RESPONSE – water fluoridation – silver bullet or another nail in the coffin?

water fluoridationSimon Hearnshaw responds to Julia Botwright’s article arguing that water fluoridation isn’t the silver bullet many make it out to be.

Julia Botwright’s article provides an opportunity to address some of the misunderstandings around community water fluoridation (CWF).

The copious misinformation found on the internet and on social media is challenging to all of us in the dental profession who support water fluoridation.

Given our responsibility to share up-to-date and accurate information, it is important to address some of Julia’s claims and terminology.

Mass medication

Mass medication is an inaccurate description for water fluoridation. Fluoride’s role is preventive; it is not a cure or remedy, but to strengthen tooth enamel and prevent dental decay.

As a constituent of toothpaste and as fluoride varnish, it is of course sold or recommended in dental practices up and down the land.

We add chlorine to water to prevent disease. No one sensibly argues that this is mass medication.


Fluoride is a nutrient that occurs naturally in all water and some foods and drink.

Public water supplies need fluoridating to ensure local people benefit from the optimum amount of fluoride – one part per million. There is plenty of evidence (Rugg-Gunn and Do, 2012) over 75 years that fluoridation is effective. An estimated 400 million people worldwide currently drink water from a deliberately fluoridated water supply.


There is no research evidence that, at one part per million of water, fluoride is: ‘A neurotoxin or endocrine disruptor’.


There is indeed evidence that CWF can cause mild fluorosis.

However, a comprehensive review of published studies found that very mild to mild fluorosis has no negative effects on the subject’s quality of life. Some evidence suggests enhanced quality of life with mild fluorosis (Chankanka et al, 2010).

A study in which children note to have mild or very mild fluorosis in 2003 and 2004 were seen seven to nine years later. The study found that these conditions have a tendency to diminish with time. They have no negative effect on the participants’ perception of their oral health (Do, Ha and Spencer, 2016).

Water fluoridation efficacy

There are a number of reviews and reports that conclude that community water fluoridation is safe and effective.

By contrast, the evidence in the article links to the Fluoride Action Network. This is an anti-fluoridation platform with links to high profile anti-vaccination campaigners.

Worryingly, Julia links to a page with an interview with Robert Kennedy who is linked to misinformation around vaccinations.

Dissolving in water

The fluoride ion used in community water fluoridation is exactly the same as that found in naturally fluoridated water.

The Royal Society of Chemistry points out that the fluoride found in water supplies originates from calcium fluoride. One of the compounds we can add to fluoridate water is sodium fluoride.

They both fully dissolve in water and dissociate into ions. Once dissociated in water, this negatively-charged fluoride species is identical, regardless of where these compounds are sourced from.

Evidence-based approach

As with vaccinations, in our discussions around fluoride and water fluoridation, the dental profession must take an evidence-based science approach in the interests of improving health and reducing health inequalities.


Chankanka O, Levy S, Warren J and Chalmers J (2010) A literature review of aesthetic perceptions of dental fluorosis and relationships with psychosocial aspects/oral health-related quality of life. Community Dent Oral Epidemiol 38(2): 97-109

Do LG, Ha D and Spencer J (2016) Natural history and long-term impact of dental fluorosis: a prospective cohort study. Medical Journal of Australia 204: 25.e1

Rugg-Gunn A and Do L (2012) Effectiveness of water fluoridation in caries prevention. Community Dent Oral Epidemiol 40 Suppl 2: 55-64

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