Talk:Water fluoridation/Archive 8

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Cancer claims

Jtbobwaysf is edit warring quite large medical claims into an article [1], and attempting to counter reviews with a primary study, contrary to WP:MEDRS. Jtbobwaysf is also engaging in OR by synthesising these points together and claiming there is a debate. Jtbobwaysf is also ignoring WP:BRD, showing how you should not edit war your claims into an article, rather discuss them first after they are reverted. IRWolfie- (talk) 10:10, 7 June 2013 (UTC)

OK, i found your response here. Please explain how the Tokyo study does not meet WP:MEDRS. The Tokyo study is a secondary source that cites a primary research in 1996. Primary: http://0-www.ncbi.nlm.nih.gov.elis.tmu.edu.tw/pubmed/9002384 Secondary: http://0-www.ncbi.nlm.nih.gov.elis.tmu.edu.tw/pubmed/11512573 Thanks Jtbobwaysf (talk) 12:14, 7 June 2013 (UTC)

The Tokyo study (PMID: PMID 11512573) is not a secondary source whereas PMID: PMID 8897753 is. Furthermore correlation does not prove causation. Tokyo study also found negative correlation between fluoridation exposure and cancer rates for some cancers. Tokyo study was very cautious with their conclusions and only suggest that further study is justified. The conclusion that there is a debate is not warranted by the sources supplied. Boghog (talk) 12:47, 7 June 2013 (UTC)

Hello Boghog, first I didn't say anything about causation. Second, can you please explain how you differentiate PMID: PMID 8897753 as a secondary source and (PMID: PMID 11512573) as a primary source. I am not experienced with PubMed. Thank you Jtbobwaysf (talk) 13:36, 8 June 2013 (UTC)

Concerning causation, I was just trying to point out that even if a study showed a correlation between fluoridation exposure and cancer rates, this is insufficient to prove that fluoridation causes cancer. In any case, it is not directly relevant to your assertion there is a controversy so please ignore that comment. Concerning how to determine if a source is secondary or not, on the PubMed abstract page, just below the abstract, click on the "+" symbol next to this "Publication types, MeSH Terms". You will see "Publication Type" for PMID 8897753 is "Review". The Tokyo study (PMID: PMID 11512573) has not been classified as a review or a meta-analysis. Hence it is a primary source. (See the last paragraph of searching for sources for more information) Boghog (talk) 15:23, 8 June 2013 (UTC)

[Edit conflict]: Just to clarify:

A survey of previous work in the field in a primary peer-reviewed source is secondary source information.
— Secondary_source#In_science_and_technology

Hence parts of the article may be considered secondary (e.g., the introduction), but the rest of the paper including the authors conclusions is primary. Boghog (talk) 13:04, 7 June 2013 (UTC)

Without commenting on the fluoridation business, the above short definition about secondary reference is not (to me) correct. All decent scientific papers begin with a review of the area, sometimes lengthy, sometimes not. The paper PMID 11512573 in question is probably not a review because it reports a new analysis. A real review conducts minimal new analysis but is a report on what has been done with comments on relative merits and contextualization. Also, reviews call themselves reviews - the abstract to PMID 11512573 does not. We should sharpen our wording at WP:SECONDARY.--Smokefoot (talk) 14:09, 7 June 2013 (UTC)

The wording at WP:SECONDARY is accurate. The introduction of a peer reviewed article that reviews the literature is secondary. There is absolutely no difference between the introduction of a peer reviewed primary source and the body of a review article other than its length. Of course one needs to be careful about using these types of sources as secondary and stick to what is presented in the introduction. Boghog (talk) 14:22, 7 June 2013 (UTC)

Agree with this, parts of research studies can be and often are secondary sources, just need to be careful in using them. Also it is important to be keenly aware that the background section of a research study is often limited to just the area being investigated and so should not be considered a complete overview, and also it may very well be slanted in its approach to the background overview so that it supports the findings of the research study. If at all possible an independent dedicated review article should really be used. Zad68 14:33, 7 June 2013 (UTC)

(ec) In theory there's no difference; in practice, there certainly is. The focus and emphasis of both the content and the peer review it receives tends to be very different when looking at a primary research paper versus a review article.

In any case, I suspect that we're probably bumping up against some Wikipedia-specific terminology or interpretation that might be slightly askew from general usage. While technically the introduction of a primary research paper contains secondary information, that should not be construed as conferring 'reliable' status on the contents of that introduction for Wikipedia article sourcing purposes. (That is, for the purposes of judging reliability, we tend to consider all content in a primary research paper as being, collectively, part of a "primary source", even if some of that content is secondary in nature.)

Treating the intro of a primary paper as a secondary source for reliability purposes gets us in a mess of trouble, among other reasons because it would permit cranks to bootstrap themselves into Wikipedia. Let's say Wingnut publishes a primary research paper in 2010. By itself, it doesn't clear the bar of WP:MEDRS. Later, Wingnut et al. (2013) cites Wingnut et al. (2010) when presenting previous work in its introduction. Suddenly, the conclusions of Wingnut et al. (2010) are endorsed by a secondary source, and Wingnut gets to put his nonsense in Wikipedia. Lather, rinse, repeat for every crank and snake-oil salesman who manages to publish two consecutive papers. TenOfAllTrades(talk) 14:44, 7 June 2013 (UTC)

Hello TenOfAllTrades, these two studies (Osaka and Tokyo) are by different authors. Confused by your comments. Please clarify. Thank you Jtbobwaysf (talk) 13:36, 8 June 2013 (UTC)

My comments were addressing (one aspect of) the problems inherent to treating the intro (or discussion) of a primary research paper as a reliable secondary source for Wikipedia's purposes. I was responding to Boghog's comment – since clarified – drawing an equivalence between a primary paper's intro and a secondary paper's content. TenOfAllTrades(talk) 14:41, 8 June 2013 (UTC)

That's why just being a secondary source isn't really enough to satisfy MEDRS. There's a reason it gives pride of place to current systematic reviews published in respected peer-reviewed journals. The more controversial a statement is, the more attentive we need to be to source quality, per wp:REDFLAG. LeadSongDog come howl! 15:23, 7 June 2013 (UTC)

Re "There is absolutely no difference between the introduction of a peer reviewed primary source and the body of a review article other than its length." At least in the technical publishing business where I work, there is a huge difference between the intro to a primary source and a review article. The former is setting up the background for a specific set of results to be disclosed, whereas a review is typically more comprehensive and is detached from supporting the disclosure of new results. That is the perception in chem, biochem, materials sci, areas. It would be a big complication for Wikipedia's reliability factor if every primary paper were also treated a secondary source. --Smokefoot (talk) 15:28, 7 June 2013 (UTC)

I fully agree that secondary sources are more likely to be reliable. Furthermore I also agree that the use of primary sources is much more likely to be abused. However secondary sources are not automatically better than primary sources. Secondary sources are often written by experts in the field as they should be but this also introduces the potential for bias. Furthermore some secondary sources are rather superficial summaries of literature that have been published in a field with little critical analysis of the reliability or significance of the results. In cases where high quality review articles are lacking, the introduction of a high quality primary source may be superior to the available low quality secondary sources. Boghog (talk) 20:49, 7 June 2013 (UTC)

Of course, if there are high quality review articles relevant to the subject, those should be used instead of the introduction of a primary source. The intention of the above quoted passaged in WP:SECONDARY was to allow supporting citations to be added in situations where relevant secondary sources are not yet be available. Getting back to the original subject of this thread, the Tokyo study (PMID: PMID 11512573) is a primary source and the way this source was used was inappropriate. I quoted WP:SECONDARY to make clear why. Boghog (talk) 16:56, 7 June 2013 (UTC)

Of the sources listed, I can't find one that mentions the Tokyo study in the background section. Perhaps someone can point out. But I think we are all clear that drawing text from the background section of a research paper is scraping the barrel in terms of desirable sourcing and raises serious questions about whether Wikipedia should be covering the points at all. Water fluoridation is a major topic, not some rare disease only three people ever had. Colin°^Talk 19:30, 7 June 2013 (UTC)

Hello Colin, you will find the PubMed search here that shows the Tokyo study (Secondary) citing the Osaka (primary) study. http://0-www.ncbi.nlm.nih.gov.elis.tmu.edu.tw/pubmed/?term=loftextEBSCOPub[filter]+AND+0917-5040[ta]+AND+1996%3A2012[dp]+AND+fluoride It is not logical that a review would be done on Regression analysis, unless a reviewer wants to dispute the math. Thank you Jtbobwaysf (talk) 13:36, 8 June 2013 (UTC)

I fully agree. Just to clarify, the Tokyo study (PMID 11512573) was in the foreground (i.e, it was cited directly and the body and not the introduction of this citation was used to support the conclusion that there is a debate) and that is why its use was inappropriate. Equally important, this primary source itself did not state there is a debate. Boghog (talk) 20:17, 7 June 2013 (UTC)

Hello Boghog, You seem to be making two points here, am I correct? Point 1: I did the citations incorrectly, is that correct? Please advise how to do the citations correctly. Point #2: Whether the primary source said there was a debate. I thought the presence of a different opinion from the summarized existing wiki section was sufficient to state there was a debate (without the cited article saying explicitly there was a debate). I did cite the Oregon Public Broadcasting ‎article which did say there was a debate. If not, please advise how to properly add the primary (Osaka) and secondary (Tokyo) research (that generated similar findings and in which the secondary cites the primary) to the page. Last, as an etiquette question, is it ok if I respond on this talk page to each comment inline, or should I summarize my response to various wiki editors in one master response (as I have done above today)? Thank you Jtbobwaysf (talk) 13:36, 8 June 2013 (UTC)

The problem is not how you formatted the citation to the 'Tokyo' study, but rather it was not appropriate to cite this source to support your contention there is a controversy. Just to be absolutely clear, the 'Tokyo' study is not a secondary source, it is a primary source. Furthermore the 'Tokyo' study does not state there is a controversy. Boghog (talk) 15:46, 8 June 2013 (UTC)

In addition to the citations ([10][11]) already contained in this article, there are following secondary sources:

• McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, Misso K, Bradley M, Treasure E, Kleijnen J (2000). "Systematic review of water fluoridation". BMJ. 321 (7265): 855–9. doi:10.1136/bmj.321.7265.855. PMC 27492. PMID 11021861. There was no clear evidence of other potential adverse effects. [cancer was one of the other potential adverse effects that was specifically examined] {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Cook-Mozaffari P (1996). "Cancer and fluoridation". Community Dent Health. 13 Suppl 2: 56–62. PMID 8897753. The present paper gives a brief overview of the evidence that fluoride in drinking water has not been shown to cause an increase in the risk of developing cancer and of the errors in the analyses that purport to show such an increase. {{cite journal}}: Unknown parameter |month= ignored (help)

The above review articles support the conclusion that there is no link between fluoridation and cancer and also support the view there is no significant debate within the scientific community concerning this conclusion.

Most of the recent "controversy" seems to be a result of this primary study:

• Bassin EB, Wypij D, Davis RB, Mittleman MA (2006). "Age-specific fluoride exposure in drinking water and osteosarcoma (United States)". Cancer Causes Control. 17 (4): 421–8. doi:10.1007/s10552-005-0500-6. PMID 16596294. Our exploratory analysis found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females. Further research is required to confirm or refute this observation. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)

Note the authors were very cautious in their own conclusions. Furthermore, this 2006 study has been challenged by two more recent primary studies:

• Kim FM, Hayes C, Williams PL, Whitford GM, Joshipura KJ, Hoover RN, Douglass CW (2011). "An assessment of bone fluoride and osteosarcoma". J. Dent. Res. 90 (10): 1171–6. doi:10.1177/0022034511418828. PMC 3173011. PMID 21799046. No significant association between bone fluoride levels and osteosarcoma risk was detected in our case-control study, based on controls with other tumor diagnoses. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Levy M, Leclerc BS (2012). "Fluoride in drinking water and osteosarcoma incidence rates in the continental United States among children and adolescents". Cancer Epidemiol. 36 (2): e83–8. doi:10.1016/j.canep.2011.11.008. PMID 22189446. Our ecological analysis suggests that the water fluoridation status in the continental U.S. has no influence on osteosarcoma incidence rates during childhood and adolescence. {{cite journal}}: Unknown parameter |month= ignored (help)

Taking the above five citations into account, I see no evidence to support there is a controversy. Boghog (talk) 16:26, 8 June 2013 (UTC)

Having now read Takahashi et al. (the 2001 'Tokyo' study), I can see an excellent example of why Wikipedia strongly discourages medical claims based on primary papers. It just...isn't very good. One low-quality, 12-year-old, seldom-cited primary paper shouldn't be held up as evidence of a "debate in the scientific community". TenOfAllTrades(talk) 15:32, 8 June 2013 (UTC)

facts, sources, NPOV ...

The article seems to overstate the benefits of water fluoridation (compared to alternatives), misrepresent the situation in Europe, does a fine job avoiding neutral sources. First non-wiki result when I google water fluoridation europe is Questions on water fluoridation - European Commission - Europa but SCHER or publications by the European commission aren't used as source anywhere in the article.

In it's 2010 report to the European Commission, the conclusions of the Scientific Committee on Health and Environmental Risks' include:

• The benefits of preventive systemic supplementations (salt or milk fluoridation) are not proven.
• The efficacy of population-based policies, e.g. drinking water, milk or salt fluoridation, as regards the reduction of oral-health social disparities, remains insufficiently substantiated.
• No obvious advantage appears in favor of water fluoridation compared with topical prevention. The effect of continued systemic exposure of fluoride from whatever source is questionable once the permanent teeth have erupted.
• SCHER agrees that topical application of fluoride is most effective in preventing tooth decay. Topical fluoride sustains the fluoride levels in the oral cavity and helps to prevent caries, with reduced systemic availability.

About the studies regarding salt fluoridation in Jamaica, SCHER finds:

• These studies are all considered of simplistic methodological quality.

The ethics and politics section doesn't mention that information gaps regarding fluoride “prevented the committee from making some judgments about the safety or the risks of fluoride at concentrations of 2 to 4 mg/L., and that water systems could supply up to 4mg/L for a year before informing the customers. Instead we get the crazy theories of some opponents. Other articles (like 9/11) don't need a list of all the conspiracy theories to strengthen the official version by contrast. (they don't even allow them in the main article)

The mechanism section:

• Fluoride's effects depend on the total daily intake of fluoride from all sources.

No they don't, at least not the beneficial effects. Together with:

• others, such as in Europe, using fluoridated salts as an alternative source of fluoride

it suggests that the situation in Europe is fundamentally no different: be it through milk, salt or water fluoridation, the systemic intake would be comparable to countries with water fluoridation. that is not the case. Also, Switzerland and Germany are the only european countries where most salt is fluoridated.

• unlike most European countries, the U.S. does not have school-based dental care

Which countries? Only Sweden provides free dental treatment for schoolchildren afaik. Eastern Europe did the same during the communist era, but those days are long gone. They may get free check-ups in some countries, and a note for the parents telling them they need to go see a dentist, that's about it. It's not the only doubtful claim about "many countries", "most people", ..

WHO DMFT data for 12-y olds in 2004 shows W. European countries scoring as good as or better than the U.S. and Canada. Helen Whelton's study shows much more cases of dental fluorosis in areas with water fluoridation or high natural fluoride content. which makes the statement dental fluorosis, which is mostly due to fluoride from swallowed toothpaste., although technically correct, a bit misleading.

• It's been official policy for 60 years, it only manages to give 75% of schoolchildren their daily dose of fluoride, and it still seems the best and only approach? I expected some sources would have noticed that obvious flaw. You teach 99% of children to read and write, giving them a glass of fluoridated water between classes shouldn't be too hard to organize. The claim that water fluoridation is the best and only way to reach those kids seems hardly justified. But that's my opinion and WP:OR

I'll leave it at that, I don't doubt WP:RS confirming the primary sources and points mentioned can be found, but don't fancy the job, given the controversy and number of watchers.. Ssscienccce (talk) 08:40, 24 June 2013 (UTC)

Very odd. I can't figure out what that SCHER link actually is. Navigating it is a nightmare, apparently there's no pdf version. "Level 3" is cited as being taken from here which states The opinions of the Scientific Committees present the views of the independent scientists who are members of the committees. They do not necessarily reflect the views of the European Commission. The opinions are published by the European Commission in their original language only. The rest is written by "Jon Turney". Not sure what to make of it. TippyGoomba (talk) 15:32, 24 June 2013 (UTC)

Alleged poison is ranked as top ten health achievement of 20th century

"In point of fact, fluoride causes more human cancer death, and causes it faster than any other chemical."--Dean Burk -- Congressional Record 21 July 1976 "They (ACS) lie like scoundrels."----Dean Burk, Ph.D., 34 years at the National Cancer Institute. — FLUORIDE "amounts to public murder on a grand scale" --Dean Burk — Preceding unsigned comment added by 50.13.53.93 (talk) 07:12, 20 July 2013 (UTC)

If you are looking for tips on how to source, here is an example:

--Smokefoot (talk) 16:09, 20 July 2013 (UTC)

• "Centers for Disease Control and Prevention listed water fluoridation as one of the ten great public health achievements of the 20th century, along with vaccination, family planning, recognition of the dangers of smoking, and other achievements.... Source: CDC. Ten great public health achievements—United States, 1900–1999. MMWR Morb Mortal Wkly Rep. 1999;48(12):241–3. PMID 10220250. Reprinted in: JAMA. 1999;281(16):1481. doi:10.1001/jama.281.16.1481. PMID 10227303"

The original title of this section was simply poison. This was changed by someone other than the originator of the section. The information provided by the CDC is inaccurate and does not reflect the views of the majority of the world. American propaganda should not bully the truth or other verifiable accurate sources out of existence. — Preceding unsigned comment added by 50.13.53.93 (talk) 12:46, 21 July 2013 (UTC)

Regardless of one's views on the merits of water fluoridation, if you think that the U.S.'s CDC is intentionally misleading the public, then you are a conspiracy theorist on this theme, . Conspiracy theorests never have a happy editing experience within Wikipedia on the topic of their theory. That is the very nature of conspiracy theories. Nothing evil or saintly, just an operational definition. So find another topic within Wikipedia that catches your fancy or where you know a lot, and edit there for a happier experience.

The other "phenotype" of conspiracy-driven editors is that they edit on narrow set of topics, they rarely register, and they never have user pages. Obsessive, noncollegial editors generally have an unhappy experience in Wikipedia.--Smokefoot (talk) 13:26, 21 July 2013 (UTC)

Yes, that's the way it works here, and fortunately so. Those who learn to follow our sourcing and content policies, edit in a collegial manner, and otherwise stop pushing fringe POV and using dubious sources, often become good editors. Otherwise they usually end up getting topic banned or blocked. In this case it might be a case of fluoride deficiency, similar to how opposers of aspartame seem to be suffering from an aspartame deficiency. (irony ) -- Brangifer (talk) 17:55, 21 July 2013 (UTC)

Thanks for the irrelevant ad hominem attacks. These are not conspiracy driven edits. There seems to be quite a lot of controversy on this topic indicated by the so far 8 pages of history here. How about this Harvard study?

http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/ — Preceding unsigned comment added by 50.13.53.93 (talk) 17:13, 21 July 2013 (UTC)

Actually this is a good source we could use. It's a review with a secondary use at Harvard. We can cite both if we wish. To make this easier, I'm going to copy this to a new section. -- Brangifer (talk) 19:04, 21 July 2013 (UTC)

The response to the first line about fluoride causing cancer seems to be: "but it cleans teeth". That does not address the issue. — Preceding unsigned comment added by 50.13.53.93 (talk) 17:24, 21 July 2013 (UTC)

Nothing new here. We've been over this countless times. If you have a concrete proposal for content that will improve the article without pushing the fringe POV (which is documented in the water fluoridation controversy article), please propose the wording and source here and we can prepare it for inclusion. Otherwise please refrain from using Wikipedia to push a fringe POV. -- Brangifer (talk) 17:55, 21 July 2013 (UTC)

So the answer upon reviewing the archives is forever the same. If someone says it's poison they are called a conspiracy theorist and it is pointed out that it's good for teeth. You are avoiding the issue not addressing it. I can accept that though. I may be back with more articles, but I do realize there's a good chance it will be drowned out by the articles on how great it is for teeth. — Preceding unsigned comment added by 50.13.53.93 (talk) 14:24, 22 July 2013 (UTC)

Dosage is important, but by putting it in the water many have no choice in the dosage. Since it is in the water it gets into the food. Many get far more than the "safe" dosage. — Preceding unsigned comment added by 50.13.53.93 (talk) 18:20, 24 July 2013 (UTC)

Choi review

How about this Harvard study?

• http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/

— Preceding unsigned comment added by 50.13.53.93 (talk) 17:13, 21 July 2013 (UTC)

Actually this is a good source we could use. It's a review with a secondary use at Harvard. We can cite both if we wish

• Choi, et al. Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis. Environmental Health Perspectives, 2012 October; 120(10): 1362–1368. Published online 2012 July 20. doi: 10.1289/ehp.1104912, PMC 3491930

• Impact of fluoride on neurological development in children. HSPH News, July 25, 2012

This is about very high exposure, not normal exposure. Let's figure out good wording and then find a spot to use it. It's usually best to use something from the conclusion. -- Brangifer (talk) 19:12, 21 July 2013 (UTC)

Since this article is about the artificial addition of fluoride to water supplies, and not about water already endemically high in fluoride as in the Choi study (as well as the fact that the study looked at levels of fluoride much higher than what is typically used in artificial water fluoridation), this is not an appropriate article here. Similar studies are already cited in the fluoride toxicity article, where it is appropriate. Yobol (talk) 15:21, 22 July 2013 (UTC)

I agree with Yobol. Unless there is comparison with the exposure levels studied with the levels in normally fluoridated water, I don't know how or why we'd include Choi. --Ronz (talk) 15:51, 22 July 2013 (UTC)

Oh it's only a neurotoxin after a certain dosage. Well that's fine then. — Preceding unsigned comment added by 50.13.53.93 (talk) 15:44, 23 July 2013 (UTC)

I heard dihydrogen monoxide in high enough doses can cause confusion, seizures, and even death. Better label it a neurotoxin and ban its use! Yobol (talk) 15:48, 23 July 2013 (UTC)

"The dose makes the poison." Paracelsus -- Brangifer (talk) 15:41, 24 July 2013 (UTC)

I have to agree with Yobol and Ronz. Many of the studies included in Choi's meta-analysis (Table 1) reported fluoride levels of 0.5-1.0 ppm (mg/L) in their "reference" populations—the same level of fluoride recommended by WHO guidelines for artificially fluoridated water. The "high fluoride" populations typically reported drinking water fluoride concentrations significantly higher, most coming in far in excess of WHO recommended levels. At best, Choi's meta lends moderate support to the hypothesis that extremely high fluoride levels may have neurotoxic effects. It says nothing about the effects of artificial water fluoridation to recommended levels; as such, it is potentially a worthwhile source for our article on fluoride toxicity, but isn't really relevant to this article. TenOfAllTrades(talk) 00:37, 24 July 2013 (UTC)

That makes sense. Use it in the other article. -- Brangifer (talk) 15:41, 24 July 2013 (UTC)

"other sources of fluoride"

I see the phrase "other sources of fluoride" mentioned in this article but it doesn't explain what those "other sources" might be. We know fluoride can be found in toothpaste, tea, tobacco, air pollution, in pesticide residues left on our foods, in soft drinks, juice, raisins, flour, etc. Perhaps it would be easier to just explain what people can ingest that DOESN'T contain fluoride?

We already know that fluoride bio-accumulates in the body from ALL sources, regardless of the amount maintained in tap water.

And what agency/organization is responsible for monitoring the bio-accumulative effects of fluoride? Would that be Colgate? Or your family dentist? Or your local water district? Is there a special lab test one can request to determine their body load of fluoride? As in determining whether they're exposed to too much, or too little? Or is this just determined by guess-timation (or psueudo-science)?

A little clairification in this area would be great and would thus reduce a great deal of controversy regarding dose... scientifically speaking... of course. — Preceding unsigned comment added by 99.61.176.89 (talk) 21:10, 4 August 2013 (UTC)

Edit request on 22 August 2013

Could you please include a link to "Fluoride - a chronological history" (http://www.infiniteunknown.net/2010/10/31/fluoride-a-chronological-history/) to provide an alternative perspective.

203.2.35.176 (talk) 22:53, 22 August 2013 (UTC)

I can't see how that is a reliable source in any way. --Ronz (talk) 23:23, 22 August 2013 (UTC)

 Not done per Ronz. TippyGoomba (talk) 23:24, 22 August 2013 (UTC)

Sources Buffet

Please enjoy with plentiful servings added to main article: http://www.slweb.org/bibliography.html Campoftheamericas (talk) 02:29, 9 September 2013 (UTC)
See also http://www.actionpa.org/fluoride/reasons.pdf
At these sites, you will find links to unbiased, relevant, peer-reviewed scientific research. Campoftheamericas (talk) 05:29, 9 September 2013 (UTC)

Firstly, these are activist sites and not relevant for our purposes. Secondly, even if they weren't activist sites no one is going to waste time reading through dozens of articles to find...what exactly? If you'd like to include something on the page then suggest specific wording and include a source or two to cite your wording. Also, I'm not sure why you reverted the archive bot - those conversations are dead so there's no reason to keep them on the page. N^oformation ^Talk 04:45, 9 September 2013 (UTC)

Also, please read WP:MEDRS and WP:NOTFORUM. Once you read these, if you think there's anything useful among those links, please suggest an edit. TippyGoomba (talk) 04:50, 9 September 2013 (UTC)

Caption

The caption on the first picture says that the fluoride in the water "doesn't change the appearance, taste or smell of drinking water." and then cites a source where those claims are inaccessible to the public because it needs to be purchased after going through login registration. In the information available to the public the claim isn't there. To view the reference it costs $35.

I live in Japan, where fluoridation is rare and went back home the the US and tasted the fluoride in concentrated orange juice. Perhaps the reason most people don't taste the fluoride in the water is that they have been drinking fluoridated water all or most of their lives. Regardless, that caption should be changed and use of the inaccessible references should be minimized.

Being that one of the first things that anyone viewing the page sees is probably those claims, doesn't that claim also poison the well? Instead of reading the article someone could go to the page and see those claims, that without $35 no one can confirm, and jump to conclusions.

Please change the caption. It isn't a good caption.

126.13.41.49 (talk) 23:23, 13 September 2013 (UTC)

No one actually pays the $35, many of us access these articles via a university proxy, which has a license to a large amount of scholarship. If you were ever enrolled at a university, you should check if you still have access to their proxy, sometimes they don't bother to turn it off. Or you could ask a friend with access... TippyGoomba (talk) 01:24, 14 September 2013 (UTC)

Even if that was not the case WP:PAYWALL, which specifically states that sources should not be rejected due to cost of access, applies here. In that case unless someone is suggesting replacing the current source with a free alternative of equal value there is nothing to discuss.--70.49.73.6 (talk) 05:29, 14 September 2013 (UTC)

IQ citations

Also, please stop adding irrelevant citations to the "IQ" line. I've said it twice but please understand: that sentence is about antifluoridationist literature on the web. not about specific studies that confirm/deny anything. That line is cited already (cite #22) and is not making the statement you think it is/should be. It would be wise for you to discuss changes before making them. N^oformation ^Talk 04:58, 9 September 2013 (UTC)

Would you suggest a different sentence to place it at? Or perhaps creating a new sentence? Campoftheamericas (talk) 05:12, 9 September 2013 (UTC)

I would suggest you revert yourself and hope an admin at WP:3RRN takes that into consideration instead of blocking you, but until then a conversation is pointless since you'll probably be taking a break for 24-48 hours otherwise. After the administrative issue is resolved the content issue can be discussed. N^oformation ^Talk 05:15, 9 September 2013 (UTC)

You don't want to talk about the article? Campoftheamericas (talk) 05:19, 9 September 2013 (UTC)

"until then a conversation is pointless since you'll probably be taking a break for 24-48 hours otherwise. After the administrative issue is resolved the content issue can be discussed" N^oformation ^Talk 05:20, 9 September 2013 (UTC)

Ok, how about now? Do you think this citation can be put somewhere in the article? I would like to say that flouride at 1.31mg/L (approx 1.31ppm) causes decreased IQ. Any objections? Campoftheamericas (talk) 01:41, 11 September 2013 (UTC)

That statement requires a source. Please provide a source which meets the criteria of WP:MEDRS. You should read it carefully, expect me to quote from it to explain why whatever source you'll come up with is invalid. 03:22, 11 September 2013 (UTC)

http://www.ncbi.nlm.nih.gov/pubmed/21237562/Campoftheamericas (talk) 03:49, 11 September 2013 (UTC)

From WP:MEDRS: In general, editors should rely upon high-quality evidence, such as systematic reviews, rather than lower-quality evidence, such as case reports, or non-evidence, such as anecdotes or conventional wisdom.

This paper which you claim to be "lower quality evidence", was published in the Journal of Hazardous Materials. The publisher is Elsevier, one of the biggest if not the biggest publisher of scientific journals. Do you think articles published by Elsevier are of low quality? Campoftheamericas (talk) 03:09, 25 September 2013 (UTC)h

That's not the point WP:MEDRS is making. What WP:MEDRS is indicating is that a secondary source is needed; the study by Ding that you mentioned is a primary source. A secondary source will gather, evaluate and analyze a number of primary sources like that one. Zad68 03:32, 25 September 2013 (UTC)

Got any systematic reviews we can look at? TippyGoomba (talk) 03:57, 11 September 2013 (UTC)

systematic review, aka "secondary" source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/ Campoftheamericas (talk) 04:15, 11 September 2013 (UTC)

How about removing the line "Other adverse effects lack sufficient evidence to reach a confident conclusion.[11]", or at least making the article clear that it is referring only to low levels of fluoride? Campoftheamericas (talk) 06:46, 11 September 2013 (UTC)

The statement is sourced, why would we remove it? It's clear that it only applies to water fluoridation, the topic of the article, and not contaminated or natural water supplies. If there is a more-recent systematic review of water fluoridation that contradicted the statement, only then would we replace the statement with the new revelation. TippyGoomba (talk) 07:07, 11 September 2013 (UTC)

The statement should be clarified, because there is a newer systematic review showing that water fluoridation can cause other ill effects. So for example, instead of "There is no clear evidence of other adverse effects.[11]", it should say "At the dosage level recommended for water fluoridation, there is no clear evidence of other adverse effects.[11]" Campoftheamericas (talk) 07:52, 11 September 2013 (UTC)

Source? (When you make a claim and don't provide a source, I will ask for the source, please provide it in advance.) TippyGoomba (talk) 04:46, 12 September 2013 (UTC)

Did you forget the systematic review above? I thought you would remember since you asked for it before. It is in bold. Campoftheamericas (talk) 21:08, 13 September 2013 (UTC)

It doesn't pertain to your suggested edit anyway. I increased the verbosity to make it clear we're talking about water fluoridation [2]. I don't think it adds anything, personally. TippyGoomba (talk) 03:18, 25 September 2013 (UTC)

RFC? I see Campoftheamericas restored the RFC notification box but it's hard to figure out what the RFC question might be, especially for a newcomer to this conversation. An RFC works best when the question is clearly defined and focused on one particular proposed change along with the source. Zad68 03:41, 25 September 2013 (UTC)

IQ Citations, Ding Et Al

http://www.ncbi.nlm.nih.gov/pubmed/21237562/Campoftheamericas (talk) 03:49, 11 September 2013 (UTC)

Fyi, the article you gave is also not about water fluoridation: Mean value of fluoride in drinking water was 1.31±1.05 mg/L (range 0.24-2.84). We require a higher quality source anyway, so it doesn't really matter but I thought you might be interested. TippyGoomba (talk)

I don't follow. How can research that involved fluoridated water, not involve the topic of water fluoridation? Campoftheamericas (talk) 04:09, 11 September 2013 (UTC)

We have to follow WP:SYNTH and WP:OR, there is an article on Fluoride toxicity. You gave a source but you didn't suggest an edit. TippyGoomba (talk) 05:36, 11 September 2013 (UTC)

I disagree with this edit that adds a primary source that does not study or review antifluoridationist literature to a sentence covering that topic. Zad68 12:40, 11 September 2013 (UTC)

(1) This is not a primary source (2) The sentence has bias, and should be changed to say: "Research presented links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid." Campoftheamericas (talk) 18:58, 11 September 2013 (UTC)

Please provide a source (like a recent systematic review) for your suggested edit. TippyGoomba (talk) 04:48, 12 September 2013 (UTC)

I wish to change the sentence to read as (2) above, without use of a source, because to say "antifluoridationist literature" is an argument from ignorance. Campoftheamericas (talk) 21:04, 13 September 2013 (UTC)

Perhaps you mean ad hominem? I don't think it's either, but I think I now understand what you're suggesting. If you're saying you'd like to replace "antifluoridationist literature" with different description, I have the same desire. However, unfortunately, that's what the source uses. TippyGoomba (talk) 01:42, 14 September 2013 (UTC)

While the source may use it, let's not purposely try to bring out the worst content in the citation. Campoftheamericas (talk) 04:47, 28 September 2013 (UTC)

Since it's in the water it's in everything

Should be made more clear that since it is in the water it ends up in most prepared food, beers, sodas, juices, and wines.

this was previously on the USDA website. http://www.fortcollinscwa.org/pages/fluoride.htm

Would be interesting to see a side by side comparison with countries that don't add fluoride to the water. — Preceding unsigned comment added by 184.78.20.231 (talk) 05:14, 4 August 2013 (UTC)

ok i found it on the USDA website. http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/Fluoride/F02.pdf

Can still be found here: http://web.archive.org/web/*/http://www.ars.usda.gov/SP2UserFiles/Place/12354500/Data/Fluoride/F02.pdf Campoftheamericas (talk) 23:33, 1 October 2013 (UTC)

A few specific foods to highlight the issue in the safety section or perhaps the ethics and politics section. Beer, wine, juice, and some fruits and vegetables should be mentioned specifically. — Preceding unsigned comment added by 184.78.20.231 (talk) 12:47, 6 August 2013 (UTC)

Don't leave out the amount of fluoride found in "Tea, instant, powder, unsweetened" of 897.72 parts per million (ppm). — Preceding unsigned comment added by 99.61.176.89 (talk) 16:44, 6 August 2013 (UTC)

I understand that you can't add a comparison of food from fluoridated countries to others, but it does seem worth mentioning that "other sources of fluoride" include beer, wine, fruits, vegetables, etc.

So It has been a month... Can someone add something to the article regarding other sources of fluoride? Also from the World Health Organization this seems quite relevant: While daily intake of 1–3 mg of fluoride prevents dental caries, long-term exposure to higher amounts may have deleterious effects on tooth enamel and bone. http://www.euro.who.int/__data/assets/pdf_file/0018/123075/AQG2ndEd_6_5Fluorides.PDF — Preceding unsigned comment added by 184.78.20.231 (talk) 10:53, 10 September 2013 (UTC)

I believe that if you sign up for an account, you can add the information yourself. Campoftheamericas (talk) 20:11, 23 September 2013 (UTC)

Aesthetic Concern

The following statement in the article: "most of this is mild and usually not considered to be of aesthetic or public-health concern.[10] "
contradicts with [11], where the research states: "At a fluoride level of 1 ppm an estimated 12.5% (95% confidence interval 7.0% to 21.5%) of exposed people would have fluorosis that they would find aesthetically concerning".
I propose changing the wording to: "Those exposed to fluoride level of 1ppm or above, have a 12.5% chance of having dental fluorosis they would find aesthetically concerning [11]"
FYI, [11] is right next to [10] on the following page: https://wiki.riteme.site/wiki/Water_fluoridation#References Campoftheamericas (talk) 08:14, 11 September 2013 (UTC)

Please provide links, rather than the reference numbers (which can change). 10 is older than 11. We always prefer newer systematic reviews, all else equal. TippyGoomba (talk) 05:01, 12 September 2013 (UTC)

How do you propose to deal with the discrepancy? Can the article be improved? Campoftheamericas (talk) 22:12, 13 September 2013 (UTC)

Generally, we go with the most recent but that's not always the case. See WP:MEDDATE. TippyGoomba (talk) 01:27, 14 September 2013 (UTC)

Any suggestions on changing the wording, since there is conflicting evidence? Definitely can't be said as if it is fact. Campoftheamericas (talk) 05:24, 1 October 2013 (UTC)

RFC

please see Talk:Water_fluoridation#IQ_citations for the topics of discussion. Also Water_fluoridation#Aesthetic_Concern and Water_fluoridation#IQ_Citations.2C_Ding_Et_Al Campoftheamericas (talk) 09:13, 26 September 2013 (UTC)

I have had a look through the above discussion but I am still not quite sure exactly what the disagreement is about. Is it principally about the standard of source required to make certain adverse comments about fluoridation? Martin Hogbin (talk) 08:28, 27 September 2013 (UTC)

What is the question being asked of the community? This does not appear to be a RfC. Doc James (talk · contribs · email) (if I write on your page reply on mine) 11:37, 27 September 2013 (UTC)

I agree with the other commenters that this RFC should be clarified so that it asks a direct question. Zad68 13:01, 27 September 2013 (UTC)

If I provide a quality source on a particular topic, then I can use it to support a sentence in the article on the same topic, correct? I believe that is how to create a well documented Wikipedia article. Campoftheamericas (talk) 15:41, 27 September 2013 (UTC)

Is this an RFC comment, or something more general? Yes we start with good-quality sources, but then we also apply things like WP:WEIGHT to make sure the information ends up in the right article and with the right emphasis. It'd be better if you would propose a specific article content change based on a named source, rather than asking a general theoretical question. Zad68 16:05, 27 September 2013 (UTC)

What text do you want to support with what ref? No ref supports all text. Doc James (talk · contribs · email) (if I write on your page reply on mine) 16:18, 27 September 2013 (UTC)

Jmh649, aka Doc James, I restored an edit by Podiaebba, which is the text that I wanted to support with the reference. I would also like to use the reference elsewhere in the article, where IQ effects are mentioned. I appreciate your work with "formatting" the reference https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=573617661&oldid=573605652, but I would like to preserve the text by Podiaebba, and the links to the articles. Campoftheamericas (talk) 20:40, 27 September 2013 (UTC)

We generally paraphrase rather than quote. And if every sentence started with the type of study supporting it our articles would look like a joke. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:08, 30 September 2013 (UTC)

I think we still need a bit more work on the use of Choi, specifically what Choi et al. mean by "high fluoride". This is being used in our article's Safety section, and it needs to be specified whether this effect is something that would be expected to be found in water that has its fluoride levels managed for the purpose of dental health. I would not want a reader of our article to come away with the idea that these effects would be found at those levels, if Choi isn't saying that. Specifically, Choi says "The exposed groups had access to drinking water with fluoride concentrations up to 11.5 mg/L (Wang SX et al. 2007); thus, in many cases concentrations were above the levels recommended (0.7–1.2 mg/L; DHHS) or allowed in public drinking water (4.0 mg/L; U.S. EPA) in the United States (U.S. EPA 2011)." I think this should be worked in if we're going to use Choi, I'd like to pore over it a bit more on this. Zad68 04:08, 30 September 2013 (UTC)

For reference, Choi et al. has come up before on this talk page, most recently in July: Talk:Water fluoridation/Archive 8#Choi review. The problem with using Choi's metaanalysis in this article is that the study populations were drawn from areas where the water had naturally abundant fluoride. In practice, the comparisons were between moderate fluoride levels (often comparable to – or even appreciably exceeding – the WHO-recommended level of 0.5-1.0 ppm fluoride in artificially-fluoridated water) in the "reference" groups, and extremely high levels (anywhere from two to more than a hundred times the WHO guideline) in their "high fluoride" groups.

Bluntly, I didn't notice that it had snuck into the body text of this article, and I'm removing it now, since the consensus in the last discussion was clear. The data are more relevant to fluoride toxicity, and may warrant mention in that article. Choi's data, unfortunately, did not include information relevant to this article, as it did not include sufficient data (or offer analysis, or draw conclusions) about the effects – if any – of the relatively low fluoride levels in artificially-fluoridated water (0.5-1.0 ppm) versus unfluoridated, naturally-low-fluoride water (<0.5 ppm). TenOfAllTrades(talk) 14:13, 1 October 2013 (UTC)

OK, I added it to fluoride toxicity. Please expand there, if you can, on the fluoride levels covered by the study. Podiaebba (talk) 14:52, 1 October 2013 (UTC)

non-article content

Is this a RfC or not? If you want to discuss a particular edit, make a section for it. You're turning the talk page into a mess. TippyGoomba (talk) 02:52, 28 September 2013 (UTC) Maybe you didn't see that the above, where I say: "Jmh649, aka Doc James, I restored an edit by Podiaebba, which is the text that I wanted to support with the reference. I would also like to use the reference elsewhere in the article, where IQ effects are mentioned. I appreciate your work with "formatting" the reference https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=573617661&oldid=573605652, but I would like to preserve the text by Podiaebba, and the links to the articles. Campoftheamericas (talk) 20:40, 27 September 2013 (UTC)". This is a discussion about article content. Feel free to reply in a logical way. Campoftheamericas (talk) 05:34, 28 September 2013 (UTC) This does not help matters. Do not refactor the comments of others. Refactoring your own comments is very confusing, please don't do that either. TippyGoomba (talk) 04:07, 28 September 2013 (UTC) Again, this does not help matters, see WP:REDACT. Please stop this. TippyGoomba (talk) 05:15, 28 September 2013 (UTC) Let's keep the bickering out of the content, shall we? If you have issues, address them on my talk page. Campoftheamericas (talk) 05:34, 28 September 2013 (UTC)

Sounds reasonable. And I removed it again. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:57, 2 October 2013 (UTC)

Please all bear in mind

We are writing an encyclopedia not acting out the pro/anti fluoridation debate. Both sides of this debate should, of course, be represented here in an encyclopedic manner but this article is not the place to push views for or against fluoridation. Martin Hogbin (talk) 09:04, 28 September 2013 (UTC)

Fluoride Research Letter

http://www.fluorideresearch.org/463/files/FJ2013_v46_n3_p104-117_pq.pdf — Preceding unsigned comment added by 99.52.192.202 (talk) 20:01, 29 September 2013 (UTC)

A systematic, second source study showing that the only safe level of Fluoride is zero. Will look further into it, and if the study is well done, it could add to the safety section. Campoftheamericas (talk) 00:00, 30 September 2013 (UTC)

An editorial is not a systematic review. The source fails WP:MEDRS pretty hard, so I'd guess it's useless for the article. But if anyone wants to suggest an edit, I'm prepared to be surprised. TippyGoomba (talk) 00:56, 30 September 2013 (UTC)

Yes, an editorial from an advocacy website. Campoftheamericas (talk) 01:50, 30 September 2013 (UTC)

By saying "Yes" here, are you agreeing that as this is an editorial from an advocacy website, it would not be a sufficient source per Wikipedia's WP:MEDRS standards to support biomedical claims? Zad68 03:50, 30 September 2013 (UTC)

I asked the editor, and he said that his editorial was published in the journal Fluoride. Fluoride is published by the International Society for Fluoride Research, and is in it's 46th year of publication. The Society does not take a position on fluoridation. To answer your question, I don't think this article qualifies as a peer-reviewed systematic study. However, his editorial cited 110 different sources. Perhaps some of those sources could be used to make the Wikipedia article more neutral, rather than only PRO-fluoridation. Campoftheamericas (talk) 05:04, 30 September 2013 (UTC)

This paper does not appear to be pubmed indexed which raises concerns. Doc James (talk · contribs · email) (if I write on your page reply on mine) 05:07, 30 September 2013 (UTC)

The journal Fluoride is not carried by the National Library of Medicine at all, its NLM catalog entry is here but this shows none of its articles are PubMed or MEDLINE indexed. I think we're all in agreement that per WP:MEDRS its articles can't be used here to source biomedical info. Campoftheamericas, although you state that the "Society does not take a position on fluoridation", Quackwatch says The International Society for Fluoride Research may sound respectable, but it is actually an antifluoridation group. We really need to be very careful about using anything published by them, even as a resource to gather sources, because clearly we'd only get one side. I do not see any value in using the lists of references their publications use when we can just use PubMed to search for well-qualified sources. Regarding "Perhaps some of those sources could be used to make the Wikipedia article more neutral, rather than only PRO-fluoridation"-- if the authoritative reliable sources do indeed express a consensus that fluoride is largely safe and beneficial, the Wikipedia article will reflect that, and it would not make it "more neutral" to change the article away from what the best-quality sources say. Zad68 15:37, 30 September 2013 (UTC)

I would consider Quackwatch to be an advocacy site, since it doesn't try to be impartial. Quackwatch does not present supporting arguements for both sides. Speaking of... how about this change: https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=575031116&oldid=574835058 Campoftheamericas (talk) 02:21, 1 October 2013 (UTC)

non-article content
What does that diff have to do with the fluoridation editorial? If you want to change topics, create a new section. TippyGoomba (talk) 03:19, 1 October 2013 (UTC) If you have an issue, please post on my talk page. Campoftheamericas (talk) 03:21, 1 October 2013 (UTC)

Quackwatch has been discussed at length on Wikipedia before and consensus is that it's a useful resource to comment on those pushing fringe views in science and medicine. Either way, as mentioned, Fluoride isn't PubMed indexed and would not be useful to look for sourcing for this article. Per WP:MEDRS The International Society for Fluoride Research isn't the kind of organization we seek out for sourcing, either. From WP:MEDRS, we're looking for: literature reviews or systematic reviews published in reputable medical journals, academic and professional books written by experts in the relevant field and from a respected publisher, and medical guidelines or position statements from nationally or internationally recognized expert bodies. Zad68 03:33, 1 October 2013 (UTC)

Regarding the single person that writes Quackwatch with no peer-review, and whose editorials are not published in any journal: "Under cross-examination Barrett conceded that he was not a Medical Board Certified psychiatrist because he had failed the certification exam. The most damning testimony before the jury, under the intense cross-examination by Negrete, was that Barrett had filed similar defamation lawsuits against almost 40 people across the country within the past few years and had not won one single one at trial. During the course of his examination, Barrett also had to concede his ties to the AMA, Federal Trade Commission (FTC) and Food & Drug Administration (FDA)." Campoftheamericas (talk) 05:22, 1 October 2013 (UTC)

No one is using quackwatch to justify anything. See WP:NOTFORUM. Let's get back on topic. Are you suggesting an edit? TippyGoomba (talk) 05:25, 1 October 2013 (UTC)

Article Edit

I would consider Quackwatch to be an advocacy site, since it doesn't try to be impartial. Quackwatch does not present supporting arguements for both sides. Speaking of... how about this change: https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=575031116&oldid=574835058 Campoftheamericas (talk) 02:21, 1 October 2013 (UTC)

Is this supposed to be a new section? TippyGoomba (talk) 06:07, 1 October 2013 (UTC)

This edit proposes the follow change to the opening sentence: "Water fluoridation is the controlled addition of fluoride to a public water supply to reduce for the purpose of reducing tooth decay." This edit appears to add more words without really changing the meaning conveyed. I prefer the existing wording. Zad68 12:52, 1 October 2013 (UTC)

I see what you mean. How about "Water fluoridation is the controlled addition of fluoride to a public water supply. This is done with the belief that this reduces tooth decay, even though there are conflicting studies on effectiveness and safety. Campoftheamericas (talk) 18:04, 1 October 2013 (UTC)

Unfortunately that would put the opening sentences of the lead at odds with the content in the article body, and specifically the information in the section Evidence basis: Effectiveness. That section states pretty clearly that fluoride is indeed effective and good-quality secondary sources are cited in support. The lead needs to summarize the article body, it really can't contradict it. Zad68 18:26, 1 October 2013 (UTC)

NPOV concerns

I was randomly selected for the RFC and I don't have any experience arguing about water fluoridation. However, it seems that the overwhelming amount of evidence supports the idea that fluoridation is completely safe. Adding caveats like Campoftheamericas proposes would be at odds with scientific consensus. Andrew³²⁷ 19:13, 1 October 2013 (UTC)

After reading this article, you may believe this. http://www.columbian.com/news/2013/may/19/fluoride-question-portland-water-supply-vote/#.Uksgm9j0f6o and https://wiki.riteme.site/wiki/Fluoridation_by_country Campoftheamericas (talk) 19:31, 1 October 2013 (UTC)

I don't have any deeply held feelings on the matter, but I just can't find any major peer reviewed study that has found any harm in fluoridation. Feel free to find something in any of these journals if you want to change my mind. Andrew³²⁷ 19:41, 1 October 2013 (UTC)

Try other search engines. For example: http://scholar.google.com/scholar?q=drinking+water+fluoride+toxicity. Or use the work of someone else who has done the search for you: http://www.adelaide.edu.au/library/guide/med/wd.html Campoftheamericas (talk) 19:57, 1 October 2013 (UTC)

Google Scholar, ProQuest, and Ebsco Host are all giving me basically the same results. Too much fluoride is bad and there are documented cases from India and elsewhere where natural fluoridation levels are unhealthy. The literature appears to agree that the amount put in drinking water is good. I'm just not finding replicable studies in peer reviewed journals that connect municipal fluoridation with negative effects. Andrew³²⁷ 20:10, 1 October 2013 (UTC)

The null hypothesis is, and will continue to be, that fluoride is toxic to humans at any level. It is not a nutrient. You could do the same study with trace amounts of cyanide in the water supply, and have a hard time proving that the trace amounts have a detrimental effect on human health. Sure, at higher amounts cyanide will kill you, but at trace amounts we do not have sufficient evidence that it is harmful. This is poor use of logic. Most developed nations do not fluoridate their drinking water. For reading about the toxicity of fluoride, see here: http://www.slweb.org/bibliography.html Campoftheamericas (talk) 20:38, 1 October 2013 (UTC)

The Environmental Protection Agency actually has standards for how much cyanide is safe to drink. On the flipside, water toxicity has been well established, meaning that water is toxic if consumed in high enough doses. What you need to prove is that the level of fluoride in municipal water systems is unhealthy, and you need to do it using respected peer reviewed medical journals. Andrew³²⁷ 20:49, 1 October 2013 (UTC)

The null hypothesis is, and will continue to be, that fluoride is toxic to humans at any level. I could also discredit previous studies for conflict of interest, correct? Campoftheamericas (talk) 21:03, 1 October 2013 (UTC)

That's not the null hypothesis. The studies I've found use variations of this as the null hypothesis: "Drinkers of fluoridated and non-fluoridated water have no differences in terms of long-term health outcomes." Besides, Wikipedia doesn't have a null hypothesis. It uses reliable sources, and you have yet to cite a single peer-reviewed medical journal article that clearly states that municipal water fluoridation causes any negative effects whatsoever. I am still open to reading any such article. The consensus of reliable medical sources appears to be that fluoridation is a good thing. Andrew³²⁷ 21:25, 1 October 2013 (UTC)

Evidence that water fluoridation is not a good thing: from http://www.ncbi.nlm.nih.gov/pubmed/10916327 " Importantly, this means that fluoride incorporated during tooth mineral development at normal levels of 20 to 100 ppm (even in areas that have fluoridated drinking water or with the use of fluoride supplements) does not measurably alter the acid solubility of the mineral. Even when the outer enamel has higher fluoride levels, such as 1,000 ppm, it does not measurably withstand acidinduced dissolution any better than enamel with lower levels of fluoride. Only when fluoride is concentrated into a new crystal surface during remineralization is it sufficient to beneficially alter enamel solubility. The fluoride incorporated developmentally, that is, systemically into the normal tooth mineral is insufficient to have a measurable effect on acid solubility. 21,3" What this is saying, is that fluoride ingested and incorporated into tooth enamel as children develop, has no measurable effect on preventing cavities for the life of the tooth In other words, there is no benefit to ingesting fluoridated water. Campoftheamericas (talk) 22:10, 1 October 2013 (UTC)

What edit are you suggesting using this source, Featherstone 2000? It's 13 years old and using it would be a problem per WP:MEDDATE. Regardless, its abstract says the same thing more up-to-date sources say: Fluoride in drinking water and in fluoride-containing products reduces caries through topical action. I'm not sure how you're getting Evidence that water fluoridation is not a good thing out of it. Zad68 01:05, 2 October 2013 (UTC)

I see you modified your statement after I replied to it, I really wish you wouldn't do that, please. Yes, I agree with you that the medical literature indicates that the anticavity action of fluoride is topical (as I said) and not systemic. The article already states that pretty clearly. I think historically people used to believe the effect was systemic but that's not the consensus today. Still not sure what the issue is you're looking to address. Zad68 02:08, 2 October 2013 (UTC)

Overall uncertainty, for both stances: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/ "Given the certainty with which water fluoridation has been promoted and opposed, and the large number (around 3200) of research papers identified,9 the reviewers were surprised by the poor quality of the evidence and the uncertainty surrounding the beneficial and adverse effects of fluoridation." Also note: "Fluoride is not in any natural human metabolic pathway." In other words, fluoride is not nutrient. Water is a nutrient. Campoftheamericas (talk) 22:17, 1 October 2013 (UTC)

This source Cheng 2007 is a nice overview of the controversies and has been used in our Wikipedia article since at least the time it was promoted to WP:FA. It's still being used now. Cheng 2007 doesn't mention "nutrient" anywhere in it, it's unclear what article edit you're proposing using this source, or why you're bringing up this "nutrient" idea. Zad68 01:09, 2 October 2013 (UTC)

Yes, the quotes above are from Cheng 2007. Also this quote: "there have been no randomized trials of water fluoridation", which means that there is not PROOF that water fluoridation reduces cavities. This Wikipedia article reads like a pro-fluoridation activist article. It does not express the current scientific establishment. Campoftheamericas (talk) 02:45, 2 October 2013 (UTC)

This Wikipedia article ... does not express the current scientific establishment <== Demonstrating that this is true through the proper use of authoritative reliable sourcing that meets WP:MEDRS is the one and only path to seeing changes to the article stick. I think most of the editors here don't agree with your statement, and feel the article already does express the views of the current scientific establishment. The sources you've brought, or your use of them, haven't yet made a convincing argument that there's a NPOV problem. Zad68 02:58, 2 October 2013 (UTC)

Edit Protection

Please keep the NPOV tag, to show that the neutrality is being discussed on the talk page. — Preceding unsigned comment added by Campoftheamericas (talk • contribs) 03:55, 2 October 2013 (UTC)

I see you applied a {{Edit protected}} template at the top of the page. That template is not for requesting page protection (it's for requesting edits to be made to a protected page), so I removed it. If you want to request protection, see WP:RFPP and follow the instructions there, although we should probably wait and see what the outcome of the WP:ANEW report is first, as page protection is a possible result from that. Zad68 04:01, 2 October 2013 (UTC)

NPOVN discussion notice

Note to editors: A WP:NPOVN noticeboard discussion has been opened about this article here. Zad68 19:10, 1 October 2013 (UTC)

And now an AN/EW. TippyGoomba (talk) 03:33, 2 October 2013 (UTC)

Sigh, edit-warred over a POV tag and got a 72 hour ban. TippyGoomba (talk) 04:36, 2 October 2013 (UTC)

Consensus over POV tag

To be clear, is there a consensus to add a POV maintenance tag to this article? I do not believe it is necessary, but I want to give a chance for broader input. I won't bother with an RFC unless there is more disagreement than I'm expecting. Andrew³²⁷ 15:50, 8 October 2013 (UTC)

I'm not sure what you're querying the necessity of—the discussion, or the tag? (Neither seems necessary.)

If there is an NPOV dispute on this article, it would be helpful to have someone actually summarize the open issues that still require discussion. The {{npov}} template isn't required to indicate that there is a tiny fringe minority that is unhappy about WP:MEDRS, else it would have to permanently decorate every article that doesn't embrace or endorse every pet conspiracy theories. TenOfAllTrades(talk) 18:27, 8 October 2013 (UTC)

Do not agree tag is needed, prerequisites of {{NPOV}} article-wide tag not met. Zad68 19:14, 8 October 2013 (UTC)

Noting also that TippyGoomba recently reverted the addition of the tag here, Jmh649 did here, and BullRangifer did here. It's up to them to provide any further clarification on their positions, but based on their recent reverts, it looks like they don't agree either. Zad68 19:18, 8 October 2013 (UTC)

Thanks, all. There are enough anti-fluoridation people out there that it's worth confirming that consensus still supports the article text as written. I completely agree that the article is written in a neutral manner. Andrew³²⁷ 19:59, 8 October 2013 (UTC)

I'm neither decidedly pro- or anti-fluoridation (I use fluoride toothpaste and drink the water), but I do not think that the article as written is neutral. It appears strictly pro-fluoridation and one-sided in my read. It feels like it is written to by anti-anti-fluoridation campaigners, and overstates the certainty of absolute safety. It does not fairly convey recent (post 2005) concern expressed by scientists about the potential impacts of fluoride levels below 4.0 mg/L or even below 1.0 mg/L. This concern is coming from the likes of the National Research Council. In 2006 the National Research Council published a review of the EPA's drinking water standard for fluoride. The report noted evidence for potential negative effects due to fluoridation, including cognitive impairment, impaired thyroid functioning, and increases in bone fractures, in addition to the fluoridosis of children's teeth. The NRC called for a reduction of the EPA's limit of 4.0 mg/L of fluoride in drinking water. It should be noted that this was a higher standard than the recommended levels for water fluoridation (targeting levels from 0.7 to 1.2 mg/L). However, members of the committee were quoted in an article published in a Scientific American expressing some concern about the fluoride exposure even at those levels.

John Doull, the chair of the NRC committee, expressed “worry” about the thyroid issue, and said that overall there was a surprising deficit of scientific information.

“What the committee found is that we’ve gone with the status quo regarding fluoride for many years—for too long, really—and now we need to take a fresh look. In the scientific community, people tend to think this is settled. I mean, when the U.S. surgeon general comes out and says this is one of the 10 greatest achievements of the 20th century, that’s a hard hurdle to get over. But when we looked at the studies that have been done, we found that many of these questions are unsettled and we have much less information than we should, considering how long this [fluoridation] has been going on. I think that’s why fluoridation is still being challenged so many years after it began."

In the Scientific American article:

"the NRC report...found that infants and toddlers in fluoridated communities ingest about twice as much fluoride as they should. Furthermore, the committee noted that adults who drink above-average amounts of water, including athletes and laborers, are also exceeding the optimal level for fluoride intake."

This is a specific place where the wiki article "slants" the interpretation of the NRC report. Members of the NRC committee, both within the report, and commenting in the media, said that their review of the scientific literature lead them to have some concerns about levels and impacts of water fluoridation, but the wiki article just says that the NRC report pertains only to high levels of natural fluoride.

Clearly, water fluoridation has been the subject of less-informed critics (conspiracy theorists, if you will). But that doesn't mean that every critic of the current water fluoridation regime is a crack pot. Pigkeeper (talk) 18:50, 24 November 2013 (UTC)

Generalization based on 11 year old study criteria

Zad68, wants to discuss the removal of the claim = "Studies on adverse effects have been mostly of low quality." and "With regard to potential adverse effects, almost all research has been of low quality." https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=prev&oldid=576431509 This generailzation on the science is based on review criteria from 2002 http://www.nature.com/bdj/journal/v192/n9/full/4801410a.html Because the statement is based on a 11 years old review criteria, it gives a false impression on current studies on potential adverse effects. Prokaryotes (talk) 13:13, 9 October 2013 (UTC)

I'd be OK with changing the text to "A comprehensive 2002 study on fluoride safety found that studies of adverse effects were generally of low quality." Andrew³²⁷ 13:25, 9 October 2013 (UTC)

The source suggest otherwise "The small quantity of studies, differences between these studies and their low quality rating suggests caution in interpreting these results." Prokaryotes (talk) 14:13, 9 October 2013 (UTC)

(e/c) Are there more up-to-date reviews we can cite to support the same statements? Can we resolve the concerns by instead stating in the article the year the source was published? Zad68 13:27, 9 October 2013 (UTC)

This meta analysis shows adverse effects on the brain http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491930/ Prokaryotes (talk) 13:29, 9 October 2013 (UTC)

Ah, yes, Choi 2012. The quality of that study is hotly debated, and even if it weren't, what they looked at isn't actually relevant to this article. Their conclusion was based on exposure to fluoride at levels many times higher than found in water fluoridated for dental health. So I don't think it's useful for these statements. Zad68 13:33, 9 October 2013 (UTC)

Choi et al 2012 isn't hotly debated, as far as i know there was 1 dispute which was based on a misunderstanding. Prokaryotes (talk) 14:22, 9 October 2013 (UTC)

(edit conflict) It appears that the study you cite refers to naturally occurring levels of fluoride as opposed to intentional water fluoridation. There's no doubt that too much fluoride is a bad thing, just like too much water. But I have not been able to find a study that says that the level of fluoride used in municipal water systems causes any harm. Even the studies conclusions only "support the possibility of adverse effects". Andrew³²⁷ 13:43, 9 October 2013 (UTC)

There's another way that this could have been written, and it points to an overall bias of the page. McDonagh et al are cited in order to dismiss concerns about adverse impacts, on the grounds that studies about adverse effects are of lower quality (mainly because they don't account for potential confounding effects). There is a failure in logic here. The same lack of quality research means that claims of safety (an absence of adverse effects) are also under-supported. As McDonagh et al. say (page xiv), "The research evidence is of insufficient quality to allow confident statements about other potential harms." I read this as saying that there is insufficient evidence to say whether fluoridation safe or unsafe. If you're going to be citing McDonagh et al, why not express what they say about the state of research overall? They also criticize the quality of research for the efficacy of water fluoridation on preventing caries. It is better than the research on safety, but it is still lacking, they say. Why not include the following quote by McDonagh? "Given the level of interest surrounding the issue of public water fluoridation, it is surprising to find that little high quality research has been undertaken." This aligns with the quote from the NRC Commission chair, above. Two groups of scientists conducted in depth reviews and both found that the scientific research basis for water fluoridation (efficacy, and especially safety) was less than you would expect for such an old and widespread program.Pigkeeper (talk) 19:56, 24 November 2013 (UTC)

WP:SYNTH

Goal section: Once a cavity occurs, the tooth's fate is that of repeated restorations, with estimates for the median life of an amalgam tooth filling ranging from 9 to 14 years.[23] Oral disease is the fourth most expensive disease to treat.[24]

Suggesting that tooth decay (dental caries) is the fourth most expensive disease to treat. As the source states, oral disease is not only dental caries, it includes periodontal disease, tooth loss, oral mucosal lesions, oropharyngeal cancers, oral manifestations of HIV/AIDS, necrotising ulcerative stomatitis (noma), orodental trauma. Periodontal disease and tooth loss are linked to chronic diseases such as diabetes mellitus.

It's as if in the article cerebrovascular disease, one would write "30% of all global death is attributed to cardiovascular disease". Ssscienccce (talk) 15:57, 6 December 2013 (UTC)

Mechanism section: Fluoride's effects depend on the total daily intake of fluoride from all sources.[12] ... Drinking water is typically the largest source of fluoride. In many industrialized countries swallowed toothpaste is the main source of fluoride exposure in unfluoridated communities. ...

Suggesting that fluoride intake is what determines the protective effect on tooth enamel, despite previously stating that the effect is mainly due to topical, not systemic fluoride. The source document itself is not about the beneficial effects or the mechanism, it deals mainly with adverse effects due to excess systemic fluoride. Of the 125 pages, 43 are about methods to remove fluoride from drinking water, 15 about testing fluoride content, and 28 pages of country specific data on skeletal and dental fluorosis associated with fluoride in drinking water. Ssscienccce (talk) 16:43, 6 December 2013 (UTC)

minor typo

"No clear evidence of other adverse effects exists though almost research thereof has been poor" - somebody accidentally a word, I think. Should be "almost *all* research". Would fix but page is locked and I have no account. — Preceding unsigned comment added by 91.237.176.7 (talk) 16:01, 27 January 2014 (UTC)

Y Done. Thanks! 0x0077BE [^talk/_contrib] 01:58, 16 February 2014 (UTC)

Natural Fluoride levels correlated to cognitive impairment, and implications for water fluoridation; impacts were found at levels which were not "much higher" than fluoridation targets

Choi et al 2012 is a major Meta-Analysis by a Harvard and Chinese team which found an association between higher fluoride levels and lower IQ. It can be found at http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/

This was discussed previously ( https://wiki.riteme.site/wiki/Talk:Water_fluoridation/Archive_9 ). Someone referenced the article and suggested it for inclusion (without making a case). Some thought it would be good to include it. Others argued against its inclusion for two reasons. First, it was argued that this page is about human-caused water fluoridation, not naturally occurring higher levels of fluoride. Second, it was argued cognitive impacts were found at water fluoride levels which were were "far in excess of WHO recommended levels" of 1.5 mg/L. People made cheeky comments that even water is toxic at very high doses.

This was too hasty a decision. There should be a reconsideration, and Choi et al should be included on this page. At a bare minimum, IQ reduction should be added to the adverse effects of elevated levels of natural fluoride in water. [Safety section] However, from Choi et al, there is justification for making a stronger statement.

First, as the article currently stands, there are references to adverse effects associated with high levels of naturally occurring fluoride in water. But this does not included reduction in IQ. Why not?

Second, most of the studies which Choi et al reference show reduced IQ scores at fluoride concentration levels which are NOT "much higher" than WHO levels (as one wikipedian said), but rather are within the same order of magnitude. From table one, I count 19 studies which look at drinking water levels within an order of magnitude of the WHO levels--and most of them were much closer than an order of magnitude. Seventeen of those found that children from areas with higher-fluoride water had significantly lower IQ.

Not good enough for you? I counted 12 studies where the "high dose" of fluoride was less than 3x the WHO recommendation, and in 10 of those, there was a detectable decrease in IQ. That's really a big deal. Consider the therapeutic ratio for drugs. Drugs which have toxic effects at 3x the therapeutic range are considered dangerous. Of course, when you're dosing whole populations with the water, dosing levels are anything but exact. Some people drink more water. And in the United States, people get a good deal of fluoride from other sources besides drinking water, too. (Fagin 2008 citing Levy's work)

Furthermore, there is a 2011 article ( http://www.ncbi.nlm.nih.gov/pubmed/21237562 ) which addresses the question of "whether low fluoride exposure levels less than 3.0 mg/L in drinking water adversely associated with children's intelligence". Children from several sites in Inner Mongolia, China were compared, where there was natural fluoridation at lower levels in the drinking water (0.24–2.84 mg/L). The sample size was 331 children, and a comparison was made between the children's urine fluoride levels and IQ. From the abstract: "Urine fluoride was inversely associated with IQ in the multiple linear regression model when children’s age as a covariate variable was taken into account (P< 0.0001). Each increase in 1 mg/L of urine fluoride associated with 0.59-point decrease in IQ (P= 0.0226). Meanwhile, there was a dose–response relationship between urine fluoride and dental fluorosis (P< 0.0001). In conclusion, our study suggested that low levels of fluoride exposure in drinking water had negative effects on children’s intelligence and dental health and confirmed the dose–response relationships between urine fluoride and IQ scores as well as dental fluorosis."

Something about this deserves to make it on the page, in the safety section. This isn't manufactured hysterical controversy, this is the real deal.Pigkeeper (talk) 23:37, 24 November 2013 (UTC)

To include such information in this article you need to find a high quality WP:MEDRS compliant source that mentions artificial water fluoridation safety in this context. Splicing together different studies as you propose above is clear WP:SYNTH. Yobol (talk) 00:34, 25 November 2013 (UTC)

That's a reasonable statement. However, neglecting any mention of the very real and repeated risks of fluoridation in multiple contexts to public health from multiple extremely credible sources in study after study may reduce the value of Wikipedia as reference material.

Both the Choi et al. meta-analysis and the small Ding et al. (2011, [3]) study were discussed across multiple sections on that archive page; I don't think you're being fair or accurate to suggest that the previous discussions were as brief or dismissive as you make them out to be. There was broad agreement that the proper place to consider the Choi study was in our article on fluoride toxicity.

Ding et al. is actually a good example of why we don't – and why we shouldn't – rush to include primary papers as sources for medical claims (not to mention why the abstract of an article should never be trusted by itself). While it appeared in a reasonably reputable journal, it also fell well outside the usual types of studies published in J. Hazardous Mater.. That journal does a lot of physical chemistry, and detection of environmental chemicals and toxins, and remediation strategies, and a wee bit of wet biology, and so forth, but precious little in the way of direct studies of human health and epidemiology (speaking anecdotally, I couldn't find any other such studies in any of the journal's recent articles or last couple of issues). It raises a red flag when a paper doing clinical chemistry and public health studies doesn't make it into a medical or public health journal. The paper itself has a number of gaps in its analysis and problems with the robustness of its raw data (which I won't go into for WP:NOTFORUM reasons), and the variety of conclusions drawn from the data (or selectively not drawn, when looking at the full paper) is quite a bit broader than one might infer from looking only at the article's (presumably length-constraimed) abstract. TenOfAllTrades(talk) 16:14, 16 February 2014 (UTC)

Addition

Have brought this here for discussion "A 2012 meta-analysis found that fluoride exposure may be associated with adverse neurodevelopmental outcomes in children, as manifested in lower IQ scores,though the authors cautioned that its results are not really applicable to the United States as their research focused on much higher levels of fluoride exposure."

The ref [4] does not appear to be about water fluoridation but high levels of naturally occuring fluoride. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:04, 23 February 2014 (UTC)

Agreed, it's important to understand the difference between problems with large amounts of the substance and problems with the level present in drinking water. Studies have shown serious issues arising from excessive levels of fluoride, but not from the small amounts that we drink. Andrew³²⁷ 18:33, 23 February 2014 (UTC)

This is just Choi et al. (2012) again, which has been discussed to death on this talk page. Heck, the most recent conversation about it is right at the top of this page. TenOfAllTrades(talk) 18:50, 23 February 2014 (UTC)

Perhaps it's worth considering what Philippe Grandjean (professor), the lead author of Choi et al., has to say about this paper, namely that its results "do not allow us to make any judgment regarding possible levels of risk at levels of exposure typical for water fluoridation in the U.S. On the other hand, neither can it be concluded that no risk is present." [5] Jinkinson talk to me 20:29, 23 February 2014 (UTC)

Also, here's an even stronger statement by Grandjean: "Fluoridation's

potential to produce "chemical brain drain," Grandjean writes, is an issue that "definitely deserves concern." And: ""only 4 of 27 studies" in the Harvard review used the high levels that the Wichita paper described, and "clear differences" in IQ "were found at much lower exposures." [6] Note: the "Wichita paper" refers to this article. Jinkinson talk to me 02:53, 24 February 2014 (UTC)

"Fluoride Action Network" is not a reliable source. Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:59, 24 February 2014 (UTC)

Alright, I guess that's true, but I still find it far-fetched that FAN would completely make up those quotes and then attribute them to Grandjean if he didn't actually say them. Jinkinson talk to me 03:17, 24 February 2014 (UTC)

Are they published in a recent review article? Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:23, 24 February 2014 (UTC)

Oh, Grandjean said it – it's at the bottom of this press release – but FAN doesn't seem to notice that he (and the first author of the paper, Choi) issued a second "revised" release a week later that walked back the overreach in Grandjean's original statement. Grandjean and Choi return to and restate the conclusions from their paper: that extremely high levels of fluoride appear to be harmful, that no conclusion can be drawn regarding fluoride at levels in artificially-fluoridated water, and that further study is warranted (please fund us). This is, incidentally, why we don't base Wikipedia article content on "science by press release". TenOfAllTrades(talk) 03:34, 24 February 2014 (UTC)

Lancet Neurology Study

This new study, conducted by a professor at Harvard's School of Public Health, was published in a high impact journal is compelling and should be integrated in this article. I heard about this study on NPR, and it has rightly gotten much press. I say "rightly" because this review of research was published in a high impact journal and was conducted by a professor at Harvard (even Harvard's press release about this study is noteworthy). http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70278-3/abstract DanaUllman^Talk 16:04, 24 February 2014 (UTC)

Yes it is a 2014 review articles in Lancet Neurol. The problem is that it does not appear to mention "water fluoridation" So what should we use it to say? Yes we all agree that large amount of fluoride are bad. So are large amounts of iron as they fairly rapidly result in death. Doc James (talk · contribs · email) (if I write on your page reply on mine) 18:27, 24 February 2014 (UTC)

Based on this important new review of research, it seems prudent to reduce exposures to certain elements, such as fluoride, and its various means to exposure, especially for children whose brains are in more active development. Because Doc James is a special in preventive medicine, I assume that he has some appreciation for the precautionary principle. I'm no expert on water fluoridation and do not plan to participate in the writing of the article, but I hope that those of you who are active in this article will figure out a place for this body of evidence. DanaUllman^Talk 01:31, 25 February 2014 (UTC)

Yes well aware of the precautionary principle. The difficulty in question is that the article you list does not mention water fluoridation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 01:57, 25 February 2014 (UTC)

The article in question provides a strong case for limiting exposure to certain toxic substances, and because fluoride in water provides additional exposure, it seems obvious that fluoridated water creates additional risk to populations, not just because of people drinking the water but also due to people using water to wash fruits and vegetables and to water their edible gardens. Whether fluoride in water is naturally occurring or fluoride in water is an added ingredient, it seems prudent to warn people about the dangers of both, especially because the evidence here commands it. DanaUllman^Talk 15:39, 25 February 2014 (UTC)

Everything after "it seems obvious..." in your statement above is unsupported by the linked paper (or the 2012 Choi meta that its fluoride claims are based on). As Wikipedia article talk pages are not discussion forums for general chat, I hope that you can understand why I would ask you to propose specific changes to this article (and indicate specifically which passages of the source support your proposed statements) if you would like to continue posting on this talk page. TenOfAllTrades(talk) 16:00, 25 February 2014 (UTC)

In the article's section on "Evidence," there is the statement: "No clear evidence of other adverse effects exists, though almost all research thereof has been of poor quality." At the very least, there is clear evidence now from a couple meta-analyses published in high impact journals that provide evidence from high quality studies verifying dangers to exposure to fluoride. For starters, this statement now needs to be removed. DanaUllman^Talk 03:53, 26 February 2014 (UTC)

I can't believe I actually have to point this out, but that statement is in a paragraph that specifically says it's talking about "water fluoridation". I know it's been mentioned many times exactly what that means, that this whole article is limited to that scope, and that the ref is not within that scope. DMacks (talk) 04:36, 26 February 2014 (UTC)

Z I'm in agreement with the others here that the Lancet article doesn't appear to be related to the topic of water fluoridation so that it can be used here. DanaUllman, what exactly is your proposed change to the Wikipedia article using this source? Without a specific change proposal this discussion doesn't appear to be a good use of time. Zad68 05:03, 26 February 2014 (UTC)

[User:Zad68] has asked me what "specific" change I was recommending. I thought I was clear about this. I will reiterate: "At the very least, there is clear evidence now from a couple meta-analyses published in high impact journals that provide evidence from high quality studies verifying dangers to exposure to fluoride. For starters, this statement now needs to be removed." And for the record, the research that I referenced provided evidence that fluoride can lead to disruption in cognitive function, and because water fluoridation increases exposure to fluoride, there IS a case for why reference to this study in a high impact journal is worthy of reference in this article. If I am the only one who considers this reference worthy, I will relent, but in any case, the above mentioned sentence still deserves to be deleted. DanaUllman^Talk 02:13, 27 February 2014 (UTC)

Can you please quote the exact passage from the paper that specifically contradicts the statement in this Wikipedia article? Like Zad68 and DMacks, I cannot find any mention of water fluoridation – the controlled addition of small, regulated amounts of fluoride to drinking water – in Grandjean's review. (As I noted a few days ago at Talk:Water fluoridation controversy, you appear to be conflating and confusing fluoridation and fluoride.)

As far as I can see, of the 115 footnotes in Grandjean, just one deals with fluoride toxicity: the already much-discussed Choi et al. 2012 meta on which Grandjean was senior author. That paper deals with studies of naturally-occurring, uncontrolled, high fluoride levels in rural Chinese water supplies; it further explicitly notes that no conclusions can be drawn from the data regarding the (potential) toxicity of fluoride exposure at the levels used for water fluoridation. TenOfAllTrades(talk) 02:58, 27 February 2014 (UTC)

My apologies for confusing people here when asked what I was specifically recommending as a change in the article. Although my original comment above was clear, my repetition of this comment was not clear and was erroneous. I meant to say that this sentence needs to be deleted from the section on "Evidence": "No clear evidence of other adverse effects exists, though almost all research thereof has been of poor quality." DanaUllman^Talk 02:14, 1 March 2014 (UTC)

Once again, you have failed to identify the passage within Grandjean that contradicts the sentence you're asking be deleted. There remains no clear evidence of other adverse effects of water fluoridation—the topic of the sentence in question and of this entire article. The only adverse effects that Grandjean has published on deal with uncontrolled exposure to high concentrations of (naturally-occurring) fluoride – generally significantly greater than those in fluoridated water – and even those possible effects are based on studies which Grandjean himself acknowledged suffer from incomplete data and methodological flaws. You're insisting on reading into Grandjean something that just isn't in his papers, and you're pushing deep into WP:IDHT territory to do it. TenOfAllTrades(talk) 02:58, 1 March 2014 (UTC)

Agree with Ten, I don't see support for this change with the source provided. Unwilling to continue down the path of repetitious arguments any further, so if that's all that's happening here it's probably best to just stop responding. Zad68 05:26, 5 March 2014 (UTC)

what about this info from NZ government site

Some of the earliest opponents of fluoridation were biochemists and at least 14 Nobel Prize winners are among numerous scientists who have expressed their reservations about the practice of fluoridation [7] 212.200.213.54 (talk) 20:46, 26 March 2014 (UTC)

Discouraging new contributions on this topic

Wikipedia is a challenging site to edit.. and takes some time to do so. As only an occasional editor, it is discouraging to have had my edits completely undone. It was fair to list the key and effective lawsuit in Israel and the resulting change in public policy. When the editors on this site reverted all work based on my citing the Choi study, the didn't remove part of it.. they removed the whole thing.

A process that is destructive to the contributions of less familiar contributors who have interest in the subjects progress!

The second effort was to properly categorize the two facts as controversy since they were not the majority opinion. That should have been let stand. I referenced the very detailed debate on why the Harvard Choi study was not listed because upon examination saw that great detail went into it. If it offended I would not have repeated it. Also again, shouldn't the editors of this page have simply removed that and not all contributions.

There seems to be a very aggressive group protecting this page. When I tried to reference one site, the computer showed me it was a blacklisted site. I found that odd as it seemed to be a simply activist site on the topic.

For all of the guarding of this page and topic, against possible zealots, the result is you are frustrating reasonable contributors.. at least me for certain, and the article has so much run on repetition it looks like a bad sales page quite frankly.

The cartoon under the Ethics topic is just prejudicial and insulting grouping dissenting opinion together with other groups.

This page has a long way to go. Please realize this is a moving subject and many quotes and sources are OLD dated and not reflective of key changes. Israel banned the use of Fluoridation after a public lawsuit. That's a whole nation, why remove that?

Please put back the content on controversy and remove the comment that offended. Thank you for any assistance!!

WikiShares (talk) 22:30, 26 March 2014 (UTC)

You are trying to edit a featured article and one of the most controversial at that. Please have a read of WP:MEDRS. Plus part of what you are attempting has been discussed above.Doc James (talk · contribs · email) (if I write on your page reply on mine) 23:06, 26 March 2014 (UTC)

Compounds used

Reverted this [8] as the compounds were already mentioned Doc James (talk · contribs · email) (if I write on your page reply on mine) 02:01, 27 March 2014 (UTC)

Fluoride vs Fluorides

The summary paragraphs are too long it obscures the Index it its fervor to sum up the process. Let readers click to topics of interest. And left out of the full screen of summary is reference to the key component being varied.

More importantly the use of fluoride is oversimplifying.. Early on varying Fluoride Compounds should be referenced, letting the reader find the variations below and not mistakenly assume as was once commonly thought a naturally occurring substance. The most predominantly used Fluoride compound is an acid compound, and was derived from fertilizer. I understand that is not a warming comment but it is real. So at the very least.. one or more of varying Fluoride compounds are added might lessen the over simplification of the summary. We do want to suggest early on that the reader look further into the types.. and might learn.. of calcium fluoride vs Fluorosilicic acid - https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=601624283&oldid=601442814 That is what is added for the most part. WikiShares (talk) 14:13, 28 March 2014 (UTC)

Lead is fine and follows policy. Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:27, 28 March 2014 (UTC)

From the standpoint of what comes out of the tap, fluoridation with sodium fluoride versus sodium fluorosilicate or fluorosilicic acid is essentially indistinguishable. At high dilution (low concentration) and near-neutral pH – that is, under the conditions at which the compounds are used in water fluoridation – fluorosilicates are rapidly and completely hydrolyzed into fluoride and trace amounts of inert silicon dioxide. (Silicon dioxide, incidentally, is the major chemical ingredient in the glass you're drinking the water from.)

As for the "acid compound" and "derived from fertilizer" stuff—I'll file that under 'factual but irrelevant and misleading'. The former is an appeal to the sort of 'acids are scary!' cartoon view of chemistry, preying on the relative lack of knowledge of readers to attempt to scare them. The latter is implicitly some combination of genetic fallacy and appeal to nature, again with the intent to scare without informing. It would be technically correct – and equally misleading – to say "Oranges contain acid compounds derived from fertilizer". We treat our readers with more respect than that. TenOfAllTrades(talk) 14:49, 28 March 2014 (UTC)

The verifiability policy

The new Choi/ Harvard study must be admitted based on Wikis Verifiability policy which is as follows:

"The threshold for inclusion in Wikipedia is verifiability, not truth — that is, whether readers are able to check that material added to Wikipedia has already been published by a reliable source, not whether we think it is true".

The Choi Harvard Study has been quoted by Harvard it its own press release supporting the research, Huffington Post, and Fox News to name a few. It is verifiable! It must be admitted as a reference on this topic of varying opinion... even if it is considered the minority, it can be shown as such. But realize it is decades newer so minimizing fewer new studies in favor of many old studies is not exactly cutting edge research, as people want to see. Its simply old science we are showing. Obviously studies based on longer time periods available have more data to utilize so it is highly imprudent to have delayed this so long.

WikiShares (talk) 06:23, 28 March 2014 (UTC)

On the same policy page you are referring to, it states (and I quote): "While information must be verifiable in order to be included in an article, this does not mean that all verifiable information must be included in an article. Consensus may determine that certain information does not improve an article, and that it should be omitted or presented instead in a different article." So there's really no "must" on what you are trying to include; except that you "must" stop trying to include it against consensus. Doc talk 08:20, 28 March 2014 (UTC)

It is helpful, when discussing sources, to include both a full citation and/or a link to the study so that we know which study we're talking about, and to avoid confusion. When you say 'new Choi/Harvard' study, do you mean Choi et al. (in Grandjean's group) from 2012, or is there a newer 'new' Choi paper? If the former, then you should know that the 2012 paper – and where it might be useful to Wikipedia – has been pretty thoroughly discussed on this talk page in the past; searching archives (using the search box near the top of this page) will find those for you.

As Doc9871 notes, reliability (per WP:RS and WP:MEDRS) is just one criterion for inclusion of material in a Wikipedia article; specific relevance and appropriate context (per WP:NPOV, especially WP:UNDUE) are others.

As a bit of general Wikipedia editing advice, when opening a talk page discussion about a specific edit or proposing the addition of particular text, it's very helpful to include a diff showing the edit, or a copy of the proposed new text, or at least a specific-as-possible description of the proposed change. Discussions about the use of sources always need to address two elements: the source itself, and how the source is intended to be used to support a specific portion of a Wikipedia article. TenOfAllTrades(talk) 13:06, 28 March 2014 (UTC)

Ten, thanks for the politeness and tips, I am finding this a cumbersome process. LOL. Lets begin with simple things that go to the datedness of this featured article. Firstly and most obviously a dated article.. is the politically incorrect pejorative reference to economically disadvantaged persons as "the poor". This was corrected quite decently of me and reverted. I found that reckless and frustrating, as if the editors were so single minded of purpose the goal being simple to guard the hope diamond, a hopelessly dated pitchy article on a very key, in trending topic, and embarrassment to Wiki. Hopefully this is a diff.. ha https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=601624283&oldid=601453146 — Preceding unsigned comment added by WikiShares (talk • contribs) 13:52, 28 March 2014‎

As near as I can tell, no one has reverted your change of "the poor" to "economically disadvantaged". It appears that you made that change with this edit. That edit appears to have inadvertently introduced a grammatical error by deleting the first part of another paragraph (by removing the Although water...); that error was corrected by Piguy101 in this edit, but the rest of your change was left unmodified. (As a general style note/opinion – and an argument that I'm not interested in starting or carrying on here – I'm not sure that you're going to get universal agreement that "the poor" is pejorative when used in an appropriate context, and you may get some pushback if you get too aggressive in trying to replace it widely with what some will see as a rather cumbersome euphemism.) TenOfAllTrades(talk) 14:20, 28 March 2014 (UTC)

We should be writing with simple English, thus "the poor" is better than "economically disadvantaged" Doc James (talk · contribs · email) (if I write on your page reply on mine) 14:28, 28 March 2014 (UTC)

I reverted the word back to "poor". Many people reading these articles are not native English speakers and do not understand the Western practice of using long unusual words as a show of respect to disadvantages persons. This community has literally thousands of pages of debate in the Manual of Style for best practices for all kinds of purposes and there is consensus for not using new jargon terms when older simple words are better understood. You could petition for change as we do wish to be as respectful as possible, but this might best be done by building off the existing precedent and years of past discussions advocating for simplicity in presentation rather than debating a single instance in a single article. Thoughts? Blue Rasberry (talk) 14:54, 28 March 2014 (UTC)

Israel Ceases Water Fluoridation - Is that Fringe?

Hardly, as a well educated industrialized nation the practice will be discontinued as pressure was brought to bear by a vocal (fringe?) citizen group led by Yaacov Gurman. A dramatic $4 billion dollar lawsuit was petitioned to their highest court. A new health minister was brought in and the court cited the cessation in reply to the petitioner. This is quite relevant as it is recent and reflects change taking place by an entire nation that is not considered radical or fringe.

The landscape of this topic changing.. lets show the current facts as they are today... not merely decades past. https://wiki.riteme.site/w/index.php?title=Water_fluoridation&diff=601624283&oldid=601390742 This is quite relevant and was reverted wholesale by doing a complete reversion. — Preceding unsigned comment added by WikiShares (talk • contribs) 14:38, 28 March 2014‎

The complete reversion was over a lot of issues. Anyone who does not want their content reverted completely should be conscious of not putting a copyediting burden on others by dividing their edits. Persons wanting points considered individually should make them individually. There are a lot of changes in this revision which have nothing to do with the issue described. Blue Rasberry (talk) 14:43, 28 March 2014 (UTC)

As a technical note, you may want to re-read the link to WP:DIFF I provided above. The diff that you've provided here covers 17 edits by six different editors; it's not clear which changes are yours, or what edits you're trying to discuss. To produce a diff of a single edit, go to the article's history page, and look at the address of (or click on) the link labelled "prev" next to a particular edit. That generates a diff (the difference) showing the changes made in that edit. If you instead click on "curr", it gives you a link showing the difference between that revision and the current version of the page (and may span dozens or hundreds of edits.) TenOfAllTrades(talk) 14:57, 28 March 2014 (UTC)

Lets be very clear. Israel did not "ban" fluoriation, it rescinded national regulations requiring local governments to ensure fluoridation, and it did so over the strong objections of national medical societies. The end result of thi will be a small number of municipalities in a small country changing their policy. Any attempt to use a decision by a small fraction of 1% to change their fluoridation policy as evidence of an incipient shift in scientific concensus would clearly be premature and misleading. Formerly 98 (talk) 16:12, 28 March 2014 (UTC)

The laws do not change for a few more months in Israel do they? Doc James (talk · contribs · email) (if I write on your page reply on mine) 22:45, 28 March 2014 (UTC)

• The problem is that antifluoridationists are (as they always do) conflating politics and science. Even if Israel banned fluoridation outright (which it hasn't), it would make precisely no difference at all to the scientific consensus that fluoridation is a safe and effective public health intervention. It's equivalent to the Indiana Pi Bill. Guy (Help!) 13:10, 29 March 2014 (UTC)

EU 2010 SCHER water fluoridation report. Not represented in the article???

I find it quite incredible that even 1 citation or even a miserly mention of the most comprehensive and updated (2010) review of water fluoridation from the European Commission - Is not in this article.

I searched the talkpage archive, and about 10 months ago, another editor raised the question and also went into specifics: https://wiki.riteme.site/wiki/Talk:Water_fluoridation/Archive_8#facts.2C_sources.2C_NPOV_...

The single response he got was basically "i don't know what this report is.." and then was completely ignored.

So I' m going to revive that thread and copy-paste it's relevant stuff.

I'll start with an answer to that question: What is the SCHER report ? "To obtain an up to date scientific view on the matter [fluoridation of drinking water] the European Commission asked the Scientific Committee on Health and Environmental Risks (SCHER) to elaborate an opinion on the safety of fluoride" http://ec.europa.eu/health/publications/docs/achievements2010_en.pdf (page 30)

And some of my additions (quotes from the report) :

• “Fluoride is not an essential element for human growth and development…”

• “Systemic exposure to fluoride through drinking water is associated with an increased risk of dental and bone fluorosis in a dose-response manner without a detectable threshold.”

• “Scientific evidence for the protective effect of topical fluoride application is strong, while the respective data for systemic application via drinking water are less convincing. No obvious advantage appears in favor of water fluoridation as compared with topical application of fluoride.”

• “For younger children (1-6 years of age) the UL (The upper tolerable intake level) was exceeded when consuming more than 1 L of water at 0.8 mg fluoride/L (mandatory fluoridation level in Ireland) and assuming the worst case scenario for other sources. For infants up to 6 months old receiving infant formula, if the water fluoride level is higher than 0.8 mg/L, the intake of fluoride exceeds 0.1 mg/kg/day, and this level is 100 times higher than the level found in breast milk (less than 0.001 mg/kg/day).”

Quoted from older thread:

The article seems to overstate the benefits of water fluoridation (compared to alternatives), misrepresent the situation in Europe, does a fine job avoiding neutral sources. First non-wiki result when I google water fluoridation europe is Questions on water fluoridation - European Commission - Europa but SCHER or publications by the European commission aren't used as source anywhere in the article.

In it's 2010 report to the European Commission, the conclusions of the Scientific Committee on Health and Environmental Risks' include:

• The benefits of preventive systemic supplementations (salt or milk fluoridation) are not proven.
• The efficacy of population-based policies, e.g. drinking water, milk or salt fluoridation, as regards the reduction of oral-health social disparities, remains insufficiently substantiated.
• No obvious advantage appears in favor of water fluoridation compared with topical prevention. The effect of continued systemic exposure of fluoride from whatever source is questionable once the permanent teeth have erupted.
• SCHER agrees that topical application of fluoride is most effective in preventing tooth decay. Topical fluoride sustains the fluoride levels in the oral cavity and helps to prevent caries, with reduced systemic availability.

About the studies regarding salt fluoridation in Jamaica, SCHER finds:

• These studies are all considered of simplistic methodological quality.

The ethics and politics section doesn't mention that information gaps regarding fluoride “prevented the committee from making some judgments about the safety or the risks of fluoride at concentrations of 2 to 4 mg/L., and that water systems could supply up to 4mg/L for a year before informing the customers. Instead we get the crazy theories of some opponents. Other articles (like 9/11) don't need a list of all the conspiracy theories to strengthen the official version by contrast. (they don't even allow them in the main article)

The mechanism section:

• Fluoride's effects depend on the total daily intake of fluoride from all sources.

No they don't, at least not the beneficial effects. Together with:

• others, such as in Europe, using fluoridated salts as an alternative source of fluoride

it suggests that the situation in Europe is fundamentally no different: be it through milk, salt or water fluoridation, the systemic intake would be comparable to countries with water fluoridation. that is not the case. Also, Switzerland and Germany are the only european countries where most salt is fluoridated.

• unlike most European countries, the U.S. does not have school-based dental care

Which countries? Only Sweden provides free dental treatment for schoolchildren afaik. Eastern Europe did the same during the communist era, but those days are long gone. They may get free check-ups in some countries, and a note for the parents telling them they need to go see a dentist, that's about it. It's not the only doubtful claim about "many countries", "most people", ..

WHO DMFT data for 12-y olds in 2004 shows W. European countries scoring as good as or better than the U.S. and Canada. Helen Whelton's study shows much more cases of dental fluorosis in areas with water fluoridation or high natural fluoride content. which makes the statement dental fluorosis, which is mostly due to fluoride from swallowed toothpaste., although technically correct, a bit misleading.109.66.59.99 (talk) 18:15, 29 March 2014 (UTC)

Well, I don't know enough about this subject to comment on all of the remarks above, but the full version of the final report is found here: http://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_139.pdf

1 “Fluoride is not an essential element for human growth and development…” Does the article say it is? I did not see that.

2 “Systemic exposure to fluoride through drinking water is associated with an increased risk of dental and bone fluorosis in a dose-response manner without a detectable threshold.” Yes, but mild dental fluorosis has almost no clinical significance at all and "intake of less than 0.1 mg F/kg BW/day in children up to 8 years old corresponds to no significant occurrence of “moderate” forms of fluorosis in permanent teeth". The report also states that skeletal fluorosis has not been observed in the EU with the exception of certain industrial workers with high exposure associated with their jobs. So the lead sentence seems to be discussing a phenomenon that is detectable but without clinical significance at fluoride levels associated with water fluoridation.

3. “For younger children (1-6 years of age) the UL (The upper tolerable intake level) was exceeded when consuming more than 1 L of water..." This might be worth looking into.

4. "The efficacy of population-based policies, e.g. drinking water, milk or salt fluoridation, as regards the reduction of oral-health social disparities, remains insufficiently substantiated." Yes, but the report waffles on this point. Elsewhere it states "Water fluoridation as well as topical fluoride applications, e.g. fluoridated toothpaste or varnish, appears to prevent caries, primarily on permanent dentition, but topical application is the more efficient measure", "water fluoridation offers additional benefits over alternative topical methods because its effect does not depend on individual compliance", and "The effect of water fluoridation tends to be maximized among children from the lower socio-economic groups, so that this section of the population may be the prime beneficiary"

Overall, I can see some possible concerns about the overall balance of this article, but I'm also struck that the SCHER report waffles a lot and that there may be some selective quotation in the above critique. — Preceding unsigned comment added by Formerly 98 (talk • contribs) 13:11, 30 March 2014 (UTC)

SCEHR

A recent edit tried to say that the EU considers fluoridation as "controversial"; while true in a general sense due to the external controversies and advocacy, this implies that the document considers the benefits "controversial" which it clearly does not, "Fluoride, either naturally present or intentionally added to water, food and consumer products, e.g. toothpaste, is generally considered beneficial to prevent dental caries." Adding this text to the lead without context would seem inappropriate. Yobol (talk) 20:03, 2 April 2014 (UTC)

You are misquoting the document . it doesn't write "EU considers fluoridation as controversial" it writes "Artificial fluoridation of drinking water reaches the whole population, but is a controversial as a public health measure". That is the position of the EUs "CDC" . You may not like it. but that is what it is. stop reverting this editLarryTheShark (talk) 20:19, 2 April 2014 (UTC)

It is controversial because others have made it controversial. The benefits are not controversial, as the quote from the professional summary shows. Yobol (talk) 20:22, 2 April 2014 (UTC)

That is your personal POV. which is violating WP:OR, there is a whole section above going in detail. “Scientific evidence for the protective effect of topical fluoride application is strong, while the respective data for systemic application via drinking water are less convincing. No obvious advantage appears in favor of water fluoridation as compared with topical application of fluoride.”LarryTheShark (talk) 20:35, 2 April 2014 (UTC)

Which means they found it beneficial. Yobol (talk) 20:45, 2 April 2014 (UTC)

Which means the benefit to risk ratio doesn't justify it when other avenues of fluoride usage are available.LarryTheShark (talk) 21:04, 2 April 2014 (UTC)

That's your interpretation, not the doucment's. The document summary says "Fluoride, either naturally present or intentionally added to water, food and consumer products, e.g. toothpaste, is generally considered beneficial to prevent dental caries." Yobol (talk) 21:06, 2 April 2014 (UTC)

I have not added any interpretation to the article. this is what you are trying to do. I have used the exact words of the document. hence NPOV. the USA is a water fluoridation hugger. the EU is not. similar to position about GMO's : USA is YES , and EU is NO. LarryTheShark (talk) 21:24, 2 April 2014 (UTC)

Without saying what is controversial about it, saying it is "controversial" is a WP:WEASEL...it suggests that the controversy is possibly "good vs bad" or "more vs less" or "what chemical to use" or any number of other aspects of it. By popular media, "controversial" generally means for-vs-against. Some of those possible meanings are clearly not what the source supports, and not-defining the scope of the controversy means you're open to interpretation in a way that has negative connotations and not supported by ref. DMacks (talk) 21:45, 2 April 2014 (UTC)

The EU general statement belongs after the CDC general statement. they are of the same quality.

WP:WEASEL talks about " Claims about what people say, think, feel, or believe, and what has been shown, demonstrated, or proved should be clearly attributed". The sentence put in the article is clearly attributed and sourced. what should be done is adding more information in the body of the article of the EU position. as requested in the section above

You also forgetting that the EU doesn't practice water fluoridation (same like the vast majority of the world). Their statement also reflects the continent practice.

According to the British Fluoridation Society (2012) : Most developed nations do not fluoridate their water. In western Europe, only 3% of the population consumes fluoridated water. While 25 countries out of 193 worldwide have water fluoridation programs, 11 of these countries have less than 20% of their population consuming fluoridated water: Argentina (19%), Guatemala (13%), Panama (15%), Papa New Guinea (6%), Peru (2%), Serbia (3%), Spain (11%), South Korea (6%), the United Kingdom (11%), and Vietnam (4%). Only 11 countries [2014 only 10] in the world have more than 50% of their population drinking fluoridated water: Australia (80%), Brunei (95%); Chile (70%), Guyana (62%), Hong Kong (100%), the Irish Republic (73%), {stop in 2014} Israel (70%), Malaysia (75%), New Zealand (62%), Singapore (100%), and the United States (64%). In total, 377,655,000 million people worldwide drink artificially fluoridated water. This represents 5% of the world’s population. There are more people drinking fluoridated water in the United States than the rest of the world combined.LarryTheShark (talk) 22:10, 2 April 2014 (UTC)

Edits reverted of 4/4/14

Editor adding only anti-fluoridation content to the article. Suspect POV editing. Should not edit on topics which we have strong opinions about, instead either avoiding them or editing neutrally. These edits were not neutral imo. Request demonstration that there is a consensus for such edits to this article using the talk page. Regards, Lesion 12:26, 4 April 2014 (UTC)

Here is the diff: [9]. Lesion 12:27, 4 April 2014 (UTC)

My last edits have been reverted Carte blanche, by the editor 'Lesion' who seems to be a water fluoridation advocate, on the ground of "anti-water fluoridation content and changing the previous tone of the article".

I find that accusation spurious.

Non of my references are coming from anti fluoridation websites. my references and statements are coming from major and consensus scientific reviews: 2000 York review/2003 addition, 2007 UK, Cheng review and 2011 EU SCHER review. The "tone" of a wikipedia article should represent WP:NPOV information. and with my edits, it does.LarryTheShark (talk) 12:37, 4 April 2014 (UTC)

When I described your edits as "anti-water fluoridation" my meaning was each edit seemed to be adding content which was worded to oppose water fluoridation. Sources sound ok, I haven't checked them, but not sure about how they are being used. Please seek consensus. Thank you, Lesion 12:55, 4 April 2014 (UTC)

Incredible. so you have not checked the information. and you revert. that is called personal POV.

Another editor/fluoride advocate, reverted on the grounds of "cherry picked quotes changing the POV of the article" deliberately omitting that most statements are backed/quoted by not 1 but 2 major sources.LarryTheShark (talk) 13:03, 4 April 2014 (UTC)

P.S. do not change the subject of this section which i have started to your POV.LarryTheShark (talk) 13:06, 4 April 2014 (UTC)

In an attempt to move things forward, I will start discussion about one of the more concerning edits (not all were this POV):

Before	After
Water fluoridation prevents cavities in both children and adults, with studies estimating an 18–40% reduction in cavities when water fluoridation is used by children who already have access to toothpaste and other sources of fluoride.	Scientific evidence for the protective effect of topical fluoride application (e.g.. Toothpaste) is strong, while the respective data for systemic application via drinking water are relatively poor and less convincing. Water fluoridation prevents cavities in both children and adults, with studies estimating an 18–40% ...

Is a major change in the previous tone of the article. Can we demonstrate that this view is supported by the majority of sources? Lesion 13:10, 4 April 2014 (UTC)

Certainly. the two references are the 2011 EU SCHER major review + UK, Cheng 2007 review. The EU uses the word "Less convincing" and Cheng uses "relatively poor" .The 2000 UK York review is much harsher (i have not placed in the lead but in the 'Evidence' section lead):

"We are concerned about the continuing misinterpretations of the evidence and think it is important that decision makers are aware of what the review really found. As such, we urge interested parties to read the review conclusions in full.

We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth.

This beneficial effect comes at the expense of an increase in the prevalence of fluorosis (mottled teeth). The quality of this evidence was poor.

http://www.york.ac.uk/inst/crd/fluoridnew.htm

What authoritative sources you have stating otherwise? LarryTheShark (talk) 13:19, 4 April 2014 (UTC)

I am mostly unfamiliar with the literature here, but just had a look through the first page of pubmed results with keywords "water fluoridation", and the scientific consensus appears to be strongly in favor of water fluoridation. Therefore a series of edits each adding content which is worded to oppose water fluoridation is questionable. Would appreciate if you gave rationale to each edit here as above, so we can move towards a consensus for each. Lesion 13:36, 4 April 2014 (UTC)

Your approach is WP:OR and amateur work. This is why the scientific community relies on Reviews/Meta analysis of studies. All the reviews (except for the australian) say that the evidence is of relatively poor quality. and this is what i stated in my edit.LarryTheShark (talk) 13:42, 4 April 2014 (UTC)

There have been only 3 reviews since 2000? Encourage you to make one of these threads for each edit, so it doesn't look like an editor adding anti water fluoridation content over and over. Lesion 13:48, 4 April 2014 (UTC)

Yes. Those are the major reviews. York 2000 study for UK government (the country fluoridates 11% of population)), Cheng 2007 (UK, independent), Australia 2007 for the australian government (the country fluoridates 80%), EU SCHER 2011 for the European Union (EU 3% water fluoridates). the very reference that is now in the article (from ireland, 73% fluoridate) states "While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality" there is no controversy that the studies used to show water fluoridation works are "relatively poor and less convincing" only the Australians think they are "great" LarryTheShark (talk) 14:12, 4 April 2014 (UTC)

Just reading the intro to this in progress Cochrane review, and it suggests that the 2000 York study was comprehensive, but needs to be updated. OK then I would happy with something like that, not sure how others feel. Could be worded better imo: "Water fluoridation prevents cavities in both children and adults, although the evidence for this is relatively less convincing than the strong evidence for the preventative benefit of topical fluoride.[reviews]" Lesion 14:20, 4 April 2014 (UTC)h

If we are to discuss the relative strength of evidence between topical/water fluoridation it should belongs in the "Alternatives" section where other forms of fluoridation are discussed, probably not in the lead of the effectiveness section. Yobol (talk) 14:32, 4 April 2014 (UTC)

Sounds reasonable. Lesion 14:36, 4 April 2014 (UTC)

Agree... The stronger evidence for the effectiveness of topical doesn't make fluoridation of water not effective. The two strategies have different purposes. In particular the sources repeatedly point to the utility of water fluoridation for the dental health of the poor. Zad68 14:41, 4 April 2014 (UTC)

No. water fluoridation efficacy is based on poor quality research. this is referenced solidly and is NPOV significant information. the only ones wanting to hide this are water fluoridation advocates.LarryTheShark (talk) 14:47, 4 April 2014 (UTC)

Re to Zad, good point. Not sure if "topical fluoride" refers to toothpastes as well as concentrated fluoride that dentists use. Water supply reaches everyone in society, not just those parents who take their kids to the dentist to get topical fluoride or even to bother to buy fluoride toothpaste. Probably the best way to get fluoride to those people who would otherwise never get it. Perhaps this should be added to the comment comparing the relative strength of evidence available for topical and water fluoridation. Lesion 14:57, 4 April 2014 (UTC)

Well, the admins blocked the editor, so I don't know if anyone wants to go through each of these edits. The thing about there being relatively less evidence for water fluoridation compared to topical application of fluoride is supported by a comprehensive review (at least according to cochrane). As mentioned above, suggest add qualifier to that statement that water fluoridation has potential to reach much more people than topical application can. Lesion 16:47, 4 April 2014 (UTC)

SCHER

OK, starting to look at the "SCHER" source, which is being characterized here as a "major review". I do not find support for this characterization. The SCHER appears to be one of several relatively small advisory bodies which produce opinion papers, and their recommendations are not binding. They publish their own works and so are self-published. Their papers are not carried by the standard major databases of biomedical articles, like PubMed or MEDLINE. I cannot find any major news sources that regularly carry articles covering their publications, like I can find for major medical organizations. Therefore I do not find any support for giving their viewpoint significant weight in our article. They may--maybe--deserve a brief mention, making sure we follow WP:ATTRIBUTEPOV, but I do not see justification for making significant use of their publication. Zad68 13:58, 4 April 2014 (UTC)

The SCHER summary states, "Fluoride, either naturally present or intentionally added to water, food and consumer products, e.g. toothpaste, is generally considered beneficial to prevent dental caries." Beneficial. LarrytheShark has cherry picked and turned every single negative commentary about fluoridation out of that review, apparently to push an agenda. Yobol (talk) 14:07, 4 April 2014 (UTC)

I should note that our article contains a number of different secondary sources that support fluoridation and so cherry picking the only negative ones/only negative comments from secondary sources, while ignoring the positive ones, appears to be more POV pushing. Yobol (talk) 14:10, 4 April 2014 (UTC)

Not disagreeing... so, other than this publication not being clearly authoritative, and the suggested edits based on it misrepresenting it, what's the problem??? :-P Zad68 14:15, 4 April 2014 (UTC)

On the topic of reliable sources, there is a cochrane review [10] but it looks like it is currently in progress. Lesion 14:12, 4 April 2014 (UTC)

Yes, when that review is published, it will certainly be useful here. What's interesting to note is that the SCHER publication isn't listed among the nearly 30 references they list. Zad68 14:20, 4 April 2014 (UTC)

Amazing, shameless POV pandering. (If you can't kill the message, try to delegitimize the messenger).

The Yeung CA. review (which is used in the article) purpose is "The systematic review was commissioned by the Australian National Health and Medical Research Council (NHMRC) to evaluate the scientific literature relating to the health effects of fluoride and fluoridation."

The SCHER review purpose is "To obtain an up to date scientific view on the matter [fluoridation of drinking water] the European Commission asked the Scientific Committee on Health and Environmental Risks (SCHER) to elaborate an opinion on the safety of fluoride" http://ec.europa.eu/health/publications/docs/achievements2010_en.pdf (page 30)

Ant yet Zad is trying to belittle it.

The EU Commission position on water fluoridation is posted on their own Public health positions section in detail. http://ec.europa.eu/health/scientific_committees/opinions_layman/fluoridation/en/ these positions which are based on the SCHER fluoride review. Not giving them 'significant weight in the article' is to omit/censor the European Union official view on water fluoridation in whole !LarryTheShark (talk) 14:39, 4 April 2014 (UTC)

If you really wish to be a productive Wikipedia editor, you really should familiarize yourself with how WP:NPOV is determined on Wikipedia. We take into account the strength and authority of a source in determining how much weight to give it in an article. Zad68 14:45, 4 April 2014 (UTC)

(e/c) The Yeung review has the added benefit of undergoing independent peer review and being published in a journal, while the SCHER review is not, making one more authoritative than the other. That being said, I would consider including a minor role for SCHER analysis, as they serve a similar role as say, the FDA, in doing independent analysis for governmental consumption. Since SCHER's view is that water fluoridation is beneficial, trying to cherry pick negative commentary out of the review that goes against this conclusion will not go anywhere. Yobol (talk) 14:51, 4 April 2014 (UTC)

Exactly... Because their publication doesn't appear to be peer-reviewed, or have had to go through an acceptance process to be picked up for publication and indexed by a database like MEDLINE, what I'm having trouble finding is evidence that the SCHER's publication is authoritative and influential. Statements from the FDA, for example, get picked up by news sources all the time. I can't find the same for the SCHER. Zad68 14:56, 4 April 2014 (UTC)

Ethics and Politics Section Update

As I was going through this section today, I noticed that some of the referenced surveys are a bit old (e.g., 1999). Do we have newer surveys and studies to replace them? If so, we should probably do that. TylerDurden8823 (talk) 18:46, 4 April 2014 (UTC)

The entire article is written like an advertisement for the promotion of water floridation. No section or even paragraph highlighting possible cause for concerns. — Preceding unsigned comment added by 78.151.186.121 (talk) 18:14, 5 April 2014 (UTC)

There's a whole article dedicated to that controversy. Please see Water fluoridation controversy. Your comment also has very little to do with this particular section... TylerDurden8823 (talk) 01:41, 6 April 2014 (UTC)

References

Just noticed the 'Lay Summary' link for reference 2 (should point to a CDC page giving an overview of the report, titled "CDC Releases New Guidelines on Fluoride Use to Prevent Tooth Decay"). The link to the main article is fine. but, using archive.org the CDC link seems to have been broken since 2011. recommend either removing the link, linking to archive.org copy, or linking to the CDC media archive for the article Nrjank (talk) 19:57, 22 April 2014 (UTC)

Cost needs updating

Fluoridation does not cost $1.02 per year; it's $3 per month. Source: my water bill. (South Salt Lake, Utah) It does not lend credibility to presume the average household have 35 people.--Choshek (talk) 21:39, 23 April 2014 (UTC)

I suspect that the amount that you are charged has very little to do with what the process actually costs the utility company. (Though it could be that there are significant overheads associated with small-town supplies; larger communities may enjoy significant economies of scale.) The fluoride charge in South Salt Lake is a flat rate per water connection; it is not based on household water usage. TenOfAllTrades(talk) 23:59, 23 April 2014 (UTC)

USPSTF

States "In April 2013, the Community Preventive Services Task Force recommended fluoridation of community water sources based on strong evidence of effectiveness in reducing dental caries" [11] based on [12] Doc James (talk · contribs · email) (if I write on your page reply on mine) 19:53, 6 May 2014 (UTC)

Insufficient sourcing

This got removed for insufficient sourcing. However, it has four sources that cover the text.

• Calcium fluoride (CaF₂) is naturally occurring in many water sources. It is the only type that is not toxic, as other fluorides have been shown to lower IQ. It also has been shown to help teeth, as there is little indication that hydrofluorosilicic acid helps teeth, and there is evidence that it causes fluorosis.

Sources:

• http://www.fluoridefreewinnipeg.com/http___www.fluoridefreewinnipeg.com/WHAT_FORM_OF_FLUORIDE_IS_WINNIPEG_DRINKING_2.htm
• articles.mercola.com/sites/articles/archive/2011/08/12/fluoride-and-the-brain-no-margin-of-safety.aspx
• http://www.gov.mb.ca/health/publichealth/environmentalhealth/docs/factsheet_fluoride.pdf
• www.prisonplanet.com/calcium-fluoride-vs-sodium-fluoride.html

Njaohnt (talk) 00:04, 29 April 2014 (UTC)

See WP:MEDRS for the kinds of sources that are acceptable to support biomedical claims (and which sources are not, like activist websites). The CA government website doesn't mention CaF₂. Zad68 00:16, 29 April 2014 (UTC)

• Actually first 3 of those references don't appear to mention calcium fluoride at all, the 4th one does mention it, but doesn't state that it naturally occurs in water.Project Osprey (talk) 00:20, 29 April 2014 (UTC)

Wow. The first one is a terrible source. ("Contaminated with the artificial fluoride ion..."—really? Apparently the aqueous F^- ion from dissolved CaF₂ is 'natural', whereas the aqueous F^- ion from dissolved NaF is 'artificial'. Seriously. The scientific illiteracy hurts to read.) The second and fourth sources are crappy, too, with similar inability to understand basic chemistry. The third source has nothing to do with the proposed text, and obviously does not support it. Has Njaohnt actually read and understood the pages that he's linking to, or is he only accidentally wasting our time? TenOfAllTrades(talk) 01:24, 29 April 2014 (UTC)

I have added sources, and changed the text. Will this be okay?

• Calcium fluoride (CaF₂) is naturally occurring in many water sources. It is the only type that is not toxic, as other fluorides have been shown to lower IQ, cause neurological developmental issues, and cause fluorosis.

Sources:

• http://www.fluoridefreewinnipeg.com/http___www.fluoridefreewinnipeg.com/WHAT_FORM_OF_FLUORIDE_IS_WINNIPEG_DRINKING_2.htm
• articles.mercola.com/sites/articles/archive/2011/08/12/fluoride-and-the-brain-no-margin-of-safety.aspx
• http://www.gov.mb.ca/health/publichealth/environmentalhealth/docs/factsheet_fluoride.pdf
• www.prisonplanet.com/calcium-fluoride-vs-sodium-fluoride.html
• http://fluoridedetective.com/types-of-fluoride/
• http://www.hsph.harvard.edu/news/features/fluoride-childrens-health-grandjean-choi/
• http://afamildura.wordpress.com/fluoridation-chemicals/
• http://preventdisease.com/home/tips79.shtml

Njaohnt (talk) 14:20, 11 May 2014 (UTC)

No. I'm not sure how to be any clearer than I was before. Both CaF₂ and NaF produce exactly the same fluoride ion (F^-) when dissolved in water. The body doesn't know which counterion – calcium or sodium – the fluoride was previously associated with. ('Worse' still, virtually all drinking water contains at least trace amounts of sodium (a few parts per million: not enough to taste); if you evaporate the water down to precipitate the salts, you're going to get some sodium fluoride back out, even if all of the fluoride in the water was originally added by dissolving calcium fluoride.)

The sources that insist there is a magical difference between fluoride ion from calcium fluoride and from sodium fluoride are wrong, and they definitely are not reliable sources by any Wikipedia standard. Try to find at least one source that is a proper, peer-reviewed, scientific journal article – and not a press release, blog, or advocacy site – that supports the specific claim that you're trying to insert into the text here. And be prepared to provide a direct quote of that source to show that it supports your proposed wording. Otherwise, you're just wasting our time. Again. TenOfAllTrades(talk) 14:52, 11 May 2014 (UTC)

Agreed. Maybe it would be best to identify just one source, maybe one you feel is especially good, and we can discuss it. --Ronz (talk) 14:58, 11 May 2014 (UTC)

Does this mean the LD50 of Calcium fluoride, Sodium Fluoride, and hexafluorosilicic acid are equal? What does LD50 mean exactly? And could you clarify which fluoride compound is used in water fluoridation and why? — Preceding unsigned comment added by 99.61.176.89 (talk) 01:25, 26 May 2014 (UTC)

Toxicity of sodium fluoride

Please include sodium fluoride toxicity. Note that it is a poison. Unlawful to dispose off. Fraudulent medicine.— Preceding unsigned comment added by 222.153.137.47 (talk) 12:24, 26 April 2014 (UTC)

According to the article sodium fluoride, NaF has a relatively low toxicity. As a poison, several grams would need to be consumed by a typical adult human. You are almost certainly correct about its disposal, which is probably regulated, depending on your home country. The use and disposal of chemical compounds generally are regulated. If you have reliable references to the use of NaF in fraudulent medicine, that might be of interest in the article on sodium fluoride. --Smokefoot (talk) 12:46, 20 June 2014 (UTC)

Good article

This article is great because it shows both negative and positive while simultaneously not discriminating any which side, while making both sides agree their points of view. Qwertyxp2000 (talk) 22:16, 27 June 2014 (UTC)

Fluoridation Controversy section could still be more objective...

I'm definitely not anti-fluoridation, but objectivity is a goal of mine. Some parts of the controversy section seem like they're slightly biased towards fluoridation. For instance, "Antifluoridation arguments are, "often based on Internet resources or books that present a highly misleading picture of water fluoridation".[28]" could be phrased more objectively, such as "According to many experts, antifluoridation arguments..." or "According to Jason Armfield, antifluoridation arguments..." so that people pay more attention to the fact that what's being said is a quote rather than an absolutely true fact (which I do believe it is, anyways, but we still should try to be as unbiased as possible). Also I cannot edit it yet, because I am a relatively new user. Ptb1999 (talk) 13:11, 30 August 2014 (UTC)

there is a well organized gang of editor/thugs that revert any change made that seeks to document the position of the anti-fluoridation group. Jtbobwaysf (talk) 16:55, 1 September 2014 (UTC)

Well it is unhelpful to resort to name-calling when one does like an article. A huge amount of effort has been dedicated to this one. And there is this: Water fluoridation controversy, which is prominently cited in the main article. The plain fact is that Wikipedia generally reflects the positions of the most authoritative sources. A good example is evolution, which is intensely controversial for some (like the majority of Americans, apparently), but the article gives no quarter to creationist views. --Smokefoot (talk) 18:07, 1 September 2014 (UTC)

If you have sources that you would like to see included in the article, I encourage you to present them here for discussion. We'll be happy to consider them. Andrew³²⁷ 20:52, 1 September 2014 (UTC)

dental flourosis

Hello. In the article it is stated that dental fluorosis happens in children between 1 and 4 years old. Directly to the right their is a picture of a mouth exposing teeth with fluorosis. The teeth in the picture cannot possibly belong to a child. Is this an outright lie? sodium fluoride is the main ingredient in rat poison. I believe that facts like this should be listed as well. Thanks. I love Wikipedia! — Preceding unsigned comment added by 71.93.215.94 (talk) 01:21, 11 September 2014 (UTC)

I suspect that its simply the best (or only) image we have of detal fluorosis. Before they emerge your adult teeth develop within your gums, this development happens when you are still a child. That’s what the article is referring to, perhaps the wording could be made more clear. Certain chemicals which contain fluorine such as Sodium fluoroacetate, 1,3-Difluoro-2-propanol and Fluoroacetamide are used as rat poisons but these are organofluorine compounds are aren't sources of fluoride (chemically that quite different and biologically very different) - I've never heard of sodium fluoride being used as a rat poison, do you have a reliable source for that? Project Osprey (talk) 09:07, 11 September 2014 (UTC)

Whether NaF is used in rat poison or other stuff is not very relevant. I think that it was used in rat poison at one time. It is not very toxic, one needs grams to kill someone. The single-issue (always unregistered, always single issue) editors on this theme are obsessed with highlighting any connection that could possibly disparage the poor old fluoride ion and boost their contention that fluoridation is used for all sorts of nefarious reasons and part of some grand conspiracies rooted in the Nazi and John Birch Society lore. --Smokefoot (talk) 13:02, 11 September 2014 (UTC)

Proposal for a table

Regarding the usage or not in various countries, perhaps we could add a table. I cannot vouch for this link [[13]]. Politis (talk) 08:21, 15 September 2014 (UTC)

Seems like a good idea to me Jtbobwaysf (talk) 06:21, 27 September 2014 (UTC)

Two comments. 1) The source is awful - advocacy group and wacked out. The parent website is maintained by "...desktop-publishing Editor from 1998-2002 for Fluoride, the journal of the International Society for Fluoride Research. ..", a journal isso disreputable so as to be refused recognition by PubMed (U.S. National Institutes of Health), a remarkable feat in scientific publishing. Sources connected to that organization do not rise to the standards here. 2) probably such a table, if you can find a source, would belong in Fluoridation by country. --Smokefoot (talk) 19:07, 27 September 2014 (UTC)

Major problems in the worldwide-use map

Looking over the world usage map (in the article and at http://wiki.riteme.site/wiki/Water_fluoridation#mediaviewer/File:Fluoridated-water-extent-world.svg ) I notice a few problems: 1) It is over five years old, apparently based on data that is over ten years old (One in a Million, 2004), yet the reference cites the 2012 version of One in a Million, 2) Brazil is shown as a very large red area at 60-80% usage, whereas the 2012 One in a Million lists Brazil at 41% artificial fluoridation. I see no way to come up with the other 19% from natural fluoride, 3) Colombia is shown at 60-80% usage, whereas 2012 One in a Million indicates no artificial fluoridation and under 2% extent of natural fluoride there, 4) Israel has discontinued fluoridation, but is shown at 60-80%, 5) the source code for the map seems to be unavailable, 6) very large areas of India have a problem with excessive natural fluoride, and India's level is indicated as unknown, 7) the map claims to show natural plus artificial fluoridation, whereas the main topic of the article is artificial fluoridation. So this graphic can easily mislead the reader. 8) the article has a good separate map showing excess natural fluoride.

I believe we need an up-to-date map showing only artificial water fluoridation. CountMacula (talk) 16:33, 2 January 2015 (UTC)

Dead Link

The link to the news article about the accidental release of 60 gallons of fluoride in 90 minutes in Asheboro, North Carolina no longer leads to the article. The reference number is 62 at the bottom of the page. I tried to find another news article regarding the event but couldn't find one. (I didn't look for very long). [14] (Griffin9898 (talk) 23:55, 10 January 2015 (UTC))

Suggested updates

I would suggest to include information and links from a research report from the Journal of Epidemiology and Community Health entitled: "Are fluoride levels in drinking water associated with hypothyroidism prevalence in England? A large observational study of GP practice data and fluoride levels in drinking water". This research report highlights evidence for the association between the fluoridation or drinking water and hypothyroidism.

The link for the research report is here:

• http://jech.bmj.com/content/early/2015/02/09/jech-2014-204971.abstract?sid=387994a1-4d28-493a-bef6-8fdf845ecbb0

Also here is a link to a Newsweek article which discusses the findings of this report:

• http://www.newsweek.com/water-fluoridation-may-increase-risk-underactive-thyroid-disorder-309173 — Preceding unsigned comment added by Buffalojack (talk • contribs) 13:58, 1 March 2015 (UTC)

I suggest inclusion of the concerns articulated in the 2006 NRC report on Fluoride in Drinking Water; a reference to the “neutral” stand of the National Kidney Foundation per 2008 position paper that advises warnings for children, the elderly and those with renal impairments; expanding on the last paragraph by acknowledging that the EPA concedes that dental fluorosis could be avoided by reducing the fluoride exposure of children under 3 (the CDC mentions under 8 and the ADA advises under 6 months) - warnings now being included on some city water quality statements; and a mention of Kaj Roholm.

You might also give a nod to the validation of the fluoride opponents complaints of “poor quality” and incorrect interpretations of trial 1950-1990 trials (see Philip Sutton for early trials ) by modern CDC, ADA and PHS. Here are some references for the primary author if he is so inclined to research these suggestions and include them in the article:

• http://dels.nas.edu/resources/static-assets/materials-based-on-reports/reports-in-brief/fluoride_brief_final.pdf
• http://www.toxipedia.org/display/toxipedia/Grand+Rapids+first+use
• http://water.epa.gov/drink/contaminants/basicinformation/fluoride.cfm#three
• http://jada.ada.org/content/141/10/1190.abstract
• http://www.cdc.gov/fluoridation/faqs/dental_fluorosis/index.htm
• http://www.ncbi.nlm.nih.gov/pubmed/10728978?dopt=Abstract
• http://www.kidney.org/atoz/content/fluoride
• articles.mercola.com/sites/articles/archive/2012/04/24/fluoride-warnings-on-water-bills.aspx
• http://www.ncbi.nlm.nih.gov/pubmed/24561004
• Links are helpful http://www.science20.com/the_fluoride_informer/dentists_admit_fluoride_bad_for_kidney_patients

Seabreezes1 (talk) 20:17, 3 October 2014 (UTC)

What is the text you wish to add? Doc James (talk · contribs · email) (if I write on your page reply on mine) 21:11, 3 October 2014 (UTC)

EVIDENCE

Existing evidence XXXXX suggests that water fluoridation reduces tooth decay. Consistent evidence also suggests that it causes varying levels dental fluorosis, most of which is mild and affects less than 50% of the enamel surfaces XXXXXX.[10] However, per the 2004 CDC analysis, 3.6% of American 14 year olds exhibit moderate to severe fluorosis, characterized by brown staining and pitting and impacting over 50% of their enamel surfaces. It is anticipated that those affected to this degree will require veneers or crowns for both aesthetic and structural reasons. (http://www.cdc.gov/nchs/data/databriefs/db53.htm) Despite the claims of efficacy and safety, there is a consensus that almost all 20th century research on the impact of fluoride has been of poor quality.[11]

Due to our emerging understanding of the development of dental fluorosis and the primary effectiveness of fluoride as a topical prophylactics, dental and medical organizations recommend not giving infants and small children fluoridated water or any drink made with fluoridated water. A growing number of city Boards of Health are including this warning on their water reports in an effort to prevent dental fluorosis. (http://jada.ada.org/content/141/10/1190.abstract)

EFFECTIVENESS

Water fluoridation is believed to reduce cavities in both children and adults:[9] earlier studies showed that water fluoridation reduced childhood cavities by fifty to sixty percent, but more recent studies show lower reductions (18–40%) likely due to increasing use of fluoride from other sources, notably toothpaste, and also the 'halo effect' of food and drink that is made in fluoridated areas and consumed in unfluoridated ones.[2] (I suggest you research that 40% figure better and that whole “halo” effect. More is not better… more is more toxic, and causes gum disease. Look up “denti neri”) Some studies indicate that the actual rate is lower due to an apparent delay in carie development in fluoridated communities. (Author is a member of 2006 NRC with a speciality in statistical analysis and risk assessment: http://www.regulations.gov/#!documentDetail;D=EPA-HQ-OPP-2011-0173-0009)

The 2006 National Research Council report on Fluoride in Drinking Water, sponsored by the National Academy of Science found that a lifetime exposure to fluoride is likely to increase the bone fracture rate, particularly in populations susceptible to accumulation of fluoride, such as those with reduced kidney function. The Council also found that there were significant gaps in the available information on dental and bone health at lower levels of exposure. The Council recommends filling these gaps as well as exposure assessment at the individual level and more studies focusing on endocrine and brain function. (http://dels.nas.edu/resources/static-assets/materials-based-on-reports/reports-in-brief/fluoride_brief_final.pdf)

Partially in response to the NRC report, the National Kidney Foundation has withdrawn its support of water fluoridation, adopting a neutral position. The NKF advises patients with chronic kidney disease (CKD) to avoid ingesting fluoride, as well as requiring non-fluoridated water for dialysis. The NKF also advises that those at risk of developing CKD, children, those with excessive fluoride intake, and those with prolonged disease monitor their fluoride intake. The reduced capacity of the kidney to excrete fluoride leads to the life long acculmination of fluoride in the body, leading to a state of chronic fluoride intoxication as described by Dr. Kaj Roholm. (http://www.kidney.org/atoz/content/fluoride)

Dr. George Waldbott observed and described the early stages of fluoride intoxication in some of his patients during the 1950s and 1960s. As an allergist, Dr. Walbott’s patients likely comprised a susceptible population. However, sensitivity to fluoride is typically not an allergic response, but a dose sensitive response to what is essentially a poison.

Ending paragraph

National studies by the CDC indicate that race and income level are more of a factor in the development of caries than fluoridation. (http://www.cdc.gov/nchs/data/databriefs/db104.pdf)

The Ethics & Politics section is better than some, but still has a POV that is less than neutral. Example: fluoridation is not like vaccinations, except in this way. Because of health reasons, as a child in the 60s, I had a medical exemption from the smallpox vaccination. When I was 17 and wanted to travel, I was vaccinated. Water fluorination does NOT allow for this type of individual consideration. However, I’m sure I wouldn’t be able to suggest any edits in this section that wouldn’t be perceived as having an opposing POV.

This is my good faith effort to respond to your query and improve the quality of the articleSeabreezes1 (talk) 23:28, 3 October 2014 (UTC)

The refs are unformatted. We are not adding content like "Existing evidence XXXXX suggests that water fluoridation reduces tooth decay." No idea what XXXXS is. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:24, 4 October 2014 (UTC)

The ref does not say "However, per the 2004 CDC analysis, 3.6% of American 14 year olds exhibit moderate to severe fluorosis, " is due to water fluoridation. Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:33, 4 October 2014 (UTC)

Were is the content that supports "It is anticipated that those affected to this degree will require veneers or crowns for both aesthetic and structural reasons" Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:36, 4 October 2014 (UTC)

This is also not supported "dental and medical organizations recommend not giving infants and small children" This is a primary source not the position of a dental or medical organization [15] Doc James (talk · contribs · email) (if I write on your page reply on mine) 00:42, 4 October 2014 (UTC)

The material about the NKF is also not supported by the cited source, which explicitly does not take a position about water fluoridation. Material about Waldbott and Roholm appear tacked on (these are scientists who published in the 1930s and 40s, and no sources have been presented to suggest their relevance to 2014). I see no material from the above suggestions that I would include in this article. Yobol (talk) 00:43, 4 October 2014 (UTC)

The XXXX was just to show how I edited a paragraph in the EXISTING article for the purpose of making it easier for your review. Ditto with my parenthetical references and comment. The CDC report gives the figures. I did the addition. Any research into the severity of fluorosis indicates that moderate and severe dental fluorosis does require treatment, which is why there is so much emphasis on minimizing it as mostly mild. And, no, the ADA does recommend that although fluoridated water is safe, that infant formula should not be made with it on a regular basis, and the primary research I provided seemed the simplest way to make that point to the editor. As to the BOH including these warnings, there is no single great reference for that, but there are many current news articles on the topic, i.e. common knowledge. The NKF is a lot of double speak, that takes a bit of review, but yes, they do state those exact words. And yes, I did tack on the bits about Waldbott and Roholm, as I did not expect every paragraph to be placed in en masse as written in one section. However, the article included info on Dean, who not only used his work but consulted with Kaj Roholm who advised that water fluoridation was ill-advised. I didn't want to go that far on this article, but any article that touches on the history of water fluoridation should acknowledge the world's leading expert in the 1940s.

You made no comments on the NRC - which is a totally citable source that reviewed the literature and made serious recommendations regarding safety, nor the comments on the EPA's response to the NRC from another very citable source, http://www.orrisk.com/about.html. Again, Dr. Thiessen was a member of the NRC. I suggest that the material I presented is an opportunity for improving the article. Seabreezes1 (talk) 01:37, 4 October 2014 (UTC)

Sorry to jump in, but we dont want any credible article citing "A founder of the International Society for Fluoride Research." This is the front organization for the Mom&Pop club that publishes the journal Fluoride, which is so disreputable that PubMed will not index it. That kind of quackery gets no standing in Wikipedia. Also including him would invite a long list of people pro and anti, and we get into an endless cycle of debating authority. --Smokefoot (talk) 04:03, 4 October 2014 (UTC)

Where did you get that? I'm not quoting any anti-fluoridationists, I'm quoting the National Research Council, the National Kidney Foundation and the CDC. Plus, because I understand fluoridation is a controversial topic, I'd rather not write the material into the article myself, only ask the editor to consider these sources and include what he deems fair. The only reference to a person, was the author of the comments who was a member of the 2006 NRC committee, here is her bio: http://www.orrisk.com/thiessen_bio.html Seabreezes1 (talk) 12:36, 4 October 2014 (UTC)

The article on George Waldbott indicates that he is founder of what is basically Fluoride Action Network. Last line of the text. Alsothe October 1982 issue of Fluoride has a biography/obituary: "the society's founder and the editor of its official journal FLUORIDE since its inception in 1968, ..." --Smokefoot (talk) 15:05, 4 October 2014 (UTC)

Ahh, Dr. Waldbott was a leading allergist and researcher who first described penicillin allergies, human anaphylactic shock and "Smoker's Respiratory Disease" which connected cigarettes with what was considered up to that point to be "asthma." Today's common knowledge about the history of the opposition to fluoride dismisses the real scientific debate in the early years that included reputable scientists about what was essentially a human trial based on a scientific hypothesis. Waldbott got involved with this topic in 1953 because of a cluster of strange illnesses among his allergic patients that were aligned with fluoridation. Yes, it isn't necessarily an allergy.... but he did skin tests on 2,000 people using 3 halogens (I believe chlorine, iodine and fluorine), and identified significant reactions associated with fluorine, albeit mostly not "allergic" but indicative of sensitivity or low tolerance to fluoride. He also did double blind studies. I only bring him up as a passing reference because of the consistent knee jerk reaction to associate fluoride opponents with the late 50s "communist conspiracy" craze, using that as an ad hominem attack to brush aside the scientific debate of the previous 15 years and that the NRC 2006 report and the NKF are tentatively admitting that there is sufficient indication that there are populations susceptible to adverse effect from low "optimal" doses of fluoride. That's the thrust here. It's not professional and not a neutral POV when Dr. Strangelove gets print but mention of Dr. Waldbott and Dr. Roholm is excluded. You can add Dr. Philip Sutton to that list, too. His objections beginning in 1957 to the faulty methods and erroneous data manipulation of those early studies has been validated by professional dental and medical organizations in recent years.

That the CDC & EPA in 2000 reversed their 50 year position that fluoride had to be ingested prior to tooth formation to be effective to saying its primarily topical and that care should be taken to NOT overdose children on fluoride in order to prevent fluorosis is significant. The NRC agrees that there is too much fluorosis due to too high an exposure to fluoride, plus worries about the health impact on other susceptible populations. The NKF officially withdrew its support on water fluoridation, adopting a "neutral" position, but actually saying that children and those with compromised kidney function or at risk of CKD should monitor their intake and discuss with their doctors.... plus there have been deaths associated with using fluoridated water in dialysis. BOTTOM LINE: The reversal in the consensus on how fluoride work and the mounting agreement concerning sub-populations susceptible to harm is, or should, be opening a scientific dialogue about this issue. It's not a "sides" thing.... it's an issue of changing context and emerging trends. Science changes... we think we "know" things only to be proven wrong, or find that things that used to work, no longer work. This article could use a little of that inserted. It doesn't need to be what I wrote, but it should be fair, balanced and reflect the current reality. Seabreezes1 (talk) 18:29, 4 October 2014 (UTC)

New US levels

On May 6th I added to the section on implementation "In 2015 the U.S. recommends fluoride be added to drinking water such that it contain no more than 0.7 mg/L (milligrams per liter, equivalent to parts per million). This was a change from a 1962"

On May 9th User:Prokaryotes added to the section on fluorosis "However, in April 2015, fluoride levels in the United States were lowered for the first time in 50 years, to the minimum recommended levels of 0.7ppm, because too much fluoride exposure has become a common issue for children teeth, visible in the form of white splotches. The basis were the results of two national surveys (1999–2004 NHANES) which assessed the prevalence of dental fluorosis, and found that two out of five adolescents had tooth streaking or spottiness on their teeth - an increase of mostly very mild or mild forms"

In summarized this as "In April 2015, recommended fluoride levels in the United States were changed to 0.7 ppm from 0.7-1.2 ppm to reduce the risk of dental fluorosis. In the US mild or very mild dental fluorosis has been reported in 20% of the population, moderate fluorosis in 2% and severe fluorosis in less than 1%"

Prokaryotes re added " for the first time in 50 years". That was already mentioned once in the article so I am not convinced it is needed a second time. Peoples thoughts? Doc James (talk · contribs · email) 21:26, 9 May 2015 (UTC)

I can't seem to find the mention in the article, can you point me to it, and this is the source i used, besides the official press release from CDC. http://www.theguardian.com/environment/2015/apr/27/fluoride-levels-us-drinking-water-lowered-splotchy-teeth prokaryotes (talk) 21:28, 9 May 2015 (UTC)

Ok i see now what you meant. prokaryotes (talk) 21:31, 9 May 2015 (UTC)