Links to Key Documents on Community Water Fluoridation

Matt Jacob
May 4, 2014

British Government Report (2014) – This report by Public Health England reviewed research on the effectiveness and safety of fluoride/fluoridation.  Its conclusion: “The report provides further reassurance that water fluoridation is a safe and effective public health measure.” The report found no link between fluoride and various health concerns, including hip fractures, Down’s syndrome and multiple forms of cancer. (posted or updated in March 2014)

CDC Presentation at Grand Rounds (2013)These are the slides from a presentation given on community water fluoridation at CDC’s Grand Rounds.  The presenter was Barbara Gooch, who is Associate Director of Science for CDC’s Division of Oral Health. There are many interesting components.  For example, Slide 5 provides a graph illustrating how the expansion of community water fluoridation corresponded with a decline in both the prevalence of tooth decay and the DMFT (Decayed, Missing and Filled Teeth). (posted or updated in December 2013)

Fluoridation & Prostate CancerDeclan Waugh, the Irish fluoride critic, and some others have asserted that fluoride causes prostate cancer.  Waugh points to Ireland’s disproportionally high rate to back this claim. But they ignore data showing that Sweden, Norway and France—all non-fluoridated nations—have rates of prostate cancer that are higher than Ireland. The link below is a table from the website of the World Cancer Research Fund International, showing the rates of prostate cancer in many countries around the world. (posted or updated in December 2013)

EPA’s Order Rejecting Request for Ban of HFSA (2013)Former EPA staffer Bill Hirzy filed a petition seeking to force his former agency to prohibit a form of fluoride called Hydrofluorosilicic Acid (HFSA). This type of fluoride is widely and safely used in many U.S. communities to supplement the fluoride that exists naturally in water.  The EPA rejected Hirzy’s petition, noting that he “miscalculated” the benefits of moving from HFSA to a different type of fluoride. The EPA wrote that the petitioners “have not set forth sufficient facts” to prove that HFSA presents “an unreasonable risk” to health. (posted or updated in August 2013)!documentDetail;D=EPA-HQ-OPPT-2013-0443-0001

Anti-Fluoride Activists Are Not CredibleThree versions of a one-pager were created demonstrating that anti-fluoride activists lack credibility. Each version is slightly different, but all three feature brief quotes from newspapers or science-related sources stating why opponents are not credible. Version 3 features more science publications than the other versions. These leaflets could be circulated at community meetings or distributed to the members of city councils, state legislatures or local water boards. (posted or updated in August 2013)

Can You Trust Paul Connett?This one-page document provides brief quotes and comments about Paul Connett or the anti-fluoride movement in general.  These newspapers and health experts reveal their view that Connett, leader of the Fluoride Action Network (FAN), is not a credible source of information. (posted or updated in July 2013)

Infographic on Fluoridation Benefits (2013)The Pew Charitable Trusts produced an infographic sharing 6 numbers that highlight the value of and need for community water fluoridation. One of the stats revealed the lifetime treatment cost of a single decayed molar. (posted or updated in July 2013)

Q&A: Public Health Law & FluoridationWhat role does the federal government play in community water fluoridation? The Children’s Dental Health Project produced a Q&A on this topic and answered five questions that sometimes arise during public discussions. (posted or updated in April 2013)

Q&A: Benefits & Safety of FluoridationThis Q&A examines 11 common questions that arise in communities that are considering starting or ceasing water fluoridation. The questions explore a variety of topics, including fluoride use in Europe and dental fluorosis. Citations are providing with hyperlinks to the original sources. (posted or updated in April 2013)

Surgeon General’s 2013 Statement on FluoridationDr. Regina Benjamin, the U.S. surgeon general, issued this public statement in support of water fluoridation.  The statement coincided with the convening of the annual National Oral Health Conference in Alabama. In her statement, Dr. Benjamin calls fluoridation “one of the most effective choices communities can make” to protect the dental health of their residents. (posted or updated in April 2013)

Dr. Louis Sullivan’s Remarks (2013) on FluoridationDr. Louis Sullivan, the former secretary of the U.S. Department of Health and Human Services (1989-1993), gave a speech at the Campaign for Dental Health’s meeting in Washington, D.C. This is a transcript of his remarks voicing strong support for community water fluoridation. (posted or updated in April 2013)

Surgeons General: Strong, Consistent Support (2013)This PDF provides brief statements from five U.S. Surgeons General — including Dr. Regina Benjamin, the current SG — who express their support for community water fluoridation. Photos of most of the SGs are displayed. (posted or updated in April 2013)

Three Harvard Deans Endorse Fluoridation (2013)The deans (3) of the Harvard medical school, dental school and School of Public Health co-wrote this letter expressing their strong support for community water fluoridation. The deans wrote that fluoridation is “a safe and effective public health measure,” and they add: “Fluoridation has made an enormous impact on improving the oral health of the American people.” (posted or updated in March 2013)

Two Harvard Deans Endorse Fluoridation (2013)The deans (2) of the Harvard medical and dental schools co-wrote this letter voicing their enthusiastic support for community water fluoridation. The deans wrote that numerous studies “have consistently demonstrated that community water fluoridation is safe, effective, and practical.” (posted or updated in March 2013)

Defense Dept. Memorandum on Fluoridation (2013)This memorandum issued by a U.S. Defense Department official outlines plans to ensure that all military personnel have access to fluoridated water. The memo directs all military bases serving at least 3,300 enlisted personnel to fluoridate their drinking water by fiscal year 2016. The memo reports that the Assistant Secretary of Defense for Health Affairs “has determined that providing optimally fluoridated water at DoD installations helps to improve and sustain the military readiness and health of military personnel.” (posted or updated in March 2013)

Former NRC Chairman Speaks Out (2013)Dr. John Doull chaired the National Research Council committee on fluoride in water.  In this 2013 email exchange with the Pew Charitable Trusts, Dr. Doull states that he does not see “any valid scientific reason for fearing adverse health conditions” from drinking fluoridated water. (posted or updated in March 2013)

Research Review Cites Fluoridation as “Optimal Method”This study in the British Dental Journal concluded that fluoridated water “is still the optimal method” for providing fluoride’s benefits because drinking water provides a frequent exposure to fluoride and is, therefore, “more beneficial in [decay] prevention” than semi-annual fluoride treatments in a dental office. (posted or updated in February 2013)

Fluoride: A Key Part of Europe’s Dental Progress (2013) – Opponents of fluoridation talk often about Europe as being virtually “fluoride-free” without recognizing that fluoride has played a crucial role in reducing the continent’s tooth decay rates.  Salt fluoridation is one of the main vehicles used in Europe.  The Children’s Dental Health Project examined tooth decay data from 15 countries in Western Europe, and this analysis determined that the five nations that have made significant use of either water fluoridation or salt fluoridation have decay rates in the lower half of this ranking. (posted or updated in 2013)

Black Organization Endorses Fluoridation (2012)The National Black Caucus of State Legislators adopted this resolution, declaring that the organization “recognizes the importance of community water fluoridation as a safe, cost-effective public health intervention proven to prevent tooth decay and reduce oral health disparities.” (posted or updated in October 2012)

Fluoride Facts: Wisconsin Infographic – This infographic was produced by the Wisconsin Dental Association in 2012. It provides 7 statistics related to water fluoridation, including some that focus on Wisconsin. (posted or updated in 2012)

Irish Rebuttal of Declan Waugh’s Report (2012) – The Irish Expert Body on Fluorides and Health (IEBFH) issued this analysis soon after a fluoridation critic named Declan Waugh circulated a report critical of this public health practice.  In its analysis, the IEBFH stated that Waugh’s analysis was flawed and added: “The Expert Body is satisfied having studied current peer reviewed scientific evidence worldwide that water fluoridation causes no ill effects to the health of adults or children.” (posted or updated in September 2012)

Water Fluoridation Status of the 50 Largest Cities in the United States (2012) – This document was updated by the American Dental Association in 2012, showing the fluoridation status of these cities. The chart also indicates what year each city initiated fluoridation.  Special notations are made, for example, to indicate that Jacksonville, Fla. Is naturally fluoridated. San Jose is listed as non-fluoridated because fluoridation had not begun by this time. (posted or updated in May 2012)

The Anti-Fluoridationist Threat to Public Health (2012)The Institute for Science in Medicine produced a report that examined numerous ways in which anti-fluoride activists misrepresent or ignore legitimate scientific research—and how they cite irrelevant and anecdotal “research” to encourage fear and doubt. (posted or updated in April 2012)

Fluoridated Water & Kidney Disease – This two-page document can be used to counter claims made by fluoridation opponents about Chronic Kidney Disease (CKD). The document points out that the National Kidney Foundation has stated that there is no scientific basis “to recommend the use of fluoride-free drinking water” for patients with kidney disease.

NALBOH’s Oral Health Guide (2012)In 2012, the National Association of Local Boards of Health (NALBOH) produced the 2nd edition of its “Oral Health Guide” and voices support for fluoridation. On page 6, the Guide explores the activities of anti-fluoride groups and notes that opponents “often contain outdated and misinterpreted studies and statements.” (posted or updated in 2012)

Oral Health During Pregnancy (2012)This report by the National Maternal and Child Oral Health Resource Center offers a consensus statement for pregnant women.  The report—produced with the cooperation of the Maternal and Child Health Bureau and the American College of Obstetricians and Gynecologists—makes this recommendation to pregnant women (page 10): “Drink water throughout the day . . . Drink fluoridated water (via a community fluoridated water source), or, if you prefer bottled water, drink water that contains fluoride.” (posted or updated in 2012)

Myths & Facts (2012) – This is a good document for providing clear and concise responses to the common claims that are made by anti-fluoride activists. The blue-and-white document is formatted so readers first see “the truth” and then see the related claim that opponents make. In the far right column is a series of bullet points that offer more details on why the opponents’ claim is inaccurate or misleading. Citations are provided near the end of the eight-page document. (posted or updated in 2012)

Fluoridation: How to Read About Research (2011) – Anti-fluoride activists often cherry-pick sentences from studies and use them in ways that misrepresent the actual findings. In a 2011 article, the Santa Cruz Sentinel (Calif.) newspaper examined the importance of relying on sound science to reach conclusions about this public health issue. As this article explains: “Many studies against fluoridation or proving negative health effects have reportedly been papers published at low-tier journals or studies withdrawn after being published.” (posted or updated in November 2011)

FDA Letter to California Expert Panel (2011) – This is a letter to California’s Office of Environmental Health Hazard Assessment (OEHHA) from senior officials at the U.S. Food and Drug Administration (FDA). OEHHA was considering a request to classify fluoride as a “toxic” substance under state law. In the letter, FDA officials inform OEHHA that the federal agency has “determined that the available data do not support a conclusion that exposure to fluoride in FDA-regulated products causes cancer.” The FDA letter explains that it concluded in 1995 that fluoride used in dental rinses, bottled water or other FDA-regulated products is a “safe and effective” way to reduce the rate of tooth decay. (posted or updated in September 2011)

ADA Remarks to Georgia Legislative Back Caucus (2011) – This is a transcript of a speech delivered in 2011 by Dr. Raymond Gist, the first African-American president of the American Dental Association, to the Georgia Legislative Black Caucus. Dr. Gist discusses the importance of water fluoridation and dispels myths about this issue. He also clarifies what fluorosis is. (posted or updated in September 2011)

Connett Panders to 9-11 Doubters (2011)This one-pager reveals that Paul Connett, leader of the Fluoride Action Network, is sympathetic to people who spin conspiracy theories about the 9/11 terrorist attack. In a speech in New Zealand, Connett referred to people who question the official account of 9/11 and said “we need to pursue questions like that.” (posted or updated in July 2011)

Salt Fluoridation in Europe and in Latin America (2011)Anti-fluoride groups often post web pages and other content that refer to Europe as “fluoride-free” and imply that Europe’s low tooth decay rates have occurred without the use of fluoride. This is not true. This article from a German economic journal outlines the various ways in which fluoride helps to reduce tooth decay in Europe and around the globe. As the article notes, fluoridated salt is sold in nine European countries, and other nations there provide fluoridated water or milk. (posted or updated in March 2011)

A Study of Dental Decay in Nevada Youth (2010)Researchers conducted a study of risk factors for dental decay among Nevada teenagers and published this article in the journal BMC Oral Health. They concluded, “Participants living in areas without community water fluoridation in Nevada were almost 2 times more likely to [have] higher DMFT (decayed, missing and filled teeth) indices.”  The article also notes, “The benefits of water fluoridation are proportionally higher for people who do not have regular access to other sources of fluoride.” (posted or updated in March 2011)

Changes in Tooth Decay in Switzerland’s Largest Cities (2010)This study examined the trends in tooth decay in 16 communities within the city of Zurich, Switzerland from 1964 to 2009. The study, published in a Swiss dental journal identified fluoride exposure as a key factor in this decline. Fluoride toothpastes were not widely used until the 1960s, and the fluoridation of table salt began in Switzerland in 1963. By 2009, fluoridated salt was reaching an estimated 81% of Swiss children, and this practice was estimated to reduce tooth decay by 21% to 24%. The co-authors share data showing that from 1964 to 2009, the average number of decayed or filled tooth surfaces for 14-year-olds fell by 93%. A graph on page 1091 of the article provides a vivid illustration of this dramatic drop. This article is a reality check to the statements circulated by anti-fluoride activists, who imply that Europe’s reductions in tooth decay occurred without fluoride. (posted or updated in January 2011)

Bazian Report on Fluoride-IQ Studies (2009)Bazian produced a report about fluoride-related studies at the request of British health officials. Bazian is an independent research firm that was founded by two clinicians who formerly worked at the British Medical Journal.  Bazian’s report analyzes the methodology and findings of about 20 studies that were circulated by anti-fluoride activists, who claimed they showed that fluoride is linked to low IQ scores in children.  Bazian’s analysis revealed significant flaws with these studies and identified “basic errors” in how the study’s authors interpreted their data. (posted or updated in 2009)

Arkansas Report Compares Communities (2008) – This report by the Arkansas Department of Health examined the scientific evidence and oral health data that are the basis for the department’s support for community water fluoridation. Three years after this report was released, Arkansas enacted a fluoridation law.  The report shares data from two adjacent counties—the fluoridated town of Morrilton (Conway County) and non-fluoridated areas of Perry County. Dental screenings of kindergarten students (see pages 13-14) revealed that children in Perry County had twice the rate of tooth decay as Morrilton children experienced. (posted or updated in 2010)

Research Review (2007) on Fluoridation in Europe – Anti-fluoride activists frequently describe Europe as being “98% fluoride free” even though Europe relies heavily on fluoride in various forms, including fluoridated water, fluoridated salt, fluoridated milk or fluoride-rinse programs for children. This 2007 research paper shares several insights, noting that logistical and cultural reasons shape the decisions that European countries have made about water fluoridation. One of the reasons why Italy lacks a national water fluoridation policy is “because in a number of areas throughout the country, water is naturally fluoridated, reaching the optimal level for [decay] prevention.” (posted or updated in 2010)

Fluoride’s Effect on Fish & Aquatic Life – Joe Carroll, an expert in freshwater science, wrote this letter to a local newspaper in Oregon in April 2005, explaining why there is no scientific evidence to support claims that fluoridated water (discharged into local rivers or streams) would harm fish or aquatic life. (posted or updated in 2010)

A Rebuttal of FAN’s “50 Reasons” – Years ago, the Fluoride Action Network (FAN) created a web page called “50 Reasons to Oppose Water Fluoridation” that its leader, Paul Connett, widely circulates. T.W. Cutress, a member of the Medical Research Council in New Zealand, examined these “50 reasons” and drafted this analysis, revealing that FAN’s reasons are based on flawed research and/or misinterpretations of legitimate research. On page 2, for example, Cutress writes that some of the reasons rely on Connett’s “subjective viewpoints, some of which lack literal or factual substance.” Although FAN periodically revises its “50 Reasons” content, Cutress’ analysis remains helpful in debunking the myths that lie at the heart of FAN’s claims. (posted or updated in 2010)

Toxicological Profile on Fluorides (2003) – The U.S. Department of Health and Human Services produced this toxicological profile on fluorides, and this is the kind of profile that federal health officials create for many other substances to indicate the levels and exposures at which health harms could occur. In this document, HHS focuses on exposure to fluoride in industrial settings where one can be exposed to the mineral in unusually high concentrations. The report notes that fluoride is a “natural component of the earth’s crust and soil” and adds that levels of fluorides in surface water average about 0.2 parts per million (PPM) and range from 0.02 to 1.5 ppm, but may exceed 1.5 ppm in a few parts of the country.  The report points out that skeletal fluorosis “is extremely rare” in the U.S. and “has occurred in some people consuming greater than 30 times the amount of fluoride typically found in fluoridated water.” (posted or updated in 2010)

Fluoride Study in Fort Collins, Colorado (2003)The Fluoride Technical Study Group (FTSG) issued this report to help city officials in Fort Collins, Colorado, assess the risks and benefits of community water fluoridation. This is one of the most thorough reviews ever commissioned by a city. The FTSG concluded that reducing tooth decay “is better achieved through community water fluoridation than through individual approaches” because fluoridation “requires minimal behavioral changes” and “is effective in reaching people” regardless of their income level. The FTSG explored a variety of health risks that opponents have raised and did not found convincing evidence that these fears are warranted. (posted or updated in 2010)

ADA Letter to Senator Mike Crapo (2000) – The American Dental Association sent this letter to U.S. Senator Mike Crapo (R-Idaho), who chaired the Environment & Public Works Committee. In the letter, ADA leaders outline the strong scientific evidence supporting community water fluoridation, and they explain why several claims by opponents are weak, inaccurate or irrelevant. (posted or updated in 2012)

Impact of Fluoridation of the Municipal Drinking Water Supply (2000) – The University of West Florida conducted this research report of fluoridation for officials in Escambia County in May 2000. The report found that the decay-fighting benefit of fluoridation—even in an era of widespread use of fluoride toothpaste—” is still highly significant.” The report explored and debunked a variety of claims made about fluoride’s effects on human health.  In its conclusion, the report observed that by 1977, scientists had published approximately 35,000 studies or research papers over the preceding 30 years “verifying the efficacy and safety of water fluoridation.” (posted or updated in 2010)

Report (1985) of the British Working Party on Fluoridation –The British Working Party on Fluoridation (BWPF) issued this report after examining the data that had been collected by two prominent researchers, John Yiamouyiannis and Dean Burk. Burk, a senior researcher at the National Cancer Institute, echoed the view advanced by Yiamouyiannis that fluoridated water contributed to higher rates of cancer in the U.S. The BWPF’s report found that the data sets on which Yiamouyiannis and Burk relied were “defective.” The BWPF also concluded that the two researchers’ analytical methods “displayed errors and questionable procedures.” The BWPF concluded that no fluoride-cancer link had been proven, and the scientific body also noted that the Committee of the Royal College of Physicians of London had reviewed this same issue in 1976 and found that “there is no evidence that fluoride increases the incidence of mortality in any organ.” (posted or updated in 2011)

U.S. House Hearings on Fluoridation (1954) – This is a transcript of hearings held in May 1954 by the U.S. House Committee on Interstate and Foreign Commerce on H.R. 2341, a bill that would have prohibited any community from fluoridating its drinking water. The official name of the bill was “Protect the Public Health from the Dangers of Fluorination of Water.”  Bear in mind that at this point in history, only about 25 million Americans were receiving optimally fluoridated water, and the residents of Los Angeles, New York, Chicago and St. Louis were among those without access to this benefit.  During the hearing, Congressman Gerald R. Ford of Michigan—who would later serve as the U.S. president—defended fluoridation against the unsubstantiated fear-based attacks that were circulated at the hearing.  H.R. 2341 eventually died.

* * * * * * * * * * * * * * * * * * * * *

Helpful Handouts for Advocates

Leading Health Experts Agree (2014)This one-pager features quotes from 5 entities: the CDC, the American Academy of Pediatrics, the American Dental Association, Public Health England, and the American Public Health Association. This document can serve as a helpful handout to circulate to policymakers or stakeholder groups. (posted or updated in March 2014)

Wrong on the Science (2013) – This one-pager provides excerpts from science writers and health reporters, explaining how Portland voters’ rejection of water fluoridation reflects a misunderstanding of the scientific evidence.  This document could be a helpful handout in communities on the West Coast where news of the Portland vote is still somewhat fresh.

Dean Burk (2012) – Burk was a longtime researcher at the National Cancer Institute, is often cited by anti-fluoride activists to back their claim that fluoridated water can cause cancer.  This one-pager summarizes the assertions that Burk made and explains why there is no solid scientific basis to support his assertions about cancer.

This page was posted on May 4, 2014.