Wikipedia:Featured article candidates/Water fluoridation/archive1

The following is an archived discussion of a featured article nomination. Please do not modify it. Subsequent comments should be made on the article's talk page or in Wikipedia talk:Featured article candidates. No further edits should be made to this page.

The article was not promoted by Raul654 10:55, 9 March 2009 [1].

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Water fluoridation

Nominator(s): Eubulides (talk)

This became a Good Article after a careful and helpful review from Doc James along with critical and ultimately supportive comments by II. It went through peer review with positive comments by Finetooth and a useful quick comment from Colin. It's ready for a shot at Featured Article status.

Fluoridation is sometimes controversial. The article focuses on technical aspects and briefly summarizes the controversy in its Ethics and politics section, with a subarticle Opposition to water fluoridation (not part of this nomination) that goes into more detail. Eubulides (talk) 06:51, 13 February 2009 (UTC)

Restart, old nom, images and sources reviewed. (Please avoid the use of caps to hide comments, per WP:FAC instructions.) SandyGeorgia (Talk) 21:07, 28 February 2009 (UTC)

• Dabs, ref formatting, and external links found up to speed using WP:REFTOOLS, dabs and external links checker tool.--TRUCO 00:33, 1 March 2009 (UTC)

My concerns regarding article structure have been moved from here to the talk article's talk page, because at approximately 6.5Kb they have been deemed too long for this venue. Xasodfuih (talk) 01:00, 2 March 2009 (UTC)

The use of templates to hide long commentary is discouraged at FAC as it causes FAC archives to exceed template limits (see the WP:FAC instructions). Long commentary is better placed on article talk, with a brief example of WP:WIAFA issues placed on this page. SandyGeorgia (Talk) 14:59, 1 March 2009 (UTC)

I agree with SandyGeorgia that long and detailed commentary such as the above would be better discussed on the talk page, and have copied it and replied to it in Talk:Water fluoridation #Article structure etc. I suggest to Xasodfuih to remove this long thread from this page, as it sort of gets in the way, but that's up to Xasodfuih of course. Eubulides (talk) 23:26, 1 March 2009 (UTC)

• Comment I intend to re-read the article before posting my opinions. However, it most certainly is not a drug article (and even if it was, WP:MEDMOS only offers suggested headings; it doesn't insist on them.) WF is a public health issue, not a treatment one gets on prescription from a pharmacist. There are medical and bio-chemical aspects to this topic but they sit alongside many others. For example, the safety of WF additionally concerns the implementation at the treatment works, and environmental impact. Neither feature in a drug article's section on side effects. Colin°^Talk 14:48, 1 March 2009 (UTC)
• Support. In general this article conveys the right message. The more egregious issues have been solved during the previous FAC round. It's clear to me that the remaining differences of opinion regarding this article will not be resolved in an editing environment like this, so this is as good as it gets. Xasodfuih (talk) 03:42, 2 March 2009 (UTC)

• Opposing comments by Peripitus (talk · contribs) - not a comprehensive read as yet but some things stand out.(note I've struck my oppose - reasons later below - Peripitus (Talk) 11:20, 9 March 2009 (UTC))
  • There is material in the lead (highlighted by the use of inline references) that is not elsewhere. The lead should be a summary of the entire article and this is instead written more as an introduction. I would suggest moving all of the material and citations to the body of the article then rewriting the lead. As it stands the lead section is full of statistics and cited details but is lacking an overview of some parts of the article.
  • The article is very US-centric in places and almost totally in others. Much of the lead, almost all of "Implementation" and "History" sections, and quite a few other places are overly focused on this one country. A worldwide perspective is needed.

- Peripitus (Talk) 06:47, 3 March 2009 (UTC)

• As far as I can see, every statement in the lead summarizes a corresponding statement (or statements) in the body. Can you please be specific about any problems in this area?
• Every inline citation in the lead is also cited in the body; surely there's nothing wrong with this style, as it's common in technical Wikipedia articles.
• "I would suggest moving all of the material and citations to the body of the article" As far as I can see, all the material and citations in the lead are already present in the body.
• "the lead section ... is lacking an overview of some parts of the article" Which parts are those?
• "The article is very US-centric in places" The topic has come up before (please see Talk:Water fluoridation/Archive 2 #Mechanism and worldwide view, for example) and the consensus has been, on reflection, that the article does not place undue weight on U.S. views. The topic is inherently U.S.-centric, as water fluoridation was first done in the U.S., most water-fluoridation research has been done in the U.S., and about half of the world's fluoridated population lives in the U.S.
• For reference, here is a list of every source in Water fluoridation that is cited 5 or more times:

• Australia: NHMRC 2007, cited 9 times.
• Italy: Pizzo et al. 2007 (PMID 17333303), cited 8 times.
• UK: McDonagh et al. 2000, cited 6 times; Jones et al. 2005 (PMID 16211158), cited 7 times; Cheng et al 2007 (PMID 17916854), cited 5 times.
• U.S.: CDC 2001 (PMID 11521913), cited 8 times

Overall these statistics do not indicate a U.S.-centric view; on the contrary, given the topic, if anything the statistics suggest a bit of a bias against the U.S.

Eubulides (talk) 08:02, 3 March 2009 (UTC)

An observation. I don't agree with his analysis, but your response is obfuscating as well because a review can be cited for any number of issues, from country specific stuff to scientific info (mechanism etc.) or a metaanalysis of some studies. He's referring to the coverage of the text, whereas you reply with a fairly meaningless argument of how often some sources are cited when that does not correlate at all with what he's talking about. It's discussion like this that made me give up trying to improve this article further. Xasodfuih (talk) 09:59, 3 March 2009 (UTC)

I agree that counting sources is only a crude approximation; my excuse is that it was the best impartial approximation I could do in a hurry. Eubulides (talk) 08:56, 4 March 2009 (UTC)

Reply to opposition. The implementation section could not possibly focus on countries that have not implemented WF. The cost in the lede is from US, and should be clarified as such. Having said that, costs for Australia are available, and could mentioned. The history section is also by necessity US-centric since the US was the first to fluoridate, and that's where the initial research took place. That section being summarized in the lede (1-2 sentences) does not appear WP:UNDUE to me. The only possible US-centrist stuff in the lede might be the juxtaposition of the percentage of the U.S. population with the one for the rest of the world; percentages for other implementing/English-speaking countries could be mentioned; the last sentence can give the impression that WF is an US-only thing. The map (later in the body) which combines natural and artificial water fluoridation (although the original data source gives them on separate columns) isn't terribly useful at pointing out which other countries implement WF on a significant scale. Xasodfuih (talk) 11:18, 3 March 2009 (UTC)

Thanks for the comment, I removed the U.S.-centric juxtaposition from the lead. The original data source gives the total fluoridation as the last (and summary) column, and this seemed to be the best column to use for the map. In the context of the article it'd be misleading to color Gabon white (for no artificial fluoridation) simply because natural fluoridation suffices. Eubulides (talk) 08:56, 4 March 2009 (UTC)

• Oppose per my comments in FAC before restart. Not going to repeat the whole thing. Your last comment, which was confusing:

• (copied from before restart - complaint that fluoridation redirects to water fluoridation so that anyone searching for fluoridation will be redirected to this article on the controlled addition of fluoride to the public water supply.) This is my main complaint about the article, that it conflates natural and artificial water fluoridation. The very first sentence is the following: Water fluoridation is the controlled addition of fluoride to a public water supply to reduce tooth decay. I still feel the article would be better off not pretending to just discuss "the controlled addition of fluoride to a public water supply" as it really discusses fluoridation in general, and mixes the statistics of natural and the "controlled addition" of fluoride, as well as discussing the effects of fluoridation in toothpaste, salt etc. The article does not remain focused on the "controlled addition of fluoride to a public water supply" that the lead sentence says is the topic. —Mattisse (Talk) 01:03, 27 February 2009 (UTC)

• (Eubulides - copied - in part - from before restart) The article is supposed to be about water fluoridation, and the vast majority of its text focuses on WF rather than on its alternatives; but it's impossible to cover WF in an encyclopedic way without also briefly discussing related topics (toothpaste, salt fluoridation, dental sealants, etc.), just as it's impossible for Autism to discuss the topic of classic autism in an encyclopedic way without also discussing Asperger syndrome, PDD-NOS, epilepsy, etc. Perhaps some of these related topics are discussed in too much detail (and if so, please say exactly where and when), but surely it'd be too much to ask Water fluoridation to not discuss these related topics at all. Eubulides (talk) 01:36, 27 February 2009 (UTC)

• (my response before restart regarding conflation of fluoridation natural water fluoridation with artificial fluoridation) This is like a situation in which Autism redirects to Asperger syndrome so Asperger syndrome is now compelled to discuss Autism in general rather than focusing on Asperger syndrome. Bear in mind that anyone who wants to know about fluoridation gets redirected to Water fluoridation which starts out by limiting the article to "the controlled addition of fluoride to a public water supply". However, in the statistics presented it is not always possible to separate the controlled addition from the effects of naturally fluoridated water, or even from the effects other fluoridation methods in all cases. Since there is no general article on fluoridation, why not make this one general. Or at the very least, water fluoridation could be defined as fluoride in the water supply whether artificer or natural. Then both could be discussed. It would be easy to explain why statistics and maps etc. cannot always separate the two, and the article could discuss the effects of fluoridation in water as well as the alternatives methods of distribution like salt, toothpaste etc. would remedy my major objection to the article which is the conflation, as mentioned many times above.

• My objections prior to restart remain. Since they have not been addressed, and do not seem to be understood, I will register a formal oppose, which previously I was trying to avoid. —Mattisse (Talk) 13:02, 3 March 2009 (UTC)

Perhaps Fluoridation should redirect to Fluoride therapy as the fluoridation of toothpaste, water, milk and salt are all delivery methods of that "therapy". The current redirect is perhaps inappropriate as it is to only one type of fluoridation and the reader wouldn't immediately be aware that there are other types. Would that help? Someone would have to check all the "what links here" to ensure they point to water fluoridation where necessary.

Water fluoridation, the article, cannot be changed to generally discuss "fluoride in the water". As mentioned in the previous FAC, "fluoridation" is an active word, not a passive description. Colin°^Talk 13:25, 3 March 2009 (UTC)

I'm okay to making the focus strictly narrower to the controlled addition, but in that case the map in the Use around the world section should not conflate the natural and artificial sources given that the data is given separately in the source cited. The lucky guys in Gabon don't seem to spend a dime to fluoridate water. The details on defluoridation implementation could be removed as well. Also details like "In some locations, notably parts of Africa, China, and India, natural fluoridation exceeds recommended levels." appear off-topic as well if assume the narrower focus. The article currently meanders between natural and artificial fluoridation in a way that may confuse readers; it confused Mattisse anyway. Xasodfuih (talk) 13:57, 3 March 2009 (UTC)

Discussion of natural fluoridation should not be removed from the article, as natural fluoridation is essential for understanding the topic of artificial fluoridation. As for meandering and the map, please see the changes discussed (outdented) below. Eubulides (talk) 08:56, 4 March 2009 (UTC)

• "... water fluoridation could be defined as fluoride in the water supply whether artificer or natural." Reliable sources don't use that terminology. The cited source, CDC 2001 (PMID 11521913), says "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." Following this source's distinction between (artificial) "water fluoridation" and (artificial or natural) "fluoridated water" should alleviate some of the confusion noted above. I did this by inserting the following immediately after the lead sentence:

"Fluoridated water has fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride."

and then went through the rest of the article, systematically using the term "water fluoridation" to refer to artificial fluoridation, and "fluoridated water" to refer to either artificial or natural fluoridation. I hope this change fixes most of the confusion noted above. (Fluoridated water already redirects to Water fluoridation, which justifies emboldening the newly-added "Fluoridated water" in the lead.)

• "in the statistics presented it is not always possible to separate the controlled addition from the effects of naturally fluoridated water, or even from the effects other fluoridation methods in all cases" Can you please mention specifically which statistics have this problem? Effectiveness does contain phrases like "Compared to water naturally fluoridated at 0.4 mg/L, fluoridation to 1 mg/L ..." which attempt to make it clear that we are comparing fluoridation at recommended levels to fluoridation at natural levels. I did find that the article did not clearly state that fluoridation has a beneficial effect even in the assumed presence of toothpaste, so I added that (citing McDonagh et al. 2000); if you can mention other specific instances of confusing wording, I'd appreciate it.
• Reliable sources generally assume that Fluoridated water's effectiveness doesn't depend on whether the fluoride is natural or artificial. This assumption has not been well-tested; however, I added to Effectiveness the York Review's comment that no differences between natural and artificial fluoridation was detected in the review, but the evidence was inadequate to reach a conclusion about this.
• "Perhaps Fluoridation should redirect to Fluoride therapy" That would be less accurate than what we have now, as the popular use of the word "fluoridation" is to refer to community fluoridation, not to individual treatments such as fluoridated toothpaste.
• "the Use around the world section should not conflate the natural and artificial sources given that the data is given separately" As mentioned above, the source for that section's image gives the data both separately and together, with its rightmost table column giving the bottom-line figures that form the basis of the map.

Eubulides (talk) 08:56, 4 March 2009 (UTC)

• Further comments from Peripitus (talk · contribs) in response to the question on my opposition. For me at the moment the article fails criteria 1(a) (well written) and 2(a) (lead).
  • In the lead, please see sentence 1, paragraph 2. The statistic is mentioned only once that I can find (not echoed in the article). The last sentence of this paragraph and the "unknown fluoride levels" section in the first paragraph at least do not seem to match what is in the text. While for some facts (and many biographies) some citations in the lead are needed, this over-abundance makes the lead far less attractive and readable. Note that ref [18] in the lead is used to assert that "moderate fluoridation prevents cavities" and yet this precise assertion is not matched by the same reference used in the text. I can't see from this that the lead is the type of summary of the article needed.
  • US-Centric. The issue is not the citations but the text itself. In the "History" section there are 4 1/2 paragraphs about the U.S. and two sentences about other countries. This article is supposed to be about water fluoridation and (if the 5.7% world pop and 60% US pop figures are correct) then most people (67%) who drink fluoridated water live outside the US, many of whom have had it for over 1/2 a century. The article continually and repeatedly mentions "U.S.". Eight paragraphs into the article, about a subject that affects over 300M people outside, the US is mentioned about 1/2 a dozen times before any other country comes into the picture. The article tells me that other countries have had fluoridation for over 50 years but in many sections I would believe that this happens only in one country.

- Peripitus (Talk) 11:26, 4 March 2009 (UTC)

Thanks for the further comments. Some thoughts:

• "sentence 1, paragraph 2. The statistic is mentioned only once that I can find" Thanks, fixed.
• "The last sentence of this paragraph and the "unknown fluoride levels" section in the first paragraph at least do not seem to match what is in the text." The last sentence of this paragraph:

"Fluoridation may be more justified in the U.S. because of socioeconomic inequalities in dental health and dental care."

summarizes the following text in Effectiveness:

"Fluoridation may be more justified in the U.S. because unlike most European countries, the U.S. does not have school-based dental care, many children do not visit a dentist regularly, and for many U.S. children water fluoridation is the prime source of exposure to fluoride."

The "unknown fluoride levels" section:

"Bottled water typically has unknown fluoride levels, and some more-expensive household water filters remove some or all fluoride."

summarizes the following text in Implementation:

"U.S. regulations for bottled water do not require disclosing fluoride content, so the effect of always drinking it is not known.... Pitcher or faucet-mounted water filters do not alter fluoride; the more-expensive reverse osmosis filters remove 65–95% of fluoride, and distillation filters remove all fluoride."

• "While for some facts (and many biographies) some citations in the lead are needed, this over-abundance makes the lead far less attractive and readable." The citations are indeed ugly, but WP:V requires them. The topic of water fluoridation is complex, current, and controversial, and as WP:LEADCITE says, the article's lead therefore needs many citations.
• "Note that ref [18] in the lead is used to assert that "moderate fluoridation prevents cavities" and yet this precise assertion is not matched by the same reference used in the text." I altered the body to make the precise assertion to mimick the lead. That part of the body is a summary of the rest of that section, so the lead already summarized substantial material in that section ("In the 1930s and early 1940s, H. Trendley Dean ..."), but I suppose it can't hurt to say it one more time so that the citations line up.
• "I can't see from this that the lead is the type of summary of the article needed." All lead-related problems specifically noted in your comment have been fixed, so I hope the lead is now a reasonable summary.
• "if the 5.7% world pop and 60% US pop figures are correct) then most people (67%) who drink fluoridated water live outside the US" I don't know where that 67% figure came from, but it's not quite right. The cited source is relying on older fluoridation estimates, I think the 355 million estimate put out by the One in a Million source (PDF); 355 million would have been 5.7% of the world population in 2002, which sounds about right for the date of that 355 million estimate. One in a Million lists 171 million in the U.S, which would mean that when that estimate was made, about 52% of the people who drank artificially fluoridated community water lived outside the U.S.
• "In the "History" section there are 4 1/2 paragraphs about the U.S. and two sentences about other countries."

• I added discussion of the Brantford-Sarnia-Stratford study in Canada (1945–1962), the Tiel-Culemborg study in the Netherlands (1953–1969), the Hastings study in New Zealand (1954–1970), and the Department of Health study in the U.K. (1955–1960).
• That same edit added discussion of the history of fluoridation in Ireland.
• It also added discussion of the discontinuance of fluoridation in Basle.
• I added discussion of the history of fluoridation in New Zealand.
• I added discussion about Africa's developing countries.
• I added discussion of early proposals in Britain and in Germany to add fluoride to the diet.
• I added a mention of Australia in the lead. (Later replaced with the World Health Organization, which is even better.)

As a result of the above changes, by my count History contains 301 words (41%) about non-US countries, 63 words (8%) of international material that is not about any country in particular, and 379 words (51%) about the U.S. This should be about right, given the topic.

• "Eight paragraphs into the article, about a subject that affects over 300M people outside, the US" According to the One in a Million source mentioned above, only 184 million people outside the U.S. use water fluoridation.
• "the US is mentioned about 1/2 a dozen times before any other country comes into the picture." As a result of the edits I've made recently, Australia the World Health Organization is now mentioned first. In the lead, Australia the World Health Organization is mentioned once, Europe once, and the U.S. 3 times.
• "The article continually and repeatedly mentions 'U.S.'" A heavy emphasis on the U.S. is required by the topic. The vast majority of reliable sources about water fluoridation are U.S. sources and use U.S. data. "The science justifying fluoridation, like the practice itself, has remained predominantly American." — Sellers C (2004). "The artificial nature of fluoridated water: between nations, knowledge, and material flows". Osiris. 19: 182–200. PMID 15478274. Hmm, maybe that should go into the article?

Eubulides (talk) 10:49, 5 March 2009 (UTC)

No further comment, so I added "Water fluoridation's science and practice are predominantly American" to Use around the world, citing Sellers 2004. Eubulides (talk) 00:46, 9 March 2009 (UTC)

• Comment - I've struck my oppose as, on the face of it, my concertns have either been explained as incorrect or the edits have removed the issue. I can't change to support as I think that, especially given the above debate, this would require a deal more familiarity with the subject that I have at present. I do note something worrying, remove the lead and read the article without it. I get quite a few words in before the article tells me what the subject is in clear terms. I would have thought that a definition of the topic would be rather earlier.- Peripitus (Talk) 11:20, 9 March 2009 (UTC)

The above discussion is preserved as an archive. Please do not modify it. No further edits should be made to this page.