Thursday, October 9, 2014

Fluoridation, or: How I Learned to Stop Worrying and Love the Water

General Jack D. Ripper with Captain Lionel Mandrake.
Most of us have heard the famous line by General Jack D. Ripper in Dr. Strangelove, "have you ever seen a Commie drink a glass of water?" The conversation thereafter satirically illustrated a fear that grew most prominent starting in the 1940s with the Second Red Scare -- public water fluoridation. Many conspiracy theories about water fluoridation arose during this time, but they all aimed to make the same case: that fluoride in drinking water is bad (sometimes just meaning unethical), and unhealthy, for various reasons that are being neglected by the government.

In a study published in JAMA by Oliver & Wood (2014) entitled "Medical Conspiracy Theories and Health Behaviors in the United States," it was found 49% of Americans believe in at least one of 6 medical conspiracy theories, including but not limited to concerns about "Agenda 21," the vaccine-autism link, and water fluoridation. For the latter, it was found that 12% of Americans believe that "public water fluoridation is really just a secret way for chemical companies to dump the dangerous byproducts of phosphate mines into the environment." This is just one of the many explanations for water fluoridation that conspiracy theorists provide, so the variation in the "theory" aspect of it is similar to that of "chemtrails;" but unlike the chemtrail conspiracy theories which are fairly recent (starting around the 1990s), water fluoridation has invoked fear from the public for quite some time, and remains a pervasive element of the disconnect between the scientific community relating to public health and the public itself. Nick has informed me already of two scenarios this semester where his classmates have promoted the concept. So with all the concern it raises, is the fear of public water fluoridation a legitimate concern?

Of course, it's unfair to group the concerns mentioned above with the Red Scare sentiments expressed in Dr. Strangelove, but the resentment against water fluoridation still fails to be substantive. The arguments of ethics not withstanding, water fluoridation is (if at all) not anywhere near as medically harmful as 12% of the American population believes it is. Here, we're going to examine some common arguments made by proponents of this conspiracy theory and refute them. Let's get started.

Fluoride is the only chemical added to water for the purpose of medical treatment.

It depends on how you define "medical treatment." One could argue that many processes conducted during water purification, such as disinfection to kill parasites and bacteria, can be considered medical treatment (specifically preventative treatment), but either way, this is actually a red herring. Whether or not it's the only chemical added to water is immaterial, because it doesn't lend any credibility to one side or the other; however, we can examine why it was added as "medical treatment," and start to make an informed decision.

Water fluoridation in the United States began in 1945 because a wave of dental hygienists began promoting the widespread distribution of fluoride to promote dental hygiene in the United States for individuals of all ages and income levels. It was meant to be a cost-effective, efficient way to distribute this treatment throughout the United States, and so it was. Approximately $40 billion have been saved in reduced oral health care expenditures in the United States over the past 40 years due to public water fluoridation.

To celebrate the coming of a new century, in 1999, the CDC released a statement about the top ten greatest public health achievements in America from 1900 - 1999. In this list, water fluoridation was listed. The report estimates that in 1999, fluoridated drinking water reached approximately 144 million people in the United States, effectively serving its purpose. The report also refers to the 1999 edition of a book by Burt and Eklund entitled Dentistry, Dental Practice, And the Community. In Chapter 25 of the book, the causes, effects and cost of water fluoridation in the United States are discussed. It estimates that there has been approximately a 40-70% decrease in child tooth decay and approximately a 40-60% decrease in adult tooth loss.

So not only were the intentions clear, but the results were evidential, and the effort was a success. The addition of fluoride to drinking water (in the United States anyway) was a medical treatment, but it was a justified one.

Dental health products, such as toothpaste and mouth wash, which contain fluoride, tell you not to swallow them.

This is due to the very high concentration of fluoride in them, which they acknowledge can make you sick. The fluoride in toothpaste and mouth wash, also, is meant for prolonged exposure to the teeth, for optimal usage.

The dose cannot be controlled.

This argument relies on two premises: (1) that without control, there is a risk for people to harm themselves from fluoridated water; and, (2) that a lack of individual dosage control is an argument against water fluoridation. For premise one, the toxic level of fluoride is around 5-10 grams for a typical 150 pound or 70 kilogram adult, using estimates provided in Clinical Toxicology of Commercial Products, a book produced by Gosselin, Smith and Hodge in 1984. The recommended number of glasses of water to drink is 8, so if there is 1 part fluoride for every million parts water, in 8 glasses of water, there is about 0.002 grams of fluoride -- this is about 1 tenth of a grain of sand. So, the toxic amount of fluoride (5-10 grams for a 70 kilogram adult) is 2500-5000 times greater than what is found in 8 glasses of water (0.002 grams of fluoride). That means that, with the strictest estimates, if all fluoride content received in water were to be retained in the body (it's not), it would take almost 7 years to reach the toxic level.

It should be noted, then, that 1 ppm was the optimal fluoridation amount at the beginning of the project, but is now around 0.7 ppm, and thus the amount of fluoride an individual receives is about 30% less than what we estimated above. The point being, however, is that the current levels of fluoride in drinking water are not enough to be of concern to people who drink a lot of it.

But going beyond premise one and onto premise two, the argument is again irrelevant. There are many chemicals introduced to public drinking water that, if ingested in excessive quantities, could pose health risks. This doesn't mean, however, that these chemicals should automatically be taken out, because this is the case for many different things we ingest, like tuna, apples or coffee. The issue is not in whether or not they could threaten their health by drinking too much, it's a question of if they will. This requires individual responsibility to an extent; however, given what we know from the content above, we can say that there isn't too much reason to start tallying your water intake and calculating the amount of fluoride you consumed therein.

The fluoride goes to everyone regardless of age, health or vulnerability.

This part of the article talks about the progression in pharmacotherapy from stereotyped medication to individualized therapy. What the quote cited failed to note is that individualized therapy is applied when there is reason to believe that patients can be divided into medically relevant subgroups that respond differently to specific treatment, and thus they need to examine an individual's characteristics (gender, age, ancestry, etc.) to make a determination of what treatment to use. What he also failed to mention is that, aside from individualized treatment, there is also evidence-based medicine (EBM), which essentially means the treatment of individuals based on the current best evidence available. Considering that water fluoridation only began after it was found in Grand Falls, Michigan that fluoride levels of 1.0 ppm in the water were optimal for preventing tooth decay, water fluoridation would be considered a public health initiative based in EBM.

Fluoride is used as a chemical in rat poison.

This is like arguing that because chlorine is used to chemically decontaminate pool water (but is toxic), and chlorine is also used in common table salt (a.k.a. sodium chloride), then chlorination of table salt should end. Chemicals used in one way do not have the same effects as chemicals used in another way.

No health agency in fluoridated countries is monitoring fluoride exposure or side effects.

Water fluoridation, in the United States, is monitored at the state level, and not by federal agencies. This should be considered a good thing, because different states have different cities and different states have different levels of naturally occurring fluoride in the water -- if this amount is too much, some is actually removed from the water supply. Aside from this, the claim that no health agency in any fluoridated countries monitors this is just unfounded. For example, here's England's 2014 report on fluoridation.

At this point, we should be able to acknowledge that water fluoridation is not a particularly harmful practice. I'm not denying here that there are some arguments to be made against water fluoridation as a governmental practice, but we can see that as a medical effort, it's not bad. For further information, I recommend reading the World Health Organization (WHO) report on water fluoridation across the world.

Thank you all very much for reading.

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Oliver, J., & Wood, T. (2014). Medical Conspiracy Theories and Health Behaviors in the United States. JAMA Internal Medicine, 174 (5) DOI: 10.1001/jamainternmed.2014.190


  1. Hilarious movie, hilarious conspiracy, but 12%? Really? I fear for America if that many people believe in something so easily disproved.

    1. Nick, if the antifluoridationist hyenas get wind of this article and begin littering this comment section with their idiocy, you'll get a real dose of what they believe. It gets truly comical.

      Steven D. Slott, DDS

    2. Thanks for your comments, Nick and Dr. Slott. It's unfortunate that so many people are so easily persuaded, but that's why we and many others produce articles like this -- if the information is readily available for everyone, and people continue to believe in the conspiracies, then it's no one's fault but their own.

      Dr. Slott, I believe I've seen you on forums debating the anti-fluoridation crowd. They can definitely be a nuisance; however if they decide to come to our blog, I have comments in moderation, and certain guidelines they have to abide by. Nothing that isn't worth publishing will see the light of day here.

  2. Excellent article, Alexis.

    I tend to get cynical and sarcastic from time to time with these folks, but having spent the overwhelming majority of my 32 year dental career providing free and low cost dental care for the underservesd population, railing publicly and privately against my state and national dental leadership over what I believe to have been inadequate attention to the access to dental care crisis in this country, I get seriously fed up with the self-absorbed whining of antifluoridationists over their "freedom of choice", "forced medication" nonsense, and fabricated "association" of fluoridated water with every conceivable disorder known to man. It's nothing more than the pursuance of the same ultraconservative ideology that these groups have been seeking to impose on society since the John Birch Society at the beginning of this initiative 7 decades ago. They use the same arguments, repackaged for each new generation, and then purport them to be "new emerging science". It is truly disgusting.

    I do spend a significant amount of time correcting the mess that these folks spew all over the internet, but it is but one aspect of my eforts on behalf of the underserved, certainly not some job for which I am paid by the aluminum industry or whatever other ridiculous nonsense of which I am constantly alleged to be doing.

    They truly are comical. We just need more like you, who can provide rational perspective to this issue.

    Steven D. Slott, DDS.

    1. What's funny about it is that, assuming the majority of these people are ultraconservatives, they're terribly missing the point. They want government regulation -- in the stead of state level regulation -- to monitor these programs, and they also want to eliminate personal responsibility in drinking chemically-treated public water. It's as if their opposition to expanding government power suddenly disappeared!

      There are times that I wish I were paid for this stuff. The best Nick and I can get is Adsense.

      Thanks for your praise, and good luck!

    2. When you think about it, the core of the fluoridation program can be considered very conservative. Individuals are receiving public access to water which can help prevent dental caries, but it's on them to retrieve it, and it's on them to monitor their dosage. You also have to pay for your own individual "treatment," because it would be covered under your personal water utility bill as opposed to your taxes.

      In many ways, it's the same conservative core that people miss when they talk about Obamacare.

  3. One word describes them, Alexis.......hypocrites. Well, maybe two words......blatant hypocrites.


  4. I was looking this up alot awhile ago about flourides affects on the body. There has not been one clinical trial by any neutral organization who would not benefit from false results that flouride benefits oral health at all or health in any capacity. I have seen a couple studies that show flouride is bad for health. It is not just flouride in the water but other things too that really all add up to the level of unhealthiness that public drinking water has. I looked up many ways to purify water of contaminants and there is only really 3 ways to make sure you are drinking clean healthy water.

    Distilling water(This is dangerous to drink in high amounts because good nutrients along with the bad stuff is snuffed out of the water and its ph level is basically 0 and so the water when drunk pulls nutrients like calcium and other things out your body so distilling is not the best option.
    Reverse Osmosis (Best way to do it) and 3rd is Carbon Filtration system( 2nd best option depending on what brand of filtration system you buy. I have A Berkey Filter.

    I am recovering from being super sick since 2008 and am slowly making changes to my life style to improve my health for the last 6 years. when I first used the berkey system after 6 days of use I could tell the difference. My bones and joints did not hurt as much when exercising and the clarity of my thining had much improved along with my mood and energy. Also when I boil water to make my green and black tea every morning I noticed the water was clearer after it cooled down after the boil and my tea tasted better aswell as just drinking the filtered water.

    There is much disinformation out here to make people believe lies but if you look hard enough you can usually find the truth. It is never good to think on these things with preconcieve thoughts or a closed mind which will keep you from learning if you are wrong in your thinking or not. I am my own living proof of many things that are hazardous along with other people I have helped change there life style. I dont really care for all the conspiracy theories although I'm sure some are true but in this matter I am looking at it as a cause and effect on health way.

    It's not just flouride though that is in the water that makes it unhealthy. Also its not just water that contributes to bad health. There are alot of things in people's life style (Especially American's) that all contribute to bad health. These things are slow killing poisons that dont kill immediately which is why alot of people dont notice or care about things like this.

    P.S. I went to a Con last friday and they had Zelda flutes and were playing zelda songs. It was awesome.

    1. Thank you for your comment, Dack!

      The reason there haven't been any randomized clinical trials of water fluoridation is because fluoride is considered a mineral, not a chemical or medicine. Because of this, many other study methodologies are possible to show its efficacy, and such studies have been conducted, as said in the post. Tap water is pretty much safe to drink (with the exception of when it's contaminated, especially well water) in the recommended amounts, or less.

      I'm not entirely convinced that using filtered water is incredibly beneficial to humans, but if you have seen beneficial results from using it, then I'm happy for you. But just keep in mind that tea leaves contain pretty high levels of fluoride -- high enough to actually cause fluorosis if you drink too much, depending on the tea (one student found that drinking 1 liter of economy tea in Britain per day would lead you to consume 4 mg of fluoride, which is the highest marker for how much you can drink before having adverse health effects).

      I'm absolutely sure that there are many things that are contributing to bad health in the general public, Americans alike, but I'm not convinced that fluoride is one of them based on the evidence.

    2. Yea Im aware of tea leaves containing high levels of flouride but that is only if the plants are water with flouridated water which is the case with non-organic tea. The organic teas generally arent watered with flouridated water although it is best to research the brand of tea and the owning company before you decide to buy it. All the products I drink and eat are organic.

      The fact that you can get flourosis and other problems from intaking alot of flouride is proof enoough that its not healthy. Although I dont think it is really dangerous by itself. there is alot of other crap in the water in the US especially West Virginia (I live in DC). When I used to drink a half a gallon of water filtered through a brita filter that doesnt remove flouride, arsenic and a few other heavy metals it used to give me a intoxicated debilitating retarde derp feeling. My cognitive abilities greatly suffered and my bones would kinda randomly fracture (one time really bad) when I used to do my toughness training of punching, kneeing, elbowing, headbutting wooding boards so I had to stop for a while but as soon as I got the filter and went back to doing my toughness training I no longer had that problem. Not only that but the tap vs my filtered water is extremely distinct in taste.

      I also did a test with my moms cat (balinese burmese mix) and dog (yorkshire terrier) and put bowls with both kinds of water down for them for a whole week and after the first day the stopped drinking the unfiltered water and only drank the filtered water so Im sure the water is not good for health but Im also not saying its only because of the flouride.

      From my experience I would have to say flouride is bad for health but if its the only negative thing you intake in your body it still wouldnt not probably cause you to become I'll unless you just have a really weak immune system. If you ever try drinking filtered water to see how it affects you dont use cheap filters like brita they are pretty much no good really. Once you make drinking clean water like that a habbit you will probably notice a difference, especially in your skin (I get almost no pimples and black heads now). is where I got my filter get Reverse Osmosis If you got the money for it, they are most expensive filtration system

    3. I'm always in favor of organic as opposed to inorganic. People argue with me until the end that there aren't any real differences in nutritional benefit but, for example, which just tastes better: organic, grass-fed, no-hormone/steroid beef or the slimy stuff you get at the deli meat counter?

      There's a true-to-its-word saying that has been passed around in toxicology, first stated by Paracelsus: "the dose makes the poison." All things are bad for you, even oxygen or water, if you have enough of it; it's about moderation, though, and personal responsibility. Being able to get fluorosis from consuming too much fluoride isn't evidence that fluoride itself is bad, just that too much of it is bad. As I said, if anecdotally you can attest that removing minerals from your tap water has benefited you, then I'm not going to say you're wrong; I'll just say there are probably other less general explanations than "the minerals in the water are unhealthy."

      I can, however, easily explain the situation with your cat and dog: the same thing happened to my cat when I swapped foods on he for about a week because the distributor for the pet store didn't restock their shelves with her brand. I had to change brands to make sure she didn't starve, but when I tried putting her back on the old stuff, she refused to take it.

      I've yet to see any rigorous study conducted to find if there are any significant benefits to drinking filtered water versus tap water, but I'll be looking now. Thank you for your input Dack; always a pleasure!

    4. P.S. In the mean time, while I'm looking for studies, I would also look into why Big Berkey is so expensive versus other filters and exactly what they do to raise that price. The company is a strong advocate against water fluoridation, and likely make a lot of money off of the people who they convince/market to. They use a lot of the false claims that were refuted in my post, which mostly come from places like Fluoride Action Network. If dose makes the "poison," money makes the "cure."


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