Water Fluoridation and the Environment:

Current Perspective in the United States

HOWARD F. POLLICK, BDS, MPH

Evidence of water fluoridations effects on plants, ani

mals, and humans is considered based on reviews by sci
entific groups and individual communities, including
Fort Collins, CO, Port Angeles, WA, and Tacoma-Pierce
County, WA. The potential for corrosion of pipes and
the use of fluoridation chemicals, particularly fluoro
silicic acid, are considered, as is the debate about
whether fluoridation increases lead in water, with the
conclusion that there is no such increase. The argu
ments of anti-fluoridationists and fluoridation propo
nents are examined with respect to the politics of the
issue. Key words: fluoridation; environment; toxicology.
I N T J O C C U P E N V I R O N H E A LT H 2 0 0 4 ; 1 0 : 3 4 3 3 5 0

as in toothpaste, have significantly reduced the preva

lence of dental caries in the United States.1
Early investigations into the physiologic effects of flu
oride in drinking water predated the first community
field trials.47 Since 1950, opponents of fluoridation
have claimed it increases the risks for cancer, Downs
syndrome, heart disease, osteoporosis and bone frac
ture, acquired immunodeficiency syndrome, low intelli
gence, Alzheimer disease, allergic reactions, and other
health conditions.8 The safety and effectiveness of water
fluoridation have been re-evaluated frequently, and no
credible evidence supports an association between
fluoridation and any of these conditions.9,10

The Environment

rior to 1945, epidemiologic and laboratory studies

confirmed the association between the environ
ment (naturally-occurring fluoride in water sup
plies) and the health and cosmetic appearance of teeth.1
Where fluoride levels were low, prevalences and severity
of dental caries were high among lifetime residents, yet
where fluoride levels were high, the prevalences and
severity of dental caries were low, but dental fluorosis
occurred with high prevalence and severity. This led to
the concept of creating an ideal environment for opti
mal dental health through adjusting the naturally occur
ring fluoride level to about 1 mg/L (1 part per million).
In 1986, the U.S. Environmental Protection Agency
(EPA) set the maximum contaminant level (MCL) for
naturally-occurring fluoride in public drinking water at
4 mg/L, with a secondary standard at 2 mg/L.2
Water fluoridation, then, is the controlled adjust
ment of fluoride concentrations of community water
systems to optimal levels to minimize the incidence of
dental caries (tooth decay) and dental fluorosis
(enamel mottling). From initial efforts begun as com
munity trials in 1945, water is now fluoridated in thou
sands of public water systems and reaches two thirds of
the U.S. population served by such systems.3 Commu
nity water fluoridation and other uses of fluorides, such

Received from the Department of Preventive and Restorative

Dental Sciences, School of Dentistry, University of California San
Francisco, San Francisco, California.
Address correspondence and reprint requests to: Howard Pollick,
Department of Preventive and Restorative Dental Sciences, 707 Par
nassus Avenue, San Francisco CA 94143-0758.

Environmental concerns have been investigated in liter

ature reviews for the TacomaPierce County Health
Department, Washington (August 2002),11 and the City
of Port Angeles, Washington (October 2003),12 and no
negative impact of water fluoridation on the environ
ment has been established. Issues related to discharge
to water; emissions to air; production, storage, or
release of toxic or hazardous substances; or production
of noise have been found to be nonsignificant. Emis
sions of fluoride into the air are not released outside the
well houses. Fluoride concentrations in rivers down
stream of the discharges increase by less than 0.01
mg/L due to adding fluoride to the water supply system.
Fluoridated water losses during use, dilution of
sewage by rain and groundwater infiltrate, fluoride
removal during secondary sewage treatment, and dif
fusion dynamics at effluent outfall combine to elimi
nate fluoridation related environmental effects. In a
literature review, Osterman found no instance of
municipal water fluoridation causing recommended
environmental concentrations to be exceeded,
although excesses occurred in several cases of severe
industrial water pollution not related to water fluoridation.13 Osterman found that overall river fluoride con
centrations theoretically would be raised by 0.001-0.002
mg/l, a value not measurable by current analytic tech
niques. All resulting concentrations would be well
below those recommended for environmental safety.
A study conducted in Phoenix, Arizona, to test the
efficacy of soil aquifer treatment systems indicated that
fluoride concentrations decline as water travels under

343

ground. This study suggests that 4050% of the fluo

ride discharged to groundwater is removed as the water
travels through the soil and aquifer. Thus, fluoride
does not concentrate in groundwater.14

PLANTS AND ANIMALS

The concentration of fluoride in the treated water does
not reach levels that could harm any plant or animal
species.11,12 A report of the effect of industrial pollu
tion, from an aluminum plant on salmon indicated that
the usual fluoride concentration of the river was 0.1
mg/L, and when the concentration was raised experi
mentally to 0.5 mg/L, there was an effect on the
salmon.15 Since rivers and streams are not fluoridated
and the increase in the fluoride concentration of a
river as a result of runoff from fluoridated water would
be insufficient to raise the level to even 0.2 mg/L,
fluoridation of water can have no effect on salmon.
There is no evidence that fluoridated water has any
effect on gardens, lawns, or plants. Although silver fluo
ride is not used in water fluoridation, silver fluoride at 1
mg/L used as a disinfectant had no effect on growth of
wheat.16 There is evidence that very high concentra
tions of fluoride have no toxic effect on plants in ponds:
The fate of fluoride in a simulated accidental release
into an experimental pond was observed for 30 days in
Grenoble, France. The components investigated were
water, sediments, plants, algae, molluscs, and fish.
Twenty-four hours after the release, most (99.8%) of
the fluoride was distributed in the physical compo
nents (water and sediments), and the biological
agents contained only 0.2% of the fluoride released.
Despite an exposure to hot spots of 5,000 ppm at the
beginning of the accidental release, no visible toxic
effects were observed on the biological components
such as plants, algae, molluscs, and fish.17

There is evidence that ladyfinger (okra) can withstand

up to 120 mg/L fluoride. The consumption by people
of this plant grown with fluoridated water at 1 mg/L
would be 0.2 mg per kg:
Because of suggestions that food is a rich source of flu
oride to humans and the absence of permissible and
upper limits of fluoride for irrigation water, plant
uptake studies were conducted using fluoride-rich irri
gation water. Ladyfinger was grown in sand and soil cul
tures for 18 wk and the accumulation of fluoride in var
ious plant parts was studied. The potential for
ingestion of fluoride by humans through this route was
also considered. The percentage uptake was greater in
sand-cultured plants than in soil-cultured plants. The
root accumulates most of the fluoride supplied
through irrigation water and the fruit accumulates the
least. Up to 120 mg/L fluoride of irrigation water did
not harm the plants. The ingestion of fluoride by
humans from plants irrigated with water containing 10
mg/L fluoride would be 0.20 mg per 100 g ladyfinger.18

344

Pollick

HUMANS
The Institute of Medicine, Food and Nutrition Board
has estimated that the tolerable upper limit for human
daily intake of fluoride is 10 mg per day for adults and
children over 8 years of age.19 Ten independent U.S.
and Canadian studies published from 1958 to 1987
showed that dietary fluoride intakes by adults ranged
from 1.4 to 3.4 mg/day in areas where the water fluo
ride concentration was 1.0 mg/L. Where the water con
centration was less than 0.3 mg/L, daily intakes ranged
from 0.3 to 1.0 mg/day.19
Several municipal or territorial reviews of the water
fluoride issue have concluded that available informa
tion indicates that there is no significant adverse health
impact associated with water fluoridation. The Fort
Collins review20 included reviews from other communi
ties, including Brisbane, Australia (1997),21 Natick,
Massachusetts (1997),22 Calgary, Alberta, Canada
(1998),23 Ontario, Canada (1999),24 and Escambia
County Utilities Authority, Florida (2000).25 Addition
ally, the Fort Collins review considered several Tier
One reviews, including reviews by or for the Centers
for Disease Control and Prevention,1 the Institute of
Medicine (1999),19 the World Health Organization
(1994),26 the National Research Council (1993),9 the
U.S. Public Health Service (1991),27 the International
Programme on Chemical Safety (1984),28 the Medical
Research Council, UK (2002),29 the Agency for Toxic
Substances and Disease Registry, U.S. Public Health Ser
vice (2001 draft and 1993),30 and York, U.K. (2000).31
The Fort Collins report found that:
The weight of the evidence suggests that there is
caries (cavities) reduction in populations exposed to
water fluoridation at or near an optimal level
Likely total exposure values for children older than
six months living in communities with water fluori
dated at up to 1.2 mg/L (ppm) do not exceed the
upper limit set to be protective of moderate dental
fluorosis by the Institute of Medicine. Total dietary
exposures of fluoride can exceed this threshold
amount (0.7mg/day) in infants fed formula recon
stituted with optimally fluoridated water.
There is no consistent evidence from human or
animal studies that exposure to optimally fluori
dated drinking water and other sources causes any
form of cancer in humans, including bone and joint
cancer
The FTSG agrees with the conclusion of the Medical
Research Council of Great Britain that states, The
possibility of an effect on the risk of hip fracture is
the most important in public health terms. The
available evidence on this suggests no effect, but
cannot rule out the possibility of a small percentage
change (either an increase or a decrease) in hip
fractures. [Medical Research Council 2002, page 3]

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 At the concentrations of fluoride provided in Fort

Collins water including exposures from all sources
over a lifetime, skeletal fluorosis caused by drinking
water exposure is not likely to be a health issue.
At the concentrations of fluoride provided in Fort
Collins water, in combination with other sources of
fluoride, as many as one in four children under age
8 may develop very mild to mild dental fluorosis.
This degree of fluorosis may or may not be
detectable by the layperson. With oral health as the
goal, this degree of dental fluorosis is considered an
acceptable adverse effect given the benefits of caries
prevention.
In the literature reviewed, doses appropriate for
caries reduction were not shown to negatively
impact thyroid function. Studies in which humans
received doses significantly higher than the opti
mum fluoride intake for long periods of time
showed no negative impact on thyroid function.
Overall, evidence is lacking that exposure to fluoride
through drinking water causes any problems to the
human immune system.20
In general, there is no credible evidence indicating
a cause-and-effect relationship between water fluorida
tion and increased health risks.

CORROSION
According to the U.S. Environmental Protection
Agency and the National Association of Corrosion Engi
neers, corrosion is not related to fluoride.32 Corrosion
by potable water is primarily caused by dissolved
oxygen, pH, water temperature, alkalinity, hardness,
salt, hydrogen sulfide, and certain bacteria. Fluoride, at
concentrations found in potable water, does not cause
corrosion. A small increase in the corrosivity of potable
water that is already corrosive may occur after treatment
with alum, chlorine, fluorosilicic acid, or sodium silico
fluoride, which decreases pH. This may occur in some
potable water sources with little buffering capacity; it
can easily be resolved by adjusting the pH upward.11,12,33

CHEMICALS USED FOR FLUORIDATION

Fluorosilicates
Urbansky reviewed available information on fluorosili
cates, with three objectives:
(1) to enumerate unresolved chemical issues germane to understanding fluoridation and ascertaining
the fate of fluoride and fluorospecies, (2) to critically
review what is known or reported, and (3) to assemble
a knowledge base to provide a starting point for
future study.34

Urbansky states:

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Since [1962], toxicity and adverse health impacts

have tested fluoride rather than fluosilicates. As a
recent example, in 2001, the FDA reported that
Americans exposure to fluoride had increased from
dentifrices, and it demonstrated that any increases
did not produce observable health effects in rats. Flu
oride salts were continually tested instead of fluorosil
icates because the complete and fast dissociationhydrolysis (eq 1) of fluorosilicates to fluoride and
(hydr)oxosilicates was generally accepted as a chemi
cal fact. Accordingly, no reason was apparent to test
fluorosilicates separately.
H2SiF6(aq) + 4H2O(l) = 6HF(aq)
+ Si(OH)4(aq)

(eq 1)

all the rate data suggest that equilibrium should have

been achieved by the time the water reaches the consumers tap if not by the time it leaves the waterworks
plant. . . . The most common fluoridating agents used
by American waterworks are sodium fluoride (NaF),
fluorosilicic acid (H2SiF6), and sodium fluorosilicate
(Na2SiF6) (see table below).

TABLE34
Sodium
Sodium
Fluorosilicic
Fluoride Fluorosilicate
Acid
(a) Number of
Utilities
(b) People served

2491
1635
11,700,000 36,100,000

5876
80,000,000

*Data for the United States from the CDCs 1992 Fluoridation Census 35: (a) Number of utilities using specific additives
as reported by those that fluoridate their water; (b) Popula
tions served by specific additives (millions of people) of
those drinking supplementally fluoridated water (does not
include waters with naturally occurring fluoride).

Although 25% of the utilities reported using NaF, this

corresponds to only 9.2% of the U.S. population
drinking fluoride-supplemented tap water. The ease
in handling NaF rather than fluorosilicates accounts
for the disproportionate use of NaF by utilities serving
smaller populations. On the other hand, the cost sav
ings in using fluorosilicates result in large systems
using those additives instead. The reduced cost of
large volume offsets the costs associated with han
dling concentrated stocks of the fluorosilicates, which
require accommodations similar to hydrochloric acid,
which is sometimes used to adjust pH. In acidic solu
tion, the dissociation and hydrolysis of fluorosilicic
acid, which occurs upon dilution, is given by eq 1. In
drinking water, pH is adjusted with the addition of
base (e.g., NaOH, NaHCO3). H2SiF6(aq) + 4H2O(l) =
6HF(aq) + Si(OH)4(aq) (eq1).34

While there may be evidence of toxicity of these sub

stances when workers involved in their production are
not protected, there is no credible evidence of toxicity
when they are diluted for use in fluoridated water.
Fluorosilicic acid is diluted with water from an initial
aqueous concentration of about 2324% by about
1:250,0001:300,000 when used for fluoridating

Water Fluoridation and Environment

345

water.36 This produces the final concentration of

between 0.71.2 mg/L, the specific level set according
to CDC guidelines.37
Concerns have been raised about arsenic and lead in
fluorosilicic-acidtreated water.38,39 However, there is
no credible evidence that this is of concern.40 Urbansky
and Schock add:
The vast preponderance of the lead(II) in nearly all
tap waters originates from the plumbing materials
located between the water distribution mains and the
end of the faucet used by the consumer.

Arsenic and lead may be present at minute unde

tectable concentrations, well below all current (50
ppb) and proposed (10 ppb) EPA standards. Following
dilution with water, the calculated range of arsenic
concentrations in the finished water contributed by
fluorosilicic acid feed is 0.10 to 0.24 g/L (parts per
billion, ppb).36 The analytic detection limit for arsenic
is 2 g/L, so the amount added by the fluorosilicic acid
would not be detected.36 In Fort Collins, the concen
tration of lead in the source waters was below the detec
tion limit for lead in the departments laboratory of 1.0
g/liter (ppb). Because lead levels are below the detec
tion limits both before and after the addition of fluo
rosilicic acid, the actual changes in lead concentrations
were not measurable.36
Masters and Coplan have alarmed the public with
their reports linking fluoridation, increased lead levels
and crime.39.41 Urbansky and Schock criticize the con
clusion reached by Masters and Coplan by stating:
Interestingly, the bibliographies of the Masters and
Coplan study most strongly asserting the adverse
effects of silicofluoride shows only a single reference
related to sampling of drinking water or the control
of lead or other metals by water treatment, so the level
of awareness in the design of the studies and inter
pretation of the data is highly questionable. By not
measuring or statistically testing numerous other
water and plumbing characteristics that could corre
late with lead(II) levels with equal to or greater statis
tical significance than those relationships that were
put forth, the studies of [Reference 2] are intention
ally biased towards what appears to be a preconceived
conclusion. Even simple analytes that are known to
affect lead mobility, such as pH or alkalinity, or ana
lytes known to play important dietary roles in health,
such as calcium, sodium or magnesium, were not
reported to be measured in their study, so possible
confounding variables are conspicuously excluded
from evaluation.
. . . Recent reports [41, 39] that purport to link cer
tain water fluoridating agents, such as fluorosilicic
acid and sodium fluorosilicate, to human lead uptake
are inconsistent with accepted scientific knowledge.
The authors of those reports fail to identify or
account for these inconsistencies, and mainly argue

346

Pollick

on the basis of speculation stated without proof as

fact. The sampling scheme employed in the studies is
entirely unrelated to any credible statistically-based
study design to identify drinking water lead and fluo
ride exposure as a significant source of blood lead in
the individuals. The authors use aggregated data
unrelated in space and time and then attempt to
selectively apply gross statistical techniques that do
not include any of thousands of other possible water
quality or exposure variables which could show simi
lar levels of correlation utterly by accident. Many of
the chemical assumptions are scientifically unjusti
fied, are contradicted by known chemistry data and
principles, and alternate explanations (such as multi
ple routes of PbII exposure) have not been satisfacto
rily addressed. The choice in water fluoridation
approach is often made for economic, commercial or
engineering reasons that may have a regional compo
nent that could also be related to various community
socio-economic measures, and so should not be con
sidered to be a purely independent variable without
investigation. At present, the highly-promoted studies
asserting enhanced lead uptake from drinking water
and increased neurotoxicity still provide no credible
evidence to suggest that the common practice of
fluoridating drinking water has any untoward health
impacts via effects on lead(II) when done properly
under established guidelines so as to maintain total
water quality. Our conclusion supports current EPA
and PHS/CDC policies on water fluoridation.40

Nevertheless, concerns have been raised about the

acidity of drinking water that may be created by fluori
dation. According to Urbansky and Schock, one
cannot demonstrate that an increase in blood lead(II)
ion levels can be linked to acidity from SiF6 2 hydroly
sis any more than one can demonstrate it results from
consuming soft drinks. Additionally they state: Note
that the species PbSiF60 is present at such low concen
trations that we would expect to find only one molecule of
this complex in more than 1,000 liters of tap water at pH 6,
which of course, far exceeds the volume possible for
water consumption and the human stomach.
A critique of this review was included in Comments
on The April 17, 2002 ICCEC Approach to Silicofluo
rides Study by Coplan.42 The ICCEC is the U.S. Public
Health Service National Toxicology Program (NTP)
Interagency Committee for Chemical Evaluation and
Coordination. Coplan states his concerns about the way
in which Urbansky and the EPA and CDC have investi
gated silicofluorides. For example, he provides the fol
lowing headings in his review: EPAs acknowledged
ignorance about a position they have adamantly held;
EPAs continued effort at misdirection; Why Urbansky
and Schock cannot be trusted; Why the CDC cannot
be trusted; A substantial body of evidence has been
submitted to the NTP clearly supporting the need for a
comprehensive program of animal testing for health
effects from chronic ingestion of SiF treated water. This

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is true now and would remain true no matter what the

EPA may learn about dissociation chemistry from a con
tractor selected by EPA employees whose objectivity and
scientific integrity are less than impeccable.
Coplans comments are in keeping with his stance as
an anti-fluoridationist (one who is strongly opposed to
the fluoridation of public water supplies).43 It should
be pointed out that Urbansky and Schock have been
highly critical of the work of Masters and Coplan. It
appears that the main thrust of contemporary antifluoridation tactics is to assert that the chemicals used
in fluoridation are causing problems of one sort or
another. Such tactics have emanated from the work of
Masters and Coplan.
The toxicology of sodium fluorosilicate and fluoro
silicic acid has been reviewed for the EPA.44 The
authors of that review state:
In water, the compound (sodium fluorosilicate) read
ily dissociates to sodium ions and fluosilicate ions and
then to hydrogen gas, fluoride ions, and hydrated
silica. At the pH of drinking water (6.5-8.5) and at the
concentration usually used for fluoridation (1 mg fluoride/L), the degree of hydrolysis is essentially 100%.
. . . Like its salt, its (fluorosilicic acid) degree of hydrol
ysis is essentially 100% in drinking water. At equilib
rium, the fluorosilicate remaining in drinking water is
estimated to be <<1 part per trillion.40 In addition,
exposure to impurities in the fluoridating agent is
judged to be of low health risk when properly treated
water is ingested. For example, in fluorosilicic acid,
iron and iodine are usually below the levels considered
useful as a dietary supplement; the phosphorus level is
reported to be insignificant; and silver is usually <4
parts per septillion in the fluoridated water.45

The Colorado City of Fort Collins has been fluoridating

with fluorosilicic acid and has responded to concerns
raised about that chemical.36 The Report of the Fort
Collins 2003 Fluoride Technical Study Group, April
2003, provides a comprehensive review that includes
The Potential for Increased Contaminant Levels Due
to the Use of Hydrofluorosilicic Acid.
The FTSGs review identified three potential con
cerns associated with hydrofluorosilicic acid (HFS).
1) co-contamination (i.e., arsenic and lead), 2)
decreased pH leading to increased lead solubility or
exposure, and 3) potential toxicological effects from
incomplete dissociation products of HFS. The FTSG
used the raw and finished water quality data for the
City of Fort Collins to determine whether the addi
tion of HFS was responsible for the potential addition
of contaminants such as heavy metals to the citys
drinking water. There was no evidence that the addi
tion of HFS increased the concentrations of copper,
manganese, zinc, cadmium, nickel, or molybdenum.
The concentrations of arsenic and lead were below
the detection limit for the Fort Collins Water Quality
Control Laboratory in both the source water and the

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finished water and below the maximum contaminant

level (MCL) for these naturally occurring elements.
There was no evidence that the introduction of HFS
changed the pH of the water appreciably. Concern
that HFS incompletely disassociates may be
unfounded when the fundamental chemical facts are
considered. Therefore, it is unlikely that community
water fluoridation poses a health risk from the expo
sure to any of these chemicals present in the water as
it leaves the plant. Further studies related to the
health effects of HFS are in progress.36

Reeves (fluoridation engineer at the CDC) outlined

the process by which the safety of fluoridation chemi
cals is assured:
Concern has been raised about the impurities in the
fluoride chemicals. The American Water Works Asso
ciation (AWWA), a well-respected water supply indus
try association, sets standards for all chemicals used in
the water treatment plant, including fluoride chemi
cals. The AWWA standards are ANSI/AWWA B701-99
(sodium fluoride), ANSI/AWWA B702-99 (sodium
fluorosilicate) and ANSI/AWWA B703-00 (fluorosili
cic acid). The National Sanitation Foundation (NSF)
also sets standards and does product certification for
products used in the water industry, including fluo
ride chemicals. ANSI/NSF Standard 60 sets standards
for purity and provides testing and certification for
the fluoride chemicals. Standard 60 was developed by
NSF and a consortium of associations, including the
AWWA and the American National Standards Insti
tute (ANSI). This standard provides for product qual
ity and safety assurance to prevent the addition of
harmful levels of contaminants from water treatment
chemicals. More than 40 states have laws or regula
tions requiring product compliance with Standard 60.
NSF tests the fluoride chemicals for the 11 regulated
metal compounds that have an EPA MCL. In order
for a product [for example, fluorosilicic acid] to meet
certification standards, regulated metal contaminants
must be present at the tap [in the home] at a con
centration of less than ten percent of the MCL when
added to drinking water at the recommended maxi
mum use level. The EPA has not set any MCL for the
silicates as there is no known health concerns, but
Standard 60 has a Maximum Allowable Level (MAL)
of 16 mg/L for sodium silicates as corrosion control
agents primarily for turbidity reasons. NSF tests have
shown the silicates in the water samples from public
water systems to be well below these levels.46

Sources of Fluoride Pollution Unrelated to

Water Fluoridation
The principal sources of fluoride pollution are indus
tries, particularly phosphate ore production and use as
well as aluminum manufacture, mining, and coal burning.28,47,48 In the absence of adequate emission control
in such settings environmental pollution can be a prob
lem. Such pollution has been a problem in the past in

Water Fluoridation and Environment

347

industrialized countries, and the WHO warns that

unless proper environmental safeguards are adhered
to, there is a danger of its occurring in developing
countries with increasing industrialization. Fluoride
pollution is therefore recognized as an industrial
hazard; however water fluoridation is not considered a
potential source of fluoride pollution.46

Arguments of Opponents and Proponents

Whereas anti-fluoridationists try to prevent the unnec
essary exposure of living things to fluoride, often in the
misguided belief that any amount of fluoride is toxic,
pro-fluoridationists try to reduce tooth decay through
the judicious use of fluoride, with the understanding
that there is an optimum amount, appropriately deliv
ered, that is both beneficial and safe. This distinction
leads to a difference in interpretation of the scientific
and popular literature on this topic, whether related to
the effects of water fluoridation on teeth or other
organs of the body, or the effects on the environment.
Similarly, there are those who may judge water fluori
dation on political or philosophical grounds, such as
being supportive or opposed to what government agen
cies may advocate. Some may have personal or anec
dotal experience that is counter to what opponents or
proponents recommend. Newbrun has characterized
the fluoridation debate as a religious argument.49
While opponents of fluoridation are not without
their supporters and supporting groups,50 almost every
reputable, recognized, competent scientific and/or
public health organization or government unit
endorses fluoridation of drinking water as safe and
effective.51,52 Furthermore, community water fluorida
tion has been heralded as one of the ten great public
health measures of the 20th century.53
Proponents of fluoridation assert that the dose of
fluoride determines whether it is beneficial or toxic,
and that there are threshold levels that must be
exceeded before there are toxic effects. This is a basic
principle of toxicology and is true of every chemical
approved for use in treating drinking water. All sub
stances are poisons: there is none which is not a poison.
The right dose differentiates a poison and a remedy.
Paracelsus (1493-1541).54
While there has been considerable scientific study of
the effects of fluorides on health and the environment,
there will always be the need for more research.29 How
ever, proponents argue that it is not rational that the
gains made from water fluoridation should be undone
because not all the research has been completed. Fur
ther, it is strongly recommended that those communi
ties that have not yet fluoridated their water supplies
should do so to protect the dental health of their cur
rent and future residents.55
Both sides use arguments related to freedom of
choice. Those supporting fluoridation argue that the

348

Pollick

public water supply is designed to protect public health

and it is more important to protect peoples health
than to protect some peoples concern for their free
dom to use unfluoridated water.56,57 Additionally, pro
fluoridationists invoke the ethical principle of social
justice arguing that the safe public health measure is
socioeconomically equitable, providing greater benefit
to the disadvantaged.1
Current anti-fluoridation tactics have focused on
chemicals used to fluoridate water supplies. As has
been shown above, there is no credible evidence to sup
port the notion that the chemicals are unsafe. In the
past, tactics have focused on studies that purported to
show that fluoridation was linked to cancer and myriad
other health problems.48 However, such assertions were
based on improper science, and numerous subsequent
studies found no association between fluoridation and
cancer.58

CONCLUSION
Scientific evidence supports the fluoridation of public
water supplies as safe for the environment and benefi
cial to people. Reports at the local, national, and inter
national levels have continued to support this most
important public health measure. There appears to be
no concern about the environmental aspects of water
fluoridation among those experts who have investi
gated the matter. Furthermore, since the chemicals
used for water fluoridation are co-products of the man
ufacture of phosphate fertilizers, and the raw material
used is a natural resource (rocks excavated for their
mineral content), water fluoridation could accurately
be described as environmentally friendly, as it maxi
mizes the use made of these natural resources, and
reduces waste.59
Note: In the text, the term fluorosilicic has been substituted for
fluosilicic, hydrofluorosilicic, and hexafluorosilicic (all being synony
mous); similarly, fluorosilicate for fluosilicate, hexafluorosilicate,
and silicofluoride. However, the original terms in all references have
not been substituted.

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