Water fluoridation

Since its inception in the 1940s, the scientifically sound concept of fluoridating water has been a source of fear and suspicion in the minds of conspiracy theorists.

Some dare call it
Conspiracy
What THEY don't want
you to know!
Sheeple wakers
v - t - e
“”Do you realize that fluoridation is the most monstrously conceived and dangerous communist plot we have ever had to face?
—General Jack D. Ripper in Dr. Strangelove, shortly before blowing the world to kingdom come[1]

Water is fluoridated by adding a small quantity (up to 2 mg/l) of a fluoride salt of fluorine. Fluoride works by converting the outer layer of tooth enamel made of hydroxylapatite, Ca5(PO4)3OH, to fluoroapatite, Ca5(PO4)3F. The latter chemical is less soluble in acidic solutions. The three most commonly added fluoride chemicals are sodium fluoride (NaF), fluorosilicic acid ((H3O)2SiF6), and sodium fluorosilicate (Na2[SiF6]).[2] Fluorosilicic acid is a byproduct of phosphate fertilizer manufacture, a fact which fluoride opponents repeat ad absurdum in an attempt to scare you.[3]

In short: The issue has been extensively studied since the 40s. As a result, every reputable public health organization endorses the benefits of fluoridation. To date, no such organizations have endorsed claims that fluoride is a secret communist mind-control plot -- though we wait with bated breath.

History of fluoridation
“”I go to the dentist every six months, I get a cleaning, so… I'm fortunate enough that those fluoride treatments as a child worked. Not getting any cavities.
—Daniel ToshFile:Wikipedia's W.svg, being serious for once[4]

There are three periods concerning the history of water fluoridation:

  1. Before 1933, the study of mottled tooth enamel, later known as fluorosis.[5]
  2. From 1933 to 1945, the study of the relationship between fluorine and tooth decay. (No, not in Nazi Germany.[6])
  3. From 1945 onward, which focused on deployment of water fluorides, creating pretty rainbows in garden sprinklers ... which definitely weren't there before and certainly are not caused by the refraction of light.

Since widespread community water fluoridation began in earnest in the 1940s in the United States, one last bastion of hope for modern anti-fluoridationists has been the city of Portland, Oregon. As of 2014, it is the last of the largest metropolitan cities in the United States to remain unfluoridated,[7] despite four popular vote attempts to add the *ahem* chemical.[8]

In the United States, the Safe Drinking Water Act (SDWA) of 1974 confers the authority for ensuring the safety of public drinking water to the Environmental Protection Agency (EPA).[9]

Arguments for fluoridation
“”Good-looking people with strong, fluoridated teeth get things handed to them on platters.
—Douglas CouplandFile:Wikipedia's W.svg[10]

Centralized fluoridation is a safe, simple, and effective way to improve the dental health of the population at large (especially children in the candy cavity-prone years). It is also extremely cost-effective: one study estimated that for every $1 a city invested in fluoridation it saved the average citizen (with a mean dental health cost) $38 on dental care.[11] The Centers for Disease Control and Prevention considers water fluoridation to be one of the top 10 public health advances of the 20th century.[12] The American Dental Association "unreservedly endorses the fluoridation of community water supplies as safe, effective and necessary in preventing tooth decay."[13] The World Health Organization states that "fluoridation of water supplies, where possible, is the most effective public health measure for the prevention of dental decay."[14]

Having been around for 70-odd years and having been the focus of much research, water fluoridation has been studied to death (the number of studies seems to have peaked around the late 1960s followed by a general decline[15][16][17]). Arguments along the lines of "the jury is out" or "the science is incomplete" are wrong. Thousands of studies and years of actual implementation have not upset the scientific consensus.

Standard arguments against fluoridation

Most of the arguments against fluoridation are based on ethical and moral issues, namely that water fluoridation is medicating large numbers of people without their explicit consent. Curiously they don't typically complain about regulations that add "drugs" to other foods, like iodine added to salt, vitamin D added to milk, iron added to cereal, or folic acid added to flour.[18]

Despite fluoride naturally occurring in food and water,[19] a common argument against it is the appeal to nature. Most health effect arguments against water fluoridation (such as toxicity and mottled teeth) base their assumptions on much higher doses of fluoride than are allowed in municipal tap water and the excessive cherry-picking of studies. Additional studies on links between fluoride and cancer, and fluoride and bone fractures have been shown to be invalid.[20] Other arguments are based on the false assumption that if fluoridation worked, there would be no tooth decay.

The favourite adverse effect of the anti-fluoride crowd, dental fluorosis,File:Wikipedia's W.svg is a scary-sounding but rather benign condition in which the teeth become slightly stained. It is a purely cosmetic issue that does not lead to tooth decay, whereas removing fluoride from water does if individuals do not brush their teeth regularly. In all but the most severe cases, the mottling is barely noticeable, and it's only significant in children whose teeth have not finished developing. By comparison, drinking a lot of coffee or tea can also make your teeth yellow, though this is reversible. Dental fluorosis is a potential risk but is not problematic if the dosage is controlled. Drinking water with fluoride above "safe dosages", such as that found in some natural ground water wells in developing countries or in brick teas exposed to excessively fluorinated water, can also cause a more serious condition called skeletal fluorosisFile:Wikipedia's W.svg.

"But the EPA opposes fluoridation!"

Deniers will typically claim 1,500+ EPA scientists are opposed to fluoridation.[21] Upon closer inspection, however, this "study" is actually just a grievance letter written in 1999 by J. William Hirzy, Ph.D. on the letterhead of his local National Treasury Employees Union Chapter 280. The letter — far from representing the views of 1,500 scientists (the union represents all employees, which includes non-scientists like lawyers[22]) — is really the result of a poorly attended meeting of one local union chapter. With only 20 of said union chapter members in attendance, Hirzy and his followers were able to adopt a resolution opposing fluoridation. When it became obvious to the wider union that Hirzy and his local chapter were falsely presenting their fringe position as representing the view of the entire union, the chapter officers who actually represented the majority of the members rapidly disowned Hirzy's position.[23] After the above incident, Hirzy seems to have gone on to becoming the deniers' go-to guy.[24]

"But the National Research Council opposes fluoridation!"

Deniers will hand wave to a 2006 500+ page report by the NRC's Committee Report on Fluoride in Drinking Water and claim that it opposes fluoridation, and of course claims will be accompanied by cherry-picked scare quotes.[25] The study makes no claims against water fluoridation. The report merely reviews the evidence for safe levels. Science does that from time to time. Reappraises safe consumption levels given changes in technologies and lifestyles. The report gives no support to fluoridation deniers as it suggests 2.0 ppm is a safe level. Most public water is fluoridated at a 0.7 ppm level, a third of what the NRC determined was still a safe level. In response to the misuse of the report, the report's chairman has stated, "I do not believe there is any valid, scientific reason for fearing adverse health conditions from the consumption of water fluoridated at the optimal level."[26]

"But the World Health Organization opposes fluoridation!"

Deniers will make various claims that the World Health Organization (WHO) opposes fluoridation. By way of evidence they will point to various WHO publications about the need to remove fluoride from water. Deniers miss that these guides are for people living in areas where there's a dangerous concentration in the local drinking water due to natural sources and a government unable to fund the technology to reduce it to a safe level. Deniers miss the notion that everything is poisonous in high enough concentrations. For example, vitamin A is critical to human health but a human (typically a child) can realistically poison himself/herself by consuming too much.[27] The 2016 WHO report, Fluoride and Oral Health, clearly supports fluoridation for populations that would benefit from it. [28]

"But a bunch of western European countries oppose fluoridation!"

Deniers will typically list nations that do not fluoridate their water.[29] Mostly they're Western European nations which lends their position a gloss of respectability because, you know, apparently Western Europeans have their shit together. What they ignore is water fluoridation is a public health measure created to benefit the poor[30] without means to access dentists. They typically list nations like Sweden, Finland, Denmark, etc. It goes without saying these nations provide excellent universal health care regardless of family income including free access to dental care for children. Most of these nations have dental care and surveillance at the school level.[31] Hilariously enough, even though water fluoridation is banned in these countries, conspiracy nuts nevertheless bring it up and call for it to be banned.[32] In addition to better access to childhood dental care, many of these nations don't fluoridate their water because they fluoridate their salt. For example Switzerland, Germany, and France don't fluoridate their water but they fluoridate their salt.[33]

"But the freakin' Nazis fluoridated the water in their death camps!"
This wonderful fluoride tank, with some help from its chemtrail friends, is busy subjugating the death camp populations, including the one where giants drowned and were tossed into the water (as pictured here). Don't bother it!

This is one of those wonderful examples of an unsourced anecdote mentioned once that gets repeated as fact for decades. The suggestion is the Nazis fluoridated the water to pacify the death camp populations. Apparently starvation, soldiers with guns, and machine gun towers that would mow you down if you got too close to the fence were not enough to mollify the death camp population. They needed to drug them up. The claim is generally attributed to an early denier named Charles E. Perkins who wrote a book called The Truth about Water Fluoridation. The claim is that Perkins' source was a worker at a German chemical company that ostensibly supplied fluoride. However, Politifact casts some doubt on the Perkins origin.[34] His actual book makes no mention of this. However, some allege he wrote a follow-on letter that made this claim.[35] Suffice it to say there's zero documentation anywhere the Nazis ever used fluoride for mind control purposes. It may be connected with claims that the similar chemical potassium bromide (once used medically as a sedative) was added to British soldiers' rations to lower their libidos or for some other reason, although this also appears to be a myth, and fluoride doesn't have the same effect anyway.[36]

"I'm fine with fluoride on toothpaste, but fluoride shouldn't be ingested!"

Just as how other denialist circles have soft and hard nuances, anti-fluoridation people have their share of softcore anti-fluoride opinions. According to them, fluoride is fine when applied topically (on toothpaste for instance), but not when it is part of the water supply (systemic).[37] The problem, particularly in the U.S., is that people, especially children, need more exposure to fluoride to appreciate the positive effects of decreasing cavities. In the U.S., fluoridated water is how most children are exposed to fluoride, since, compared to Europe, children do not have school-based dental care and do not visit the dentist regularly. Additionally, fluoride, when swallowed, can be distributed throughout the body, which includes being in the saliva that covers the teeth. Nevertheless, fluoridated water has been shown with more than enough evidence to improve the quality of teeth in humans compared to its risks, if any, and removing them in water will reduce those benefits. The main problem is that it goes against the heaps of evidence demonstrating the safety and benefits of drinking fluoridated water.

The IQ studies
  • In 2006, the National Research Council (NRC) published a review of the EPA's drinking water standard for fluoride.[38] The report noted potential negative effects due to fluoridation, including cognitive impairment, impaired thyroid functioning, and increases in bone fractures, in addition to the fluorosis of children's teeth. The NRC called for a reduction of the EPA's limit of 4.0 mg/L of fluoride in drinking water.[38] This was a much higher standard than the recommended levels for water fluoridation (targeting levels from 0.7 to 1.2 mg/L).

These results do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S. On the other hand, neither can it be concluded that no risk is present.

  • In 2014, a study conducted in New Zealand examined the relationship between fluoridation and IQ directly on a cohort of people born in Dunedin in the 1970s. It found no statistically significant link. The authors suggest that the earlier Harvard study might have been affected by confounding variables, especially urban or rural status.[39]
  • In 2017, there is another study conducted in Mexico, published in Environmental Health Perspectives, determining the effects of high fluoridation and IQ scores called "Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico". It is shortened to the "Bashash study".[40] Despite being the largest long-term study and following standard protocal for measurements, it is still limited by a multitude of factors being lack of data for fluoride intake, the only recorded fluoride intake being salts and naturally occurring fluoride, a relatively small convenience sample, and a lack of factoring for confounding factors such as accounting for possible arsenic, thus making this study far from conclusive in determining the effects.[41]

"But, informed consent!"

The pseudo-Libertarian argument Concern trolling. The basic premise is that not everyone "agrees" to have their water fluoridated. This might be valid logic in magical sunshine land where the unicorns fart dollar bills, but unfortunately we do not live in such a world. Giving everyone the ability to choose whether or not their water was fluoridated would effectively mean that every single house would have its own fluoridation unit which could be turned on or off, meaning it's prohibitively expensive to install, let alone maintain. Instead, everyone "consents" in the sense that in a democracy, every town/municipality has elected people who chose to fluoridate the water. If such a thing was tyranny, then having any municipal water system at all would equally be tyranny, since you also didn't consent to having your water chlorinated, either.

Conspiracy theories
Impurifying your precious bodily fluids for more than half a century.
“”General Jack D. Ripper: You know when fluoridation first began?

Group Capt. Lionel Mandrake: I... no, no. I don't, Jack.

General Jack D. Ripper: Nineteen hundred and forty-six. 1946, Mandrake. How does that coincide with your post-war Commie conspiracy, huh? It's incredibly obvious, isn't it? A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly without any choice. That's the way your hard-core Commie works.
—Dr. Strangelove[42]

Water fluoridation as a commie plot started among the wingnut paranoids during the Cold War, most notably the John Birch Society — the "dark age" claims of which were being debunked in public at least as early as 1962.[43] The conspiracy theory gained currency among far-left moonbats after it mutated in the early 1990s into a plot by the aluminum industry to dispose of their fluoride wastes by dumping them into the water supply for profit.[44] The implication that Big Pharma is out to poison you and that the scientific consensus is proof of a massive world-wide conspiracy of scientists/dentists makes reasoning with conspiracy theorists particularly difficult.

Another popular claim is that fluoridation is a method of nuclear waste disposal.[45] It is true that gaseous fluorine was first used during the Manhattan Project in the process of uranium enrichment, which involves the conversion of uranium oxide to uranium hexafluoride. However, this is irrelevant, because fluoridation uses fluoride (i.e., soluble salts that contain fluorine) rather than fluorine (a gas so corrosive that it violently reacts with water). Furthermore, uranium enrichment does not involve any nuclear reactions, so no radioactivity or nuclear waste is generated in this process. Finally, this is actually a niche use of fluorine compounds. They are mainly used in steelmaking, aluminium smelting, and the production of specialty plastics (such as PTFE, also known as Teflon) and pharmaceuticals. Cranks apparently find these uses much less interesting.

“”Does a tiger brush his teeth?
—Mao Zedong, veterinary dentistryFile:Wikipedia's W.svg denialist[46]

Prominent commie Mao Zedong's refusal to brush his teeth is not only definitive proof that the commies were indeed behind US fluoride use all along; his aversion to fluoride also helps to explain his super-appalling dental hygiene.[47] The cranks agree — resist world communism by not listening to scientists, instead following the Dear Leader's example.

The cream of the anti-fluoridation crap
See the main article on this topic: Crank magnetism

Trivia
  • A word of advice — if you're the type of person who freaks out about the fluoride in the water supply, it is advised that you never drink tea; this is because the tea plant — both black and green — is exceptionally good at soaking up fluoride in its soil.[58] If you're sane, then well, drinking tea without sugar is a good way to improve your dental hygiene because of its high fluoride concentration. People in China commonly used to brush their teeth with tea as an alternative, though their teeth were still significantly worse off than those of the modern toothpaste user.[59]
  • Due to a pressing need among cranks to rationalize away why your average person won't just run along with any zany Internet theory accept the facts as provided by truthers, the term "fluoride stare" has actually been popularized in the fringe. This term denotes the embarassed glance of non-judgemental (though, palpable) disbelief given by those whose first reaction to having been dragged through a lecture on Obama being a reptilian isn't "YES!! IT ALL FITS!".

In a nutshell
gollark: If you pick a word to start with, then the next possibilities for your thing are a limited subset of all words - those without the letters in said first word. Though admittedly checking that would be slow too.
gollark: `/usr/share/dict/words` or `wc`?
gollark: `wc -l < /usr/share/dict/words` says there are only 123115 words.
gollark: It shouldn't even take that long with good optimizatiom.
gollark: Look, if you really want you can brute-force-search all possible reasonably short combinations of words or something.

See also
For those of you in the mood, RationalWiki has a fun article about Anti-fluoridation argument Bingo.

References
  1. http://www.visual-memory.co.uk/amk/doc/0055.html
  2. Water Fluoridation: A Manual For Engineers and Technicians, CDC
  3. Fluoride Action Network: Fluoridation Chemicals
  4. http://www.brainyquote.com/quotes/quotes/d/danieltosh575328.html
  5. See the Wikipedia article on History of water fluoridation.
  6. Truth about fluoride doesn't include Nazi myth, PolitiFact
  7. Water Fluoridation Status of the 50 Largest Cities in the United States, Wisconsin Dental Association (San Jose, which ranks above Portland in population, was unfluoridated until 2012.)
  8. Why Portland Is Wrong About Water Fluoridation, Scientific American
  9. Basic Information about Fluoride in Drinking Water, EPA
  10. http://www.brainyquote.com/quotes/quotes/d/douglascou411342.html
  11. Do cities really save $38 for every $1 they spend on fluoridation?, PolitiFact
  12. Here, here, here and here
  13. What the National and International Experts Say About Water Fluoridation, Ontario Dental Association
  14. Water Fluoridation, WHO
  15. PubMed has over six thousand citations to studies regarding water fluoridation, and this is by no means a complete registry of every study ever done.
  16. Centers for Disease Control and Prevention. Last Updated May 12, 2015. Scientific Reviews and Reports: Assessing the Evidence. Retrieved March 20, 2017.
  17. Yeung, Ca. PubMed. A systematic review of the efficacy and safety of fluoridation. Retrieved March 20, 2017. This is one systematic review on the many, many studies done.
  18. http://www.dietitians.ca/Dietitians-Views/Food-Regulation-and-Labelling/Food-Fortification.aspx
  19. Naturally occurring hazards: Fluoride, WHO
  20. Review of Fluoride: Benefits and Risks, US Department of Health and Human Services
  21. http://www.fluoridation.com/epa2.htm
  22. http://nteu280.org/history/
  23. http://www.in.gov/isdh/24525.htm#Does_the_US_EPA_oppose_water_fluoridation
  24. https://openparachute.wordpress.com/tag/hirzy/
  25. http://fluoridealert.org/researchers/nrc/
  26. http://www.ilikemyteeth.org/wp-content/uploads/2013/03/Doull-Email-on-CWF-March-2013.pdf
  27. http://www.ewg.org/research/how-much-is-too-much/up-to-half-of-young-children-get-too-much-vitamin-zinc-and-niacin
  28. http://who.int/oral_health/publications/2016_fluoride_oral_health.pdf
  29. http://www.slweb.org/50reasons.html
  30. https://www.cda-adc.ca/jcda/vol-66/issue-11/592.html
  31. http://www.fyidenmark.com/dentalcare.html
  32. https://www.adressit.com/fluori
  33. http://fluoridealert.org/studies/caries01/
  34. http://www.politifact.com/florida/statements/2011/oct/06/critics-water-fluoridation/truth-about-fluoride-doesnt-include-nazi-myth/
  35. https://skepticalvegan.com/2013/03/07/water-fluoridation-a-communist-plot/
  36. Potassium bromide, Chemistry World
  37. Mercola says [http://articles.mercola.com/sites/articles/archive/2014/07/01/water-supply-fluoridation.aspx "Most dental authorities now agree that the predominant benefit of fluoride is topical, not systemic."
  38. Fluoride in Drinking Water: A Scientific Review of EPA's Standards, National Research Council
  39. Community Water Fluoridation and Intelligence: Prospective Study in New Zealand by Jonathan M. Broadbent et al., American Journal of Public Health Volume 105, Issue 1, 2015.
  40. Bashash et. al. (2017). Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6–12 Years of Age in Mexico. Environmental Health Perspectives. Retrieved April 22, 2018.
  41. American Dental Association. (November 27, 2017). Comments on a Study Published in Environmental Health Perspectives Prenatal Fluoride Exposure and Cognitive Outcomes in Children at 4 and 6-12 Years of Age in Mexico.
  42. http://www.imdb.com/title/tt0057012/quotes
  43. https://news.google.com/newspapers?nid=1891&dat=19620321&id=M54fAAAAIBAJ&sjid=qNUEAAAAIBAJ&pg=694,2464316&hl=en
  44. Fluoridation of water, The Skeptic's Dictionary
  45. Fluoride, Teeth, and the Atomic Bomb, fluoridation.com (crank site)
  46. The Tyrant's Physician by Bill Hewitt (October 24, 1994 at 12:00pm EST) People.
  47. http://www.people.com/people/archive/article/0,,20104202,00.html
  48. https://www.google.com/search?q=site:infowars.com+flouride&ie=utf-8&oe=utf-8&gws_rd=cr&ei=RxVSVrmBG4K5swHtmZ_4AQ#q=site:infowars.com+fluoride
  49. http://store.infowars.com/Fluoride-In-The-Tap-Water--Blue-Shirt_p_453.html
  50. http://www.davidicke.com/headlines/tag/fluoride/
  51. http://www.infowars.com/the-fluoride-deception-whats-added-to-your-water-supply/
  52. Ludwik Gross, a Trailblazer in Cancer Research, Dies at 94, The New York Times
  53. "Water fluoridation DEFEATED in Portland"
  54. "Ralph Nader on Water Fluoridation" (Sigh)
  55. "Erin Brockovich on Water Fluoridation"
  56. https://groups.yahoo.com/neo/groups/FluoridePoisoning/conversations/topics/12181
  57. https://www.youtube.com/watch?v=bRUjjyD21OY
  58. Do fluoride levels in cheap tea pose a health risk?, NHS
  59. Concerns over China's teeth, BBC
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