Talk:Water fluoridation

Mistakes in first paragraphs

The NTP did not find that 1.5 ppm fluoride (which denotes concentration in water) was harmful. It found that the individual dose of 1.5 mg/L fluoride is harmful, resulting in lower IQ in offspring.

A concentration "ppm" assumes an equivalent dose of "mg/L" provided the only source of fluoride is limited to 1 liter of 'optimally' fluoridated water per day. Since some of us drink a lot more water than others, and some of us drink black tea or consume other substances containing fluoride, like sardines, the individual doses of pregnant women living in 'optimally' fluoridated communities (like in Canada) frequently exceeded 1.5 mg/L. Eighteen out of 19 high quality studies and the majority of the moderate quality studies had the same finding of lower IQ on a dose-response line for these women-child pairs.

That maternal exposure, in addition to the exposure of bottle-fed babies whose formula is reconstituted with fluoridated water, was crux of the verdict in the Sept 2024 "Findings of Fact and Conclusions of Law" in the lawsuit against the EPA. Judge Edward Chen ruled that since the EPA standards require factors of ten (Uncertainty Factor, i.e. UF) between an adverse effect and exposure (the lowest UF on EPA books is 30), that fluoridation at 0.7 ppm poses an "unreasonable risk" to pregnant women and their off-spring who will experience developmental neurotoxicity resulting in lower IQs. Judge Chen also commented on the BMCL published after the NTP report which identified 0.28 mg/L as harmful when he wrote that no matter what "point of departure" EPA used, 0.7 ppm is a validated hazard to millions of pregnant women and their offspring.

The Judge does not have the authority to tell EPA how to eliminate that risk, but he reminded the EPA that they could not ignore his ruling that fluoridation concentrations poses an "unreasonable risk" under the Toxic Substances Control Act (TSCA) which requires EPA take action to protect the public.

Since the states own fluoridation, the reasonable course for the EPA is to lower their MCLG, MCL and SMCL. The 2006 National Research Council (NASEM/NRC) whose purview was limited to commenting on the existing EPA MCLG assumed to be the threshold of harm told the EPA that its MCLG of 4 ppm was unsafe, that there was evidence of harm to bodies, brains and bones, and no evidence of safety to "susceptible sub-populations" who included pregnant women and bottle-fed babies, even at lower concentrations. The EPA failed to take action even though the WHO uses 1.5 ppm as its threshold for safety.

The 2024 Cochrane Systematic Review found only low quality reports that did not provide any evidence of benefit to adults, and only a fraction of a single cavity benefit to children which has no clinical significance. Percentages often are used instead of absolute values because is seems more impressive, but I believe the one quarter of a single cavity less translates to 4% less. Moreover, Cochrane authors noted that small benefit "may not be real" because of the bias in the reports. Two large UK reviews (2022 CATFISH, 2024 LOTUS) found the same thing.

Dental fluorosis, on the other hand is well documented and affects more than half of American teens per U.S. NHANES reports. Both the 2015 and 2024 Cochrane Reports, like the 2000 York Review, predicts 12% of those with stained teeth will find it "aesthetically" displeasing. Moreover, the incidence of moderate to severe dental fluorosis in the U.S. has increased dramatically. These teeth are brittle and compromised. And they are evidence of fluoride overdose while young. (Neurath et al. 2019, Wiener et al. 2018, Veneri et al. 2024)

I do not have access to edit this protected article. Seabreezes1 (talk) 18:48, 19 November 2024 (UTC)

Someone may have changed the notations in the first paragraph but it is still a misrepresentation of both proper nomenclature and fact. May I suggest:

In 2011, the World Health Organization suggested a water concentration of fluoride no higher than 1.5 ppm (parts per million) to protect population health. In 2024, a systematic review by the Department of Health and Human Services' National Toxicology Program found that individual doses at or above 1.5 mg/L are associated with lower IQ in children, a dose-response trend with no discernible threshold below 1.5 mg/L. The ppm concentration is the equivalent mg/L dose assuming that fluoride in water is the only source of fluoride exposure and that the individual only consumes one liter of that water per day, i.e. 1.5 concentration equals 1.5 dose. However, many consumers consume over two liters of water per day as well as consume foods and pharmaceuticals containing fluoride. Hence, the emphasis on individual dose rather than water concentration.

In September 2024, a U.S. federal court ruling found that "fluoridation of water at 0.7 milligrams per liter (“mg/L”) – the level presently considered “optimal” in the United States – poses an unreasonable risk of reduced IQ in children." Judge Edward Chen further pointed out that EPA's own processes require a 10x "uncertainty factor," aka safety factor, between a hazard and exposure, that the hazard determination has been met by the examination of facts at trial and that the EPA must take action to eliminate that risk per the Toxic Substances Control Act. The current EPA maximum contaminant level (MCL) which requires remedial action is 4 ppm.

An October 2024 Cochrane Systematic Review found that the reduction in cavities in fluoridated communities is waning, i.e. only a fraction of a single cavity in baby teeth which "may not be real" because of the low quality of the efficacy studies. Dental fluorosis, the evidence of fluoride toxicity during early childhood that stains and sometimes pits teeth, is well-documented as increasing. Bottled water typically has unknown fluoride levels in the U.S. Canada, which has a MCL of 1.5 ppm, labels fluoride content on bottled water.

FWW et al. v. EPA et al. (Case e 3:17-cv-02162-JSC) https://www.foodandwaterwatch.org/wp-content/uploads/2024/09/2024.09.24-Opinion.pdf

National Toxicology Program. NTP monograph on the state of the science concerning fluoride exposure and neurodevelopment and cognition: a systematic review. NTP Monogr. 2024 Aug;(8):NTP-MGRAPH-8. https://pubmed.ncbi.nlm.nih.gov/39362658/

Iheozor-Ejiofor Z, Walsh T, Lewis SR, et al. Water fluoridation for the prevention of dental caries. Cochrane Database Syst Rev. 2024 Oct 4;10(10):CD010856. https://pubmed.ncbi.nlm.nih.gov/39362658/

Seabreezes1 (talk) Seabreezes1 (talk) 14:55, 29 November 2024 (UTC)

ANOTHER MISTAKE The comment from the ADA about fluoridation in Europe (an archived article) is both disingenuous and wrong. Europe has the better part of a billion people. Yes, the Republic of Ireland mandates fluoridation, and there are small pockets of fluoridation in England and Spain. Fluoridated Salt is an option in a few countries which I understand is mostly used in institutional settings like prisons. Fluoridated school milk programs were in a couple of former Soviet Block countries. The sum is still 5% or less of the 742 million Europeans consume fluoride. Yet cavity rates declined in non-fluoridated European countries apace with fluoridated English speaking countries proving that fluoridation was coincidental, not causal. Better water infrastructure, diet and dental care were the causal elements in all countries. Seabreezes1 (talk) 20:01, 19 November 2024 (UTC)

Semi-protected edit request on 12 April 2024

There is a simple grammatical error in the following sentence:

"Although fluoridation can cause dental fluorosis, which can alter the appearance of developing teeth or enamel fluorosis;[3] the differences are mild and usually not an aesthetic or public health concern."

In the sentence above, the semi-colon after "fluorosis" should be replaced with a comma. 2600:1700:110:DB0:C19C:115E:42DB:B03D (talk) 14:41, 12 April 2024 (UTC)

 Done Jamedeus (talk) 16:57, 12 April 2024 (UTC)

Contradictory information in the article?

Maybe I'm reading it wrongly, but the sentence at the beggining of the article "In 2024, the Department of Health and Human Services' National Toxicology Program found that water fluoridation levels above 1.5 mg/L are associated with lower IQ in children." seems to be in direct contradiction to a later sentence in the next paragraph, which states "There is no clear evidence of other side effects from water fluoridation." Maybe this needs a correction or some sort of rephrasing? 2001:818:E94C:D00:38B7:BE7D:D8D2:776D (talk) 02:00, 3 November 2024 (UTC)

Yeah I think the intro is messed up and could do with a refresh. It has the "in 2024..." claim preceding the definitive "There is no clear evidence...". I think the definitive sentence is implying that the "in 2024..." claim is not clear evidence. I am not surprised we are confused. Hopefully someone will see your post and fix the lead. Commander Keane (talk) 02:14, 3 November 2024 (UTC)

Unless it means that the side effect of lower IQ is correct, but there are no is no clear evidence of other side effects. Commander Keane (talk) 02:17, 3 November 2024 (UTC)

Plagiarism

"In most drinking waters, over 95% of total fluoride is the F− ion, with the magnesium–fluoride complex (MgF+ ) being the next most common." and additional text lifted verbatim from https://www.researchtrend.net/ijtas/ijtas_2013/4%20GEETA%20ATERIA.pdf Physicsjock (talk) 21:02, 6 November 2024 (UTC)

@Physicsjock interesting, thanks for bringing it up. Using wikiblame (if these external tools ask for login and you are logged in to Wikipedia you just have to click a button) it seems some of the material was added by @Eubulides in 2009, referenced to another paper from 2009 (Ozsvath). The paper you point out is 2013. The 2013 paper doesn't cite Ozsvath, I couldn't work out where that exact passage in the 2013 paper is referenced to. Ozsvath is paywalled so I couldn't read it.

I haven't checked into any other plagiarism issues with the 2009 edit. I have only looked at the passage you quoted, the copyvio detector may help with the rest, although I do struggle to interpret its output. Commander Keane (talk) 23:53, 6 November 2024 (UTC)

I said the offending paper was from 2013 but it is actually from 2015. It doesn't change my point. Commander Keane (talk) 00:07, 7 November 2024 (UTC)

@Commander Keane I see, you're saying the 2015 paper plagiarized Wikipedia. Possibly this Plagiarism section can be removed, from this Talk page, although it was unclear to me what the reference was supposed to be for that sentence, so I'll add a citation needed tag.Physicsjock (talk) 04:24, 9 November 2024 (UTC)

@Physicsjock to me it was clear that the passage is attributed to the next inline citation. Like I said I can't access that citation to double check. I tried adding a reason to the [citation needed] but I don't think it shows up anywhere. I do fear that someone will see the [citation needed] and either remove the passage or cite the 2015 paper.

As a side note, this talk page section will just sit here until an archive bot comes along. Commander Keane (talk) 05:24, 9 November 2024 (UTC)

Paper claiming that most fluoridation (using non-USP additives) adds arsenic and may cause lead to leach into the water

Seems important to add to the Implementation section and/or Controversy section. The paper seems well researched. https://www.sciencedirect.com/science/article/abs/pii/S1462901113000087 Physicsjock (talk) 04:35, 9 November 2024 (UTC)

Not necessarily, this topic is not as easy as you state it: PMID 27105409 . --Julius Senegal (talk) 15:30, 9 November 2024 (UTC)

The level found in the paper you cite (0.078 ppb) is exactly the value used in case 1 of the paper I cited (Table 1). Seems like a small increase but based on current understanding the increase in cancer costs is huge compared to the cost of switching to USP NaF for fluoridation. Physicsjock (talk) 17:49, 11 November 2024 (UTC)