[like_any_other]

Are teeth the only thing affected by water fluoridation?

Why do almost no other countries fluoridate drinking water?

Even if it does turn out to be unambiguously good, people have a basic right to make their own medical decisions.

Recent systematic reviews suggest an association between higher fluoride exposure and lower IQ in children. - https://en.wikipedia.org/wiki/Water_fluoridation

[jandrewrogers]

That study is taken grossly out of context. It doesn’t claim what people claim it does and even the study states that the quality of the data on which the weaker claim was made is suspect.

The bigger issue is that we have vast amounts of scientific data and empirical evidence around fluoride toxicity. People are injured and die due to fluorine exposure, we understand how it interacts with biology. Any mechanism of action that can support the hypothesis that fluorine causes brain damage necessarily invalidates all of this evidence and is difficult to explain as a matter of basic chemistry.

And then we have to explain why fluoride in water has this effect but the much higher levels of fluoride in food does not.

Fluoridating municipal water may not offer much benefit but there is no credible science that it is actually harmful. Large regions of the world have water that naturally has far higher fluorine content than municipal water and there is no evidence of IQ reduction in these regions either.

[wokwokwok]

If you're not prepared to listen to an expert, and that's what your dentist is on this topic, then nothing I, or anyone else can say, makes any difference to you.

At some point, you have to accept that your random wikipedia page and 5 minutes on google is not a convincing argument.

This is right up there in the conspiracy theory territory.

Rational discussion means listening to experts and admitting that you are not an expert.

What do you want me to say?

You aren't a qualified expert on this topic. If you want an expert opinion, talk to an expert, not some dubious fucking provenance wikipedia page.

[nostrebored]

Your dentist is not an expert in this — that’s like saying the guy implementing your frontend is an expert in design. Yes, they’re working in the space, but their job isn’t understanding the whole system.

If you’re this deep on the appeal to authority train, the NIH released a report in the last year linking fluoride exposure to moderate drops in IQ with moderate confidence.

It’s probably not the worst thing in the world, but is definitely not inert.

[jandrewrogers]

I am competent on this particular subject matter, I have worked in fluorine chemistry and am familiar with the biology and medical literature of fluorine toxicity. The report made much weaker claims than people seem to think.

There is a very serious mechanism of action problem. Fluorine poisoning is a thing that happens. The observed effects and empirical evidence, as well as the mechanisms of action that cause them, are incompatible with any mechanism of action that supports the hypothesis that it causes brain damage. Basically, it would invalidate the entire history of actual fluoride exposure.

The other serious problem is that people are exposed to far more fluorine through what they eat than through water. What is special about trace levels in municipal water? And many parts of the world have far higher natural fluoride levels in their water than any municipal water supply with no evidence of adverse consequences. This has been studied many times in many countries! In fact, the only consistent correlation with naturally high fluoride levels is better cardiovascular health (for which there is a known mechanism of action).

This notion that trace levels of fluoride in some municipal water is adversely impacting IQ based on thin evidence from the developing world is just the public health version of “faster than light neutrinos”. Someone thinks they measured it but it contradicts everything we know about the subject. The rational approach isn’t to discard everything we know without a hell of a lot more evidence.

I don’t think adding fluoride to municipal water does much these days but it also isn’t harming anyone.

[hayst4ck]

It also seems to mirror the rhyme with the vaccine "debate."

That debate is framed around being vaccinated vs the scare of "vaccine caused autism" (or myocarditis), but that frame is missing the risk of things like measles.

Likewise tooth decay is not only expensive, but it can have dreadful health consequences if left unaddressed. Missing teeth is also socially costly. Being poor or "ugly" or poor looking is a serious adverse health consequence. Imagine parents barely making ends meet or working multiple jobs. It's easy to imagine disadvantaged kids missing out on dental care.

I also explicitly remember reading multiple reports of poor tooth health correlating with dementia development. I've also read that serious infections of any sort can harm IQ.

[kelnos]

Sure, but we need to look at this from the other side, too. Does fluoridating water provide benefits? I think it's safe to say it did way back when we started doing it. But we didn't have fluoride toothpaste back then. Putting fluoride in the water is presumably more costly than not doing it. If it's actually providing benefits, and the risk of harm is below some very low threshold, then sure, let's keep doing it. But is it actually providing benefits?

[noodletheworld]

Dentists have to spend 8 years at school right? …and do various annual training to stay licensed?

I’d say that’s a reasonable sign of someone qualified to have an opinion.

I think you’re getting confused with a dental technician.

[jandrewrogers]

I would be really surprised if dentists had much expertise on the impact of fluorine on physiology or the mechanisms of action for its toxicity. They know what it does to your teeth, and maybe that it is known to have positive effects for cardiovascular health, but that is about the extent of it. The systematic effects on the rest of your body are outside their domain.

Chemists who work in fluorine chemistry on the other hand have to become experts on the biological effects of fluorine exposure. Small and seemingly innocuous exposures can do a lot of damage and kill you, though not in a way that lends any support to the idea that municipal fluoridation will harm you. If you do understand how it kills you (basically by being exceptionally narrowly focused on making free calcium ions and to a lesser extent magnesium ions biologically unavailable), it is hard to describe a chemically plausible scenario that somehow avoids this basic fact of chemistry. Fluoride behaves the same way outside the body.

Municipal water exposure is far below the noise floor for fluoride. Food has far higher levels of fluoride than municipal water and the body has ample excess calcium and magnesium to absorb the loss of bioavailability of a microscopic amount of those minerals. Humans consume calcium measured in grams per day, multiple orders of magnitude more than can be lost via municipal fluoridation. Natural dietary variation will have a far larger effect.

[petesergeant]

You don’t seem to understand the difference between public and private health.

Your dentist is well qualified to have an opinion on the effects of fluoride on your teeth.

They are poorly qualified to have an opinion on whether it should be added to the water supply at source.

[like_any_other]

> If you're not prepared to listen to an expert

Who do you think conducted those peer-reviewed systematic reviews? I'm sorry if I don't take the word of some random guy's dentist over multiple meta analyses in major medical journals.

And I don't need an expert to tell me people should have the right to make their own medical decisions.

And finally, I live in a country where public health experts have decided against water fluoridation. This is represents the vast majority of countries. What now? Should I pick some other experts to listen to?

[robbiep]

Who do you think conducted those peer-reviewed systematic reviews? I'm sorry if I don't take the word of some random guy's dentist over multiple meta analyses in major medical journals.

I don’t understand what you mean here. Are you just wholly rejecting the concept of expert knowledge, trials, meta analyses, basically the foundations of science, just because in order to participate in it you have to have tainted yourself by rigorously studying it?

[like_any_other]

> Are you just wholly rejecting the concept of expert knowledge

I am embracing expert knowledge in trusting meta-analyses and the decisions of EU health experts.

[wokwokwok]

You are not an expert in this field, and cherry-picking random articles in random journals does not make you an expert.

> Should I pick some other experts to listen to?

I think it's reasonably clear that you haven't spoken to an expert in this field.

> I'm sorry if I don't take the word of some random guy's dentist over multiple meta analyses in major medical journals.

Are you certain you're competent to review and understand the literature on the topic? It takes a lot of time and effort; that's what dentists do as a job. That's why they have to go to school. That's why random people on the internet do not do dentistry.

If you don't trust my dentist, then talk to your dentist.

This is literally my point: I'm not telling you how it is; I'm telling you, talk to someone who knows what they're talking about; and, don't believe that you are an expert because you put some trivial amount of effort into investigating it yourself.

You can't be an expert at everything. No one can.

As some point, you have to trust other people.

[kelnos]

I'm also not convinced that a dentist is credibly an expert here. Sure, I would absolutely expect my dentist to understand what benefits fluoridated water might provide to my teeth. I would not, for example, expect my dentist to be an expert in whether or not fluoridated water could cause damage to other parts of my body.

My previous dentist pushed these $80 (not covered by insurance) fluoride treatments on every cleaning visit. There's no research that shows much of anything about their effectiveness (good or bad). Yet they push them anyway, because it (their words) might help and probably won't harm. That doesn't give me a good feeling about their competence to have an expert opinion on this sort of thing.

I would, however, trust the opinion of someone who is doing medical/dental research, and holds a doctorate in a relevant field.

[Ajedi32]

Dentists are experts on neurology now? I don't think the debate here has anything to do with the effects of fluoride on teeth.