Fluoride is a substance present naturally in water, food such as tea and fish and even in the air we breathe. The level of fluoride in water varies between places. Water fluoridation is the practice of adding fluoride compound into water system (in areas with low natural fluoride content) with the intention to reduce caries prevalence in a population.

It is a safe, cost-effective method of delivering fluoride on a community basis. It also helps reduce inequalities in dental health across social classes.

The beneficial effect of fluoride in preventing caries was discovered 30 years after Dr. McKay noticed fluorosis (mottled enamel) in many of his patients in Colorado in 1900s. These patients also had low caries level. Subsequent studies have found that fluoride over 2.0ppm was responsible for this mottling, as well as low caries activity (Dean, 1942). Based on findings, 1ppm fluoride was recommended as the optimum level of fluoride in drinking water. Many researches have been performed since then. Data from 113 studies involving 23 countries have shown that water fluoridation is associated with 40-49% caries reduction in the primary dentition and 50-59% decrease in caries in the permanent dentition (Murray, 1993).

The University of York has conducted a systematic review on the efficacy and safety of water fluoridation (MacDonaugh et al, 2000). A well-conducted systematic review looks at all available evidence from relevant studies and grades the level of evidence (whether it's good, moderate or poor) based on how well the studies were conducted and makes conclusions based on these. From this review, it was found that water fluoridation was associated with an average of 2.25 reduction in decayed, missing, and filled teeth (dmft) and an increase of 15% in caries-free proportion in children. Isn't that fantastic!

They also looked at risks associated with water fluoridation such as cancer, bone fracture, Alzheimer's disease, Dementia and Down's syndrome. There is currently insufficient evidence to support these negative effects of water fluoridation. I have read the articles in fluoridealert.org website myself. It is very important to be careful when reading articles from the internet. The following questions must be asked:

1.What is the source of the statement?

2.Is it based on a research study?

3.If it is, is it a human-based or animal study? (Results from animal studies should be carefully interpreted and may not be extrapolated to human population. Why? Different genes, different body mass, different anatomy.

4.Was the study well-conducted? Who did the study? How did they perform the study? Any control group? (There are certain criteria that need to be met in order for a study to be a considered as good)

5.What was the result of the study? Did they perform correct statistical analysis?

In this modern day, we are moving towards evidence-based health care. The Cochrane Collaboration provides a reliable source of evidence in medical or dental field (www.cochrane.org). It has a database of systematic reviews to help clinicians and others make evidence-based decisions. They only include the best available evidences in their reviews based on very strict criteria. You can find reviews on the efficacy of different forms of fluoride delivery system including toothpaste, mouthwash, gel and varnish. Sad to know, caries level in Brunei is among the highest in the region.

The Department of Health Promotion of the Dental Department has been working really hard to improve the dental health of our population including the implementation of water fluoridation. This decision, I believe, was based on the evidence to support its efficacy in preventing caries. We, as Bruneians, should support our ministry in achieving a better oral health. Not only we must clean our teeth properly with the correct fluoride-containing toothpaste, we have to watch what we eat and go for check-ups regularly.

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Unsafe, ineffective and unethical.
written by Brian Jackson , November 14, 2009

Even the York Review said that it could not recommend an expansion of fluoridation due to lack of scientific research. Since then much damning research has found links with adverse major human health effects. Fluoride doesnt work, its unethical for anyone to be forced to take fluoride in the water supply. The UK Government as usual, ignored the expert evidence of the York Review and even re-wrote the conclusions in order to support its illegal policy. The only benefits of fluoride are to those who produce it either deliberately or merely as a bi-product. Who in their right minds would go to a politician or the local water company for a medical prescription. Even dentists know little about toxicology or epidemiology. Say No To Fluoridation and dont vote for those who advocate it. Brian Jackson, Friends of the Earth Fluoride Campaign.

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Natural fluoride is not an industrial waste
written by jwillie6 , November 15, 2009

Arsenic, like fluoride, also naturally occurs in water, but it kills us.
When the fertilitzer companies, and others, clean their smokestacks, they bag the waste fluoride chemical, ( Hydrofluorosilicic Acid), which contains lead, mercury, arsenic, etc. and sell it to communities to add to our water systems. The Government tries to convince us that it does not harm us if it is diluted enough. It is a hoax on the public. Follow the money!
Those promoting fluoridation simply refuse to read the current research showing it is ineffective and dangerous to health. Go to (www.fluoridealert.org) and read several scientific articles.
Read the letter from Dr. Hardy Limeback ( DDS, PhD Biochemistry) --- Head, Preventive Dentistry, University of Toronto entitled "Why I am now officially opposed to adding fluoride to drinking water"
He was the principal research advisor to the Canadian Dental Asociation for over 10 years in promoting fluoridation. His letter is an apology to other dentists and the public.
Over 140 Research studies listed, including:
Increased risk of bone cancer -- 13 studies
Lead, arsenic, radium contaminants causing toxic water -- 10 studies
Link with fluoride and other cancer -- 12
Fluoride causes birth defects -- 5
Fluoride affects the immune systems -- 12
Fluoride is neurotoxic (brain, nerves, lowering IQ) -- 11
Etc.
Also see the petition signed by over 2600 professionals opposing fluoridation.

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14 Noble Prize Winners Reject Water Fluoridation
written by steveW , November 15, 2009

A few quote`s: Albert Schatz, Ph.D - "Fluoridation ... it is the greatest fraud that has ever been perpetrated and it has been perpetrated on more people than any other fraud has."Professor Albert Schatz, Ph.D. (Microbiology), Discoverer of streptomycin and Nobel Prize Winner
Dr. Charles Gordon Heyd MD -"I am appalled at the prospect of using water as a vehicle for drugs. Fluoride is a corrosive poison that will produce serious effects on a long range basis. Any attempt to use water this way is deplorable." Dr. Charles Gordon Heyd MD is the Past President of the American Medical Association. See the actual effects in peer review science on bones and teeth:
http://www.youtube.com/watch?v=t9RXfOuylWo

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...
written by Thinker , November 17, 2009

Anything that is taken in excessive amount is toxic/harmful.. be it too much water, too much sugar, too high doses of drugs or medication. Yes, dentist may not be toxicologist but they are aware of the effects that fluoride can have on the dental health

There is evidence that too much fluoride ingestion can cause dental fluorosis, and it happens in young children eating toothpaste without parental supervision; toothpaste contains about 1000ppm fluoride which is equivalent to 1mg fluoride per gram of toothpaste. Thus young children should have only a smear of toothpaste and be supervised by their parents when brushing and to rinse their mouth thoroughly with water afterwards.

Community water fluoridation is 0.8-1 ppm, a concentration that will not cause dental fluorosis, but has the beneficial effect of reducing dental decay

NHS centre for Reviews and Disemination 2000 found that in a systemic review:

(1)Fluoride was associated with a reduction in level of dental decay (2) There was a dose response between the amount of fluoride in the water and the level of fluorosis (3) No harmful effects were found (4) Fluoride was still associated with reduction in caries even in later years when fluoride toothpaste was commonly used.

Systemic review differ from other types of review in that they adhere to strict scientific design in order to make them more comprehensive, to minimise the chance of bias and to ensure the reliability of the evidences.

From the 'published studies' you mentioned, there are not a lot of evidence saying water fluoridation causes cancers such as osteosarcoma/osteogenic sarcoma or that it causes lower IQ among children. These studies are mainly case reports or 'short stories' that do not give the evidence much strength. Furthermore, horses dental health do not and will not reflect on human's dental health. It's wiser to look at solid evidences and not to accept and take anything that is loosely told by scientists with "PhD or nobel prize winners". Again, they are not within the dental field in the first place and it makes me wonder whether they read dental literature well enough.

Some simple facts regarding water fluoridation: (1) 20-40% reduction in caries over a lifetime (2) Caries increase after fluoridation cessation. Water fluoridation is advantageous in that it is safe, efficacious, cost- effective, consistent, good population coverage, low risk of overdose, reduces social economic inequalities and patient compliance is not needed.

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