Talk:Water fluoridation

This entire article ....

The entire article on water fluoridation is very unbalanced. Criticism of it seems to be limited to negatively calling it 'conspiracy theories'. Funny thing is, in this case, the conspiracy happens to be a true one. Read the book, 'The Fluoride Deception' By Christopher Bryson. No, it's not some quack paranoia book full of sensationalism with no references or research. It's a book by a BBC journalist, and if you want references and proof, there is PAGES of them at the back of the book.

After going through the references, the links to the manhattan project, aluminium manufacture and fluoride as a waste product with no use, dumping it into water supplies to get rid of it, is all proven in the book. This is one of the biggest medical and governmental coverups in 50 odd years.

The whole article needs to be re written, using references and evidence from the book (many from science journals) to show both sides of the story.

50 years from now, we will be shaking our heads at how we were dumb enough to put it in toothpaste and dump it into water, in the same way we laugh at how dumb it was to add radium to skin creams at one time. — Preceding unsigned comment added by 70.75.21.118 (talk) 00:16, 3 November 2012 (UTC)

We need good references in scientific journals. If any of the references you mentioned satisfy that criteria, please let us know. TippyGoomba (talk) 23:53, 4 November 2012 (UTC)

The dentists who support this also suggest the mercury in amalgams is totally safe. How can non-scientists/non-physicians be so incredibly knowledgeable completely outside of their own fields? — Preceding unsigned comment added by 64.134.237.16 (talk) 05:35, 29 January 2013 (UTC)

Biased article

Why is there absolutely no mention of the use of water fluoridation at concentration camps in Nazi Germany and Soviet Russia? It was used to make the inmates more docile and apathetic. Just asking why Wiki agents are hiding truths that contradict government propaganda. I'm glad my water company refuses to fluoridate water - https://www.affinitywater.co.uk/water-quality-fluoride.aspx — Preceding unsigned comment added by 2.29.204.253 (talk) 11:37, 6 November 2012 (UTC)

You are welcome to add such information but Wikipedia expects reliable sources. Websites are usually not good enough. --Smokefoot (talk) 12:11, 6 November 2012 (UTC)

@ 2.29.204.253. Whilst I can sympathise with your worries, yet there is no 'reliable' evidence that I have found that the Nazi’s used fluoridation of water for this purpose.

There is far more evidence that the Nazi's used and developed Chlorpromazine and Thalidomide but non, for fluoridation of water. Chronic hunger and malnutrition, can better explain the docile and apathetic behaviour of those inmates you refer to. They had so little food that they started to metabolize their own body mass. However strong the will, the body could not stand up against their oppressors under these conditions.--Aspro (talk) 20:36, 6 November 2012 (UTC)

Aspro, the intertwining of Nazi's and fluoridation is deep in the culture of many (most?) anti-fluoridationists. Go to their main organization - fluoride action network - and search "Nazi". You'll get pages of assertions (for amusement you can also search "pineal" - even more pages). Many antifluoridationist disagree with our definition of reliable source since, they suggest, conventional sourcces are involved in a conspiracy (to promote fluoride to (i) passivate society or (ii) dispose of toxic waste or, more calmly, (iii) to medicate when the costs outweigh the benefits). Since the antifluoride groups do not accept Wikipedia's idea of reliable sources, editors find themselves in a Catch-22. Wikipedia is implicated in the same conspiracy. You will also notice that with rare exception, those complaining on these pages (a) are unregistered, (b) have a single minded focus on fluoride, and (c) are inarticulate with science - these characteristics also complicate communications. --Smokefoot (talk) 23:50, 6 November 2012 (UTC)

Fluoridation of public water supplies

Please check the Center for Disease Control website on this topic. Unless I am misunderstanding, it indicates that the source of fluoride used in public water supplies is the the pollution-scrubbing devices of the phosphate fertilizer industry. I think the article should have mentioned that this is where the fluoride comes from. — Preceding unsigned comment added by 72.211.178.151 (talk) 20:24, 2 December 2012 (UTC)

I checked, here's what I found. No reference to "pollution-scrubbing devices", whatever that means. The site mentions phosphate fertilizer but doesn't explicitly say it's part of the supply chain. I don't see anything particularly interesting to add to the article. Got any other references we can take a look at? TippyGoomba (talk) 21:25, 2 December 2012 (UTC)

Oh 72.211.178.151 is referring to an old howler about how fluoride is obtained industrially. The idea is basically rubbish (IMHO) found in blogs written by people who do not understand how chemical industry operates. The basic idea is that phosphate rock is solubilized for eventual conversion to phosphate fertilizer by treatment with sulfuric acid. Phosphate salts needs to be soluble to be beneficial to plants. The phosphate rock contains substantial amounts of fluoroapatite (also a phosphate source) which reacts with the sulfuric acid to solubilizes/volatilzes any fluoride. My understanding is that the fluoride is liberated as gaseous hydrogen fluoride, which is captured and used to make fluorine compounds (drugs, Teflon, fluoride salts for water treatment, etc). My further understanding is that in some cases the HF is allowed to (or just does) react with silicaceous material (i.e., sand), which is a common impurity in phosphate rock. The reaction of HF and SiO₂ leads to hexafluorosilicic acid, which is also used in some water fluoridation facilities. Since the fertilizer is the main target of the phosphate rock plants, one could say that HF and hexafluorosilicic acid are waste products. The bloggers have concluded that that the evil-doers in these industries can't figure out a better way of disposing of their fluoride waste-stream than sticking it into drinking water (very dilute). The fundamental aspect that some folks cannot fathom is that many, many chemicals produced in industry are also impurities from another process. In a classic case, platinum is a common impurity in some nickel ores and the industry happily collects the platinum. Similarly gold and silver and germanium and rhenium, and on and on. The petrochemical industry generates all manner of niche compounds that are used in diverse apps. The case against fluoridation of public waters has various degrees of merit, but this line of reasoning comes from a chemically illiterate part of that group, hence my contemptuous comments. --Smokefoot (talk) 21:47, 2 December 2012 (UTC)

? Non of your comment makes sense Smokefoot. How does that equate to what in Europe we recognise as naturally occurring Calcium Fluoride.--Aspro (talk) 19:30, 3 December 2012 (UTC)

Smokefoot's comments make perfect sense to me - he explained the likely basis for the "pollution-scrubbing devices" concerns of the ip that started this discussion.

What does calcium fluoride have to do with anything written here? --Ronz (talk) 20:33, 3 December 2012 (UTC)

The OP is asking about the industrial source of fluoride used in water fluoridation. The addition of Hexafluorosilicic acid is a US thing. Several European countries have tried this approach, instead of calcium fluoride , only to find that the science is lacking and failed to provide the promised results. Thus, they discontinued the program. Would you sprinkle sodium chlorate on your fish 'n chips?--Aspro (talk) 23:05, 3 December 2012 (UTC)

You are probably correct that fluorite is used as the source of fluoride that goes into water treatment facilities. Relative to phosphate rock, fluorite is the more traditional commercial source of fluoride and fluorine. We would very much welcome articles or even policy statements from the EU concerning fluoride from fluorite vs phosphate rock or related topics. I think that fluoride is fluoride though, and there is probably not much written along the lines that seem to worry you. But maybe I misunderstand. If fluoride is bad for people (your assertion, I take it), it wont matter where it is coming from, fluoroapatite or fluorite. --Smokefoot (talk) 23:43, 3 December 2012 (UTC)

Example: Sodium is sodium & chloride is chloride and oxygen is oxygen. But if you take it in the form of sodium chlorate it is more toxic. So likewise: One has to consider the the form of the hexafluorosilicic acid additive after it has passed through the supply and comes out the tap. Then look at the dental health of the population before it was added and compare those studies to the dental health of the same cohort after introduction. The original studies were far to small to exclude conflation. The European introduction of this type of fluoridation exposed the short comings (methodical errors) of these early studies. Currently, it seems only Ireland in Europe that is still keen on this form of water fluoridation (being the most resent) and it is now finds itself far enough into the experiment, that the authorities are also now under pressure to discontinue it for the same reasons that it has been discontinued elsewhere. I.e., the original studies, judged by modern standards -was poor science.--Aspro (talk) 20:49, 5 December 2012 (UTC)

Staying on the topic (the charge that fluoride and hexafluorosilicic acid are "waste products"). We're cool that fluoride is fluoride (no conflation). We're also cool that chlorate is not chloride (that would be conflation). Fluoride and hexafluorosilicic acid are not the same. On the other hand "form of the hexafluorosilicic acid additive" means hexafluorosilicic acid. The main point of this conversation was to resolve the accusation that fluoridation involves disposing of wastes. --Smokefoot (talk) 14:20, 6 December 2012 (UTC)

That’s already established fact. The source of fluoride for water treatment (under current methods) utilises an unwanted industrial by-product. That is the definition of waste... Waiting now for the circular augment- but it does have use... - 'Water Fluoridation'. A fallacy that the Europe (and now Chines) experience, exposed for what it was. So by using this industrial by-product, it is a way of deposing of industrial waste that otherwise would have to be deposed of like other toxic waste. So this does answers the OP's question. i.e., It does constitute the disposal of toxic industrial waste.--Aspro (talk) 00:52, 7 December 2012 (UTC)

Sounds more like phosphate fertilizer is the "toxic industrial waste", you should go rant on that article as well. TippyGoomba (talk) 02:12, 7 December 2012 (UTC)

Phosphate fertilizer is the 'end product'. The industrial wast, is the by products that does not end up in the sack of fertilizer.--Aspro (talk) 20:19, 7 December 2012 (UTC)

Phosphate fertilizer and fluoride are the 'end product'. TippyGoomba (talk) 00:16, 8 December 2012 (UTC)

Using semantic gymnastics the sophists where able to prove black-was-really-white. So I'll be more specific: The intended and sort for end product of the process in other words, the the industry's raison d'être. Therefore, hexafluorosilicic acid is in the proper sense the by-product of this process. --Aspro (talk) 15:06, 8 December 2012 (UTC)

Is an edit being proposed? Alexbrn (talk) 06:34, 7 December 2012 (UTC)

I dont think so, we were just discussing whether fluoridation represents disposal of wastes or use of a chemical valued for water fluoridation and other applications.--Smokefoot (talk) 14:40, 7 December 2012 (UTC)

A better way of viewing it perhaps would be along the lines that there is no such thing as rubbish (waste); as rubbish (waste) is just something in the wrong place at the wrong time. Example: Small amounts of the nuclear industries radioactive 'waste' such as Strontium-90 has found useful applications. Yet it is obtained from the nuclear industries waste, which un-contained would pollute the environment. --Aspro (talk) 20:01, 7 December 2012 (UTC)

Edit request on 18 December 2012

This article is heavily biased regarding controversial issues. It dismisses people who are in opposition to water flouridation as non credible and "conspiracy theorists." Evidence is stated in this article that is in favor to flouridation, but none of the many studies regarding the dangers of flouridation is stated, take this for example. This article clearly has an agenda and needs more balance. 149.63.60.58 (talk) 23:16, 18 December 2012 (UTC) Josh

Citing an article that misrepresents research findings?! No, per MEDRS. --Ronz (talk) 00:44, 19 December 2012 (UTC)

Agreed, sources for the article need to meet our guideline on sourcing for medical content. Yobol (talk) 01:12, 19 December 2012 (UTC)

See below references to fluoride and cancer--

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/7679201

"Clastogenic activity of sodium fluoride in great ape cells"

"Conflicting evidence has been reported concerning the mutagenicity of sodium fluoride (NaF), especially clastogenicity at concentrations of more than 1 mM. NaF is known to induce chromosome aberrations at these concentrations in human cells, but not in most rodent cells. We considered that such species-specific difference in chromosomal sensitivity would be derived from the phylogenetic distance between rodents and man. To clarify the role of interspecies differences, we investigated the chromosomal sensitivity to NaF in cell lines from various primates, which diverged into many species, including rodent-like prosimians and human-like great apes. The results showed that the clastogenicity of NaF was limited to human and great ape cells." PMID: 7679201

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/9002384

"Relationship between fluoride concentration in drinking water and mortality rate from uterine cancer in Okinawa prefecture, Japan"

"The Okinawa Islands located in the southern-most part of Japan were under U.S. administration from 1945 to 1972. During that time, fluoride was added to the drinking water supplies in most regions. The relationship between fluoride concentration in drinking water and uterine cancer mortality rate was studied in 20 municipalities of Okinawa and the data were analyzed using correlation and multivariate statistics. A significant positive correlation was found between fluoride concentration in drinking water and uterine cancer mortality in 20 municipalities " PMID: 9002384

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/16596294

"Age-specific fluoride exposure in drinking water and osteosarcoma (United States)."

"We explored age-specific and gender-specific effects of fluoride level in drinking water and the incidence of osteosarcoma. ..."

"Our exploratory analysis found an association between fluoride exposure in drinking water during childhood and the incidence of osteosarcoma among males but not consistently among females." PMID: 16596294

Also on PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/19812419

"Is there a need of extra fluoride in children?"

"Fluoride consumption by human beings increases the general cancer death rate, disrupts the synthesis of collagen and leads to the breakdown of collagen in bone, tendon, muscle, skin, cartilage, lungs, kidney and trachea, causing disruptive effect on tissues in the body. It inhibits antibody formation, disturbs immune system and makes the child prone to malignancy. Fluoride has been categorized as a protoplasmic poison..." PMID:19812419

On PubMed.gov http://www.ncbi.nlm.nih.gov/pubmed/11512573

"Regression analysis of cancer incidence rates and water fluoride in the U.S.A. based on WHO data..."

"...cancers of the oral cavity and pharynx, colon and rectum, hepato-biliary and urinary organs were positively associated with Fluoridated Drinking water (FD). This was also the case for bone cancers in male, in line with results of rat experiments. Brain tumors and T-cell system Hodgkin's disease, Non-Hodgkin lymphoma, multiple myeloma, melanoma of the skin and monocytic leukaemia were also correlated with Fluoridated Drinking water." PMID: 11512573

I was thinking that if it really did cause cancer, wouldn't that make it in violation of the Delaney Clause? "the Secretary of the Food and Drug Administration shall not approve for use in food any chemical additive found to induce cancer in man, or, after tests, found to induce cancer in animals.--"Merrill, Richard A. "Food Safety Regulation: Reforming the Delaney Clause" in Annual Review of Public Health, 1997, 18:313-40. This source includes a useful historical survey of prior food safety regulation. If fluoride is in water that goes into foods wouldn't it be in violation of this clause?

The following papers explain that some caries are due to high lead levels and fluoride doesn't help in these cases.

"Enamel biopsies taken from school children in a community where exposure to lead was a health hazard were analyzed for lead and fluoride. The children with high enamel lead had significantly higher caries scores than the children with low enamel lead, in spite of the fact that the high lead group also was higher in enamel fluoride. There was no increase in enamel lead with age. The lead in saliva was only a fraction of that in blood. Infants with lead poisoning showed higher saliva lead than a normal infant."

•"Lead in Enamel and Saliva, Dental Caries and the Use of Enamel Biopsies for Measuring Past Exposure to Lead" http://jdr.sagepub.com/content/56/10/1165.abstract The fluoride in their teeth did not prevent the caries.

Lead is passed on from mother to child. The child doesn't necessarily have to ingest the lead. It can be transferred by the mother to her offspring, just like fluoride.

See "Association of Dental Caries and Blood Lead Levels" in JAMA. http://jama.jamanetwork.com/article.aspx?articleid=190537

See "Blood lead level and dental caries in school-age children" http://www.ncbi.nlm.nih.gov/pubmed/12361944

"Mean blood lead level was significantly greater among the urban subgroup, as was the mean number of carious tooth surfaces. Blood lead level was positively associated with number of caries among urban children, even with adjustment for demographic and maternal factors and child dental practices."This study suggests that the fluoridation of water can lead to higher lead levels:

•"Association of silicofluoride treated water with elevated blood lead" PMID: 11233755 http://www.ncbi.nlm.nih.gov/pubmed/11233755

Chronic, low-level dosage of silicofluoride (SiF) has never been adequately tested for health effects in humans. We report here on a statistical study of 151,225 venous blood lead (VBL) tests taken from children ages 0-6 inclusive, living in 105 communities of populations from 15,000 to 75,000. For every age/race group, there was a consistently significant association of SiF treated community water and elevated blood lead. The highest likelihood of children having VBL> 10 microg/dL occurs when they are exposed to SiF treated water and subject to another risk factor known to be associated with high blood lead (e.g., old housing). "Abstract: Lead, a toxin that lowers dopamine function, has been associated with violent behavior as well as learning deficits. Hydrofluosilicic acid and sodium silicofluoride, which were substituted for sodium fluoride without testing as chemicals for public water treatment, increase absorption of lead from the environment and are associated with violent behavior. Given the costs of incarcerating violent criminals, these side-effects justify a moratorium on using silicofluorides for water treatment until they are shown to be safe."

http://oehha.ca.gov/prop65/public_meetings/052909coms/fluoride/RMasters.pdf — Preceding unsigned comment added by 99.61.178.14 (talk) 22:53, 27 December 2012 (UTC)

The request should be of the form please change sentence X to Y. Alternatively, you can create an account. TippyGoomba (talk) 01:03, 28 December 2012 (UTC)

Aren't there any better studies to cite?

The claim is made "Water fluoridation is effective at reducing cavities in both children and adults.[9]", but the paper linked to says in the abstract "While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality." It seems weak to make this claim without pointing out that the citation used to back it up is of studies that are generally moderate to low in quality. Isn't there a review based on good quality science? — Preceding unsigned comment added by 75.164.193.55 (talk) 04:18, 20 February 2013 (UTC)

That is the conundrum. There is not at present any good quality science to to review. That would require a large cohorts with checks to identify and mitigated social/economic/ecological effects that might conflate the data collected. That type of research requires a lot of money because of its scale. The only 'general' guide are those counties that introduced fluoridation of water, then abandoned it when the promised benefits did not appear in their population. Some European countries -for instance- provided either free or subsidized dental treatment for children, so they were more keen to objectively look at the results. "Severe" fluoridosis may be rare percentage-wise but when it starts to cost the government health care services so many thousand dollars per patent to venire (several times as the teeth grow) and correct, then the economic advantage of remedial dental work plus the cost of the fluoridation itself, moves to give a negative cost benefit. The only way to settle it for good would be a very large, world wide (and thus expensive) study. Conflation is an important issue, not only did Switzerland abandon fluoridation of water 'they did not abandon their very high gun ownership and yet have very little gun crime. A mere dribble compared -with say the US. So simplistic comparisons (poor quality studies) can be really misleading. Real world examples (rather than theory) suggest: Good Dental Health Care, Sensible Diets and Responsible Gun Ownership certainly seams better than the uniformed opinions reflected in countries like the US etc.--Aspro (talk) 17:21, 20 February 2013 (UTC)

Don't agree with Aspro, there are some good studies in the peer-reviewed literature that quantify the relationship between caries reduction and fluorosis (BMC Public Health. 2012 Dec 28;12:1122.) that account for socio-economic status as well. Also lots of cohort studies; the nature of the investigation would limit you to cohort studies. You may not find randomized controlled placebo controlled trials however, I think because you can't consent a population to randomization process in the case of water fluoridation. There are many RCTs where fluoride from other delivery vehicles is given and, in my mind, the caries reduction potential is well proven but their is the risk of fluorosis. I can find other references however, that a well matched cohort on a large sample is a very close approximation to randomization. Ian Furst (talk) 18:42, 20 February 2013 (UTC)

The reviews didn't find studies that in a scientific sense were good. Period. Don't disagree with me but with all those scientists that studied the available data. --Aspro (talk) 19:38, 20 February 2013 (UTC)

There's not much point arguing about it - let's see if we can find a meta-study or review that includes good quality research. Tilapidated (talk) 19:49, 20 February 2013 (UTC)

This is not an “argument”. That requires a logical process and sound evidence that productive 'argument' requires; which in this case is sorely lacking. That is the problem – good quality studies have yet not been done – so they is no hope of you finding them if the experts can’t find any because non have been conducted yet.--Aspro (talk) 21:35, 20 February 2013 (UTC)

What I mean is that there is no point arguing about this here - if what you say is true then we need solid academic sources who hold that opinion. Tilapidated (talk) 21:37, 20 February 2013 (UTC)

You might like to start here for solid academic sources who hold that opinion. A Systematic Review of Public Water Fluoridation 2000 A more complete meta study in its scope I don't know off – and I doubt if anybody else knows better. PS. don't be lazy and read others articles of what some want you you to believe this study came up with. Read the this original thoroughly. Some reviews have twisted the finding round to agree with their own POV hoping that no one will bother to read the actual study.--Aspro (talk) 22:00, 20 February 2013 (UTC)

I added a section on the York review to the article - I'm also looking for other good quality reviews. Tilapidated (talk) 22:10, 20 February 2013 (UTC)

section on studies and reviews

I think it would be great to start a section on the general quality of the research, the different types of research, studies and reviews in the article. Tilapidated (talk) 19:23, 20 February 2013 (UTC)

I took the liberty of beginning this - I am a little troubled at the overall poor quality of the data - I hope someone will be able to add more impressive reviews and meta-studies. Tilapidated (talk) 21:10, 20 February 2013 (UTC)

Natural and artificial water fluoridation

Colin - it looks like you removed the reference to the WHO study on the hazards of over-floridated water - it's not clear to me why you think this article should only relate to artificial water fluoridation - water fluoridation is a natural process as well, and a huge amount of the fluoride that gets added to water is through natural processes - it seems to me that it's appropriate to deal with that here. Tilapidated (talk) 19:21, 20 February 2013 (UTC)

See the lead. "Water fluoridation" is controlled and artificial. "Fluoridated water" covers both but isn't the subject of the article. The difference is absolutely vital. Colin°^Talk 20:32, 20 February 2013 (UTC)

Not so sure - fluoridated water is water that has fluoride added to it, either naturally or by a human process. Fluoridation is the process of adding fluoride, be it human or geological processes at work. Why is the distinction vital? Many of the issues are intertwined, for example the recommended amounts to be added to municipal systems, or removed from consumption depend on natural fluoridation processes. BTW "Fluoridated water" redirects to this page.

The term is commonly used to refer to natural processes - for example this CDC pamphlet - "Fluoridation: nature’s way to prevent tooth decay", and this study in the bmj, "Objective: To examine the effect of water fluoridation, both artificial and natural, on dental decay, after socioeconomic deprivation was controlled for." http://www.bmj.com/content/315/7107/514Tilapidated (talk) 20:49, 20 February 2013 (UTC)

This paper refers to "Currently about 49 % of the U.S. population is artificially fluoridated (hydrofluorosilicic acid, sodium silicofluoride and sodium fluoride) and 7 % have natural water fluoridation" http://www.xxfluoride.com/Dr_Russell_statement.cfm

"The only area in Scotland which did have naturally fluoridated water at 1ppm was on the Moray coast" http://www.sdmag.co.uk/index.php/articles/pm_article/public_health/

"Muskegon [not fluoridated] and nearby Aurora [naturally fluoridated at 1.4ppm]) (Bellemare 1979)" https://www.ucalgary.ca/PHIRC/pdf/Synthesis_flouridation.pdf

etc etc. Tilapidated (talk) 21:01, 20 February 2013 (UTC)

Sorry about the glitch with the talk-page-revert earlier. I was trying to use my mobile phone and must have hit the wrong link. Won't do that again. The article's lead is sourced to the CDC which states "Fluoridated drinking water contains a fluoride concentration effective for preventing dental caries; this concentration can occur naturally or be reached through water fluoridation, which is the controlled addition of fluoride to a public water supply.". Other people might use the term more liberally, but ultimately the scope of the term wrt this wikipedia article is the one reflected by the current lead: artificial and controlled. Many articles on Wikipedia cover terms where the scope can vary in practice but Wikipedia needs to pick one well defined scope in order to form a cohesive article topic. If you want to change the scope, you need to gain consensus. We don't do that in a hurry, especially for a featured article. Also, we simply can't add unsourced text to the article: it will just be removed per WP:V. The text you are adding about the York review is already covered by the article. Please note that if you quote text then you absolutely need to give a citation and here it would have been necessary to give a date -- which is 2003. So given that is 10 years ago, the statement is now very out-of-date and an update required.

This is a controversial subject and the text needs to reflect the best professional consensus on the topic. By conflating natural (and often toxic levels of) fluoride with fluoridation, the article will inevitably foul WP:SYN. Before you know it, the lead sentence will mention brain damage and government mind control and the lead image will be this one.

Please can you discuss edits to this FA before making significant changes. Anything you add must cite high quality sources per WP:MEDRS and be in proportion per WP:WEIGHT. Colin°^Talk 21:47, 20 February 2013 (UTC)

Colin - no worries on the revert - re the definition - I'm not sure why you would want to limit the definition to that CDC comment - any discussion of fluoride levels in water has to take into account natural and added fluoride, right? Common usage of the term is to include natural and artificial fluoridation. BTW - I'm not at all suggesting we 'conflate' them - we just need to be clear that fluoridation comes from a variety of sources. I'm going to presume that you're joking about mind control. The studies I added are the most thorough I could find, from the most mainstream science.

Re the York study - absolutely - I welcome your addition of more recent quality reviews, but the York study remains a major land-mark in the literature - I'd like to put together a section that includes the most important literature reviews and short summaries of their findings - I look forward to your contributions! What concerns me is that it seems that we are making statements that imply a consensus that I can't find in any serious reviews of the literature. Which more recent literature reviews are you most impressed by?

Tilapidated (talk) 21:56, 20 February 2013 (UTC)

Terminology

Given the common and technical uses of the term 'water fluoridation' include both natural water fluoridation and human water fluoridation, and given the importance of all sources of fluoride in water when discussing the topic, it seems prudent to adopt the standard language around this issue.

• Natural water fluoridation, to refer to the process of fluoridation of water by (usually) geological means.
• Community water fluoridation, to refer to the deliberate addition of fluoride for public health purposes.

Both of these are, prima facie water fluoridation, since they are processes by which water becomes fluoridated. In discussion above I listed examples of the use of this terminology in academic and public health settings. It is clear, unambiguous, neutral, and the normal language used by the community of experts dealing with this issue.

It's also important to consider all sources of fluoride when discussing the issue - the article currently does this already, which, without clarity on terms, risks ambiguity and confusion. Tilapidated (talk) 23:25, 20 February 2013 (UTC)

Water can be fluoridated, naturally, but it has not undergone fluoridation.CDC That is the terminology.Novangelis (talk) 23:48, 20 February 2013 (UTC)

I appreciate your thoughtful contribution (that link appears to be broken, so I can't check it), but on what basis do you think the CDC should be the reference for terminology? In fact the CDC themselves use the term - they also use the term 'community water fluoridation' - for example here - http://www.cdc.gov/fluoridation/fact_sheets/cwf_qa.htm#4

This British Medical Journal article is an example of common usage of 'natural water fluoridation', and 'artificial water fluoridation' when used in a trial to assess the effectiveness of each. This article in the Scottish Dental Magazine likewise follows the same pattern.

I wonder whether you are taking a slightly US centric view in assuming that a US public health agency should be the final arbitrator of this, rather than common global academic and professional usage? http://www.bmj.com/content/315/7107/514 , http://www.sdmag.co.uk/index.php/articles/pm_article/public_health/

For more like this, see:

• Ziegelbecker R. Natural water Fluoridation: Multifactorial Influence on Dental Caries in 21 Cities Study. XVIIth Conference of the International Society for fluoride Research. Budapest (Hungary) June 22-25 1989.
• Here is a UK Royal College of Surgeons article that uses the term to make the important distinction. http://www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/documents/discolor.pdf
• Although most examples I have found that use the term 'natural water fluoridation', it is very common in the US to refer to deliberate fluoridation for public health purposes by the term 'Community water fluoridation'. One among very many is this one from the American Journal of Preventive Medicine. http://thecommunityguide.org/oral/oral-ajpm-ev-rev.pdf. They Define 'Community water fluoridation (CWF) as adjusting and monitoring fluoride in public water supplies to reach optimal fluoride concentrations in community drinking water.'

I'm interested in what you want to re-name the geological process by which water becomes fluoridated, if you don't want to allow the community the term 'natural water fluoridation'?

Tilapidated (talk) 23:52, 20 February 2013 (UTC)

The CDC link works on my machine and goes to a simple HTML link, so the problem is your machine or firewall. It is an expert review, published in MMWR, and is a sound basis for defining the scope of the article. The NCI uses the same definition.[1] The York review uses fluoridated/fluoridation in the same manner, even if their glossary is woefully deficient on the central topic, so it is not a British vs. American English usage. I am not aware of any fringe groups that blame naturally occurring fluoride for their problems (although I would not be shocked if there was one which thought it was the action of evil nature spirits). A quibble in terminology is not a basis for changing the clearly defined scope of an article.Novangelis (talk) 00:47, 21 February 2013 (UTC)

I'm not sure that I follow your comments on 'fringe groups'. I don't have a 'quibble' - I've presented to you both a logical case for an improvement in clarity of meaning, and plenty of examples of this usage in academia and public health, and a question about why you think the CDC definition (which seems to be used inconsistently even by the CDC) should prevail even when it is confusing.

I'm not certain what your basis for objecting to this clarification could possibly be - perhaps you could outline any possible drawbacks you perceive to this clarification of terminology? Tilapidated (talk) 01:06, 21 February 2013 (UTC)

One option would be to have a 'definitions' section that outlines the major definitions, and who uses them - this would be clear, neutral, verifiable and sourced, and would avoid the problem of having to select one definition as the only one used in the article? I'm not hugely in favor of this, since you are the only person who seems to have a problem with the commonly used definitions. The CDC, while declaring that it is talking about community water fluoridation on its site, elsewhere uses the term natural water fluoridation when that is what it is talking about, and CWF is the mainstream term where both types are in place. Tilapidated (talk) 01:31, 21 February 2013 (UTC)

The point about fringe groups was that people with the critical reasoning skills of lint would have had no problems figuring out what this article had about before you edited. You made the article more confusing by changing the terminology to one that is inconsistent with the scope of the article, and was also inconsistent with the reference (which you obviously had not read). Adding a section that discusses alternate definitions in use might not be unreasonable assuming that formal, not inferred, definitions are used.Novangelis (talk) 02:08, 21 February 2013 (UTC)

Perhaps English isn't your first language, but I think I get the jist of your meaning. Unfortunately you didn't answer the bulk of the issues raised. I understand from your edits that you bring a strong point of view to this article, but please try to remain civil and focussed on the issue, which is that there is not one clear, official definition in use, and no clear reason to use the CDC one over any other (even the CDC mixes and matches). I'll work on a section discussing definitions. Tilapidated (talk) 02:20, 21 February 2013 (UTC)

Someone reverted my suggestion based on this discussion within 7 minutes of my making it without bothering to discuss, but I suppose you could go look in the change log. I have to say this is a surprisingly hostile page. Tilapidated (talk) 02:38, 21 February 2013 (UTC)

Please read/review WP:LEAD, the lead is the very last thing that gets updated. The lead summarizes what's in the article body, there should not be anything in the lead that isn't covered thoroughly in the article body. Changing the lead to redefine the scope of the article without having the content in the article body already in place is a serious WP:MOS problem. Please first get consensus here on the Talk page for your proposed changes (I do not see consensus here yet), then work on developing the content in the article body, and then the last thing to do is update the lead. The reverse approach, which you appear to be trying to take, will find lots of opposition. Zad68 02:44, 21 February 2013 (UTC)

I think you may be a little confused - the changes clarifying definitions used in the academic literature and public health agencies do not change the scope of the article. Recognizing the language that is actually used in the field to distinguish different sources of water fluoridation is not the same as suggesting that this article should include the geology and chemistry of natural water fluoridation, simply to explain that when discussing community water fluoridation, natural water fluoridation is often contrasted, and that the shorthand 'water fluoridation' is often used to mean exclusively 'community water fluoridation'. What changes to the body of the article could you be expecting on this basis? Tilapidated (talk) 02:48, 21 February 2013 (UTC)

It's possible I was reacting to what I was expecting vs. what the actual edit was, and I apologize for that. Give me a sec to try to improve the wording, though... Zad68 03:00, 21 February 2013 (UTC)

No problem - we all react in haste from time to time ;) Tilapidated (talk) 03:02, 21 February 2013 (UTC)

The issue that I'm seeing with the proposed edit:

Water fluoridation is the addition of fluoride to water. In public health, it refers to the controlled addition of fluoride to a public water supply to reduce tooth decay. Community water fluoridation is also used to mean the same thing, especially when used in contrast to 'natural water fluoridation', a (mainly) geological process.

is that it does indeed change the scope of the article from having F- added to water for the purpose of controlling tooth decay to the general topic of water having F- added to it for any reason. I think this is the point being raised elsewhere on this page and this edit is still running into that problem, can we work on it to maintain the article's scope to be the control of F- level in water for the purposes of controlling tooth decay? Zad68 03:10, 21 February 2013 (UTC)

Sure - there's no debate that this is about the public health application, it's just that 'water fluoridation' has a plain language meaning of 'processes that add fluoride to water', this comes out in the literature where you see papers and public health authorities distinguishing between community fluoridation and natural fluoridation. My edit is meant to make clear that, in this context, 'water fluoridation' is used as short hand for 'community water fluoridation'. Tilapidated (talk) 03:21, 21 February 2013 (UTC)

Glad we agree on that. So what exactly is missing from the current sentences:

Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride.

Aren't all the items covered: F- is controlled for the purposes of dental health, it may come naturally, it may be added. Is the only thing missing the mention of the term Community water fluoridation? We can do that by just changing the opening words to: "Community water fluoridation is..." and we're done? Zad68 03:42, 21 February 2013 (UTC)

Well the problem is that this is only true from a fairly specific perspective. People who are familiar with the term from a public health perspective are used to using the term 'water fluoridation' to mean 'community water fluoridation', for their purposes there are no other meanings. People who are used to the research around this are more used to carefully distinguishing between community water fluoridation and natural water fluoridation, for example when conducting comparison studies of communities who receive water fluoridation from natural sources. It's fine to declare that this article will use the term in a specific way, and changing the opening words as you suggest gets us most of the way there, but I'm not sure why you're opposed to recognizing that term 'natural water fluoridation' exists, or that water fluoridation is also a natural process, and that important studies examine the effects of community water fluoridation alongside natural water fluoridation, both of which are types of water fluoridation? Tilapidated (talk) 06:11, 21 February 2013 (UTC)

I want to make sure I understand your concern correctly: Regarding natural water fluoridation, are you saying that there's an encyclopedic topic regarding the study of the health effects of naturally fluoridated water on communities, and that those health effects being studied are things other than dental health?

If that's not your concern, and we're all still in agreement that the scope of this article is the control of the F- levels in water (whether the F- got there naturally or artificially) for the purposes of improving public dental health, then I'm still missing what the issue is. Is it just that the term natural water fluoridation should appear? I did searches on PubMed - "water fluoridation" is by far the most common term, "community water fluoridation" is used but much less frequently, and "natural water fluoridation" is relatively uncommon. The current lead does say "this can occur naturally" and, in my opinion, that's sufficient to cover it. Would adding a redirect from natural water fluoridation to this article cover this part of your concern? Zad68 14:35, 21 February 2013 (UTC)

I don't think we're in substantial disagreement. This page is about the addition of fluoride to water for public health reasons. As you point out, PubMed most commonly calls that 'water fluoridation', which isn't really shocking, because it's medical journal search tool. As you also point out 'community water fluoridation' is also used as a synonym in the public health literature.

Of course 'natural water fluoridation' isn't a common term in public health, because the process of adding fluoride to water through geological means is not something that public health researchers concern themselves with.

It seems clumsy to me to lead with a narrow and specific definition, which, while it it the most common, leads us to have to go back and explain its inadequacy later on. It's fine to use 'water fluoridation' in this context as a short-hand for community water fluoridation, knowing that our audience doesn't assume that we're meaning the sum of all water fluoridation processes, but I feel for the sake of correctness and clarity we should get the issue out of the way, define our terms correctly and declare that we're going to be using the terms in a particular way.

Not doing this means that we have to use an ambiguous term, and then scatter awkward explanatory statements throughout the article.

Rather than saying "a: Water fluoridation is the process of fluoridating water, by whatever means, b: Community water fluoridation is the deliberate public health application, frequently used synonymously, and c: natural water fluoridation is the geological process that is beyond the scope of this article." We have, instead to pretend that the narrow public health shorthand is the only valid definition of the term, rather than just the prevalent one. It leads us to "Water fluoridation is the deliberate public health application of fluoride, it also happens naturally" which leads me to ask - well what's it called when it happens naturally? When it comes up in the article the term 'naturally fluoridated water' is always used - how did it come to be 'naturally fluoridated'? One presumes that water fluoridation took place naturally, but are assured by the definition that the term only applies to artificial fluoridation.

I guess my concerns come down to: a) the current definition is very narrow in scope, and fails to recognize the terms broader meaning before settling into the common public health meaning, and that b) this leads to confusing asides throughout the article, and c) obscures the fact that natural water fluoridation is of concern to people studying optimal fluoride levels. Hope that makes sense. Tilapidated (talk) 15:09, 21 February 2013 (UTC)

We're not in substantial disagreement, good! I understand your points regarding the wording, and with them in mind, I read through the article paying special attention to the coverage of natural vs. artifical fluoridation. Personally, I don't think the article exhibits a tremendous problem with first describing fluoridation as the "controlled addition" of fluoride and then noting that due to natural fluoride levels, some water has to undergo defluoridation. The article's main focus is (correctly) the health effects of fluoridated water, and not how the fluoride got there, so this seems like not an overwhelmingly important issue. As you correctly point out, the normal public health view is that water has to have fluoride added to it. Because that's the normal view, it's perfectly appropriate for the article to approach it that way too, even though some water naturally has the right amount of fluoride, or has too much fluoride and needs to be defluoridated - these things are covered by the article just fine, in my opinion.

As we're writing articles for humans to read, developing them is only part science; it's in large part art, and often the choice of wording comes down to subjective choices over what sounds good. So, I understand what you're saying, but I don't think a change to the article is warranted. You are of course welcome to try develop a consensus of support from other editors for your proposed changes. Zad68 19:32, 21 February 2013 (UTC)

Your reply makes me think we're talking at crossed purposes. The issue I'm raising is the by defining 'water fluoridation' as 'community water fluoridation', we make the article inconsistent with studies that use the term 'water fluoridation' to mean both natural and community water fluoridation (all processes that add fluoride to water). That's all. Tilapidated (talk) 16:45, 22 February 2013 (UTC)

Nature and quality of scientific studies

A couple of users have reverted the addition of a section looking at the major academic reviews of community water fluoridation, and I'm struggling to understand their reasoning in doing this. The section as I inserted it is copied below, and consists of direct quotes from the most thorough peer reviewed literature reviews I have been able to find, all published from highly regarded research institutions in significant journals. I invite those reverting this information to kindly explain their reasoning, and am excited to see any other quality reviews that they feel are relevant. Tilapidated (talk) 23:31, 20 February 2013 (UTC)

The York Review

In 1999, the Department of Health commissioned CRD to conduct a systematic review into the efficacy and safety of the fluoridation of drinking water. The review was published on the CRD Fluoridation Review website and in the BMJ in October 2000. The authors stated in 2003: "We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth. The evidence about reducing inequalities in dental health was of poor quality, contradictory and unreliable. Since the report was published in October 2000 there has been no other scientifically defensible review that would alter the findings of the York review."

University Dental School, Cork, Ireland

A report on systematic reviews and studies was conducted. Of the 59 publications identified, 3 systematic reviews and 3 guidelines were included. The paper states: "While the reviews themselves were of good methodological quality, the studies included in the reviews were generally of moderate to low quality."

Department of Public Health, National Health Service Lanarkshire, UK

A 2008 literature review was undertaken on English language publications from 1996 onwards. Of a total 5418 nonduplicate citations identified, 77 were included in the review. The review concluded "fluoridation of drinking water remains the most effective and socially equitable means of achieving community-wide exposure to the caries prevention effects of fluoride."

The goal of Wikipedia is to create a cohesive article. Listing selected quotes from selected reviews is antithetical to this goal.Novangelis (talk) 00:51, 21 February 2013 (UTC)

I'm a little confused by your comment. The article already has a section entitled 'evidence basis'. I can't believe that you are seriously suggesting that the most significant reviews of the evidence basis should be excluded from this section? It's a little disturbing to me that you want to remove referenced descriptions of the best available science and replace them with unsupported claims. Tilapidated (talk) 01:01, 21 February 2013 (UTC)

Stop trying to argue to exhaustion by straw man (and ad hominem as above). We write in prose that follows sources.Novangelis (talk) 03:11, 21 February 2013 (UTC)

I don't understand your post at all I'm afraid. Let me re-phrase my question, in case I was not clear.

Currently, there is a section entitled 'Evidence basis'. It currently contains an entirely unsourced claim of effectiveness as an opening statement. I introduced an expanded section, giving more detail of the major literature reviews that address these issues.

I am a little perplexed that you want to remove well sourced references to the best science available and replace them with an unsourced statement. I understand you bring a strong point of view to this discussion, but it's my strong belief that the best way to resolve controversy is by reference to the science. I welcome you adding reviews and meta-studies that you think add to the debate, but am disturbed that you want to remove them. Tilapidated (talk) 03:18, 21 February 2013 (UTC)

That's not what he's saying. This is more a matter of style than anything else: Wikipedia articles that cite well-respected, very reliable sources like meta-analyses, literature reviews and statements from major medical organizations just state the results. We do not have to say "A review of this many studies by this organization said that F- reduces tooth decay." We just say, "F- reduces tooth decay" and cite the source. Zad68 03:24, 21 February 2013 (UTC)

Adding: I find this article's paragraph starting "A 2000 systematic review..." as pretty unusual, but the exception might be being made here because that 2000 review is historically significant and was very influential in driving the direction of the use of F-. Zad68 03:27, 21 February 2013 (UTC)

Adding again: The opening sentence of that section "Existing evidence strongly suggests that water fluoridation reduces tooth decay" is simply an overview or summary sentence to introduce the section. True there is no in-line cite for it, but that's because the entire section and the sources it cites support it. There isn't a need for a cite on that one sentence. Zad68 03:30, 21 February 2013 (UTC) -- In fact the NHMRC source, current citation #10, which is on the second sentence, supports the first. Zad68 03:32, 21 February 2013 (UTC)

There are 10 references used for the first time in the section and ~35 references (not necessarily unique) used in total. They include all three that you listed and (many) more.Novangelis (talk) 03:44, 21 February 2013 (UTC)

Exactly... it maybe just be Tilapidated was expecting see every sentence have a number in brackets after it, and just this one didn't. Zad68 03:47, 21 February 2013 (UTC)

Hi there - let's step back a minute - let me try to explain my concern with this section. It contains a number of different and conflicting statements about the effectiveness of fluoride for different purposes. This is quite confusing, and suggests that the evidence is strong, and unified in its findings. The final sentence references (among other things) the York study, and states that 'With regard to potential adverse effects, almost all research has been of low quality.[11]', what the York study says is that 'The quality of (ALL) studies was low to moderate.' They conclude that ' 214 studies; none was of evidence level A (high quality, bias unlikely).'

In the second paragraph we get into a relatively large section on the York Study "A 2000 systematic review found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth),[11]" . In a clarifying statement the study authors report 'We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth.' There is nothing in this section that gets to any of the nuance, methodological issues, study quality, and design issues that make the results of these studies as complex as they are.

With regard to the 10 / 35 references, I found the referencing confusing, with studies referenced that as far as I could see fairly clearly did not support the statements made. Also individual studies were cited alongside large scale reviews and meta studies. I think, given the contentious nature of this, and the generally mixed quality of the data and research, some discussion of the major landmark reviews of the literature, of the methodological issues, and of the problems interpreting the data would be helpful.

You rightly point out that current citation number 10 does support the opening statement, but the problem is that there is such a wide range of studies and reviews, concluding a wide range of findings, from strong support to weak support with some contrary findings. To pick one of them, without declaring the range of serious scientific work, and disagreement within the field, is problematic.

I do understand what I think is motivating you on this - you don't want to be seen to give any ground on the issue of certainty of belief in fluoride - but I hope you understand that being unwilling to critically examine the evidence actually undermines the claim to be scientifically driven. Tilapidated (talk) 06:32, 21 February 2013 (UTC)

The article reflects the complete lack of scientific descent on the issue. Your current objection is that the article loses some nuance as it summarizes a particular source. So far, it sounds like you're cherry picking. TippyGoomba (talk) 06:43, 21 February 2013 (UTC)

I'm not certain how you can suggest that there is a 'complete lack of scientific descent on the issue'. The article (not me) cites a literature review commissioned by the UK Chief Medical Officer of the Department of Health which involved “an up to date expert scientific review of fluoride and health”. It was published in the British Medical Journal and reviewed 214 studies. The authors state: "We were unable to discover any reliable good-quality evidence in the fluoridation literature world-wide. What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth."

I fail to see how that reflects either cherry picking on my part, or a 'complete lack of scientific descent on the issue'. I am simply pointing out that the evidence is complex and mixed in quality. Tilapidated (talk) 06:52, 21 February 2013 (UTC)

By descent I mean a quote along the lines of "it's bad for reasons XYZ" or "we could not disprove the null hypothesis to a high degree of certainty". Use whatever word you want. It's cherry picking because you picked one sentence form one source. TippyGoomba (talk) 07:42, 21 February 2013 (UTC)

I did refer to 'one source', the source that the paragraph in the article that we're talking about refers to. I fail to see how citing from the authors of the study that the article is talking about is 'cherry picking'. To cite from a different one would be irrelevant and misleading.

While the study (that the article, not me) chose to talk about is 'one source', it is one of the most significant peer reviewed literature reviews available, covering, as I pointed out, hundreds of studies, so while it is 'one source', its scope is enormous - that's why it's mentioned in the article. Not having the space to quote the whole text, I picked a sentence that summarizes the results of the study. Luckily, I don't have to pick a quote that could be unrepresentative, since the authors themselves summarize the study clearly. The statement on the Center for Reviews and Dissemination website is short and concise, and gives insight into the opinions of the authors http://www.york.ac.uk/inst/crd/fluoridnew.htm. I still struggle to understand your accusation of 'cherry-picking', and your claim that there is a 'complete lack of scientific descent on the issue'.

The current paragraph on the scientific research is inadequate and misleading. The most significant finding from the York review was not that they thought that the research supported or did not support fluoridation, but that the data was so poor in quality that it was difficult to be sure with any degree of certainty. Nothing in the current section indicates any such issues. Tilapidated (talk) 15:20, 21 February 2013 (UTC)

Proposal to add some material on the scientific research to the 'science basis' section

Currently the article refers to the York Review explicitly, but does not deal with it in any systematic way. I propose a short section that outlines the largest and most significant reviews of research in this area, with a summary of their findings, which are typically much more nuanced than the statements in the article right now. Currently the article does not do justice to the methodological issues, data and analysis quality, and types of study. I feel that the three major studies proposed above would be a good start, but am very open to discussion about which ones are the most significant and scientifically rigorous. Tilapidated (talk) 16:28, 21 February 2013 (UTC)

The York report is from 2000, states "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence" and the evidence quality is described as "moderate". We also have multiple, other newer analyses and statements from major medical organization. In particular we have a newer (NHMRC 2007) analysis from the Australian government, and after reviewing basically the same data, it states "The existing body of evidence strongly suggests that water fluoridation is beneficial at reducing dental caries". This Australian NHMRC study specifically talks about the York analysis (McDonagh 2000). We generally prefer the findings of the most up-to-date secondary sources. Any changes proposed to the article in this area would have to based not only on McDonagh 2000 but also NHMRC 2007 and the several other newer reviews and meta-analyses available. I cannot find any compelling reason to have the article feature McDonagh 2000 over the several other, newer sources we have. Zad68 20:10, 21 February 2013 (UTC)

The quote you mention is referenced in the article to a number of studies, including the York study, which clearly does not support it.

The article already does feature McDonagh 2000 over other newer reviews, and the authors' statement is from 2003. It also mentions the NHMRC, although gives it less text real-estate, then goes back to talk about a 2002 study. What I am proposing is that we update this to feature the various major literature reviews and their findings systematically, rather than in the rather haphazard way it is done now. I think the NHMRC review is significant, partly because it follows the same inclusion methodology as the York study, so it is directly comparable, although disapointingly it only adds one study to the York dataset. While many are referenced, pulling this one out in the text, and then misrepresenting what it says, seems odd. It sounds like you are agreeing with me? Tilapidated (talk) 22:54, 21 February 2013 (UTC)

Eubulides, the main author of this article till 2010 was fastidious about using the best and most up-to-date sources, and sticking closely to what they said. Hence the "strongly suggests" phrase comes exactly from the NHMRC 2007 source. As noted further up, the best encyclopaedic style is for us to state facts rather than argue the case in front of the reader. The reader has links to the sources of those facts if they wish to examine the reviews and studies in detail. It may be that we personally disagree with those sources or feel we could do a better review of the primary literature, but that is not our job and as Wikipedians we have limitations that don't exist in other publications. Where there are high quality reports or reviews published since 2010, then I would think they are worth examining. Such as the US lowering of the recommended levels in 2011. On a personal note, I've been struck down with a cold and my brain has turned to cotton wool -- so I may not be up to much for the next few days. Colin°^Talk 21:17, 21 February 2013 (UTC)

Colin, the issue isn't whether any of us personally agree or disagree, but about presenting the range of findings in the serious literature. I find it strange that you would want to throw out literature reviews done before 2010, that certainly isn't normal practice, and Eubulides certainly didn't do that. Indeed some of the most useful research in this area comes from the 50s and 60s. The change over time of findings, interpretation, and methodologies is useful in understanding how policy has changed over time. The York dataset is essentially the same (with one fewer study) so the differences in findings language seems interesting. The fact that two respected groups can come up with reviews of essentially the same studies, and come up with completely different results is very significant. To obscure that is to mislead the reader into thinking that the science is uniformly interpreted. Tilapidated (talk) 22:54, 21 February 2013 (UTC)

I agree with Colin about the style of the presentation. IMHO, "a short section that outlines the largest and most significant reviews of research in this area" would be unwise because we get into cherry picking of "significant reviews" and of phrases from those reviews. I also think that as an encyclopedia, Wikipedia has useful scholarly inertia, it does not report the latest review ([{WP:NOTNEWS]]) especially in an area where there are virulent fringe groups (like the infamous Fluoride Action Network). And I worry about taking advice from new, single issue editors. What is lacking in this article are citations to mainline dental textbooks. But I am jumping into a long conversation, I can see. --Smokefoot (talk) 23:28, 21 February 2013 (UTC)

Hi there Smokefoot - I'd encourage you to try to set aside your prejudices and think instead about the issue. I'm a little disturbed by your comments - we already have the section that you think is unwise, it's just that currently is rambling and does not really do justice to any of the reviews it cites, cherry-picking, as you warn against. The section is really not a news report - the latest review that is significant is a couple of years old as far as I can see. I don't think anyone is mentioning campaign groups, we're talking about peer reviewed scholarship in mainstream journals. I don't really see any dispute here about the type of study that would qualify for such as section. Hope that clarifies! Tilapidated (talk) 00:02, 22 February 2013 (UTC)

Tilapidated, where have I said I "want to throw out literature reviews done before 2010". We will not make progress with such nonsense misinterpretations. Slow down. Read the whole article. Read the existing sources. Read what other people are actually saying. I'm saying this article is almost certainly good wrt any sources published up to 2010 but may be lacking in newer sources. Therefore my priority is to consider if there is anything new to report because I'm very doubtful that rehashing reports from 2000, no matter how important they may be, will bring new light. Colin°^Talk 14:09, 22 February 2013 (UTC)

Hi Colin - it was you saying that you wanted to use only the most up-to date sources, and that 'Where there are high quality reports or reviews published since 2010, then I would think they are worth examining.' that led me to believe you were not interested in sources pre 2010. I'm glad I misunderstood you! I'm not sure what you mean by 'rehashing', but as you most likely know, research is iterative. Eubulides referenced the York study (I imagine) because it remains one of the most significant reviews. Subsequent studies have often adopted the same inclusion methodology, and draw heavily from it. The MHMRC study reanalyses (rehashes, if you will) largely the same dataset. ;) Tilapidated (talk) 16:50, 22 February 2013 (UTC)

Changes to the effectiveness section

I made some minor edits to split paragraphs, and removed a sentence from the section on the York review that was in direct contradiction to the text of the review. I removed:

which is roughly equivalent to preventing 40% of cavities.

because the text of the York Review (page xii) says 'The degree to which caries is reduced, however, is not clear from the data available.' The quote refers to topical fluorides, and is original research in direct contradiction of the study in question.

It appears that TippyGoomba reverted the change within four minutes of my making it, of course without commenting here, claiming that there is no consensus for the change. So - I guess the question is - is there a consensus that clear factual errors in citation remain on the page? Thanks.Tilapidated (talk) 02:14, 22 February 2013 (UTC)

OK Tippy - that's now twice you've reverted without discussion in the same few minutes. Since you posted a link to the BRD, please do explain your commitment to keeping errors of fact in the article. Thanks, Tilapidated (talk) 02:47, 22 February 2013 (UTC)

I'm not Tippy but here's my observation - The edit under discussion made this change:

...water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth) , which is roughly equivalent to preventing 40% of cavities., but found that the degree to which caries were reduced was not clear from the data available.

I agree with the revert of this change, because it appears to make the article self-contradictory. The previous sentence explained the degree to which caries were reduced, and so it's incongruous to follow that up with a statement that the degree to which caries were reduced wasn't determinable. The statement that the York report "found that the degree to which caries were reduced was not clear" isn't an accurate representation of the source. I don't find a problem with the use of PMID 12914024. Zad68 02:48, 22 February 2013 (UTC)

So Zad - I have a couple of questions for you: in what respect is "the degree to which caries were reduced was not clear from the data available." (my summary) not an accurate representation of the source text "'The degree to which caries is reduced, however, is not clear from the data available."?

I think there is confusion around the stated ranges of observations in the studies with the degree of claimed reductions in caries that the analysis supports. While they report the observations, the data quality and ranges make it impossible for the study authors to specify the real reductions. They say this clearly in the review. To splice in our own analysis from another study is not only original research, it's poor quality original research.

The statements are not contradictory - one statement reports values, the other conclusions that can be drawn from them. We can't remove the conclusions that the original authors came to and replace them with our own because we don't like the original ones. Tilapidated (talk) 02:55, 22 February 2013 (UTC)

Here - to be clear, is the whole original quote from the study (page xii) "The studies were of moderate quality (level B), but of limited quantity. The degree to which caries is reduced, however, is not clear from the data available. The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%)." The two statements are not contradictory, and are taken directly from the source. Tilapidated (talk) 03:04, 22 February 2013 (UTC)

Again with the cherry picking. TippyGoomba (talk) 04:10, 22 February 2013 (UTC)

I think perhaps that term doesn't mean what you think it means. That is the whole of the relevant quote from the original study that is referenced in the article. Perhaps you could show me where in the review there is more context that changes the meaning of the statement "The degree to which caries is reduced, however, is not clear from the data available.'? Tilapidated (talk) 04:13, 22 February 2013 (UTC)

You are reading the sources for quotes which serve your agenda. That's cherry picking. Now you're asking me to cherry pick my own quotes. Cute game, shall we play for shots? TippyGoomba (talk) 04:18, 22 February 2013 (UTC)

I'm sorry - I'm not able to understand you at all. The article version that you reverted to takes a quote from the York Review "The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%)", then cuts in a completely different claim about the number of carries that is reduced, referencing a topical fluoride study. That is what 'cherry picking' refers to - taking the pieces that you want from two different studies, and pasting them together to form a meaning not found in the original. The complete quote from the original study is what I included - that is the opposite of cherry picking. Tilapidated (talk) 04:22, 22 February 2013 (UTC)

Regarding the York study results, I think what I'm trying to get at is that we need to re-present the technical information the study gives us in a way that's accurate but also meaningful to a layperson, our intended audience. The lack of clarity (I would say precision) in the York summary is expressed in the large ranges of the means, and this is faithfully represented in our article, and then a layperson-friendly equivalent is given. The "roughly 40%" isn't out of line with what other reputable sources say, for example the ADA says "Today, studies prove water fluoridation continues to be effective in reducing tooth decay by 20 – 40%", this large study from Australia found about a 30% reduction. It's reasonable to take the study's description of the effects as imprecise, put the ranges in the article, and use language that expresses that level of impreciseness in providing a lay-friendly interpretation. P.S. The Princess Bride was one of my favorite movies! Zad68 04:20, 22 February 2013 (UTC)

The way that the paragraph reads right now implies that the York Review shows 40%. If you want to put another paragraph in about another study that shows a 40% reduction that's great, but what I was correcting is the addition of a comment to the findings of the York Study, the authors of which specifically say in the same paragraph in which they report the ranges, that the degree of reduction of caries is impossible to report from their data set. It's not lay-friendly to replace their conclusion with someone elses - it's in direct contradiction of their conclusion. Tilapidated (talk) 04:27, 22 February 2013 (UTC)

You missed my zoidberg :P TippyGoomba (talk) 04:25, 22 February 2013 (UTC)

How did a Futurama ref blow by me?? Must be bedtime... Zad

Are we having the same conversation? Tilapidated (talk) 04:28, 22 February 2013 (UTC)68 04:28, 22 February 2013 (UTC)

OK - lets try this - does anyone dispute that the original review says 'The degree to which caries is reduced, however, is not clear from the data available.", and that they are talking about the ranges they report?

If so, that's pretty easy to fix. If not, please explain why it's ok to remove their conclusion, and replace another one from a completely different study? Tilapidated (talk) 04:30, 22 February 2013 (UTC)

The source text "The degree to which caries is reduced, however, is not clear from the data available" is not a "conclusion" but an introductory clause to their more detailed figures of the range/median etc. The words "not clear" are unhelpful imo. I can see what they are saying but the reader will too easily confuse that with "might be nonsense" -- scientists fall over themselves to clarify the uncertainties in their research, and this is often interpreted by the public as them not really having a clue or changing their minds all the time (is red wine good or bad for me this week?). As Zad notes, it is lack of precision that upsets the York authors, not whether there is a reduction at all. We already give (almost too much) detail on the statistics. I propose our version of this clause says "although the degree to which caries was reduced varied considerably in the studies examined." This is imo a fine introduction and lay summary of the rather complex statistics that follow. Colin°^Talk 14:57, 22 February 2013 (UTC)

Hi Colin - I understand that you don't like the conclusions that the York Review authors came to, I just think it's not appropriate to change their conclusions, and substitute ones we prefer. When they use 'not clear' they are expressing uncertainty about the ability to specify a reduction in caries based on the available data. It's not simply a lack of precision, some of the studies show an increase in caries from fluoridated water (-5.0 to 64%) so it's not simply that there is a problem about specifying degree of reduction. It's really important to try to understand the difference between a reported range (which is what the numbers are) and conclusions that are drawn from that. The York team are explicit that they cannot make any claim about the degree to which caries are reduced based on their data.

Perhaps you want more evidence that this is not simply an obtuse reading of the paper? Let's go to their statement, three years later, where they clarify their findings. "What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth." http://www.york.ac.uk/inst/crd/fluoridnew.htm

I would propose that statement as a clear, layman's explanation of what they found. Tilapidated (talk) 16:59, 22 February 2013 (UTC)

Worthington

Colin - for clarity I created a new section here - I hope you don't mind me splitting your post - let me know if you do and I will restore it. Tilapidated (talk) 17:01, 22 February 2013 (UTC)

Wrt to the 40% figure from Worthington2003:

"Other researchers claim that fluoridation results in a reduction of 40% in cavities. Worthington H, Clarkson J. The evidence base for topical fluorides. Community Dent Health. 2003;20(2):74–6. PMID 12914024."

Does anyone here have access to that paper? Although it is ostensibly about topical fluoride, I can only assume that the 40% figure is those authors' interpretation of the York review data, otherwise it wouldn't have been spliced into that paragraph. Or perhaps they cite yet another source for that figure. We need to get to the bottom of that. Btw, we should avoid using the word "claim" for results coming from reliable secondary sources because it implies we may not believe them. That word should be used with caution and only where we are talking about "facts" stated by unreliable sources. For example, Wakefield's claims about autism. Therefore I propose we remove that sentence/source from the article text until someone with access to it can convince us of why it should be included. Colin°^Talk 14:57, 22 February 2013 (UTC)

I have no idea why a reference to a study about topical fluoride was added, I can only assume, as you do, that it was citing the York study, but that's not clear. Either way, what's important to me is that we make clear who is making what claim.

I take your point on the word 'claim', and am happy to remove it - I certainly believe them, and put it in because I felt you did not. Consider that the term has a technical usage too that may be appropriate here as we deal with several different studies that assert different things. We're not doubting any of the studies, simply dealing with the fact that different researchers find different results and draw different conclusions. Tilapidated (talk) 17:05, 22 February 2013 (UTC)

I have found another source based on Worthington here page 6. The 40% figure is a calculation based on York's 2.25 teeth median figure. Therefore it is valid expert interpretation of the York data and quite acceptable to be spliced into that paragraph. Colin°^Talk 17:36, 22 February 2013 (UTC)

Colin, that's completely disingenuous. It's fine to have a sentence saying that some other researcher chosen to draw different conclusions than the authors of the study, but cherry picking the beginning and ending of the sentence from different places, directly contradicting the meaning of the original author is ridiculous. Tilapidated (talk) 17:47, 22 February 2013 (UTC)

I'm going to see if I get hold of Worthington. Until one of us has actually read it, please hold your tongue. Colin°^Talk 17:54, 22 February 2013 (UTC)

STOP

Can I request that everyone stop editing this article right now. It is clear that recent changes reflect a misunderstanding of the sources used and that the original text was absolutely fine. In light of this we need to discuss changes before editing the article any further. Colin°^Talk 17:36, 22 February 2013 (UTC)

Page is fully protected for one week. I will add consensus changes if developed here. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:55, 22 February 2013 (UTC)

It's not remotely clear that the original text was fine - in fact its blindingly obvious that the original text is a gross misrepresentation. I get that you're passionately invested in this issue, but taking the conclusions of a serious study, and replacing them with those of a pamphlet put out by the British Fluoridation Society that better fits your point of view is ridiculous.

The authors of the York Review say ""What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth." http://www.york.ac.uk/inst/crd/fluoridnew.htm

I am honestly baffled that you think it is ok to represent in the same sentence as reporting their numbers that it is "is roughly equivalent to preventing 40% of cavities." It's directly contradicting their reported findings. Tilapidated (talk) 17:57, 22 February 2013 (UTC)

When reporting the results a scientific review, is it appropriate to substitute other researcher's interpretations, or should we report on the original author's conclusions?

Currently the article section in question reads: "A 2000 systematic review found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth), which is roughly equivalent to preventing 40% of cavities."

The authors of the review cited state "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score. The studies were of moderate quality (level B), but of limited quantity. The degree to which caries is reduced, however, is not clear from the data available. The range of the mean difference in the proportion (%) of caries-free children is -5.0 to 64%, with a median of 14.6% (interquartile range 5.05, 22.1%). " and that "What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth." http://www.york.ac.uk/inst/crd/fluoridnew.htm , http://www.york.ac.uk/inst/crd/fluorid.htm

The York authors' conclusion is that, while the evidence suggests that fluoridation reduces caries, it is not possible to make definitive statements about levels of reduction of caries based on their data. This has been replaced with the interpretation of Worthington H, Clarkson J. (The Evidence Base for Topical Fluorides. Community Dental Health, 2003, 20: 74-76.) cited in a pamphlet by the British Fluoridation society offering the interpretation their interpretation of the York data as "roughly equivalent to preventing 40% of cavities."

Tilapidated (talk) 18:39, 22 February 2013 (UTC)

I propose presenting the views of both the authors and commentators (from quality peer reviewed sources) and clearly attributing them, but the current phrasing (omitting the original conclusion and inserting another) suggests that the 40% figure comes from the review, and obscures the different conclusions of the original study authors. Tilapidated (talk) 18:39, 22 February 2013 (UTC)

I propose the following wording for the paragraph (citations are not shown in this version): "A 2000 systematic review of 214 studies (The York Review) stated that 'the best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence', but 'that the degree to which caries is reduced, however, was not clear from the data available', and that 'the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth'. Commentators (including Worthington et al) propose that the York data may be interpreted as "roughly equivalent to preventing 40% of cavities."

The review found that the evidence was of moderate quality: many studies did not attempt to reduce observer bias, control for confounding factors, report variance measures, or use appropriate analysis. Although no major differences between natural and artificial fluoridation were apparent, the evidence was inadequate to reach a conclusion about any differences."

The conclusions quoted are from the study or the subsequent author's statement. Tilapidated (talk) 18:59, 22 February 2013 (UTC)

• Comment This RFC seems to be comparing apples and oranges, the two items mentioned aren't dependent on each other. Worthington and Clarkson's analysis is from PMID 12914024, it may have been cited in a pamphlet but it's also cited by, for example, Ireland's comprehensive Oral Health Services Research Centre report, and was made in direct comment and review of the York report. Worthington and Clarkson are the editors for the Cochrane Oral Health Group, which makes them as prestigious and reliable a source as needed for the kind of basic math analysis they're making. If that's the apple, the orange is whether the York study's findings are accurately represented in the article. As has been mentioned elsewhere on this Talk page, the view is that the specific ranges provided in the York report are represented in the article. Expanding the citing of this 13-year-old report (especially as we have newer sources reviewing the same data) to essentially repeat the fact that the range of the specific values provided was broad seems unnecessary. Zad68 18:55, 22 February 2013 (UTC)

I'm not suggesting that Worthington et al are not suitable commentary, simply that we should not substitute their conclusions for those of the original authors. I propose mentioning Worthington's comment, but clearly attributing it. Unfortunately the math is far from basic. Simply taking the median of the means of the studies, and then attempting to figure out from that the reduction in caries is something the York team declines to do on the basis of their understanding of the quality of the data. There are all kinds of methodological reasons why this is not a simple or appropriate thing to do, as they point out in several different places (another example "The best available evidence on stopping water fluoridation indicates that when fluoridation is discontinued caries prevalence appears to increase in the area that had been fluoridated compared with the control area. Interpreting from this data the degree to which water fluoridation works to reduce caries is more difficult" page 67 of the report). I'm not opposed to showing that others do it, but I think it's important to point out that the authors specifically claim that the data doesn't support it.

Since we do mention the 13 year old article, we should represent what it says accurately. Tilapidated (talk) 19:03, 22 February 2013 (UTC)

The statement above "cited in a pamphlet by the British Fluoridation society" isn't a helpful characterisation of the source. Where it ends up getting cited is of little matter. More important to consider whether the authors and journal form a reliable source. They do. I now have access to the editorial and is indeed those esteemed authors' interpretation of the York figures. Since as Wikipedian's we are unable to perform such interpretations, we rely on the best authors in the best publications to do that for us. The article text currently makes it quite clear, both in that paragraph and surrounding text, that studies vary hugely in their numbers and that the York findings were of a wide range so I don't think we are misguiding the readers at all. In fact, wrt the 14.6% figure, Worthington and Clarkson state "It is important to emphasise that a change of 15% in caries free is a huge reduction in caries". Colin°^Talk 20:07, 22 February 2013 (UTC)

I agree - I was simply citing where I was shown it (by you). It's standard practice to report where you saw citations if you have not seen the original. I also agree that Worthington is an appropriate source to cite.

Where I disagree is that we should, in describing the York Review's findings, replace their conclusions with those of Worthington. We should represent Worthington, but separate from our reporting of the York review's findings. The two sources disagree on the meaning of the data - we should reflect that. The 15% figure is the median of the means of the studies reviewed, and the York authors assert that in their opinion it is not possible given the quality of the data to draw conclusions about the degree of reduction from it. That Worthington disagrees is fine, but it's not our role to replace one set of findings with another. Tilapidated (talk) 20:20, 22 February 2013 (UTC)

We have policies for this. The York Review looked at primary sources and is so better that the original sources and is a reliable source. It also looks to be unbiased when compared to the cheery-picking of many of the tertiary sources that comment on the York Review to support their own field or specialty. However see Wikipedia:PSTS#Primary.2C_secondary_and_tertiary_sources and make your own mind up.--Aspro (talk) 20:37, 22 February 2013 (UTC)

There is nothing in PSTS to say that tertiary sources are more biased or likely to cherry-pick. Indeed the whole ethos of Wikipedia is that editors must not themselves cherry pick. Therefore, I'm far more comfortable with Worthington and Clarkson of the Cochrane Oral Health Group interpreting the York review than User:Tilapidated, User:Colin, User:Aspro or User:AnyoneElse. Because experience is that Wikipedian's are awful cherry pickers. It is easy to assume "X says something I disagree with => X must be biased". Far harder to accept that X may have a point even if I disagree with them. But ultimately I'm puzzled by the fuss created because the section on efficacy is quite clear about the range of study results and the lack of truly high-quality research in this area. The worry over who's wording this is isn't really that important to the reader: like worrying which of the York study's authors wrote that bit or who of Worthington or Clarkson came up with the 40% figure. We cite where it came from, and the reader can follow the links if they care to. Colin°^Talk 22:24, 22 February 2013 (UTC)

That's a bizarre characterization Colin - it is not me interpreting the York Review. My view on this is that we should present the conclusions of the York Review, and the conclusions of relevant commentators, not remove the conclusions of the review authors and replace them with the commentators, especially where there is a direct conflict between them. The issue is not simply the range, but the fact that the York authors specifically state that the data does not support conclusions in the size of the effect. Tilapidated (talk) 23:21, 22 February 2013 (UTC)

WP also expects editors to use their common sense. Say a tire/tyre manufacture reviews a review, on general aircraft safety. Would you expect it to only comment on those aspects that affects it position... Yes. Would it included self criticism on over-speed-tire busts (pilot error) etc.? Or included its on analysis of air craft safety that concerns flight engineering and systems that is out of its field of expertise? No. So it would cheery pick from the whole mass of data. Therefore, they would not give balanced view of the whole original study. Thus, is the problem with many and most tertiary reviews and why we should not use them as summary’s. I would have been shot if I included such a reference in a technical report.--Aspro (talk) 23:07, 22 February 2013 (UTC)

Wikipedia is quite different source-wise and editing-wise from any other publication on the planet. Academic writing would cite primary sources and landmark reviews only -- citing a plain old literature review would be very bad form. As for common-sense, I have no reason to think that Worthington and Clarkson's comments on the York data are faulty and every reason to think they know an awful lot more about the subject than any of us. Colin°^Talk 23:20, 22 February 2013 (UTC)

Colin - I'm not sure you understand what is being proposed - you seem to be arguing a point that no one is making. Worthington disagrees with the conclusions of the York review. Replacing the York review's conclusions with those of Worthington is confusing and does not make plain the range of opinions. The proposal is to state the conclusions of both, but state and attribute them clearly. I'm baffled as to why you would want to oppose that. Tilapidated (talk) 23:24, 22 February 2013 (UTC)

"Worthington disagrees with the conclusions of the York review" Really? You know them personally? You've read the paper and they say this? -- Colin°^Talk 23:28, 22 February 2013 (UTC)

Actually Colin. The WP article say: “A 2000 systematic review found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth),[11] which is roughly equivalent to preventing 40% of cavities.[52]” (emphases mine). Yet, Worthington is accentual talking about 'topical' fluorides -which the York Review does give some credence to . So this sentence in the article is misleading to link it to water fluoridation. This goes back to my comment above, that I would have been shot for mixing things up like this.--Aspro (talk) 00:10, 23 February 2013 (UTC)

I'm aware of what the article is about and fully aware of what Worthington and Clarkson wrote because I've read it. If you had, you wouldn't make this remark. Colin°^Talk 16:01, 23 February 2013 (UTC)

Honestly, Colin, I have a hard time following you. I think you are misunderstanding me for comic effect? Worthington, in his paper (the one we're talking about above) offers an estimate of the percentage reduction in caries based on the median of the means of the 214 studies in the York Report. In the York report (and in subsequent writing) the York authors explicitly state that this is not possible based on the data quality. They come to different and incompatible conclusions about the ability to make a determination about the size of the effect. I hope that is clear? It is these different conclusions that make it inappropriate to remove York's conclusions and substitute Worthington. We should cite both, but be clear which is the original author and which is commentary. Tilapidated (talk) 23:42, 22 February 2013 (UTC)

On Wikipedia, we are writing an encyclopaedia, not an academic journal. For that to work, and be accessible to a wide range of readers, some interpretation of complex statistics and figures is helpful. But we cannot do such interpretations ourselves beyond the most basic maths per WP:OR. The Worthington and Clarkson figure is an interpretation of the York results. Several times in the section we talk of "reduction in cavities" but the York figures are a "reduction in children with any cavities" or a "decrease in decayed teeth". For the reader to compare the various reviews, it is helpful to not be comparing apples with oranges. The Worthington and Clarkson figure lets the reader see that the median result in the York review roughly corresponds to a 40% reduction in cavities. But we make quite clear that the York results cover a wide spread. Indeed reading the whole section, the reader is left in no doubt that reviews vary widely in their results and there is no one true figure.

Pulling out Worthington and Clarkson's 40% figure into its own paragraph ("Other researchers claim that fluoridation results in a reduction of 40% in cavities.") made it appear this value was the result of different review or even a different study performed by those authors. It isn't and so doing that is misleading.

I think the statement "range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth" is a quite misleading summary of their figures. Although factually correct, it gives equal emphasis to the "slight disbenefit" side which is clearly an outlier in their data (it comes from one study out of 30, whereas 20 showed a significant benefit). It should be noted that this text is from a press-release on their website and not from the report itself or from a peer-reviewed journal. It is the sort of phrasing someone might make in a heated argument to make a point but hardly a balanced summary of the data.

On an encyclopaedia, the facts are more important than academic trivia like "The York Review" or "Worthington and Clarkson say..." This is just noise. The reader says "Why am I being told these names?" I do see some of Tilapidated's points though I feel the reader is not being nearly as misled as he thinks. How about

A 2000 systematic review of 30 studies found that water fluoridation was statistically associated with a decreased proportion of children with cavities (the median of mean decreases was 14.6%, the range −5 to 64%), and with a decrease in decayed, missing, and filled primary teeth (the median of mean decreases was 2.25 teeth, the range 0.5–4.4 teeth),[York] The range of study results varied considerably but for comparison with other reviews, the median figures have been interpreted as roughly equivalent to preventing 40% of cavities.[Worthington]

Colin°^Talk 16:01, 23 February 2013 (UTC)

Colin - there's plenty of interpretation in the article - this section is specifically on the scientific basis, and calls out several key literature reviews (I think there should be more, and more recent, but that's another issue). This isn't an introductory paragraph, it's a section devoted to the key science. I realize that what the York Review concluded isn't what you would have liked, but we need to stick to the science. It's fine to note that commentators have interpreted their figures differently, but the York authors are specific in pointing out that the quality of the data does not, in their view, allow conclusions about the size of the effect.

You say you are worried that "Pulling out Worthington and Clarkson's 40% figure into its own paragraph ... made it appear this value was the result of different review" - that's the point - Worthington is not an author of this review - his conclusions are a different piece of work, commenting on the York Review. They're not the same review.

Perhaps if you don't have a background in statistics this could seem obtuse, and it definitely sounds as if you feel that this is minor. Your statement that the -5% study is 'clearly an outlier' makes me think that you might not understand what the review is doing. This isn't a normal distribution that they are dealing with - it's the median of the means of all the 26 studies. Without knowing the population sizes, and the ranges and distribution characteristics of those studies, drawing conclusions about the size of the effect is impossible, and whether or not any particular study is an outlier is impossible (that data is not available for all the studies). When they say it's impossible to know the size of the effect from their data, they are making a statement about the quality of the data, not about fluoridation.

I'm not sure if I'm more amused or horrified that you characterize this as 'academic trivia'. To go ahead and do the calculation for them is to misrepresent their findings. Now, I'm happy to note that some commentators have gone ahead and done this, presumably they have their reasons, and that's fine, but to not represent the findings of the study is not a commitment to the facts, its a misrepresentation of the facts. Again, you may think it is misleading, but "range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth" is THEIR summary of their study. For the purposes of this article, whether you agree with them or not isn't the point. Tilapidated (talk) 17:36, 23 February 2013 (UTC)

As long as you keep saying things like "I realize that what the York Review concluded isn't what you would have liked, but we need to stick to the science" there really is no point in you or I conversing. I've made my position clear: I have none. Worthington is a not separate review but is a separate "commentator" as you put it earlier. And Worthington is a she. Again, I see little point in arguing over what that Worthington states with someone who misinterprets from a position of ignorance. I'm aware the studies don't form a normal distribution. But neither are they utterly random. Otherwise the author's wouldn't have stated their median or interquartile range but merely held up their hands in despair. But they did give the median figures and the 40% is an interpretation of that median so no more incorrect to give than the 14.6% decrease or the 2.25 teeth. Just another way of looking at those figures. I appreciate the nature of the studies and their analysis means this median is less useful a figure and that perhaps some authors are over-emphasising it.

The single negative result is unique, unrepresentative of the 30 studies and drowned out by the 20 studies that show a significant positive result. To give it equal weight when characterising the range is simply misleading. But this is beside the point -- we don't source an FA from a press-release on a website. Let's stick to what the serious academic literature says.

Re-read what I said was "academic trivia". Again, it is quite tiresome to argue with someone who misinterprets what the other person said. Must I spend most of my response correcting your mistakes while ignoring your insults?

Well I've offered a suggested change. It increases the emphasis on the wide range of results and makes it clear what the 40% figure is an interpretation of. Let's see what other people think, and I suggest you wait a few days till folk get back from the weekend. Colin°^Talk 20:23, 23 February 2013 (UTC)

Colin, let's get a few of the facts straight - the York authors don't throw up their hands in despair, no one is claiming they do. They quote the median and the ranges, and conclude that the evidence shows a benefit to fluoridation. They then explicitly go on (in the paper - you can ignore the press release, it's simply a re-stating of the paper, and I thought it might help you to understand the issues in the paper) to state that their data does not allow conclusions as to the magnitude of the benefit.

You may think that the York review is misleading, but frankly that's not relevant. Your or my opinion of the scientists' interpretation is not important - stating what their interpretation was is what is important. You statement that the 40% interpretation is no more incorrect than the other is fascinating, but not grounds for inclusion in an encyclopedia article. Your position disagrees with the author's of the studies. You have someone who commented on the study who agrees with you, that's fine, but it is important to include the conclusions of the original authors, even when they don't agree with our own positions.

Worthington's 40% is an interpretation, but it's an interpretation that is incompatible with the author of the study's interpretation, which is that you cannot conclude the degree of effect on the basis of their data. Worthington is not part of the review - she is writing a separate commentary on it.

You seem to be misunderstanding the claim that is being made still. The authors do claim a beneficial result, and don't give equal weight to the negative result, but the essential problem with the data quality (according to the authors) is that there is no way to tell reliably how much of a beneficial effect there is or how much weight to give to each study. That is why they conclude that there is an effect, but that it's impossible to know how big it is.

As I've said time and again, commentary of the study by third parties has a place, but it's not in the sentence where we report what the study found, especially where it conflicts with the study.

I have not insulted you. Tilapidated (talk) 22:09, 23 February 2013 (UTC)

Since nearly every statement above is a misinterpretation of what I said, I see no further benefit in continuing the conversation between us two. If someone else joins the conversation (be patient) then perhaps they can help or mediate. Colin°^Talk 22:39, 23 February 2013 (UTC)

From the above:Since nearly every statement above is a misinterpretation of what I said, I see no further benefit in continuing the conversation between us two. If someone else joins the conversation (be patient) then perhaps they can help or mediate.... It boils down to your view Colin, It doesn't it make sense on the basis of the evidence of resent scientific reviews of the literature. Water fluoridation has moved from a scientific hypothesis to a religious cult. Today, we need good evidence. What goes on WP should have some basis on scientific fact. Not, Oh well. we believed this for the last forty years so it must be true. Colin, Stop bashing your head against the brick wall of blind believe. To day we have Google and Google Scholar and medical practitioners (in Europe) have free access to data bases such as Ovid. Most of Europe ( and China et.al.) has now abandoned water fluoridation as a waste of money and scientific gobble gook. The English version of WP covers the English speaking world – please stop trying to impose you unscientific beliefs upon us for the reason it gives you a nice warm feeling inside. It is dental heath which matter -and don't forget you that!--Aspro (talk) 01:12, 24 February 2013 (UTC)

Aspro, per WP:NOTAFORUM any further posts like that will just be deleted. Per WP:NPA further posts like that will get you blocked. I will not warn you again. Stick to discussing the article text wrt the highest quality sources. If you can't do that, don't comment. Colin°^Talk 09:44, 24 February 2013 (UTC)

I'm sorry Colin - I am having a hard time understanding what it is you're trying to communicate. I do hope you try again, Tilapidated (talk) 23:20, 23 February 2013 (UTC)

I am not a big fan of the proposed new wording for a number of reasons "A 2000 systematic review of 214 studies (The York Review) stated that 'the best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence', but 'that the degree to which caries is reduced, however, was not clear from the data available', and that 'the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth'. Commentators (including Worthington et al) propose that the York data may be interpreted as "roughly equivalent to preventing 40% of cavities.""

• 1) If people which to know how many studies it is based on they can look at it.

• 2) We do not name any of the other reviews in the article so why this one?

• 3) It is IMO preferable to paraphrase as is done than to quote the exact wording. Doc James (talk · contribs · email) (if I write on your page reply on mine) 03:16, 24 February 2013 (UTC)

Plus the evidence for "does reduce caries" was drawn from far fewer than 214 studies. It is the paucity of even moderate-quality studies that is part of the issue, so claiming that 214 studies produce this result is widely over-stating the evidence-base. Colin°^Talk 09:44, 24 February 2013 (UTC)

Colin - you're quite right on the 214 - it should read 26 - 214 is the total number of studies considered, 26 is the number relevant to this issue.

Jmh - thanks for commenting - there are several studies called out in the science paragraph - I was proposing to name them for clarity, rather than referring to each as 'a study in 2000', or a study in 2007'. It's not important to me to name them, it just seems clearer. Stating the number of studies gives an indication of the scale of the review - several large scale reviews are cited, and there are others that have been proposed as relevant. These large scale literature reviews are one of the best ways of understanding the state of the science. Paraphrasing is fine, the issue is that the original conclusion has been removed and replaced with a conflicting one from another author entirely. Tilapidated (talk) 16:13, 24 February 2013 (UTC)

Support Colin's proposal above as it's a perfectly reasonable and accurate representation of both the York study findings, including a plain-language interpretation of the authors' observation of the wide result ranges, but also cites Worthington appropriately as an expert for a plain-language interpretation of the primary finding of a median 15% (rounded up from York's 14.6%) decrease in caries-free children which is exactly the thing Worthington comments on. The York study cannot at all be used in support of article content suggesting that no benefit was found, or that the benefit suggested by the data was statistically insignificant. York states very clearly and plainly at the introduction of the paragraph discussing the findings, "The best available evidence suggests that fluoridation of drinking water supplies does reduce caries prevalence, both as measured by the proportion of children who are caries free and by the mean change in dmft/DMFT score." Zad68 21:33, 25 February 2013 (UTC)

Holy-molly Zad. The York review doesn’t suggest that. Have any of you, done any more than skim though and cherry pick? They went on to say What the 'York Review' on the fluoridation of drinking water really found. “What evidence we found suggested that water fluoridation was likely to have a beneficial effect, but that the range could be anywhere from a substantial benefit to a slight disbenefit to children's teeth.” From an encyclopedic point of view this analysis should be accurately reflected in its 'proper' context. The word 'suggests ' is as they say based on poor studies. Thus, it is not WP's job to pass judgement on this evidence and unilaterally suggest “that fluoridation of drinking water supplies does reduce caries prevalence.” Surly you see this. We have to report the evidence as accurately as possible. I may have the advantage that havimg working in an R&D environment I am more use to annualising this type of literature but whilst Colin may accuse me of an ad hominem attack, when all I am attempting, is to get him to read the ruddy report as it is written. Why does subject of fluoridation warrant such convoluted debates. Just look at the length of this talk page. The Circular arguments just go round and round – lets just stop it... and just accurately report the unadulterated knowledge of what is and isn't known.--Aspro (talk) 19:06, 26 February 2013 (UTC)

It'd be very nice if you'd assume good faith, stop making snarky comments about your fellow editors at this article, and comment only on the content.

What exactly are you saying is the thing the York review authors do not suggest? The review itself, and the 2003 clarifying comment, state two important things regarding fluoridation and dental health: 1) there is moderate but not good quality evidence that fluoridated water is likely to reduce caries, and 2) the range of benefit of the evidence reviewed was wide. Now, please take a close look at Colin's suggestion above, both items are represented. Perhaps we can change "found" to "suggested". Also note that in the article right now, the very next sentence after this starts "The review found that the evidence was of moderate quality".

You state The word 'suggests ' is as they say based on poor studies - be careful here, the quality of evidence for a consequent increase in fluorosis was described as "poor". The quality of evidence for the reduction in caries was "moderate".

I'm still not seeing a significant problem with how Colin's suggestion, or the existing article content for that matter, seriously misrepresents the sources. Zad68 19:50, 26 February 2013 (UTC)

Request to Aspro - I haven't seen your suggestion for article content. Maybe you could clarify your position on how the sources can best be represented if you'd suggest a specific article content change? Thanks... Zad68 19:53, 26 February 2013 (UTC)

Hey, step back fellas and look at this unemotionally. I'd be happy to clarify my position (and I was trying to do before but obviously not well enough). Remove the opportunity of pro/anti fluoridation faux arguments and rename the article water fluoridates (there are two main common chemical compounds). Then have artifactual water fluoridation as a sub heading. Not a panacea but better than the situation we have at present. Why? The lead in the article: Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride.[2] is misleading. The York Review found that the much quoted studies did not control for any confounding factors. So, to a scientist they are not of a good quality. Argue that as you will but but it doesn’t change anything. So the phrase “ that is effective” needs qualifying with the word 'thought'. Water that contains certain levels of fluoride is 'thought' by some studies to prevent dental caries. Also if drinking water has high 'natural' or 'artificial' fluoridates which go onto cause server dental fluorosis, that make the teeth more susceptible to decay (there is no argument about this, last figures is saw suggested that over the life of a dental patient with server fluorisosis, costs for veneers etc., are currently somewhere in excess of US$10,000). It may be easy to concatenate 'artificial' and 'natural' into the same paragraph... that just-anybody-can-edit but it reads very amateurish. A 'Total dietary fluoride load' sub section can then be added in the appropriate place to give proper context to artificial water fluoridation’s Raison d'être (i.e., too little dietary fluoride) . Thus giving the WP reader (which is why we contribute is it not) a broad NPOV of the subject and the current state of knowledge.--Aspro (talk) 18:29, 27 February 2013 (UTC)

Quit with the "look at this unemotionally" crap please. The only thing I care about here is a high quality article on WP and have zero zip nada emotions wrt fluoridation. The article topic is artificial fluoridation. Deal with it. You are wrong about confounding factors. Read pages 5 and 6 of the report and note the studies were classed "B". That doesn't demote them to junk science as you are trying to make out. They have value but clearly everyone would want better designed studies. Very little in health and medicine is based on A-class research and indeed most government-led initiatives are based on no research whatsoever. Artificial fluoridation does not produce "high" levels of fluoride and does not cause "severe dental fluorosis". Concatenating natural and artificial text, when the sources don't (and they do so rarely) is called synthesis and not allowed per policy. We know why folk want to mix natural and artificial fluoride -- because then the lead image can be horrible brown stained teeth and the lead paragraph can mention brain-damaged children living in some toxic Chinese valley. But our best reliable sources do nothing of the sort, and neither should we. -- Colin°^Talk 19:14, 27 February 2013 (UTC)

Aspro, let me try to summarize your suggestions, and provide my responses:

• You are suggesting that this article should be renamed from "Water fluoridation" to "Water fluoridates" - this would have the effect of expanding the scope of this article from covering the artificial control of the F- level in water for the intended purpose of improving dental health, to the more general topic of the existence of F- in water, no matter how it got there, and not limited to a discussion of considering it for the purposes of dental health.

• My response: I do not support this proposal, as I think there should be a Wikipedia article about the specific topic of artificial control of the F- level in water for the intended purpose of improving dental health, and that is this article. However, others might support your suggestion. The way for you to go about this would be to start a requested move and explain your proposal, and there will be a discussion about how that will affect the article's scope. As an alternative, instead of doing this, consider creating a new article Water fluoridates, but be sure it does not duplicate or become a WP:POVFORK of this article.

• You appear to be suggesting that the existing article content (the opening sentences) "Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride." is misleading because of something in the York review, and that "that is effective" should be changed to "that is thought to be effective".

• My response: The article content you're quoting doesn't cite York, it cites the CDC. Are you saying the existing article content doesn't reflect the CDC's statement accurately? The CDC is unequivocal in its assertion that water fluoridation is effective. Or that the York review should be used in place of the CDC? Is there an argument being made that the York report should be considered more authoritative than the CDC? We need more clarity on what your suggestion is here.

• You appear to be suggesting adding more content on fluorosis.

• My response: Fluorosis is already covered well under Safety. What is missing? Sources for your suggested additional content?

• You are suggesting to add a "Total dietary fluoride load" section with the idea that fluoride is added because it is thought people are getting "too little dietary fluoride".

• My response: This suggestion doesn't seem to be based on what the sources say. As the article states, fluoride is not an essential dietary element, and its effect is topical and not systemic.

Feel free to correct where I may have misunderstood. Zad68 19:33, 27 February 2013 (UTC)

Agree, the authors do not use the term "poor" to describe the fluoride-reduces-caries aspect of their review. Per WP:MEDRS we do not base featured articles on press releases. Instead we should do as they recommend themselves: "we urge interested parties to read the review conclusions in full". And I suggest folk also read the existing Wikipedia article in full. And read the other cited reviews and sources too, for the York authors are not gods. The text could be clarified a little as I proposed above, but on the grand scale of things this is a small change. We have wasted enough time on this silly game, frankly. Colin°^Talk 20:09, 26 February 2013 (UTC)

recommended changes to lede

I made what I thought were a few minor wording changes in the lede that were reverted, so I am bringing it here for consensus. The changes I recommend in the final paragraph are shown in bold below, with justification to follow.

The final paragraph states "The goal of water fluoridation is to prevent a chronic disease whose burdens particularly fall on children and on the poor.[19] Its use presents a potentialconflict between the common good and individual rights.[20] It is controversial,[21] and opposition to it has been based on the grounds of perceived ethical, legal, safety, and efficacy issues. (deleted "grounds").[22] Health and dental organizations worldwide have endorsed its safety and effectiveness.[3] Its use began in 1945, following studies of children in a region where higher levels of fluoride occur naturally in the water.[23] Researchers discovered that moderate fluoridation prevents tooth decay,[24] and as of 2004 about 400 million people worldwide received fluoridated water.[18]"

The intent was to recognize that there are a multitude of sources and opinions on the topic, as represented within the body of the article. Stating that there is a conflicr between common good and individual rights is a subjective opinion espoused by some factions. Some factions believe there is not conflict there. Whether or not there is a conflict between two social constructs is not a measurable thing or a universal; it is an opinion. One I happen to agree with, but one which remains an opinion. I think it best to simply add "potential" to indicate that there is debate about this, as represented by the sources and discussion in the article. Similarly, the sentence about opposition gives what I assume is an unintended implication that opposition has been based on the grounds of actual ethical, legal, safety and efficacy problems. Again, since different factions have different takes on this, I think it best to indicate that opposition is based on what the opponents view as those factors instead of stating that those issues universally and objectively exist. Another alternative for the latter sentence would simply be to say "...opposition to it has been based on arguments concerning...etc etc etc". IN that way it's clear we're indicating the position of the opposition, and not implying that the grounds are universally held to be true things.I don't want to argue about whether fluoridation is good or is not...that's not the purpose of this page, though I know it's a touch issue. I'm just trying to make a minor change to improve neutrality.Jbower47 (talk) 21:17, 22 February 2013 (UTC)

I don't think that either change is an improvement. Watering down statements with unnecessary qualifiers is not a move towards neutrality. Public health always involves a balance between the community good and the individual, not just potentially. Courts do not rule on "grounds of perceived... issues".Novangelis (talk) 21:35, 22 February 2013 (UTC)

I don't agree that that;s a universal. As reflected in the varying viewpoints in the article, the community good/individual rights issue is not recognized universally as an issue for this topic. It's inherently a subjective opinion. When we say that there is "conflict" we are lending creedence to one viewpoint over another. If there are better ways to word either, I'm certainly up for hearing them. I just would like to see us veer away, as we have done in other areas, from anything that implies, intentionally or not, that there is validity or invalidity of subjective opinions held by either faction in the discussion. It's not intended as watering down; it's intended to recognize the complexity of the issue and avoid endorsing any given view of it. Saying the opposition sees a conflict between public good and individual rights is decidedly different than saying there IS a conflict. One is recognizing an opinion exists; the other is endorsing that opinion as universal fact.Jbower47 (talk) 21:55, 22 February 2013 (UTC)

I agree with Novangelis that the addition of mitigating or viewpoint language, (which can less charitably be viewed as weasel words) does not add significantly to the article, and in fact detracts from it. -- [ UseTheCommandLine ~/talk ] #_ 22:04, 22 February 2013 (UTC)

In that case, can you recommend a way that would be mutually agreeable to deal with the "conflict" sentence at least? The latter change is somewhat negligible, so I'm not too concerned about it. But stating there IS a conflict between public good and individual rights is a viewpoint not held universally. I think something as simple as saying that "opponents believe that..." would make it a much more verifiable statement. Again, it's the difference between saying there is a conflict, and saying that opponents feel there is. The former is advocating that belief, that latter simply recognizes that it is there. I think that might be a simple way to make the statement more neutral.Jbower47 (talk) 22:18, 22 February 2013 (UTC)

Is it a big enough issue to be mentioned in the lead section more than it already is (why do these conversations always seem to be about changes to the lead section? in my experience anyway) without being WP:UNDUE? mention of ethical/political conflict/controversy has been in the lead section for some time. Would additional language actually achieve anything? -- [ UseTheCommandLine ~/talk ] #_ 22:43, 22 February 2013 (UTC)

Thank-you for proposing this change here for discussion. I see the earlier edit was reverted by Zad68 here with the comment "sources cited do not limit these ethical concepts to opponents only, advocates and critics draw different conclusions but they both deal with the ethical issues". I agree with his comment. I'm not convinced that one side thinks there are ethical problems and the other side thinks there are none. Even if fluoridation was completely without potential side-effects, there would be ethical considerations about adding it to the water supply. But all sides accept there is a potential for side-effects. There will be some children who have excellent oral health, use fluoride toothpaste, eat a healthy diet and develop mild fluorosis because of fluoridation yet wouldn't have suffered cavities without fluoridation. Is there anyone who doesn't think that is the case at all? There will be other children who develop no or fewer cavities because of fluoridation. And there will be others whose minds are taken over by the government in an evil scheme in collaboration with the nuclear and fertilizer industry. Ok perhaps not that bit. Therefore the "common good and individual rights" issue raises its head and must be dealt with. Lots of things involve a balance of risk and only work at the collective-statistics level. An individual might drive faster with the reassurance of wearing a seatbelt, and then lose control at a sharp corner and crash into a bus shelter -- killing the occupants of the bus shelter but his seatbelt prevents him flying through the window so he survives with minor chest bruising. So essentially I'm happy with saying there is conflict and there are ethical issues. The difference between the sides is the conclusion one comes to when dealing with these. -- Colin°^Talk 22:51, 22 February 2013 (UTC)

Pinellas County, Florida recently did away with fluoridation

Per community pressure and vote of County Commission. See: Pinellas county commission votes to stop putting fluoride in water supply Star767 (talk) 02:17, 24 February 2013 (UTC)

But they return it amongst some bitter feelings. See Pinellas county commission voes 6-1 to return fluoride to drinking water Star767 (talk) 02:29, 24 February 2013 (UTC)

article does not reference relevant facts

Attempts to correct false statements in this article have been strongly resisted by parties that are unknown. The article promotes the infusion into public water supplies of diluted industrial hazardous waste fluorosilicic acid simply because it contains some fluoride. Adding waste or any proposed medicament into public water supplies and then recommending that people consume it is a violation of the intent of the Safe Drinking Water Act, the Water Pollution Control Act and the Food Drug and Cosmetic Act. Indeed no controlled clinical trials in human volunteers even exist for this material or for sodium fluoride. The article is promoting quackery since the science is compelling and complete indicating that industrial fluoride (rather than the nontoxic calcium fluoride) is a cumulative substance that causes harm, is present in saliva to bathe teeth at only 0.02 ppm which is 75,000 times less concentrated than in toothpaste,and is unable to influence teeth caries. If you don't do your own hand-on research, you have no right to force your opinions in an article such as this. It destroys the credibility of Wikipedia and makes a mockery out of a source that some perceive as a credible reference.The article cannot be repaired and should be completely re-written, this time with facts such as summarized in lay terms by the NRC 2006 Report, the 2013 monographs by Declan Waugh for fluoridated Southern Ireland, and the text by Connett, The Case Against Fluoride, 2010.