Fluoridation and General Health

The format of this page is

• A summary of the key points relevant up to 2020
• An online and printable version of the 2012/3 publication “one in a million”
• A summary of the main points raised by more recent papers and reports
• Access to a list of the key papers and reports published since 2012/3
• Access to an archive of other reports etc.

Is it safe? Yes

• • Fluoride naturally present in drinking water, water quality standards based on WHO guidance allow for up to 1.5mg/L – e. 1.5 times the target level for CWF schemes
  • Some parts of UK naturally have fluoride levels similar to CWF schemes (e.g. Hartlepool). Fluoride in many foods, particularly tea (c.5mg/L)
  • No convincing scientific evidence (incl. international evidence reviews) of harm to general health from water containing fluoride within regulatory limits
  • (Increase in mild dental fluorosis – not an issue, no greater dissatisfaction with appearance)
• Oral health and general health are strongly linked. Poor oral health can impact adversely on general health and well-being.
• Epidemiological studies and independent review of the relevant medical and scientific literature have consistently failed to find evidence that fluoride in water at or around one part per million has any deleterious effect on general health.
• People have drunk naturally fluoridated water at or around the one part per million concentration for generations. There is no evidence that they have suffered harm to their general health from doing so. There is evidence, however, that naturally fluoridated water benefits dental health.
• Today, an estimated 50 million people around the world are drinking naturally fluoridated water. More than  400 million people in 25 countries are supplied with fluoridated water.

Where can I learn more?

• UK policy/ reports

PHE (2016, 2020); Improving oral health: community water fluoridation toolkit (withdrawn due to changes in legislation but still a useful resource)

https://www.gov.uk/government/publications/improving-oral-health-community-water-fluoridation-toolkit

 

CMO Statement 2021

Water fluoridation: statement from the UK Chief Medical Officers – GOV.UK (www.gov.uk)

 

Policy Summary Paper for Health and Care Bill 2022

https://www.gov.uk/government/publications/health-and-care-bill-factsheets/health-and-care-bill-water-fluoridation

 

PHE (2014); Water fluoridation health monitoring report for  England 2014 https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2014

 

PHE (2018); Water fluoridation health monitoring report for  England 2018 https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2018

 

OHID (2022); Water fluoridation health monitoring report for  England 2022 https://www.gov.uk/government/publications/water-fluoridation-health-monitoring-report-for-england-2022

2023 summary series in Dental Update

 

Cockcroft BM, Hearnshaw S.  Water fluoridation: what, why, where and when.  Dental Update 2023;50:707-709.

https://www.dental-update.co.uk/content/guest-editorial/water-fluoridation-what-why-where-and-when/

 

Morris AJ, Lowry R. Community water fluoridation: legislation and evidence base.  Dental Update 2023;50:707-709.

https://www.dental-update.co.uk/content/guest-editorial/community-water-fluoridation-legislation-and-evidence-base/

 

Atkinson et al.  Community water fluoridation and the benefits for children. Dental Update 2023;50:707-709.

https://www.dental-update.co.uk/content/community-water-fluoridation/community-water-fluoridation-and-the-benefits-for-children/

 

Walsmley AD, Jones C, Morris J.  Community water fluoridation and the benefits for adults.  Dental Update 2023 50:8, 707-709.

https://www.dental-update.co.uk/content/community-water-fluoridation/community-water-fluoridation-and-the-benefits-for-adults/

 

 

 

 

 

 

Profession/ Commissioner guidance on prevention

& oral health promotion

 

Public Health England (2021); Delivering better oral health: an evidence-based toolkit for prevention

https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention

 

PHE (2014); Improving oral health: an evidence-informed toolkit for local authorities.  Commissioning better oral health for children and young people.

https://www.gov.uk/government/publications/improving-oral-health-an-evidence-informed-toolkit-for-local-authorities

 

PHE (2018); Commissioning better oral health for vulnerable older people

https://www.gov.uk/government/publications/commissioning-better-oral-health-for-vulnerable-older-people

 

PHE (2016); Improving oral health: supervised tooth brushing programme toolkit

https://www.gov.uk/government/publications/improving-oral-health-supervised-tooth-brushing-programme-toolkit

 

Environment

 

Elizabeth Elleray, Alexandra Lyne, Brett Duane.  Sustainability of Different Fluoride Delivery Methods.  Dental Update 2024 50:9, 707-709. https://www.dental-update.co.uk/content/community-water-fluoridation/sustainability-of-different-fluoride-delivery-methods/

 

Duane, B., Lyne, A., Parle, R. et al. The environmental impact of community caries prevention – part 3: water fluoridation. Br Dent J 2022;233:303–307 https://doi.org/10.1038/s41415-022-4251-5

 

European Commission Scientific Committee on Health and Environmental Risks SCHER (2011). Critical review of any new evidence on the hazard profile, health effects, and human exposure to fluoride and the fluoridating agents of drinking water

https://ec.europa.eu/health/scientific_committees/environmental_risks/docs/scher_o_139.pdf

 

CADTH technology review.  Community Water Fluoridation Programs: A Health Technology Assessment — Environmental Assessment (2019)

See https://www.cda-adc.ca/en/services/essentials/2019/issue4/14/

 

Public Health England.  Carbon modelling within dentistry: towards a sustainable future (2018). https://www.gov.uk/government/publications/carbon-modelling-within-dentistry-towards-a-sustainable-future

International reviews/ guidance

 

US Centers for Disease Control (CDC)

https://www.cdc.gov/fluoridation/basics/index.htm

 

CADTH (2019). CADTH TECHNOLOGY REVIEW.  Community Water Fluoridation

Programs: A Health Technology Assessment — Review of Dental Caries and Other Health Outcomes

See https://www.cda-adc.ca/en/services/essentials/2019/issue4/14/

https://canadianfluoridationsociety.ca/wp-content/uploads/2023/04/HT0022-CWF-Clinical-report.pdf

 

NHMRC (Australia). Health effects of water fluoridation (2017)

https://www.nhmrc.gov.au/fluoridation

 

Office of the Prime Minister’s Chief Science Advisor (New Zealand). Fluoridation: an update on evidence (2021)

https://www.pmcsa.ac.nz/topics/fluoridation-an-update-on-evidence/

 

Health Review Board (Ireland).  (2022) Impact of community water fluoridation on systemic health excluding oral health. An evidence review.

https://www.hrb.ie/publications/publication/impact-of-community-water-fluoridation-on-systemic-health-excluding-oral-health-an-evidence-review/

 

 

 

 

 

• Additional systematic reviews have been carried out in Ireland, New Zealand and Australia (Sutton et al, 2015; Royal Society of New Zealand, 2014; Jack et al, 2016; NHMRC, 2017a) covering a wide range of conditions. The three reviews could find no reliable evidence of any association between any of these conditions and community water fluoridation. The Australian review went further noting that there was clear evidence that cancer, Down syndrome, cognitive function, IQ, and hip fracture were not associated with community water fluoridation. In 2022 a new review was conducted by colleagues in Ireland.
  
• Kim et al (2020) extend their2011 study to reaffirm that “community water fluoridation is not associated with an increased risk for osteosarcoma”.
• The Journal of the American Dental Association (JADA) has published a study that examined the potential link between topical fluoride or dietary fluoride supplements and osteosarcoma (bone cancer). The authors reached this conclusion: “Neither topical nor dietary fluoride supplements are associated with an increased risk of developing osteosarcoma.” The JADA article’s authors included Catherine Hayes, Chet Douglass and Frances Kim, all of whom collaborated on a 2011 article, which examined whether there was an association between the bone fluoride levels and osteosarcoma risk. The 2011 article found no significant association between the two. Many of you can recall that 10 years ago, bone cancer was one of the leading issues that fluoridation opponents raised (at least within the United States) when they attacked state or local CWF policies.  https://jada.ada.org/article/S0002-8177(21)00043-X/pdf
• A recent study has raised once again the issue of hypothyroidism (Peckham et al, 2015; 2017). However, this study has been widely criticised (Newton et al 2015; 2017; Foley, 2015; Grimes, 2015; Warren and Saraiva, 2015;) for a misleading interpretation of the existing literature, for an unusual analysis of the data and for failing to recognise the limitations of the study in drawing conclusions and recommendations. Analysing data from the national Canadian Health Measures Survey, Barbeirio et al (2017) found no association between fluoride exposure and thyroid functioning.
• Public Health England’s monitoring report (2018) presents new data on Down’s syndrome, hip fracture, kidney stones, osteosarcoma and bladder cancer.    The report concludes that the findings are consistent with the view that water fluoridation is an effective and safe public health measure. The 2022 Health Monitoring Report backs up earlier reports into the safety and efficacy of water fluoridation.
  
•  Researchers in Canada have presented new data claiming an association between fluoride exposure in pregnant women and cognitive function of their offspring. As a consequence, the US National Toxicology Program (NTP) undertook a systematic review of the literature. The NTP’s draft review (2019) was subjected to peer review by the prestigious National Academy of Sciences, Engineering and Medicine (2020). The National Academy’s Expert Committee was critical of the design and methods of many of the studies reviewed by the NTP, was critical of NTP’s own analysis, and of NTP’s failure to provide adequate support for its conclusions. The National Academy’s Expert Committee recommended that NTP conduct further work. The NTP has subsequently produced a second monograph, but a committee of The NASEM says that it ‘still falls short of providing clear and convincing documentation of the evidence to support its conclusions.’ The NASEM committee has recommended that the NTP further improves its monograph. It issued a review rejecting the NTP conclusion regarding fluorides safety. NASEM specifically states that NTP’s analysis cannot be used to draw any conclusions in regards to fluoride at the concentration used for community water fluoridation. Australian researchers meanwhile have stated thet “Exposure to fluoridated water during the first 5 yrs of life was not associated with altered measures of child emotional and behavioral development and executive functioning. “Do, Spenser and Ha https://doi.org/10.1177/00220345221119431. In 2023, Kumar et al published a meta-analysis which concluded “These meta-analyses show that fluoride exposure relevant to community water fluoridation is not associated with lower IQ scores in children. However, the reported association observed at higher fluoride levels in endemic areas requires further investigation”.  In 2024, a new review further deflated the IQ issue: Flawed MIREC fluoride and intelligence quotient publications: A failed attempt to undermine community water fluoridation; Guichon et al. https://onlinelibrary.wiley.com/doi/full/10.1111/cdoe.12954.
• The Irish Health Research Board updated its evidence review regarding the health effects of CWF(2022), especially intersting is appraisal of neurodevelopmental studies.
• Report on fluoride in the diet (2018)
  “Based on the results of this study, the FSAI Scientific Committee concluded that there is currently no scientific basis for concerns about the safety of children and adults in Ireland from exposure to fluoride from foods and beverages.”Total Diet Study 2014–2016: Assessment of dietary exposure to fluoride in adults and childrenin Ireland. ISBN: 978-1-910348-15-4. Food Safety Authority of Ireland, The Exchange, George’s Dock, IFSC, Dublin D01 P2V6
• A review by researchers in Germany (Guth et al 2020) concluded that “based on the totality of currently available scientific evidence the present review does not support the presumption that fluoride should be assessed as a human developmental neurotoxicant at the current exposure levels in Europe” and that “the evidence does not provide sufficient arguments to raise concerns” about water fluoridation or “justify the conclusion that fluoride is a human developmental neurotoxicant.”.
•   Meanwhile, commenting on the new Canadian studies, the NHS website (2019) noted that “considerable past research has been conducted into the safety of fluoride including those conducted by the UK government and other international organisations. Overall, these studies all found that fluoride was not associated with significant health risks”.