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Environmental Public Health Home > Water Fluoridation Program > Questions and Answers about Fluoridation Questions and Answers about Fluoridation

The following are some commonly asked questions about fluoridation and its uses. More information is available from the Centers for Disease Control and Prevention (CDC) at http://www.cdc.gov/Fluoridation/

Is fluoride toxic?

Do fluoride chemicals include arsenic and silicates?

Have there been legal challenges to fluoridation?

Don’t we need more research to prove the absolute safety of fluoridation?

Will fluoridation stain my teeth?

Does the U.S. EPA oppose water fluoridation?

Has Switzerland banned water fluoridation?

Does the aluminum industry promote fluoridation so it can dispose of its toxic waste?

Shouldn’t we have a debate on the merits of fluoridation?

Are there scientific articles or studies showing the dangers of fluoridation?

Is fluoride toxic?

While a substance may be toxic when ingested in large amounts, but in the correct amount it may be necessary to sustain life. Iodine is an example. While iodine is toxic at high concentrations, if it were not added to table salt the incidence of goiter would skyrocket. Not all chemicals are used by every water utility, but chlorine and fluoride are almost universal, and both are toxic at high concentrations. But both are added to drinking water in very low concentrations. As stated previously, dissolved in water, a compound will dissociate into its component elements, called ions. Thus, fluorine in water is present as the fluoride ion. One fluoride ion is the same as the next, no matter what other elements it was originally combined with. There is no difference between water that naturally contains fluoride ions, and water that has been purposely fortified with fluoride ions at the optimum concentration for reduction of tooth decay.

Do fluoride chemicals include arsenic and silicates?

The EPA hasn’t set a Maximum Contaminant Level (MCL) for the silicates because there is no known health concern at the low concentrations found in drinking water. ANSI/NSF Standard 60 sets standards for products used by the water industry, including standards for purity. NSF testing has demonstrated that the majority of fluorosilicic acid produced is incapable of imparting even a detectable level of arsenic to finished water. Of those that did have a detectable level, the average arsenic concentration in finished water was 0.43 micrograms per liter (ug/l). That’s less than 1/20th of EPA’s MCL for arsenic, 10 ug/l. While EPA has not established an MCL for silicates (again, there being no known health concern), NSF Standard 60 does include a standard for sodium silicates used for corrosion control. That standard is 16 mg/l to prevent excessive turbidity. The residual concentration of silicates added to drinking water via fluoridation is well below 16 mg/l.

Have there been legal challenges to fluoridation?

Yes. Antifluoridationists once pursued litigation as a means to stop water fluoridation, but that tactic has been a dismal failure. Many courts have ruled in favor of water fluoridation. With only two exceptions*, no court has ruled against fluoridation. Instead, they have looked to science, which includes clinical research and peer review, as the determinant on whether community water fluoridation is acceptable. In doing so, they have determined that:

  • fluoride is a nutrient…not a medication;
  • water fluoridation is an acceptable public health measure;
  • nobody is forced to drink fluoridated water (There are other options available, like bottled water or treatment units that employ reverse-osmosis or distillation…however, most bottled water contains fluoride in minute amounts);
  • water fluoridation does not interfere with religious freedom; and
  • mandating fluoridation is a valid use of police power.

*In the two exceptions, on appeal, a higher courts overruled the lower court decisions, and allowed community water fluoridation to continue.

Don’t we need more research to prove the absolute safety of fluoridation?

No. Despite the fact that thousands of studies, analyses, and experiments have shown fluoridation to be safe and effective, some insist that it cease until all doubts about its safety have been resolved. Of course, it is impossible to prove the absolute safety of anything. But in the case of fluoridation, opponents are constantly making new allegations, none of which are supported by science. Which means fluoridation could never be instituted. If we followed that line of reasoning on all issues, there would never be another technological advance implemented.

Will fluoridation stain my teeth?

No. Some antifluoridationists have trotted out photographs of teeth stained by tetracycline or severe dental fluorosis caused by water from a private well having a high concentration of fluoride. They claim those pictures depict what will happen to anyone who drinks fluoridated water. They do so despite that fact that most Hoosiers drink fluoridated water now, yet we don’t see wholesale numbers of Hoosiers with stained teeth.

Does the U.S. EPA oppose water fluoridation?

No. EPA has no authority under law to oppose or endorse fluoridation. But they can, and have, stated that "Fluoride in drinking water at levels of about 1 ppm reduces the number of dental cavities" (51 Fed Reg 1140, 1986). They have also stated that "There exists no directly applicable scientific documentation of adverse medical effects at levels of fluoride below 8 mg/l," (62 Fed Reg 64297, 1997). In effect, U.S. EPA has gone on record that there are no adverse medical effects from fluoridation even at eight times the optimum concentration for reduction of tooth decay. The basis for an allegation that the EPA opposes fluoridation occurred on July 2, 1997, when 20 EPA employees who opposed fluoridation attended a meeting of Chapter 280 of the National Federation of Federal Employees (NFFE). At that time, EPA had approximately 18,000 employees, and Chapter 280 of NFFE represented 1000-1600 of them. Because those 20 EPA employees constituted a majority of the union members attending the meeting, they were able to adopt a resolution opposing California's mandatory fluoridation law. At a subsequent press conference they claimed that NFFE adopted the resolution. Within a few days, Chapter officers issued an official statement declaring that the press conference was held without their knowledge or consent. Subsequent to that, two employees implied that EPA opposed fluoridation. Neither NFFE nor its successor, the National Treasury Employees' Union, has published an official position on fluoridation. The lack of all pertinent details, has mislead some of the public into thinking that EPA is opposed to water fluoridation.

Has Switzerland banned water fluoridation?

No. In Switzerland both water and salt fluoridation was practiced. Water fluoridation was used in the Canton of Basle, starting in 1962. To avoid overexposure to fluoride, fluoridated salt was prohibited from sale in Basle. But in 1995, Swiss federal law was changed to prohibit local regulation of salt. As a result, fluoridated salt began to be sold in Basle. Since many Basle citizens were unknowingly ingesting both fluoridated salt and fluoridated drinking water, the Canton voted to cease water fluoridation. Water fluoridation in Basle was challenged by some citizens; however, the Basle Cantonal Parliament determined that their concerns to be unfounded. Subsequently, the Swiss Federal Courts determined that water fluoridation was constitutional.

Does the aluminum industry promote fluoridation so it can dispose of its toxic waste?

No. The aluminum industry is the largest consumer of fluoride compounds. They use them as catalysts to smelt aluminum. For that reason, more than 40 years ago the Aluminum Company of America (ALCOA) acquired a plant that produced sodium fluoride. Not long after, ALCOA began buying fluoride compounds for less than it cost them to make at their own plant. ALCOA then sold their sodium fluoride manufacturing plant. Their last sale of sodium fluoride was in 1952. Since 1952, the aluminum industry has had no interest in promoting water fluoridation, whatsoever. In fact, if water fluoridation were to cease there would be more fluoride compounds available, and the aluminum industry’s smelting costs would go down. Yet some antifluoridationists still make the claim.

Shouldn’t we have a debate on the merits of fluoridation?

While the people should be allowed to decide the issue, their decision should not be based on debate, as there are no legitimate issues to debate. Debates are held to win arguments, not to prove the validity of science. Science is advanced by carefully planned experiments, by independent parties repeating the same experiment, by submission of all findings to peers for scrutiny and critical analysis; and by publication of those findings in reputable scientific journals for even wider scrutiny. A debate gives the illusion that there is scientific controversy, when in fact there is none.

Are there scientific articles or studies showing the dangers of fluoridation?

Some antifluoridationists have tried to submit poorly researched, poorly documented pseudoscientific articles to legitimate scientific journals, hoping that something would be published that they could then quote. As might be expected, these articles have been rejected for not meeting rigorous scientific standards. Fluoride opponents have formed their own pseudoscientific organizations, and given them impressive scientific-sounding names. While these organizations produce journals, and claim their journal articles are peer-reviewed, they are not. Be suspicious of any alleged medical journal that isn’t referenced in Index Medicus, the U.S. National Library of Medicine’s listing of peer-reviewed biomedical journals.