There have been dozens of posts about water fluoridation in the past on scattered topics about the subject, we decided to compile all of the studies together into one reference sheet. Brace for impact.

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Greetings, so I have noticed in the past there were tons of posts about water fluoridation and I decided compile all of the links and evidence together into one giant reference table. Enjoy! ~Tony


All assumptions aside, I am relying on strict, hard evidence and studies.

Disclaimer: I am not an expert in this field. Many studies are incomplete, and some have great margins of error, so please be note and weary of that. Lots of data in this come from the National Academies of Science, Engineering, and Medicine and mainly reference a summary from this very lengthy report done by the academy1 in 2006. They also come from both British, American, Australian, and International sources.

Water fluoridation

It is a process done in mainly western countries, most especially in the United States for the purposes of public health to combat tooth decay, particularly in children. Water fluoridation is done to help create a “modern standard” for teeth, especially since America is infamous for always having clean teeth.2,3,4

In fact, America makes up the vast majority plurality of fluoridated citizens worldwideaccording to the Center for Disease Control itself. Out of the 435 million people worldwide drinking water actively fluoridated by government, more than 200 million of them are in the United States.

Here are some statistics on populations of the fluoridated citizenry as of 2014, according to the CDC link:

Group Diagnostic
Total US population, persons 318,857,056
US population on community water systems (CWS), persons 284,099,832
Total US population on fluoridated drinking water systems, persons 211,393,167
Percentage of US population receiving fluoridated water 66.3%
Percentage of US population on CWS receiving fluoridated water 74.4%
Number of CWS providing fluoridated water 18,186
Number of CWS adjusting fluoride 5,919
Number of CWS consecutive to systems with optimal fluoride levels 6,015
Number of CWS with naturally occurring fluoride at or above optimal levels 6,205
Population served by CWS with naturally occurring fluoride at or above optimal levels 11,883,007

And that was just the national level. Let’s take a look at it state by state:

State Persons receiving fluoridated water Persons served by CWS % Rank
United States 211,393,167 284,099,832 74.4% x
Alabama 3,812,180 4,849,377 78.6% 23
Alaska 335,555 680,780 49.3% 43
Arizona 3,199,068 5,536,324 57.8% 38
Arkansas 1,973,169 2,808,508 70.3% 32
California 24,699,693 38,802,500 63.7% 34
Coloradof 3,963,472 5,355,866 74.0% 27
Connecticut 2,409,333 2,690,930 89.5% 15
Delaware 712,420 818,110 87.1% 19
District of Columbia 595,000 595,000 100%
Florida 13,302,502 17,151,024 77.6% 24
Georgia 9,717,858 10,097,343 96.2% 6
Hawaii 159,935 1,419,516 11.7% 50
Idaho 388,678 1,218,565 31.9% 47
Illinois 12,687,788 12,880,580 98.5% 3
Indiana 4,388,330 4,582,546 94.7% 8
Iowa 2,575,373 2,778,151 92.7% 12
Kansas 1,707,050 2,689,904 63.5% 35
Kentucky 4,388,383 4,393,871 99.9% 1
Louisiana 2,056,595 4,649,676 44.2% 45
Maine 524,240 661,140 79.3% 21
Maryland 5,021,283 5,206,520 96.4% 5
Massachusetts 4,750,952 6,745,408 70.4% 31
Michigan 7,519,064 8,201,134 91.7% 13
Minnesota 4,165,301 4,215,391 98.8% 2
Mississippi 1,796,005 2,994,079 60.0% 37
Missouri 4,010,999 5,226,030 76.8% 26
Montana 265,783 788,805 33.7% 46
Nebraska 1,020,092 1,425,664 71.6% 29
Nevada 1,873,848 2,544,079 73.7% 28
New Hampshire 406,336 872,864 46.6% 44
New Jersey 1,206,930 8,288,715 14.6% 49
New Mexico 1,210,877 1,571,600 77.0% 25
New York 12,934,585 18,106,193 71.4% 30
North Carolina 6,067,182 6,907,674 87.8% 18
North Dakota 616,946 637,796 96.7% 4
Ohio 9,790,109 10,557,092 92.7% 11
Oklahoma 2,231,658 3,564,183 62.6% 36
Oregon 833,557 3,688,540 22.6% 48
Pennsylvania 5,882,330 10,780,146 54.6% 41
Rhode Island 842,987 997,824 84.5% 20
South Carolina 3,468,425 3,706,859 93.6% 10
South Dakota 646,671 690,759 93.6% 9
Tennessee 5,103,368 5,789,624 88.1% 17
Texas 19,645,292 24,869,812 79.0% 22
Utah 1,382,188 2,672,278 51.7% 42
Vermont 253,548 450,710 56.3% 40
Virginia 6,166,729 6,429,902 95.9% 7
Washington 3,530,835 5,525,840 63.9% 33
West Virginia 1,367,215 1,509,995 90.5% 14
Wisconsin 3,579,100 4,025,387 88.9% 16
Wyoming 256,350 449,223 57.1% 39

It’s not a surprise that the CDC actually prides itself in water fluoridation, saying that it is one of the ten greatest public health achievements in United States History.

Now back to the rest of the world

Dental hygiene and cavities remain a public health concern5 for 60-90% of children6 in industrialised countries7,along with adults8. Water fluoridation may be a solution to this, and according to the United Kingdom, there are no adverse effects of this9, but that has been disputed over the years10 by academia. The process by which public drinking water is fluorided has shown to cause dental fluorosis11. Australian government health councils have noticed this but say that it is “not a public health concern”.12

However, there are some problems associated with the benefits and buffetings done by water fluoridation by government; in fact, evidence has shown in Europe13 to have little influence over tooth quality in adults, but major differences in children. Many countries in Europe have experienced substantial declines in tooth decay14even without its use, even to the point where it may be unnecessary due to personal choices to keep up with dental hygiene.

Government standards and practices

For the purposes of this to let me add many links quickly, some of the links quoted here are not shown in the reference table (works cited) found below. Please refer to the reference table for citations in the footnotes above.

In 2011 the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L, tailored to climate, locality, and other sources of fluoride. To avoid repetition in referencing, please refer to this gigantic document released by the World Health Organisation concerning international standards for the practice of water fluoridation. It took a very long time for me to read.

As of 2012, 25 countries have actively participated in water fluoridation, 11 of them have more than half of the population drinking water with dangerous amounts of fluorine15, the health effects I will list below.

In the United States, the CDC has also provided a national table guideline for how fluoride should be placed in the water. It is yet again an extremely lengthy document, so brace yourself and grab some coffee (hopefully without sodium fluorine).

Included in that bible-sized document are some very important tables:

TABLE 2. Recommended optimal fluoride levels for community public water supply systems:

Annual average of maximum daily air temperatures Recommended fluoride Recommended control range (mg/L) 0.1-0.5
F C (mg/L)
50.0-53.7 10.0-12.0 1.2
53.8-58.3 12.1-14.6 1.1
58.4-63.8 14.7-17.7 1.0
63.9-70.6 17.8-21.4 0.9
70.7-79.2 21.5-26.2 0.8
79.3-90.5 26.3-32.5 0.7

Here are some of the chemicals frequently added to 63% of the US population’s drinking water according to the CDC:

  • Sodium Fluoride. (NaF), the US Government administers 1/5th of a lethal dose per liter of water.
  • Fluorosilicic acid. (H2SiF6), which is expensive to transport. This one is most frequently used by the United States. It is also a byproduct of fertilizer.
  • Sodium fluorosilicate. (Na2SiF6), it is easier to ship.

References, there are five of them that each contain lengthy files concerning the content and how it is administered. The references are tedious to repeat, but nevertheless, I have them below in the works cited table as references 16-20.

Also I will admit that I found this (the following) on Wikipedia and it is rather concerning:

> Although fluoride was once considered an essential nutrient, the U.S. National Research Council has since removed this designation due to the lack of studies showing it is essential for human growth, though still considering fluoride a “beneficial element” due to its positive impact on oral health.

And perhaps the scariest find of them all, from the CDC again, saying that:

> …..optimal level of fluoride to range from 0.7 to 1.2 mg/L…..

Okay, now on to some more stuff.

Safety concerns and hazards

There have been many cases of fluoride accidents resulting in illness and death in state populations in the past, particularly in the 1990’s. Such cases can cause severe vomiting, nausea, and diarrhea. One such case was in 1992 in Alaska, where 262 people became ill and one person passed away. Another incident in 2010 in Asheboro, North Carolina, where 60 gallons of fluoride were released into the water in 90 minutes.

Health effects and experimentation

Experimentation with both low and high concentrations of fluoride in water among native and eastern societies shows that fluoride in drinking water has a significantly high impact on IQ.

I will mainly be referencing this study, done by the National Academy of Sciences, Engineering, and Medicine. Also, remember and recall the World Health Organisation’s standards regarding fluoride levels and implementation; keep that in mind as you read my remarks on the study. For those of you who have trouble loading PDF’s, here is an archived link to an html of the same document. Since the study is very lengthy containing several chapters, I mainly reference the summary but also some elements of chapters 1, 2, and 7. The study contains more chapters, especially very concerning ones about fluoride drinking water’s effects on the endocrine system in chapter 8, but I may save that for another time.

The reasoning behind the study was actually because of the EPA:

> In response to EPA’s request, the NRC convened the Committee on Fluoride in Drinking Water, which prepared this report. The committee was charged to review toxicologic, epidemiologic, and clinical data on fluoride— particularly data published since the NRC’s previous (1993) report—and exposure data on orally ingested fluoride from drinking water and other sources.

Furthermore, this is the scary part, particularly recalling earlier in this post when I referenced the safety levels of fluoride:

> Overall, the committee found that the contribution to total fluoride exposure from fluoride in drinking water in the average person, depending on age, is 57% to 90% at 2 mg/L and 72% to 94% at 4 mg/L.

So clearly for above-average water drinkers like me, I’m getting a very large dose of this stuff.

Musculoskeletal concerns:

> There were few studies to assess fracture risk in populations exposed to fluoride at 2 mg/L in drinking water. The best available study, from Finland, suggested an increased rate of hip fracture in populations exposed to fluoride at concentrations above 1.5 mg/L.

Keep in mind that those bone fractures only occurred at 1.5 or 2 mg/L, when above average people like me get 4 mg/L.

Skeletal fluorosis:

> Skeletal fluorosis is a bone and joint condition associated with prolonged exposure to high concentrations of fluoride. Fluoride increases bone density and appears to exacerbate the growth of osteophytes present in the bone and joints, resulting in joint stiffness and pain. The condition is categorized into one of four stages: a preclinical stage and three clinical stages that increase in severity. The most severe stage (clinical stage III) historically has been referred to as the “crippling” stage. At stage II, mobility is not significantly affected, but it is characterized by chronic joint pain, arthritic symptoms, slight calcification of ligaments, and osteosclerosis of the cancellous bones. Whether EPA’s MCLG of 4 mg/L protects against these precursors to more serious mobility problems is unclear.

Gastrointestinal and other organ systems:

> The committee also considered effects on the gastrointestinal system, kidneys, liver, and immune system. There were no human studies on drinking water containing fluoride at 4 mg/L in which gastrointestinal, renal, hepatic, or immune effects were carefully documented. Case reports and in vitro and animal studies indicated that exposure to fluoride at concentrations greater than 4 mg/L can be irritating to the gastrointestinal system, affect renal tissues and function, and alter hepatic and immunologic parameters. Such effects are unlikely to be a risk for the average individual exposed to fluoride at 4 mg/L in drinking water. However, a potentially susceptible subpopulation comprises individuals with renal impairments who retain more fluoride than healthy people do.

And finally, chapter 7 of the entire study concludes effects on neurological and IQ systems:

A lengthy description of the experiment and study:

> Several studies from China have reported the effects of fluoride in drinking water on cognitive capacities (X. Li et al. 1995; Zhao et al. 1996; Lu et al. 2000; Xiang et al. 2003a,b). Among the studies, the one by Xiang et al. (2003a) had the strongest design. This study compared the intelligence of 512 children (ages 8-13) living in two villages with different fluoride concentrations in the water. The IQ test was administered in a double-blind manner. The high-fluoride area (Wamiao) had a mean water concentration of 2.47 ± 0.79 mg/L (range 0.57-4.50 milligrams per liter [mg/L]), and the low-fluoride area (Xinhuai) had a mean water concentration of 0.36 ± 0.15 mg/L (range 0.18-0.76 mg/L). The populations studied had comparable iodine and creatinine concentrations, family incomes, family educational levels, and other factors. The populations were not exposed to other significant sources of fluoride, such as smoke from coal fires, industrial pollution, or consumption of brick tea. Thus, the difference in fluoride exposure was attributed to the amount in the drinking water. Mean urinary fluoride1 concentrations were found to be 3.47 ± 1.95 mg/L in Wamiao and 1.11 ± 0.39 mg/L in Xinhuai. Using the combined Raven’s Test for Rural China, the average intelligence quotient (IQ) of the children in Wamiao was found to be significantly lower (92.2 ± 13.00; range, 54-126) than that in Xinhuai (100.41 ± 13.21; range, 60-128). The IQ scores in both males and females declined with increasing fluoride exposure. …..A study conducted by Lu et al. (2000) in a different area of China also compared the IQs of 118 children (ages 10-12) living in two areas with different fluoride concentrations in the water (3.15 ± 0.61 mg/L in one area and 0.37 ± 0.04 mg/L in the other). The children were lifelong residents of the villages and had similar social and educational levels. Urinary fluoride concentrations were measured at 4.99 ± 2.57 mg/L in the high-fluoride area and 1.43 ± 0.64 mg/L in the low-fluoride area. IQ measurements using the Chinese Combined Raven’s Test, Copyright 2 (see Wang and Qian 1989), showed significantly lower mean IQ scores among children in the high-fluoride area (92.27 ± 20.45) than in children in the low-fluoride area (103.05 ± 13.86). Of special importance, 21.6% of the children in the high-fluoride village scored 70 or below on the IQ scale. For the children in the low-fluoride village, only 3.4% had such low scores. Urinary fluoride concentrations were inversely correlated with mental performance in the IQ test. Qin and Cui (1990) observed similar negative correlation between IQ and fluoride intake through drinking water.

Here is Figure 7-1, showing females; and here is Figure 7-2 showing males.

Furthermore, referencing another study inside of this one:

> Spittle (1994) reviewed surveys and case reports of individuals exposed occupationally or therapeutically to fluoride and concluded there was suggestive evidence that fluoride could be associated with cerebral impairment. A synopsis of 12 case reports of fluoride-exposed people of all ages showed common sequelae of lethargy, weakness, and impaired ability to concentrate regardless of the route of exposure. In half the cases, memory problems were also reported. Spittle (1994) described several of the biochemical changes in enzymatic systems that could account for some of the psychological changes found in patients. He suggested that behavioral alterations found after excessive exposure could be due to the disruption of the N-H bonds in amines, and subsequently in proteins, by the production of N-F bonds (Emsley et al. 1981). This unnatural bond would distort the structure of a number of proteins with the collective potential to cause important biological effects. Fluorides also distort the structure of cytochrome-c peroxidase (Edwards et al. 1984). Spittle also noted the likelihood of fluoride interfering with the basic cellular energy sources used by the brain through the formation of aluminum fluorides (Jope 1988) and subsequent effects on G proteins.

Even furthermore, on the topic of silcofluorides which may even contain lead:

> Another issue that has been raised about differential effects of silicofluorides comes from the dissertation of Westendorf (1975). In that study, silicofluorides were found to have greater power to inhibit the synthesis of cholinesterases, including acetylcholinesterase, than sodium fluoride (NaF). For example, under physiological conditions, one molar equivalent of silicofluoride is more potent in inhibiting acetylcholinesterase than six molar equivalents of NaF (Knappwost and Westendorf 1974). This could produce a situation in which acetylcholine (ACh) accumulates in the vicinity of ACh terminals and leads to excessive activation of cholinergic receptors in the central and peripheral nervous system. At high concentrations, agents with this capability are frequently used in insecticides and nerve gases. At intermediate concentrations, choking sensations and blurred vision are often encountered. Modifications of the effectiveness of the acetylcholinergic systems of the nervous system could account for the fact that, even though native intelligence per se may not be altered by chronic ingestion of water with fluoride ranging from 1.2 to 3 mg/L, reaction times and visuospatial abilities can be impaired. These changes would act to reduce the tested IQ scores. Such noncognitive impairments in children were reported in a meeting abstract (Calderon et al. 2000), but a full publication has not been issued. Extended reaction times have been associated with impaired function of the prefrontal lobes, a behavioral change not directly tied to alterations in IQ (Winterer and Goldman 2003). Because almost all IQ tests are “time-restricted,” slow reaction times would impair measured performance.

It can also be linked to Dementia due to the way that fluorides react with certain minerals in the body which produces a severe impact on cerebral metabolism:

> For more than 30 years it has been known that Alzheimer’s disease is associated with a substantial decline in cerebral metabolism (Sokoloff 1966). This original observation has been replicated many times since then. The decrease is reflected in the brain’s metabolic rate for glucose, cerebral rate for oxygen, and cerebral blood flow. In terms of reduced cerebral blood flow, the reduction found in Alzheimer’s patients is about three times greater than in patients with multi-infarct dementia. As early as 1983, Foster et al. (1983) demonstrated a general decline in the rate of utilization of glucose with the marker F-2-fluorodeoxyglucose with a positron-emission tomography scan. Recently, over and above the general decline in aerobic metabolism, several patterns of enhanced decreases in energy utilization have been demonstrated. The temporal, parietal, and frontal regions are areas with some of the greatest reductions (Weiner et al. 1993; Starkstein et al. 1995). It is possible that the decline in glucose utilization is an early sign of the onset of dementia (Johnson et al. 1988; Silverman and Small 2002). In addition there is evidence from a number of sources that alterations induced by Alzheimer’s disease can be observed in many body regions and in blood. This indicates that the disease has system-wide effects in the body. One system particularly sensitive to carbohydrate utilization is the collection of areas involved with the synthesis of ACh. The release of this transmitter is also negatively affected by the interruption of aerobic metabolism and the effect can be noticed in the projection fields of the cholinergic systems. Fluoride produces additional effects on the ACh systems of the brain by its interference with acetylcholinesterase.

Furthermore, concerning aluminum and how it reacts with fluoride that may be a contributing factor to the development of Alzheimer’s:

> ….Because of the great affinity between fluorine and aluminum, it is possible that the greatest impairments of structure and function come about through the actions of charged and uncharged AlF complexes (AlFx). In the late 1970s and through the early 1990s there was considerable interest in the possibility that elemental aluminum was a major contributing factor to the development of dementia of the Alzheimer’s variety as well as to other neurological disorders. In a study of more than 3,500 French men and women above the age of 65 (Jacqmin et al. 1994), a significant decrease in cognitive abilities was found when their drinking water contained calcium, aluminum, and fluorine.

Neurochemical effects of fluoride in drinking water in animals that may be similar to humans:

> Fluoride has been shown to decrease the activities of superoxide dismutase (Guan et al. 1989) and glutathione peroxidase (Rice-Evans and Hoschstein 1981), the consequences being increased free radicals.

> ….NaF injected subcutaneously into rabbits altered brain lipid metabolism (Shashi 1992b) and concentrations of protein, free amino acid, and RNA in the brain (Shashi et al. 1994).

Further findings by the study:

> In assessing the potential health effects of fluoride at 2-4 mg/L, the committee found three studies of human populations exposed at those concentrations in drinking water that were useful for informing its assessment of potential neurologic effects. These studies were conducted in different areas of China, where fluoride concentrations ranged from 2.5 to 4 mg/L. Comparisons were made between the IQs of children from those populations with children exposed to lower concentration of fluoride ranging from 0.4 to 1 mg/L. The studies reported that while modal IQ scores were unchanged, the average IQ scores were lower in the more highly exposed children. This was due to fewer children in the high IQ range. While the studies lacked sufficient detail for the committee to fully assess their quality and their relevance to U.S. populations, the consistency of the collective results warrant additional research on the effects of fluoride on intelligence. Investigation of other mental and physiological alterations reported in the case study literature, including mental confusion and lethargy, should also be investigated.

> ….On the basis of information largely derived from histological, chemical, and molecular studies, it is apparent that fluorides have the ability to interfere with the functions of the brain and the body by direct and indirect means.

There you go, the National Academy is recommending the EPA to do something about this. Too bad that the EPA doesn’t have power to control it, only to regulate the content. The CDC controls the substances and administers them to the drinking water.

Please take note of all methods of proof, verification, and sources and make note of many disclaimers associated with the use of these studies, along with the disclaimers inside of the studies concerning the material.

Works cited

These are perhaps the most important references, so I listed them twice, the first listing being the link found in my post.

Ref Author/proprietor “Title”/Origin(?) Year(?)
1 See footnote x 2006
2 Scholastic Teacher Educational Resources, found in reference 2 x
3 Strauss, Valerie “Ever Wondered How People Cleaned Their Teeth Before They Had Toothbrushes?” The Washington Post x
4 University of Michigan School of Dentistry “A Timeline of Dental Hygiene.” x
5 Petersen PE, Lennon MA “Effective use of fluorides for the prevention of dental caries in the 21st century: the WHO approach” PDF Community Dent Oral Epidemiol 2004
6 World Health Organization The World Oral Health Report Geneva: WHO; 2003
7 World Health Organization “Fluorides and oral health”. WHO Technical Report Series 846. Geneva: WHO; 1994
8 Medical Research Council Working Group Report. Water fluoridation and health. London: Medical Research Council; 2002
9 McDonagh M, Whiting P, Bradley M et al. A systematic review of public water fluoridation; NHS Centre for Reviews and Dissemination. Fluoridation of drinking water: a systematic review of its efficacy and safety; 2000
10 Treasure ET, Chestnutt IG, Whiting P, McDonagh M, Wilson P, Kleijnen J. The York review—a systematic review of public water fluoridation: a commentary. 2002
11 Pizzo G, Piscopo MR, Pizzo I, Giuliana G. “Community water fluoridation and caries prevention: a critical review”. Clin Oral Investig. 2007
12 Yeung CA. “A systematic review of the efficacy and safety of fluoridation.” Evid Based Dent. 2008
13 Iheozor-Ejiofor, Z.; Worthington, H. V.; Walsh, T.; O’Malley, L.; Clarkson, J. E.; Macey, R.; Alam, R.; Tugwell, P.; Welch, V.; Glenny, A. M. “Water fluoridation for the prevention of dental caries”. The Cochrane Database of Systematic Reviews 2015
14 Wisconsin Dental Association “Fluoridation in Europe”. Wisconsin Dental Association – Oral & Dentistry Advocates 2013
15 The British Fluoridation Society; The UK Public Health Association; The British Dental Association; The Faculty of Public Health. “One in a Million: The facts about water fluoridation”. 3rd ed. Manchester: British Fluoridation Society; 2012
16 Reeves TG. Centers for Disease Control. “Water fluoridation: a manual for engineers and technicians”. [PDF]; 1986
17 Lauer WC. “Water Fluoridation Principles and Practices”. 5th ed. Vol. M4. American Water Works Association; 2004
18 Nicholson JW, Czarnecka B. “Fluoride in dentistry and dental restoratives”. In: Tressaud A, Haufe G, editors. Fluorine and Health. Elsevier; 2008
19 Centers for Disease Control “Water Fluoridation Additives Fact Sheet”, CDC. x
20 Division of Oral Health. National Center for Prevention Services, CDC. Fluoridation census 1992 PDF. 1992-3
21 Bailey W, Barker L, Duchon K, Maas W. “Populations receiving optimally fluoridated public drinking water—United States”; 2008
22 Balbus JM, Lang ME. “Is the water safe for my baby?”. Pediatr Clin North Am. 2001
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