So the article seems to imply that fluoride is effective when applied topically and need not be ingested. So isn't fluoride toothpaste enough? Does it really need to be added to the water supply? How many studies have been done on the effects of bathing, cooking, watering plants, ingestion by pets, etc. with fluoridated water?
One thing the article doesn't mention is where the fluoride is sourced from. Is it true that the fluoride that goes into the water supply is a waste product from fertilizer production? If this "waste" wasn't being put into the water how much would it cost fertilizer manufacturers to dispose of it? Is there some perverse incentive here?
Most people don't leave toothpaste in contact with their teeth for long enough. My dentist recommends not rinsing after brushing, and just leaving the toothpaste in there.
(Fun aside: This is also the procedure on the ISS to avoid having to spit in zero gravity.)
Many people rinse with water afterwards. If I don't rinse I get a wicked stomach-ache almost immediately after swallowing some toothpaste residue, so I rinse
One problem with relying on toothpaste, is that for many children, the parents are not good at parenting and don't provide tooth brushes/ toothpaste or enforce regular tooth brushing
(and from experience, my teens/twenty somethings are somewhat hit and miss in this area as well since they moved out)
Putting it in the water supply ensures most people will at least get some fluoride.
One big problem not covered in the article, is this leads to fluorosis - my eldest has permanently stained teeth due to me not making him spit out his tooth paste after brushing when he was a toddler combined with the fluoride he was getting from town supply water.
You can use a flouride rinse. Most kids with braces use a flouride rinse. I'm not sure how long you're supposed to use it for, I think it's 45 seconds twice a day.
My town (~500,000) stopped putting fluoride in the drinking water in Jan 2013.
According to the Oral Health 2018 [0] report released by the health unit, the percentage of children with tooth decay or requiring urgent care has increased by 51 per cent in 2016-17 compared to 2011-12.
Two similarly sized cities, one stopped fluoridation, the other didn't, the study shows a 17.6% increase in cavities in grade 2 students[0]. So yes, there seems a benefit of fluoride to children's teeth. Although, better dental hygiene can also do this, and on average cavities have trended down around the world (fluoride in water or not).
But that's not what the article is about.. is fluoride dangerous for humans to ingest? (also yes) So given there are more direct ways to get fluoride to teeth (toothpaste - somewhat, varnishes, lacquers or rinses - good), should we continue to cause damage to all in the name of helping young children's teeth?
As someone with a naturophile mother who grew up drinking nothing but filtered water as a child, I was riddled with tooth decay. So many cavities and fillings that I lost count. Two crowns and one root canal all before my 13th birthday.
I believe we also used some kind of natural toothpaste that was probably fluoride free.
It's only recently that I connected the dots and realized that never drinking tap water is probably why my teeth are a mess. I'm almost certainly going to have to get implants much earlier in life than I should have.
It might be possible to avoid this with proper fluoride toothpaste or mouth wash, but you simply can't rely on most people knowing enough to care or understand the importance of it. For most people, if an issue hasn't personally affected them, they tend to not consider a risk that needs to be mitigated.
In the 2016/2017 school year, 18,179 children from 119 schools were screened for oral health issues. Between 2011/2012 to 2016/2017, the percentage of children with decay or requiring urgent care has increased by 51%.
This is a terrible statistic. Out of such an exact number of children and schools there is no numerator or denominator for the increase of 51%. I suppose a minimum number would be an increase from 100 to 151 and a max of 12,039 to all 18,179.
They don't know that... it's an anecdote, not an epidemiological study.
But you also have no evidence that diets changed drastically for the whole city of 500k people around the same time... Probably because we don't even know what city this is actually referring to.
Maybe all 500,000 people all stopped brushing their teeth... Maybe all the dentists left town... Maybe aliens are dosing the town from orbit with radiation weapons.
It's not a useful counter-point for you to just assert some alternative causation... Of course there could be other causes, that's literally always true about any causative assertion.
I’m not the person you replied to but the Affordable Care Act implemented a requirement that health insurance plans offer optional pediatric dental coverage for anyone under 18 and IIRC it requires companies offering dental plans to employees to provide options for family coverage and not just individual plans.
I recently posted a similar comment in a thread about drug addiction but perhaps it’s not an increase in cavities so much as it’s an increase in access to affordable pediatric dental care.
Be serious. You’re suggesting that at the exact same time that this town, and only this town, stopped using fluoride, it is also the same case that this town, and only this town, had a rapid change in children’s diets?
I mean fluoride is one of the most interactive elements on the periodic table. It’s pretty clear it interacts with the body in pathogenic ways. That’s part of the reason why it bonds to the enamel of the teeth so well.
I don’t think we need to supplement tapwater with fluoride now that toothbrushes and toothpaste are so widely available.
You can’t control the dosage since people can drink as much tapwater as they want and still do not know how much they actually are receiving.
That being said I highly recommend everybody get a reverse osmosis water filter. Add in some electrolytes and you’re good to go.
Edit: Never mind, I was wrong. Fluoride isn't an element. It's somewhat reactive, but not nearly as much as Fluorine.
Just note that Flouride and Flourine are very different things. Chlorine is also very highly reactive and dangerous but you think nothing of eating table salt.
You'll find fluorine atoms in a disproportionate number of poisons, while other halogens are much weaker. It really is an anomalous atom and the comparison to Chlorine is not accurate (which is less electronegative than oxygen).
I wondered why we don't use something that can also promote crystallization of hydroxyapatite (primary mineral in surface tooth enamel), and apparently it's because carbonate also promotes plaque crystallization. However, if you go to the dentist regularly, it seems an objectively better personal option.
The argument for water fluoridation is a macro-argument that looks good from 10,000 feet, but when you apply nuance, such a policy does not benefit (and probably subtly harms) the vast majority of readership on HN, and is more likely to affect the most impoverished who do not brush their teeth regularly and cannot afford or do not prioritize going to the dentist (which is a surprisingly high percentage of the general public).
That isn't to say it's a bad policy, but it certainly isn't black and white.
Sure fluorine is extremely reactive but once a F is bonded to a C, it's quite hard to dislodge. To remove that bounded F you need a really strong oxidant like ozone.
Chlorofluorocarbons were used as propellant in sprays and asthma pump because they didn't react with the active substances.
The presence of fluoride in a disproportionate number of poisons (FOOF excluded) is due to the fact that as far as biological binding site are concerned it's almost like a really heavy hydrogen but metabolically it protect that carbon from being the target of an enzyme¹. This enable a toxic molecule that would be quickly metabolized to stay active long enough to do some damage.
It's important to note that the presence of a C-F bond doesn't make a molecule inherently toxic, it just make it harder to metabolize when that bond is placed at the target of an enzyme.
It's true that F isn't a good leaving group, but that's a double edged sword. By the same token, continuous exposure means that when it is occasionally substituted into organic molecules throughout the body, it will be not easily substituted out. I am curious now what the equilibrium retention point is for typical fluoridation levels.
I know this is an attempt at humor, but this kind of low quality engagement has no place on HN.
Carbon is the backbone of almost all compounds used by life. Feel free to check the ratio of poisons/non-poisons containing Carbon and those containing Fluorine and report back.
Carbon is fundamentally different than halogens and really all other nonmetals due to its unique, strong affinity for 4 bonds, its small size, its relative non-electronegativity compared to other common elements in organic compounds (besides hydrogen), and the lack of d orbital complexity.
I just bought an RO system of Amazon and it is great. There is a relatively newer design that doesn't require the external pressurization tank and uses a single easily-replaceable filter.
The faucet even has a realtime TDS measurement (inlet water is over 400 and the filter brings it down to about 17-18). I put a higher flow filter (doesn't lower the TDS) in front of the RO system so that my regular faucet water is filtered and it extends the life of the RO filter. Takes like 30 minutes to get everything installed. Totally worth it!
I'm really fond of the Brondell H2O+ Circle RO filter. It's the best system I've ever used and the filters are so easy to replace it boggles my mind why every other filter isn't like it.
It comes with a reverse flush system that makes the RO filter last for years. Takes our water from 250ppm to 12ppm.
Used to be around 850ppm but luckily, the city improved its water filtration practices.
What kind of fluoride? Fluoride salts can be extremely stable even at very high temperatures. They were used in prototype molten salt nuclear reactors and uranium hexafluoride gas is used in uranium enrichment.
Why? A small amount of arsenic or fentanyl wouldn't be difficult to study. There is nothing intrinsic about any number that makes it difficult to perform science.
I've worked with fluoride chemistry in the lab, which entails some specific safety protocols due to its effects on the human body if you make a mistake. Your characterization of the health risks to humans is misinformation, particularly at the exposure levels in water regardless of how much you drink.
Fluoride aggressively and preferentially binds to calcium in the human body. That's how it protects teeth, the chemicals that cause tooth decay have a weaker affinity for calcium than fluorine, and therefore can't displace it.
The mechanism of action for its lethality is the same. Calcium ions are used throughout the human body, notably in the heart for critical signaling functions. If you are exposed to sufficient quantities of fluoride, it will circulate until it finds some calcium in your body, including readily depleting your calcium ion channels which causes your heart to stop working.
Human bodies have significant excess calcium floating around. There is simply not enough fluoride in water, no matter how much you drink, to tax those calcium reserves. People have been drinking naturally fluoridated water, some at much higher concentrations than municipal water, for millennia.
We can argue about the relative safety of fluoride to the human body. Maybe there's a middle ground somewhere, but saying that it is hazardous to your health in excess amounts and that those excess amounts can be found in tap-water isn't controversial nor is it misinformation.
For example, as a very basic, low-level example, exposing children to fluoride early on when teeth are forming causes dental fluorosis. This is well-known, well-studied, and not at all controversial. And in fact, tap water is the most common source of dental fluorosis.[1]
Now there are clear benefits to fluoride: It can be used in a variety of circumstances and probably has done humanity a net good, especially in areas where dental hygiene (for whatever reason) isn't well understood or well-practiced.
But there's clearly a level where it's not safe to expose to human beings.
A 2012 book by Kozol regarding poor children in the South Bronix (fluoridated since 1965) reports ""Many of the children who attend these schools also suffer the emotional and physical attrition that results from chronic illnesses like asthma and anxiety, as well as the steady and low-level misery of rotting teeth, infected gums, and festering, untreated sores. " https://thirdworldtraveler.com/Third_World_US/AmazingGrace_K...
Based on NYS Department of health data researchers found " For every age/race group, there was a consistently significant association of SiF [silicofluoridated] treated community water and elevated blood lead" https://pubmed.ncbi.nlm.nih.gov/11233755/
Well, I don't think that's a good heuristic for determining whether something is bad. There are plenty historical examples of doctors not washing their hands even when there was substantial evidence suggesting it decreased deaths.
Fluoride works both topically and systemically to reduce tooth decay and is delivered through water, salt, milk, toothpaste, varnish, rinse depending on age, country of origin, income etc. For children ages 0-8 it is incorporated into the enamel of the teeth growing under the gums. After that, the mechanism is largely "topical" - however, that includes fluoride ions incorporated into the saliva and plaque in the process of ingesting it. Sipping water throughout the day bathes the teeth in fluoride each time and allows there to be a very small but impactful amount of fluoride in the mouth environment. This assists in the remineralizations of teeth enamel after acid attacks. The "topical vs. systemic" debate is a bit of a red herring. Its asking how does it work, not if it works. The evidence is clear that fluoridation does work to prevent tooth decay.https://fluorideexposed.org/fluoridescience/fluoride-mechani... additionally, a recent economic review of fluoridation found that the benefits in terms of reduced cavity rates and related dental costs outweigh the cost of implementing the strategy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171335/
>Many dentists, having seen what life was like before fluoridation, have no interest in returning to the pre-fluoridation era of widespread cavities, abscesses, dentures and people in pain.
Is that really true? I live in a country without drinking water medication (thank god) and it's not such a horror story as this article makes it sound. I know that dental health was worse in the past and has improved since, but it doesn't seem to be due to water fluoridation but rather other advances in dentistry and personal dental care.
I asked my pediatric dentist (our city was flirting with de-flouridating), and he produced a number of studies where cities with unfluoridated water had significantly higher rates of those tooth issues mentioned. It also impacts lower income communities more, possibly because the supplies of and access to dental care aren't what middle class and higher communities are accustomed to.
The Kumar study you cite has many limitations and alternate explanations - one, of which, isn't mentioned - that Medicaid fraud is rampant in New York State.
Kumar writes " one should be cautious in attributing this geographic variation solely to water fluoridation. Furthermore, the availability of fluoride in beverages and fluoride provided through organized programs, which distribute tablets and rinses in non-fluoridated communities, may underestimate [over over-estimate] the effect of fluoridation. A survey of third-grade children in less fluoridated communities in NYS showed that reportedly 20% to 80% of children had received fluoride tablets on a regular basis.34 About 100,000 school-aged children in non-fluoridated areas are targeted for participation in a weekly fluoride rinse program. In addition, toothpaste and processed beverages are the other sources of fluoride. Programs such as school-based sealant programs are also available in these areas."
The second link to a Calgary study concludes that tooth decay rates in Calgary, Alberta, have increased because of the city's decision to scrap its fluoridation program. But the study omits data showing that the spike in decay mostly occurred when fluoride was still in the water and used methods that a leading scientist says do "not provide a valid assessment," https://www.prnewswire.com/news-releases/calgary-fluoride-st...
Thanks for sharing that article. In reading it I noticed a few things: 1) the primary author is a well published structural engineer. The article was billed as review of the medical literature, so this is an odd match in regards to expertise and content. Their first co-author does have MD, MPH credentials, but they were fairly green having published only one other article. The journal itself seems legit and has been around for 100+ years.
In looking at the content 1) The methodology was essentially one paragraph and in execution it appears they cherry picked the literature and did not clearly indicate concentration of fluoride as they discussed certain postulated effects. 2) Often they reached conclusions based on single studies that do not seem to reflect the current body of evidence. For example, the reference to a Utah study on bone fracture in the elderly population. Many other studies have found opposite results and have been published prior to the publication of this study. 3) Their graphs that show a lack of association of water and salt fluoridation are used as evidence to make the declaration that there is no effect without discussion of causation for that difference.
In essence, this piece seems like a regurgitation of soundbites from US advocates opposed to fluoridation.
Chile continues its fluoridation program (70% of its population) and milk fluoridation for rural areas https://www.borrowfoundation.org/chile. The question over how to address cavities rates at the population level in rural areas where water fluoridation is not practical is a good one. And in looking at the evidence on milk fluoridation programs as I considered this article, there is room for further consideration and study there. However; this particular study is not enough to base such a policy discussion/ decision. The US does not currently offer or consider milk fluoridation in rural areas.
When added, fluoride is generally adjusted to 0.5-1.5ppm, a bit less than ocean water. Depending where you live, your water supply probably has plenty of fluoride. (Perhaps you can consider it "pre-medicated").
Natural water sources vary widely. Above 2ppm it starts to become a problem. In Africa and China 60% of the population have these levels or higher in their drinking water.
Some of the initial studies in the early 1900s which identified fluoride as a factor in dental health were of children in Colorado with discolored, but very strong, teeth. Their water sources were up to 13ppm fluoride.
Many people in the US don’t have access to dental care. Dentists managed to stay at arms length from insurance in general and many employers don’t offer it.
For poor people, access is difficult. Dentistry is optional in Medicaid and many states opt out. My state Medicaid funds dental, but in my county (pop 350k), there are 4 dentists that accept Medicaid dental.
Right? We even have electric toothbrushes now which are way better than manual toothbrushes. Maybe if it was the 18th century and we somehow had access to fluoride it would be justified.
I don't think this is fair? Perhaps you haven't seen the $4 electric brushes.. perhaps they're not as good as the $80+ devices, but it's still an improvement over manual brushing. I've even seen them used in "buy N grocery products get a free electric toothbrush" promotions (I want to say it was a cereal company)
Maybe we should just stop putting gross amounts of sugar in everything. People have no problems getting rid of beef or meats. We should be able to get rid of some of our worst industries.
Environmental case for this stuff is bad because of insane amount of chemicals necessary to grow unnattural (i.e. GMO) products. Those chemicals then run off and poison the environment. Then we need to add more chemicals, (i.e. flouride) to deal with consumption.
Economically sugar/corn-syrup receive an enormous amount of subsidies.
From a human rights perspective sugar farming is terrible (google Fanjuls to learn more).
Obesity was the greatest risk factor besides age for COVID-19, so if as a society we can start mandating the jab, we can mandate some people don't get their "treats".
Tooth decay and the disease that comes with it is a multi-factorial disease - its not enough to simply eliminate "sugar" from the diet.
So, although I agree 100% that we need put systemic interventions to make those that promote a sugary diet accountable for the externalities they create, like hospitalizations, lower quality and length of life, lower incomes and educational attainment etc., We still need to focus on preventing cavities. Cavities are caused by all carbohydrates, including crackers, bread, etc. that have time on teeth allowing the bacteria that cause cavities to digest them and excrete acid on the tooth.
Eliminate enough risk factors and you will prevent the disease - in fact cavities are 100% preventable - with proper hygiene, enough fluoride, healthy diet and early prevention of the bacteria that spreads the disease from childcare provider to baby.
Once we figure out how to repair the tooth enamel properly, there will be no need for fluoride in dental care. We're still relying on epoxies & other glues.
Fluoride supplementation in water is less of a concern for me than chloramine. All my friends strongly defend the quality of Hetch Hetchy and I just don't get it. Fish can't even live in the water you're drinking. It affects plant growth too. We're showering in this stuff and vaporizing ammonia directly into our lungs.
I don't think anything I said was hyperbole. Chloramine is ammonia and chlorine. You heat it up and vaporize it and it splits apart. That's basic chemistry. Ammonia is well-known to be an irritant. We are questioning the addition of fluoride, but not chloramine?
But to respond to you, well, that's the thing... there are very few studies. It is one of those things where they just say "trust us" and there isn't much data to back it up in either direction. There are some definite hyperbole websites that suggest it causes (or increases) IBS, which you can google, they come up first in the search results.
I was living in San Francisco when they switched. I had two fish tanks and all the fish died immediately upon a water change. I ended up having to add neutralizer to the water. I was also commercially growing some plants in my basement and it definitely had an effect on them. Immediately stunted growth. I did a lot more research and found that chloramine is hard to filter out as well. You need higher quality carbon or RO systems. It doesn't just dissipate naturally like chlorine alone does.
If our plants and fish can't live in it... why would we want that anywhere near us?
People complain about a lot of things. That doesn't mean it's true. Maybe it is for some individuals, maybe it's in their head due to stereotyping/priming.
> From the fact that the results of the human studies are not consistent and it is assumed that most studies using beverages as a vehicle are not properly blinded, we suggest that a causal relationship between MSG and headache has not been proven. In addition, statistically significant differences in the incidence of headache were not observed when MSG was administered with food, except in one case of the female group where the blind integrity was questionable. It would seem premature to conclude that the MSG present in food causes headache.
> So increasing our natural amounts is somehow ok?
It can be OK, or it can be not. That's why we pay scientists to study how safe these things are.
> MSG is in our system too, but people who eat food with it added in, often complain of headaches.
You could have chosen a better example: MSG is a prime example of people overreacting to what is essentially a tasty placebo. Gram by gram, it's safer than salt.
I didn't say MSG caused headaches, because we all know that may or may not be true. I've seen the long threads on HN about it. I specifically said they complain of it. In the same way that people complain about IBS with chloramine.
At the end of the day though, I see no problem with winning by filtering it out of my water supply. It is a small cost to do so.
If the argument is that we should have it in there to keep the water clean on the way to my house, great! I'll filter it out when it gets here and I am more than happy to not drink and especially not vaporize the stuff into my lungs in the shower.
> Fish can't even live in the water you're drinking. It affects plant growth too.
Yeah, that would be the point -- kill the nasties that otherwise get into the broken-ass pipe system, and kill them with something that our physiology is well prepared to handle but theirs is not.
I am sure there are some nature fetishists who prefer their water "raw." I do not.
One alternative to fluorine that has been shown clinically to be equally or more effective is nanohydroxyapatite, which was developed by NASA some time ago to treat astronauts for loss of tooth enamel and bone density. (Some background info here https://www.oralscience.com/en/ingredients/mhap/
The rights were sold to Japan where a leading toothpaste has for decades used nanohydroxyapatite rather than fluoride. The exclusive rights of the Japanese company have expired, so nanohydroxyapatite toothpaste is not also made in Canada and the US. It's more expensive than fluoride toothpaste but if you'd like to avoid these questions, might be worth it.
I don't see in the article how they control for the IQ drop they think occurs (up to 5 points) being the same as the error margin for IQ tests (+/- 5 points).
How does that work.. ? It's not like IQ tests are considered that reliable or unbiased.
Also looking for studies.. they're observing the IQ drops in children who were exposed to excessive flouride beyond what's supposed to be in water. US levels all fall into the "low exposure" range in these studies.
Hey, my hometown was mentioned. Calgary has been on and off again with Fluoride for decades and the evidence definitely shows an increase in caries when we don't add it.
One thing the article doesn't mention is where the fluoride is sourced from. Is it true that the fluoride that goes into the water supply is a waste product from fertilizer production? If this "waste" wasn't being put into the water how much would it cost fertilizer manufacturers to dispose of it? Is there some perverse incentive here?
https://www.cdc.gov/fluoridation/engineering/engineering-sho...
>The three fluoride additives used for water fluoridation are derived principally from phosphate fertilizer production.