As a dental student, I regularly experience the commitment of the medical establishment providing my education to fluoride. At times, it feels like a cult, with the sacred texts of ‘Delivering Better Oral Healthcare’ and other NHS guidelines, the ritual of the three-monthly fluoride varnish, and a need to preach to those opposed to fluoride all pitched as part-and-parcel of being a dental practitioner in the UK.
COVID-19 has demonstrated that supposed ‘consensus’ on an issue needs to be challenged in the pursuit of what is best for people’s health. ‘Following the science’ is not taking authorities at their word that what they propose is right, as much as some in positions of authority might believe it to be; it is about asking questions, including uncomfortable ones, to bring forth truth. Just like with Covid, it seems an unquestionable narrative has formed around fluoride, and particularly water fluoridation, or artificially adding fluoride to water supplies.
Proponents of water fluoridation often give the following arguments in favour of their position:
- Fluoride is found naturally in water supplies, so we shouldn’t be afraid to ‘copy nature’
- Fluoridation of water supplies reduces dental decay
- Fluoride is cost-effective in the health benefit that it provides
- Fluoride is safe
In this article, I’ll be evaluating each of these claims and, in the interest of science and open debate, provide reasonable counters to each of these points. I will also bring up a number of prominent sceptics of water fluoridation to demonstrate how, despite claims to the contrary, there is not a ‘consensus’ among scientists and health experts on water fluoridation. In doing all this, I hope to encourage readers to evaluate water fluoridation with the same rigor as any other scientific matter, and not simply to assume one way or another because of the stance of a particular authority.
"Fluoride is found naturally in water supplies, so we shouldn't be afraid to 'copy nature'"
It is true to say that fluoride is found naturally in some sources of water, hence it could be seen as appropriate to “copy nature” in adding fluoride to other sources. In the UK, Easington, Hartlepool and Uttoxeter are examples of places where this occurs. However, to suggest this demonstrates fluoride’s safety is a strawman; I wouldn’t eat poison ivy just because it occurs naturally in nature. Arsenic can also be found naturally in water sources, yet I doubt anyone would argue that arsenic is ‘safe’ because of this, or that we should copy nature and add arsenic to water supplies.
"Fluoridation of water supplies reduces dental decay".
The proposed mechanism action of fluoride in reducing dental decay is through mineralising the outer layers of the tooth surface, making it more resistant to being dissolved and progressing into decay. This has not always been the case however, as it was previously assumed that the benefit comes from systemic ingestion. Many of the studies typically use fluoride-containing varnishes to apply high concentrations of fluoride directly to a tooth’s surface, rather than examining whether this occurs with lower-concentration sources of fluoride, such as in drinking water. It has also been acknowledged that the benefits of a fluoride-hardened tooth surface may be limited, as fluoride bonding is not permanent and will ultimately still be dissolved by dietary acids due to the porous, thin nature of the material. As such, one might expect that any fluoride ions absorbed into a tooth’s surface will not stay there and will likely end up being consumed.
As the Nobel Prize Laureate Dr. Arvid Carlsson said on the nature of fluoride’s action:
“In pharmacology, if the effect is local (e.g., topical), it’s of course absolutely awkward to use it in any other way than as a local treatment. I mean this is obvious. You have the teeth there, they’re available for you, why drink the stuff?… I see no reason at all for giving it in any other way than locally.”
Examining water fluoridation specifically, literature that demonstrates the lack of evidence in fluoridation’s favour is highly abundant. Proponents may point to the 2015 Cochrane review and the review from the University of York as evidence of a positive impact of fluoridation on decay, yet both of these studies highlight the lack of high-quality, contemporary evidence that adequately accounts for bias. As stated in the York study:
“Many studies did not present an analysis at all, while others did not attempt to control for potentially confounding factors. Age, sex, social class, ethnicity, country, tooth type (primary or permanent), mean daily regional temperature, use of fluoride, total fluoride consumption, method of measurement (clinical exam or radiographs, or both), and training of examiners are all possible confounding factors in the assessment of development of dental caries.”
It is also interesting to note that the Israeli Ministry of Health cited WHO data on the lack of decay difference between fluoridated and non-fluoridated countries when discontinuing its fluoridation scheme. Other studies, such as the Hastings study in New Zealand, have been demonstrated as fraudulent.
"Fluoride is cost-effective in the health benefit that it provides"
Taking into consideration questions around efficacy, a cost-benefit evaluation further challenges the mainstream notion that fluoridation is not the ‘silver bullet’ as it can sometimes be painted as. While Public Health England claims to show a greater return-on-investment from fluoridation compared to other means of managing decay, it should not be forgotten that only a tiny fraction of fluoridated water will actually be used for drinking. Furthermore, because of the complex design of many water systems around the world, fluoridation schemes can be highly expensive to implement in some areas.
"Fluoride is safe"
Trials on water fluoridation schemes as a means of reducing dental decay began in 1945 in the US and Canada. However, the US Public Health Service endorsed water fluoridation before these studies, along with health-oriented studies, had been completed. Even after some of these studies were completed, scientists have pointed out several issues with these studies, such as omissions and lack of statistical analysis. In the UK, trials for fluoridation that began in the 1950s were supposed to include “full medical and dental examinations at all ages”, yet these examinations were never completed. Thus, the question still needs to be asked; are there any negative health implications of fluoride that have been identified?
The medical establishment readily recognises the risk of dental fluorosis – a kind of tooth mottling which damages the outer layer of teeth – and the increased risk of fluorosis for children consuming fluoridated water. UNICEF elaborates on this in an article on their defluoridation schemes, published in 1999:
“Agreement is universal that excessive fluoride intake leads to loss of calcium from the tooth matrix, aggravating cavity formation throughout life rather than remedying it, and so causing dental fluorosis. Severe, chronic and cumulative overexposure can cause the incurable crippling of skeletal fluorosis.”
Studies also point to other health concerns which are strenuously denied by fluoridation proponents. Increasing and consistent evidence has emerged within the past 20 years pointing to fluoride being a neurotoxin, with adverse effects on adolescent mental development. Perhaps the claims of water fluoridation being used as a means of psychological manipulation by German and Russian forces on prisoners of war during World War Two should be re-evaluated in light of such data.
The possibility of fluoride acting as a mutagen – something encouraging cancer formation – has also been floated. Associations have been reported between systemic fluoride intake and bone cancers, possibly due to fluoride affecting chromosome structures. Other tissues within the body accumulate fluoride in much higher concentrations than would be found in the bloodstream, such as the kidneys, the pineal gland, where it affects melatonin creation and sleep patterns, and in the walls of arteries, possibly contributing to atherosclerosis and subsequent risk of stroke.
Many of the world’s top scientists have all expressed concerns over water fluoridation’s safety. This includes at least 13 Nobel Prize laureates:
- Arvid Carlsson (2000, Medicine/Physiology)
- Giulio Natta (1963, Chemistry),
- Nikolai Semenov (Chemistry, 1956),
- Sir Cyril Norman Hinshelwood (Chemistry, 1956),
- Hugo Theorell (Medicine, 1955),
- Walter Rudolf Hess (Medicine, 1949),
- Sir Robert Robinson (Chemistry, 1947),
- James B. Sumner (Chemistry, 1946),
- Artturi Virtanen (Chemistry, 1945),
- Adolf Butenandt (Chemistry, 1939),
- Corneille Jean-François Heymans (Medicine, 1938),
- William P. Murphy (Medicine, 1934),
- Hans von Euler-Chelpin (Chemistry, 1929).
Other noteworthy names, among many others, include Dr. John Colquhon, former Chief Dental Officer in New Zealand, Dr William Marcus, former senior advisor for the EPA’s Office for Drinking Water, and Dr Albert Schatz, one of the discoverers of the antibiotic streptomycin, which has proved invaluable in treating tuberculosis.
Seeing as fluoride is known to interfere with enzymes in bacteria associated with tooth decay, it perhaps needs to be asked what other enzymes fluoride might interact with, including those for commensal, beneficial bacteria or indeed within human cells. The Nobel Prize Laureate Dr James Sumner, included in the list above, had the following to say regarding fluoride and enzymes:
“We ought to go slowly [with water fluoridation]. Everybody knows fluorine and fluorides are very poisonous substances…We use them in enzyme chemistry to poison enzymes, those vital agents in the body. That is the reason things are poisoned; because the enzymes are poisoned and that is why animals and plants die.”
The intention of this article is not to draw a definitive conclusion on fluoride, but to instead to highlight the counters to the mainstream narrative that sceptics might draw upon. In doing so, I encourage readers to come to their own informed decision about this issue.
There is perhaps one final question that should be addressed when exploring this issue that should be asked by both proponents and sceptics alike; are there any alternatives to fluoride that can help in preventing decay? That said, I think this is better to explore in an article of its own.
For further reading about the history of water fluoridation from a sceptical perspective, consider Christopher Bryson’s book ‘The Fluoride Deception’. This book, highly documented and evidenced, explores links between the United States’ Manhattan Project and the beginnings of water fluoridation schemes.
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