In Calgary, a city of about 1.8 million people in Alberta, the City Council voted to remove fluoride from its drinking water in 2011, two decades after it was introduced in 1991. The water treatment infrastructure to process the fluoride was at the end of its life cycle and councilors did not believe that the cost to replace it outweighed the existing science around the health value.
...
The effects before and after fluoridation were most apparent in children, researchers in Calgary found.
The Alberta Children’s Hospital saw a stark increase in the number of children from Calgary who needed antibiotics to treat dental infections after fluoride was removed from the drinking water.
A study in 2021 from the University of Calgary compared the dental health of about 2,600 children with a similar group in Alberta’s capital, Edmonton, where the water remained fluoridated. In the Calgary group, about 65 percent of the children developed one or more cavities, while in Edmonton, that number was about 55 percent.
The research, led by Lindsay McLaren, a professor of community health sciences at the university, mirrored findings in studies she conducted about three years after fluoride was removed from Calgary’s water.
...
The fluoridation was supposed to begin in 2023, but was delayed several times pending upgrades to two water treatment plants, which cost about 28 million Canadian dollars, or $20 million.
Isn't it so great that a chemical exists that can be added in small amounts to water to have such a positive effect on dental health? This has to be the cheapest public health measure per capita...
Isn't it so great that a chemical exists that can be added in small amounts to water to have such a positive effect on dental health? This has to be the cheapest public health measure per capita in human history. Thanks fluorine, you don't deserve the flak you get.
Maybe iodine in salt is a challenger? "Crétin des Alpes" (cretins from the alps) is now just a creative way to insult someone instead of a genuine condition.
Maybe iodine in salt is a challenger? "Crétin des Alpes" (cretins from the alps) is now just a creative way to insult someone instead of a genuine condition.
That would go to something like mandating surgeons wash their hands between surgeries. Or building your sewage outflow pipes downstream of your drinking water intake pipe.
This has to be the cheapest public health measure per capita in human history.
That would go to something like mandating surgeons wash their hands between surgeries. Or building your sewage outflow pipes downstream of your drinking water intake pipe.
I would put forward folic acid added to flour to prevent neural tube defect: Emphasis added. That's a LOT of babies having normal spine development from just adding a bit to flour
I would put forward folic acid added to flour to prevent neural tube defect:
After the discovery of the link between insufficient folic acid and neural tube defects, governments and health organizations worldwide made recommendations concerning folic acid supplementation for women intending to become pregnant. Because the neural tube closes in the first four weeks of gestation, often before many women even know they are pregnant, many countries in time decided to implement mandatory food fortification programs. A meta-analysis of global birth prevalence of spina bifida showed that when mandatory fortification was compared to countries with voluntary fortification or no fortification program, there was a 30% reduction in live births with spina bifida,[33] with some countries reporting a greater than 50% reduction.[34] (wikipedia)
Emphasis added. That's a LOT of babies having normal spine development from just adding a bit to flour
You can comfortably survive without fluoridated water if you just brush and floss and use fluoridated toothpaste. I grew up in a country that stopped adding fluoride just before I was born and I...
This has to be the cheapest public health measure per capita in human history.
You can comfortably survive without fluoridated water if you just brush and floss and use fluoridated toothpaste. I grew up in a country that stopped adding fluoride just before I was born and I don't think our oral health suffers. So I'm somewhat hesitant calling it that, but now I wonder what other low cost and high scale interventions there were, historically. Iodine mentioned below is probably one with potentially fewer people affected but more severely, and maybe using salt that's partly KCl instead of standard table salt has a similar potential in improving cardiovascular health and reducing mortality at a similarly low price, but it hasn't been promoted at scale anywhere afaik.
My guess is that fluoride is one of those interventions that does the most good for the worse-off. Same with iodine, really -- the people brushing their teeth and the people eating a varied diet...
My guess is that fluoride is one of those interventions that does the most good for the worse-off. Same with iodine, really -- the people brushing their teeth and the people eating a varied diet are always fine, it's the poor that benefit. (Which is great, obviously).
To restate what @R3qn65 said, ti make this claim there must be a nuanced comparison. In addition to overall numbers, comparison of the bottom third of various socio-economic-healty strata. And...
stopped adding fluoride just before I was born and I don't think our oral health suffers.
To restate what @R3qn65 said, ti make this claim there must be a nuanced comparison. In addition to overall numbers, comparison of the bottom third of various socio-economic-healty strata.
And even if one is a callous conservative, poor health outcomes for a significant percentage of population creates costs for everyone.
It would be nice to have more info about what studies have shown. I expect there will be a lot of variation for people within a region, so averages are likely to be misleading. The moderately...
It would be nice to have more info about what studies have shown. I expect there will be a lot of variation for people within a region, so averages are likely to be misleading. The moderately beneficial results from the Calgary studies likely include people for whom there's no effect , either because their children do brush regularly with fluoride or because they naturally don't get cavities, while for others it will have a much greater effect if they're particularly susceptible to cavities.
Also, since it depends on culture (specifically, the prevalence of brushing with fluoride and similar habits, along with diet) and culture varies, the results of studies might be different between different regions?
Yes that was kind of my point. Parent’s community, perhaps even country, likely have good oral hygiene and regular dental care. One cannot extrapolate from that the benefits of drinking water...
Yes that was kind of my point. Parent’s community, perhaps even country, likely have good oral hygiene and regular dental care. One cannot extrapolate from that the benefits of drinking water fluoridation generally.
Edit: I bet there’s some pretty solid before and after data around the time fluoridation began.
I’ll also add, there’s this phenomenon where a public health measure achieves really great results, and everyone forgets about the original problem it solved and start to zero in on the relatively limited side effects. After which, they start clamoring to remove the measure. see also vaccination.
Sure. I'm not claiming adding fluoride is necessarily wrong, I'm claiming it may not be the cheapest public health measure per capita in human history - there are large populations for whom it...
And even if one is a callous conservative, poor health outcomes for a significant percentage of population creates costs for everyone.
Sure. I'm not claiming adding fluoride is necessarily wrong, I'm claiming it may not be the cheapest public health measure per capita in human history - there are large populations for whom it doesn't bring much value.
Side note, but I never understood why leftists don't use your reasoning when pushing for policies, because this is true for almost everything targeting the poor or otherwise disenfranchised people. I assume there has to be a reason why it's not done other than "it's cynical and leftists are too empathetic", which is what a very left acquaintance told me - almost all of political marketing is cynical, especially in the US, this should not be a problem - but I haven't found it yet.
Curious if there's any DIY solution to add flouride and other minerals back into water. Even if it's for a single tap. My current place only uses ground water and while the RO has it pretty pure,...
Curious if there's any DIY solution to add flouride and other minerals back into water. Even if it's for a single tap. My current place only uses ground water and while the RO has it pretty pure, I've noticed a bit more gut issues and tooth decay over the last 2 years. Most of the mineral injection cartridges seem to market themselves on the fact that they don't specifically have flouride and the only trusted one that I found is bundled in systems way too big for what we need.
Beside
I’ve had well water nearly my whole life - fluoridated toothpaste is probably the most cost effective answer. I’ve always just used the OTC ones and never had a cavity, but you can get Rx versions...
I’ve had well water nearly my whole life - fluoridated toothpaste is probably the most cost effective answer. I’ve always just used the OTC ones and never had a cavity, but you can get Rx versions that are a bit stronger from your dentist.
Worth mentioning that being on well water doesn’t mean you aren’t getting fluoride. Groundwater fluoride content varies widely. Some groundwater has so much natural fluoride that it causes fluorosis.
Worth mentioning that being on well water doesn’t mean you aren’t getting fluoride. Groundwater fluoride content varies widely. Some groundwater has so much natural fluoride that it causes fluorosis.
This is true, and if you’re on well water you should be getting it tested when moving in, and probably periodically after that. Not just for this, but to understand the water quality in general...
This is true, and if you’re on well water you should be getting it tested when moving in, and probably periodically after that.
Not just for this, but to understand the water quality in general and ensure you’re treating it appropriately.
Looking at the other posts here, seems like my big confusion comes from one-time topical applications vs. ingesting it. Think I got some info years back that explained it as ingested fluoride...
Looking at the other posts here, seems like my big confusion comes from one-time topical applications vs. ingesting it. Think I got some info years back that explained it as ingested fluoride being present in saliva/blood and that keeps teeth protected. Will probably go check in with a dentist for a stronger toothpaste solution since store stuff has not been as effective lately.
Your PCP may also be able/willing to prescribe it, if that’s easier for you. Worth calling and asking, anyway. Also, if you have kids - we had Rx multivitamins with fluoride as kids, which might...
Your PCP may also be able/willing to prescribe it, if that’s easier for you. Worth calling and asking, anyway.
Also, if you have kids - we had Rx multivitamins with fluoride as kids, which might be worth asking their pediatrician about.
It would be great if you could find out where you learned that ingestion is important. It's news to me, and seems a bit dubious given that fluoride toothpaste, etc, are common. Why do all these...
It would be great if you could find out where you learned that ingestion is important. It's news to me, and seems a bit dubious given that fluoride toothpaste, etc, are common. Why do all these remedies involve not swallowing fluoride if it's important to ingest it?
I think the general consensus is that systemic (ingested) fluoride is most beneficial for children whose teeth are growing, while topical fluoride is all you can do for fully erupted teeth. One...
I think the general consensus is that systemic (ingested) fluoride is most beneficial for children whose teeth are growing, while topical fluoride is all you can do for fully erupted teeth.
One line of evidence that seems compelling is that ingested fluoride can cause fluorosis, while topical fluoride does not, which clearly indicates that systemic fluoride has a strong effect on tooth development.
It’s a pretty strong argument for water system level supplementation as well since the vast majority of people won’t be feeding their babies fluoridated toothpaste before they have visible teeth.
I grew up in a house with a well, so I was thinking I didn't have fluorinated water growing up, but on second thought, I probably got some from drinking water at school. Also, I wonder which...
I grew up in a house with a well, so I was thinking I didn't have fluorinated water growing up, but on second thought, I probably got some from drinking water at school. Also, I wonder which beverages might be made with fluorinated water?
It seems like it might be most important when a child's adult teeth are growing, which is a pretty specific age range? And it would be reasonable to think that pediatricians and dentists could educate parents so they take steps if their kids aren't drinking fluorinated water (another way of promoting public health) but the studies apparently show that if they're doing that, it's not that effective.
As I mentioned in another comment, well water is sometimes naturally fluoridated. In fact, that's how we actually know about the effects of fluoride in the water -- a scientist in Colorado Springs...
I grew up in a house with a well
As I mentioned in another comment, well water is sometimes naturally fluoridated. In fact, that's how we actually know about the effects of fluoride in the water -- a scientist in Colorado Springs noticed that the native population not only had weird discolouration on their teeth (the result of fluorosis from very high natural fluoride content in their local water supply), but also had virtually no cavities.
Yep. I'm doubtful that upstate New York is one of those places, though? Natural fluoridation seems to be high in Texas and the western US more generally. It's surprising that there don't seem to...
Yep. I'm doubtful that upstate New York is one of those places, though? Natural fluoridation seems to be high in Texas and the western US more generally.
It's surprising that there don't seem to be any maps showing fluoride levels in groundwater in the US. I did find a dataset of well water readings and made a half-hearted attempt to get ChatGPT and Claude to plot it on a map, but they didn't get very far. Perhaps someone else wants to try? It seems like a nice problem to see if your AI-prompting skills are any good. (Or you could do it yourself, of course.)
I did find this, which indicates that Monroe county in New York has naturally occurring levels of fluoride that are about 20-30% of the target of 0.7 mg/L....
I did find this, which indicates that Monroe county in New York has naturally occurring levels of fluoride that are about 20-30% of the target of 0.7 mg/L.
Presently, nearly 76% of U.S. residents who receive water from a public water system receive fluoridated water. That includes 45 of the largest 50 cities in the country. Within our service areas the level of fluoride in the water is adjusted to an optimal concentration of 0.7 mg/L. Water samples are collected daily too so that fluoride levels in the water we deliver to you remain within the optimal range.
Fluoride is an inorganic anion of Fluorine (F) – the 9th element listed on the Periodic Table of Elements. Fluorine is estimated to be the 13th-most abundant element in the Earth’s crust. Fluoride is naturally present in saltwater, groundwater, and fresh water sources. Concentrations in surface water sources can vary generally between 0.01 to 0.3 mg/L. Groundwater concentrations can vary even more ranging from 0.05 to 8 mg/L or even higher. Naturally occurring fluoride concentrations are a function of the erosion of mineral deposits and the presence of fluoride-containing minerals. Generally, the source waters for our water treatment plants have naturally occurring fluoride levels in the range of 0.15 – 0.2 mg/L.
Went through the YouTube channels and blogs I follow to trace it back to a source and not much luck. Closest ideas I could dig up mostly references back to a 1999 study, Prevention and reversal of...
Fluoride in drinking water and in fluoride‐containing products reduces tooth decay via these mechanisms. Low but slightly elevated levels of fluoride in saliva and plaque provided from these sources help prevent and reverse caries by inhibiting demineralization and enhancing remineralization.
But it looks like common consensus is that topical applications are more effective as the remineralization process is:
When fluoride is present, it scavenges excess phosphate and calcium in the saliva for partial tooth remineralization, as well as displaces the hydroxyl group in remaining enamel.
This also sent me down the wonderful rabbit hole that is the development of tooth repair technology.
Considering that you need very precise levels of fluoride and too much is more harmful than none, that sounds like a bad idea. Consider other solutions like salt with added fluoride plus perhaps a...
Considering that you need very precise levels of fluoride and too much is more harmful than none, that sounds like a bad idea. Consider other solutions like salt with added fluoride plus perhaps a more fluoridated toothpaste.
One of my quirks is that I can't let things just be a coincidence. Helps in professional settings. Not so great everywhere else. Drinking water is a theory because it's probably the biggest...
One of my quirks is that I can't let things just be a coincidence. Helps in professional settings. Not so great everywhere else. Drinking water is a theory because it's probably the biggest meaningful change that could affect things. Moved less than a 3km from where I was and can't think of other major lifestyle changes.
My main consideration is that it's the hereditary gastro issues catching up to me late and causing the tooth decay. Acid reflux and can cause some acid to flow into the mouth and cause decay.
The insane conspiracy theory is that my dentist is sabotaging me in to getting implants before he retires. I'm the last family member with all my teeth and I'll be damned if the old man takes more of my money.
Almost any illness can affect the gut microbiome and start issues if you were already predisposed to that. From the ones commonly floating around covid is the worst I think, outside of gastric...
Drinking water is a theory because it's probably the biggest meaningful change that could affect things.
Almost any illness can affect the gut microbiome and start issues if you were already predisposed to that. From the ones commonly floating around covid is the worst I think, outside of gastric infections with severe diarrhea etc. which you would know about. Generally the change in the microbiome seems to be proportional to how severe the illness is, but iirc covid does cause changes even when it's asymptomatic.
My main consideration is that it's the hereditary gastro issues catching up to me late and causing the tooth decay. Acid reflux and can cause some acid to flow into the mouth and cause decay.
If it is a gut microbiome issue, then gut microbiome is generally connected to the oral microbiome and when one gets worse, the other does too, though I don't think we know specifically by how much worse and in what ways specifically. And oral microbiome affects tooth decay, so here's another theory. If you like to experiment you can try looking up probiotic lozenges or chewables that are supposed to reduce the population of streptococcus mutans and improve oral health, no idea what's available around where you live but I know BioGaia makes one specifically for that.
I'd be curious to see the specific research on stuff like this. I was taught that surface application of fluoride, at least of the widely available concentrations not applied by dentists, has very...
I'd be curious to see the specific research on stuff like this. I was taught that surface application of fluoride, at least of the widely available concentrations not applied by dentists, has very little effect. This is because teeth aren't so easy to penetrate that just putting stuff on them really gets anything inside.
This is connected to that people misunderstand the purpose of putting fluoride in water. They think it's so that the fluoride often runs over their teeth and swallowing it is incidental, but the actual goal is to get the low concentrations into your blood so it can work from the inside. I think this idea that people are being made to drink something that is meant to go on teeth is where some of the conspiracy comes from because they think of it like being made to drink mouthwash.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3525928/ https://en.m.wikipedia.org/wiki/Decay-missing-filled_index Admittedly this is a 0.2% fluoride rinse used weekly as opposed to the 0.02% used daily...
Following the use of 0.2% sodium fluoride mouthwash, mean DMFT index in case group decreased as much as 51.5% compared to that of control group. The mean values of decrease for the decayed, missing and filled indices were 45%, 44% and 59%, respectively. The decrease in DMFT value of the case group compared to that of control group was statistically significant (p<0.001). A statistically significant decrease was seen in the decayed and filled indices of case group (p=0.042 and p=0.016, respectively)
Admittedly this is a 0.2% fluoride rinse used weekly as opposed to the 0.02% used daily (the product I linked) but there is absolutely evidence to support topical fluoride benefiting oral health. Considering it's <$5 and lasts almost two months between my wife and I, I consider it reasonable insurance while we're on well water.
You are not wrong that ingestion of fluoride is also considered beneficial though - I don't have a study for this one but my daughter's pediatrician encouraged us to brush the baby's gums with half a grain of rice of fluoride toothpaste and encourage her to swallow it before her teeth came in, because it could help them grow healthier. Of course now that she actually has teeth, we brush them directly as well.
The conversation around fluoride is muddied by the RFK Jrs of the world but, putting the conspiracy theorists aside, the science is actually very clear: Fluoride is effective at remineralizing...
The conversation around fluoride is muddied by the RFK Jrs of the world but, putting the conspiracy theorists aside, the science is actually very clear: Fluoride is effective at remineralizing teeth and reducing the incidence of cavities, particularly in children. However, the evidence shows that its effectiveness is primarily topical. There isn't a reason to drink it. Fluoride toothpaste is a much better choice.
Meanwhile the negative health effects of ingesting fluoride are well documented and extensive. They include thyroid issues, neurological symptoms, development issues, in one study fluoride at levels comparable to drinking water caused amyloid plaques in rats (associated wirh Alzheimers).
There is an association between relatively low intake of aluminum and fluoride with dementia according to NIH. It's thought that fluoride increases the bioavailability of aluminum and results in more of it making it into the brain.
The available evidence implies (I say implies because the specific forms of fluoride used in drinking water in the US have never been studied for safety) that the amount used in drinking water is below the threshold that will cause problems, however because of side effects like dental and skeletal fluorosis the recommended amount of fluoride in drinking water in the US was lowered in 2015.
There is significant reasonable debate about safety nevertheless. The NIH did a large scale scientific review and found a strong correlation between fluoride levels that are found in many municipal water supplies and lower IQ in children.
One cause for concern is that people get more fluoride from other sources than they did historically, potentially pushing their intake to unsafe levels. This includes both pollution and processed foods and drinks from factories which use municipal fluoridated water and effectively concentrate it during manfacturing.
Interestingly, in pretty much all of Western Europe they don't fluoridate their water but have experienced the same dramatic decline in dental issues like cavities in recent decades. It's thought that fluoridated toothpaste is part of the reason for this.
One prevalent line of reasoning in Europe is that nonconsensual medication via drinking water is inappropriate.
Note: This is one of those issues that causes a lot of emotion so I should point out that there's a lot of peer reviewed science, published in reputable journals, to back all this up. Much more than I've alluded to or could hope to cover in this post. I chose to link to studies from the National Institutes of Health which is part of the US Dept of Health and Human services because it's hard to argue they aren't a reputable source.
It's possible that the evidence against population scale fluoride supplementation, copious as it is, is all flawed. More research is definitely needed. But in the meantime it's not an experiment I feel like we should be conducting on two thirds of the children in the US.
I haven’t looked into it myself, but my general impression is that it’s a case of “the dose makes the poison” and there are communities where the natural level of fluoride in the water is too...
I haven’t looked into it myself, but my general impression is that it’s a case of “the dose makes the poison” and there are communities where the natural level of fluoride in the water is too high.
Edit: after looking into it a little:
Here’s a quote from the discussion from your second link, the NIH scientific review:
The body of evidence from studies in adults is also limited and provides low confidence that fluoride exposure is associated with adverse effects on adult cognition. There is, however, a large body of evidence on associations between fluoride exposure and IQ in children. There is also some evidence that fluoride exposure is associated with other neurodevelopmental and cognitive effects in children; although, because of the heterogeneity of the outcomes, there is low confidence in the literature for these other effects. This review finds, with moderate confidence, that higher estimated fluoride exposures (e.g., as in approximations of exposure such as drinking water fluoride concentrations that exceed the World Health Organization Guidelines for Drinking-water Quality of 1.5 mg/L of fluoride) are consistently associated with lower IQ in children. More studies are needed to fully understand the potential for lower fluoride exposure to affect children’s IQ.
For comparison, the CDC (in the US) recommends a level of 0.7 mg/L in drinking water. Apparently it was lowered from 1.0 to 0.7 mg/L in 2011.
Here's an article about communities that have too-high levels of fluoride:
Many cities add low levels of fluoride to drinking water in a bid to prevent tooth decay, but the policy has long been controversial. Lost in that debate are the roughly 3 million Americans whose water naturally contains higher concentrations of fluoride — often at levels that even some fluoridation advocates now acknowledge could have neurodevelopmental effects.
...
Perhaps nowhere is the issue more pervasive than Texas, where, according to data supplied to Undark by the Texas Commission on Environmental Quality, hundreds of communities have elevated fluoride levels, and several dozen are in clear violation of EPA regulations.
The legal limit in the US is 4 mg/L, but it doesn't seem very well enforced.
For accuracy, the original guidance of .07 to 1.2 ppm was lowered to .07 ppm in 2015. You're right neither the legal limit or the recommendation are well enforced, and neither take into...
For accuracy, the original guidance of .07 to 1.2 ppm was lowered to .07 ppm in 2015.
You're right neither the legal limit or the recommendation are well enforced, and neither take into consideration the increasing exposure from other sources
I don’t know about Europe but in the US many staple foods are “medicated”. Salt almost always comes with iodine, and both milk and flour is enriched with additional vitamins.
One prevalent line of reasoning in Europe is that nonconsensual medication via drinking water is inappropriate.
I don’t know about Europe but in the US many staple foods are “medicated”. Salt almost always comes with iodine, and both milk and flour is enriched with additional vitamins.
The purpose of putting chemicals in the water should be for treating the water, not the people. ...and to keep the frogs gay Yeah well I wouldn't like it if my drinking water was anything more...
The purpose of putting chemicals in the water should be for treating the water, not the people.
...and to keep the frogs gay
One prevalent line of reasoning in Europe is that nonconsensual medication via drinking water is inappropriate.
Yeah well I wouldn't like it if my drinking water was anything more than what I imagine the concept of it to be.
Is it really true that this wasn't conclusive even as late as 2011? That sounds surprisingly recent to my ears!
In Calgary, a city of about 1.8 million people in Alberta, the City Council voted to remove fluoride from its drinking water in 2011, two decades after it was introduced in 1991. The water treatment infrastructure to process the fluoride was at the end of its life cycle and councilors did not believe that the cost to replace it outweighed the existing science around the health value.
Is it really true that this wasn't conclusive even as late as 2011? That sounds surprisingly recent to my ears!
One thing to consider isn't so much about evidence, but that Alberta generally is sort of like the Texas of Canada, where personal freedoms and fiscal responsibility are really important (and they...
One thing to consider isn't so much about evidence, but that Alberta generally is sort of like the Texas of Canada, where personal freedoms and fiscal responsibility are really important (and they are the major oil-producing province, so they like to limit regulations on oil production). A good friend of mine is a native Calgarian and he is often very skeptical, so we've had long debates about climate science and other topics. I can totally see how the local government might have observed that a treatment plant was getting old, felt unconvinced about the benefits of fluoride, and decided to save some money by letting it lapse. I'm more surprised that they've added it back!
I love that my Podunk city of goofballs is the topic of conversation in Tildes. I was too young to pay more than a moment's worth of attention when it was removed and nothing's really changed....
I love that my Podunk city of goofballs is the topic of conversation in Tildes.
I was too young to pay more than a moment's worth of attention when it was removed and nothing's really changed. Trust people in the know to do what's right - that's my take.
I wonder why putting fluoride into public water supplies became a standard public health remedy, versus putting it in milk or something like that, like we do with vitamins?
I wonder why putting fluoride into public water supplies became a standard public health remedy, versus putting it in milk or something like that, like we do with vitamins?
Cost is almost certainly part of it, given how much potable water currently isn't used for drinking. Beyond that, stability of the nutrient over time? Vulnerability to temperature changes?...
Cost is almost certainly part of it, given how much potable water currently isn't used for drinking. Beyond that, stability of the nutrient over time? Vulnerability to temperature changes? Possibility of overdose? Negative effects when used for non-drinking purposes?
This is one of those instances where (RFK and conspiracies/shenanigans aside), you can find legit peer-reviewed studies on nih.gov that support both sides. For as to why we don't add it to other...
This is one of those instances where (RFK and conspiracies/shenanigans aside), you can find legit peer-reviewed studies on nih.gov that support both sides.
For as to why we don't add it to other stuff, I suspect because fluoride is actually reactive/bad for most things to which you'd like to add it or it doesn't function properly as a dried constituent (like sodium or iodine can do), though I'm not 100% sure. I do know that in water treatment here in the US, all water treatment folks working in the industry hate the stuff, and that's coming from the two people I know who work there (yeah, I realize that's not a huge study group :). One's opinion is that it's not water treatment's job to provide nutrients, it's to provide good, clean water without government telling them what extraneous things to do with it (and he doesn't use it in treatment processes, but does with the end result), and the other dislikes the use of it in the treatment process and has done some research (most of which you can find with a search of "study fluoride bones" that pop up on nih.gov as well) that has swapped him from indifferent to the "respectful, but HELL NO" opinion.
https://archive.is/xcnWk
From the article:
...
...
Isn't it so great that a chemical exists that can be added in small amounts to water to have such a positive effect on dental health? This has to be the cheapest public health measure per capita in human history. Thanks fluorine, you don't deserve the flak you get.
Maybe iodine in salt is a challenger? "Crétin des Alpes" (cretins from the alps) is now just a creative way to insult someone instead of a genuine condition.
That would go to something like mandating surgeons wash their hands between surgeries. Or building your sewage outflow pipes downstream of your drinking water intake pipe.
I would put forward folic acid added to flour to prevent neural tube defect:
Emphasis added. That's a LOT of babies having normal spine development from just adding a bit to flour
You can comfortably survive without fluoridated water if you just brush and floss and use fluoridated toothpaste. I grew up in a country that stopped adding fluoride just before I was born and I don't think our oral health suffers. So I'm somewhat hesitant calling it that, but now I wonder what other low cost and high scale interventions there were, historically. Iodine mentioned below is probably one with potentially fewer people affected but more severely, and maybe using salt that's partly KCl instead of standard table salt has a similar potential in improving cardiovascular health and reducing mortality at a similarly low price, but it hasn't been promoted at scale anywhere afaik.
My guess is that fluoride is one of those interventions that does the most good for the worse-off. Same with iodine, really -- the people brushing their teeth and the people eating a varied diet are always fine, it's the poor that benefit. (Which is great, obviously).
To restate what @R3qn65 said, ti make this claim there must be a nuanced comparison. In addition to overall numbers, comparison of the bottom third of various socio-economic-healty strata.
And even if one is a callous conservative, poor health outcomes for a significant percentage of population creates costs for everyone.
It would be nice to have more info about what studies have shown. I expect there will be a lot of variation for people within a region, so averages are likely to be misleading. The moderately beneficial results from the Calgary studies likely include people for whom there's no effect , either because their children do brush regularly with fluoride or because they naturally don't get cavities, while for others it will have a much greater effect if they're particularly susceptible to cavities.
Also, since it depends on culture (specifically, the prevalence of brushing with fluoride and similar habits, along with diet) and culture varies, the results of studies might be different between different regions?
Yes that was kind of my point. Parent’s community, perhaps even country, likely have good oral hygiene and regular dental care. One cannot extrapolate from that the benefits of drinking water fluoridation generally.
Edit: I bet there’s some pretty solid before and after data around the time fluoridation began.
I’ll also add, there’s this phenomenon where a public health measure achieves really great results, and everyone forgets about the original problem it solved and start to zero in on the relatively limited side effects. After which, they start clamoring to remove the measure. see also vaccination.
Sure. I'm not claiming adding fluoride is necessarily wrong, I'm claiming it may not be the cheapest public health measure per capita in human history - there are large populations for whom it doesn't bring much value.
Side note, but I never understood why leftists don't use your reasoning when pushing for policies, because this is true for almost everything targeting the poor or otherwise disenfranchised people. I assume there has to be a reason why it's not done other than "it's cynical and leftists are too empathetic", which is what a very left acquaintance told me - almost all of political marketing is cynical, especially in the US, this should not be a problem - but I haven't found it yet.
Curious if there's any DIY solution to add flouride and other minerals back into water. Even if it's for a single tap. My current place only uses ground water and while the RO has it pretty pure, I've noticed a bit more gut issues and tooth decay over the last 2 years. Most of the mineral injection cartridges seem to market themselves on the fact that they don't specifically have flouride and the only trusted one that I found is bundled in systems way too big for what we need.
Beside
I’ve had well water nearly my whole life - fluoridated toothpaste is probably the most cost effective answer. I’ve always just used the OTC ones and never had a cavity, but you can get Rx versions that are a bit stronger from your dentist.
Worth mentioning that being on well water doesn’t mean you aren’t getting fluoride. Groundwater fluoride content varies widely. Some groundwater has so much natural fluoride that it causes fluorosis.
This is true, and if you’re on well water you should be getting it tested when moving in, and probably periodically after that.
Not just for this, but to understand the water quality in general and ensure you’re treating it appropriately.
Looking at the other posts here, seems like my big confusion comes from one-time topical applications vs. ingesting it. Think I got some info years back that explained it as ingested fluoride being present in saliva/blood and that keeps teeth protected. Will probably go check in with a dentist for a stronger toothpaste solution since store stuff has not been as effective lately.
Your PCP may also be able/willing to prescribe it, if that’s easier for you. Worth calling and asking, anyway.
Also, if you have kids - we had Rx multivitamins with fluoride as kids, which might be worth asking their pediatrician about.
It would be great if you could find out where you learned that ingestion is important. It's news to me, and seems a bit dubious given that fluoride toothpaste, etc, are common. Why do all these remedies involve not swallowing fluoride if it's important to ingest it?
I think the general consensus is that systemic (ingested) fluoride is most beneficial for children whose teeth are growing, while topical fluoride is all you can do for fully erupted teeth.
One line of evidence that seems compelling is that ingested fluoride can cause fluorosis, while topical fluoride does not, which clearly indicates that systemic fluoride has a strong effect on tooth development.
It’s a pretty strong argument for water system level supplementation as well since the vast majority of people won’t be feeding their babies fluoridated toothpaste before they have visible teeth.
https://www.ada.org/resources/ada-library/oral-health-topics/fluoride-topical-and-systemic-supplements
I grew up in a house with a well, so I was thinking I didn't have fluorinated water growing up, but on second thought, I probably got some from drinking water at school. Also, I wonder which beverages might be made with fluorinated water?
It seems like it might be most important when a child's adult teeth are growing, which is a pretty specific age range? And it would be reasonable to think that pediatricians and dentists could educate parents so they take steps if their kids aren't drinking fluorinated water (another way of promoting public health) but the studies apparently show that if they're doing that, it's not that effective.
As I mentioned in another comment, well water is sometimes naturally fluoridated. In fact, that's how we actually know about the effects of fluoride in the water -- a scientist in Colorado Springs noticed that the native population not only had weird discolouration on their teeth (the result of fluorosis from very high natural fluoride content in their local water supply), but also had virtually no cavities.
https://www.nidcr.nih.gov/health-info/fluoride/the-story-of-fluoridation
Yep. I'm doubtful that upstate New York is one of those places, though? Natural fluoridation seems to be high in Texas and the western US more generally.
It's surprising that there don't seem to be any maps showing fluoride levels in groundwater in the US. I did find a dataset of well water readings and made a half-hearted attempt to get ChatGPT and Claude to plot it on a map, but they didn't get very far. Perhaps someone else wants to try? It seems like a nice problem to see if your AI-prompting skills are any good. (Or you could do it yourself, of course.)
I did find this, which indicates that Monroe county in New York has naturally occurring levels of fluoride that are about 20-30% of the target of 0.7 mg/L.
https://www.mcwa.com/my-water/water-quality/my-water-fluoride-in-your-drinking-water/
Went through the YouTube channels and blogs I follow to trace it back to a source and not much luck. Closest ideas I could dig up mostly references back to a 1999 study, Prevention and reversal of dental caries: role of low level fluoride
But it looks like common consensus is that topical applications are more effective as the remineralization process is:
This also sent me down the wonderful rabbit hole that is the development of tooth repair technology.
You'll find gripping reads like Minimally invasive endodontics: a new era for pulpotomy in mature permanent teeth which explores alternatives to root canal treatments in treating exposed soft tissue/dental pulp. There's also Evaluation of the Shear Bond Strength of Immediate and Delayed Restorations of Various Calcium Silicate-Based Materials with Fiber-Reinforced Composite Resin Materials which is just a fancy comparison of between dental glue brands.
Overall, pretty fun use of insomnia time.
Considering that you need very precise levels of fluoride and too much is more harmful than none, that sounds like a bad idea. Consider other solutions like salt with added fluoride plus perhaps a more fluoridated toothpaste.
The gut issues are likely just a coincidence.
One of my quirks is that I can't let things just be a coincidence. Helps in professional settings. Not so great everywhere else. Drinking water is a theory because it's probably the biggest meaningful change that could affect things. Moved less than a 3km from where I was and can't think of other major lifestyle changes.
My main consideration is that it's the hereditary gastro issues catching up to me late and causing the tooth decay. Acid reflux and can cause some acid to flow into the mouth and cause decay.
The insane conspiracy theory is that my dentist is sabotaging me in to getting implants before he retires. I'm the last family member with all my teeth and I'll be damned if the old man takes more of my money.
Almost any illness can affect the gut microbiome and start issues if you were already predisposed to that. From the ones commonly floating around covid is the worst I think, outside of gastric infections with severe diarrhea etc. which you would know about. Generally the change in the microbiome seems to be proportional to how severe the illness is, but iirc covid does cause changes even when it's asymptomatic.
If it is a gut microbiome issue, then gut microbiome is generally connected to the oral microbiome and when one gets worse, the other does too, though I don't think we know specifically by how much worse and in what ways specifically. And oral microbiome affects tooth decay, so here's another theory. If you like to experiment you can try looking up probiotic lozenges or chewables that are supposed to reduce the population of streptococcus mutans and improve oral health, no idea what's available around where you live but I know BioGaia makes one specifically for that.
You can just buy fluoride rinse - usually called alcohol free mouthwash. We are also on well water and we use this: https://www.kroger.com/p/kroger-vivid-mint-alcohol-free-fluoride-mouthwash/0004126038141
With fluoride toothpaste we are probably okay without it, but it's nice to have peace of mind for $4.50 every two months.
I'd be curious to see the specific research on stuff like this. I was taught that surface application of fluoride, at least of the widely available concentrations not applied by dentists, has very little effect. This is because teeth aren't so easy to penetrate that just putting stuff on them really gets anything inside.
This is connected to that people misunderstand the purpose of putting fluoride in water. They think it's so that the fluoride often runs over their teeth and swallowing it is incidental, but the actual goal is to get the low concentrations into your blood so it can work from the inside. I think this idea that people are being made to drink something that is meant to go on teeth is where some of the conspiracy comes from because they think of it like being made to drink mouthwash.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3525928/
https://en.m.wikipedia.org/wiki/Decay-missing-filled_index
Admittedly this is a 0.2% fluoride rinse used weekly as opposed to the 0.02% used daily (the product I linked) but there is absolutely evidence to support topical fluoride benefiting oral health. Considering it's <$5 and lasts almost two months between my wife and I, I consider it reasonable insurance while we're on well water.
You are not wrong that ingestion of fluoride is also considered beneficial though - I don't have a study for this one but my daughter's pediatrician encouraged us to brush the baby's gums with half a grain of rice of fluoride toothpaste and encourage her to swallow it before her teeth came in, because it could help them grow healthier. Of course now that she actually has teeth, we brush them directly as well.
The conversation around fluoride is muddied by the RFK Jrs of the world but, putting the conspiracy theorists aside, the science is actually very clear: Fluoride is effective at remineralizing teeth and reducing the incidence of cavities, particularly in children. However, the evidence shows that its effectiveness is primarily topical. There isn't a reason to drink it. Fluoride toothpaste is a much better choice.
Meanwhile the negative health effects of ingesting fluoride are well documented and extensive. They include thyroid issues, neurological symptoms, development issues, in one study fluoride at levels comparable to drinking water caused amyloid plaques in rats (associated wirh Alzheimers).
There is an association between relatively low intake of aluminum and fluoride with dementia according to NIH. It's thought that fluoride increases the bioavailability of aluminum and results in more of it making it into the brain.
The available evidence implies (I say implies because the specific forms of fluoride used in drinking water in the US have never been studied for safety) that the amount used in drinking water is below the threshold that will cause problems, however because of side effects like dental and skeletal fluorosis the recommended amount of fluoride in drinking water in the US was lowered in 2015.
There is significant reasonable debate about safety nevertheless. The NIH did a large scale scientific review and found a strong correlation between fluoride levels that are found in many municipal water supplies and lower IQ in children.
One cause for concern is that people get more fluoride from other sources than they did historically, potentially pushing their intake to unsafe levels. This includes both pollution and processed foods and drinks from factories which use municipal fluoridated water and effectively concentrate it during manfacturing.
Interestingly, in pretty much all of Western Europe they don't fluoridate their water but have experienced the same dramatic decline in dental issues like cavities in recent decades. It's thought that fluoridated toothpaste is part of the reason for this.
One prevalent line of reasoning in Europe is that nonconsensual medication via drinking water is inappropriate.
Note: This is one of those issues that causes a lot of emotion so I should point out that there's a lot of peer reviewed science, published in reputable journals, to back all this up. Much more than I've alluded to or could hope to cover in this post. I chose to link to studies from the National Institutes of Health which is part of the US Dept of Health and Human services because it's hard to argue they aren't a reputable source.
It's possible that the evidence against population scale fluoride supplementation, copious as it is, is all flawed. More research is definitely needed. But in the meantime it's not an experiment I feel like we should be conducting on two thirds of the children in the US.
I haven’t looked into it myself, but my general impression is that it’s a case of “the dose makes the poison” and there are communities where the natural level of fluoride in the water is too high.
Edit: after looking into it a little:
Here’s a quote from the discussion from your second link, the NIH scientific review:
For comparison, the CDC (in the US) recommends a level of 0.7 mg/L in drinking water. Apparently it was lowered from 1.0 to 0.7 mg/L in 2011.
Here's an article about communities that have too-high levels of fluoride:
...
The legal limit in the US is 4 mg/L, but it doesn't seem very well enforced.
For accuracy, the original guidance of .07 to 1.2 ppm was lowered to .07 ppm in 2015.
You're right neither the legal limit or the recommendation are well enforced, and neither take into consideration the increasing exposure from other sources
I don’t know about Europe but in the US many staple foods are “medicated”. Salt almost always comes with iodine, and both milk and flour is enriched with additional vitamins.
The purpose of putting chemicals in the water should be for treating the water, not the people.
...and to keep the frogs gay
Yeah well I wouldn't like it if my drinking water was anything more than what I imagine the concept of it to be.
Is it really true that this wasn't conclusive even as late as 2011? That sounds surprisingly recent to my ears!
One thing to consider isn't so much about evidence, but that Alberta generally is sort of like the Texas of Canada, where personal freedoms and fiscal responsibility are really important (and they are the major oil-producing province, so they like to limit regulations on oil production). A good friend of mine is a native Calgarian and he is often very skeptical, so we've had long debates about climate science and other topics. I can totally see how the local government might have observed that a treatment plant was getting old, felt unconvinced about the benefits of fluoride, and decided to save some money by letting it lapse. I'm more surprised that they've added it back!
I love that my Podunk city of goofballs is the topic of conversation in Tildes.
I was too young to pay more than a moment's worth of attention when it was removed and nothing's really changed. Trust people in the know to do what's right - that's my take.
I wonder why putting fluoride into public water supplies became a standard public health remedy, versus putting it in milk or something like that, like we do with vitamins?
That’s a really interesting question, as well as, why don’t we put essential nutrients in water? Costs?
Cost is almost certainly part of it, given how much potable water currently isn't used for drinking. Beyond that, stability of the nutrient over time? Vulnerability to temperature changes? Possibility of overdose? Negative effects when used for non-drinking purposes?
This is one of those instances where (RFK and conspiracies/shenanigans aside), you can find legit peer-reviewed studies on nih.gov that support both sides.
For as to why we don't add it to other stuff, I suspect because fluoride is actually reactive/bad for most things to which you'd like to add it or it doesn't function properly as a dried constituent (like sodium or iodine can do), though I'm not 100% sure. I do know that in water treatment here in the US, all water treatment folks working in the industry hate the stuff, and that's coming from the two people I know who work there (yeah, I realize that's not a huge study group :). One's opinion is that it's not water treatment's job to provide nutrients, it's to provide good, clean water without government telling them what extraneous things to do with it (and he doesn't use it in treatment processes, but does with the end result), and the other dislikes the use of it in the treatment process and has done some research (most of which you can find with a search of "study fluoride bones" that pop up on nih.gov as well) that has swapped him from indifferent to the "respectful, but HELL NO" opinion.
Science is great like that.