The scientific literature indicates that fluoride levels greater than 1.5 mg/L is consistently associated with lower IQ levels in children. In many of these studies the water being consumed was several times greater than 1.5 mg/L. In addition, many of the subjects of these studies are drinking water that would be considered unsafe, by North American standards, not only because of unacceptably high levels of fluoride but also with other contaminants associated with negative impacts on neurodevelopment. To clear up the confusion related to the current level of CWF (0.7 mg/L commonly), we need new studies designed to control for bias, that are based on reliable measures of neurological function. What’s notable is that the court did not offer an opinion on the relative merits of the scientific evidence presented, but rather reasoned that since potential exposure to fluoride in water is frequent, continuous and long-lasting, the EPA should take further action under the 2016 legislation. The court was clear that the ruling did not mean that CWF is not safe, just that there are arguments on both sides of the debate. The court ruling does not impact CWF practises in the U.S. or Canada. QCould you talk about the updated Cochrane review of water fluoridation for the prevention of dental caries that was published in October 2024? AB: Cochrane reviews offer a gold standard of evidence-based guidance from a very reputable organization. The update to an existing Cochrane review in October reported that levels of dental disease in the U.S., Canada and other high-income countries have dropped substantially since CWF was introduced about 60 years ago, and, accordingly, suggests that the relative effectiveness of CWF is less apparent than in past. Between the 1950s and 1970s, when CWF was first being introduced as a public health measure, a tremendous oral health benefit was evident to the public. Reports of a more than 50% decrease in childhood dental caries from the combined effects of fluoride in water and toothpastes were widespread. One weakness of the updated Cochrane review is that it’s limited to studies of children. A finding of reduced benefit to childhood decay is not unexpected, given the growing number of children who never experience tooth decay in high-income countries. The long-term, lifelong benefit of drinking fluoridated water among adults has not been studied to the same extent. One reason for the focus on children was the belief that fluoride was incorporated into teeth during their development, which made enamel more resistant to caries. We now know that only represents a minor part of fluoride protection, and that ongoing exposure to trace levels of fluoride provide the primary anti-caries benefit in many populations. When the average level of decay is very low, like it is now, the overall benefit of CWF is less evident. As with all public health measures, when the risk falls, public support also declines, and individuals are more likely to focus on a potential individual risk, even if it’s negligible, rather than the broader benefits for others. In Canada and the U.S., there are antifluoridation groups who believe that because dental decay is low, there’s no reason to have fluoridated water. This makes fertile ground for political debate, particularly when the benefits are less absolute than they once were. QHow has CDA responded to the recent increased coverage of fluoride in the media? AB: CDA worked directly with our newly formed advocacy and policy committee, who review scientific information related to oral health, such as with fluoride. With a topic like this, CDA also consults with its network of external experts, particularly when the scope is outside of dentistry or dental public health. This is done on an ongoing basis. If there is any new information or evidence that necessitates a change to CDA’s official positions on any scientific matter, it is revised accordingly and circulated for review. On this issue, at this time, there’s no new science that would warrant an update. As with all public health measures, when the risk falls, public support also declines, and individuals are more likely to focus on a potential individual risk. 14 | 2024 | Issue 6 CDA atWork
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