Heated debate. Fluoride in your water. (Updated September 16th, 2013)
(to be clear, brushing your teeth with a toothbrush, fluoride toothpaste and flossing are the most sure ways to prevent dental caries. It does not matter if you "know" this person or that person that did, or did not, get dental caries. This little write up is about whether or putting fluoride in the water actually does anything)
Some that want it propose that the "anti-fluoride" crowd are just plain stupid, illogical, crazy, conspiracy theorists, who think it will make everyone have hip fractures. I do not care about the studies discussing how fluoride can disrupt body-systems, or cause fluorosis. I don't care about those. I care about the efficacy of the conclusion that fluoride in the water supply actually reduces tooth decay. If it does, then by how much? Also, what about the underlying causes that reduce tooth decay?
Instead of being put into the category of "crazy" by the pro fluoride crowd that picks arguments about government conspiracy weirdos (8), I would prefer that people focus on one solid idea:
Does fluoridation of your water supply actually reduce tooth decay? Could it be from more use of tooth brushes since the 1970s in other countries? Think about how brushing with fluoride reduces cavities, twice per day (we know this is certainly a fact, which I don't need to discuss).
From the Portland Mercury (the pro-fluoride crowd), states this:
"The simple and reasonable case for fluoridation—which the federal Centers for Disease Control and Prevention (CDC) definitively urges for the prevention of tooth decay in children and adults—is drowning under a hailstorm of counter-arguments that look, sound, and seem rational. Except that they aren't." (8).
What the Portland Mecurcy doesnt' realize is that I too, have also used the CDC as a source then checked the CDC's sources as well...
Fluoride toothpaste was also starting to be used in other countries in the 1970s. Fluoride toothpaste does lower the rate of tooth decay (because you brush it on/around your teeth, instead of drinking it and having the low-level of fluoride just go right past your teeth into your gut).
Also, the rates of decline of tooth decay were ALREADY on the decrease prior to fluoridation of water. In some cases, fluoridation of water did not reduce the rate of tooth decay but sometimes it increased.
Logic--> If fluoride in drinking water truly worked by itself (not including brushing teeth with fluoride and eating less candy/soda), then every single county/country and city would have lower rates every single time. Since the the results are mixed, at best, then fluoridating the water is not the answer to solving dental caries (cavities). In class, I learned about confounding variable but I always just thought of this as an "extra" variable. :)
Taken from the study (several pages into it)
"If water fluoridation is shown to have beneficial effects, what is the
effect over and above that offered by the use of alternative interventions and strategies? Studies carried out after 1974 were selected to examine the effect of water fluoridation over and above the effect of other sources of fluoride, especially fluoridated toothpaste. As toothpaste containing fluoride was being widely used in industrialised countries by the early 1970’s, examining the effect of water fluoridation after 1974 should allow for any modifying effect of fluoride toothpaste and other sources of dental fluoride (e.g. mouth rinses, tablets) to be apparent. Studies carried out post-1974 which were conducted in industrialised countries were considered to have included the effects of these sources of fluoride, unless the study stated otherwise." (2)
Also...
"“No randomised controlled trials of the effects of water fluoridation were found. . . . None of the included studies were of evidence level A. The reason for this among the studies evaluating dental caries was that none addressed three or more confounding factors.” (2)
Which these confouding factors may have been people in that country starting to brush their teeth more often, an increase in dental care, and social services directed at the most vulnerable members of society.
And....
"Given the certainty with which water fluoridation has been promoted and opposed, and the large number (around 3200) of research papers identified, the reviewers were surprised by the poor quality of the evidence and the uncertainty surrounding the beneficial and adverse effects of fluoridation. Studies that met the minimal quality threshold indicated that water fluoridation reduced the prevalence of caries but that the size of the effect was uncertain. Estimates of the increase in the proportion of children without caries in fluoridated areas versus non fluoridated areas varied (median 15%, inter quartile range 5% to 22%). These estimates could be biased, however, because potential confounders were poorly adjusted for. Water fluoridation aims to reduce social inequalities in dental health, but few relevant studies exist. The quality of research was even lower than that assessing overall effects of fluoridation." (3)
So, these researchers imply that there are far more variables that what is mentioned in the studies. Bias does not necessarily mean a skew/slant towards an already pre-concieved objective but instead simply missing some valuable variables. Stated above, I mentioned that there are many variables that exist that may reduce dental caries.
Some of these include:
1. People brushing their teeth more often
2. Exponential use with fluoride-based toothpaste
3. Increase awareness of cavities
4. Increase of social services for those most at risk
5. Diagnostic equipment improvement
6. Better treatnents for root canals, sealants
*Note: sealants were mentioned becuase it's possible that if someone's
cavity sealant came off or was broken, they may get another cavity....which means they would be counted as an extra number of people having another dental cavity. This would increase the rate and prevalence of those having dental caries.
7. Increase in flossing because of an awareness of flossing (eduation?)
8. (I'll update more later)
The part that surprised me is that one of the CDC graphs unusually started showing the decline of dental caries at the same time of fluorodation of the water supply. Why didn't the graphs start earlier, before the introduction of fluoride? Maybe the dental were getting worse or maybe even better?
The CDC implies that the use of fluoride in the water reduces tooth decay. (4) The most obvious part of the graph at the bottom really shows something interesting. Want to know what I've notice in that graph? The graph unusually starts exactly when they start introducing fluoride into the water supply. Was their already a decline of tooth decay, prior to the use of fluoride in the water?
Also, does it even mention that people were starting to use toothbrushes with fluoride toothpaste during these times?
The CDC gives information about how fluoride in the water can reduce tooth decay (5). Also, it mentions that "studies have shown" that fluoride in the water will reduce tooth decay by a large percentage (5). Now the "studies" are directly from the Surgeon General (6), not from a peer-reviewed source. You have read that correctly. Not a peer-reviewed source. This means that one of the most prestigious organizations did not use an scientific, peer-reviewed article from a journal or database. Even though this data does exist, much of my argument stems from attempting to dig deeper into the data the "pro-fluoride" movement has used.
Another note, the CDC (7) uses the source (2) the York review, which concludes that further evidence is needed. This is interesting because the York review did not find conclusive evidence that the, well, hell....another summary:
"The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score. The studies were of moderate quality (level B), but of limited quantity." (2)
To argue against my point of view
"The best available evidence from studies following withdrawal of water fluoridation indicates that caries prevalence increases, approaching the level of the low fluoride group. Again, however, the studies were of moderate quality (level B), and limited quantity. The estimates of effect could be biased due to poor adjustment for the effects of potential confounding factors." (2). What this means is that the amount of people with dental caries slightly increased after fluoride was taken out of the water. Of course, this argument came from studies that were of "moderate quality" and did not include other factors that could increase the prevalence (# of people with dental cavities). An example of what could increase the prevalence would be if more people moved into the area with more cavities (there is a huge list of things that can disfigure the statistics) or if there are more people available for dental screenings and checkups. Which, if you had more people getting screened for cavities, don't you suppose that there would be a higher number of people with dental caries? Just sayin'....
In conclusion, the York Review has used over 200 studies related to fluoride in the water, and they agreed that the conclusion was hardly mixed at best. This debate is continued on throughout the Portland area and there are several sides of the story. I think the idea of professionalism ends when you start mocking your opponents, not giving them a chance to voice a logical argument, dismissing theirs as "junk" science when they use peer-review literature, or simply implying that they're false.
I realize that this is a blog and some might feel as though because of this, my views are illegitimate. I try, within the time that I have to produce somethind decent. My views are very important to me and I will argue as such.
Updated May 10, 2013:
Regardless...
I have realized there's a tendency for people to use video-hosting sites to make an argument, which may be useful at times. In this "blog," I have spent a great deal of time looking for peer-reviewed evidence. There are hundreds of studies related to adding fluoride in the water supply, and most are of a "moderate level" leaving out important variables. Implying that fluoride in drinking water will prevent tooth decay without looking at increase/decrease of teethbrushing, dental care/treatments, is unwise and is a disservice to those that want to look for the best evidence. The York review has pretty much all of these studies that were the best.
With this, if people (everyone) are so adament on using the best evidence to support, then they should multiple sources. I have cited the CDC and some of it's sources as well. Which, is odd that the CDC uses a source that admits there's not enough conclusive evidence.
Then why spend money on adding it to the water when there may be other ways?
Maybe give toothbrusing classes in schools?
I used the CDC, which "Healthy Kids" also uses the CDC as well.
I read an article today from the Willamette Week that mentioned the "pro-fluoride" side had "bigger" players on their side, like the CDC and Healthy Kids.
Guess what. I used the CDC, too....with it's sources. The CDC site even mentioned that the York meta-analysis was one of the most comprehensive compilations of all these fluoride studies.Yes, the Portland Mercury and the Willamette Week will be more content with stabbing fun at people like me, instead of actually reading from their own peer-reviewed sources. If the CDC is to use a large meta-analysis of studies that say, at a moderate level, that fluoride does reduce dental caries, they should also include the other variables.
Sources:
1. http://www.virtualschool.edu/mon/SocialConstruction/Logic.html and http://www.dartmouth.edu/~writing/materials/student/ac_paper/logic.shtml
2. http://www.york.ac.uk/inst/crd/fluores.htm (where you can find the summary)
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/
4. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm
5. http://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html
6. http://www2.nidcr.nih.gov/sgr/sgrohweb/home.htm
7. http://www.cdc.gov/fluoridation/benefits.htm
8. http://www.portlandmercury.com/portland/the-sanest-arguments-against-fluoride/Content?oid=9212701
(to be clear, brushing your teeth with a toothbrush, fluoride toothpaste and flossing are the most sure ways to prevent dental caries. It does not matter if you "know" this person or that person that did, or did not, get dental caries. This little write up is about whether or putting fluoride in the water actually does anything)
Some that want it propose that the "anti-fluoride" crowd are just plain stupid, illogical, crazy, conspiracy theorists, who think it will make everyone have hip fractures. I do not care about the studies discussing how fluoride can disrupt body-systems, or cause fluorosis. I don't care about those. I care about the efficacy of the conclusion that fluoride in the water supply actually reduces tooth decay. If it does, then by how much? Also, what about the underlying causes that reduce tooth decay?
Instead of being put into the category of "crazy" by the pro fluoride crowd that picks arguments about government conspiracy weirdos (8), I would prefer that people focus on one solid idea:
Does fluoridation of your water supply actually reduce tooth decay? Could it be from more use of tooth brushes since the 1970s in other countries? Think about how brushing with fluoride reduces cavities, twice per day (we know this is certainly a fact, which I don't need to discuss).
From the Portland Mercury (the pro-fluoride crowd), states this:
"The simple and reasonable case for fluoridation—which the federal Centers for Disease Control and Prevention (CDC) definitively urges for the prevention of tooth decay in children and adults—is drowning under a hailstorm of counter-arguments that look, sound, and seem rational. Except that they aren't." (8).
What the Portland Mecurcy doesnt' realize is that I too, have also used the CDC as a source then checked the CDC's sources as well...
Fluoride toothpaste was also starting to be used in other countries in the 1970s. Fluoride toothpaste does lower the rate of tooth decay (because you brush it on/around your teeth, instead of drinking it and having the low-level of fluoride just go right past your teeth into your gut).
Also, the rates of decline of tooth decay were ALREADY on the decrease prior to fluoridation of water. In some cases, fluoridation of water did not reduce the rate of tooth decay but sometimes it increased.
Logic--> If fluoride in drinking water truly worked by itself (not including brushing teeth with fluoride and eating less candy/soda), then every single county/country and city would have lower rates every single time. Since the the results are mixed, at best, then fluoridating the water is not the answer to solving dental caries (cavities). In class, I learned about confounding variable but I always just thought of this as an "extra" variable. :)
Taken from the study (several pages into it)
"If water fluoridation is shown to have beneficial effects, what is the
effect over and above that offered by the use of alternative interventions and strategies? Studies carried out after 1974 were selected to examine the effect of water fluoridation over and above the effect of other sources of fluoride, especially fluoridated toothpaste. As toothpaste containing fluoride was being widely used in industrialised countries by the early 1970’s, examining the effect of water fluoridation after 1974 should allow for any modifying effect of fluoride toothpaste and other sources of dental fluoride (e.g. mouth rinses, tablets) to be apparent. Studies carried out post-1974 which were conducted in industrialised countries were considered to have included the effects of these sources of fluoride, unless the study stated otherwise." (2)
Also...
"“No randomised controlled trials of the effects of water fluoridation were found. . . . None of the included studies were of evidence level A. The reason for this among the studies evaluating dental caries was that none addressed three or more confounding factors.” (2)
Which these confouding factors may have been people in that country starting to brush their teeth more often, an increase in dental care, and social services directed at the most vulnerable members of society.
And....
"Given the certainty with which water fluoridation has been promoted and opposed, and the large number (around 3200) of research papers identified, the reviewers were surprised by the poor quality of the evidence and the uncertainty surrounding the beneficial and adverse effects of fluoridation. Studies that met the minimal quality threshold indicated that water fluoridation reduced the prevalence of caries but that the size of the effect was uncertain. Estimates of the increase in the proportion of children without caries in fluoridated areas versus non fluoridated areas varied (median 15%, inter quartile range 5% to 22%). These estimates could be biased, however, because potential confounders were poorly adjusted for. Water fluoridation aims to reduce social inequalities in dental health, but few relevant studies exist. The quality of research was even lower than that assessing overall effects of fluoridation." (3)
So, these researchers imply that there are far more variables that what is mentioned in the studies. Bias does not necessarily mean a skew/slant towards an already pre-concieved objective but instead simply missing some valuable variables. Stated above, I mentioned that there are many variables that exist that may reduce dental caries.
Some of these include:
1. People brushing their teeth more often
2. Exponential use with fluoride-based toothpaste
3. Increase awareness of cavities
4. Increase of social services for those most at risk
5. Diagnostic equipment improvement
6. Better treatnents for root canals, sealants
*Note: sealants were mentioned becuase it's possible that if someone's
cavity sealant came off or was broken, they may get another cavity....which means they would be counted as an extra number of people having another dental cavity. This would increase the rate and prevalence of those having dental caries.
7. Increase in flossing because of an awareness of flossing (eduation?)
8. (I'll update more later)
The part that surprised me is that one of the CDC graphs unusually started showing the decline of dental caries at the same time of fluorodation of the water supply. Why didn't the graphs start earlier, before the introduction of fluoride? Maybe the dental were getting worse or maybe even better?
The CDC implies that the use of fluoride in the water reduces tooth decay. (4) The most obvious part of the graph at the bottom really shows something interesting. Want to know what I've notice in that graph? The graph unusually starts exactly when they start introducing fluoride into the water supply. Was their already a decline of tooth decay, prior to the use of fluoride in the water?
Also, does it even mention that people were starting to use toothbrushes with fluoride toothpaste during these times?
The CDC gives information about how fluoride in the water can reduce tooth decay (5). Also, it mentions that "studies have shown" that fluoride in the water will reduce tooth decay by a large percentage (5). Now the "studies" are directly from the Surgeon General (6), not from a peer-reviewed source. You have read that correctly. Not a peer-reviewed source. This means that one of the most prestigious organizations did not use an scientific, peer-reviewed article from a journal or database. Even though this data does exist, much of my argument stems from attempting to dig deeper into the data the "pro-fluoride" movement has used.
Another note, the CDC (7) uses the source (2) the York review, which concludes that further evidence is needed. This is interesting because the York review did not find conclusive evidence that the, well, hell....another summary:
"The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score. The studies were of moderate quality (level B), but of limited quantity." (2)
To argue against my point of view
"The best available evidence from studies following withdrawal of water fluoridation indicates that caries prevalence increases, approaching the level of the low fluoride group. Again, however, the studies were of moderate quality (level B), and limited quantity. The estimates of effect could be biased due to poor adjustment for the effects of potential confounding factors." (2). What this means is that the amount of people with dental caries slightly increased after fluoride was taken out of the water. Of course, this argument came from studies that were of "moderate quality" and did not include other factors that could increase the prevalence (# of people with dental cavities). An example of what could increase the prevalence would be if more people moved into the area with more cavities (there is a huge list of things that can disfigure the statistics) or if there are more people available for dental screenings and checkups. Which, if you had more people getting screened for cavities, don't you suppose that there would be a higher number of people with dental caries? Just sayin'....
In conclusion, the York Review has used over 200 studies related to fluoride in the water, and they agreed that the conclusion was hardly mixed at best. This debate is continued on throughout the Portland area and there are several sides of the story. I think the idea of professionalism ends when you start mocking your opponents, not giving them a chance to voice a logical argument, dismissing theirs as "junk" science when they use peer-review literature, or simply implying that they're false.
I realize that this is a blog and some might feel as though because of this, my views are illegitimate. I try, within the time that I have to produce somethind decent. My views are very important to me and I will argue as such.
Updated May 10, 2013:
Regardless...
I have realized there's a tendency for people to use video-hosting sites to make an argument, which may be useful at times. In this "blog," I have spent a great deal of time looking for peer-reviewed evidence. There are hundreds of studies related to adding fluoride in the water supply, and most are of a "moderate level" leaving out important variables. Implying that fluoride in drinking water will prevent tooth decay without looking at increase/decrease of teethbrushing, dental care/treatments, is unwise and is a disservice to those that want to look for the best evidence. The York review has pretty much all of these studies that were the best.
With this, if people (everyone) are so adament on using the best evidence to support, then they should multiple sources. I have cited the CDC and some of it's sources as well. Which, is odd that the CDC uses a source that admits there's not enough conclusive evidence.
Then why spend money on adding it to the water when there may be other ways?
Maybe give toothbrusing classes in schools?
I used the CDC, which "Healthy Kids" also uses the CDC as well.
I read an article today from the Willamette Week that mentioned the "pro-fluoride" side had "bigger" players on their side, like the CDC and Healthy Kids.
Guess what. I used the CDC, too....with it's sources. The CDC site even mentioned that the York meta-analysis was one of the most comprehensive compilations of all these fluoride studies.Yes, the Portland Mercury and the Willamette Week will be more content with stabbing fun at people like me, instead of actually reading from their own peer-reviewed sources. If the CDC is to use a large meta-analysis of studies that say, at a moderate level, that fluoride does reduce dental caries, they should also include the other variables.
Sources:
1. http://www.virtualschool.edu/mon/SocialConstruction/Logic.html and http://www.dartmouth.edu/~writing/materials/student/ac_paper/logic.shtml
2. http://www.york.ac.uk/inst/crd/fluores.htm (where you can find the summary)
3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2001050/
4. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4841a1.htm
5. http://www.cdc.gov/healthywater/hygiene/disease/dental_caries.html
6. http://www2.nidcr.nih.gov/sgr/sgrohweb/home.htm
7. http://www.cdc.gov/fluoridation/benefits.htm
8. http://www.portlandmercury.com/portland/the-sanest-arguments-against-fluoride/Content?oid=9212701
