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)

Absolutely. This article is so one-sided that there's hardly any baby with the bathwater. We should merge it with the well-sourced and neutrally-written article Water fluoridation controversy. Most of the content honestly isn't worth keeping, but I made a new talk section at bottom for discussion.Boleroinferno (talk) 20:17, 18 March 2013 (UTC)

Instead of talking about updating this article with this research, why not just do it? I'm not trolling, I'm being serious. Lets get the ball rolling here. Neillithan (talk) 06:21, 21 March 2013 (UTC)

Disagree, that's not a good idea. The Bryson book is not an acceptable source to support scientific or medical content in this article, see WP:MEDRS for Wikipedia's sourcing guidelines for biomedical information. The Bryson book is appropriate for use in the article Water fluoridation controversy, and I see it is already used there. Zad68 12:16, 21 March 2013 (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

hatter per WP:NOTFORUM

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) It appears that many papers/studies on PubMed are leaning away from water fluoridation. See "Caries frequency in permanent teeth before and after discontinuation of water fluoridation in Kuopio, Finland." "In spite of discontinued water fluoridation, no indication of an increasing trend of caries could be found in Kuopio. The mean numbers of fluoride varnish and sealant applications decreased sharply in both towns between 1992 and 1995. In spite of that caries declined." "Caries prevalence after cessation of water fluoridation in La Salud, Cuba" "In the past, caries has usually increased after cessation of water fluoridation. More recently an opposite trend could be observed: following the cessation of drinking water fluoridation, in contrast to an expected rise in caries prevalence, DMFT and DMFS values remained at a low level for 6-9-year-olds and to decrease for 10/11-year-olds. In the 12/13-year-olds, there was a significant decrease." "Decline of caries prevalence after the cessation of water fluoridation in the former East Germany" "In contrast to the anticipated increase in dental caries following the cessation of water fluoridation in the cities Chemnitz and Plauen, a significant fall in caries prevalence was observed. This corresponded to the national caries decline and appears to be a new population-wide phenomenon. There is still no explanation for the pattern." "Prevalence and severity of dental caries in adolescents aged 12 and 15 living in communities with various fluoride concentrations" "In an analysis of caries severity (DMFT > or = 4), both adolescents with very mild/mild and moderate/severe dental fluorosis have higher caries severity. Fluoride exposure (measured through fluorosis presence) does not appear to be reducing the caries prevalence (DMFT > 0) or caries severity (DMFT > or = 4) in these high-altitude communities." "An epidemiological profile of dental caries in 12-year-old children residing in cities with and without fluoridated water supply in the central western area of the State of São Paulo, Brazil" "There was no statistically significant difference between DMFT in municipalities of the same size, regardless of the presence or absence of fluoride in the water supply... Prevalence of caries in the region was 'high', with a DMFT of 4.82, thus failing to reach the goals set for the year 2000." "Patterns of dental caries following the cessation of water fluoridation" Canada "The prevalence of caries (assessed in 5,927 children, grades 2, 3, 8, 9) decreased over time in the fluoridation-ended community while remaining unchanged in the fluoridated community." "The fluoride content of drinking water and caries experience in 15-19 year old school children in Ibadan, Nigeria" "Nine hundred and fifty five students aged 15-19 years randomly selected from eleven secondary schools in Ibadan metropolis were examined for dental caries over a period of 4-5 months. Only teeth with obvious cavitations were recorded as being carious using the WHO standard method. The fluoride level of the different water sources was between 0.02 and 0.03 ppm. [only] Forty-four (4.6%) of the children had dental caries. In conclusion, both the fluoride level and caries prevalence were low." "The effects of a break in water fluoridation on the development of dental caries and fluorosis" North Carolina "It was concluded that while the break had little effect on caries, dental fluorosis is sensitive to even small changes in fluoride exposure from drinking water, and this sensitivity is greater at 1 to 3 years of age than at 4 or 5 years." "New evidence on fluoridation" "A review of recent scientific literature reveals a consistent pattern of evidence--hip fractures, skeletal fluorosis, the effect of fluoride on bone structure, fluoride levels in bones and osteosarcomas--pointing to the existence of causal mechanisms by which fluoride damages bones. In addition, there is evidence, accepted by some eminent dental researchers and at least one leading United States proponent of fluoridation, that there is negligible benefit from ingesting fluoride, and that any (small) benefit from fluoridation comes from the action of fluoride at the surface of the teeth before fluoridated water is swallowed." "Is there a need of extra fluoride in children?" "The issues related to fluoridation of water or fortification of tooth paste with compounds of fluorides are controversial. Fluoride is stored mainly in the bones, where it increases the density and changes the internal architecture, makes it osteoporotic and more prone to fractures. 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 various 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 and any additional ingestion of fluoride by children is undesirable." "Developmental fluoride neurotoxicity: a systematic review and meta-analysis" "The results support the possibility of an adverse effect of high fluoride exposure on children's neurodevelopment." "Impact of fluoride on Neurological Development in Children" "Some studies suggested that even slightly increased fluoride exposure could be toxic to the brain."... "Fluoride seems to fit in with LEAD, MERCURY, and other poisons that cause chemical brain drain," Grandjean says. "The effect of each toxicant may seem small, but the combined damage on a population scale can be serious, especially because the brain power of the next generation is crucial to all of us." "Effects of the fluoride on the central nervous system" "The prolonged ingestion of F may cause significant damage to health and particularly to the nervous system. Therefore, it is important to be aware of this serious problem and avoid the use of toothpaste and items that contain F, particularly in children as they are more susceptible to the toxic effects of F." "Fluorine as a factor in premature aging" "In conclusions, the use of fluoride, particularly by dentists and pediatricians, must be controlled and adapted to individual needs." "Oral manifestations of thyroid disorders and its management" "Fluoride was used as a drug to treat hyperthyroidism because it reduces thyroid activity quite effectively. This is due to the ability of fluoride to mimic the action of thyrotropin (TSH). Excess fluoride correlates with the other thyroid-related issues such as iodine deficiency. Fluorine and iodine, both being members of the halogen group of atoms, have an antagonistic relationship. When there is excess of fluoride in the body it can interfere with the function of the thyroid gland. Thus, fluoride has been linked to thyroid problems." The prior therapeutic use of F to reduce thyroid hormone levels in cases of thyrotoxicosis is well documented (Goldemberg, (1926, 1930, 1932); May (1935, 1937); Orlowski (1932) and Galletti and G. Joyet, (1958)). "Fluoridation: a fifty-year-old accepted but unconfirmed hypothesis" "The fifty-year-old fluoridation hypothesis has not been confirmed. Despite this, millions of people are still medicated with fluoride by government decree, on the assumption that this process has been proved to be entirely safe, and very efficacious in reducing dental caries. In fact, the scientific basis of fluoridation is very unsatisfactory. It is promoted, in the main, by emotion-based 'endorsements' rather than by scientifically-acceptable evidence." "Fluoridation: a violation of medical ethics and human rights" "Silicofluorides, widely used in water fluoridation, are unlicensed medicinal substances, administered to large populations without informed consent or supervision by a qualified medical practitioner. Fluoridation fails the test of reliability and specificity, and, lacking toxicity testing of silicofluorides, constitutes unlawful medical research. It is banned in most of Europe; European Union human rights legislation makes it illegal. Silicofluorides have never been submitted to the U.S. FDA for approval as medicines. The ethical validity of fluoridation policy does not stand up to scrutiny relative to the Nuremberg Code and other codes of medical ethics, including the Council of Europe's Biomedical Convention of 1999. The police power of the State has been used in the United States to override health concerns, with the support of the courts, which have given deference to health authorities." — Preceding unsigned comment added by 99.61.178.14 (talk) 19:44, 6 April 2013 (UTC) I reviewed the sources provided: PMID 9758426 is a primary study from 1998 PMID 10601780 is a primary study from 2000 PMID 11014515 is a primary study from 2000 PMID 17436973 is a primary study from 2007 PMID 12244360 is a primary study from 2002 PMID 11153562 is a primary study from 2001 PMID 18756850 is a primary study from 2008 PMID 10728978 is a primary study from 2000 PMID 9161076 is a review from 1997 PMID 19812419 is an editorial from 2009 PMID 22820538 is a 2012 review article but with extremely qualified findings ("The results suggest that fluoride may be a developmental neurotoxicant...", "The results support the possibility...") with no conclusion of a cause-and-effect relationship. The HSPH article is a commentary on PMID 22820538 PMID 21255877 focuses on "populations exposed to the intake of this mineral at concentrations outside official guidelines", and so outside the scope of this article PMID 16892576 is a review from 2004, also doesn't appear to be talking about flouride levels like those discussed in this article PMID 21966646 talks about treatment of patients with thyroid disfuction, does not appear to discuss flouride levels like those discussed in this article PMID 3059145 is a Medical Hypotheses article from 1988 PMID 12749628 is an editorial from 2003 In short, not a single one of these articles looks appropriate for use here. Please refer to WP:MEDRS for Wikipedia's standards for sourcing biomedical information, and please take care not to misrepresent the applicability of sources. Zad68 03:31, 7 April 2013 (UTC) WP:MEDRS states that PubMed is an excellent source of information. Are you stating that it is not? — Preceding unsigned comment added by 99.61.178.14 (talk) 04:48, 7 April 2013 (UTC) See WP:MEDDATE. TippyGoomba (talk) 04:58, 7 April 2013 (UTC) @TippyGoomba - WP:MEDDATE is a rule of thumb but isn't mandatory. "Here are some rules of thumb for keeping an article up-to-date, while maintaining the more-important goal of reliability. These instructions are appropriate for actively researched areas with many primary sources and several reviews and may need to be relaxed in areas where little progress is being made or few reviews are being published." I am still searching for safety studies done on consuming & bathing in water with added hexafluorosilicic acid instead of calcium fluoride. There is quite a difference in the LD50 toxicity levels. The LD50 for calcium fluoride is 4250 mg/kg. The LD50 for hexafluorosilicic acid is 70 mg/kg. Hexfluorosilicic acid (also known as hydrofluorosilicic acid) was banned by the EU in 2006 due to lack of toxicological data to show it was safe for humans and the environment yet this banned biocide/pesticide is used to fluoridate the water. Confounding many of these epidemiological studies is the fact that artificially added inorganic fluoride is much more damaging to living tissue (not to mention corrosive to pipes) than organic, naturally occurring calcium fluoride. And when measuring only the absolute levels of the fluoride anion, studies end up comparing apples to oranges. — Preceding unsigned comment added by 99.61.178.14 (talk) 05:52, 7 April 2013 (UTC) Are you trying to be funny, or just bog-ignorant? CaF2 is organic??? If you don't know anything about chemistry, much less organic chemistry, not even to mention metabolic or biochemistry, and too dumb or bone-idle to do some homework, then stop wasting the time of people who have something more useful to do. JonRichfield (talk) 06:41, 7 April 2013 (UTC) @JonRichfield - When I used the word "organic", I was using it in an "informal way". See Wikipedia, "Organic Matter". "Organic matter is present throughout the ecosystem. After degrading and reacting, it can then move into soil and mainstream water via waterflow. A majority of organic matter not already in the soil comes from groundwater." Didn't mean to enrage anyone. I stand corrected. — Preceding unsigned comment added by 99.61.178.14 (talk) 08:13, 7 April 2013 (UTC) You appear to be confused. WP:MEDDATE is the same essay as WP:MEDRS, the one you quoted as saying "PubMed is an excellent source of information" in order to dispute Zad's observation that your citations are out of date. TippyGoomba (talk) 06:03, 7 April 2013 (UTC) @TippyGoomba - What date should it be? Can you find something more recent? It doesn't appear that there are any peer-reviewed safety studies done on consuming hexafluorosilicic acid, aka hydrofluorosilicic acid, in tap water. Odd when you consider the difference in their LD50 toxicity levels to naturally occurring "calcium fluoride". Here's some information on hexafluorosilicic acid used for water fluoridation. See "Sodium Hexafluorosilicate and Fluorosilicic Acid, Review of Toxicological Literature". Its just a pesticide and rodenticide. Lets add it to tap water and feed it to American infants and children. — Preceding unsigned comment added by 99.61.178.14 (talk) 19:50, 7 April 2013 (UTC) And with this last response you reveal that your intention is not article development in line with Wikipedia policy and guideline but rather an intention to use Wikipedia articles to advance a position. See WP:NOTADVOCACY. As this discussion was proposed in bad faith, it is now closed. Zad68 22:32, 7 April 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)

OK, so I'm easily wearied. I admit it. I saw this controversy for the first time 1958 maybe, when I was student. The main thing that has changed since then is that nowadays the exchange of spittle more reliably starts with the second breath, sometimes with the first. The only reason I am here is the RFC. I suggest:

• Colin's suggested amendment looks like a good basis.
• List all the items or wording that it should not contain and does
• List all the items or wording that it should contain and does not
• Amend accordingly as necessary. If both lists are empty of substantial items, consider the process completed for now.
• Schluss until someone has something new and constructive to say (like "Say guys, have you seen this NEW, HIGH-QUALITY study?") and redirect off-topic nattering such as comparisons between the merits of water fluoridation and additives in toothpastes etc, to appropriate articles like Water fluoridation controversy. JonRichfield (talk) 12:24, 14 March 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)

That was a year ago. --Orange Mike | Talk 02:15, 5 March 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)

CLAIMED: 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. — Preceding unsigned comment added by 72.199.234.172 (talk) 16:50, 3 March 2013 (UTC)

Actually, the "parties" that write these "false statements" are rather well known, we are registered editors at Wikipedia, generally with elaborate user pages. It is those that disagree that rant from behind anonymous IP addresses and never join the rest of us in writing this encyclopedia. --Smokefoot (talk) 18:32, 3 March 2013 (UTC)

That's perhaps overbroad, Smokes: I'm sure that some of the anti-fluoridation folks who bombard this article have contributed useful edits on other topics. They just don't do it here, since they have The Truth™® and thus are impervious to mere scientific consensus. --Orange Mike | Talk 02:11, 5 March 2013 (UTC)

Systemic Fluoride Intake vs. Topical Application to the Teeth

hatted per WP:NOTFORUM

Why does this article not discuss systemic effects of the fluoride on the human body (replacement of calcium in the bones making them brittle - fluorosis and thyroid supression)? What is the advantage or negative effect of fluoride in the drinking water vs. fluoride in toothpastes and mouthwashes? Why do we need fluoride in the drinking water, when it is already available in most toothpastes and many mouthwashes? Effect of fluoride on thyroid - fluoride used to be prescribed for overactive thyroid to reduce its activity. What is the effect of fluoride on a normal thyroid? What daily intake of fluoride should be deemed above dangerous levels? What fluoride dosages are commonly found in our tap water? — Preceding unsigned comment added by Poisonedwater (talk • contribs) 21:20, 6 March 2013 (UTC) "Fluoride was used as a drug to treat hyperthyroidism because it reduces thyroid activity quite effectively. This is due to the ability of fluoride to mimic the action of thyrotropin (TSH). Excess fluoride correlates with the other thyroid-related issues such as iodine deficiency. Fluorine and iodine, both being members of the halogen group of atoms, have an antagonistic relationship. When there is excess of fluoride in the body it can interfere with the function of the thyroid gland. Thus, fluoride has been linked to thyroid problems." http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169868/ — Preceding unsigned comment added by 99.61.178.14 (talk) 21:54, 6 March 2013 (UTC) The prior therapeutic use of F to reduce thyroid hormone levels in cases of thyrotoxicosis is well documented (Goldemberg, (1926, 1930, 1932); May (1935, 1937); Orlowski (1932) and Galletti and G. Joyet, (1958)). — Preceding unsigned comment added by 99.61.178.14 (talk) 14:50, 8 March 2013 (UTC) What specific article content change are you suggesting, using what sources? Zad68 14:53, 8 March 2013 (UTC) The rationale for the systemic intake of fluoride from our water vs. just topical application of fluoride to teeth would be a good start. Are there advantages to systemic fluoride intake from water vs. application to teeth from dentifrice? Also recommended maximum safe daily systemic fluoride intake, and the approximate average systemic intake from fluoridated water and other fluoride sources in the USA. Poisonedwater (talk) 03:37, 12 March 2013 (UTC) You've missed the key points so let me emphasis them. What specific article content change are you suggesting, using what sources? TippyGoomba (talk) 05:09, 12 March 2013 (UTC) Even more specifically: using what RELIABLE sources? --Orange Mike | Talk 15:16, 12 March 2013 (UTC) What does that have to do with this article? It sounds to me like content for Water fluoridation controversy. Don't be greedy, one soapbox at a time please! JonRichfield (talk) 12:07, 14 March 2013 (UTC) Fluoride readily crosses the placenta. See "Developmental Fluoride Neurotoxicity: A Systematic Review and Meta-Analysis" Fluoride readily crosses the placenta (Agency for Toxic Substances and Disease Registry 2003). "Fluoride exposure to the developing brain, which is much more susceptible to injury caused by toxicants than is the mature brain, may possibly lead to permanent damage (Grandjean and Landrigan 2006). The results suggest that fluoride may be a developmental neurotoxicant that affects brain development at exposures much below those that can cause toxicity in adults (Grandjean 1982). The estimated decrease in average IQ associated with fluoride exposure based on our analysis may seem small and may be within the measurement error of IQ testing. However, as research on other neurotoxicants has shown, a shift to the left of IQ distributions in a population will have substantial impacts, especially among those in the high and low ranges of the IQ distribution (Bellinger 2007)." — Preceding unsigned comment added by 99.61.178.14 (talk) 20:56, 6 April 2013 (UTC) Fluoridated water can cause kidney damage in children. See "The dose-effect relationship of water fluoride levels and renal damage in children". "Over 2.0 mg/L fluoride in drinking water can cause renal damage in children, and the damage degree increases with the drinking water fluoride content. Renal damage degree is not related to whether the children suffered from dental fluorosis and mainly due to water fluoride concentration." Fluoride may reduce Fertility Rates. See "Exposure to high fluoride concentrations in drinking water is associated with decreased birth rates". "A review of fluoride toxicity showed decreased fertility in most animal species studied. The current study was to see whether fluoride would also affect human birth rates. Most regions showed an association of decreasing TFR with increasing fluoride levels. There is no evidence that this outcome resulted from selection bias, inaccurate data, or improper analytical methods. However, the study is one that used population means rather than data on individual women." — Preceding unsigned comment added by 99.61.178.14 (talk) 00:42, 7 April 2013 (UTC) And at least one paper on PubMed links fluoride to Autism. See "A possible central mechanism in autism spectrum disorders...". "In addition, a number of environmental neurotoxins, such as FLUORIDE, lead, cadmium, and aluminum, can result in these pathological and biochemical changes." — Preceding unsigned comment added by 99.61.178.14 (talk) 00:59, 7 April 2013 (UTC) Yet another scattershot batch of inappropriate sources, either from questionable journals or outdated. As above see WP:MEDRS for Wikipedia's sourcing guidelines. Zad68 03:35, 7 April 2013 (UTC) Exactly what dates must they be? And can you please list the journals that you find "unquestionable"? — Preceding unsigned comment added by 99.61.178.14 (talk) 04:27, 7 April 2013 (UTC) I have a different objection. Your sources have nothing to do with the article, since they don't mention water fluoridation. TippyGoomba (talk) 04:37, 7 April 2013 (UTC) @TippyGoomba - At least three of the sources above are specifically discussing water fluoridation. Two others are regarding fluoride in general but may include fluoride in water. — Preceding unsigned comment added by 99.61.178.14 (talk) 05:18, 7 April 2013 (UTC) Fine, what edits are you suggesting? TippyGoomba (talk) 06:08, 7 April 2013 (UTC) @TippyGoomba - I'm still searching PubMed for more information but we were discussing Systemic Fluoride Intake vs. Topical Application to the Teeth. — Preceding unsigned comment added by 99.61.178.14 (talk) 06:46, 7 April 2013 (UTC)

Merge this article with "Water fluoridation controversy"

The article Water fluoridation controversy deals with the exact same subject, bears a wealth of reliable sources, and deals with the subject in a much more neutral way. The fact is that the entirety of continental Europe and East Asia all decry the use of fluoride in drinking water. Why is the fact that fluoridated water is illegal in half the world not even hinted at in this article? It seems the only reason these two articles are separated is to allow the one-sided authors of this article to make unequivocal claims about the safety & efficacy of fluoridated water. They achieve this agenda by delegating all the 'alternative' critical points of view to a different article.

This article should be stripped for the few bits of neutral claims which can be added to the Water fluoridation controversy article, then be deleted. If there continue to be unprincipled edits intended to reduce the validity of sourced claims, especially those intended to minimize the very significant criticisms against water fluoridation, this article needs to be protected and repeat offenders banned from editing it. It would not be outside the scope of reason to find that someone has been editing this article on direct behalf of an organization involved in selling fluoridation to municipal water supplies. Boleroinferno (talk) 19:48, 18 March 2013 (UTC)

Dream on. Colin°^Talk 20:41, 18 March 2013 (UTC)

Agreed. Water fluoridation and the controversy around it are two different topics, deserving their own articles as sources clearly show. I can't imagine how any attempt to conflate the two wouldn't be a FRINGE and NPOV violation. --Ronz (talk) 21:50, 18 March 2013 (UTC)

• Oppose They are separate topics, and this is a fully developed WP:FA quality article. Zad68 23:08, 18 March 2013 (UTC)

A bit like merging Kepler's laws of planetary motion into Flat earth. The comment suggest that the "Water fluoridation controversy" article doesn't make it obvious enough where the science falls. But the article looks fine to me. Am I mistaken? TippyGoomba (talk) 03:16, 19 March 2013 (UTC)

• Oppose on is a medical / scientific topic the other is a social movement. Doc James (talk · contribs · email) (if I write on your page reply on mine) 06:49, 19 March 2013 (UTC)
• Oppose I found the Water fluoridation controversy non-neutral and doesn't cover the scientific side. This article covers the topic well and neutrally.Ian Furst (talk) 22:12, 19 March 2013 (UTC)
• Comment. I do not think that editors need to respond to radical recommendations by timid drive-by conspiracy theorists. Unhappy editors come to this page regularly to espouse fringe views with lackluster sources. This activity has been ongoing for years. Almost none of these unhappy editors have an active talk page that would enable consensus-seeking conversations or collegial argumentation. So my point is that proposals - such as the present one about merging two mature articles - from these timid conspiracy theorists should be ignored or even deleted. There is no conversation with them to be had. --Smokefoot (talk) 01:26, 20 March 2013 (UTC)

The benefits are that the proposed change will clearly be shown not to have consensus, and also a future editor making a similar change proposal can be pointed to a long history of such proposals and how they've consistently been rejected. Also, we shouldn't WP:BITE, these proposals are coming from real live people who are (probably) making a good-faith effort to correct what they see as a problem, and so they should be given some respect. Besides, it only takes a few seconds to !vote appropriately for an obviously misguided proposal to an article you're familiar with. Zad68 04:10, 20 March 2013 (UTC)

The policy WP:BITE is intended to encourage greater tolerance by established editors to help WP recruit new editors. The anti-BITE policy in this case involves do-gooders (you, me) falling pray to evil doers: those with zero intention of editing, only seeking a soapbox. Their goal, rather successful, is to convert Talk pages into forums for fringe views. Their request for a change is invariably prefaced with some polemic - mission accomplished. I understand that my perspective does not present any nice directions forward. --Smokefoot (talk) 13:00, 20 March 2013 (UTC)

• Oppose The Water fluoridation controversy article is not neutral. I do not believe a single source makes for a reliable source that can be used here. We have an obligation to resist hyperbole in encyclopedia articles. — UncleBubba ^{( T @ C )} 06:32, 21 March 2013 (UTC)
• Oppose The two topics are different topics. And whichever of the various points of view one can take, this is the most blatantly juvenile POV tactic I have seen in a long time. Those who disagree with the proposer and fail to oppose it are passing up their duty; those who do agree and put up with having their views parodied in such a childish fashion, are doing their cause a disservice. JonRichfield (talk) 11:49, 21 March 2013 (UTC)

Shouldn't this article state what level of fluoride you should not exceed?

See "CDA Position on Use of Fluorides in Caries Prevention".

"...the total daily fluoride intake from ALL sources should not exceed 0.05-0.07 mg F / kg body weight". So as with most chemicals on which we rely (H2O, O2, C27H44O NaF/SnF2...), there is a range of intakes which are beneficial. Below or above that range there may be either no benefit, or harm. Communities considering water fluoridation are encouraged to review their individual circumstances carefully and in detail, giving attention to any available data on the dental health of community members, the size of the group not likely exposed to adequate fluoride from other sources, and the minimum level of fluoride required to be beneficial.

"Dental and public health administrators should be aware of the TOTAL fluoride exposure in the population before introducing any additional fluoride programme for caries prevention." (Fluorides and Oral Health, WHO, 1994). — Preceding unsigned comment added by 99.61.178.14 (talk) 01:55, 7 April 2013 (UTC)

"Most published reports show 1 to 5 milligrams of fluoride per liter of black tea, but a new study shows that number could be as high as 9 milligrams." Science Daily "Tea May Contain More Fluoride Than Once Thought, Research Shows". — Preceding unsigned comment added by 99.61.178.14 (talk) 02:35, 7 April 2013 (UTC)

The article already has content covering this. Zad68 03:39, 7 April 2013 (UTC)

Well it should also be noted that 41% of children between the ages of 12 and 15 years old in the USA have been overexposed to fluoride whether they live in fluoridated areas or NON-fluoridated areas. See CDC, "Prevalence and Severity of Dental Fluorosis in the United States, 1999-2004".

It doesn't say that, it says "Prevalence of dental fluorosis was higher among younger persons and ranged from 41% among adolescents aged 12-15 to 9% among adults aged 40-49." The source makes no equivalence between fluorosis and 'overexposure.' There's no discussion of 'overexposure' on that page at all. Zad68 04:20, 7 April 2013 (UTC)

Do you understand that dental fluorosis is caused by overexposure to fluoride? See WebMD, "Fluorosis Overview". "It’s caused by overexposure to fluoride during the first eight years of life. This is the time when most permanent teeth are being formed."

Quite frankly, I'm confused as to what your objection to that is.

"overexposure" isn't defined, hence the quotes. Your suggested definition combined with the article you cite is a textbook case of WP:SYNTH. Also, what edit are you suggesting? TippyGoomba (talk) 05:01, 7 April 2013 (UTC)

@TippyGoomba - Dental fluorosis is a result of overexposure to fluoride. Overexposure to fluoride results in dental fluorosis. Its not difficult. I simply felt the article should state somewhere that the total daily fluoride intake from ALL sources should not exceed 0.05-0.07 mg F / kg body weight. This would be helpful given the rate of dental fluorosis in the USA. Furthermore some people may not be aware of the high levels of fluoride found in black tea. — Preceding unsigned comment added by 99.61.178.14 (talk) 05:27, 7 April 2013 (UTC)

"The article already has content covering this" TippyGoomba (talk) 06:07, 7 April 2013 (UTC)

CLAIMED: There is no difference in tooth decay rates in fluoridated versus non-fluoridated areas

See http://pubs.acs.org/doi/pdf/10.1021/cen-v067n019.p005

"An analysis of national survey data collected by the National Institute of Dental Research (NIDR) concludes that children who live in areas of the U.S. where the water supplies are fluoridated have tooth decay rates nearly identical with those who live in nonfluoridated areas."

Chem. Eng. News, 1989, 67 (19), pp 5–6 DOI: 10.1021/cen-v067n019.p005 Publication Date: May 08, 1989 Copyright © 1989 AMERICAN CHEMICAL SOCIETY — Preceding unsigned comment added by 99.61.178.14 (talk) 17:17, 8 April 2013 (UTC)

Really, a 1989 article by the American Chemical Society? After you posted your last batches of sources, I assumed good faith and carefully reviewed each one, explained how they did not meet Wikipedia medical sourcing guidelines, and pointed you to WP:MEDRS so that you could learn how to identify useful sources. You followed that up with a declaration indicating your involvement here is in opposition to WP:NOTADVOCACY, and now you're bringing more inappropriate sources, without any clear suggestion for the article.

I recommend that nobody bother with these bad-faith source dumps. Zad68 17:25, 8 April 2013 (UTC)

It is regarding the largest study ever undertaken regarding tooth decay in fluoridated versus non-fluoridated areas but you find it insignificant? Your motives are quite telling. — Preceding unsigned comment added by 99.61.178.14 (talk) 17:36, 8 April 2013 (UTC)

Oh riiight! Bigger means better? Grow up! Any idiot who is willing to ask the wrong questions can get any answer he pleases to any study, big or small. Did you see who ran the study? Do me a favour! JonRichfield (talk) 18:30, 8 April 2013 (UTC)

@JonRichfield - Yiamouyiannis obtained the survey data from NIDR under the Freedom of Information Act.

It's clear you don't understand. Read PROCEEDINGS Fourth Annual Conference of State Dental Directors with The Public Health Service and The Children's Bureau, June 6-8, 1951; Federal Security Building, Washington, D.C..

This is the United States Government documentation of the minutes of a meeting sponsored by the U. S. Public Health Service in regards to the “Promotion and Application of Water Fluoridation.” Thesetminutes are officially recorded in Volume #5 of Hearings, 89th Congress, Dept. of Labor and Health Education and Welfare Appropiations for 1967. They are also recorded, Case #8425, Exihibit 108, of Public Utilities Commission of Calif. 1966. Its the infamous U.S. Dental Conference, 1951 with the "missing" minutes. I'm sure you'll find it interesting. — Preceding unsigned comment added by 99.61.178.14 (talk) 21:12, 8 April 2013 (UTC)

Clearly you're not getting support for this. Got any better references? TippyGoomba (talk) 02:44, 9 April 2013 (UTC)

As an outsider to this conversation, I am curious as to learning more about why this article is unreliable per WP:MEDRS. It seems to me that the ACS would have a conflict of interest in favor of water fluoridation, if anything, but I am not particularly familiar with them. I also have not seen the IP's declaration "indicating that his/her involvement here is in opposition to WP:NOTADVOCACY", but I would take care to note that being personally opposed to water fluoridation cannot instantly qualify as a violation of WP:NOTADVOCACY unless personally supporting water fluoridation is a violation of WP:NOTADVOCACY. Perhaps the IP believes that the article does not adhere to WP:NPOV but is not expressing this. Lastly, does the source presented not immediately disprove that this is scientific consensus: "Water fluoridation is effective at reducing cavities in both children and adults"? Thanks, Gold Standard 03:10, 9 April 2013 (UTC)

it's out of date, see WP:MEDDATE. Also, it meets none of the criteria of This page in a nutshell: Ideal sources for biomedical material include general or systematic reviews in reliable, third-party, published sources, such as reputable medical journals, widely recognised standard textbooks written by experts in a field, or medical guidelines and position statements from nationally or internationally recognised expert bodies. TippyGoomba (talk) 03:52, 9 April 2013 (UTC)

Got it, that clears things up. One last thing, assuming the source was recent, why wouldn't the ACS be considered a "reliable, third-party, published source"? Gold Standard 04:06, 9 April 2013 (UTC)

The same reason you don't see any theological scholarship in the evolution article, it's not a medical journal. It may be that the journal is a reliable source, just not for medical claims. TippyGoomba (talk) 04:10, 9 April 2013 (UTC)

I see, I hadn't considered that. Is it specifically a medical claim, though? It seems to me that the ACS would not have published a study if it was not related to their area of study. Could this claim not be considered both a medical claim and a claim relating to chemicals? For example, would a study from the ACS identifying a certain chemical as damaging to the eyes not be considered reliable when writing about that chemical? Gold Standard 04:19, 9 April 2013 (UTC)

I could imagine not needing a WP:MEDS citation for the fact that putting lye in my eyes is harmful. But it's hard to think of an example where we'd wish to discuss such effects, not be able to find a meds source, and require a source in the first place (see WP:BLUE). I'm fairly certain the example I gave fits none of these criteria. TippyGoomba (talk) 06:51, 9 April 2013 (UTC)

So a meds citation is only necessary for controversial claims (e.g. that sodium fluoride doesn't actually slow tooth decay)? Gold Standard 07:17, 9 April 2013 (UTC)

Yes, except I would replace "controversial" with WP:EXCEPTIONAL. Also, I would apply it more broadly, to all of science and history at the very least. There's nothing special about meds in this case, it's simply that meds has some unusual requirements like 5 year systematic reviews. TippyGoomba (talk) 08:07, 9 April 2013 (UTC)

Cool, thanks for your help! It's always good to learn and understand more of Wikipedia's policy as it applies to real scenarios. Hopefully our conversation helps the IP too if he/she reads this. Gold Standard 08:31, 9 April 2013 (UTC)

Evidence-basis

"Fluoride's caries-preventive properties initially were attributed to changes in enamel during tooth development because of the association between fluoride and cosmetic changes in enamel and a belief that fluoride incorporated into enamel during tooth development would result in a more acid-resistant mineral. However, laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are TOPICAL for both adults and children "

"Achievements in Public Health, 1900-1999..".

This deserves at least a mention somewhere in this article. — Preceding unsigned comment added by 99.61.178.14 (talk) 19:48, 9 April 2013 (UTC)

And amazingly enough it already is in the article. Zad68 19:55, 9 April 2013 (UTC)

STATEMENT OF Dr. J. WILLIAM HIRZY of the EPA

STATEMENT OF Dr. J. WILLIAM HIRZY.

Why is this completely omitted in this article?

Dr. J. William Hirzy of the EPA states, "Kingston and Newburg, New York Results- In 1998, the results of a fifty-year fluoridation experiment involving Kingston, New York (un-fluoridated) and Newburg, New York (fluoridated) were published (17). In summary, there is NO overall significant difference in rates of dental decay in children in the two cities, but children in the fluoridated city show significantly higher rates of dental fluorosis than children in the un-fluoridated city."

He further states, "a massive experiment that has been run on the American public, without informed consent, for over fifty years".

Does Wikipedia consider this insignificant? — Preceding unsigned comment added by 99.61.178.14 (talk) 20:15, 9 April 2013 (UTC)

Dr. William L. Marcus of the EPA is considered a "whistle-blower" concerning government policy regarding fluoridation. It was in the Washington Post on March 1, 1994. See Washington Post Article, "Whistle-Blower Clears the Air" dated March 1, 1994.

Why is this ignored in this article?