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“Very Little Evidence” for Fluoridation, Says New Cochrane Review

Though his years of travels, meeting indigenous populations around the globe, Dr. Weston Price – one-time head of research for the American Dental Association – documented the impact of diet on dental health and development. Invariably, he found that those who ate their traditional, local diet had healthy teeth and good orofacial development. Widespread problems only arose with the introduction of refined sugar, white flour and other mainstays of the Standard Western Diet.

What such observations remind us that nutrition is the foundation of good oral health, as well as systemic, no modern interventions such as sealants and fluoride required.

Yet there are those who will insist otherwise, even claiming that fluoride is an essential nutrient – as if a fluoride deficiency and not an infectious disease process were the cause of caries (tooth decay). Clearly, it is not.

water treatment facilityYou also hear fluoridation called one of the greatest public health achievements ever. But according to the latest relevant meta-analysis in Cochrane Reviews, the science doesn’t necessarily support that.

The research team looked at more than 150 studies dealing with the effect of fluoridated water on caries. They did find that caries rates among children dropped with the introduction of fluoridation – but with some major caveats.

For one, most all of the studies they looked at – 97% – were considered highly biased. This makes the findings less than reliable.

The authors also noted that most of these studies were done before fluoride was widely available – when fluoride in water may have been, for many, their only consistent exposure.

Today, of course, fluoride is everywhere. In some stores, it is impossible to find fluoride-free toothpaste. Fluoride is also readily available in mouthwashes, and even products like floss now come in fluoridated versions. Such abundance is one reason why, earlier this year, the US Department of Health and Human Services lowered its recommended level of fluoride for community water systems.

Yet even that may be too much – especially when you consider that fluoride’s main effects are topical – that is, when it’s applied directly to the tooth. (Indeed, another recently published review from Cochrane found moderate quality evidence for the use of fluoride gels.) There is no demonstrated benefit from swallowing it but quite a lot of evidence as to its potential harm. As the authors of a 2014 review in the Scientific World Journal put it,

Fluoride has modest benefit in terms of reduction of dental caries but significant costs in relation to cognitive impairment, hypothyroidism, dental and skeletal fluorosis, enzyme and electrolyte derangement, and uterine cancer. Given that most of the toxic effects of fluoride are due to ingestion, whereas its predominant beneficial effect is obtained via topical application, ingestion or inhalation of fluoride predominantly in any form constitutes an unacceptable risk with virtually no proven benefit. [emphasis added]

Notably, the Cochrane Review on fluoridation found insufficient evidence that stopping fluoridation results in more caries. There was also no evidence of any benefit to adults. And this points to yet another problem with fluoridation as public health policy: With fluoridated water, everyone receives fluoride whether they “need” it or not, let alone want it. Nor is there any control over the dose. Is there any other drug we would dole out in such a cavalier fashion? Dr. Peter Mansfield powerfully pointed out the folly of this more than a decade ago:

No physician in his right senses would prescribe for a person he has never met, whose medical history he does not know, a substance which is intended to create bodily change, with the advice: “Take as much as you like, but you will take it for the rest of your life because some children suffer from tooth decay.” It is a preposterous notion.

Image by Pam Broviak, via Flickr