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Overview
An article in the August 2006 issue of Prevention magazine  presents the positions of both opponents and advocates of community water fluoridation. However, in the ADA’s opinion, several statements within the article are misleading. Some of these items are discussed below.
In March 2006, the National Research Council (NRC) published the findings of a panel of dentists, toxicologists, and epidemiologists assembled to evaluate the U.S. Environmental Protection Agency (EPA) standards for maximum levels of naturally occurring fluoride in drinking water.1 According to the Prevention article, the NCR “determined that the level of fluoride allowed in community drinking water in this country is too high.” This is misleading in that the NRC report evaluated the EPA standards for the maximum level of naturally occurring fluoride in drinking water, which is currently set at four parts per million. This is significantly higher than the optimal fluoride levels (0.7 to 1.2 ppm) in the drinking water to prevent dental decay.
The Prevention article also alludes to a recent study that suggested a possible link between fluoridated water and the development of osteosarcoma (a rare type of bone cancer) in adolescent males. 2 However, this is in contrast to the vast amount of peer-reviewed publications that support the safety of water fluoridation. In addition, the study authors noted several limitations to their study and recommended that the findings be confirmed or refuted using data from other studies.
The article also suggests that high levels of fluoride are associated with IQ deficits, and cites a study conducted in China as supporting evidence. 3 However, the participants in the study had excessively high urinary fluoride levels (2.08 +/- 1.03 mg/L) and were subject to many environmental and dietary factors that may contribute to excessive fluoride exposure, including the consumption of large amounts of fluoride-rich tea. Additionally, the NRC report indicated that little information was available regarding the conditions surrounding the IQ testing, so the significance of this study was questionable. The article also cites a 1992 JAMA study suggesting that there may be a small association between hip fracture rates and water fluoridation.4 However, this study did not evaluate all sources of fluoride to adequately determine total fluoride exposure, nor did it address the length of time that individual residences were exposed to fluoridated water.
Two previous Science in the News features have addressed some of the topics presented in the Prevention article: the March 2006 National Research Council report, and the study suggesting a possible link between fluoridated water and osteosarcoma in adolescent males. The reader is urged to review these features for additional information.
The vast majority of studies by nationally recognized researchers in widely-published, respected and peer-reviewed scientific journals conclude that there are no adverse health effects associated with optimal levels of fluoride in drinking water. Based on the substantial body of peer-reviewed evidence, the ADA supports water fluoridation as a safe and effective means of preventing tooth decay. The ADA also recommends fluoride supplementation for children who live in communities without optimal fluoride in their water. The ADA will continue to monitor the available scientific literature on the safety and efficacy of fluoridation of drinking water, and will advise the public and the dental profession as appropriate.
Footnotes
1. Committee on Fluoride in Drinking Water NRC. Fluoride in Drinking Water: A Scientific Review of EPA's Standards. 2006. http://fermat.nap.edu/catalog/11571.html . Accessed: July 15, 2006.
2. Bassin EB, Wypij D, Davis RB, Mittleman MA. Age-specific fluoride exposure in drinking water and osteosarcoma (United States). Cancer Causes Control 2006;17(4):421-8.
3. Yang Y, Wang X, Guo X. [Effects of high iodine and high fluorine on children's intelligence and the metabolism of iodine and fluorine]. Zhonghua Liu Xing Bing Xue Za Zhi 1994;15(5):296-8.
4. Jacobsen SJ, Goldberg J, Cooper C, Lockwood SA. The association between water fluoridation and hip fracture among white women and men aged 65 years and older. A national ecologic study. Ann Epidemiol 1992;2(5):617-26.
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Science in the News is a service by the American Dental Association (ADA) to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.
Document Posted July 2006
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