Water fluoridation
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{{POV|date=March 2008}}
'''Water fluoridation''' is the addition of a chemical to increase the concentration of [[fluoride]] [[ions]] in [[drinking water]] to reduce the incidence of [[tooth decay]].<ref>[http://www.epa.gov/OCEPAterms/fterms.html]Environmental Protection Agency. Terms of Environment: Glossary, Abbreviations and Acronyms.</ref> Fluoride compounds are found naturally in the ground water in some regions but not in others. Fluoridation chemicals are typically added to [[potable water]] in the form of sodium hexafluorosilicate or [[hexafluorosilicic acid]] (also known as hydrofluorosilic acid). <ref>Reeves T.G.: "Technical aspects of water fluoridation in the United States and an overview of fluoridation engineering world-wide", Community Dent. Health 13: Suppl. 2 (1996) 21-26.</ref><ref>Bellack E.: "Fluoridation Engineering Manual", Report EPA-520/9-74-022, (1974)</ref>
==History==
While the use of fluorides for prevention of [[dental caries]] (cavities) was discussed in the 19th century in Europe,<ref>Meiers, Peter: [http://www.fluoride-history.de/fteeth1.htm "Early Fluoride research in Europe"] from the [http://www.fluoride-history.de Fluoride History] website, page accessed 21 May, 2006.</ref> community water fluoridation in the United States owes its origin in part to the research of Dr. Frederick McKay, who pressed the dental community for an investigation into what was then known as "Colorado brown stain."<ref name="csdshistory">[http://www.cs-ds.org/history.asp#fluoride History of Dentistry in the Pikes Peak Region],[http://www.cs-ds.org/index.asp Colorado Springs Dental Society] webpage, page accessed 25 February, 2006.</ref> The condition, now known as [[dental fluorosis]], when in its severe form is characterized by cracking and pitting of the teeth. <ref>[http://209.85.173.104/search?q=cache:K0_jvti21LsJ:www.med.uwo.ca/ecosystemhealth/education/casestudies/fluorosismed.htm+%22colorado+brown+stain%22+dental+fluorosis&hl=en&ct=clnk&cd=5&gl=us&client=firefox-a]</ref><ref>[http://www.accessscience.com/studycenter.aspx?main=7&questionID=4858]</ref><ref>[http://www.npr.org/templates/story/story.php?storyId=5295412]</ref> In 1909, of the 2,945 children seen by Dr. McKay, 87.5% had some degree of stain or mottling. All the affected children were from the [[Pikes Peak]] region. Despite having a negative impact on the physical appearance of their teeth, the children with stained, mottled and pitted teeth also had fewer cavities than other children. McKay brought the problem to the attention of [[Greene Vardiman Black|Dr. G.V. Black]], and Black's interest into the Colorado stain led to greater interest throughout the dental profession.
[[Image:McKayandBlackCDC01.jpg|thumb|200px|left|Photograph of Dr. G.V. Black (left) and Drs. Isaac Burton and F. Y. Wilson, 1909, studying the "Colorado Brown Stain" (picture taken by McKay, printed in Douglas W.A.:"History of dentistry in Colorado, 1859-1959").]]
Initial hypotheses for the staining included poor [[nutrition]], overconsumption of [[pork]] or [[milk]], [[radium]] exposure, [[List of childhood diseases|childhood disease]]s, or a [[calcium]] deficiency in the local drinking water.<ref name="csdshistory">[http://www.cs-ds.org/history.asp#fluoride History of Dentistry in the Pikes Peak Region],[http://www.cs-ds.org/index.asp Colorado Springs Dental Society] webpage, page accessed 25 February, 2006.</ref> In 1931, researchers from the Aluminum Company of America (ALCOA) finally concluded that the cause of the [[Colorado]] stain was a high concentration of fluoride ions in the region's drinking water (ranging from 2 to 13.7 ppm) and areas with lower concentrations had no staining (1 ppm or less).<ref>Meiers, Peter: [http://www.fluoride-history.de/bauxite.htm "The Bauxite Story - A look at ALCOA"], from the [http://www.fluoride-history.de Fluoride History] website, page accessed 12 May, 2006.</ref> Pikes Peak's rock formations contained the [[mineral]] [[cryolite]], one of whose constituents is fluorine. As the rain and snow fell, the resulting runoff water dissolved fluoride which made its way into the water supply.
[[Dental]] and aluminum [[researchers]] then moved toward determining a relatively safe level of [[fluoride]] chemicals to be added to water supplies. The research had two goals: (1) to warn communities with a high concentration of fluoride of the danger, initiating a reduction of the fluoride levels in order to reduce incidences of [[fluorosis]], and (2) to encourage communities with a low concentration of fluoride in drinking water to add [[fluoride]] chemicals in order to help prevent [[tooth decay]].
A study of varying amounts of fluoride in water was led by Dr. H. Trendley Dean, a dental officer of the [[U.S. Public Health Service]].<ref>Dean, H.T. "Classification of mottled enamel diagnosis." ''Journal of the American Dental Association'', 21, 1421 - 1426, 1934.</ref><ref>Dean, H.T. "Chronic endemic dental fluorosis." ''Journal of the American Dental Association'', 16, 1269 - 1273, 1936.</ref> In 1936 and 1937, Dr. Dean and other dentists compared statistics from [[Amarillo]], which had 2.8 - 3.9 [[Parts-per notation|ppm]] fluoride content, and low fluoride [[Wichita Falls]]. The data is alleged to show less cavities in Amarillo children, but the studies were never published.<ref>http://www.fluoride-history.de/bartlett.htm</ref> Dr. Dean's research on the fluoride - dental caries relationship, published in 1942, included 7,000 children from 21 cities in [[Colorado]], [[Illinois]], [[Indiana]], and [[Ohio]]. The study concluded that the optimal amount of fluoride which minimized the risk of severe fluorosis but had positive benefits for tooth decay was 1 mg. per day, per adult. Although fluoride is more abundant in the environment today, this was estimated to [[correlate]] with the concentration of 1 [[part per million]] ([[Parts-per notation|ppm]]).
In 1939, Dr. Gerald J. Cox <ref>Meiers, Peter: [http://www.fluoride-history.de/cox.htm "Gerald Judy Cox"].</ref> conducted laboratory tests using [[rats]] that were fed [[aluminum]] and fluoride. The anti-carries data from his studies were described as, "inconclusive" and, "anything but convincing," by fluoride historian Peter Meiers.<ref>http://www.fluoride-history.de/cox.htm</ref> But Dr. Cox suggested adding fluoride to drinking water (or other media such as [[milk]] or bottled water) in order to improve oral health.<ref>Cox, G.J., M.C. Matuschak, S.F. Dixon, M.L. Dodds, W.E. Walker. "Experimental dental caries IV. Fluorine and its relation to dental caries. Journal of Dental Research, 18, 481-490, 1939. Copy of original paper can be found [http://jdr.iadrjournals.org/cgi/reprint/18/6/481 here].</ref> In 1937, dentists Henry Klein and Carroll E. Palmer had considered the possibility of fluoridation to prevent cavities after their evaluation of data gathered by a Public Health Service team at dental examinations of Native American children.<ref>Klein H., Palmer C.E.: "Dental caries in American Indian children", Public Health Bulletin, No. 239, Dec. 1937</ref> In a series of papers published afterwards (1937-1941), yet disregarded by his colleagues within the U.S.P.H.S., Klein summarized his findings on tooth development in children and related problems in epidemiological investigations on caries prevalence.
In the mid 1940s, four widely-cited studies were conducted. The researchers investigated cities that had both fluoridated and unfluoridated water. The first pair was [[Muskegon, Michigan]] and [[Grand Rapids, Michigan]], making Grand Rapids the first community in the world to add fluoride chemicals to its drinking water to benefit dental health on [[January 25]], [[1945]].<ref name="mntmichigan">[http://www.medicalnewstoday.com/medicalnews.php?newsid=27595 After 60 Years of Success, Water Fluoridation Still Lacking in Many Communities]. [http://www.medicalnewstoday.com Medical News Today] website, accessed 26 February, 2006.</ref> [[Kingston, New York]] was paired with [[Newburgh (city), New York|Newburgh, New York]].<ref>Ast, D.B., D.J. Smith, B. Wacks, K.T. Cantwell. "Newburgh-Kingston caries-fluorine study XIV. Combined clinical and roentgenographic dental findings after ten years of fluoride experience." ''Journal of the American Dental Association'', 52, 314-25, 1956.</ref> [[Oak Park, Illinois]] was paired with [[Evanston, Illinois]]. [[Sarnia, Ontario]] was paired with [[Brantford, Ontario]], [[Canada]].<ref>Brown, H., M. Poplove. "The Brantford-Sarnia-Stratford Fluoridation Caries Study: Final Survey, 1963." Canadian Journal of Public Health,56, 319–24, 1965.</ref>
In 1951, a member of the Newburgh - Kingston Fluoridation Committee, Katherine Bain, stated: "''the technical committee set up to work with that study set itself a goal which it wasn´t able to achieve. It had hoped to keep the study under wraps for ten years, and at the end of ten years come out with a definitive answer about what fluoride did, what its harmful effects might be. As you know, that study and other studies began having such results that people became interested, and the pressure was such that people felt we must go ahead with these programs.''"<ref>http://www.fluoride-history.de/bartlett.htm</ref> The Newburgh-Kingston study has been sharply criticized by the [http://www.fluoride-history.de Fluoride History] website for its, "ludicrous inadequacy," and for engaging in, "obvious manipulations."<ref>[http://www.fluoride-history.de/bartlett.htm]</ref>
In 1952 Nebraska Representative A.L. Miller complained that there had been no studies carried out to assess the potential adverse health risk to [[senior citizens]], [[pregnant women]] or people with [[chronic diseases]] from exposure to the fluoridation chemicals.<ref>http://www.fluoride-history.de/bartlett.htm</ref>
A decrease in the incidence of tooth decay was found in some of the cities which had added fluoride chemicals to water supplies. However, tooth decay was declining in similar rates in non-fluoridated cities.<ref> Diesendorf, Mark '' The mystery of declining tooth decay'' Nature, July 10, 1986 [http://www.nature.com/nature/journal/v322/n6075/pdf/322125a0.pdf]</ref> The early comparison studies would later be criticized as, "primitive," with a, "virtual absence of quantitative, statistical methods...nonrandom method of selecting data and...high sensitivity of the results to the way in which the study populations were grouped..." in the journal [[Nature (journal)|Nature]].<ref> Diesendorf, Mark '' The mystery of declining tooth decay'' Nature, July 10, 1986</ref>
==Effects==
Fluoride, while toxic at moderate to high doses, may be beneficial for dental health at very low doses. The most commonly recommended dosage of fluoride for humans is 1 mg. per day. Fluoridation is intended to reduce tooth decay, with its associated health problems, at a low cost.<ref name="CDC">{{cite web|url=[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5107a2.htm]|publisher=Centers for Disease Control and Prevention|title=Populations Receiving Optimally Fluoridated Public Drinking Water --- United States, 2000|accessdate=2008-01-31}}</ref> However, in 2001, the United States [[Centers for Disease Control and Prevention]] stated, “Although solid data on the cost-effectiveness of fluoride [[modalities]] alone and in combination are needed, this information is scarce.” <ref>
Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States, Morbidity and Mortality Weekly Report, August 17, 2001, Centers for Disease Control and Prevention [http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm]</ref> Many communities need to reduce fluoride exposure. Consumption of water exceeding 10 [[Parts-per notation|ppm]] fluoride has been shown to lead to pathological changes in bone structure, and [[skeletal fluorosis]].<ref> [http://www.krepublishers.com/02-Journals/JHE/JHE-18-0-000-000-2005-Web/JHE-18-2-000-000-2005-Abst-PDF/JHE-18-2-105-107-2005-1287-Bharati-P/JHE-18-2-105-107-2005-1287-Bharati-P-Full-Text.pdf]</ref> <ref>[http://www.who.int/water_sanitation_health/naturalhazards/en/index2.html]</ref> Debilitating environmental fluorosis of a portion of the population is a problem in several developing countries, where it is complicated by malnutrition. The effects of skeletal fluorosis can be slowly reversed through a reduction of fluoride intake and improved diet.<ref>[http://www.inchem.org/documents/ehc/ehc/ehc36.htm#SectionNumber:8.3.2]</ref>
Data on fluoride's ability to cause [[cancer]] is mixed. Some human and animal studies have shown an increase in [[osteosarcoma]], a rare bone cancer, coinciding with exposure to fluoride, including fluoridated water.<ref>[http://emporium.turnpike.net/P/PDHA/fluoride/adverse.htm Adverse Health Effects of Fluoride<!-- Bot generated title -->]</ref><ref>[http://www.slweb.org/bibliography.html#cancer A Bibliography of Scientific Literature on Fluoride<!-- Bot generated title -->]</ref><ref>[http://www.fluoridealert.org/health/cancer/ Fluoride & Cancer<!-- Bot generated title -->]</ref><ref>[http://www.fluoridation.com/cancer.htm The mutagenicity of fluoride supports the conclusion that fluoride is a probable human carcinogen<!-- Bot generated title -->]</ref>
==Endorsements==
The [[American Dental Association]] states on their website that many prominent organizations endorse water fluoridation, including the [[World Health Organization]], the [[Centers for Disease Control and Prevention]], and the [[American Medical Association]]. <ref>[http://www.ada.org/public/topics/fluoride/facts/compendium.asp ]American Dental Association, Fluoridation Facts, National and International Organizations That Recognize the Public Health Benefits of Community Water Fluoridation for Preventing Dental Decay: Web page accessed June 15, 2008.</ref>
On April 2, 1999, the U.S. [[Centers for Disease Control and Prevention]] listed water fluoridation as one of the 10 greatest public health achievements of the 20th century.<ref>[http://www.cdc.gov/MMWR/preview/mmwrhtml/00056796.htm Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, April 02, 1999] / 48(12);241-243 Ten Great Public Health Achievements -- United States, 1900-1999</ref>
== Opposition ==
{{main|Water fluoridation opposition}}
Water fluoridation opposition refers to activism against the addition of fluoride chemicals to public water supplies. Concerns include the lack of quality research data available,<ref>Centre for Reviews and Dissemination, University of York, York, UK. http://www.york.ac.uk/inst/crd/fluorid.htm Fluoridation of Drinking Water: a Systematic Review of its Efficacy and Safety. Accessed 2007-06-23</ref> evidence that it may cause serious health problems,<ref>{{cite journal | journal = [[Fluoride (journal)|Fluoride]] | volume = 31 | issue = 2 | year = 1998 | pages = 103–118 | author = John Colquhoun | title = Why I changed my mind about water fluoridation | url = http://www.fluoride-journal.com/98-31-2/312103.htm | format = reprinted from ''[[Perspectives in Biology and Medicine]]''}}</ref><ref>[http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16834990&query_hl=3&itool=pubmed_docsum PubMed NCBI Dose-effect relationship between drinking water fluoride levels and damage to liver and kidney functions in children.]</ref><ref>[http://emporium.turnpike.net/P/PDHA/fluoride/adverse.htm Adverse Health Effects of Fluoride<!-- Bot generated title -->]</ref><ref>[http://www.slweb.org/bibliography.html#cancer A Bibliography of Scientific Literature on Fluoride<!-- Bot generated title -->]</ref><ref>[http://www.fluoridealert.org/health/cancer/ Fluoride & Cancer<!-- Bot generated title -->]</ref><ref>[http://www.fluoridation.com/cancer.htm The mutagenicity of fluoride supports the conclusion that fluoride is a probable human carcinogen<!-- Bot generated title -->]</ref><ref>[http://www.fluoridealert.org/health/cancer/mutagen.html Health Effects: Fluoride's Mutagenicity (Genotoxicity)], [http://www.fluoridealert.org Fluoride Alert] website, accessed 18 February, 2006.</ref><ref name="CDCOsteo">[http://www.cdc.gov/fluoridation/safety/osteosarcoma.htm CDC Statement on Water Fluoridation and Osteosarcoma], from the [http://www.cdc.gov CDC] website, page accessed 18 March, 2006.</ref><ref name="nciosteosarcomas">[http://www.cancer.gov/cancertopics/factsheet/Risk/fluoridated-water National Cancer Institute] website, "Fluoridated Water: Questions and Answers", page accessed March 3, 2006.</ref><ref>"Effects of Fluoride on Immune System Function" by Sheila L.M. Gibson, M.D., Complimentary Medical Research, October 1992, pp. 111-113.</ref><ref>[http://www.fluoridedebate.com/question25.html Diseases: Question 25], [http://www.fluoridedebate.com Fluoride Debate] website, accessed 19 February, 2006.</ref><ref>[http://www.fluoridation.com/sperm.htm The reproductive effects of fluoride intake], [http://www.fluoridation.com Fluoridation.com] website, accessed 18 February, 2006.</ref><ref>[http://www.dartmouth.edu/~rmasters/AHABS/ Adverse Health and Behavior from Silicoflourides.]</ref><ref>[http://www.dartmouth.edu/~news/releases/2001/mar01/flouride.html Dartmouth News. 2001. March. Dartmouth researcher warns of chemicals added to drinking water.]</ref> and ethical issues. <ref>[http://www.fluoridedebate.com/question34.html The Fluoride Debate: Question 34], [http://www.fluoridedebate.com Fluoride Debate] website, accessed 23 February, 2006.</ref><ref>[http://www.iicph.org/docs/fluoride_primer.htm Fluoride Primer: Fluoridation is a serious breach of ethics], [http://www.iicph.org International Institute of Concern for Public Health] website, accessed 22 February, 2006.</ref><ref>[http://www.greenparty.org.uk/files/reports/2003/F%20illegality.htm] Water fluoridation contravenes UK law, EU directives and the European Convention on Human Rights and Biomedicine</ref><ref>[http://www.ncbi.nlm.nih.gov/pubmed/12749628?dopt=Abstract] NCBI. PubMed. Int J Occup Environ Health. 2003 Jan-Mar;9(1):24-9.
Fluoridation: a violation of medical ethics and human rights. Cross DW, Carton RJ.</ref>
Some concerns raised include:
*A 2006 U.S. [[United States National Academy of Sciences|National Academy of Sciences]] (NAS) panel's conclusion that 4 ppm fluoride in drinking water is not sufficiently protective against [[dental fluorosis]]. A majority of the researchers also agreed that 4 ppm fluoride in drinking water is also not protective against bone fractures. Although water fluoridation targets a fluoride ion content of 0.7 ppm to 1.2 ppm, the U.S. [[Environmental Protection Agency]] (EPA), which regulates fluoride levels in tap water, allows a [[Maximum Contaminant Level]] (MCL) of 4 ppm fluoride in public water supplies. The NAS has recommended that the EPA lower the MCL for fluoride in municipal water supplies.<ref>[http://books.nap.edu/openbook.php?record_id=11571&page=R1 Fluoride in Drinking Water: A Scientific Review of EPA's Standards<!-- Bot generated title -->]</ref>
*An increased [[prevalence]] of [[dental fluorosis]] (especially in children) from an elevated dose of fluoride due to additional sources of fluoride (such as processed foods<ref name="sciam">''[[Scientific American]]'' Jan. 2008 p.80 [http://www.sciam.com/article.cfm?id=second-thoughts-on-fluoride Article]</ref> and dental products).<ref name="sciam"/><ref>Timing of Fluoride Intake in Relation to Development of Fluorosis on Maxiallry Central Incisors. L. Hong, S. Levy at al. [http://www.blackwell-synergy.com/doi/abs/10.1111/j.1600-0528.2006.00281.x ''Community Dentistry and Oral Epidemiology'' Vol. 34, No. 4, pp 299-309, Aug 2006]</ref>
*A link in some, but not all studies between high levels of fluoride and bone weakening<ref name="sciam"/> and more recently with [[bone cancer]] ([[osteosarcoma]]) in boys.<ref name="sciam"/><ref>Age-Specific Fluoride Exposure in Drinking Water and Osteosarcoma. E. Bassin et al. ''Cancer Causes and Control'' Vol. 17, No. 4, pp 421-428, May 2006</ref><ref>Caution Needed in Fluoride and Osteosarcoma Study. C. Douglas, K. Joshipura ''Cancer Causes and Control'' Vol. 17, No. 4, pp 481-482, May 2006</ref> In a 2007 publication, the United States [[Centers for Disease Control and Prevention]] stated, ''"At this time, the weight of the scientific evidence, as assessed by independent committees of experts, comprehensive systematic reviews, and review of the findings of individual studies does not support an association between water fluoridated at levels optimal for oral health and the risk for cancer, including osteosarcoma."'' The document described the overall evidence on osteosarcoma to be "tentative and mixed", and indicated that further research is forthcoming. <ref name="CDCOsteo"/>
*A 2001 report by Dr. Roger Masters that linked elevated blood-lead levels with consumption of fluorosilicates (chemicals used in the fluoridation of drinking water).<ref>[http://www.dartmouth.edu/~rmasters/AHABS/]</ref><ref>[http://www.dartmouth.edu/~news/releases/2001/mar01/flouride.html]</ref>
*A lowering of IQ where drinking water fluoride levels were greater than 3 mg/L<ref>[http://www.fluoride-journal.com/00-33-2/332-74.pdf]</ref> which is within the limits of the standard set by the United States Environmental Protection Agency (EPA).<ref>[http://www.epa.gov/ogwdw/hfacts.html] EPA Ground Water & Drinking Water</ref>
*A disruption in endocrine function, especially in the thyroid.<ref>[http://www.reuters.com/article/pressRelease/idUS108377+02-Jan-2008+PRN20080102 'Second Thoughts about Fluoride,' Reports Scientific American | Reuters<!-- Bot generated title -->]</ref>
==Countries where fluoridation is practised==
{{Refimprove|section|date=August 2007}}
===Asia===
====Japan====
Less than 1% of Japan practices water fluoridation. <ref>[http://books.google.com/books?id=0YhymbzXAukC&pg=PA15&lpg=PA15&dq=fluoridation+austria&source=web&ots=w2lBQ5Erzx&sig=irvSUgBrc-F0OHiPwBmYLwTB-Ic&hl=en&sa=X&oi=book_result&resnum=10&ct=result#PPA16,M1]</ref><ref>[http://www.fluoridationcenter.org/papers/2001/antifluoride.html]</ref>
===Europe===
====Ireland====
In the [[Republic of Ireland]] the majority of drinking water is fluoridated. The fluoridation agent currently used in Ireland for addition to drinking water supplies is [[hydrofluorosilicic acid]] (HFSA; H<sub>2</sub>SiF<sub>6</sub>).<ref>[http://www.dohc.ie/publications/pdf/fluoridation_forum.pdf?direct=1 Report of the Forum on Fluoridation 2002] - [http://www.dohc.ie Dept of Health and Children] - Ireland</ref> The original legal basis for fluoridation of water in the Irish Republic until 2007 was the Fluoridation of Water Supplies Regulations, 1965. Those regulations set the level of fluoride in drinking water to between 0.8 to 1.0 ppm. Since 1<sup>st</sup> July 2007, the legal basis for the fluoridation of drinking water in Ireland is the Fluoridation of Water Supplies Regulations, 2007.<ref>[http://www.dentalgain.org/SI%2042%20of%202007.doc Statutory Instrument No. 42 of 2007] - Fluoridation of Water Supplies Regulations 2007</ref> These regulations set the level of fluoride in drinking water to between between 0.6 and 0.8 ppm, with a target value of 0.7 ppm.
====Spain====
Around 10% of the population receives fluoridated water.<ref>Mullen, Joe. [http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html "History of Water Fluoridation"], British Dental Journal, 2005, page accessed April 29, 2006.</ref><ref>[http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html] British Dental Journal (2005); 1-4. doi: 10.1038/sj.bdj.4812863Help History of Water Fluoridation by Dr Joe Mullen</ref>
====United Kingdom====
Around 10% of the population of the United Kingdom receives fluoridated water.<ref>Mullen, Joe. [http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html "History of Water Fluoridation"], British Dental Journal, 2005, page accessed April 29, 2006.</ref><ref>[http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html] British Dental Journal (2005); 1-4. doi: 10.1038/sj.bdj.4812863Help History of Water Fluoridation by Dr Joe Mullen</ref> The All Party Parliamentary Group on Primary Care and Public Health recommended in April 2003 that fluoridation be introduced "as a legitimate and effective means of tackling dental health inequalities", laws were created allowing but not requiring fluoridation of water. The following UK utilities companies fluoridate their water [[Anglian Water]] Services Ltd., [[Northumbrian Water]] Ltd., [[South Staffordshire Water]] plc, [[Severn Trent]] plc and [[United Utilities]] Water plc. Earlier schemes were undertaken in the Health Authority areas of [[Bedfordshire]] and [[Hertfordshire]], [[Birmingham]] and the [[Black Country]], [[Cheshire]] and [[Merseyside]], [[County Durham]] and [[Tees Valley]], [[Cumbria]] and [[Lancashire]], [[North Yorkshire|North]] and [[East Yorkshire]] and Northern [[Lincolnshire]], [[Northumberland]], [[Tyne and Wear]], [[Shropshire]] and [[Staffordshire]], Trent, and [[West Midlands (region)|West Midlands]] South whereby fluoridation was introduced progressively in the years between 1964 and 1988.<ref>[http://www.bma.org.uk/ap.nsf/Content/Water+fluoridation#Hansard British Medical Association]</ref>
===North America===
====Canada====
Approximately 40% of the Canadian population receives fluoridated water<ref>[http://www.hc-sc.gc.ca/iyh-vsv/environ/fluor_e.html "Fluorides and Human Health"], from the [http://www.hc-sc.gc.ca/index_e.html Health Canada] website, page accessed March 25, 2006.</ref>
Implementation of fluoridation usually lies with provincial or city governments. Brantford, Ontario became the first city in Canada to fluoridate its water supplies in 1945. In 1955, Toronto approved water fluoridation, but delayed implementation of the program until 1963 due to a campaign against fluoridation by broadcaster [[Gordon Sinclair]].<ref>[http://archives.cbc.ca/IDC-1-75-341-1816/science_technology/fluoride/clip4 "Gordon Sinclair's rant"], from the [http://archives.cbc.ca/index.asp?IDLan=1 Canadian Broadcasting Corporation Archives] website, page accessed March 27, 2006.</ref> The city continues to fluoridate its water today.<ref>[http://www.toronto.ca/water/supply/supply_facilities/rlclark/filtration_process.htm "Water supply - R. L. Clark Filtration Plant"], from [http://www.toronto.ca/index.htm Toronto's] website, page accessed March 27, 2006.</ref> There have been some recent decreases in the amount of fluoridation used, however, from 1 mg per litre to between 0.6 and 0.8 mg per litre. Historically, British Columbia has been the province with least percentage of its population receiving fluoridated water;<ref>[http://www.env.gov.bc.ca/wat/wq/BCguidelines/fluoride/fluoridetoo-03.html "Ambient Water Quality Criteria for Fluoride"], from the [http://www.env.gov.bc.ca/epdiv/ Environmental Protection Division] of British Columbia's Ministry of Environment website, page accessed March 27, 2006.</ref> Greater Vancouver Water District member municipalities within the [[Metro Vancouver]] region receive water supplies that do not have added [[fluoride]].<ref name="GVRDDrinkingwater">[http://www.gvrd.bc.ca/water/pdfs/DrinkingWaterFAQs.pdf Drinking Water FAQ]</ref>
On April 21, 2008, the town of Dryden, Ontario overwhelmingly rejected a water fluoridation proposal at the ballot box. <ref>[http://www.tbtv.com/NWNews-Story.aspx?cid=106869]</ref>
====United States====
As of May 2000, 42 of the 50 largest U.S. cities had water fluoridation.<ref>[http://www.cdc.gov/fluoridation/fact_sheets/benefits.htm The Benefits of Fluoride], from the [http://www.cdc.gov/ Centers for Disease Control and Prevention] website, accessed 19 March, 2006.</ref> According to a 2002 study,<ref>[http://www2.cdc.gov/nohss/FluoridationV.asp Fluoridation Status: Percentage of U.S. Population on Public Water Supply Systems Receiving Fluoridated Water], from the [http://www.cdc.gov Centers for Disease Control and Prevention] website, accessed 19 March, 2006.</ref> 67% of U.S. residents were living in communities with fluoridated water at that time.
The United States [[Centers for Disease Control]] proclaims, "Community water fluoridation is safe and effective in preventing tooth decay, and has been identified by CDC as one of 10 great public health achievements of the 20th century." <ref>[http://www.cdc.gov/fluoridation/]</ref>The CDC states that water fluoridation is safe at a level of (0.7 mg/L-1.2 mg/L). The CDC also advises avoiding water with fluoride concentrations of 2mg/L or higher for children up to age 8.<ref>http://www.cdc.gov/fluoridation/faqs.htm: Community Water Fluoridation :FAQ</ref> There is a CDC database for researching the water fluoridation status of neighborhood water.<ref>[http://apps.nccd.cdc.gov/MWF/index.asp Oral Health - My Water's Fluoride<!-- Bot generated title -->]</ref>
In 1998, 70% of people polled in a survey conducted by the [[American Dental Association]] (ADA) believed community water should be fluoridated, with 18% disagreeing and the rest undecided.<ref>American Dental Association Survey Center. 1998 consumers' opinions regarding community water fluoridation. Chicago, Illinois: American Dental Association, 1998</ref> In November of 2006, the [[American Dental Association|ADA]] began recommending to [[parents]] that [[infants]] from 0 through 12 months of age should have their [[formula]] prepared with water that is fluoride-free or contains low levels of fluoride to reduce the risk of fluorosis.<ref> What is the ADA’s interim guidance on infant formula and fluoride? American Dental Association Website accessed May 28, 2008 [http://www.ada.org/public/topics/fluoride/infantsformula_faq.asp#2]</ref>
The issue of whether or not to fluoridate water supplies frequently arises in local governments. For example, on November 8, 2005, citizens of [[Mt. Pleasant, Michigan]] voted 63% to 37% in favor of reinstating fluoridation in public drinking water after a 2004 ballot initiative ceased water fluoridation in the city.<ref>Crozier, Stacie. [http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=1684 "Michigan town votes to return fluoridation"] November 30, 2005.</ref> At the same time, voters in Xenia, Ohio; Springfield, Ohio; Bellingham, Washington; and Tooele City, Utah all rejected water fluoridation.<ref>[http://www.noforcedfluoride.org No Forced Fluoride in Bellingham, Washington (Fluoride)<!-- Bot generated title -->]</ref>
In [[Skagit County]], in [[Washington State]], the [[county commissioners]] have voted 2 to 1 to order the local public utility district to begin fluoridating the public water supply by Jan. 2009. $1.2 million could be provided by the privately funded Washington Dental Service Foundation to begin building the [[equipment]] needed to add fluoride chemicals to the Judy [[Resevoir]], which supplies the majority of Skagit Valley's water [[customers]]. The [[source]] and type of fluoride to be added to the drinking water of more than 70,000 [[citizens]] has not been disclosed.<ref>[http://www.goskagit.com/home/article/state_attorney_general_says_board_can_require_fluoridation/]</ref>
The cost of adding fluoridation chemicals to the water of 44 Florida communities has been researched by the State Health Office in Tallahassee.<ref name="RingelbergCost">Ringelberg, M. L., S. J. Allen, L. J. Brown. [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1564695&dopt=Citation "Cost of fluoridation: 44 Florida communities."], abstract from [http://www.pubmed.gov PubMed] website, page accessed 19 March, 2006.</ref> In communities with a population of over 50,000 people, fluoridation costs were estimated at 31 cents per person per year. The estimated cost rises to $2.12 per person in areas with a population below 10,000. Unintended consequences, such as equipment malfunction, can substantially raise the financial burden, as well as the health risks, to the consumer.<ref>Flanders, R. A.; Marques, L. (May-June 1993). "Fluoride overfeeds in public water supplies". Illinois dental journal 62 (3): 165-169.</ref><ref>^ Gessner, B. D.; Beller, M.; Middaugh, J. P.; Whitford, G. M. (January 1994). "Acute fluoride poisoning from a public water system". New England journal of medicine 330 (2): 95-99.</ref>
<ref>[http://www.ncbi.nlm.nih.gov/pubmed/12369244?dopt=Abstract]</ref>
<ref>[http://www.nofluoride.com/Dublin_overdose.htm]</ref>
<ref>[http://www.ncbi.nlm.nih.gov/pubmed/9323392?dopt=Abstract]</ref>
<ref>CHICAGO SUN-TIMES, July 31, 1993, Fluoride Blamed in 3 Deaths: Traces found in Blood of U. of C. Dialysis Patients Gary Wieby</ref><ref>EVENING CAPITAL (Annapolis, Maryland), November 29, 1979, Fluoride Linked to Death, Mary Ann Kryzankowicz</ref>
<ref>[http://www.fluoridealert.org/health/accidents/fluoridation.html]</ref>
=== Oceania ===
====Australia====
[[Australia]] has fluoridation in all but one state, [[Queensland]], in which water fluoridation is under local government control. However, on 5 December 2007 [[Queensland]] Premier [[Anna Bligh]] announced fluoridation of most of Queensland's water supply will begin in 2008.<ref>[http://www.abc.net.au/news/stories/2007/12/05/2110402.htm Qld to get fluoridated water - ABC News (Australian Broadcasting Corporation)<!-- Bot generated title -->]</ref> The city of [[Geelong]], west of [[Melbourne]], does not fluoridate its water supplies. This is despite the fact that all of Melbourne's water is fluoridated. The first town to fluoridate the water supply in Australia was [[Beaconsfield, Tasmania]] in [[1953 in Australia|1953]].<ref>{{cite book | editor = Editors: Graham Aplin, S.G. Foster and Michael McKernan | title = Australians:Events and Places | year = 1987 | publisher = Fairfax, Syme & Weldon Associates | location = Sydney, NSW, Australia | id = ISBN 0-521-34073-X | pages = page 366 | chapter = Tasmania}} </ref> Fluoridation commenced January 7th, 2008 in the City of [[Gosford, New South Wales|Gosford]], [[New South Wales]].<ref>[http://www.gosford.nsw.gov.au/water_and_sewer/fluoride Gosford City Council Water Information Centre] </ref>
====New Zealand====
[[New Zealand]] has fluoridated nearly all water-supplies except those in remote areas. The use of water fluoridation first began in New Zealand in Hastings in [[1954 in New Zealand|1954]]. A Commission of Inquiry was held in 1957 and then its use rapidly expanded in the mid 1960s.<ref>[http://www.moh.govt.nz/moh.nsf/0/AB32B58A8D61D9DACC256F47007C32BB New Zealand Ministry of Health]</ref>
===South America===
====Chile====
In [[Chile]] 70.5% of the population receive fluoridated water (10.1 million added by chemical means, 604,000 naturally occurring).<ref>Information from the Oral Health Department of the Chilean Ministry of Health. December 2004.</ref>
==Countries that do not fluoridate their water==
Water fluoridation is not practiced in [[Austria]], [[China]], the [[Czech Republic]], [[Iceland]], [[India]], [[Italy]], [[Belgium]], [[Bulgaria]], [[Denmark]], [[Finland]], [[France]], [[Germany]], [[Greece]], [[Hungary]], the [[Netherlands]], [[Northern Ireland]], [[Norway]], [[Scotland]], [[Sweden]], or [[Switzerland]]. <ref>[http://www.pr.com/press-release/9026]</ref><ref>[http://books.google.com/books?id=0YhymbzXAukC&pg=PA15&lpg=PA15&dq=fluoridation+austria&source=web&ots=w2lBQ5Erzx&sig=irvSUgBrc-F0OHiPwBmYLwTB-Ic&hl=en&sa=X&oi=book_result&resnum=10&ct=result#PPA16,M1]</ref><ref>[http://www.africanwater.org/randwater_fluoride.htm]</ref><ref>[http://www.newmediaexplorer.org/sepp/2003/11/14/irish_ask_eu_to_help_rid_drinking_water_of_toxic_fluoride.htm]</ref><ref>[http://www.elc.org.uk/pages/campaigns.htm]</ref><ref>[http://www.actionpa.org/fluoride/countries.pdf]</ref><ref>[http://www.fluoridationcenter.org/papers/2001/antifluoride.htm]l</ref><ref>[http://waterindustry.org/Water-Facts/fluoride-8.htm]</ref><ref>[http://news.bbc.co.uk/1/low/scotland/4022833.stm BBC - Fluoride plan goes down the drain]</ref><ref>Statment of C.J. Grimes, Department for Regional Development, Belfast, November 6, 2000. Letter available here: [http://www.fluoridealert.org/Northern-Ireland.jpeg]</ref>
[[South Africa]]'s Health Department recommends adding fluoridation chemicals to drinking water in some areas. It also advises removal of fluoride from drinking water (defluoridation) where the fluoride content is too high.<ref>[http://www.doh.gov.za/department/fluoridation.html "Water Fluoridation - The Facts"], from South Africa's [http://www.doh.gov.za/department/ Department of Health] website, page accessed April 29, 2006.</ref>
In [[China]], water fluoridation began in 1964 in Guangzhou, and ceased in 1983.<ref>[http://www.fluoride-journal.com/02-35-1/351-01.pdf]</ref> The Chinese government considers any water supply containing over 1 [[Parts-per notation|ppm]] fluoride a risk for [[skeletal fluorosis]].<ref>Bo Z, et al. (2003). Distribution and risk assessment of fluoride in drinking water in the West Plain
region of Jilin Province, China. Environmental Geochemistry and Health 25: 421-431.</ref>
The water supply in [[Northern Ireland]] has never been artificially fluoridated except in two small localities where fluoride was added to the water for about 30 years. By 1999, fluoridation ceased in those two areas, as well.
<ref>Statment of C.J. Grimes, Department for Regional Development, Belfast, November 6, 2000. Letter available here: [http://www.fluoridealert.org/Northern-Ireland.jpeg]</ref> Scotland's parliament rejected proposals to fluoridate public drinking water following a public consultation. Instead relying on other methods to improve dental health of children<ref>[http://news.bbc.co.uk/1/low/scotland/4022833.stm BBC - Fluoride plan goes down the drain]</ref>.
In 1952, [[Norrköping]] in [[Sweden]] became one of the first cities in Europe to fluoridate its water supply.<ref>{{cite book
| last = Larsson
| first = Gerhard
| coauthors = Bengt Bengtsson, Eva Hjelmström, Ove Karlsson, Maj-Inger Klingvall, Knut Wachtmeister, Karin Östergren
| title = Fluor i kariesförebyggande syfte - Betänkande av fluorberedningen
| publisher = Statens offentliga utredningar / Socialdepartementet
| year = 1981
| month = May
| language = Swedish
| location = Stockholm
| pages = 12
| id = SOU 1981:32
| quote = }}</ref> It was declared illegal by the Swedish [[Supreme Administrative Court]] in 1961, re-legalized in 1962<ref>{{cite news | title = Fluoreringsfrågan avgjord | work = Västmanlands läns tidning | language = Swedish | date=1962-11-22 }}</ref> and finally prohibited by the parliament in 1971,<ref>{{cite news | title = Stopp för fluor | work = Västmanlands läns tidning | pages = 1 | language = Swedish | date = 1971-11-19}}</ref> after considerable debate. The parliament majority said that there were other and better ways of reducing tooth decay than water fluoridation. Four cities received permission to fluoridate tap water when it was legal.<ref>{{cite book
| last = Larsson
| first = Gerhard
| coauthors = Bengt Bengtsson, Eva Hjelmström, Ove Karlsson, Maj-Inger Klingvall, Knut Wachtmeister, Karin Östergren
| title = Fluor i kariesförebyggande syfte - Betänkande av fluorberedningen
| publisher = Statens offentliga utredningar / Socialdepartementet
| year = 1981
| month = May
| language = Swedish
| location = Stockholm
| pages = 56-57
| id = SOU 1981:32
| quote = }}</ref> An official commission was formed, which published its final report in 1981. They recommended other ways of reducing tooth decay (improving food and oral hygiene habits) instead of fluoridating tap water. They also found that many people found fluoridation to impinge upon personal liberty/freedom of choice, and that the long-term effects of fluoridation were not sufficiently known. They also lacked a good study on the effects of fluoridation on formula-fed infants.<ref>{{cite book
| last = Larsson
| first = Gerhard
| coauthors = Bengt Bengtsson, Eva Hjelmström, Ove Karlsson, Maj-Inger Klingvall, Knut Wachtmeister, Karin Östergren
| title = Fluor i kariesförebyggande syfte - Betänkande av fluorberedningen
| publisher = Statens offentliga utredningar / Socialdepartementet
| year = 1981
| month = May
| location = Stockholm
| pages = 29
| id = SOU 1981:32
| quote = }}</ref>
In [[Switzerland]] since 1962 two fluoridation programmes had operated in tandem: water fluoridation in the City of Basel, and salt fluoridation in the rest of Switzerland (around 83% of domestic salt sold had fluoride added). However it became increasingly difficult to keep the two programmes separate. As a result some of the population of Basel were assumed to use both fluoridated salt and fluoridated water. In order to correct that situation, in April 2003 the State Parliament agreed to cease water fluoridation and officially expand salt fluoridation to Basel.<ref>J. MEYER and P. Wiehl in Schweiz Monatsschr. Zahnmed 2003; 113: 702 (in French) and 728-729 (in German)</ref>
Water fluoridation is not practiced in India.<ref>[http://books.google.com/books?id=0YhymbzXAukC&pg=PA15&lpg=PA15&dq=fluoridation+austria&source=web&ots=w2lBQ5Erzx&sig=irvSUgBrc-F0OHiPwBmYLwTB-Ic&hl=en&sa=X&oi=book_result&resnum=10&ct=result#PPA16,M1]</ref><ref>[http://www.windsofchange.eu.com/fluoride03.html]</ref> [[Fluorosis]] is endemic in at least 20 states, including [[Uttaranchal]], [[Jharkhand]] and [[Chhattisgarh]].<ref>[http://www.laleva.org/eng/2004/06/fluoridation_and_fluorosis_disaster_india_fluoride_in_water_takes_its_toll_in_assam.html]</ref> The maximum permissible limit of fluoride in drinking water in [[India]] is 1.2mg/L.<ref>[http://www.who.int/water_sanitation_health/naturalhazards/en/index2.html]</ref>
==Malfunctions in water fluoridation equipment==
At least 17 incidences of fluoridation equipment malfunction, and their associated deaths and poisonings, have been documented in U.S. newspapers and [[medical journals]]. <ref>Flanders, R. A.; Marques, L. (May-June 1993). "Fluoride overfeeds in public water supplies". Illinois dental journal 62 (3): 165-169.</ref><ref>^ Gessner, B. D.; Beller, M.; Middaugh, J. P.; Whitford, G. M. (January 1994). "Acute fluoride poisoning from a public water system". New England journal of medicine 330 (2): 95-99.</ref>
<ref>[http://www.ncbi.nlm.nih.gov/pubmed/12369244?dopt=Abstract]</ref>
<ref>[http://www.ncbi.nlm.nih.gov/pubmed/9323392?dopt=Abstract]</ref>
<ref>CHICAGO SUN-TIMES, July 31, 1993, Fluoride Blamed in 3 Deaths: Traces found in Blood of U. of C. Dialysis Patients Gary Wieby</ref><ref>EVENING CAPITAL (Annapolis, Maryland), November 29, 1979, Fluoride Linked to Death, Mary Ann Kryzankowicz</ref>
<ref> Compendium of accidents available here: [http://www.fluoridealert.org/health/accidents/fluoridation.html]</ref>
Perhaps the worst incident in the United States occurred in [[Hooper Bay, Alaska]] in 1992. When fluoridation equipment failed, a large amount of fluoride was released into the drinking water supply and 296 people were poisoned; 1 person died,<ref>{{cite journal
| last = Flanders
| first = R. A.
| authorlink =
| coauthors = Marques, L.
| title = Fluoride overfeeds in public water supplies
| journal = Illinois dental journal
| volume = 62
| issue = 3
| pages = 165–169
| date = May-June 1993
| url = [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8259189}}]</ref> marking the first reported death due to fluoride toxicity caused by drinking water from a community water system.<ref>{{cite journal
| last = Gessner
| first = B. D.
| authorlink =
| coauthors = Beller, M.; Middaugh, J. P.; Whitford, G. M.
| title = Acute fluoride poisoning from a public water system
| journal = New England journal of medicine
| volume = 330
| issue = 2
| pages = 95–99
| date = January 1994
| url = [http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8244437&dopt=Abstract
| doi = 10.1056/NEJM199401133300203
| pmid = 8259189}}] </ref>
3 [[dialysis]] patients died and 6 were sickened at the [[University of Chicago Hospitals]] when the water filtration system failed on July 16, 1993. A hospital spokesperson said that the deaths and reactions “were consistent with fluoride exposure.”<ref>CHICAGO SUN-TIMES, July 31, 1993, Fluoride Blamed in 3 Deaths: Traces found in Blood of U. of C. Dialysis Patients Gary Wieby</ref>
Schoolchildren in [[Portage, Michigan]] experienced vomiting and stomach pains when an electrical surge caused excessive amounts of fluoridation chemical to be injected into the school’s well in July 1991.
<ref>[http://www.ncbi.nlm.nih.gov/pubmed/12369244?dopt=Abstract]</ref>
In June, 2002, 23 employees of Humphry Systems Inc. in [[Dublin, California]] became ill after a fluoride pump malfunctioned near the business. All of the affected workers had drank from the water fountains, and experienced vomiting and nausea. <ref>Contra Costa Times, 2000. Story available here: [http://www.nofluoride.com/Dublin_overdose.htm]</ref>
34 restaurant diners became sick after a fluoridation equipment malfunction caused an acute outbreak of fluoride poisoning in August 1993, in [[Poplarville, Mississippi]]. Severe [[gastrointestinal]] illness was reported by 34 out of 62 customers in a 24 hour period. <ref>[http://www.ncbi.nlm.nih.gov/pubmed/9323392?dopt=Abstract Outbreak of acute fluoride poisoning caused by a fluoride overfeed, Mississippi, 1993. Penman AD, Brackin BT, Embrey R. Office of Community Health Services, Mississippi State Health Dept. Public Health Report 1997 Sep-Oct;112(5):403-9]</ref>
A [[dialysis]] patient died from fluoride overdose in [[Annapolis, Maryland]] when 1,000 gallons of excess fluoride chemical spilled into the drinking water on November 11, 1979. 7 others became critically ill. [[Brain damage]], a [[heart attack]] and many other illnesses resulted.<ref>EVENING CAPITAL (Annapolis, Maryland), November 29, 1979, Fluoride Linked to Death, Mary Ann Kryzankowicz</ref>
==Alternative methods of fluoridation==
===Milk===
Fluoridation of milk is being practiced in some parts of [[Bulgaria]], [[Chile]], [[Peru]], the [[Russian Federation]], [[Thailand]] and the [[United Kingdom]]. A pilot fluoridated milk program was in effect in the Haidian district of [[Beijing]], [[China]] from 1994 through 1999.<ref>Fluoride History, Borrow Foundation [http://www.fluoride-history.de/borrow.htm]</ref><ref>Borrow Foundation History [http://www.borrowfoundation.com/html/background.asp Borrow Foundation Background]</ref>
===Salt===
Salt was first fluoridated in Switzerland in 1955 followed by France in 1986 and shortly after by Jamaica and Costa Rica. Costa Rica, Jamaica and Columbia today practice universal salt fluoridation, whereby all salt bound for human consumption is fluoridated, this includes salt that is added to ready prepared food, and where no fluoride free salt is available.<ref>Fluoridated Salt Facts [http://poisonfluoride.com/pfpc/html/salt_facts.html#1]</ref>
===Bottled water===
Some dental professionals are concerned that the growing use of bottled water may decrease the amount of fluoride exposure people will receive.<ref>Smith, Michael. [http://www.medpagetoday.com/PrimaryCare/DentalHealth/tb/1756 "Bottled Water Cited as Contributing to Cavity Comeback"], from the [http://www.medpagetoday.com/ MedPage Today] website, page accessed 29 April, 2006.</ref> Some bottlers such as [[Danone]] have begun adding fluoride to their water.<ref>[http://www.waterindustry.org/Water-Facts/fluoride-13.htm Press release] from the Water Industry News website]</ref> On April 17, 2007, [http://www.medicalnewstoday.com/articles/68093.php Medical News Today ] stated, "''There is no correlation between the increased consumption of bottled water and an increase in cavities.''"<ref>[http://www.medicalnewstoday.com/articles/68093.php]</ref>
In October 2006, the [[United States Food and Drug Administration]] issued a [[health claim]] notification permitting water bottlers to claim that fluoridated [[bottled water]] can promote [[Mouth|oral]] [[health]]. The claims are not allowed to be made on bottled water [[marketed]] to [[infants]].<ref> Why was the interim guidance on infant formula and fluoride issued? American Dental Association Website accessed May 28, 2008 [http://www.ada.org/public/topics/fluoride/infantsformula_faq.asp#3]</ref>
==See also==
*[[Fluoride]]
*[[Fluoride therapy]]
*[[Fluorine deficiency]]
*[[hexafluorosilicic acid]]
*[[Water fluoridation opposition]]
==References==
{{reflist|2}}
==External links==
*[http://www.york.ac.uk/inst/crd/pdf/summary.pdf] York Review Executive Summary, Water Fluoridation
*[http://apps.nccd.cdc.gov/MWF/index.asp CDC] database for the fluoridation status of neighborhood water
*[http://www.ada.org/public/media/presskits/fluoridation/epa_flouoridation_letter_on_thesis.pdf Letter on fluoridation from EPA] (PDF) supporting fluoridation hosted by ADA
*[http://fluoridealert.org/carlsson-interview.html Fluoride Action Network Interview of Nobel Laureate (2000, Medicine/Physiology) Arvid Carlsson]
*[http://www.nature.com/bdj/journal/v199/n7s/full/4812863a.html History of Water Fluoridation]
*[http://archives.cbc.ca/IDC-1-75-341-1829/science_technology/fluoride/clip5 1970s discussion on fluoridation]
*[http://www.inchem.org/documents/ehc/ehc/ehc36.htm World Health Organization report on fluorine and fluorides (1984)]
*[http://earthisland.org/eijournal/fluoride/fluoride_index.html Articles focusing on the potential risks and benefits of water fluoridation]
*[http://www.inchem.org/documents/ehc/ehc/ehc227.htm "Environmental Health Criteria for Fluorides," World Health Organization (2002)]
*[http://www.fluorideinformation.com Fluoride Information - UK National Fluoride Information Centre] - Joint venture between The University of Manchester and the UK Department Of Health. Content includes coverage of the York review (see above)
*[http://www.sptimes.com/2007/06/04/Tampabay/Fluoride__a_longtime_.shtml Article on use of fluoridated drinking water in baby formula]
*[http://www.slweb.org/bibliography.html A bibliography critical of fluoride]
[[Category:Dentistry]]
[[Category:Fluorine]]
[[Category:Water treatment|Fluoridation]]
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[[ja:水道水フッ化物添加]]
[[pt:Fluoretação]]