Fluoride: The American Dental Association (ADA) View
The following is an excerpt from the ADA booklet concerning fluoridation which addresses the main points of the ADA's stance on the subject. Please visit the ADA website to download the entire publication.
This 56-page booklet is a comprehensive encyclopedia of fluoridation facts with over 200 scientific references. This ADA booklet includes information from scientific research in a helpful question and answer format. You may also order a copy of the booklet from the ADA Product Catalog.
- Support for Water Fluoridation
- Scientific Information on Fluoridation
- History of Water Fluoridation
- Water Fluoridation as a Public Health Measure
- Water Fluoridation's Role in Reducing Dental Decay
- Figure 1: Dental Decay
- Ongoing Need for Water Fluoridation
Since 1956, the American Dental Association (ADA) has published Fluoridation Facts. Revised periodically, Fluoridation Facts answers frequently asked questions about community water fluoridation. In this 1998 edition, the ADA Council on Access, Prevention and Interprofessional Relations provides updated information for individuals and groups interested in the facts about fluoridation. The United States now has over 50 years of practical experience with community water fluoridation. Its remarkable longevity is testimony to fluoridation's significance as a public health measure.
Important points to remember about fluoride and community water fluoridation are:
- Fluoridation is considered beneficial by the overwhelming majority of the health and scientific communities as well as the general public.
- Fluoride helps prevent tooth decay. All ground and surface water in the U.S. contains some naturally occurring fluoride. If a community's water supply is fluoride-deficient (less than 0.7 parts fluoride per million parts water), fluoridation simply adjusts the fluoride's natural level, bringing it to the level recommended for decay prevention (0.7 - 1.2 parts per million).
- Fluoridation is a community health measure that benefits children and adults. Simply by drinking optimally fluoridated water, members of a community benefit, regardless of income, education or ethnicity - not just those with access to dental care.
- Fluoridation protects over 360 million people in approximately 60 countries worldwide, with over 10,000 communities and 145 million people in the United States alone.
- As with other nutrients, fluoride is safe and effective when used and consumed properly. From time to time, opponents of fluoridation have questioned its safety and effectiveness. None of these charges has ever been substantiated by generally accepted science. After 50 years of research and practical experience, the overwhelming weight of scientific evidence indicates that fluoridation of community water supplies is both safe and effective.
- Just fifty cents per person per year covers the cost of fluoridation in an average community. Over a lifetime, that is the approximate price of one dental filling, making fluoridation very cost effective.
- Time and time again, public opinion polls show an overwhelming majority of Americans support water fluoridation.
Support for Water Fluoridation
Since 1950, the American Dental Association (ADA), along with the United States Public Health Service (USPHS), has continuously and unreservedly endorsed the optimal fluoridation of community water supplies as a safe and effective public health measure for the prevention of dental decay. The ADA's policy on fluoridation is based on its continuing evaluation of the scientific research on the safety and effectiveness of fluoride. Over the years, and as recently as 1997, the ADA has continued to reaffirm its position of support for water fluoridation and has strongly urged that its benefits be extended to communities served by public water systems. Today, fluoridation is the single most effective public health measure to prevent tooth decay and to improve oral health over a lifetime.
The American Dental Association, the U.S. Public Health Service, the American Medical Association and the World Health Organization all support community water fluoridation. Other national and international health, service and professional organizations that recognize the public health benefits of community water fluoridation for preventing dental decay are listed under the Compendium.
Scientific Information on Fluoridation
The ADA's policies regarding community water fluoridation are based on generally accepted scientific knowledge. This body of knowledge is based on the efforts of nationally recognized scientists who have conducted research using the scientific method, have drawn appropriate balanced conclusions based on their research findings and have published their results in refereed (peer-reviewed) professional journals that are widely held or circulated. Confirmation of scientific findings also reinforces its validity of existing studies.
From time to time, opponents of fluoridation have questioned its safety and effectiveness. None of these charges has ever been substantiated by generally accepted science. It is important to review information about fluoridation with a critical eye. Listed below are several key elements to consider when reviewing information about fluoride research.
- The author's background and credentials should reflect expertise in the area of research undertaken.
- The year of the publication should be apparent. The information should be relatively current, although well-designed studies can stand the test of time and scientific scrutiny (e.g. overwhelming evidence already exists to prove the effectiveness of water fluoridation). A review of existing literature can provide insight into whether the results of older studies have been superceded by subsequent studies.
- If the information is a review of other studies, it should be representative of the original research. Information quoted directly from other sources should be quoted in its entirety.
- The research should be applicable to community water fluoridation and use an appropriate type and amount of fluoride. Many research projects investigate the use of fluoride at much higher levels than recommended for community water fluoridation. For example, the results of a study using a concentration of 125 parts per million (ppm) doses of fluoride are not comparable to water fluoridated at 0.7 to 1.2 ppm.
- How the research is conducted is relevant. Research conducted in vitro (outside the living body and in a laboratory environment) may not lead to the same results as research conducted in vivo (in a living human or other animal).
- Animal studies should be carefully reviewed. In animal studies (e.g., rodent), excessively high doses of fluoride are sometimes used. In addition, the fluoride used in these experiments is often administered by means other than in drinking water (e.g. by injection). Information obtained in animal studies may be highly questionable as a predictor of the effects of human exposure to low concentrations of fluoride, such as those used to fluoridate water.
- Publications presenting scientific information should have an editorial review board to help ensure that scientifically sound articles are published.
- The publication should be easily obtainable through a medical/dental library.
With the advent of the Information Age, a new type of "pseudo-scientific literature" has developed. The public often sees scientific and technical information quoted in the press, printed in a letter to the editor or distributed via an Internet Web page. Often the public accepts such information as true simply because it is in print. Yet the information is not always based on research conducted according to the scientific method, and the conclusions drawn from research are not always scientifically justifiable. In the case of water fluoridation, an abundance of misinformation has been circulated. Therefore, scientific information from all print and electronic sources must be critically reviewed before conclusions can be drawn. Pseudo-scientific literature may peak a reader's interest but when read as science, it can be misleading. The scientific validity and relevance of claims made by opponents of fluoridation might be best viewed when measured against criteria set forth by the U.S. Supreme Court.
Fluoridation Facts is designed to answer frequently asked questions about fluoridation by summarizing relevant published articles as indicated by numbered references within the document. A corresponding list of references appears in the back of the booklet. Fluoridation Facts is not intended to include and review the extensive literature on community water fluoridation and fluorides.