I initially dismissed it as the same category of stupid as anti-vax beliefs, but it turns out that there are a decent amount of good studies showing a link between fluoride in water and (slightly) lower IQ when pregnant mothers ingest the fluoride. Note that there is no significant effect after birth.
The idea is to remove fluoride from water and advise pregnant women to use fluoride-free toothpaste.
Everyone else can get enough fluoride from modern toothpastes, or regular dentist treatments.
The logic is that fluoride in tap water made sense in the era before toothpaste had it, but now it is “overmedicating” a vulnerable fraction of the population.
In the actual research the main "risk" posed by flouridated water is actually fluorosis. This causes minerals in your enamel to be replaced with flouride which can cause them to be brittle in the long term. It's pretty uncommon but the thought is that now that flouride toothpaste are commonplace, the benefit of flouridated water is also way less. Which changes the calculus.
A not insignificant number of researchers are advocating for the view that flouridating water just isn't worth it anymore and the (slight) risk of flourosis is more significant than the (slight) benefit of decreased dental caries.
Children are the main group that benefits from fluoride in water because the fluoride helps strengthen teeth as they form. Lack of fluoride increases childhood cavities, leading to decreased academic performance.
This was a real problem in the San Jose school district until recently. They started fluoridation of water in the last ten years, and were the biggest US city that didn’t fluoridate. The evidence of the above is clear according to SJ dentists I have talked to.
The National Toxicology Program recently completed a fairly substantial meta study and concluded that "for every 1 mg/L increase in urinary fluoride, there is a decrease of 1.63 IQ points in children.". [1] This is also relevant to OP since it's not just pregnant women at risk from excessive fluoridation but also children. For now it seems that adults are, somewhat oddly, unaffected.
Fluorosis is very common afaik. My dentist told me I have it: slightly whiter patches on my teeth. Then he showed me his own fluorosis. It actually is stronger than the old enamel.
> but now it is “overmedicating” a vulnerable fraction of the population.
Makes sense, but the intention also is that many people do not brush their teeth, or at least do not brush them as often as they should, and so fluoride is added to drinking water to compensate so people's teeth don't start to fall out at an alarming rate.
Sadly, an alarming percentage of Americans don't drink water. I’ve spoken to way too many people who think water tastes wrong because it’s not sweet enough.
I'm pretty sure that no amount of fluoridated water is going to save you if you do not brush your teeth.
Even if the fluoride somehow manages to overcome all that and prevent you from getting cavities, the gum disease will eventually cause all your teeth to fall out.
The levels of fluoridation in order to cause difference in IQ as I understand it, from the Chinese studies, suggest that basically the effect if true occurs at around 2x+ the concentration found in supplemented water supplies.
My understanding also is that if you’re a dentist wanting to get rich, move somewhere that has unfluoridated water.
2x is basically no safe margin for something like water. Of course you can question the quality of the study, but if it's actually 2x, fluoride in tap water should be treated like lead pipes.
So if your training and double your water intake your basically lowering you IQ? (according to the Chinese studies) I wonder the method this uses.. has anyone looked at dementia rates in high fluoride areas.. Particularly in people with high water intake?
There is also a host of things we use water for from cooking to preserving, distilling and cooling.. i wonder if any of these things could concentrate the fluoride.
Also since fluoride has a lower boiling point any studies tracked what breathing in fluoride gas over long periods cause?
2x is honestly pretty small. I would expect the amount required to drop IQ to be larger by an order of magnitude or more to conclude that fluoridating water is totally safe.
> I initially dismissed it as the same category of stupid as anti-vax beliefs
Dismissing things out of hand like this is a category of stupid in itself.
Look at the current research, listen to people who devoted their careers to studying this, make up your own mind. If you're on HN, then you're qualified enough to at least figure out who the genuine experts are and read what they recommend.
Putting any science-based debate into a "category" to dismiss is turning yourself into one of the stupid people.
This is bad advice that no one could possibly follow.
> Look at the current research, listen to people who devoted their careers to studying this, make up your own mind.
Do you honestly do this with every single belief you have? Even every single controversial belief? Have you looked, yourself, into whether the world is flat? Whether the 9/11 conspiracy theories are true? Whether crop circles were created by aliens? These are all absurd conspiracy theories, but I assume most people don't know the "up to date" research on any of them, or what people who have "devote their careers" to research them say.
And those are incredibly common and well known to be false theories.
You have to take some things on faith to at least some degree - though to be clear, by "on faith" I mean "on faith of people you trust", which should really start with professional scientists etc. Also, it's totally fine to just say "I have no actual idea" about most things, and just go with what your current understanding of the status-quo position is.
> Everyone else can get enough fluoride from modern toothpastes, or regular dentist treatments.
The advantage of putting it in water is that it ensures all children get it, not just the children whose parents can and do make sure they brush their teeth and go to the dentist.
Agree, my biggest issue is often where they source the fluoride and whether they test it. We found out in my (liberal) hometown that they were actually sourcing some derivative which has no human studies.
Given that everyone gets enough in toothpaste I just don’t see the reason to keep doing it, too much can go wrong. It’s kind of a strange mass medication that I’m not sure the government needs to be involved in.
> The idea is to remove fluoride from water and advise pregnant women to use fluoride-free toothpaste.
What most people don't understand here are the levels of fluoride being ingested. You can very easily remove all fluoride from your water with a relatively cheap RO system. But the recommendation to use "fluoride-free toothpaste" is just plain misinformation.
The reason is that you don't eat toothpaste. And even when adults ingest small amounts of toothpaste, again, the amount of fluoride is basically beyond negligible. Fluoride can both be applied to teeth as a varnish and/or consumed in drinking water. Using a flouride-free toothpaste can oftentimes do more damage than good because of SLS in those alternatives and because those alternatives often have abrasives that do far more harm than good. It's amazing people will recommend a product that may likely be worse because they have no domain expertise. So, yes, people should talk to their Dentist about these things and ask questions of them vs the Internet.
Really the downside to removing fluoride from city water is that low income families will be worse off with respect to dental related issues compared to more well off families that spend time instilling dental hygiene and preventative care for their kids. As you mentioned most people who have decent oral hygiene get enough flouride.
Where we live we have well water. Fluoride in the water isn't a concern, and if it was in our drinking water it generally wouldn't be consumed because of the water filtration anyway.
My anecdotal experience says that using fluride-free biomine toothpaste makes my tooth highly sensitive than using a good ol' Colgate. Now, I use it only twice or thrice per month randomly.
It is trivial today to get whatever level of fluoride is recommended for dental health, via toothpaste. So there is no compelling need to fluoridate as there exist viable alternatives to achieve the same that fluoridation is for any other purpose than dental health.
In the USA, dental care is not covered by public insurance, and is an optional add-on to insurance through one’s employer.
So without addressing at all whether fluoridation is effective or safe, there doesn’t seem to be any compelling need to fluoridate public water, and there’s no economic down side for the public if governments choose not to do so.
Given this, why not just leave people alone to make their own choices? If the citizens in a city or state want to fluoridate the public water supply, then do so; if they choose not to, then leave them alone. It’s a free country and voters are grownups; let them choose for themselves.
If you live in a place that chooses the choice you dislike but for some reason fluoridated public water supply is a critical issue for you, either campaign to change it or vote with your feet.
This issue just doesn’t seem important enough to me to spend any effort arguing either way.
> This issue just doesn’t seem important enough to me to spend any effort arguing either way.
Your comment is well-stated, and in the spirit of a free and liberal society. The problem—not with your argument, but with the world—is that today there seems to be literally no issue unimportant enough not to argue about, or use as the battlefield for an unending ideological proxy war. My guess is that few of the people arguing this issue on HN have strong feelings about flouride qua flouride, but have strong feelings about the kinds of people they believe oppose or support the use of flouride in water, and this notion is what they're really railing against.
This rings true for my gut reaction. The family and acquaintances in my life who have been up in arms against fluoride for years now are actual neo nzs (like “deport all non whites”, “you-know-who controls america”, “superiority of the white race” level).
So my instinct is to really be afraid of this anti-fluoride wave, even tho practically I don’t care one way or another.
I think one thing you're not considering (especially when you say we should vote with our feet) is poverty. It’s true that fluoride toothpaste is widely available, but for people in poverty, of which there are millions in our country, basic hygiene items like toothpaste and a toothbrush aren’t guaranteed. Neither is it guaranteed that everyone has a perfect daily brushing habit like the dentist tells us; there are people who don't brush every day, or even every week.
You talked about dental care not being covered by public insurance — is it not worth considering that some basic level of dental care is already being applied to the country via fluoridation? It's a minimal, cost-effective way to prevent tooth decay at scale. Fluoridated water is one of the few dental protections available to everyone regardless of their income.
If you're not brushing your teeth, periodontitis will get you; the resulting bone decay will cause your teeth will fall out. But sure, great, the water was fluoridated, so I guess it's nice that those now-missing teeth are free of caries?
I don't believe there's a single person in the USA that's so poor they can't pay $3 for toothpaste every 3 months. I also believe that having such a low personal hygiene where you don't brush your teeth altogether, even if you drink water with fluoride, will have terrible results anyway for your teeth anyway.
I'm completely sure that any people that don't brush their teeth is just because they are too lazy to even bother.
This trope of justifying everything with "but there are millions of poor people in the USA" is really tiresome.
Trivial is what we have now. Taking fluoride from the water means people will have to spend extra time and money on fluoride and dental treatments. When I viewed it, your comment appeared directly after this one (https://news.ycombinator.com/item?id=43524171), which talks about a town in Canada that voted to abandon fluoride , saw worse health outcomes, and then voted to reinstate it. This tells us that fluoride is not trivially available to people, and taking it away from them enriches corporations while making people less healthy.
Your indifference is based on some core assumptions that are false. In reality,
1) Fluoride in water works in addition to fluoride in toothpaste to protect our teeth - rather than two highly concentrated events of reminieralization, fluoriated water reminieralizes the teeth throughout the day.
2) There is a strong economic downside to ceasing fluoridation: Fluoridation saves millions of dollars that otherwise would be spent on dental bills by the public - https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2016.0... - shows cost savings ratio of twenty dollars for every.
dollar invested in reduced treament costs. This remains apt: https://pmc.ncbi.nlm.nih.gov/articles/PMC7164347/
3) The best way to preserve choice is to maintain fluoridation. People cannot choose to fluoridated their own water system - they can choose to live in unfluoridated areas, use filters that remove fluoride, or otherwise avoid the tap water.
4) Removing fluoridation means acces to fluoride becomes much more difficult and expensive. The reason fluoridation is so cost effective is that it is delivered through the public water system - a community resource. Bottled fluoridated water is more expensive than gasoline. It is also less regulated and less available in the U.S.A.
In general it's some weird relic of medieval view on dentists not being medical professionals but someone akin to barbers. It shouldn't exits but it persists.
That’s going to go poorly. A Canadian city removed fluoride from water in 2011 and reversed that decision 10 years later. There’s hard data on the effects and they’re not good [0].
The study [1] that's based on seems pretty typical, and is precisely what drives skepticism towards these policies. The differences for permanent teeth were not significant. The paper claimed this may be because "7-year-olds have not had the time to accumulate enough permanent dentition caries experience for differences to have become apparent." The differences in temporary teeth had a deft (decay, extracted, filled teeth) of 66.1% in Calgary (no fluoride) and 54.3% in Edmonton (fluoridated).
So you're looking at a small positive improvements in dental outcomes, for what may be a permanent decline to IQ. That's obviously not a trade I think anybody would make, so the real issue is not whether or not it improves dental outcomes but whether it's having measurable effects on IQ as we have seen in other studies. [2] I don't understand why a study operating in good faith wouldn't also pursue this question in unison, or in fact as the primary question. I think relatively few people outright doubt the dental benefits of fluoride, but rather are concerned about the cost we may pay for such.
In the 2nd study that shows correlation between fluoride and lower IQ in children, the water had twice as much fluoride as the recommended amount in the US (1.5 mg/L vs 0.7 mg/L).
The most ridiculous part is that we have an alternative way to apply fluoride without intaking it. It's called toothpaste. But for some reason people act like Utah is banning vaccine.
I don't think it's about hard data and optimization of health, but rather bodily autonomy.
I'm sure there are plenty of chemicals that could be forcibly put in the drinking supply that, based on current scient, would be beneficial for the public. But I would still be skeptical. Sell me these substances in my food or toothpaste, but don't put it in my drinking water by default.
It's also worth noting about 3% of western Europe has fluorinated so let's not pretend like this is unprecedented
Many places in Europe have high levels of fluoride in their water naturally. In fact many of them are likely getting far too much fluoride.
Also realistically, if people cared about bodily autonomy cars would've been banned immediately thanks to the amount of particulates and local pollution produced causing far more adverse health effects.
Is one due the right to potable water at a tap at their home? Or is purified water a service offered by the government as one source of many available to the us population?
Are you not allowed to pay for bottled water instead of paying your local utility for drinking water?
The bodily autonomy argument seems bad to me because you are buying water from the government when you could buy water from any other source instead.
Is the argument that the government water is too convenient and so it should be unfiltered? Who is to say that filtering out poop is not infringing on my right to consume unfiltered water?
Fluoride was introduced late enough in Zimbabwe that many of my childhood adults easily remembered life before it. There were many horror stories about the general state of teeth prior.
That being said, your dentist can apply fluoride to your teeth (boggles the mind why insurance won't pay the $50), and flouride toothpaste is still much more common than not. It's probably not needed in the water supply for dental purposes.
That being said, what are the other fringe benefits: such as microbe control?
The city of Houston has stopped adding fluoride to water but allows natural fluoride levels to exist[0]. We are going on year 6 and the only thing we have noticed is harder water.
There is probably more nuance to both stories tho.
Perhaps more could be done. The situation is complex because of several compounding factors for sure. There are European countries that have no water fluoridation and better oral health outcomes than in North America.
Regardless, there’s 10 years where a city in North America turned off water fluoridation and we have results of that decision to study.
Hawaii does not add fluoride to their water. Utah may be the first to out-right ban it, but there are quite a few local communities and cities that opt-out of adding it to their drinking water.
The US is, according to Wikipedia, among a small minority of countries in which a majority of people drink fluoridated water. Various European countries have discontinued doing so. <https://en.wikipedia.org/wiki/Water_fluoridation>
Yeah, this is one of those places where because RFK Jr took the anti- stand there's an understandable assumption that it's more nutty anti-science stuff, but it's much less clear cut when it comes to fluoridation. Europe has much lower rates than the US, which is an outlier on these stats only approached by Australia, and before Utah the major high profile anti-fluoride stance was made by Portland:
I was surprised to learn this. "Worldwide, the Irish Republic, Singapore and New Zealand are the only countries which implement mandatory water fluoridation."
I live in New Zealand and my town doesn't put fluoride in the water but it seems like they'll be made to do so fairly soon. I don't really care one way or the other from the point of view of ingesting the stuff, but I do consider it a bit of a waste of money. People who brush with toothpaste don't need this and people who don't are probably drinking too much soda. A more useful thing to do might be to subsidize toothpaste for people who can't / won't buy it for their kids.
Many other places fluoridate salt. There’s many ways to get flourish (toothpaste being the best if you can get people to use it correctly) but the evidence that mass fluoridation of some kind is good for dental health is enormous.
It seems like they could compare states/countries/cities while controlling for other factors (age, income level, etc) to see how well fluoridation works. I'm pretty sure you'll find that fluoridation helps lower the number of cavities, but it's not going to be a slam dunk.
People who want to remove fluoride from the water should visit countries where fluoride is not added and look at people's teeth.
I live in France and it's just so obvious that people grew up without fluoride — even celebrities try to talk without showing their teeth when they're on TV!
I'm all for getting consent in most cases, but sometimes you'd have to be an idiot not to take the obvious win.
It's like we were delivering flakes of gold with the mail and people complained — that's not what mailboxes are for!
You're misattributing: the U.S. has a perfect white teeth culture that doesn't exist elsewhere. Many people outside of the U.S. have healthier but uglier teeth. Fluoride isn't the reason for good/bad teeth inside/outside of the U.S, it's cultural. Many places outside of the U.S. do put fluoride in their water (nationally or regionally) and have "bad" teeth (e.g: England).
People in the U.S. don't have perfect white teeth, they have are cosmetic procedures on their teeth equivalent to liposuction, silicone, botox, hair plugs and/or laminated face.
While tooth whiteness in the US is often divorced from tooth health, fluoride does add a yellowish tint to your teeth, so the healthiest teeth — those imbued with fluoride — are slightly yellow. (In fact when they first decided to add fluoride to water, one of the questions was just how much they could add before your teeth would turn completely yellow. Health-wise the yellowing was fine, but it was obviously visually unappealing.) Ugly teeth may be due to poor/lack of orthodontia, but it's probably not due to better dental care.
But flakes of gold are not associated with a lower IQ in children.
"The NTP monograph concluded, with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children."
So it is also not clear, if the lower concentration typically found also has this effect.
"It is important to note that there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ."
But the solution of just using (cheap) Fluor in toothpaste to apply the Flour where it should go - to the teeth and not the stomach, sounds smarter to me.
So in other words, 0.7mg/L fluoridated water is also not associated with lower IQ in children. That study did not prove it safe, but it did prove it unsafe, either.
Where I live, dental health is good and we don’t have fluorides in the water (we have free, mandatory dental care for children). We recently banned the use of fluorides to make our skis go fast because of the environmental impact.
Utah has naturally occurring fluoride in their water and some water systems its more than double(2.0mg/l) what they add to prevent dental issues. Why were they fluorinating their water?
I am saying it’s weird to fluoridate water in areas with high levels of naturally occurring fluoride. Also to point out that there is naturally occurring fluoride. If Utah believed fluoride was a health risk, why aren’t they spending tens of millions to filter it out. Or is it just virtue signaling.
> This is the US health system being lead by a bunch of woo-woo people who don’t understand how research works.
The majority of the developed world does not fluoridate their water supply. The US has one of the highest rates of fluoridation in the developed world. Within America, fluoridation rates are highest on the East Coast and in the South, and lowest on the Left Coast.
The people leading the health system are highly credentialed. Moreover, highly credentialed people, in medicine as in all fields, frequently disagree on what studies show, how valid a study is, what it's flaws and limits are, how conclusive it is, and so forth. And the consensus has a long, time honored tradition of being wrong from time to time.
Ultimately, the woo woo people are the ones who rely on someone in a labcoat to tell them whether ingesting government approved (there's your first red flag) synthetic fluoride from industrial byproducts is "necessary".
If it's useful, brushing it onto your teeth and into your gums 56,000 times in your life is probably sufficient, particularly given that we don't know with absolute certainty beyond any shadow of a doubt that the industrial waste options are totally without health consequences. I'll literally just take care of my teeth and cross my fingers over listening to modern medical consensus on a range of topics where I simply trust intuition and common sense more.
For me as a European, adding fluoride to water for your teeth is as ridiculous as cutting the foreskin of babies' penis in name of (dubious) "hygienic reasons".
But people get used to it. Specially when they don't get to experience the alternative. Most people rationalise it is a good thing. Stockholm syndrome.
Which part of Europe are you in? Countries in Europe add fluoride to water, salt, milk, and Italy has naturally fluoridated water.
> The European Academy of Pediatric Dentistry
(EAPD) recently called water fluoridation "a core component of oral health policy" and adds that salt fluoridation "is suggested when water fluoridation cannot be implemented" due to
technical, logistical or political reasons.
I was thinking exactly the same thing, down to the circumcision thing. This whole discourse gives me the vibe of something the American society has randomly walked on and now is an "it has always been like this".
They also keep passing laws to specifically support burning coal, which is (slightly more credibly) shown to reduce IQ in children exposed to its pollution.
Readit News
The idea is to remove fluoride from water and advise pregnant women to use fluoride-free toothpaste.
Everyone else can get enough fluoride from modern toothpastes, or regular dentist treatments.
The logic is that fluoride in tap water made sense in the era before toothpaste had it, but now it is “overmedicating” a vulnerable fraction of the population.
In the actual research the main "risk" posed by flouridated water is actually fluorosis. This causes minerals in your enamel to be replaced with flouride which can cause them to be brittle in the long term. It's pretty uncommon but the thought is that now that flouride toothpaste are commonplace, the benefit of flouridated water is also way less. Which changes the calculus.
A not insignificant number of researchers are advocating for the view that flouridating water just isn't worth it anymore and the (slight) risk of flourosis is more significant than the (slight) benefit of decreased dental caries.
This was a real problem in the San Jose school district until recently. They started fluoridation of water in the last ten years, and were the biggest US city that didn’t fluoridate. The evidence of the above is clear according to SJ dentists I have talked to.
[1] - https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...
Was that intentional? (https://en.wiktionary.org/wiki/dental_calculus for those who didn't get the reference.)
Not really: https://jamanetwork.com/journals/jamapediatrics/fullarticle/...
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Makes sense, but the intention also is that many people do not brush their teeth, or at least do not brush them as often as they should, and so fluoride is added to drinking water to compensate so people's teeth don't start to fall out at an alarming rate.
Even if the fluoride somehow manages to overcome all that and prevent you from getting cavities, the gum disease will eventually cause all your teeth to fall out.
many? (!!!)
Googling it all I found was one dentist website that said 2%, but didn't seem that reliable
My understanding also is that if you’re a dentist wanting to get rich, move somewhere that has unfluoridated water.
There is also a host of things we use water for from cooking to preserving, distilling and cooling.. i wonder if any of these things could concentrate the fluoride.
Also since fluoride has a lower boiling point any studies tracked what breathing in fluoride gas over long periods cause?
Dismissing things out of hand like this is a category of stupid in itself.
Look at the current research, listen to people who devoted their careers to studying this, make up your own mind. If you're on HN, then you're qualified enough to at least figure out who the genuine experts are and read what they recommend.
Putting any science-based debate into a "category" to dismiss is turning yourself into one of the stupid people.
> Look at the current research, listen to people who devoted their careers to studying this, make up your own mind.
Do you honestly do this with every single belief you have? Even every single controversial belief? Have you looked, yourself, into whether the world is flat? Whether the 9/11 conspiracy theories are true? Whether crop circles were created by aliens? These are all absurd conspiracy theories, but I assume most people don't know the "up to date" research on any of them, or what people who have "devote their careers" to research them say.
And those are incredibly common and well known to be false theories.
You have to take some things on faith to at least some degree - though to be clear, by "on faith" I mean "on faith of people you trust", which should really start with professional scientists etc. Also, it's totally fine to just say "I have no actual idea" about most things, and just go with what your current understanding of the status-quo position is.
The advantage of putting it in water is that it ensures all children get it, not just the children whose parents can and do make sure they brush their teeth and go to the dentist.
Bad parents are gonna be bad parents.
Given that everyone gets enough in toothpaste I just don’t see the reason to keep doing it, too much can go wrong. It’s kind of a strange mass medication that I’m not sure the government needs to be involved in.
What most people don't understand here are the levels of fluoride being ingested. You can very easily remove all fluoride from your water with a relatively cheap RO system. But the recommendation to use "fluoride-free toothpaste" is just plain misinformation.
The reason is that you don't eat toothpaste. And even when adults ingest small amounts of toothpaste, again, the amount of fluoride is basically beyond negligible. Fluoride can both be applied to teeth as a varnish and/or consumed in drinking water. Using a flouride-free toothpaste can oftentimes do more damage than good because of SLS in those alternatives and because those alternatives often have abrasives that do far more harm than good. It's amazing people will recommend a product that may likely be worse because they have no domain expertise. So, yes, people should talk to their Dentist about these things and ask questions of them vs the Internet.
Really the downside to removing fluoride from city water is that low income families will be worse off with respect to dental related issues compared to more well off families that spend time instilling dental hygiene and preventative care for their kids. As you mentioned most people who have decent oral hygiene get enough flouride.
Where we live we have well water. Fluoride in the water isn't a concern, and if it was in our drinking water it generally wouldn't be consumed because of the water filtration anyway.
Source: spouse is a DDS.
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They banned it as part of the culture war. That's 100% of the reason. "The libs" want it, so it must be banned.
In the USA, dental care is not covered by public insurance, and is an optional add-on to insurance through one’s employer.
So without addressing at all whether fluoridation is effective or safe, there doesn’t seem to be any compelling need to fluoridate public water, and there’s no economic down side for the public if governments choose not to do so.
Given this, why not just leave people alone to make their own choices? If the citizens in a city or state want to fluoridate the public water supply, then do so; if they choose not to, then leave them alone. It’s a free country and voters are grownups; let them choose for themselves.
If you live in a place that chooses the choice you dislike but for some reason fluoridated public water supply is a critical issue for you, either campaign to change it or vote with your feet.
This issue just doesn’t seem important enough to me to spend any effort arguing either way.
Your comment is well-stated, and in the spirit of a free and liberal society. The problem—not with your argument, but with the world—is that today there seems to be literally no issue unimportant enough not to argue about, or use as the battlefield for an unending ideological proxy war. My guess is that few of the people arguing this issue on HN have strong feelings about flouride qua flouride, but have strong feelings about the kinds of people they believe oppose or support the use of flouride in water, and this notion is what they're really railing against.
So my instinct is to really be afraid of this anti-fluoride wave, even tho practically I don’t care one way or another.
You talked about dental care not being covered by public insurance — is it not worth considering that some basic level of dental care is already being applied to the country via fluoridation? It's a minimal, cost-effective way to prevent tooth decay at scale. Fluoridated water is one of the few dental protections available to everyone regardless of their income.
I'm completely sure that any people that don't brush their teeth is just because they are too lazy to even bother.
This trope of justifying everything with "but there are millions of poor people in the USA" is really tiresome.
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I’m not sure what your anecdote proves because I’m wholly in support of a polity being able to make that decision.
I wonder how many people really brush their teeth on a regular basis.
> either campaign to change it or vote with your feet.
I imagine that campaigning to change it requires notifying people there is a problem, and getting it into the news and spreading that news.
Whatever the number is it's not appropriate for the state to medically intervene on their behalf.
[0] https://www.npr.org/2024/12/13/nx-s1-5224138/calgary-removed...
So you're looking at a small positive improvements in dental outcomes, for what may be a permanent decline to IQ. That's obviously not a trade I think anybody would make, so the real issue is not whether or not it improves dental outcomes but whether it's having measurable effects on IQ as we have seen in other studies. [2] I don't understand why a study operating in good faith wouldn't also pursue this question in unison, or in fact as the primary question. I think relatively few people outright doubt the dental benefits of fluoride, but rather are concerned about the cost we may pay for such.
[1] - https://onlinelibrary.wiley.com/doi/full/10.1111/cdoe.12685
[2] - https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...
All previous data is ignored because of political reasons.
Teeth to slowly rot in heads.
Sometime in the 2030s, local voters will notice they have very bad teeth.
Locals will debate if adding fluoride is going to make teeth great again.
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I'm sure there are plenty of chemicals that could be forcibly put in the drinking supply that, based on current scient, would be beneficial for the public. But I would still be skeptical. Sell me these substances in my food or toothpaste, but don't put it in my drinking water by default.
It's also worth noting about 3% of western Europe has fluorinated so let's not pretend like this is unprecedented
Also realistically, if people cared about bodily autonomy cars would've been banned immediately thanks to the amount of particulates and local pollution produced causing far more adverse health effects.
Are you not allowed to pay for bottled water instead of paying your local utility for drinking water?
The bodily autonomy argument seems bad to me because you are buying water from the government when you could buy water from any other source instead.
Is the argument that the government water is too convenient and so it should be unfiltered? Who is to say that filtering out poop is not infringing on my right to consume unfiltered water?
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That being said, your dentist can apply fluoride to your teeth (boggles the mind why insurance won't pay the $50), and flouride toothpaste is still much more common than not. It's probably not needed in the water supply for dental purposes.
That being said, what are the other fringe benefits: such as microbe control?
There is probably more nuance to both stories tho.
[0] https://houstonherald.com/2018/11/lindsey-and-long-win-count...
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The actual high quality evidence shows that water fluorination has minimal impact on tooth health in 2025: https://www.cochrane.org/news/water-fluoridation-less-effect...
https://onlinelibrary.wiley.com/doi/full/10.1111/cdoe.12215
Perhaps more could be done. The situation is complex because of several compounding factors for sure. There are European countries that have no water fluoridation and better oral health outcomes than in North America.
Regardless, there’s 10 years where a city in North America turned off water fluoridation and we have results of that decision to study.
https://chatgpt.com/share/67e8572d-c5f4-8000-9393-c2e894c922...
https://www.wweek.com/portland/blog-30229-portland-voters-so...
To the extent this is a polarized left-right issue, it's only recently and only because everything is polarized right now.
I live in New Zealand and my town doesn't put fluoride in the water but it seems like they'll be made to do so fairly soon. I don't really care one way or the other from the point of view of ingesting the stuff, but I do consider it a bit of a waste of money. People who brush with toothpaste don't need this and people who don't are probably drinking too much soda. A more useful thing to do might be to subsidize toothpaste for people who can't / won't buy it for their kids.
I live in France and it's just so obvious that people grew up without fluoride — even celebrities try to talk without showing their teeth when they're on TV!
I'm all for getting consent in most cases, but sometimes you'd have to be an idiot not to take the obvious win.
It's like we were delivering flakes of gold with the mail and people complained — that's not what mailboxes are for!
"The NTP monograph concluded, with moderate confidence, that higher levels of fluoride exposure, such as drinking water containing more than 1.5 milligrams of fluoride per liter, are associated with lower IQ in children."
https://ntp.niehs.nih.gov/whatwestudy/assessments/noncancer/...
So it is also not clear, if the lower concentration typically found also has this effect.
"It is important to note that there were insufficient data to determine if the low fluoride level of 0.7 mg/L currently recommended for U.S. community water supplies has a negative effect on children’s IQ."
But the solution of just using (cheap) Fluor in toothpaste to apply the Flour where it should go - to the teeth and not the stomach, sounds smarter to me.
So fluoride would somehow magically replace braces or teeth whiteners?
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US is an outlier there, so there is that.
And yet France does not have a dental health crisis so it's just for cosmetic reasons we don't need fluoride
https://cascadefamily.com/images/WaterFluoridationLevelsUtah...
Or, toothpaste has enough extra fluoride, adding it to water is just a waste of money.
This is not that. This is the US health system being lead by a bunch of woo-woo people who don’t understand how research works.
The majority of the developed world does not fluoridate their water supply. The US has one of the highest rates of fluoridation in the developed world. Within America, fluoridation rates are highest on the East Coast and in the South, and lowest on the Left Coast.
Ultimately, the woo woo people are the ones who rely on someone in a labcoat to tell them whether ingesting government approved (there's your first red flag) synthetic fluoride from industrial byproducts is "necessary".
If it's useful, brushing it onto your teeth and into your gums 56,000 times in your life is probably sufficient, particularly given that we don't know with absolute certainty beyond any shadow of a doubt that the industrial waste options are totally without health consequences. I'll literally just take care of my teeth and cross my fingers over listening to modern medical consensus on a range of topics where I simply trust intuition and common sense more.
But people get used to it. Specially when they don't get to experience the alternative. Most people rationalise it is a good thing. Stockholm syndrome.
> The European Academy of Pediatric Dentistry (EAPD) recently called water fluoridation "a core component of oral health policy" and adds that salt fluoridation "is suggested when water fluoridation cannot be implemented" due to technical, logistical or political reasons.
https://static.spokanecity.org/documents/citycouncil/interes...
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