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)

Foetus neurological development impact of water fluoridation

Is there a reason that this article doesn’t mention the growing body of scientific evidence of negative behavioural and neurological effects of water fluoridation on developing foetuses? 2001:4479:D003:6900:D599:2993:ACF0:AA92 (talk) 12:37, 5 December 2024 (UTC)

Semi-protected edit request on 17 December 2024

The latter part of the following paragraph is incorrect; the cited report (Reference 7, https://www.ncbi.nlm.nih.gov/books/NBK606081/) only found reliable evidence of lower IQ in children in areas where fluoride levels exceeded the WHO Guidelines for Drinking-water Quality of 1.5 mg/L (as per the conclusion of said report), not "within the range of ordinary water fluoridation levels" as currently stated. To correct this, consider removing the bold parts in square brackets and then appending the suggested replacement that follows in italics:

In 2024, the Department of Health and Human Services' National Toxicology Program found that higher [cumulative] fluoride exposure is consistently linked to lower IQ in children[, even within the range of ordinary water fluoridation levels. These findings emphasize that as fluoride exposure increases, IQ consistently decreases, regardless of whether the exposure is considered normal or within regulatory limits.] Suggested replacement: [ from areas where fluoridation levels exceeded the 1.5 mg/L recommended by the WHO Guidelines for Drinking-water Quality.] 2406:2D40:726E:1710:E90B:B414:995D:24F9 (talk) 04:28, 17 December 2024 (UTC)

This critique overlooks the NTP’s clear acknowledgment that "because people receive fluoride from multiple sources (not just drinking water), individuals living in areas with optimally fluoridated water can have total fluoride exposures higher than the concentration of their drinking water." While the strongest evidence comes from high-exposure regions (fluoride concentrations at or above 1.5 mg/L), the findings remain relevant to children in areas with lower drinking water fluoride concentrations if cumulative exposure surpasses neurotoxic thresholds.

The report further emphasizes that cumulative exposure matters, noting that "additional exposures to fluoride from other sources would increase total fluoride exposure," making the conclusion of an inverse association between total fluoride exposure and IQ in children applicable beyond high-exposure areas. In order to correctly address the cumulative fluoride intake, while also taking into account your critique, I've modified the summary of the NTP's conclusion to accurately reflect their findings, which highlights risks tied to total fluoride exposure, not just water concentrations. MightyLebowski (talk) 06:04, 18 December 2024 (UTC)

 Done PianoDan (talk) 19:29, 17 December 2024 (UTC)

Semi-protected edit request on 17 December 2024 (2)

Edit #1: The following misrepresents the cited documents. Current: No clear evidence of other adverse effects exists, though almost all research thereof has been of poor quality. Suggested Revision: No clear evidence of other adverse effects exists. Many studies of other potential negative effects have not met inclusion criteria on each specific outcome and studies were generally of poor quality. (citation stays the same)

Edit #2: The following is a misrepresentation of the source cited. The paper states that there is no evidence that one type of topical application is more effective than another. Current: The World Health Organization reports that water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk,[12] while the European Commission finds that while water fluoridation likely reduces caries, there is no evidence that it is more effective than topical application.[20] Suggested Revision: The World Health Organization reports that water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk,[12] and the European Commission finds that water fluoridation likely reduces caries.[20] Jaredagilbert (talk) 21:23, 17 December 2024 (UTC)

I'm assuming you intended "cavities," rather than "caries" here? PianoDan (talk) 22:29, 17 December 2024 (UTC)

See our article on dental caries. WhatamIdoing (talk) 00:17, 20 December 2024 (UTC)

NTP report

The NTP report is highly flawed, the CDA even stated that "Media coverage of the report has been misleading." Hence, there is no point of a flawed report to press it prominently w/o any criticism in the lead. Stop it. --Julius Senegal (talk) 19:19, 19 December 2024 (UTC)

Hi Julius, your interpretation of the National Toxicology Program's (NTP) systematic review on fluoride exposure and neurodevelopment/cognition is subjective and violates WP:OR. Personal opinions hold no weight when discussing scientific and medical research. By removing the NTP's findings from the lead, which have had community consensus since August 2024, you are engaging in disruptive editing (WP:DE) and pushing original research/your point of view. Your statement saying "the NTP report is highly flawed" is a clear admission that your intentions behind the deletions/edits are based on WP:OR. You cannot remove content from the lead or other parts of the article because you don't personally like them.

This article requires claims to be supported by peer-reviewed, high-quality evidence like the NTP's systematic review—not personal judgments such as "I think the study is flawed, so it shouldn't be included." Additionally, your repeated deletions suggest a misunderstanding of the NTP's findings, as you referred to the NTP's systematic review as a "single study" in one of your edit summaries, indicating you may not have read or understood it, despite claiming to have knowledge that would warrant its removal. This behavior is inconsistent with Wikipedia's standards, especially for articles reliant on rigorous scientific research.

Please refrain from removing key content from the article and attempting to obscure these deletions with additional edits. MightyLebowski (talk) 21:02, 19 December 2024 (UTC)

Lebowski, this study does not belong in the lead. WP:MEDRS requires that we don't overstate or give undue weight to single studies, yes, even systemic reviews. Julius is not engaging in OR. DolyaIskrina (talk) 22:41, 19 December 2024 (UTC)

They are engaging in WP:OR, since they stated that the systematic review is flawed, with zero evidence to backup their claim. Do you have evidence to backup their claim that the NTP's findings are "flawed"?

Nothing is being overstated. Based on recency of the findings, the high-quality nature of the studies in the systematic review, and the fact that it was funded and released by a major government agency (Health and Human Services), this absolutely belongs in the lead. It has been in the lead for 4 months, since August 2024, and has been edited by others during that timeframe.

Additionally, I do not believe that you read the study before editing the lead, because it clearly states that higher fluoride exposures are "consistently associated with lower IQ in children." I know that you had a problem with the use of "consistently", but that is the verbatim findings of the NTP in their systematic review. MightyLebowski (talk) 23:27, 19 December 2024 (UTC)

There is a very large "Limitations" section of the review makes it clear that it's not "hight-quality" I could quote it all day long, but here is a particularly damning bullet point: "Studies conducted in areas with high, naturally occurring fluoride levels in drinking water often did not account for potential exposures to arsenic or iodine deficiencies in study subjects in areas where these substances were likely to occur." This is not WP:MEDRS compliant to have this in the lead. DolyaIskrina (talk) 00:33, 20 December 2024 (UTC)

You are misinterpreting the findings of the systematic review. The limitation you cited explicitly refers to epidemiological studies with a high risk of bias. This is clearly stated in the text: "Limitations in the epidemiological studies with high risk of bias include..." Not all studies reviewed were of high risk of bias. In fact, the review distinguishes between studies of varying quality, and 18 studies were specifically noted as high quality. These high-quality studies consistently found that higher estimated fluoride exposures were "consistently associated with lower IQ in children."

Your edit also misrepresents the findings of the report and references information completely out of context. The monograph states:

"higher estimated fluoride exposures (e.g., as in approximations of exposure such as drinking water fluoride concentrations that exceed the WHO Guidelines for Drinking-water Quality of 1.5 mg/L of fluoride) are consistently associated with lower IQ in children."

However, your edit altered this to:

"concentrations that exceed the WHO Guidelines for Drinking-water Quality are consistently associated with lower IQ in children."

This mischaracterization disregards the fact that the findings relate to estimated fluoride exposures, not just drinking water concentrations. The systematic review explicitly considers cumulative fluoride intake from all sources, not solely water.

Additionally, your wording without context—"concentrations that exceed the WHO Guidelines"—could lead to confusion about the scope of the findings and lacks the nuance conveyed in the systematic review's conclusion. To ensure accuracy and alignment with WP:MEDRS, direct quotes or well-contextualized summaries should be used rather than vague or overly broad paraphrasing that you included. MightyLebowski (talk) 02:05, 20 December 2024 (UTC)

"The current version of the report concludes “with a moderate degree of confidence” that 1) exposure to fluoride at/above the level of ≥1.5 mg/L is “consistently associated with lower IQ in children” and 2) “more research is needed on the effects of fluoride exposure at levels below 1.5mg/L.”"[1]https://ilikemyteeth.org/troubled-government-report-finally-sees-the-light-of-day/ DolyaIskrina (talk) 18:13, 20 December 2024 (UTC)

The "I Like My Teeth" website does not meet Wikipedia's WP:MEDRS standards, as it is not peer-reviewed or a respected scientific source. Replacing the NTP systematic review's conclusions with this water fluoridation advocacy site's analysis violates WP:MEDRS and misrepresents the NTP's findings. MightyLebowski (talk) 21:25, 20 December 2024 (UTC)

That is an extremely legalistic argument,WP:LAWYER and misrepresents MEDRS. This is a direct quote from the review itself. DolyaIskrina (talk) 00:27, 21 December 2024 (UTC)

Dolya, you're misrepresenting WP:MEDRS, the NTP review, and now WP:LAWYER. First, WP:MEDRS requires high-quality, peer-reviewed sources. Replacing the NTP’s findings with a fluoride advocacy site like "I Like My Teeth" fails this standard. Second, you misrepresented the NTP review by claiming all the studies were biased and low-quality. The purpose of a systematic review is to weigh studies based on quality. The NTP explicitly highlighted 18 high-quality studies that consistently found higher fluoride exposure linked to lower IQ in children. Lastly, calling this a WP:LAWYER issue misrepresents that policy—it’s not legalistic or pedantic to insist on using accurate sources adhering to scientific rigor and a faithful representation of the findings; it’s following Wikipedia’s core standards. MightyLebowski (talk) 02:50, 21 December 2024 (UTC)

The study you like says itself that "more research is needed on the effects of fluoride below 1.5mg/L". It is lawyering to try to keep this off the page because a source that quotes the original source isn't up to your standards. DolyaIskrina (talk) 02:14, 22 December 2024 (UTC)

That is not an accurate representation of the study. The actual statement from the study is:

"More studies are needed to fully understand the potential for lower fluoride exposure to affect children’s IQ."

This means the researchers are acknowledging the need for further investigation into whether fluoride exposures (from any source, not just water) lower than those studied might also have an adverse impact on children’s neurodevelopment and IQ. It does not, however, diminish their conclusion that higher estimated fluoride exposure is associated with lower IQ in children. The systematic review is clear on this point, and it is important to understand the difference between "lower" and "higher" exposure levels, as conflating the two misrepresents the findings.

Criticizing your use of a fluoride advocacy site has nothing to do with my standards, but rather the rigorous scientific standards outlined in WP:MEDRS. It's not even close to lawyering to point that out. MightyLebowski (talk) 03:16, 22 December 2024 (UTC)

"Associations between lower total fluoride exposure [e.g., as in approximations of exposure such as drinking water fluoride concentrations that were lower than the WHO Guidelines for Drinking-water Quality of 1.5 mg/L of fluoride (WHO 2017)] and children’s IQ remain unclear."

The association with IQ is unclear at levels below 1.5. DolyaIskrina (talk) 03:40, 22 December 2024 (UTC)

That is given as an example of a single exposure source, not a total exposure threshold, hence the "e.g." Did you not read the qualifying condition in the very next sentence?

"However, because people receive fluoride from multiple sources (not just drinking water), individuals living in areas with optimally fluoridated water can have total fluoride exposures higher than the concentration of their drinking water."

That's why the NTP found an inverse association between fluoride exposure and children's IQ: as fluoride exposure increases, IQ decreases, and vice versa. However, they did not establish a specific exposure threshold, only that the relationship was consistently negative. MightyLebowski (talk) 06:52, 22 December 2024 (UTC)

No, you have reverted all criticism (coming from experts) to this "report":

• https://adanews.ada.org/ada-news/2024/august/national-toxicology-program-releases-fluoride-exposure-monograph/
• https://www.cda.org/newsroom/community/national-toxicology-program-releases-systematic-review-on-fluoride-exposure/
• https://www.statnews.com/2024/09/05/fluoride-water-child-iq-study-national-toxicology-program/
• https://www.health.govt.nz/system/files/2024-12/Appendix%205%20CWF%20assessment%20of%20additional%20publications.pdf

You don't even know the history of the report.

What you are doing is sole POV pushing of a highly controversial report as given fact. --Julius Senegal (talk) 17:48, 20 December 2024 (UTC)

You are engaging in POV pushing by relying on non-peer-reviewed sources to discredit the NTP's findings. The NTP's systematic review represents the gold standard of evidence synthesis, while your approach selectively amplifies weaker critiques, undermining Wikipedia's reliance on high-quality, peer-reviewed secondary sources for scientific accuracy and neutrality. MightyLebowski (talk) 21:26, 20 December 2024 (UTC)