Water fluoridation opposition
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'''Water fluoridation opposition''' refers to activism against the [[water fluoridation|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>[http://www.cdc.gov/oralhealth/waterfluoridation/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>
==Ethics==
Many people consider water fluoridation to be compulsory mass [[medication]], because it does not allow proper [[consent]] of the individual being treated.<ref>[http://www.fluoridedebate.com/question34.html The Fluoride Debate: Question 34], [http://www.fluoridedebate.com Fluoride Debate] website, accessed 23 February, 2006.</ref> The water supplier cannot control the patient's [[dose]] of fluoride, nor can the [[municipality]] monitor the response of each [[recipient]].<ref>[http://www.fluoridealert.org/absurdity.htm]</ref> It is also argued that, because of the negative health effects of fluoride exposure, [[mandatory]] fluoridation of public water supplies is a [[breach]] of [[ethics]] and a [[human rights]] violation.<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> [[Litigation]], both pro and con, has been a frequent outcome of public water fluoridation. In the [[United Kingdom]] the [[Green Party of England and Wales|Green Party]] refers to fluoride as a poison.<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> They say water fluoridation violates Article 35 of the [[European Charter of Fundamental Rights]], and the UK poisons act of 1972 which bans fluorosilicates (chemicals used in the [[fluoridation]] of [[water]] such as [[hexafluorosilicic acid]]). Because they believe that fluoride is a [[poison]] they say it also violates Articles 3 and 8 of the [[Human Rights Act]], and also Articles 3 and 8 of the Convention because governments are forbidden from harming their [[citizens]]. Such an act also raise issues under the [[United Nations Convention on the Rights of the Child]]. Water fluoridation has also been criticized for violating the [[Nuremberg Code]] and the Council of Europe's Biomedical Convention of 1999.
<ref>[http://www.ncbi.nlm.nih.gov/pubmed/12749628?dopt=Abstract]</ref>
==Health risks==
While the available data is sometimes contradictory, water fluoridation has been linked to:
*A weakening of [[bones]], leading to an increase in hip and wrist fracture.<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>
*[[Liver]] damage, impaired [[kidney]] function, and [[fluorosis]] in children.<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>
*[[Cancer]].<ref>[http://emporium.turnpike.net/P/PDHA/fluoride/adverse.htm Adverse Health Effects of Fluoride<!-- Bot generated title -->]</ref> Available [[data]] is conflicting, but [[osteosarcoma]] (a rare bone cancer) has been shown to be associated with fluoride exposure, including fluoridated water, in humans and animals.<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>
*Increased uptake of [[lead]].<ref>[http://www.dartmouth.edu/~rmasters/AHABS/]</ref><ref>[http://www.dartmouth.edu/~news/releases/2001/mar01/flouride.html]</ref>
*[[Chromosomal]] damage and interference with [[DNA]] repair.<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>[http://www.cdc.gov/oralhealth/waterfluoridation/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>
*A lowering of IQ.<ref>National Research Council. [http://books.nap.edu/openbook.php?record_id=11571&page=205 Neurotoxicity and Neurobehavioral effects'] Fluoride in Drinking Water: A Scientific Review of EPA's Standards (2006). Page accessed 23 February, 2007.</ref>
* Inhibition of [[melatonin]] production and promotion of precocious [[puberty]] in animal studies.<ref>[http://fluoridealert.org/health/pineal/luke-1997.html The Effect of Fluoride on the Physiology of the Pineal Gland<!-- Bot generated title -->]</ref> Fluoride may have an analogous inhibitory effect on human melatonin production, as fluoride accumulates readily in the human [[pineal gland]], the brain organ responsible for melatonin [[synthesis]].<ref>[http://www.icnr.com/jluke/fluoridedeposition.html Fluoride Deposition in the Aged Human Pineal Gland<!-- Bot generated title -->]</ref>
*A weakened [[immune system]], leaving people vulnerable to the development of [[cancer]] and [[AIDS]].<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>
*Damage to the male [[reproductive system]] in various [[species]].<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>
*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>
==Fluorosis==
[[Image:Fluorosis-severe.jpg|right|150px|thumb|Discoloration of teeth as seen in dental fluorosis caused by excessive fluoride.]]
[[Dental fluorosis]] is an [[adverse]] health condition that is caused by an [[overdose]] of fluoride. In its severe form it is characterized by black and brown stains, as well as 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>
<ref>[http://www.aapd.org/publications/brochures/fluorosis.asp Enamel Fluorosis], from the [http://www.aapd.org American Academy of Pediatric Dentistry] website, page accessed 18 March, 2006.</ref> Government agencies, such as the Center for Disease Control and Prevention, keep records on the [[prevalence]] of fluorosis in the general public.<ref>[http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5403a1.htm#tab23 Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism, and Enamel Fluorosis --- United States, 1988--1994 and 1999--2002], from the [http://www.cdc.gov CDC] website, page accessed 18 March, 2006.</ref> In November of 2006, the [[American Dental Association]] 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> [[Skeletal fluorosis]] is a crippling disease in which fluoride deposits into [[bone]], causing [[joint]] stiffness, joint pain, and sometimes changes in bone shape.<ref>[https://www.who.int/water_sanitation_health/diseases/fluorosis/en/ Water-related diseases: Fluorosis], from the [https://www.who.int/en/ World Health Organization] website, page accessed 18 March, 2006.</ref> A mild form of skeletal fluorosis, [[osteosclerosis]], is seen when levels of fluoride reach 5 parts per million (ppm) and the time of exposure lasts for 10 years.<ref name="adafluoridationfacts">[http://www.ada.org/public/topics/fluoride/facts/fluoridation_facts.pdf Fluoridation Facts] (in pdf format), from the [http://www.ada.org ADA] website, page accessed 18 March, 2006.</ref>
The [[World Health Organization]] cautions that fluoride levels above 1.5 milligrams per liter leaves the risk for fluorosis.
<ref>[http://www.who.int/water_sanitation_health/naturalhazards/en/index2.html Fluoride], from the [http://www.who.int/en/ Agency for World Health Organization] website, page accessed 18 March, 2006.</ref>
To protect against these and other diseases, health organizations in some high fluoride areas endorse providing alternative water sources, or removing fluoride from the water. .<ref>[http://www.who.int/water_sanitation_health/oralhealth/en/index3.html "World Water Day 2001: Oral health"], [http://www.who.int World Health Organization] website, page 4, page accessed March 4, 2006.</ref>
==Concentration of fluoride==
In 1986 the [[United States Environmental Protection Agency]] (EPA) established a [[maximum contaminant level]] (MCL) for fluoride at a concentration of 4 milligrams per litre (mg/L). In 2006 the [[National Research Council]] (NRC) concluded that the current MCL of 4 mg/L should be lowered. The EPA has yet to act on the NRC's recommendation.
<ref>[http://www.cdc.gov/fluoridation/faqs.htm EPA: Community Water Fluoridation, FAQ]</ref><ref>[http://www.epa.gov/safewater/standard/setting.html EPA: Setting Standards for Safe Drinking Water]</ref><ref>[http://www.fluoridealert.org/health/epa/dental-fluorosis.html]</ref>
==Efficacy of water fluoridation==
The largest study of water fluoridation's efficacy, conducted by the National Institute of Dental Research, showed no statistically significant difference in [[tooth decay]] rates among children in fluoridated and non-fluoridated communities.<ref>[http://www.icnr.com/NIDRStudy.html NIDR Study on Fluoridation<!-- Bot generated title -->]</ref>
A review of the evidence from the [[University of York]], published in 2000, examined 30 studies.<ref> York Review, Executive Summary [http://www.york.ac.uk/inst/crd/pdf/summary.pdf]</ref> The researchers concluded that the quality of evidence in most studies was poor, also expressing concern over the "continuing misinterpretations of the [[evidence]]." <ref>[http://news.bbc.co.uk/2/hi/health/7226655.stm Should fluoride be forced upon us?], from the [[BBC]]. Published [[February 5]] [[2008]]; accessed Feb 5, 2008.</ref> Many medical [[authorities]] argue that the effects of fluoridation on teeth are [[topical]] (brushed on) rather than [[systemic]](swallowed). <ref>[http://www.fluoridealert.org/health/teeth/caries/topical-systemic.html]</ref><ref>Cheng KK, et al. (2007). Adding fluoride to water supplies. British Medical Journal 335(7622):699-702.</ref><ref>Pizzo G, Piscopo MR, Pizzo I, Giuliana G. (2007). Community water fluoridation and caries prevention: a critical review. Clinical Oral Investigations 11(3):189-93.</ref><ref>National Research Council. (2006). Fluoride in Drinking Water: A Scientific Review of EPA's Standards. National Academies Press, Washington D.C. p 13.</ref><ref>European Commission. (2005). The Safety of Fluorine Compounds in Oral Hygiene Products for Children Under the Age of 6 Years. European Commission, Health & Consumer Protection Directorate-General, Scientific Committee on Consumer Products, September 20.</ref><ref>Hellwig E, Lennon AM. (2004). Systemic versus topical fluoride. Caries Research 38: 258-62.</ref><ref>Fejerskov O. (2004). Changing paradigms in concepts on dental caries: consequences for oral health care. Caries Research 38: 182-91.</ref><ref>Warren JJ, Levy SM. (2003). Current and future role of fluoride in nutrition. Dental Clinics of North America 47: 225-43.</ref><ref>Brothwell D, Limeback H. (2003). Breastfeeding is protective against dental fluorosis in a nonfluoridated rural area of Ontario, Canada. Journal of Human Lactation 19: 386-90.</ref><ref>Zimmer S, et al. (2003). Recommendations for the Use of Fluoride in Caries Prevention. Oral Health & Preventive Dentistry 1: 45-51.</ref><ref>Aoba T, Fejerskov O. (2002). Critical Review of Oral Biology and Medicine 13: 155-70.</ref><ref>Centers for Disease Control and Prevention. (2001). Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. Morbidity and Mortality Weekly Report 50(RR14): 1-42.</ref><ref>Centers for Disease Control and Prevention. (2001). Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States. Morbidity and Mortality Weekly Report 50(RR14): 1-42.</ref><ref>Featherstone, JDB. (2000). The Science and Practice of Caries Prevention. Journal of the American Dental Association 131: 887-899.</ref><ref>Formon, SJ; Ekstrand, J; Ziegler, E. (2000). Fluoride Intake and Prevalence of Dental Fluorosis: Trends in Fluoride Intake with Special Attention to Infants. Journal of Public Health Dentistry 60: 131-9.</ref><ref>Adair SM. (1999). Overview of the history and current status of fluoride supplementation schedules. Journal of Public Health Dentistry 1999 59:252-8.</ref><ref>Burt BA. (1999). The case for eliminating the use of dietary fluoride supplements for young children. Journal of Public Health Dentistry 59: 260-274.</ref><ref>Featherstone JDB. (1999) Prevention and Reversal of Dental Caries: Role of Low Level Fluoride. Community Dentistry & Oral Epidemiology 27: 31-40.</ref><ref>Centers for Disease Control and Prevention. (1999). Achievements in Public Health, 1900-1999: Fluoridation of Drinking Water to Prevent Dental Caries. Morbidity and Mortality Weekly Report 48: 933-940.</ref><ref>Limeback, H. (1999). A re-examination of the pre-eruptive and post-eruptive mechanism of the anti-caries effects of fluoride: is there any caries benefit from swallowing fluoride? Community Dentistry and Oral Epidemiology 27: 62-71.</ref><ref>Locker D. (1999). Benefits and Risks of Water Fluoridation. An Update of the 1996 Federal-Provincial Sub-committee Report. Prepared for Ontario Ministry of Health and Long Term Care.</ref><ref>Diesendorf, M. et al. (1997). New Evidence on Fluoridation. Australian and New Zealand Journal of Public Health 21 : 187-190.</ref><ref>Ekstrand J, et al. (1994). Fluoride pharmacokinetics in infancy. Pediatric Research 35:157–163.</ref><ref>Zero DT, et al. (1992). Fluoride concentrations in plaque, whole saliva, and ductal saliva after application of home-use topical fluorides. Journal of Dental Research 71:1768-1775.</ref><ref>Leverett DH. (1991). Appropriate uses of systemic fluoride: considerations for the '90s. Journal of Public Health Dentistry 51: 42-7.</ref><ref>Wefel JS. (1990). Effects of fluoride on caries development and progression using intra-oral models. Journal of Dental Research 69(Spec No):626-33;</ref><ref>Carlos JP. (1983) Comments on Fluoride. Journal of Pedodontics Winter. 135-136.</ref><ref>Fejerskov O, Thylstrup A, Larsen MJ. (1981). Rational Use of Fluorides in Caries Prevention: A Concept based on Possible Cariostatic Mechanisms. Acta Odontologica Scandinavica 39: 241-249.</ref>
In 2005, eleven environmental protection agency [[EPA]] employee unions, representing over 7000 environmental and public health professionals of the Civil Service, called for a halt on drinking water fluoridation programs across the USA and asked EPA management to recognize fluoride as posing a serious risk of causing [[cancer]] in people. The unions acted on an apparent cover-up of evidence from [[Harvard]] School of Dental Medicine linking fluoridation with an elevated risk of [[osteosarcoma]] in boys, a rare but fatal bone cancer.<ref>The Washington Post: "Professor at Harvard Is Being Investigated" [http://www.washingtonpost.com/wp-dyn/content/article/2005/07/12/AR2005071201277.html]</ref> <ref>[http://nteu280.org/Issues/Fluoride/fluoridesummary.htm]</ref>
In addition, over 1,730 health industry professionals, including doctors, dentists, scientists and researchers from a variety of disciplines are calling for an end to water fluoridation in an online petition to Congress. <ref>[http://www.fluoridealert.org/statement.august.2007html]</ref>
Their petition highlights eight recent events that they say mandates a moratorium on water fluoridation, including a 500-page review of fluoride’s toxicology that was published in 2006 by a distinguished panel appointed by the [[United States National Research Council|National Research Council]] of the [[National Academies]]. <ref>[http://www.nap.edu/catalog.php?record_id=11571]</ref> While the NRC report did not specifically examine artificially fluoridated water, it concluded that the [[United States|U.S.]] [[United States Environmental Protection Agency|Environmental Protection Agency's]] safe drinking water standard of 4 parts per million (ppm) for fluoride is unsafe and should be lowered. Despite over 60 years of water fluoridation in the U.S, there are no double-blind studies which prove fluoride's effectiveness in tooth decay. The panel reviewed a large body of literature in which fluoride has a statistically significant association with a wide range of adverse effects.<ref>[http://www.nap.edu/catalog.php?record_id=11571 Fluoride in Drinking Water: A Scientific Review of EPA's Standards<!-- Bot generated title -->]</ref>
The petition signers express concern for [[vulnerable]] groups like "small [[children]], above average water drinkers, [[diabetics]], and people with poor [[kidney]] function," considering that many members of these sub-populations may already be [[overdosing]] on fluoride.<ref>[http://www.fluoridealert.org/statement.august.2007html]</ref>
Another concern that the petition signers share is, "The admission by federal agencies, in response to questions from a Congressional subcommittee in 1999-2000, that the industrial grade waste products used to fluoridate over 90% of America's drinking water supplies (fluorosilicate compounds) have never been subjected to [[toxicological]] testing nor received FDA approval for human ingestion."<ref>[http://www.fluoridealert.org/statement.august.2007html]</ref>
A separate petition that calls on the United States congress to halt the practice of fluoridation has received over 12,300 signatures.<ref>[http://www.fluoridealert.org/]</ref>
In the book, "The Fluoride Deception," author Christopher Bryson claims that "industrial interests, concerned about [[liabilities]] from fluoride [[pollution]] and health effects on workers, played a significant role in the early [[promotion]] of fluoridation."<ref>[http://books.google.com/books?id=q3v_JgjZ6fsC&dq=fluoride+deception+bryson&pg=PP1&ots=N33qiJvkHS&sig=SGTf9EUQV84S8SisMQXmaqlkb8M&hl=en&prev=http://www.google.com/search%3Fq%3Dfluoride%2Bdeception%2Bbryson%26ie%3Dutf-8%26oe%3Dutf-8%26rls%3Dorg.mozilla:en-US:official%26client%3Dfirefox-a&sa=X&oi=print&ct=title&cad=one-book-with-thumbnail]</ref>
Several prominent dental researchers and government advisors who were leaders of the pro-fluoridation movement have announced reversals of their former positions after they concluded that water fluoridation is not an effective means of reducing dental caries and that it poses serious risks to human health. The late Dr. John Colquhoun was Principal Dental Officer of [[Auckland]], [[New Zealand]]. In an article titled, ''"Why I changed my mind about water fluoridation''", he published his reasons for changing sides. <ref>[http://www.fluoride-journal.com/98-31-2/312103.htm]</ref> <ref>[http://www.fluoride-journal.com/98-31-2/312103.htm ''Why I changed my mind about water fluoridation.'' Colquhoun, J. Perspectives in Biology and Medicine 41 1-16 (1997)]</ref>
Dr. Hardy Limeback, BSc, PhD, [[Doctor of Dental Surgery|DDS]] was one of the 12 scientists who served on the [[United States National Academy of Sciences|National Academy of Sciences]] panel that issued the aforementioned report, ''Fluoride in Drinking Water: A Scientific Review of the EPA's Standards.'' Dr. Limeback is an associate professor of dentistry and head of the preventive dentistry program at the [[University of Toronto]].<ref>[http://www.fluoridealert.org/limeback.htmLetter. Limeback, H. April 2000. Faculty of Dentistry, University of Toronto]</ref> He detailed his concerns in an April 2000 letter titled, ''"Why I am now officially opposed to adding fluoride to drinking water"''. <ref>[http://www.fluoridealert.org/limeback.htm]</ref>
In a presentation to the [[California]] Assembly Committee of Environmental Safety and Toxic Materials, Dr. Richard Foulkes, B.A., M.D., former special consultant to the Minister of Health of [[British Columbia]], revealed:
<blockquote>The [water fluoridation] studies that were presented to me were selected and showed only positive results. Studies that were in existence at that time that did not fit the concept that they were "selling," were either omitted or declared to be "bad science." The endorsements had been won by coercion and the self-interest of professional elites. Some of the basic "facts" presented to me were, I found out later, of dubious validity. We are brought up to respect these persons in whom we have placed our trust to safeguard the public interest. It is difficult for each of us to accept that these may be misplaced.<ref>[http://www.sonic.net/kryptox/politics/lead20s.htm]</ref></blockquote>
In January 2008 ''Scientific American'' posted significant concerns about the use of fluoride.<ref>[{{cite web|url=http://www.sciam.com/article.cfm?id=second-thoughts-on-fluoride
|title=Second Thoughts on Fluoride|publisher=Scientific American|accessdate=2008-01-24|last=|first=}}] Exerpts available here: [http://www.fluoridealert.org/sc.am.jan.2008.html]</ref>
On April 15, 2008, the United States [[National Kidney Foundation]] (NKF) updated their position on fluoridation for the first time since 1981.<ref>[{{cite web|url=http://www.organicconsumers.org/articles/article_12710.cfm|title=Kidney Patients Should be Notified of Potential Risk from Fluorides and Fluoridated Drinking Water|publisher=Organic Consumers Association|date=2008-06-03|accessdate=2008-06-16}}]</ref><ref>[http://www.kidney.org/atoz/pdf/Fluoride_Intake_in_CKD.pdf National Kidney Foundation. Fluoride Intake in Chronic Kidney Disease. April 15, 2008.]</ref> Formerly a supporter of water fluoridation, the NKF now takes a neutral position on the practice.
==The precautionary principle==
In an analysis published in the March 2006 issue of the ''Journal of Evidence Based Dental Practice,'' the authors examine the water fluoridation controversy in the context of the [[precautionary principle]]. The authors note that:
* There are other ways of delivering fluoride besides the water supply;
* Fluoride does not need to be swallowed to prevent tooth decay;
* Tooth decay has dropped at the same rate in countries with, and without, water fluoridation;
* People are now receiving fluoride from many other sources besides the water supply;
* Studies indicate fluoride’s potential to cause a wide range of adverse, systemic effects;
* Since fluoridation affects so many people, “one might accept a lower level of proof before taking preventive actions.” <ref>Tickner J, Coffin M. (2006). ''What does the precautionary principle mean for evidence-based dentistry?'' Journal of Evidence Based Dental Practice, Issue 6, pages 6-15.</ref>
==Use throughout the world==
{{main|Water fluoridation#International status}}
Water fluoridation is used in the [[United States]], [[United Kingdom]], [[Canada]], and [[Australia]], among other countries. The following [[developed nation]]s previously fluoridated their water, but stopped the practice, with the years when water fluoridation started and stopped in parentheses:
* German Federal Republic (1952-1971)
* Sweden (1952-1971)
* Netherlands (1953-1976)
* Czechoslovakia (1955-1990)
* German Democratic Republic (1959-1990)
* Soviet Union (1960-1990)
* Finland (1959-1993)
* Japan (1952-1972)<ref>[http://www.kirj.ee/esi-l-k/k50-2-2.pdf]</ref>
The prevalence of [[dental caries|dental decay]] has decreased in both Western Europe and the United States.<ref>[http://www.nature.com/nature/journal/v322/n6075/abs/322125a0.html Nature 322, 125 - 129. 10 July 1986. The mystery of declining tooth decay. Mark Diesendorf]</ref>
<ref>[http://www.fluoridealert.org/health/teeth/caries/who-dmft.html Health Effects: Tooth Decay Trends in Fluoridated vs. Unfluoridated Countries], [http://www.fluoridealert.org Fluoride Alert] webpage, page accessed 22 February, 2006.</ref> Some countries had water fluoridation but then abruptly stopped the practice. These countries, including the former [[East Germany]] and [[Cuba]], have continued to see drops in the incidence of tooth decay.<ref>[http://www.fluoridealert.org/feb-2001.htm Cavities Not Increasing, But Decreasing, When Fluoridation Stops], [http://www.fluoridealert.org Fluoride Alert] webpage, page accessed 22 February, 2006.</ref><ref>Gulzow HJ. (1990). [Preventive dentistry in the Federal Republic of Germany] [Article in German] Oralprophylaxe 12: 53-60</ref> Based on this evidence, opponents conclude that water fluoridation is unnecessary.
In areas with complex water sources, water fluoridation is more difficult and more costly. Alternative fluoridation methods have been proposed, and implemented in some parts of the world. The [[World Health Organization]] is currently assessing the effects of fluoridated toothpaste, milk fluoridation and salt fluoridation in [[Africa]], [[Asia]], and [[Europe]]. <ref>[http://www.who.int/entity/oral_health/media/en/orh_report03_en.pdf WHO World Oral Health Report] (in pdf format), from the [http://www.who.int World Health Organization] website, accessed on 4 March, 2006.</ref>
Though they still list fluoridation of water as a viable and safe option of maintaining a healthy level of fluoride in the oral cavity.{{Fact|date=July 2008}}
==Court cases==
===United States===
Fluoridation has been the subject of many court cases. Activists have sued municipalities, asserting that their rights to consent to medical treatment, [[right to privacy|privacy]], and [[due process]] are infringed by mandatory water fluoridation.<ref>Cross, D. W., R. J. Carton. [http://www.ncbi.nlm.nih.gov:80/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12749628&dopt=Abstract "Fluoridation: a violation of medical ethics and human rights."], abstract from [http://www.pubmed.gov PubMed] website, page accessed 19 March, 2006.</ref> Individuals have sued municipalities for a number of illnesses that they believe were caused by fluoridation of the city's water supply. So far, the majority of courts have held in favor of cities in such cases, finding no or only a tenuous connection between health problems and widespread water fluoridation.<ref name="beck">Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) ("Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the police power in the interest of public health. The matter is no longer an open question." (citations omitted)).</ref> To date, no federal appellate court or state court of last resort (i.e., state supreme court) has found water fluoridation to be unlawful.<ref>Pratt, Edwin, Raymond D. Rawson & Mark Rubin, ''Fluoridation at Fifty: What Have We Learned'', 30 J.L. Med. & Ethics 117, 119 (Fall 2002)</ref>
====Early cases====
A flurry of cases were heard in numerous state courts across the U.S. in the 1950s during the early years of water fluoridation. State courts consistently held in favor of allowing fluoridation to continue, analogizing fluoridation to mandatory vaccination and the use of other chemicals to clean the public water supply, both of which had a long-standing history of acceptance by courts.
In 1952, a [[Code of Federal Regulations|Federal Regulation]] was adopted that stated in part, "The [[Federal Security Agency]] will regard water supplies containing fluorine, within the limitations recommended
by the Public Health Service, as not actionable under the [[Federal Food, Drug, and Cosmetic Act]]."<ref>17 Fed. Reg. 6743 (July 23, 1952).</ref> <!--what exactly did this do?-->
The [[Supreme Court of Oklahoma]] analogized water fluoridation to mandatory vaccination in a 1954 case.<ref name="dowell">273 P.2d 859, 862-63 (Okl. 1954) (available at [http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=ok&vol=/supreme/1954/&invol=1954OK194 FindLaw for Legal Professionals])</ref> The court noted, "we think the weight of well-reasoned modern precedent sustains the right of municipalities to adopt such reasonable and undiscriminating measures to improve their water supplies as are necessary to protect and improve the public health, even though no epidemic is imminent and no contagious disease or virus is directly involved . . . . To us it seems ridiculous and of no consequence in considering the public health phase of the case that the substance to be added to the water may be classed as a mineral rather than a drug, antiseptic or germ killer; just as it is of little, if any, consequence whether fluoridation accomplishes its beneficial result to the public health by killing germs in the water, or by hardening the teeth or building up immunity in them to the bacteria that causes caries or tooth decay. If the latter, there can be no distinction on principle between it and compulsory vaccination or inoculation, which, for many years, has been well-established as a valid exercise of police power."<ref name="dowell">273 P.2d 859, 862-63 (Okl. 1954) (available at [http://caselaw.lp.findlaw.com/scripts/getcase.pl?court=ok&vol=/supreme/1954/&invol=1954OK194 FindLaw for Legal Professionals])</ref>
In the 1955 case ''Froncek v. City of Milwaukee'', the [[Wisconsin Supreme Court]] affirmed the ruling of a circuit court which held that "the fluoridation is not the practice of medicine, dentistry, or pharmacy, by the City" and that "the legislation is a public health measure, bearing a real, substantial, and reasonable relation to the health of the city."<ref>69 N.W.2d 242, 252 (Wis. 1955)</ref>
The [[Supreme Court of Ohio]], in 1955's ''Kraus v. City of Cleveland'', said, "Plaintiff's argument that fluoridation constitutes mass medication, the unlawful practice of medicine and adulteration may be answered as a whole. Clearly, the addition of fluorides to the water supply does not violate such principles any more than the chlorination of water, which has been held valid many times."<ref>127 N.E.2d 609, 613 (Ohio 1955)</ref>
====Fluoridation consensus====
In 1973, as cases continued to be brought in state courts, a consensus developed that fluoridation, at least from a legal standpoint, was acceptable.<ref name="beck">Beck v. City Council of Beverly Hills, 30 Cal. App. 3d 112, 115 (Cal. App. 2d Dist. 1973) (citations omitted).</ref> In 1973's ''Beck v. City Council of Beverly Hills'', the [[California Court of Appeal]], Second District, said, "Courts through the United States have uniformly held that fluoridation of water is a reasonable and proper exercise of the [[police power]] in the interest of public health. The matter is no longer an open question."<ref name="beck" />
====Contemporary challenges====
Advocates continue to make contemporary challenges to the spread of fluoridation. For instance, in 2002, the city of [[Watsonville, California|Watsonville]], [[California]] chose to disregard a California law mandating fluoridation of water systems with 10,000 or more hookups, and the dispute between the city and the state ended up in court. The trial court and the intermediate appellate court ruled in favor of the state and its fluoridation mandate, however, and the Supreme Court of California declined to hear the case in February of 2006.<ref>Jones, Donna [http://www.santacruzsentinel.com/archive/2006/February/10/local/stories/07local.htm "Supreme Court turns down Watsonville's appeal to keep fluoride out of its water."] Santa Cruz Sentinel. February 10, 2006.</ref> Since 2000, courts in Washington,<ref>Parkland Light & Water Co. v. Tacoma-Pierce County Bd. of Health, 90 P.3d 37 (Wash. 2004)</ref> Maryland,<ref>Pure Water Committee of W. MD., Inc. v. Mayor and City Council of Pure Water Comm. of W. MD., Inc. v. Mayor and City Council of Cumberland, MD. Not Reported in F.Supp.2d, 2003 WL 22095654 (D.Md. 2003)</ref> and Texas<ref>Espronceda v. City of San Antonio, Not Reported in S.W.3d, 2003 WL 21203878 (Tex. App.-San Antonio 2003)</ref> have reached similar conclusions. Citizens for Safe Drinking Water is raising money to support a lawsuit in federal court seeking an injunction against public water districts' use of unapproved drugs in the drinking water supply in the United States.<ref>[http://www.wnd.com/index.php?fa=PAGE.view&pageId=64168 Citizens uniting against fluoride. Large-scale lawsuit seeks to ban chemical poisoning of water supply. May 13, 2008. Chelsea Schilling. WorldNetDaily.]</ref>
===Republic of Ireland===
In ''Ryan v. Attorney General'' (1965), the [[Supreme Court of Ireland]] held that water fluoridation did not infringe the plaintiff's right to bodily integrity.<ref>[http://www.bailii.org/ie/cases/IESC/1965/1.html Ryan v. A.G. IESC 1; IR 294 (3 July, 1965)] — ''text of the Irish Supreme Court's judgement''</ref> However, the court found that such a right to bodily integrity did exist, despite the fact that it was not explicitly mentioned in the [[Constitution of Ireland]], thus establishing the doctrine of [[unenumerated rights]] in Irish constitutional law.
==References==
===Footnotes===
{{reflist|2}}
==External links==
* [http://www.fluoridealert.org Fluoride Action Network]
* {{DMOZ|Society/Issues/Health/Water_Treatment/Fluoridation/|Water fluoridation}}
[[Category:Dentistry]]
[[Category:Fluorine]]
[[Category:Water treatment]]
[[Category:Environmental controversies]]
[[Category:Medical controversies]]
[[Category:Political controversies]]
[[ja:水道水フッ化物添加についての議論]]