The core of this article is uncontroversial: water fluoridation is effective, but less effective than it was half a century ago because fluoridated toothpaste is now nearly universal.
With that said, the author commits the two cardinal sins of public health journalism: they allow dangerous levels of a substance to be conflated with recognized safe levels, and they confuse value for a sub-sample of the population (those who can/do use fluoride toothpaste and go to the dentist regularly) with value for the entire population.
The latter in particular is why water fluoridation in areas with low natural fluoride levels is sound public health policy: it helps the population as a whole, even when not all segments can or will obtain appropriate dental care.
Adding elements to stuff we assume UNIVERSALLY is universally wrong because we do not assume them at similar level. For instance here in EU most table salt is with added iodine, witch in general is good IF you do not live near the sea, but being universal this salt also goes to people living near the see adding potentially to much iodine (an thyroid problems are on the rise since decades).
For fluorine it's the same: some drink tap water, some drink only bottled water, so some get potentially too much some potentially nearly none.
Nobody is saying that universal fluoridation is good public health policy. It’s about local conditions, including existing dietary sources and groundwater levels. In much of the US, trends in both combined with persistent access problems around dental care warrant fluoridation in most municipalities.
Every comment thread about fluoridation on HN goes like this. Most countries that don’t fluoridate their water don’t do so either because they fluoridate something else (table salt) or because their natural groundwater contains sufficient fluoride, or because dietary trends in those areas already provide dietary fluoride.
Western Europe and Latin America are examples of (1), Central Europe is an example of (2), and much of Asia is (2) or (3).
And this is the point: if you have naturally occurring fluoride at safe levels, you shouldn’t add it. If you have it at unsafe levels (which much of the world does!), you should defluoridate your water. But the body of evidence is overwhelming that 0.7mg/L for fluoridation is not a significant public health risk, especially in contrast with its tangible benefits.
In many parts of the world, natural dietary fluoride exposure from food greatly exceeds the levels anyone adds to water. Some regions also have naturally high fluoride levels in water as well.
As I understand it, the EPA is required to reanalyze the current florudation recommendations.
> 121. Plaintiffs have proven, by a preponderance of the evidence, that water fluoridation at the level of 0.7 mg/L – the prescribed optimal level of fluoridation in the United States – presents an “unreasonable risk of injury to health or the environment, without consideration of costs or other non-risk factors, including an unreasonable risk to a potentially exposed or susceptible subpopulation under the conditions of use.” 15 U.S.C. § 2620(b)(4)(B)(ii).
In fact, Flouride may be actually harmful in children. According to a peer-reviewed finding, "aggregate fluoride exposure from all sources in an amount equivalent to 1.5 mg/L in drinking water is consistently associated with lower IQ in children." See https://www.law.com/thelegalintelligencer/2024/10/04/fluorid....
Nobody fluoridates the water to 1.5 mg/L. If you're fluoridating the water, your target is 0.7 mg/L.
The people with 1.5 mg/L fluoride (or higher--the EPA limit is 2.0mg/L) are because the groundwater is percolating through rock that is high in fluorides, and people don't want to spend the money on defluoridating the water down to acceptable standards. Defluoridation is of course much harder than fluoridation because fluorides are highly soluble.
The limits are set such that if you _only_ drank tap water you won't consume more than the safe limit. If you then reduce how much tap water you consume because you get hydration from other sources, your well under the limit.
Not accounting for someone eating tubes of fluorinated toothpaste, which is out of specified usage.
The coffee, soda, beer, or kombucha you drink was made with fluoridated water. Your salad was grown with fluoridated fruit was washed in fluoridated water.
Fluoride permeates modern supply chains because it’s literally in the water which is an input to countless things.
Fluoride proponents have utterly failed to control dosage and harmed public health in doing so.
The underlying study makes a much weaker claim than the people who are using it to campaign against fluoridation.
A big issue in this discourse is that for the strong claims to be true, it would essentially require existing science around fluoride toxicity and the related mechanisms of action to be materially incorrect, contrary to all historical evidence. Fluoride poisoning is a thing that happens and has straightforward interventions. Are we supposed to pretend this science doesn't exist? I actually worked in fluoride chemistry, it is difficult to square this circle.
In addition to the "plausible mechanism of action" question, there is the inconvenient observation that exposure to fluoride from natural dietary sources is far higher today than from municipal water. Why the obsession with municipal water augmentation in historically low-fluoride environs? Most people eat far more fluoride than what their water exposes them to.
I find this particular social contagion deeply weird. You see the same persistent misrepresentation on social media as climate science, but in the case of climate science the effects on people is obviously consequential so the motivated reasoning is more understandable. The fluoride thing is trying to invent an issue around a topic that is inconsequential by all evidence and science.
Who benefits by encouraging people to tilt at this windmill?
The NSA can’t regulate itself - it needs court oversight. Courts are allowed to decide what matters to national security and what doesn’t, despite not being agents.
The Police can’t regulate themselves - they need court oversight. Courts are allowed to define what is acceptable policing and what is not, despite not being police.
The EPA can regulate itself and understands science. Courts aren’t allowed to weigh in because they aren’t scientists. The EPA is a morally upright actor, all other government agencies aren’t.
A perfectly rational position. (I say that with extreme sarcasm - it’s malarkey.)
The EPA was already significantly more subject to judicial review than the NSA, even prior to Chevron deference falling.
The cops are theoretically subject to it, but in practice... nah, mostly not. They receive at least Chevron-levels of deference for things like "I feared for my life!" or "he was coming right at me!" or "I thought it was a gun!" or "based on my experience and training the suspect was acting suspiciously" sort of expert claims.
That is a minuscule disaster versus the overall impact of those mines and other similar industry activities on the environment. All that contamination used to just get dumped in the water supply.
It’s only big because we don’t really consider Cleveland’s burning river or LA’s smog blanket to have been “disasters”.
(As the link notes: "The event drew attention to toxic drainage from many similar abandoned mines throughout the country.")
> Prior to the spill, the Upper Animas water basin had already become devoid of fish, because of the adverse environmental impacts of regional mines such as Gold King, when contaminants entered the water system.
> In the 1990s, sections of the Animas had been nominated by the EPA as a Superfund site for clean-up of pollutants from the Gold King Mine and other mining operations along the river. Lack of community support prevented its listing… Locals had feared that classifying this as a Superfund site would reduce tourism in the area, which was the largest remaining source of income for the region since the closure of the metal mines.
Yeah, it was really bad already so good on EPA for making it a lot worse. ("miniscule" is not applicable to this disaster and casual readers may see it as emotion-based hyperbole.)
I assure you that the kids that are struggling with severe dental problems are not drinking two liters of tap water per day. Maybe we should fluoridate Coca Cola.
Of course it depends on whether the target demographic has adequate access to fluoride by other means, such as toothpaste.
A similar case might be iodine in table salt. A lot of salt available in America is iodized on purpose. We don't do that where I live, where the usual diet is already rich in iodine. There is no single right answer, only a cost-benefit analysis for each location.
This isn't really something new - it's been known for a long time that fluoride needs to be on the surface of the teeth to work. In jested fluoride doesn't do anywhere near as much.
So fluoride toothpaste, or even better fluoride rinse's are much more effective.
There is though. It's a great way to offload fluoride waste. In fact, the reason we discovered the dental effects of fluoride was because a dentist noticed the yellowed and hardened teeth of patients in the area where the water was contaminated from local industrial waste.
That actually does not refute GP, rather, it changes the conversation to "do we want to preserve civilization". The cynic would note that many have demonstrated in the past year that they are willing to sacrifice civilization.
This better not result in another push by the Pacific Northwest about removing fluoride from drinking water. Don't rest on your laurels people, complacency leads down the path of rotting from within. It's not as useful because it's working, the things we are doing are working, keep them up. Fight tooth decay.
Comments like this are the clearest sign that this topic has become so politicized that rational judgement is out the window. If fluoride in the water is opposed by *those people*, or is supported by *those people*, then even if new clear evidence comes out one way or another, it will be undermined by not wanting to hand the other side a ‘W’.
In an era where conspiracy theories are rampant, yeah, I'm kind of averse to letting conspiracy theorists win anything.
I'm not going to put myself in danger to avoid it. But when the evidence is marginal, social factors are something I'll take into account.
Even if there is indeed a problem with fluoridated water, it only shows up in a small effect that requires a large sample to see. The conspiracy theorists were guessing, even if they guessed right. And they ignored the data that had been gathered.
Science changes its mind, but conspiracy theorists never do. They accumulate, and it looks to me as if we're about to drown in them.
I'm getting the feeling that you are constantly fighting against a set of made up conspiracy theorists that exist in your head. I will refuse to live like that lol.
We literally just got a ruling against the EPA on fluoridation as being dangerously risky levels. As even The Guardian admits, it’s possible there actually is something to the claims of danger.
Of course, the EPA would never live it down if the anti-fluoridation people actually had something to their claims. However, I’m not the EPA. If they were wrong, screw them.
That’s not an accurate summary of the ruling. The ruling orders the EPA to re-evaluate the safety of fluoridation, but does so because the statutory evidentiary standard here is preponderance, not overwhelming evidence.
(It’s also not a ruling “against” the EPA. It’s entirely consistent with the statute, and the EPA will presumably act in accordance with it and produce yet another study demonstrating marginal-to-zero harm associated with fluoridation below 1.5mg/L.)
You are only feeding the growth of conspiracy theories if, when confronted with one that is true, you continually deny it. If they see actual evidence being denied, they think there’s something there.
I'm not planning to deny evidence. But I don't think the conspiracy theorists need my help to think there's something there. If I don't give them something they will just make something up. That is the definition of a conspiracy theory.
Since we're doing anecdotes, my kids grew up on well water and have never had cavities or tooth problems. They (most of the time) brush their teeth daily, eat sugary crap, and get fluoride treatments applied yearly from the dentist (they "paint" a gel on the kids teeth, I believe this is standard in the US for all children regardless of water fluoridation).
I’ll note that this anecdote can cut both ways: well water is just as likely to have more fluoride than fluoridated municipal water, since fluoride is naturally occurring, soluble, and commonly found in rock formations that also hold water.
> Portland, where I live, is the last major city to not have fluoride in the water.
Kind of depends how you track things I'd think. New Jersey, the state with the highest population density in the US, largely doesn't put fluoride in the water outside of a few municipalities.
There's no fluoride in the water in almost the entirety of Hudson, Essex, and Bergen counties, which are located near NYC and include the cities of Newark and Jersey City. Combined population of those three counties is over 2.5 million people.
Tablets that the kids ingest?? After so much evidence of the neurotoxic effects of ingested fluoride, it's worse than criminal if these dentists are giving fluoride for kids to eat.
Dietary fluoride has a minimal impact, you need fluoride on the surface of the tooth. A fluoride rinse is much more effective that tablets or in the water.
The core of this article is uncontroversial: water fluoridation is effective, but less effective than it was half a century ago because fluoridated toothpaste is now nearly universal.
With that said, the author commits the two cardinal sins of public health journalism: they allow dangerous levels of a substance to be conflated with recognized safe levels, and they confuse value for a sub-sample of the population (those who can/do use fluoride toothpaste and go to the dentist regularly) with value for the entire population.
The latter in particular is why water fluoridation in areas with low natural fluoride levels is sound public health policy: it helps the population as a whole, even when not all segments can or will obtain appropriate dental care.
Adding elements to stuff we assume UNIVERSALLY is universally wrong because we do not assume them at similar level. For instance here in EU most table salt is with added iodine, witch in general is good IF you do not live near the sea, but being universal this salt also goes to people living near the see adding potentially to much iodine (an thyroid problems are on the rise since decades).
For fluorine it's the same: some drink tap water, some drink only bottled water, so some get potentially too much some potentially nearly none.
That's why "universal" is essentially wrong.
Nobody is saying that universal fluoridation is good public health policy. It’s about local conditions, including existing dietary sources and groundwater levels. In much of the US, trends in both combined with persistent access problems around dental care warrant fluoridation in most municipalities.
> with recognized safe levels,
Funny because many countries choose to NOT add fluoride to their water sources. Despite all the "safety" data available.
Every comment thread about fluoridation on HN goes like this. Most countries that don’t fluoridate their water don’t do so either because they fluoridate something else (table salt) or because their natural groundwater contains sufficient fluoride, or because dietary trends in those areas already provide dietary fluoride.
Western Europe and Latin America are examples of (1), Central Europe is an example of (2), and much of Asia is (2) or (3).
And this is the point: if you have naturally occurring fluoride at safe levels, you shouldn’t add it. If you have it at unsafe levels (which much of the world does!), you should defluoridate your water. But the body of evidence is overwhelming that 0.7mg/L for fluoridation is not a significant public health risk, especially in contrast with its tangible benefits.
What does the body of evidence show is safe for your third eye? Because that's who you're having to disprove safe flouride levels to.
In many parts of the world, natural dietary fluoride exposure from food greatly exceeds the levels anyone adds to water. Some regions also have naturally high fluoride levels in water as well.
Did you know there are places that BAN chewing gum despite all the “safety” data available and history of use elsewhere?!?!!!
As I understand it, the EPA is required to reanalyze the current florudation recommendations.
> 121. Plaintiffs have proven, by a preponderance of the evidence, that water fluoridation at the level of 0.7 mg/L – the prescribed optimal level of fluoridation in the United States – presents an “unreasonable risk of injury to health or the environment, without consideration of costs or other non-risk factors, including an unreasonable risk to a potentially exposed or susceptible subpopulation under the conditions of use.” 15 U.S.C. § 2620(b)(4)(B)(ii).
Full ruling: https://fluoridealert.org/wp-content/uploads/2024/09/Court-R...
The law mentioned: https://www.law.cornell.edu/uscode/text/15/2620
In fact, Flouride may be actually harmful in children. According to a peer-reviewed finding, "aggregate fluoride exposure from all sources in an amount equivalent to 1.5 mg/L in drinking water is consistently associated with lower IQ in children." See https://www.law.com/thelegalintelligencer/2024/10/04/fluorid....
Nobody fluoridates the water to 1.5 mg/L. If you're fluoridating the water, your target is 0.7 mg/L.
The people with 1.5 mg/L fluoride (or higher--the EPA limit is 2.0mg/L) are because the groundwater is percolating through rock that is high in fluorides, and people don't want to spend the money on defluoridating the water down to acceptable standards. Defluoridation is of course much harder than fluoridation because fluorides are highly soluble.
Yes, because people only drink a certain amount of tap water so you know they're getting the recommended dosage of fluoride.
Fairly bad faith argument on your part.
The limits are set such that if you _only_ drank tap water you won't consume more than the safe limit. If you then reduce how much tap water you consume because you get hydration from other sources, your well under the limit.
Not accounting for someone eating tubes of fluorinated toothpaste, which is out of specified usage.
Absolute nonsense.
The coffee, soda, beer, or kombucha you drink was made with fluoridated water. Your salad was grown with fluoridated fruit was washed in fluoridated water.
Fluoride permeates modern supply chains because it’s literally in the water which is an input to countless things.
Fluoride proponents have utterly failed to control dosage and harmed public health in doing so.
The underlying study makes a much weaker claim than the people who are using it to campaign against fluoridation.
A big issue in this discourse is that for the strong claims to be true, it would essentially require existing science around fluoride toxicity and the related mechanisms of action to be materially incorrect, contrary to all historical evidence. Fluoride poisoning is a thing that happens and has straightforward interventions. Are we supposed to pretend this science doesn't exist? I actually worked in fluoride chemistry, it is difficult to square this circle.
In addition to the "plausible mechanism of action" question, there is the inconvenient observation that exposure to fluoride from natural dietary sources is far higher today than from municipal water. Why the obsession with municipal water augmentation in historically low-fluoride environs? Most people eat far more fluoride than what their water exposes them to.
I find this particular social contagion deeply weird. You see the same persistent misrepresentation on social media as climate science, but in the case of climate science the effects on people is obviously consequential so the motivated reasoning is more understandable. The fluoride thing is trying to invent an issue around a topic that is inconsequential by all evidence and science.
Who benefits by encouraging people to tilt at this windmill?
Attention everyone: This is not just some kooky conspiracy theory anymore. We have federal rulings against the EPA on this matter.
https://www.theguardian.com/us-news/2024/oct/04/fluoridation...
The US court system is not a good arbiter of scientific accuracy. I'd trust the EPA a lot more here.
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It’s very simple - when it suits your argument, Trust the Science and go with the government position.
When it doesn’t, say they courts and the regulators are captured and crooked.
The NSA can’t regulate itself - it needs court oversight. Courts are allowed to decide what matters to national security and what doesn’t, despite not being agents.
The Police can’t regulate themselves - they need court oversight. Courts are allowed to define what is acceptable policing and what is not, despite not being police.
The EPA can regulate itself and understands science. Courts aren’t allowed to weigh in because they aren’t scientists. The EPA is a morally upright actor, all other government agencies aren’t.
A perfectly rational position. (I say that with extreme sarcasm - it’s malarkey.)
The EPA was already significantly more subject to judicial review than the NSA, even prior to Chevron deference falling.
The cops are theoretically subject to it, but in practice... nah, mostly not. They receive at least Chevron-levels of deference for things like "I feared for my life!" or "he was coming right at me!" or "I thought it was a gun!" or "based on my experience and training the suspect was acting suspiciously" sort of expert claims.
The EPA caused one of the largest environmental disasters ever in North America.
https://en.m.wikipedia.org/wiki/2015_Gold_King_Mine_waste_wa...
That is a minuscule disaster versus the overall impact of those mines and other similar industry activities on the environment. All that contamination used to just get dumped in the water supply.
It’s only big because we don’t really consider Cleveland’s burning river or LA’s smog blanket to have been “disasters”.
(As the link notes: "The event drew attention to toxic drainage from many similar abandoned mines throughout the country.")
> Prior to the spill, the Upper Animas water basin had already become devoid of fish, because of the adverse environmental impacts of regional mines such as Gold King, when contaminants entered the water system.
> In the 1990s, sections of the Animas had been nominated by the EPA as a Superfund site for clean-up of pollutants from the Gold King Mine and other mining operations along the river. Lack of community support prevented its listing… Locals had feared that classifying this as a Superfund site would reduce tourism in the area, which was the largest remaining source of income for the region since the closure of the metal mines.
Yeah, it was really bad already so good on EPA for making it a lot worse. ("miniscule" is not applicable to this disaster and casual readers may see it as emotion-based hyperbole.)
The conspiracy theory component isn't that there is some downside to fluoride in water, it's that the government did it for nefarious purposes.
Both tea leaves and California rice have fluoride also; absorbed by the plants as they grow.
Foreign sources of rice have to pass tests for fluoride while California rice is exempt, from my understanding.
People drink a cup or two of tea a day while they drink more than 2 liters of water a day. It's a magnitude difference.
Plus, drinking tea or eating California rice are completely optional. While you have to go through a filtering process to get ride of fluoride.
I assure you that the kids that are struggling with severe dental problems are not drinking two liters of tap water per day. Maybe we should fluoridate Coca Cola.
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There are definitely people who drink a lot of tea or eat a lot of rice in California.
Sure, if only there were studies measuring their IQ.
Plus, the strongest effects of fluoride are on kids and kids might drink 0 to half a cup of tea a day.
Of course it depends on whether the target demographic has adequate access to fluoride by other means, such as toothpaste.
A similar case might be iodine in table salt. A lot of salt available in America is iodized on purpose. We don't do that where I live, where the usual diet is already rich in iodine. There is no single right answer, only a cost-benefit analysis for each location.
This isn't really something new - it's been known for a long time that fluoride needs to be on the surface of the teeth to work. In jested fluoride doesn't do anywhere near as much.
So fluoride toothpaste, or even better fluoride rinse's are much more effective.
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There is though. It's a great way to offload fluoride waste. In fact, the reason we discovered the dental effects of fluoride was because a dentist noticed the yellowed and hardened teeth of patients in the area where the water was contaminated from local industrial waste.
Tell us more about your qualifications
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Or people could just not eat carbs and there would be no need for this debate at all.
Carbs are the base of civilizations. With the exception of herders or raiders every large population of humans was/is sustained by plant starches.
That actually does not refute GP, rather, it changes the conversation to "do we want to preserve civilization". The cynic would note that many have demonstrated in the past year that they are willing to sacrifice civilization.
This better not result in another push by the Pacific Northwest about removing fluoride from drinking water. Don't rest on your laurels people, complacency leads down the path of rotting from within. It's not as useful because it's working, the things we are doing are working, keep them up. Fight tooth decay.
Comments like this are the clearest sign that this topic has become so politicized that rational judgement is out the window. If fluoride in the water is opposed by *those people*, or is supported by *those people*, then even if new clear evidence comes out one way or another, it will be undermined by not wanting to hand the other side a ‘W’.
In an era where conspiracy theories are rampant, yeah, I'm kind of averse to letting conspiracy theorists win anything.
I'm not going to put myself in danger to avoid it. But when the evidence is marginal, social factors are something I'll take into account.
Even if there is indeed a problem with fluoridated water, it only shows up in a small effect that requires a large sample to see. The conspiracy theorists were guessing, even if they guessed right. And they ignored the data that had been gathered.
Science changes its mind, but conspiracy theorists never do. They accumulate, and it looks to me as if we're about to drown in them.
Lol wow, this is such a non-rational mindset that I can't even imagine being that way for even a few minutes.
You have a set of experiences where the scientific method didn't allow for changing of results or conclusions?
Maybe you have a set of experiences where you've successfully debunked conspiracy theories and converted previous believers?
Otherwise I'm not sure how you can make such a wild claim.
I'm getting the feeling that you are constantly fighting against a set of made up conspiracy theorists that exist in your head. I will refuse to live like that lol.
Mate, you've just outlined what I'd describe as a conspiracy theory:
You've decided to weigh social factors over evidence because you believe the other side isn't behaving rationally.
We literally just got a ruling against the EPA on fluoridation as being dangerously risky levels. As even The Guardian admits, it’s possible there actually is something to the claims of danger.
https://www.theguardian.com/us-news/2024/oct/04/fluoridation...
Of course, the EPA would never live it down if the anti-fluoridation people actually had something to their claims. However, I’m not the EPA. If they were wrong, screw them.
That’s not an accurate summary of the ruling. The ruling orders the EPA to re-evaluate the safety of fluoridation, but does so because the statutory evidentiary standard here is preponderance, not overwhelming evidence.
(It’s also not a ruling “against” the EPA. It’s entirely consistent with the statute, and the EPA will presumably act in accordance with it and produce yet another study demonstrating marginal-to-zero harm associated with fluoridation below 1.5mg/L.)
"The EPA now must perform a risk assessment that is among the first steps in setting new limits under the Toxic Substances Control Act."
What's stopping them from coming back with the same or higher acceptable levels of that's where the evidence leads?
You are only feeding the growth of conspiracy theories if, when confronted with one that is true, you continually deny it. If they see actual evidence being denied, they think there’s something there.
I'm not planning to deny evidence. But I don't think the conspiracy theorists need my help to think there's something there. If I don't give them something they will just make something up. That is the definition of a conspiracy theory.
How about brush your teeth with fluoride and spit it out instead?
Fluoride in the water impacts the development of teeth. Portland, where I live, is the last major city to not have fluoride in the water.
So kids have to take tablets if they want the impact. But this is far less effective.
Ask a dentist here. Locals have more tooth decay.
Since we're doing anecdotes, my kids grew up on well water and have never had cavities or tooth problems. They (most of the time) brush their teeth daily, eat sugary crap, and get fluoride treatments applied yearly from the dentist (they "paint" a gel on the kids teeth, I believe this is standard in the US for all children regardless of water fluoridation).
I’ll note that this anecdote can cut both ways: well water is just as likely to have more fluoride than fluoridated municipal water, since fluoride is naturally occurring, soluble, and commonly found in rock formations that also hold water.
What are the measured natural flouride levels of the well water you referenced and how did they compare to the municipal water supply?
What about genetic predisposition to cavities?
> Portland, where I live, is the last major city to not have fluoride in the water.
Kind of depends how you track things I'd think. New Jersey, the state with the highest population density in the US, largely doesn't put fluoride in the water outside of a few municipalities.
There's no fluoride in the water in almost the entirety of Hudson, Essex, and Bergen counties, which are located near NYC and include the cities of Newark and Jersey City. Combined population of those three counties is over 2.5 million people.
Tablets that the kids ingest?? After so much evidence of the neurotoxic effects of ingested fluoride, it's worse than criminal if these dentists are giving fluoride for kids to eat.
Other American cities without fluoride in their water include Tucson, Wichita, Fresno, Albuquerque and San Jose. I wonder how their teeth are doing.
Check again.
Dietary fluoride has a minimal impact, you need fluoride on the surface of the tooth. A fluoride rinse is much more effective that tablets or in the water.
Not for tooth development - ie permanent teeth in children.