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Oasis Podcasts Oral Health Research Professional Issues Restorative Dentistry

AADR/CADR Annual Meeting 2014: Water Fluoridation: Safety, Effectiveness and Value in Oral Health Care

Stephen H. AbramsPodcast Icon SmallOn Friday March 21st, 2014, the American Association for Dental Research (AADR) will hold a symposium on Water Fluoridation: Safety, Effectiveness & Value in Oral Health Care.

Dr. John O’Keefe interviewed Dr. Stephen H. Abrams, about the significance of bringing the issue of water fluoridation to the general practitioner’s attention in order to start an informed dentist-patient and community-wide conversation.


Community water fluoridation (CWF) and other fluoride modalities historically have been and remain the cornerstone for the prevention and control of dental caries. There is extensive evidence on the efficacy and cost‐effectiveness of these interventions as well as assessments of the risks associated with fluoride ingestion.

In 2006 the National Research Council identified severe fluorosis as the only documented health effect of fluoride at 2 – 4 mg/L in drinking water. Concentrations recommended for CWF and current dosage schedules for other modalities ensure safety. Systematic reviews on fluorides have identified gaps in knowledge or the need to replicate some of the previous studies under current widespread use of fluorides.

The objective of this symposium is to review evidence of effectiveness and safety, identify research gaps and consider implications for optimizing use of fluoride in public health and clinical practice.

Interview Key Messages

  • It is important to bring research and knowledge about water fluoridation, its safety and effectiveness to the general dentists so they can talk to their patients as experts about the issue.
  • It is also important to provide dentists with the required knowledge to speak to politicians about this issue: is water fluoridation safe? Does it work? and why should we keep fluoridating water?
  • The goal of the symposium is to start an expert conversation about water fluoridation and to expose the core issues presented by the anti-fluoridation groups in an effort to understand the validity of their claims and identify what we need to be looking at as researchers and clinicians in order to ensure that patients are getting optimal oral health. 
  • It is important to develop a toolkit to help the provinces and their members discuss water fluoridation in a clear and simple way with their patients and with the broader community.
  • Dentists need to become well versed in the issue of water fluoridation as it is becoming a political topic.

Listen to the audio interview

Downloadable audio version (MP3)

Right click on the link and choose “Save Link As”

Click here for the symposium program (PDF)


  1. Marielle Pariseau February 10, 2014

    I applaud this effort of bringing American and Canadian communities of dental researchers together around issues of water fluoridation and I look forward to hearing a lot more about this important issue. Dr Steve Abrams, your leadership shines as you approach issues of safety, effectiveness and value with the open mind of a true health professional and researcher. The idea of developing a strong evidence based toolkit to help dentists become well versed with all issues surrounding water fluoridation articulates a need that, if when filled can strengthen our organization.

  2. Jeffery Schau February 13, 2014

    I find it appalling that water fluoridation is being referenced as the “cornerstone for the prevention and control of dental caries”. This kind of attitude is exactly why the dental community has failed at preventing so many cavities. Caries can easily be prevented in a fluoride free environment. What is needed is education and better understanding of diet and oral hygiene. Improving education of children and new parents will have more impact than water fluoridation ever could. And for those who do not adopt better eating lifestyles (which also affects all aspects of health, not just oral), what difference does it make if the fluoride prevented them from getting that 12th cavity?
    The dental community needs to stop clinging to water fluoridation as the easy answer (which has minimal to no real impact, and should not be ingested by children under 6 months of age) and focus on the real answers to the problem (enough with the band-aid, lets go to the source of the problem).
    It is exactly this type of stuff that has caused so many people to no longer trust dentists and go to extremes to find alternative methods.

    1. Dr, Art Piercy February 18, 2014

      The major reason water fluoridation is “the cornerstone for prevention of caries” is
      1) It is systemic and is part of the whole tooth structure forever – it is NOT a surface only fluoride treatment.
      2) This means young, old, rich, poor, careless, handicapped/mental and physical, etc. patients will still benefit FOREVER.
      3) Any decay that does start will progress very slowly.
      4) Failing restorations will not suffer quick extensive caries thus less damage and future treatment. When our city stared fluoridation approx. 30-35 years ago, the obvious caries in size, number of surfaces, number of teeth, number of pulpotomies and stainless steel crowns on children under 6-8 years went from a large number per quadrant per patient to close to zero within the 6-8 years from birth onward. It was a huge difference that helped all children regardless of homecare, income, education, etc. Who likes sticking needles and drilling on little kids or old people?
      5) The dental community has not failed at preventing decay – has never been better in fact. I have practiced in the same area of our city for over 40 years. The level of education about prevention, oral hygiene, and diet has never been higher and is very important but fluoridation is cheap, effective and easy to use for everyone as they age. The statement that it has minimal effect to no real effect over the broad population is not realistic. It is not a Band-Aid but a cheap, safe PREVENTATIVE measure for all. I say safe because as more people have water fluoridation (natural or added) North Americans have never been so healthy or lived so long.

      1. Jeffery Schau February 19, 2014

        Thank you for your feedback. However, I will re-iterate, water fluoridation should not be the cornerstone to prevention of dental decay. There are better methods that work without risk, and also improve overall health.
        In response to your points:
        1) This is also part of the problem. The delivery systemically is too complex to control and can easily irreversibly destroy a tooth. Especially when combined with all the other sources of fluoride children are exposed to and lack of regulations for how companies use fluoridated water in there food processing practices.
        2)I agree, if just the right amount of fluoride is incorporated into the developing teeth, there can be a life long benefit. But, to what degree? And to what negative impact does fluoridated water have on health over time? Consider 4 glasses of fluoridated water (at 1ppm) contain the same daily dose of fluoride that was used to treat hyperthyroidism.
        3) You mention the decay will progress very slowly. I am curious as to what you consider slow. I have seen incredibly fast progressing decay in fluoridated teeth. This is a very subjective comment and I would love to see data that supports your claim, as I have not seen this clinically. The rate of decay is most directly related to diet and oral hygiene practices, not fluoride water consumption.
        4) Do you have any studies that support these claims? To my knowledge, I believe it is Edmonton that is redoing studies on this topic due to lack of adequate quality research to support water fluoridation for their area (they recognized a study done in one country does not automatically apply across the board). Further, I would be curious as to what else was done at the same time as the water fluoridation initiation that may have contributed. This is one of the biggest challenges with this subject is there are too many variables to say all those changes are only due to water fluoridation. Especially is public awareness was increased at the same time of its introduction.
        And again, extent of damage is more related to diet and OH than previous fluoride exposure. I look at my elderly patient base for that as they did not have the fluoridated water as children. Some get fast progressing decay, some get slow progressing, and other don’t get any decay. Their diet and OH are the targets for making changes.
        5) wow, were do I start with this one.
        First off, North Americans are living longer, but have lots of other health issues. Just look at cancer stats, Alzheimer, ADD, autism, etc. Just because we live longer, does not mean we are healthier. A lot of that is attributed to methods of treating and prolonging. And guess what, even in areas where there is no water fluoridation people are living longer. Further, if fluoridation was introduced in your area 35 years ago, you still have another 35 to go before the newborns reach age 70 to really see the impact water fluoridation may have had on their health (the other problem, studies need to be very long term to fully analyze the risk).
        For dental community being better than ever at preventing decay, I will disagree again. This may be the case for your area. I know my area is improving, but has really missed the mark in the past. The number of patients that come to me because I discuss with them more on natural ways of preventing decay and improving their health is actually quite scary. Too many dentists just drill and fill and say brush your teeth. That is not enough. I have also seen a lot of reports from different areas in North America where people have these kinds of issues with dentists and overall trust for dentists has reached all time lows in many places.
        You mention fluoridation is effective for everyone as they age. You may mean from the initial dose while the teeth were developing. But to be sure, I hope you are aware that fluoridated water has been demonstrated to have zero impact on the health of fully developed teeth vs straight water. The concentrations are not sufficient enough to have a topical effect.
        You mention my statement on generalized effectiveness/benefit is not realistic. If that was the case, than why do so many studies prove the lack of effectiveness of water fluoridation? Sure, there are ones that show the opposite is true, but this raises the issue that there is way more involved than water fluoridation. Just because it is cheap and easy, does not mean it should be done.
        I will end this with two final thoughts.
        #1: There is enough fluoride in a tube of toothpaste to kill a 6 month old child. So you cannot say that fluoride is perfectly safe and risk free. I would never give fluoridated water to a child under 6 months of age (even infant formula containers state this should not be done). However, many do not even know this and babies are given fluoridated water all the time. And guess what, childhood conditions/diseases are insane (I cannot believe the number of kids with cancer and other issues). Sure, fluoride may not be the direct cause for a lot of this stuff, but it may be. More likely it is a contributing factor. One more toxin the body has to fight.
        #2. I am pro fluoride for topical use. I know the effectiveness of topical fluoride and use it regularly with my patients. Especially my elderly patients who are at higher risk for decay where it is harder to address diet and OH issues. But we can live just fine without water fluoridation. It may have had its time, but it is not controlled and there is too much fluoride in other sources that kids are being overloaded with it.
        Ok, one last remark. You also should recognize that the quality of fluoride being used in the water is not the same throughout the world. There are more toxic versions of it that are dumped into the water in many places, like in many of the US states. So not all water fluoridation is equal.
        I have said my piece. I recommend you hit the research with an opened mind rather than following the dental associations doctrine as preached. Actually, even in school we were taught that water flouridation has no impact topically and only during the initial development, and even then it was hard to control dosing to have it be effective without causing harm. But that does not seem to be readily acknowledged by those pushing for water fluoridation.
        Peace out.

      2. Jeffery Schau February 19, 2014

        Was Reading February’s Oral Health journal and found an interesting article on trends in paediatric general anesthesia in Canada. Very interesting read. Althouth this was not a conclusion of the author, this would suggest water fluoridation is not working. Hospitalization of children under the age of 6 for early childhood caries is on the rise across Canada. Some of this is due to increase in favour of the procedure, but the numbers are outstanding, and in a very bad way.
        There is on average 19,000 kids each day being put under for ECC treatment (this is only factoring in kids treated in hospitals and does not include private clinic settings). And these are the kids that are the most fluoridated yet. To me this is borderline criminal. There is no need for this to occur. Whether you are for or against water fluoridation, these stats clearly demonstrate that water fluoridation is not working as “the cornerstone of prevention”. Time for a different approach or more kids will suffer.

  3. Frank Ferreira February 18, 2014

    Stay calm and Fluoride on


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