Fluoride in the Water: A Public Health Discussion

RFK, Jr.'s Plan to Ban Fluoridation

Robert F. Kennedy Jr. has been reported by Politico to be planning a ban on water fluoridation. Despite this news being echoed by multiple media outlets, it appears that none of them have taken the time to verify the evidence behind this claim.

The CDC's Stance on Water Fluoridation

According to the Centers for Disease Control and Prevention (CDC), the addition of fluoride to water supplies is among the top ten public health achievements of the 20th century. The CDC views water fluoridation as a practical, cost-effective, and equitable strategy for improving oral health across communities, regardless of age, education, or income. They claim that fluoridated water strengthens teeth and reduces cavities by about 25% in both children and adults.

Studies Referenced by the CDC

To support their stance, the CDC cites two studies. The first is a meta-analysis of 20 studies, none of which were Randomized Controlled Trials (RCTs), and all were cross-sectional studies. This review was not systematic and only included adults, concluding that fluoride effectively prevents caries in adults of all ages. The second study was a Cochrane review, with most studies (71%) conducted before 1975, before the widespread introduction of fluoride toothpaste. This review concluded that there is little contemporary evidence evaluating the effectiveness of water fluoridation in preventing caries. The observational nature of the studies, the high risk of bias, and the lack of generalisability to current lifestyles limit confidence in the size of the effect estimates.

RFK, Jr.'s View on Fluoride

RFK, Jr. believes that more safety studies need to be conducted on fluoridation. He views fluoride as industrial waste and thinks a federal court ruling could expedite the end of water fluoridation in the United States. A judge has ordered the US Environmental Protection Agency (EPA) to conduct a risk assessment after finding that fluoridation could cause developmental damage and lower IQ in children at the levels found in drinking water. Following this ruling, several water systems, including Salt Lake City's provider, have halted or suspended fluoridation.

Recent Evidence on Fluoride

A recent review of ten studies on Brazilian populations reported that water fluoridation effectively prevents dental caries in children younger than 13 years, even with the widespread use of fluoridated toothpaste. However, the World Health Organization (WHO) reports that fluoride intake can have both beneficial effects, such as reducing the incidence of dental caries, and negative effects, such as causing tooth enamel and skeletal fluorosis following prolonged high exposure.

Potential Risks of Fluoride

Several reviews have assessed potential risks associated with fluoride, such as dental fluorosis, which affects individuals of all ages, with the highest prevalence below age 11. Other potential risks include an association with hypothyroidism and children's intelligence. However, the evidence is inconclusive, and further epidemiological studies are needed to provide more evidence regarding these possible associations.

Impact of Stopping Fluoride

A systematic review indicated that fluorosis significantly decreased following either a reduction in fluoride concentration or the cessation of adding fluoride to the water supply. Another systematic review of 15 studies identified methodological considerations for designing community water fluoridation cessation studies.

What Does This Mean for RFK, Jr.?

RFK, Jr. is asking questions about an intervention based on evidence dating back to the 1930s. There have been growing concerns about harm and little contemporary evidence evaluating the effectiveness of water fluoridation in preventing caries. Therefore, stopping fluoride in the context of epidemiological evaluations seems reasonable.

Authors' Note

This article was written by two individuals who regularly clean their teeth and remain overworked and politically neutral.

Bottom Line

The debate surrounding water fluoridation is complex and multifaceted. While it has been hailed as a significant public health achievement, there are growing concerns about its potential risks and the lack of contemporary evidence supporting its effectiveness. RFK, Jr.'s questions about water fluoridation are valid, and further research is needed to fully understand the implications of this practice. What are your thoughts on this issue? Share this article with your friends and sign up for the Daily Briefing, delivered every day at 6pm.