), but even then, the public frequently objected. Opponents drew on distrust of experts and unease about medicine and science. Controversies include disputes over fluoridation's benefits and the strength of the evidence basis for these benefits, the difficulty of identifying harms, legal issues over whether water fluoride is a medicine, and the ethics of mass intervention.
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 poisoning" 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.
Conspiracy theories involving fluoridation are common, and include claims that fluoridation was motivated by protecting the U.S. atomic bomb program from litigation, that (as famously parodied in the film Dr. Strangelove, where a deranged U.S. Army general claimed that it would "sap and impurify all of our precious bodily fluids") it is part of a Communist or New World Order plot to take over the world, that it was pioneered by a German chemical company to make people submissive to those in power, that behind the scenes it is promoted by the sugary food or phosphate fertilizer or aluminium industries, or that it is a smokescreen to cover failure to provide dental care to the poor. One such theory is that fluoridation was a public-relations ruse sponsored by fluoride polluters such as the aluminium maker Alcoa and the Manhattan Project, with conspirators that included industrialist Andrew Mellon and the Mellon Institute's researcher Gerald J. Cox, the Kettering Laboratory of the University of Cincinnati, the Federal Security Agency's administrator Oscar R. Ewing, and public-relations strategist Edward Bernays. Specific antifluoridation arguments change to match the spirit of the time.
Outside North America, water fluoridation was adopted in some 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.
Communist conspiracy theory (1940s–1960s)
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. These opponents believed it was "another aspect of President Truman's drive to socialize medicine." 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.
Others asserted the existence of "a Communist plot 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 controversy had a direct impact on local program during the 1950s and 1960s, where referendums on introducing fluoridation were defeated in over a thousand Florida communities. It was not until as late as the 1990s that fluoridated water was consumed 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'."
Later conspiracy theories
In 1987, Ian E. Stephens authored a self-published booklet, an extract of which was published in the Australian New Age publication Nexus Magazine in 1995. In it he claimed he was told by "Charles Elliot Perkins" that: "Repeated doses of infinitesimal amounts of fluoride will in time reduce an individual's power to resist domination by slowly poisoning and narcotising a certain area of the brain and will thus make him submissive to the will of those who wish to govern him ... Both the Germans and the Russians added sodium fluoride to the drinking water of prisoners of war to make them stupid and docile." These statements have been dismissed by reputable Holocaust historians as untrue, but they are regularly repeated to the present day in conspiracy publications and websites.
In 2004, on the U.S. television program Democracy Now, investigative journalist and author of the book The Fluoride Deception, Christopher Bryson claimed 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."
2006 US NRC report
U.S. opponents of fluoridation were heartened by a 2006 National Research Council report about hazards of water naturally fluoridated to high levels; the report recommended lowering the U.S. maximum limit of 4 mg/L for fluoride in drinking water.
Court cases
Europe
Water was fluoridated in large parts of the Netherlands from 1960 to 1973, at which point the Supreme Court of the Netherlands declared fluoridation of drinking water unauthorized. The Dutch Court decided that authorities had no legal basis for adding chemicals to drinking water if they did not also improve safety. It was also stated as support 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. 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.
United States
See also: Water fluoridation in the United StatesFluoridation has been the subject of many court cases 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.
See also
Portals:References
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- Politifact Florida "Say water fluoridation started in Nazi Germany ghettos and death camps to pacify the Jews." Politifact Florida accessed on 27 March 2014
- Bryson, Christopher. "The Fluoride Deception: How a Nuclear Waste Made its Way Into the Nation's Drinking Water", Democracy Now, 17 June 2004
- Fagin D. Second thoughts about fluoride. Sci Am. 2008;298(1):74–81. doi:10.1038/scientificamerican0108-74. PMID 18225698.
- National Research Council. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. Washington, DC: National Academies Press; 2006. ISBN 0-309-10128-X.
- Bram van der Lek (1976). "De strijd tegen fluoridering". De Gids. 139 (2).
- Leonardus Johannes Antonius Damen, Peter Nicolaï, J.L. Boxum, K.J. de Graaf, J.H. Jans, A.P. Klap, A.T. Marseille, A.R. Neerhof, B.K. Olivier, B.J. Schueler, F.R. Vermeer, R.L. Vucsán (2005). "Deel 1: systeem, bevoegdheid, bevoegdheidsuitoefening, handhaving". Bestuursrecht. Boom juridische studieboeken (in Dutch). Boom Juridische uitgevers. pp. 54–55. ISBN 978-90-5454-537-8.
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suggested) (help)CS1 maint: multiple names: authors list (link) - "Ryan v. A.G. IESC 1; IR 294 (3 July, 1965)". Irish Supreme Court.
- Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) ("Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question." (citations omitted)).
- Pratt, Edwin, Raymond D. Rawson & Mark Rubin, Fluoridation at Fifty: What Have We Learned, 30 J.L. Med. & Ethics 117, 119 (Fall 2002)
Further reading
- Connett, Paul; Beck, James; Micklem, H. Spedding (2010). The case against fluoride; how hazardous waste ended up in our drinking water and the bad science and powerful politics that keep it there. White River Junction, Vermont: Chelsea Green Publishing. p. 384. ISBN 978-1-60358-287-2.
- Fawell, John Wesley (2006). Fluoride in drinking-water. Geneva: World Health Organization. ISBN 92-4-156319-2.
- Freeze, RA; Lehr, JH (2009). The fluoride wars: how a modest public health measure became America's longest-running political melodrama. Hoboken: Wiley. ISBN 0-470-44833-4.
{{cite book}}
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suggested) (help) - Martin, Brian (1991). Scientific knowledge in controversy: the social dynamics of the fluoridation debate. Albany: State University of New York Press. ISBN 0-7914-0538-9.
- Martin, Brian, The Controversy Manual (Sparsnäs, Sweden: Irene Publishing, 2014).