Still Fighting About Fluoride

Fluoride started being introduced into drinking water when I was a child, and the number of children with cavities began dropping almost immediately. But it's still a controversial subject, as evidenced by the recent vote by Calgary, Alberta city council to reintroduce fluoride into the city's water system. 

Now in California there's an attempt to sue the Environmental Protection Agency to have fluoride removed immediately. Nature has a good article about the subject and why fluoride is still controversial. It seems like the evidence for the benefits of water fluoridation isn't as clear-cut as many people assumed, myself included.

It is difficult to ignore the importance of equity in these arguments. On the one hand, dentists think that fluoridated water most benefits those who lack access to dental services, oral-health education, or a steady supply of fluoridated toothpaste — the very people who are most susceptible to poor oral health and who experience the greatest financial hardship when dental problems strike. On the other hand, toxicologists worry about any impact of fluoridated water on IQ, especially in populations that are already vulnerable because of exposure to high rates of air pollution and elevated poverty rates, for example. And even if such populations are aware of the potential risks of fluoridation, they are least likely to be able to afford bottled water to use when formula-feeding infants, for instance.

“A couple of cavities and a couple of IQ points are both serious when you think about a population. If you’re in a place of privilege, and luck and environment is with you, and you have a child testing in the high percentile, a few IQ points may not be of great impact. But for others, in different conditions, it can be.” And, she says, “At a population level, it’s a big shift. Being in a disadvantaged position cuts across domains — health, economics, education, exposure. The most vulnerable populations are most vulnerable to a lot of things, not just dental caries and neurotoxicants.”