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Contents 1 Which Green parties? 2 Essential Nutrient 2.1 Essential nutrient 2 2.2 Why was this edit done? 2.3 Conditionally essential 2.4 Repeated removal of discussion of nutrient status 3 NPOV: Missing philosophical argument and citing weakest opponents (straw man fallacy) 4 Removal of CDC material from body of article 5 Article praise 6 Missing Opposition? 6.1 It's hard to follow this entire discussion 7 Rephrase of last para in lead 7.1 5.7% bit 8 Ethics and Politics section & note 81 9 What? 10 Western Europe Comparison 11 Linking common units 12 Remove improperly cited vague sentence leading the Effectiveness section 13 No mention of blood concentration of fluoride? 14 Highest disease cost uncited. 15 Recent edits 16 Weapons grade uranium etc. 17 Yiamouyiannis and other low-quality sources 18 Fluoride toothpaste is widely used 19 Mainly because 20 Hoge Raad der Nederlanden 20.1 European views 21 Calcium-fluoro-phosphate

[edit] Which Green parties?

A recent edit replaced "Green Party" with "New Zealand Green Party". However, the cited source (Nordlinger 2003) mentions the Green Parties of both New Zealand and the United Kingdom. Shouldn't the phrase be replaced instead with something like "New Zealand and UK Green parties"? Eubulides (talk) 00:59, 12 October 2009 (UTC)

There is no UK Green party. If you can find a source as to whether it was the Green Party of England and Wales, the Scottish Green Party, or the Green Party in Northern Ireland, then by all means add it. jnestorius^(talk) 01:15, 12 October 2009 (UTC)

I can easily find reliable sources showing that all three of those Green parties oppose water fluoridation. However, this article is not the place to publish a list of Green party organizations that oppose water fluoridation. Rather than list individual organizations I'm inclined to rewrite the text to say something like "Green parties in the UK and New Zealand", which (1) is correct (if I've got the wording/punctuation right) and (2) is directly supported by the cited source. How does that sound? Eubulides (talk) 04:35, 12 October 2009 (UTC)

That's fine. I didn't like the unqualified link to Green party, as not all such parties oppose fluoridation. jnestorius^(talk) 13:13, 12 October 2009 (UTC)

OK, thanks, I did that. Eubulides (talk) 07:03, 13 October 2009 (UTC)

[edit] Essential Nutrient

The previous discussions on this subject were interesting, but based on original research of what an essential nutrient is. None of the cited sources state that fluoride is an essential nutrient. WP does not list it as essential nutrient. There is no need to quote (and not show that we are quoting) their ridiculous wordplay on Wikipedia to give the impression that it could be essential when there is no evidence to back up those statements. Speculation should be explicitly labeled as such. —Preceding unsigned comment added by Gregwebs (talk • contribs) 04:52, 12 October 2009 (UTC)

The coverage that's currently in Water fluoridation is directly supported by the cited sources, and is not original research. The first cited source, Olivares and Uauy 2005 (PDF), says "The essentiality of fluoride for humans has not been proven unequivocally", which is pretty much what Water fluoridation currently says. The same source goes on to say "However, this element has beneficial effects on the prevention of dental caries" which is pretty much the same point that all reliable sources on this topic say: namely, that fluoride has a beneficial effect even if it's not an essential nutrient. This point is elaborated further by the second source, Jones & Varady 2008 (PMID 18347661), which provide dietary fiber as helpful example of another nutrient that has beneficial effects but is not essential. This discussion is highly relevant to fluoride and is well supported by reliable sources, with no serious dispute about it in reliable sources; I see no reason to remove the discussion, though of course there is always room for improvement in the coverage of any topic. Eubulides (talk) 05:06, 12 October 2009 (UTC)

The current material is being directly quoted (and not shown as such). So if you are going to continue to revert my edits which are consistent with Wikipedia's guidelines, an alternative that does not violate those guidelines should be provided. Gregwebs (talk) 06:14, 12 October 2009 (UTC)

It's not supposed to be a direct quote: it's supposed to be a close paraphrase. In a controversial area like this, it's wise to not stray too far from the sources. If there is any real objection to it based on direct quotation, please specify the objectionable words. Wording we can fix. Eubulides (talk) 07:16, 12 October 2009 (UTC)

I don't think a discussion about the definition of an essential nutrient belongs on this page, it belongs on the essential nutrient page. A citation of someone proposing a new definition of essential nutrient that could possibly include fluoride just proves that point. I don't see why we need to make this speculation part of this page without labeling it as such. Gregwebs (talk) 06:14, 12 October 2009 (UTC)

The article text in question does not propose a new definition of essential nutrient; it uses the traditional definition. We cannot expect the typical reader to know the distinction between a nutrient and an essential nutrient (which is the main distinction here). The question of whether fluoride is an essential nutrient or just a nutrient is an important one, supported by many reliable sources (not just the sources listed here). It's inappropriate to unilaterally remove this longstanding material over reasonable objections. Please restore it while we thrash out the wording on the talk page. Eubulides (talk) 07:16, 12 October 2009 (UTC)

My suggestion is to avoid copying pro-fluoride speculation and to state the facts: "Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans. A diet low in sugar removes the need for fluoride." Gregwebs (talk) 15:17, 12 October 2009 (UTC)

The existing article text in question does not contain speculation, either pro- or anti-fluoride. And the existing text states all the facts given in your proposal. No valid reason has been given to remove the material in question, which is well-supported by reliable sources. Eubulides (talk) 19:42, 12 October 2009 (UTC)

The text "It has not been proven unequivocally whether fluoride is an essential nutrient" contains quoted weasel words with the goal of making it sound like fluoride is probably an essential nutrient. Keeping this obtuse wording is not required for an accurate summary of the facts at hand. Gregwebs (talk) 19:59, 12 October 2009 (UTC)

The cited source (Olivares and Uauy 2005) says "The essentiality of fluoride for humans has not been proven unequivocally". It would be misleading to summarize this source by writing "Fluoride is not considered an essential nutrient ...". It would be OK to summarize it as "It is not known whether fluoride is an essential nutrient ...", or something like that. Furthermore, the previous comment doesn't address the point that the example of dietary fiber helps explain to the reader the distinction between a nutrient and an essential nutrient, which is clearly an important distinction to make in this context. No reason has been given for removing this example, which is well supported by a reliable source. Eubulides (talk) 23:41, 12 October 2009 (UTC)

The goal here is not to repeat the weasel words of one paper, but to summarize the facts at hand and make proper attributions. I would prefer not to explain by analogy, particularly with fiber. If someone wants to more deeply understand the concept they can click on the wiki link to essential nutrient. One sentence of explanation should be able to suffice.

"Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans since a diet low in sugar removes the need for fluoride. Scientists have proposed that in modern high sugar diets fluoride should be considered an essential nutrient.[citations]"

Gregwebs (talk) 04:07, 14 October 2009 (UTC)

• "Fluoride is not considered an essential nutrient" Again, that is not what the cited source says. The cited source (Olivares and Uauy 2005) says that it's not known whether fluoride is an essential nutrient. Sources can certainly be cited saying tht fluoride is an essential nutrient (e.g., Tang et al. 2009, doi:10.1016/j.jhazmat.2009.06.079, Chipponi et al. 1982, PMID 6805293). Other sources say that fluoride is not an essential nutrient, with Jones & Varady 2008 (PMID 18347661) being one of those sources. In an uncertain area like this, the Wikipedia article cannot take sides; the science is genuinely unsettled.
• "Scientists have proposed that" Those are weasel words, no? And they are not in the source.
• "I would prefer not to explain by analogy" Some sort of explanation is needed, because the topic of whether fluoride is an essential nutrient or just a nutrient is directly relevant to the topic of water fluoridation. Several sources say that fluoride is an essential nutrient (see the previous bullet), while several (less-reliable) sources deny that fluoride is a nutrient at all (e.g., "The FDA states specifically that fluoride is not a nutrient"[1]). It's clearly a topic worth covering, so we shouldn't remove all discussion of fluoride as a (inessential) nutrient. The explanation by analogy is a good one, because it conveys to the reader the distinction between an essential and a merely beneficial nutrient far more clearly than a dry definition would. The analogy is not original research, as it's taken straight from the cited source.
• "The goal here is not to repeat the weasel words of one paper, but to summarize the facts at hand and make proper attributions." No weasel words are in this part of the article text now, and the facts are being summarized and properly attributed.

Eubulides (talk) 06:22, 14 October 2009 (UTC)

"Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans- a diet low in sugar removes the need for fluoride. However, in the typical modern high sugar diets fluoride could be considered an essential nutrient."

Again, it is absolutely ridiculous to state "it has not been unequivocally proven", since we are not (and should not be) quoting the article. If that stays here, we should insert it in every other sentence in the article. If you cannot yield on this point, there is no point in continuing this discussion. Gregwebs (talk) 15:51, 14 October 2009 (UTC)

This new version removes the "Scientists have reported that" weasel words, which addressed the least important of my objections, but the other objections remain. First, the distinction between essential and beneficial nutrients should be made. Second, the science is not settled as to the essentiality of fluoride as a nutrient, and the text shouldn't say or imply otherwise. Eubulides (talk) 06:50, 15 October 2009 (UTC)

"Fluoride is not considered an essential nutrient in the sense of being required to sustain life or growth in humans- a diet low in sugar removes the need for fluoride. However, in the a modern high sugar diet fluoride acts as a nutrient against tooth decay and could be considered an essential nutrient."

If something is being proposed as a potential nutrient, then that means it is not considered to *be* an essential nutrient, and the text needs to reflect this fact, instead of implying through weasel words that fluoride is an essential nutrient. The statement about fiber also should be removed until it can be reworded or cited- as it stands the "harmful biological process" it acts against is unknown. Gregwebs (talk) 03:12, 17 October 2009 (UTC)

Please see #Essential nutrient 2 below. Eubulides (talk) 06:27, 17 October 2009 (UTC)

[edit] Essential nutrient 2

• "If something is being proposed as a potential nutrient" But that's not what's happening. The cited source (Jones & Varady 2008, PMID 18347661) doesn't say that it is proposing that fluoride is an essential nutrient: it is saying that fluoride is an essential nutrient, using the more-modern definition of essential nutrient. The article's proposal is not about fluoride at all: it is a proposal that plant sterols and omega-3 fatty acids should be considered to be essential nutrients in this more-modern sense.
• "instead of implying through weasel words that fluoride is an essential nutrient" The current text does not imply that fluoride is an essential nutrient. It says only that we don't have conclusive proof that it is essential (in the traditional sense of "essential"). There is some evidence that fluoride is essential (in the traditional sense), but the evidence is too weak to draw such a conclusion unequivocally.
• "The statement about fiber also should be removed until it can be reworded or cited" The statement is cited. It's sourced to Jones & Varady 2008, who compare fluoride to "dietary fiber in its capacity to slow or restrict glucose and bile acid absorption."
• "in the a modern high sugar diet fluoride acts as a nutrient against tooth decay" This isn't quite right; as Jones & Varady write, the modern lifestyle involves both sugar and oral microbes, and it would suffice to remove either. It may become practical to vaccinate against the microbes, for example.
• 'as it stands the "harmful biological process" it acts against is unknown' I don't see the need for this article to go into the details about dietary fiber's action against glucose and bile acid absorption. The point is that fluoride is not alone in being a nutrient that works in a negative way, and mentioning dietary fiber suffices to make that point. Anybody curious about the details can click on the wikilink to Dietary fiber.

Eubulides (talk) 06:27, 17 October 2009 (UTC)

Part of the problem is clicking on the link to the dietary fiber page doesn't give the details as to what the harmful process is. On that page, and in popular knowledge, fiber does not so much "act against a harmful biological process", but instead it is supposed to provide various benefits. The claims for fiber are varied, whereas the claim for fluoride is it helps one specific biological pathway. If instead it stated "like fiber, fluoride is only beneficial under certain dietary circumstances", that would be more to the point.

as per microbes, I thought the logic for stopping cavities is an OR, not an AND- eliminating either one of the two stops cavities (but I assume the practical idea is to somehow reduce microbes to reduce cavities, not elimination) —Preceding unsigned comment added by Gregwebs (talk • contribs) 20:52, 17 October 2009 (UTC)

• 'On that page, and in popular knowledge, fiber does not so much "act against a harmful biological process", but instead it is supposed to provide various benefits.' Many of those benefits accrue not because fiber is an essential nutrient in the traditional sense: they accrue because fiber interferes with other processes. I've added a new section Dietary fiber #Mechanism to try to cover this issue better.
• "I thought the logic for stopping cavities is an OR, not an AND" Yes, that's right. The point is that the text should mention both arms of the OR. And you are correct that the vaccines would not eliminate all microbes, just as dietary intervention would not eliminate all sugar.
• "like fiber, fluoride is only beneficial under certain dietary circumstances" That wouldn't be quite right, as dietary fiber is beneficial pretty much everywhere, whereas fluoride isn't needed in locations where people practice low-sugar (and low-starch) diets.

Eubulides (talk) 07:37, 19 October 2009 (UTC)

The point still remains that the claims for fiber are varied and complex (not to mention made with weak evidence), which means this comparison can introduce confusion instead of clarity, particularly if there are no specifics with fiber.

There are well-documented examples of cultures that have had great teeth and great health and no need for fluoride or fiber (Eskimos are the first that come to mind). So to the best of scientific knowledge, flouride and fiber are only useful under certain dietary circumstances, and have never been shown to be useful for everyone, everywhere. But while the statement I made was accurate, you and others will still read it with confusion about its accuracy, which is why this article would be better off without the fiber reference.

Gregwebs (talk) 19:00, 19 October 2009 (UTC)

You are correct about fluoride (and that point is made in the Water fluoridation article), but incorrect about dietary fiber. Although the traditional Eskimo diet was significantly lower in dietary fiber than (say) the traditional western European diet, it did contain dietary fiber derived from animals (nondigestible aminopolysaccharides). I don't know of any human diet that was essentially fiber-free. Furthermore the "great health" of the traditional Inuit was actually not that good by modern standards, and although of course there are no reliable health statistics for the Inuit before European contact, more-recent statistics include higher rates of some diseases, such as gallbladder cancer, that are associated with low-fiber diets. Anyway, we are starting to diverge from the subject of this talk page. I'm a bit lost about which statement is meant by "the statement I made was accurate", so I can't follow the last sentence in the previous comment. Eubulides (talk) 20:45, 19 October 2009 (UTC)

Do you have any more information about dietary fiber from animals? I am interested in this information, and it should be added to the dietary fiber page when you have time. The only information I can find is that connective tissue could be considered fiber. Recent studies of the Inuit also show diabetes and alcoholism, and are quite useless for determining pre-contact health. The only information I have come across so far (observational or archeological) seems to show good health, including an absence of dental caries.

We digress. But the above points that there are multiple claimed mechanisms of fiber for different processes in the body, with varying degrees of effectiveness that are generally based on low quality research means that making a non-specific comparison to dietary fiber is a source of confusion and should be removed. —Preceding unsigned comment added by Gregwebs (talk • contribs) 23:37, 19 October 2009 (UTC)

[edit] Why was this edit done?

Why was this edit (which removed the "Like dietary fiber" clause) done? What I see above is an original-research discussion on whether the analogy is appropriate. That's fine to a degree but since it appears to have reached a stalemate, the casting vote should really go to our sources, which use the analogy. Or have I've missed something, and Eubulides has conceded the analogy is not appropriate? I think the analogy has some merit but like all analogies, can be shown to be not exactly 1:1. Colin°^Talk 08:34, 26 October 2009 (UTC)

AFAIK Eubulides has not conceded, but he has stopped discussing. I propose to removing the reference to fiber until it is defended. The issue is less one of original-research and more one of: is the analogy appropriate considering the complex multiple mechanisms by which fiber is explained to work, and the lack of explanation following the wiki link. What sources are using a direct analogy? This article explains the specific biological pathway and condition that can be improved for flouride. If the fiber reference is maintained, I think it should make a specific statement about either a biological pathway or a condition it can improve. —Preceding unsigned comment added by Gregwebs (talk • contribs) 14:25, 26 October 2009 (UTC)

That would be OK; I inserted something along the lines of this suggestion. Eubulides (talk) 15:48, 26 October 2009 (UTC)

The source doesn't just say "slow bile acid absorption" it says "slow or restrict glucose and bile acid absorption". I'm absolutely no expert here but the dietary fiber article particularly mentions the reduction in bile acid absorption rather than slowing (the reduction lowers cholesterol levels in the blood, apparently). The slowing seems more applicable to the glucose absorption, which smooths out variance in blood glucose levels. Why don't we just keep the whole phrase? Colin°^Talk 16:56, 26 October 2009 (UTC)

I'm no expert either, but when it comes to the gut my impression is that there's not a sharp line between slowing and restricting. That being said, it's OK to mention both, and to mention glucose too, so I added that as well. I hope it's OK that my change substituted the plainer-language but less-precise "sugar" for the scientific "glucose". Looking back on my change now, this material is starting to become a digression, and I wouldn't object if it got trimmed back to something shorter. Do we really need to mention both bile acid and glucose? Surely one's enough here. Eubulides (talk) 17:08, 26 October 2009 (UTC)

I like the changes. Probably only 1 mechanism is necessary for comparison purposes. Note that "the harmful biological process" has still not been stated for fiber. The grammar seems incorrect. "Just as dietary fiber can slow sugar absorption to act against the harmful process of (insulin spikes?) ..." Gregwebs (talk) 17:27, 26 October 2009 (UTC)

I interpret "restriction" as actually limiting or reducing the amount absorbed whereas "slowing" may not limit or reduce the amount at all. If we want to just mention one, the problem might be picking the appropriate combination. This is the problem I had with "slow bile acid absoption" in that I think the wrong combination was picked. I'm not sure we can give details of the benefit of either of these effects without including another source. I think the current text is fine and doesn't need to be shortened or give more detail on any one of the effects. Colin°^Talk 17:47, 26 October 2009 (UTC)

Really, to bring the analogy full circle we need something like this: "Just as dietary fiber can act as a nutrient to aid in slowing the digestion of sugar, fluoride can act as a nutrient in a diet high in sugar to prevent tooth decay. A diet low in sugar removes the need for fluoride." Gregwebs (talk) 20:03, 26 October 2009 (UTC)

Where does the "high in sugar" == needed / "low in sugar" not needed rule come from? And the reader is going to think the connection is "sugar" and not "sort of a nutrient". Colin°^Talk 22:38, 26 October 2009 (UTC)

The point that needs to be made is that both are conditionally essential. If we can't come up with a good way to state that fiber is conditionally essential, then it should be removed altogether. Gregwebs (talk) 17:23, 27 October 2009 (UTC)

Please see #Conditionally essential below. Eubulides (talk) 17:45, 27 October 2009 (UTC)

[edit] Conditionally essential

"The point that needs to be made is that both are conditionally essential." No, the cited source doesn't say that. The source (Jones & Varady 2008, PMID 18347661) likens dietary fiber to fluoride not on the grounds of conditional essentiality, but on the grounds that both are counter-permissive nutrients, i.e., both have beneficial nutritional effects that occur because they counter an adverse action of some other biological process. The current text in Water fluoridation captures this, in that it says that fluoride is like dietary fiber in that it "acts against a harmful biological process". The text goes on to say that fluoride's benefit is conditional, but it (correctly) does not claim that the same thing is true for dietary fiber. Eubulides (talk) 17:45, 27 October 2009 (UTC)

Ok, but the "harmful biological process" that fiber acts against is still not stated. —Preceding unsigned comment added by Gregwebs (talk • contribs) 00:59, 29 October 2009 (UTC)

[edit] Repeated removal of discussion of nutrient status

Gregwebs (talk · contribs) is repeatedly removing material discussing fluoride as a nutrient (first time, second time). The material is directly supported by high-quality sources, is not controversial among reliable sources, and was carefully reviewed as part of the featured-article process. Please don't simply remove such material without consensus. I suggest that the section be restored to its stable version and that further changes be discussed here. Eubulides (talk) 05:15, 12 October 2009 (UTC)

I started the discussion of the topic on this page, so it is odd for you accuse me of edit warring. I am all for consensus instead of one person owning this page. Gregwebs (talk) 06:21, 12 October 2009 (UTC)

You started this thread only after your second revert of well-sourced material, and only after I informed you of the 3RR rule. You are continuing to install obviously-controversial edits into a stable featured article without discussion and without consensus, for example, this edit. These actions are inconsistent with a claim to be all for consensus instead of one person owning the article. I suggest that these changes be reverted and that we discuss them on the talk page. Eubulides (talk) 07:16, 12 October 2009 (UTC)

I started discussion of the edit in question before I was "informed" of the 3RR rule that I have not violated, and before my first undo. Gregwebs (talk) 14:53, 12 October 2009 (UTC)

Gregwebs, a reminder to unestablished users to be aware of WP:3RR is not intended as an accusation. Please be aware of 3RR and refrain from reinserting text that does not have consensus; discuss first. SandyGeorgia (Talk)

For the benefit of editors new to the article, it may be useful to review Talk:Water fluoridation/Archive 3#Essential nutrient, which contains a detailed discussion of the sources and the consensus that was reached, before making changes to the text related to essential nutrients. --RexxS (talk) 17:06, 12 October 2009 (UTC)

[edit] NPOV: Missing philosophical argument and citing weakest opponents (straw man fallacy)

Dr. Strangelove's character and the extreme right- and left-wing groups may indeed be opposed to fluoridation, but that movie was clearly intended to ridicule opponents of fluoridation, among other targets. Although some mention is made of medical treatment without informed consent, what's missing is the philosophical debate on whether Government should force medical treatment on an entire population. For example, isn't global overpopulation an even more pressing issue than tooth decay? Ergo (per the ideology that supports fluoridation), put birth-control medications in drinking water globally, until the population is reduced to sustainable levels. Sound silly? Substitute "birth-control medication" for "fluoride" in almost every one of the "pro" arguments. Yes, silly indeed.

Mass forced medication smacks of the comparison we're not allowed to use here (the dreaded H- and N-words, of course). This is the strongest philosophical argument -- the right of individual choice -- but the sources cited seem to focus on the least attractive opponents, namely, a movie intended as slapstick satire, though with a message indeed, and those screaming of Communist plots. The Cold War is over, and fluoride is still here.

I'm not a reliable source to advance this argument, and no, I haven't time to be bold, do the research, source it properly, and edit the article myself. I just came here to look up something else, saw the FA, and... surprised it made it to FA with this notorious example of the Straw man fallacy of logic. Cheers. Unimaginative Username (talk) 05:26, 12 October 2009 (UTC)

^{[citation needed]} Shii (tock) 05:36, 12 October 2009 (UTC)

As the Ethics and politics section says, there are important ethical arguments on both sides of the question. The main point made in the above comment seems to be that the phrase "mass medication" is missing from that section. It would be reasonable to add that phrase, supported by a reliable source. However, if you aren't willing to propose specific wording or to do any research, adding a tag to the whole article would seem to be an instance of driveby tagging, a practice that is strongly discouraged on Wikipedia. Eubulides (talk) 05:40, 12 October 2009 (UTC)

Since Unimaginative Username admits to not having done the research, I have removed the POV tag s/he placed. SandyGeorgia (Talk) 05:42, 12 October 2009 (UTC)

And also keep edit-conflicting me from responding. I didn't say I haven't done the research in the past, just that I haven't time to collate sources and get it done, not only before FA changes, but before bedtime. A legitimate question has been raised and I invite legitimate opposing comments. Or leave the slanted article up -- this is how you lose formerly active editors like myself, (no threat, statement of past event), impair credibility, and discourage even trying.

For an ordinary article, I can understand that policy -- very reasonable. However, this is FA on the Main Page. By the time I were to do all the research necessary, prepare, and edit, it would no longer be FA, and the effect of disputing it, and my reasons for doing so, are lost to all but a fraction of those who will see it while it is Main Page. I think the arguments, which I was enhancing but ran into an edit conflict, speak for themselves, and certainly opposing comments can be added.

"if you aren't willing to propose specific wording" .... doing so without reliable sources is original research, no? Cheers. Unimaginative Username (talk) 05:52, 12 October 2009 (UTC)

• Edit, after edit conflict: Edit: As more evidence that the article is slanted "pro", consider the picture caption: "Fluoridation does not affect the appearance, taste, or smell of drinking water.[1]" So? Many known poisons are tasteless, odorless, and colorless. This is hardly an argument in favor of fluoridation or its safety, only the answer to a much more trivial argument, whether the water tastes, smells, or looks different. Cf. the fairly recent disclosures by US Environmental Protection Agency finding 50-odd prescription drugs in the drinking water of many US cities -- tranquilizers, anti-depressants, sleeping pills, aforementioned birth control pills, antibiotics, etc, presumably via said drugs being eliminated in urine, and the resultant sewage not being treated sufficiently to eliminate them before being recycled back into tap water. Apparently, none of those affected taste, smell, or color enough for users to gasp, nor to shrink from drinking it. One more example of trivial arguments in favor, the false dichotomy of "public good vs. individual rights" (without individual rights, no public good, nor any other, is possible. You're in a totalitarian slave state, and the possibility of fewer cavities is a ludicrously small compensation), and the presentation of the weakest arguments by the least respected opponents. Unimaginative Username (talk) 05:52, 12 October 2009 (UTC)

• As you mention, the statement "Fluoridation does not affect the appearance, taste, or smell of drinking water." is not an argument in favor of fluoridation or its safety. So I'm puzzled why you are objecting to it. This is an article about water fluoridation in general: it is not particularly an article about whether water fluoridation should or should not be done. When covering the general topic, one of the obvious areas to cover is how fluoridation affects water's taste etc. This is completely independent of whether fluoridation is safe. The lead sentence of Carbon monoxide says that CO is "colorless, odorless, and tasteless", but that doesn't mean we should slap a POV tag on that article. Eubulides (talk) 06:27, 12 October 2009 (UTC)

wow isn't it ironic that this article doesn't mention how hitler, stalin, AND mussolini all fluoridated their population's water to pacify them? lol isn't it ironic dont u think, wikipedia is neutral (LMFAO) —Preceding unsigned comment added by 75.1.48.21 (talk) 06:09, 12 October 2009 (UTC)

The Ethics and politics section does cover the theory that water fluoridation was designed to make people submissive to those in power. No reliable sources support the claim that Hitler, Stalin, and Mussolini all fluoridated their population's water to pacify them, but the topic is notable enough to be briefly summarized in that section. Eubulides (talk) 06:27, 12 October 2009 (UTC)

I agree that NPOV is missing from this article. Take a look at the cited study "Community water fluoridation and caries prevention: a critical review" doi:10.1007/s00784-007-0111-6. PMID 17333303. It is very harsh on water fluoridation, and yet it seems to be used only to point out that water fluoridation is safe. Given all the previous discussions about problems with this article and the doppelganger opposition article, it was very suprising to see this article on the front page of Wikipedia. Gregwebs (talk) 06:43, 12 October 2009 (UTC)

The previous comment is completely incorrect. The study in question, Pizzo et al. 2007 (PMID 17333303), is cited ten times in the article, to support many claims that are critical of water fluoridation, including questions of violations of ethical and legal rules, issues of informed consent, legal issues, the claim that water fluoridation may not be needed at all, the claim that toothpaste is a better way to prevent cavities, the claim that the main reason for the decline in tooth decay is toothpaste, the claim that there is only limited evidence that fluoridation reduces oral health inequalities, the claim that most countries of Europe have experienced decline in dental caries without using water fluoridation, and the claim that all fluoridation methods (including toothpaste) work about the same way. Eubulides (talk) 07:16, 12 October 2009 (UTC)

Ok, good point, but the problem still remains that much of the point of that review has been put into the alternatives section, instead of the effectiveness section, and that it is being countered by weak evidence about inequalities in the U.S. Overall this article maintains a dispassionate tone and abides by the rules Wikipedia has layed out, but it has managed to make fluoridation appear to be a godsend, when this, many other sources, and the history of Europe have made an extremely strong case that it is unneeded in the modern world. —Preceding unsigned comment added by Gregwebs (talk • contribs) 15:36, 12 October 2009 (UTC)

From the point of view of someone who supports fluoridation, the article gives a too-heavy coverage to opponents. From the point of view of someone who opposes it, the article gives a too-heavy coverage to proponents. In no sense does the article make fluoridation appear to be a "godsend". It extensively covers the evidence from Europe that fluoridation is not needed in industrialized countries, and mentions this in the lead. It also mentions, both in the lead and in the body, that the evidence in favor of fluoridation is not of high quality, and that the practice is controversial. This is not to say that the article is perfect (far from it!), and specific suggestions for improvement are welcome, but please bear in mind that the article is supposed reflect what reliable sources say about fluoridation, roughly in proportion to the weight that they say it, regardless of one's own personal opinion about fluoridation. Eubulides (talk) 19:42, 12 October 2009 (UTC)

[edit] Removal of CDC material from body of article

This edit removed from the body the claim "Water fluoridation has been listed as one of the ten great public health achievements of the 20th century in the U.S." (leaving it only in the lead), and removed from the article entirely the point that this was "alongside vaccination, family planning, recognition of the dangers of smoking, and other achievements." The first deletion violates WP:LEAD, which says that the lead should summarize the body: it's not right for the lead to make a claim that is not also in the body. The second deletion removes valuable context, in that it gives the reader a better feeling for how important the CDC thinks water fluoridation is. Regardless of whether one agrees with the CDC, this context should be presented. I suggest that the edit be reverted. Perhaps the material should be moved or reworded, but it shouldn't be deleted entirely.

Also, I'd like to suggest that in the future, possibly-controversial edits like this should be discussed first on the talk page, before being installed. Eubulides (talk) 07:16, 12 October 2009 (UTC)

I have reverted this change. This text has been thoroughly discussed and reviewed. There's WP:BOLD and there's taking a scythe to an article on the main page. Controversial articles should be edited delicately and after discussion reaches consensus. The article will still be here tomorrow. Colin°^Talk 07:48, 12 October 2009 (UTC)

Sorry, I didn't think this edit could possibly be controversial. Making someone's top-ten list has nothing do with evidence basis of effectiveness. Please move this text to an appropriate section (history?) of the article. Gregwebs (talk) 14:10, 12 October 2009 (UTC)

That is a reasonable proposal. I suggest that we move the top-ten material to the 2nd paragraph of Ethics and politics. (But not right now, as the article is being munged too much while it's on the main page, and anyway other editors may want to chime in here first.) Eubulides (talk) 19:42, 12 October 2009 (UTC)

Even when its about health and from the CDC? 173.22.123.35 (talk) 22:04, 12 October 2009 (UTC)

It is partly a health statement, and partly a political statement. There are valid arguments for putting it in Evidence basis, and valid arguments for putting it in Ethics and politics. I would be interested to hear what other editors think on the subject. Eubulides (talk) 23:41, 12 October 2009 (UTC)

No further comment, so I moved it as suggested above. Eubulides (talk) 20:01, 16 October 2009 (UTC)

Thank you. —Preceding unsigned comment added by Gregwebs (talk • contribs) 02:44, 17 October 2009 (UTC)

[edit] Article praise

I like this article, it's quite a nice one to be featured. One question, is a see also section with one point really worth it? Either expand it (perhaps with an article on water contamination rates per country, or something like that, or incorporate the existing link into the prose and remove the section? Good work. SGGH ^ping! 11:51, 12 October 2009 (UTC)

Good catch, thanks! SandyGeorgia (Talk) 14:09, 12 October 2009 (UTC)

[edit] Missing Opposition?

I used to be all for Fluoridation, but much of the opposition, starting as early as the '50's, was evidence of lowered test scores. This is not addressed; it is only "glazed over" by: "lack of evidence of harmful effects". There IS evidence. I ask this point be included in "Opposition".68.231.189.108 (talk) 12:59, 12 October 2009 (UTC)

Agree. Such prominent opponents of water fluoridation have included Dr. Bronner, who was arrested for his activities to protest water pluoridation in the 1950s. Drinking water sources have been a convenient source for the disposal of fluoride waste under the reasoning of, "fluoride prevents tooth decay." Meanwhile many brands of natural toothpaste now boast that they do not contain fluoride because of health concerns. This article, as it stands today as Wikipedia's featured article, reads as propaganda for water fluoridation, not presenting a neutral view of the subject as is befitting of Wikipedia's standards. —Morganfitzp (talk) 13:23, 12 October 2009 (UTC)

These arguments should be based on reliable sources that are peer-reviewed and recent. Opposition is well covered, and included in the lead. SandyGeorgia (Talk) 13:45, 12 October 2009 (UTC)

I'd object to putting pluride in water; is it a form of plutonium? Sounds nasty. In order to avoid accusations of being off topic, I agree with Sandy, and we have a different article for these sorts of things too (which also requires RS). Verbal chat 14:01, 12 October 2009 (UTC)

There is no reliable evidence that water fluoridation lowers test scores or IQ, or that it causes Down's syndrome, senile dementia, goiter, etc. The article is relying on recent reliable reviews of fluoridation (some pro-fluoridation, and some anti-); none of them say that there is any evidence along these lines. The only clear adverse effect is dental fluorosis, and this is covered at some length in the Safety section and mentioned in the lead. Eubulides (talk) 19:42, 12 October 2009 (UTC)

I don't have any axe to grind on this topic but I agree that the opposition argument is not well covered at all and this article doesn't present a balanced view. If I can quote from the opening paragraphs of article used for reference no. 79:

For eons now, liberals have teased conservatives about one thing (well, many things, but I'm thinking of one in particular): the fluoridation of water fluoridation of water Addition of fluoride compounds to water (see fluorine) at one part per million to reduce dental caries (cavities). This practice is based on the lower rates of caries seen in areas with moderate natural fluoridation of water and on studies ..... Click the link for more information.. "Oh, you work at National Review? What do you do, write editorials denouncing the fluoridation fluoridation (flr'ĭdā`shən), process of adding a fluoride to the water supply of a community to preserve the teeth of the inhabitants. of the water supply?" Ha, ha, ha. (Actually, we spend our time advocating separate lunch counters for Negroes.) In many quarters, "fluoridation of water" is a code word for right-wing kookery. Well, imagine my surprise -- and delight -- when I was talking recently with a dentist friend of mine and the subject of water fluoridation came up: "We still have to fight on that, all over the country," he said. "What," I said, "you mean the Birchers are still at it?" "Oh, no," he replied. "It's the Left. The opposition comes from the environmentalist environmentalist a person with an interest and knowledge about the interaction of humans and animals with the environment. , earthy-crunchy, sandal-wearing Left." Well, well, well. Who's laughin' now, baby?

Is this what passes for a reliable source that is peer-reviewed and recent?

Then there is a passage in the wikipedia article that says:

Media reporters are often poorly equipped to explain the scientific issues, and are motivated to present controversy regardless of the underlying scientific merits. Internet websites, which are increasingly used by the public for health information, contain a wide range of material about fluoridation ranging from factual to fraudulent, with a disproportionate percentage opposed to fluoridation. Antifluoridationist literature links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid.

I think it would be much better to preface this with something like " a critical examination of antifluoridationist literature published in 2007 argued that" rather than present these arguments as a statement of facts. Richerman (talk) 15:10, 12 October 2009 (UTC)

• The first source mentioned above, Nordlinger 2003, is cited only on the politics of water fluoridation, not about its medical or technical aspects. I agree that it would be better to cite a peer-reviewed source on the topic, preferably something more recent, but in the meantime this source is adequate to support the entirely non-controversial claim that opposition to fluoridation has come from right wing groups such as the John Birch Society, and more recently from left-wing groups such as some Green parties.
• The second source mentioned above, Armfield 2007 (PMID 18067684), is a reliable peer-reviewed source, and none of the article text that it supports is controversial among reliable sources. There is no need for in-text attribution for claims that are not controversial among reliable sources.

Eubulides (talk) 19:42, 12 October 2009 (UTC)

The "balance" is given by WP:UNDUE and WP:FRINGE covers the minority view that fluoride in water is dangerous. Verbal chat 15:14, 12 October 2009 (UTC)

Have you read WP:FRINGE?. Almost all of the mainstream pro-fluoride review articles acknowledges the opposition arguments. That alone is enough to show it is not fringe. —Preceding unsigned comment added by Gregwebs (talk • contribs) 15:45, 12 October 2009 (UTC)

The statement of supporting arguments as facts (when all opposing must be qualified) may be the main problem with this article. This may be a violation of WP:ATTRIBUTEPOV Gregwebs (talk) 16:31, 12 October 2009 (UTC)

Generally speaking, the article uses in-text attribution only when discussing topics that are disputed among reliable sources. For example, reliable sources do not agree that fluoridation is one of the top-ten public health achievements of the 20th century, so it's appropriate for an in-text attribution of this opinion to the CDC. However, where reliable sources agree on a topic, it would be misleading to use in-text attribution for that topic, as it would incorrectly suggest to the reader that the topic is controversial among reliable sources. So, for example, reliable sources agree that the goal of fluoridation is to prevent tooth decay, so it would be misleading for the Goal section to begin with something like "The Centers for Disease Control says that water fluoridation's goal is to prevent tooth decay", as this would suggest to the reader that other reliable sources say that fluoridation's goal is actually something else; here, it more accurate simply to give a footnoted attribution in the usual way. This style is standard in Wikipedia, and you'll see it used in many other high-quality articles that discuss controversial subjects. Eubulides (talk) 19:42, 12 October 2009 (UTC)

Of course I am not arguing against the sample you gave. I take issue mostly with statements like "Fluoride has contributed to the dental health of children and adults worldwide." in the evidence section. Besides lacking attribution to POV, it is also vague to the point that it is simply promotional. Gregwebs (talk) 20:18, 12 October 2009 (UTC)

But there is no dispute among reliable sources that fluoride has contributed to the dental health of children and adults worldwide. Fluoride does have disadvantages, which are also discussed. It is not POV or promotional to list its advantages as well as its disadvantages. Eubulides (talk) 23:41, 12 October 2009 (UTC)

I'm not asking that you give them more weight - just that they aren't dismissed out of hand. Although the reference I mentioned is pretty poor for a citation as it's not peer reviewed as far as I can see, the writer does make some valid points. To quote:

Still, the mainstreamers can be awfully high-handed when it comes to the anti-fluoridationists. Paul Connett complains, "Promoters of fluoridation refuse to recognize that there is any scientific debate on this issue." That's largely true. Connett points out that a leading fluoridation proponent has said, "Debates give the illusion that a scientific controversy exists when no credible people support the fluorophobics' view." That is patently untrue. Many dentists -- unorthodox, to be sure -- oppose fluoridation, and the "fluorophobics" can boast some heavy-hitters, like Arvid Carlsson, winner of the 2000 Nobel prize Nobel Prize, award given for outstanding achievement in physics, chemistry, physiology or medicine, peace, or literature. The awards were established by the will of Alfred Nobel, who left a fund to provide annual prizes in the five areas listed above. ..... Click the link for more information. in medicine. And yet many of the mainstreamers persist in treating every anti-fluoridationist like a street-corner quack. Indeed, there are anti-anti-fluoridationist whacks at QuackWatch.org. This site contains an article -- generally informative and persuasive -- that says, "The anti-fluoridationists' basic technique is the big lie. Made infamous by Hitler, it is simple to use, yet surprisingly effective." This is perhaps not the best way to win an argument, especially with serious-minded people. The anti-fluoridationists complain that the mainstreamers are afraid to debate them, relying on dogma, tradition, and prejudice instead of scientific fact.

Richerman (talk) 15:28, 12 October 2009 (UTC)

The previous comment is a reasonable request. However, Water fluoridation does not dismiss antifluoridationist arguments out of hand. It describes them prominently, and mentions them in the lead, giving them the approximate weight that reliable sources do. The article should not say or imply that there is no scientific debate on this issue, and it should not say or imply that all antifluoridationist arguments are street-corner quackery. If there's any specific place in Water fluoridation where it mistakenly dismisses antifluoridationist arguments, please let us know, ideally with suggestions for improved wording. Eubulides (talk) 19:42, 12 October 2009 (UTC)

First of all I think that labelling the The John Birch Society and Greenpeace as right wing and left wing, although probably somthing many would agree with, is POV and sounds rather dismissive of their views. Secondly I think the sentence I mentioned earlier needs some qualification and would suggest that it should read "Proponents argue that media reporters are often poorly equipped to explain the scientific issues......etc." When I say about dismissing the arguments out of hand, maybe that's a bit strong, but what I mean is coming down too heavily on the side of proponents. So saying "Opposition campaigns involve newspaper articles, talk radio, and public forums. Media reporters are often poorly equipped to explain the scientific issues..." Is implying that the proponents are right and the "antis" are obviously wrong, and that's not neutral enough. Richerman (talk) 10:02, 13 October 2009 (UTC)

My sense on reading this report is that it approaches over-legitimizing the opposition to the fluoridation of water. The practical problem arises as to when and how it is appropriate to be dismissive. The opposition is diverse organizationally and highly vocal, but the opposition is represented by no large scientific organization on the scale and with the legitimacy of the AMA, WHO, CDC, National Academy, Royal Society. Instead, the opposition is more commonly represented by single issue books or organizations such as the Fluoride Action Network. A related practical problem is that so much energy is focused on subtly rebalancing this article, yet parallel care is not diected at the Wiki articles that have been created to cater to the opposition. These articles lose their legitimacy because they come across as less balanced and in some cases almost strident. In the perfect world the POV aspect would be discussed in the content of the collection of articles on fluoridation. But the topic is too hot emotionally to handle cooly.--Smokefoot (talk) 12:56, 13 October 2009 (UTC)

The article says that Organized political opposition has come from right-wing groups ... and more recently from left-wing groups ... - both John Birch Society and Greenpeace are given merely as examples. The point is, surely, that both sides of the political spectrum have provided organised political opposition? (rather than "these groups can be dismissed because they are labelled X or Y".) Also, I cannot see how you draw your implication on the second point. Opposition campaigns involve newspaper articles, talk radio, and public forums. Media reporters are often poorly equipped to explain the scientific issues, and are motivated to present controversy regardless of the underlying scientific merits implies nothing more than the vehicle chosen for the campaign is not good at explaining the science, but instead will convey that campaign for other reasons. It makes no comment on the underlying rightness of the opposition's campaign. That's as neutral as anyone could reasonably expect. --RexxS (talk) 13:13, 13 October 2009 (UTC)

In answer to the point above about other articles on this subject, I'm interested in this one because it's a featured article that was on the front page and as such is supposed to be the best that wikipedia can produce and should stand on its own merits. I presume the others you're talking about are not featured articles for the reasons you've mentioned. As I said I have no strong opinions on this subject either way and was merely acting as devil's advocate trying to see how someone from the "anti" side would see the way the arguments were presented. I notice no-one has seen fit to comment on what I said about the quality of reference 79. However, I know when I'm flogging a dead horse so, if you're happy with the article, by all means leave it as it is. Richerman (talk) 14:34, 13 October 2009 (UTC)

[edit] It's hard to follow this entire discussion

It's hard to follow this entire discussion, but I'd like to note briefly that I've noticed the same thing as the original poster. The section on "safety" uses several paragraphs to present water fluoridation as essentially safe, containing only a small link named "several long-term adverse effects" detailing possible adverse effects of excessive fluoride intake. Meanwhile, arguments against fluoridation are relegated to the section "Ethics and politics", which presents the issue as a complete fiction without any basis in fact, with no attempt being made to examine what specific claims are being made or what documentation may be available to support those claims. It's one thing to take controversial claims with a grain of salt, but to maintain an article so biased that it reads like a pro-fluoridation activism site is a bit much.

(On a related note, the section also links to an additional article, Opposition to water fluoridation, whose "Potential health risks" section simply links back to the previous section again in a circular manner, with neither containing much information on the topic.)

On the other hand, some anti-fluoridationists go to great lengths to document their claims with references to scientific literature, for instance the so called "Fluoride Action Network": [EFFECTS: Bibliography of Papers Cited by FAN] [23 published studies report an association of reduced IQ with high fluoride exposure]. If Wikipedia continues to misrepresent the issue as nonexistent, anyone able to Google their way to one of these pages will have to doubt Wikipedia's credibility as a source.

Rōnin (talk) 15:27, 12 November 2009 (UTC)

• "arguments against fluoridation are relegated to the section "Ethics and politics"" No, they're presented in many sections. For example, the lead section talks about dental fluorosis, about other adverse effects, about the low quality of safety studies, about the fact that European countries seem to be doing just fine without water fluoridation, about the conflict between individual rights and the common good, about the controversy, and about ethical, legal, safety, and effectiveness arguments against fluoridation. Each of these comments in the lead section are followed up in multiple sections in the body. For example, the Implementation section says that the U.S. standard for fluoridation has become obsolete; the Mechanism section says that it's not known whether fluoride is an essential nutrient; the Evidence basis says that there's consistent evidence that fluoridation causes dental fluorosis and that research into most potential adverse effects has been almost all of low quality; the Alternatives section says that toothpaste is more widely used and more rigorously evaluated; the Economics section says there's little high-quality research on cost-effectiveness and that fluoridation harms the income of dentists; the Use around the world section that many communities have discontinued fluoridation, due not only to political opposition but also by alternative strategies; and the History section says that pioneering studies of fluoride were crude and gives more examples of discontinuance of fluoridation. This is just a summary of some of the arguments against fluoridation presented in these sections: I have not enumerated them all.
• "the section "Ethics and politics", which presents the issue as a complete fiction without any basis in fact" The Ethics and politics section focuses on ethics and politics; by design, the science and medicine topics are discussed in Evidence basis and it would be repetition to re-discuss them in Ethics and politics. The same holds for pro-fluoridation arguments, of course: the science behind them is not discussed in Ethics and politics, because it's already covered in Evidence basis.
• "to maintain an article so biased that it reads like a pro-fluoridation activism site is a bit much." From the point of view of an anti-fluoridationist, this article no doubt appears to be pro-fluoridation. Similarly, pro-fluoridationists probably view this article as being anti-fluoridation, because it gives so much space to anti-fluoridation sources. For example, the two most-commonly cited sources in this article are Pizzo et al. 2007 (PMID 17333303), which is anti-fluoridation, and NHMRC 2007, which is pro-fluoridation. You would never see that in pro-fluoridation website. Instead, you'd see language like "Fluoridation is the perfect public health intervention."[2] That's not language that you see here. (Of course, you'd never see all those citations to a pro-fluoridation review in an anti-fluoridationist summary either.)
• "the section also links to an additional article, Opposition to water fluoridation, whose "Potential health risks" section simply links back to the previous section again in a circular manner" That is a problem, but it's really a problem with Opposition to water fluoridation (a much lower-quality article), and should be fixed there.
• "the so called "Fluoride Action Network" The Fluoride Action Network is a partisan source that does not follow established scientific principles of peer review. As a questionable source it cannot be used in Wikipedia articles to support claims about fluoridation. We need reliable sources to support such claims. Please see Wikipedia:Reliable sources (medicine-related articles) for guidelines on reliable sources on medical topics.

Eubulides (talk) 21:07, 12 November 2009 (UTC)

[edit] Rephrase of last para in lead

This edit ("edited last paragraph of lead for style and accuracy") introduced a POV style where the previous text was neutral. The "but" and the "although" set sentences in opposition to each other where none is required. Also the change from "It is controversial..." to "Treatment of the public water supply is controversial..." is incorrect. The previous "it" referred to water fluoridation whereas treatment of the water supply (in general, for example to clean it and add chlorine) is not a controversial subject.

The other changes made the prose wordier and added unnecessary detail for the lead.

The change to the last sentence paragraph I'm not sure about. It previously said "it is now used by 5.7% of people worldwide." but now says "some 5.7% of people worldwide now receive water containing fluoride to around 1 mg/L". The latter includes naturally fluoridated water. Which is correct?

I've reversed the edit for now. Colin°^Talk 16:05, 12 October 2009 (UTC)

Thanks. I agree with the reversal. Eubulides (talk) 19:42, 12 October 2009 (UTC)

The reason why I changed the wording was that the construction of the paragraph was not good with short sentences and too many "its". I accept that the bit about treatment of water was not the best wording but I was trying to make it less repetitive. The bit in last sentence "5.7% of people worldwide now receive water containing fluoride to around 1 mg/L" is what the reference says - it's on line you can check it yourself. The bit about flouridation preventing cavities is complete nonsense - it reduces the incidence of them. I changed cavities to dental caries as that's the correct term and it's what they are called in the reference. By all means change what you don't like but don't throw out the baby with the bathwater. Richerman (talk) 19:57, 12 October 2009 (UTC)

You are right about the 5.7 bit, sorry about that. The prose might not have been perfect but the changes were worse as they introduced POV. I've removed the "now" as it isn't in the source and the word best avoided on WP. The "preventing cavities" isn't nonsense -- only if you take it as 100% effective as preventing cavities. Vaccines and washing your hands both prevent disease -- there's no "may prevent" about it. The point is that saying "may help prevent" introduces doubt as to whether it has any preventative action, which isn't the case. Colin°^Talk 22:23, 12 October 2009 (UTC)

Colin's right about "may prevent" being wrong; the first paragraph of the source talks about fluoridation being a "method of caries prevention", with no "may" in sight. The phrase "reduces the incidence of dental caries" is too technical for the lead; as per WP:LEAD and WP:MEDMOS the lead should prefer widely-accessible language to technically-correct but hard-to-understand language. There's no reason to wikilink to dental caries here, since the lead has already wikilinked to tooth decay, an easier-to-understand redirect to dental caries. It's better to be consistent in using simpler terminology in the lead, so I changed "reduces the incidence of dental caries" back to the simpler "prevents tooth decay". The "now" was in the text to provide linkage from the 1st half of the sentence, which talks about events in the 1950s; that same edit inserted "as of 2004" to restore this linkage and to reflect the date of the estimate. Eubulides (talk) 06:33, 13 October 2009 (UTC)

[edit] 5.7% bit

The source for the 5.7% is an article in the BMJ. Good. It says "Worldwide, about 5.7% of people receive water containing fluoride to around 1 mg/l." This is slightly different to our current lead text which says "about 5.7% of people worldwide receive water fluoridated to around 1mg/L." It is ambiguous whether "fluoridated" implies human intervention but on balance it probably would read that way in an article on the human intervention. So perhaps this should be fixed. However, the BMJ's source for this is National Public Health Service for Wales Briefing paper on fluoridation and the implications of the Water Act 2003. This contains the text "Worldwide over 360 million people drink fluoridated water -- either naturally occurring or adjusted to the optimum level of fluoride to reduce tooth decay." It doesn't mention 5.7 and it doesn't include 1mg/l in that sentence (though earlier it does say the optimum level is 1mg/l). The sentence doesn't indicate the level of fluoride in the naturally-occurring water. I wonder if the BMJ is not only using a sub-optimal source but is also reading too much into the source in order to do its maths. The National Public Health Service for Wales must have got its data from somewhere better. Can we find it? Colin°^Talk 22:45, 12 October 2009 (UTC)

I remember following the exact same reference trail that you did, and ended up with "moderate fluoridation prevents cavities,^[1] and it is now used by 5.7% of people worldwide." being the best summary of the original source (while also agreeing with the cited source). I'll see if I can reconstruct that when I have a bit more time. Eubulides (talk) 23:41, 12 October 2009 (UTC)

The Wales briefing paper got its data from an earlier edition of "One in a million", whose latest (2004) edition (PDF) estimates about 400 million people worldwide drink fluoridated water; this includes about 50 million who drink water that is naturally fluoridated to a value around optimal. (These figures are rounded, by the source, from more-precise figures.) Given that we now have later figures, we should consistently cite the newer figures instead of the older ones, and I installed an edit to do that. Eubulides (talk) 06:33, 13 October 2009 (UTC)

[edit] Ethics and Politics section & note 81

A passage immediately after note 80 and before note 81 reads:

Many people do not know that fluoridation is meant to prevent tooth decay, or that natural or bottled water can contain fluoride

Is the source for note 81 being cited for this claim, or only for the sentence following, the one beginning, "A 2009 survey of Australians..."? Only an abstract of the source article is available to non-subscribers, so perhaps someone with access can confirm that the source makes a claim about the prevalence of knowledge about the purpose or fluoridation or the presence of fluoride in bottled water. If it doesn't, this claim is unsourced and ought to be removed. --Rrburke^(talk) 16:37, 12 October 2009 (UTC)

Thank you for catching that error. The source for that claim is actually Griffin et al. 2008 (PMID 18333872), which says (p. 100) "However, many had a poor understanding of the benefits and costs associated with fluoridation. They seemed unaware that water could naturally contain fluoride or that some bottled mineral waters actually have a very high fluoride content. Studies in the USA and South Africa have shown that many people did not know water fluoridation was intended to prevent tooth decay, although that knowledge was better in higher educated groups and among older people." The claim was properly sourced when it was originally inserted, but became separated from its source in a later edit. I fixed the problem by adding a named ref to the source. Eubulides (talk) 19:42, 12 October 2009 (UTC)

But since it is apparent that there is indeed disagreement as to whether there are or are not benefits associated with the use of fluoride and fluoridation, isn't this a rather poor source? The statement "many had a poor understanding of the benefits . . ." actually means, "a lot of people disagreed with this estemmed group of scientists and social engineers." If this had been an anti-fluoride source, wouldn't it have read, "many seemed to naturally sense the harmful affects of forced fluoridation"? The poor quality of the source is further indicated by the use of "very high" as a precise measurement of some approximation. It doesn't matter what side you pick, but the sources ought to be good sources. 67.172.153.122 (talk) 20:24, 12 October 2009 (UTC)

There's nothing wrong with the sentence or the use of the source to support it. It provides support for people being unaware that fluoridation is intended to prevent caries, and that people are unaware that bottled water may contain fluoride. Fences&Windows 21:44, 12 October 2009 (UTC)

I agre with Fences and windows here. Also, the word "benefits" does not appear in the Water fluoridation passage in question, so I don't see why it's important to focus on that word in this thread. Eubulides (talk) 23:41, 12 October 2009 (UTC)

[edit] What?

I edited this page, saying that flouride was different than flourine. Later, the administrator deleted it and sent me a message saying I needed to cite the source. I'm sorry, but I think that pretty common knowledge. Sdeas (talk) 23:22, 12 October 2009 (UTC)Sdeas

Indeed, it is such common knowledge that it doesn't need to be stated in an article about Water fluoridation, and that's the reason why your edit was removed (three times). Thank you for taking the time to discuss this here, but unless you can show that there exists some confusion between fluoride and fluorine (using reliable sources), then the statement really is unnecessary in this featured article. Hope that helps --RexxS (talk) 23:33, 12 October 2009 (UTC)

The change did not say that fluoride is different from fluorine; it said that fluoride is not to be confused with fluorine. It's not clear that such a statement is important to be in the lead. Is there a reliable source saying that such confusion is common and is notable in the context of water fluoridation? If not, I suggest moving the point to Fluoride, where it's more relevant. Eubulides (talk) 23:41, 12 October 2009 (UTC)

[edit] Western Europe Comparison

A fairly large number of western european countries do not have any form of water flouridation and have the same, if not lower, levels of dental problems. - Dr. Joseph Diamond, Dimensio —Preceding unsigned comment added by Dimensio (talk • contribs) 23:11, 12 October 2009 (UTC)

The article says Most countries in Europe have experienced substantial declines in cavities without the use of water fluoridation. - citing

• Pizzo G, Piscopo MR, Pizzo I, Giuliana G (2007). "Community water fluoridation and caries prevention: a critical review". Clin Oral Investig 11 (3): 189–93. doi:10.1007/s00784-007-0111-6. PMID 17333303. 

Are you suggesting a different wording, and if so, what is your source? --RexxS (talk) 23:26, 12 October 2009 (UTC)

The comment "A fairly large number of western european countries do not have any form of water flouridation and have the same, if not lower, levels of dental problems." is surely well intentioned, but it glosses over a complex aspect. There are many countries in western europe and thus many modalities have come and gone in these countries, in some cases with variations province by province. As explained in the article, among the many modalities are salt fluoridation and milk fluoridation. Concurrently, fluoridated toothpaste became widely used as did the use of topical fluoride gels during dental check-ups. So Europe and other parts of the 1st world have experienced a broad multifaceted exposure to fluoridation. Would-be correlations of dental caries rates require an assessment of the total fluoride exposure. With many fluoridation modalities in place, the fluoridation of public waters would have less impact on dental health.--Smokefoot (talk) 02:45, 13 October 2009 (UTC)

[edit] Linking common units

Any thoughts on whether the links in milligrams per liter serve any purpose at all? (The second one crept in yesterday.) I know that WP:LINK#What generally should not be linked qualifies its recommendation not to link common units with a suggestion to provide conversions, but here there isn't an appropriate conversion - unless somewhere in the backwoods they're measuring fluoridation levels as 0.0001 ounces per gallon? Would anyone unfamiliar with these units gain a better understanding of the concentration of fluoride by reading where those links take them? I seriously doubt it, and would strongly suggest removing those links in this case. --RexxS (talk) 12:39, 13 October 2009 (UTC)

[edit] Remove improperly cited vague sentence leading the Effectiveness section

"Fluoride has contributed to the dental health of children and adults worldwide."

This sentence leading the Effectiveness section is vague to the point of being useless and just looks like fluoride promotion. The statement is not event supported by its citation. —Preceding unsigned comment added by Gregwebs (talk • contribs) 02:58, 14 October 2009 (UTC)

It looks like a straightforward statement of fact to me, particularly as the introductory sentence to a section on "Effectiveness". The source cited states:

Widespread use of fluoride has been a major factor in the decline in the prevalence and severity of dental caries (i.e., tooth decay) in the United States and other economically developed countries. When used appropriately, fluoride is both safe and effective in preventing and controlling dental caries.

Perhaps it would be helpful if you could indicate which part(s) of the sentence you have problems with?

• Fluoride's contribution to dental health?
• The contribution to children's dental health?
• The contribution to adults' dental health?
• The contribution to dental health in many countries?

I think that when you define your objections, you'll see that the sources in the article actually do support the sentence. --RexxS (talk) 03:34, 14 October 2009 (UTC)

Objections: WP:WEASEL, WP:NPOV, mixes concepts

• The statement is about "Fluoride" instead of "Water fluoridation"
• The vagueness of "worldwide"
• The vagueness of "has contributed"
• The interjection of the word "children"
• The statement being made factual instead of attributed

This section is supposed to be about the effectiveness of water fluoridation, not about how wonderful fluoride is for our children. —Preceding unsigned comment added by Gregwebs (talk • contribs) 03:58, 14 October 2009 (UTC)

The section does need a lead; we can't simply remove the sentence and leave a gap. It would make sense to make the sentence more specific about water fluoridation. How about replacing the lead with "Water fluoridation reduces tooth decay in children and adults."? That's short and sweet and summarizes the section nicely. The cited source makes a clear distinction between children and adults, so our text should too. The sentence should be attributed in the usual way with a footnote, not with in-text attribution, because in-text attribution would incorrectly convey to the reader the impression that the claim is controversial among reliable sources. Eubulides (talk) 06:22, 14 October 2009 (UTC)

Indeed, this lead sentence would be more useful if it specified "water fluoridation" vs just "fluoride." Other sentences in the same paragraph also could be improved as indicated by my {inserts}: "Moderate-quality research {sounds like an attempt to placate a complaining group}} exists as to water fluoridation's effectiveness {for what?, dental health one assumes, isn't that the point of the whole article and the reason that the US CDC lists fluoridation of water as a top ten advance?}"--Smokefoot (talk) 12:54, 14 October 2009 (UTC)

The suggested intro is better, but still not specific enough. "Water fluoridation reduces tooth decay in those whose teeth do not regularly come in contact with fluoride." Gregwebs (talk) 15:31, 14 October 2009 (UTC)

That's circular. With water fluoridation their teeth will regularly come in contact with fluoride. Colin°^Talk 15:37, 14 October 2009 (UTC)

"... teeth do not *otherwise* regularly ...". Reliable sources used in this article show that in Europe, where there is no water fluoridation, they have reduced tooth decay. These sources attribute it in large part to other sources of fluoride, such as fluoridated toothpaste. Water Fluoridation would have been of little benefit to them, just as it is of little benefit to anyone who already has adequate fluoride exposure. —Preceding unsigned comment added by Gregwebs (talk • contribs) 16:00, 14 October 2009 (UTC)

The claim "Water fluoridation reduces tooth decay in those whose teeth do not otherwise regularly come in contact with fluoride." is not directly supported by the cited source, so we can't use that wording. Furthermore, the wording clearly implies that fluoridation does not reduce tooth decay in those who brush with fluoride toothpaste regularly, an implication that is incorrect. Let's leave the topic sentence short, sweet, and a summary of the section, rather than introduce unsupported (and incorrect) editorial opinion. Eubulides (talk) 06:50, 15 October 2009 (UTC)

This is directly supported by citations in the article "Community water fluoridation and caries prevention: a critical review" PubMed 17333303: "...the caries reduction directly attributable to water fluoridation have declined in the last decades as the use of topical fluoride had become more widespread... studies conducted in fluoridated and nonfluoridated communities suggested that this method of delivering fluoride may be unnecessary for caries prevention particularly in the industrialized countries where the caries level has became low."

This major point about the effectiveness of water fluoridation should be in the introductory statements to maintain accuracy and a NPOV. —Preceding unsigned comment added by Gregwebs (talk • contribs) 03:55, 17 October 2009 (UTC)

"This is directly supported by citations in the article" No, those quotes from Pizzo et al. 2007 (PMID 17333303) do not establish that water fluoridation does not reduce tooth decay in those who brush with fluoride toothpaste regularly. On the contrary, they say that water fluoridation has less of an effect (not "no effect") on regular tooth-brushers, and that in an industrialized society willing to tolerate a somewhat-higher level of caries than would obtain with water fluoridation + fluoride toothpaste (perhaps because dental treatments are free or low-cost) the water fluoridation may be unnecessary. The implication is that, in a society where dental treatments are unavailable or are too expensive for the poor, society might not be willing to tolerate this somewhat-higher level of caries, and water fluoridation would then still be necessary. This point is currently made in the lead in the last sentence of the 2nd paragraph, citing Burt & Tomar 2007. The opinion of Pizzo et al. 2007 is already featured quite prominently in the lead compared to the weight given their arguments by other reliable sources; there would be a WP:WEIGHT problem in featuring them much more than they're already featured. But perhaps, if you think this part of their argument is crucial, it could replace some of the existing text. Eubulides (talk) 06:27, 17 October 2009 (UTC)

I do think for this section titled "effectiveness" the fact that the effectiveness greatly varies if there are other methods of fluoride exposure needs to be clearly stated and reflected in the introductory remarks. —Preceding unsigned comment added by Gregwebs (talk • contribs) 20:16, 17 October 2009 (UTC)

The Effectiveness section already does what you're requesting. Its second sentence says the effectiveness of water fluoridation has gone down significantly with time, likely due to the introduction of fluoride toothpaste, plus the halo effect. Eubulides (talk) 07:37, 19 October 2009 (UTC)

Ok, I was in the mindframe of only thinking about an intro sentence, not an intro paragraph. If we remove the first sentence that doesn't add useful information, then we will have a good intro paragraph that goes over the historical effectiveness of water fluoridation and makes very specific statements with useful information. Gregwebs (talk) 23:52, 19 October 2009 (UTC)

[edit] No mention of blood concentration of fluoride?

There is no mention of fluoride levels found in blood. This needs to be resolved. There is also evidence suggesting that animals will suffer kidney and liver function damage due to water fluoridation. This is important information for this article: http://www.ncbi.nlm.nih.gov/pubmed/16834990

[edit] Highest disease cost uncited.

The reference to "and costing society more to treat than any other disease." is unsupported by the reference given. Forbes calls "Heart Disease" the highest: http://www.forbes.com/2005/04/14/cx_mh_0414healthcosts.html though I don't know who they are citing.

This claim needs to be investigated before it goes on the article. —Preceding unsigned comment added by Bitcloud1 (talk • contribs) 12:41, 15 October 2009 (UTC)

The cited source says "Dental diseases, particularly dental caries, are the most expensive part of the body to treat. Caries is indeed the most expensive human disease in terms of direct costs. For example, the direct costs of caries treatment in Germany was 20.2 billion, CVD 15.4 billion DM, diabetes 2.3 billion DM.4. In West Germany, the cost of dental care was 10.3% of the health budget in 1994." (my emphasis) I suspect Forbes either forgot that caries was a disease, or asked a bunch of doctors and forgot to ask the dentists too. Colin°^Talk 12:52, 15 October 2009 (UTC)

Thanks for the citation. A little extra research yeilds this from WHO: "Moreover, traditional treatment of oral disease is extremely costly, the fourth most expensive disease to treat in most industrialized countries." http://www.who.int/oral_health/disease_burden/global/en/index.html

This journal agrees with Forbes as "Heart Disease" being the most expensive in the UK: http://www.accessmylibrary.com/coms2/summary_0286-2712108_ITM

This article puts heart disease in Australia at $5.924 billion/year, while oral care was $5.305 billion: http://www.aihw.gov.au/publications/cvd/hcecd04-05/hcecd04-05.pdf

This appears to be the article cited by Forbes (for the US figures 2002) http://www.ahrq.gov/research/ria19/expendria.htm#diff4

The originally cited article does specifically state "Caries is indeed the most expensive human disease in terms of direct costs.". The phrase "and costing society more to treat than any other disease" isn't indicative of direct costs, and incorrectly suggests broader societal costs. I don't think direct costs are appropriate for an encyclopaedia article, and we should only cite this if there is evidence that tooth decay is actually the highest costing disease. (the WHO appraisal doesn't seem to support this) Bitcloud1 (talk) 13:39, 15 October 2009 (UTC)

Thanks for those sources. They are more recent than Sheiham 2001 (PMID 11683551), the source we had cited as saying that dental caries was #1. I found another WHO source, Petersen 2008 (PMID 18630105) which the article is already citing, agreeing with the "fourth most expensive" claim. Looking further, I even found a 2005 editorial by Sheiham (PMID 16211151) agreeing with the "fourth most expensive", so it appears that the claim about being #1 is dated at best. I switched to saying it's #4, citing the 2008 WHO source. Sorry about taking so long to look into this: I lost this thread in the main-page flurry of comments. Eubulides (talk) 08:39, 7 November 2009 (UTC)

[edit] Recent edits

While some of Bitcloud1 (talk · contribs)'s recent edits may be helpful, I recommend that most of them be reverted because improper sources are being used, and it seems s/he may be using abstracts rather than relying on full articles. I also left Bitcloud a WP:3RR reminder, as the account was registered right after I reverted 118.208.108.188 (talk • contribs • info • WHOIS) twice, and is making similar edits. Hopefully the notification will suffice, and a checkuser won't be needed. SandyGeorgia (Talk) 14:31, 15 October 2009 (UTC)

I don't recommend we blanket revert edits. These are all legitimate, unbiased edits backed up by legitimate citations. If anyone would like to modify citations to point to full articles rather than abstracts, they are welcome to do so. I will try to correct this minor administrative technicality as well.

Meta: I made two edits before logging in. My old account is attached to my old email address, so i was forced to create a new account when I noticed the omissions on this article. (though I really feel that this is irrelevant. The edits are legitimate and are cited.)

Please discuss any issues with any of the changes in discussions.

Bitcloud1 (talk) 14:53, 15 October 2009 (UTC)

Then please be aware that 3RR applies to all of your edits; you may have already violated it. If you have, you can avoid being blocked by reverting your edits post-haste. SandyGeorgia (Talk) 15:04, 15 October 2009 (UTC)

I'm assuming you're talking about the "and costing society more to treat than any other disease." section. This citation is inaccurate and misleading by anyone's account. I can't revert this because it is an inaccurate statement. If anyone feels this to not be the case, the topic is "Highest disease cost uncited." in discussions. Let's add it back in if information comes to light suggesting tooth decay to be the highest societal cost amongst diseases.

Re: 3RR. I have made two reverts, the second after comprehensively citing sources for the edit I originally made. The other revision was flagged as an "undo" (because i entered the edit through the "undo" link), but was a simple edit/rewrite removing the specific aspects you objected to. I hope you understand, this was not a "war" revision. It was simple collaborative editing. Bitcloud1 (talk) 15:29, 15 October 2009 (UTC)

The cited source, Sheiham 2001 (PMID 11683551), clearly supports the claim that dental caries costs society more to treat than any other disease. It says, for example, "Caries is indeed the most expensive human disease in terms of direct costs." (p. 569). I don't know what the phrase '"Highest disease cost uncited." in discussions' is referring to. Eubulides (talk) 20:53, 15 October 2009 (UTC)

This is incorrect. The discussions clearly discusses the costs of diseases. Heart disease is listed as the highest by many sources, including the WHO. "direct costs" are not "societal costs". Please revert this deletion. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

I don't know what "discussions" are being referred to. The phrase "societal costs" does not appear in Water fluoridation. The cited source, Sheiham 2001 (PMID 11683551), gives the direct costs of caries treatment and cardiovascular disease, with the former being significantly greater. No reliable source disagreeing with this claim has been given in this thread. Eubulides (talk) 07:47, 16 October 2009 (UTC)

I have undone this edit. I can't make sense of the edit summary ("removed reference to animals and "weasle words") as the edit didn't remove anything and added words rather than fixing "weasel words".

No, this edit reduced the sentence (paraphrased) "similarly there is an increase in levels of fluoride in the blood, and..." to "Similarly there is an increase in levels of fluoride in the blood.". Where there is mention of fluoridated water increasing levels of fluoride in the body, if a specific body area (saliva) is mentioned, then other specific body areas should also be mentioned. If no specific areas are mentioned, it should read "increased levels in the body". Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The previous comment incorrectly characterizes the edit in question. The edit didn't "reduce" the sentence: it inserted the sentence into the lead. The sentence does not summarize anything in the body (violating WP:LEAD) and is supported by a poor-quality source. The edit also inserted some phrases not supported by the cited sources. Eubulides (talk) 07:47, 16 October 2009 (UTC)

• The text introduced "maximum safe" into the "level of fluoride". This is not supported by the source, which says: "The optimum water fluoride concentration will normally be within the range 0.5-1.0 mg/l."
• The text introduced "in an attempt" wrt reducing tooth decay. Those words imply a belief that is not proven to be substantiated. This is false and not supported by the source which clearly says water fluoridation is effective at preventing caries.

The assumption is that it by default will reduce tooth decay. Vaccines are used in an attempt to immunise against disease. Police speed checks are used in an attempt to reduce road fatalities. Water fluoridation can only ever be "in an attempt" to reduce tooth decay. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The introduction of "in an attempt" is an editorial comment that undermines what the cited source says. Let's stick with what the reliable source says. Eubulides (talk) 07:47, 16 October 2009 (UTC)

• The text removed "naturally occurring" wrt defluoridation. That was not helpful.

This article isn't about "naturally occurring" fluoridation. De-fluoridation has also been needed in non-naturally occurring water supplies. This should be corrected. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The cited source talks about defluoridation as "the lowering of the naturally occurring fluoride level in drinking water to prevent dental fluorosis". Water defluoridation is highly relevant to water fluoridation, as they have similar goals. Eubulides (talk) 07:47, 16 October 2009 (UTC)

• The text introduced the sentence "Similarly, it creates an increased level of fluoride in the blood." into the lead, sourced to a primary research paper. The WP article does talk about fluoride being absorbed into the blood and indeed deposited in the bones. It uses a better source. I don't quite know what "Similarly" is meant to imply as there's nothing similar about it. If we are going to cover systemic absorption of fluoride in the lead, we should use better sources and revise the wording and possibly position within the lead. For example, it is not clear to the reader why this should be relevant at this point. I think Eubulides should be able to suggest something here.

Colin°^Talk 16:28, 15 October 2009 (UTC)

I have undone this edit, which had the summary "Removed weasle words and restored impartiality to the section regarding "dental fluorosis"".

• The text removed the qualification on fluorosis: "most of this is mild and usually not considered to be of aesthetic or public-health concern". This qualification is supported by the source, which says "the majority of this fluorosis was mild and would not be considered to be of aesthetic concern." The "most" is not a weasel word here as it is equivalent to "majority of". The aesthetic concerns (or lack of) are not the opinions of pro-fluoride writers -- they are a result of questioning people (e.g. teenagers) on whether they regard the effects as of any aesthetic concern. One can't "restore impartiality" by removing bits of the text one doesn't like. If our sources say it generally isn't of aesthetic concern, then this can and should be reflected in our text.

Colin°^Talk 16:41, 15 October 2009 (UTC)

This uses biased, subjective language. Perhaps better wording would be "Surveys conducted suggest that most of this is mild and usually not considered to be of aesthetic or public-health concern" Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

The cited source does not use this sort of qualification ("Surveys conducted suggest") and neither should this article. The word "considered" suffices in the source to indicate the obvious point that the esthetic judgment is subjective, and that wording suffices in this article too. Eubulides (talk) 07:47, 16 October 2009 (UTC)

I have undone this edit, which had the summary "Clarified the statement "has substantial advantages". Now specifically addresses the advantages.".

• The text replaced "Water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk." with "Water fluoridation, when feasible and culturally acceptable, can lead to a substantial decrease in tooth decay, especially for subgroups at high risk." This is not the point of the sentence. The point of the sentence, is that it has advantages over the other means of delivering fluoride or improving dental health, and those advantages are particularly seen in certain subgroups at high risk. Nobody needs reminding, at this stage, what the aim is ("a substantial decrease in tooth decay"). Colin°^Talk 18:22, 15 October 2009 (UTC)

This needs to be clarified in this case. It's ambiguous in its current wording. We should replace "has substantial advantages" with "has substantial advantages over other fluoridation methods".

The cited source, Petersen et al. 2004 (PMID 15341615) does not say "substantial advantages over other fluoridation methods"; it merely says "substantial advantages". In the context of the cited source it's clear that it is talking about other fluoride methods; that same context is present here, as the text in question is following the discussion of other fluoride methods. There's no need to add "over other fluoridation methods" here, just as there is no need in the source. 07:47, 16 October 2009 (UTC)

Colin, as Sandy has pointed out, there is a WP:3RR rule. You might need to address this. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

WP:3RR says "A series of consecutive saved revert edits by one user with no intervening edits by another user counts as one revert." I chose to revert those changes bit-by-bit rather than revert back to an earlier version of the article. That was because I wanted to review and discuss each edit rather than just say "it was all bad". BTW: I follow a one-revert-rule. Colin°^Talk 08:13, 16 October 2009 (UTC)

(update) Hmm, I'd always understood WP:3RR as warring against one party (or group of editors) over an issue. But the policy page doesn't restrict the reverts in that way, so several IP/newbie editors come along and add different sorts of nonsense (such as this poison-nerve-agent theory), I'm limited after the first revert. Oh, well. I guess we need more eyes on this article. Colin°^Talk 11:02, 16 October 2009 (UTC)

I undid this edit, which added material supported by a news article about a fluoride overfeed in Australia. This overfeed isn't particularly notable compared to the ones already mentioned (no injuries were reported, as opposed to the incidents already noted, which included many injuries and one fatality). It's better to use reliable secondary sources for material like this, to avoid problems with WP:WEIGHT and WP:RECENTISM; see WP:PSTS and WP:MEDRS. I also removed the insertion of the phrase "maximum safe" when talking about WHO suggestions; that WHO document is talking about recommended levels, not maximum safe levels. I removed a couple of insertion of "in humans" as the surrounding text is clearly already about humans (and the sources don't say "in humans", for the same reason, so we shouldn't either). And I changed an "effective" back to a "justified" because the cited source says "justified", not "effective" (see Talk:Water fluoridation/GA1 #Europe and Canada). I suggest that future edits that are likely to be controversial be discussed on the talk page first, to save us all some time and effort. Eubulides (talk) 20:53, 15 October 2009 (UTC)

I disagree with a 20 times over the limit fluoridation news article not being notable. Please revert this edit, or include this information in another way. Bitcloud1 (talk) 23:21, 15 October 2009 (UTC)

I respectfully but firmly disagree. There are countless public water supply systems in the world and some small percentage are almost always botching something. In my area we see spikes in chlorination. The acute toxicity of fluoride indicates that it is grams per liter is when things get dangerous, not milligrams. The LD50 for sodium fluorosilicate in rats is 125 mg/kg (that's a big rat!, but seriously...) for a 50 kg person that LD50 translates to several grams per liter. So the incident in Brisbane is a non-event for most neutral readers (i.e., those neither for or against fluoridation). In fact, the absence of anything particularly bad happening with a spike in fluoride if anything, undermines some of the alarmist rhetoric on this page. --Smokefoot (talk) 00:01, 16 October 2009 (UTC)

Perhaps a subpage or subcategory of "incidents of accidental over fluoridation" should be made rather than just ignoring these news items. It was a national news item. Your comments lead me to believe that it may be a commonly reported occurrence, in which case it definitely needs to be addressed. If the other illnesses are a result of negligence in fluoridation, then all incidences of negligence are notable. Bitcloud1 (talk) 02:02, 16 October 2009 (UTC)

That sort of material would be original research in this article, and can't appear here. Eubulides (talk) 07:47, 16 October 2009 (UTC)

Wikipedia is an encyclopaedia, not a collection of bad-news stories. It is a very poor and unfair way of conducting an argument to list all the bad things one can find. Naturally, the press covers bad news. Nobody writes/reads news stories like "Wee Jonny went to the dentist for a checkup and didn't require any fillings." So such an article or set of articles would be perceived as a WP:POVFORK and foul WP:NPOV by seeking to cast a topic solely in a bad light. Colin°^Talk 08:13, 16 October 2009 (UTC)

"justified" section. Why does this belong in the lead? Citation is a subjective work, and includes the subjective terms "may be". I don't feel this is appropriate for the lead. Bitcloud1 (talk) 23:36, 15 October 2009 (UTC)

The cited source, Burt & Tomar 2007 (ISBN 0195150694), is high-quality expert opinion, and the opinion is properly qualified with a "may be" here. The sentence in question is extremely helpful in the lead, as it ties together the previous sentences' coverages of alternative fluoride methods and of different experiences in U.S. and Europe. No reliable sources disagree with the claim in question. Eubulides (talk) 07:47, 16 October 2009 (UTC)

[edit] Weapons grade uranium etc.

A recent edit by the new user Roger Masters (talk · contribs), whose user name suggests that of the antifluoridation activist Roger Masters, inserted a large quantity of material that was original research, had serious WP:WEIGHT issues, and promoted WP:FRINGE theories (e.g., "waste products from processing weapons grade uranium"). I reverted the edit. Normally I would copy the material in question to the talk page for further discussion, but this insertion is fairly long and appears to contain copyrighted material that is reproduced without permission, so I'm not going to do that here. The main issue that the inserted material discussed, namely the safety of silicofluorides, is already covered in the 4th paragraph Water fluoridation #Safety, citing sources that are far more reliable than what was in the inserted text. Eubulides (talk) 07:47, 16 October 2009 (UTC)

[edit] Yiamouyiannis and other low-quality sources

A recent edit inserted the following text:

"Even though it it widely endorsed, various scientific studies have found fluoridation to have a detrimental effect or no effect at best."

citing the following sources:

• Yiamouyiannis, J (1990). "Water Fluoridation and Tooth Decay: Results From the 1986-1987 National Survey of U.S. Schoolchildren". Journal of The International Society for Fluoride Research 23 (2): 55-67. 
• Ziegelbecker RC, Ziegelbecker R (1993). "WHO data on dental caries and natural water fluoride levels". Fluoride 26: 263-266. 
• Diesendorf M (1986). "The mystery of declining tooth decay". Nature 322: 125-129. 

These sources do not support the claim in question: they do not say "Even though it it widely endorsed, various scientific studies have found". The claim in question is therefore original research. Furthemore, the first two sources are WP:FRINGE sources. For example, Yiamouyiannis was a notorious laetrile and fluoridation activist, and his work is discreded; see, for example, Horowitz 2000 (PMID 10929563), who writes

"Yiamouyiannis has repeatedly obtained data from government sources and then analyzed them to show damaging effects from community water fluoridation. His spurious analysis–based on crude mortality data unadjusted for age, sex, or race, showing that persons in fluoridated communities die from cancer more than do persons in non-fluoridated communities–has been fully discredited by the National Cancer Institute of NIH."

Ziegelbecker & Ziegelbecker 1993 has similar problems: it is also fringe. The third source, Diesendorf 1986, was a reasonable source in the middle 1980s when it was published, but its point is that dental caries has been reduced even in areas that do not practice water fluoridation, which is quite a different matter (and one that is already covered by the lead, with much better and more-recent reviews). Even if the first two sources were reliable, which they are not, they are primary sources, and as per Wikipedia policy and guidelines they should not be used to attack or undermine reliable secondary sources. The third source is far too old and does not support the claim in question. Please see WP:PSTS and WP:MEDRS for the Wikipedia policy and guidelines that are clearly violated by this insertion. For now, I've reverted the change. I suggest that further discussion on this topic be done on this talk page first, before attempting to make obviously-contradictory changes like this. Eubulides (talk) 16:36, 16 October 2009 (UTC)

[edit] Fluoride toothpaste is widely used

A recent deletion by 71.235.238.78 (talk • contribs • info • WHOIS) (which has been reverted twice, and then reinstated twice by the same IP address) removed the sentence, talking about fluoride toothpaste, that "It is widely used, but less so among the underprivileged.". with edit summaries like "again, that part of the sentence sounded like it was advertising fluoride toothpaste, or in some way promoting its use".

The cited source, Jones et al. 2005 (PMID 16211158), directly supports the sentence. The source says "Probably the most widespread and significant vehicle used for fluoride has been toothpastes.... Uptake and use has not been uniform and is less likely among underprivileged groups." This is not an advertisement: it is a public-health paper published in the Bulletin of the World Health Organization, with a wide variety of dental and public-health coauthors. Because the sentence is well-sourced and relevant, I've restored it. I suggest to the IP address to please discuss the matter here rather than continuing to remove the material against consensus. Eubulides (talk) 03:31, 31 October 2009 (UTC)

[edit] Mainly because

A recent edit added the text:

"mainly because addition of fluoride does not improve the safety of drinking water as such (legal reason) and because of the availability of alternatives."

However, the cited source, Martin 1989 (doi:10.1111/j.1533-8525.1989.tb01511.x), does not support this newly added text. That source does not come to any conclusions about the main reasons for the administrative decisions in Europe. The source gives just one example, in Denmark, and this example does not talk about improving the safety of drinking water, or about legal reasons, or about the availability of alternatives. As the change is not at all supported, I have reverted it for now. Eubulides (talk) 19:41, 4 November 2009 (UTC)

• I agree that there is no link between the reference and my added text. I added a modified text with reference. E.J.Hoekstra (talk) 21:03, 4 November 2009 (UTC)

[edit] Hoge Raad der Nederlanden

A recent edit reinserted material about a 1973 decision by the Hoge Raad der Nederlanden. This level of detail is inappropriate for Water fluoridation. There must be hundreds of court decisions all over the world about fluoridation, and there's no particular reason to emphasize this one here. When similar material was added earlier, it was promptly and properly moved to Fluoridation by country #Netherlands; that is a much better place for that sort of detail. Please don't continue to reinsert this material without proper discussion and consensus. Eubulides (talk) 21:23, 4 November 2009 (UTC)

I reverted my edit on The High Council of The Netherlands in The Netherlands forbid fluoridation since addition of fluoride does not improve the safety of drinking water as such and water suppliers go beyond their legal task as requested by Eubulides on my talk. In my opinion my contribution is important because the present section on Ethics and politics seem to me a little unbalanced towards Anglo-Saxon countries. This is most probably due to the fact that in continental Europe there is almost no discussion on water fluoridation. The section just addresses Europe in half a sentence. However, Europe exists of many countries, all with there own approach. Martin states that most public administrations in continental Europe has taken the decision not to fluoridise, however, without giving a reference. This means not all of them used governmental decisions. In my opinion it is informative to mention in this section more background why there is little discussion in continental Europe. This is not addressed in this section. My contribution, although maybe not perfect, was a first try.

Eubulides states that we should use reliable reviews of the topic, rather than citing court decisions directly. The article currently cites several reviews of water fluoridation (including negative opinion) and as far as I know none of these reviews mention this 1973 court case. As per WP:WEIGHT, we can't assign far more weight to this subtopic than reliable sources do, nor should we be citing primary sources directly when we have substantial secondary sources available Although I agree that reviews should have preference over specific papers, the references on water fluoridation are mainly primary sources and even some gray literature. That the Dutch Supreme Court case is not mentioned in reviews may have several reasons. First, the Dutch language is not well accessible for non-speakers and second, court cases in general are not easy to access. This problem is also valid for other European languages. So my conclusion is that due to the absence of substantial secondary sources, primary sources can be used. However, what disturbed me most is the fact that Eubulides’ statement implicitly marginalises the reference I used as unreliable.

In order to balance the section on ethics and politics I propose elements of the following text. Martin gives three main grounds for against fluoridation. First, opponents claim the benefits are exaggerated or not established. Second, there are claims of health risks to some members of the population; the Danish government seems to have followed this line. Third, fluoridation is thought to be an infringement on individual rights because it is compulsory medication of all members of a community, as opposed to chlorination, which is treatment of the water. This line was more or less followed by the High Council of The Netherlands that forbid fluoridation based on the judgement that addition of fluoride does not improve the safety of drinking water as such and water suppliers go beyond their legal task. The prohibition of fluoridation by the High Council due to the lack of a legal basis stopped the whole discussion in The Netherlands in 1973 (see also nl:drinkwater#Het drinkwaterfluorideringsdebat). Sweden followed similar route as The Netherlands.

E.J.Hoekstra (talk) 23:39, 6 November 2009 (UTC)

Thanks for your thoughtful comments. Please see #European views below. Eubulides (talk) 06:32, 7 November 2009 (UTC)

[edit] European views

• "in continental Europe there is almost no discussion on water fluoridation" I expect there's not that much discussion anywhere. Most people have more-important things to worry about. I agree that the topic comes up even more rarely in Europe, because water fluoridation is more-rarely practiced there.
• "it is informative to mention in this section more background why there is little discussion in continental Europe" But we'd need a reliable source to make that point, no? I.e., we'd need a source making the point that there is little discussion in continental Europe because fluoridation is rarely practiced there. Although that point is probably true, we can't make it without a good source.
• "The section just addresses Europe in half a sentence." Not true. The Ethics and politics section specifically mentions the European Academy of Paediatric Dentistry, a German chemical company, the Green party in the UK, a 2003 study of focus groups from 16 European countries, and a 1999 survey in Sheffield, UK, in addition to the administrative decisions you noted. Also, that section cites European sources heavily. It cites:

• Pizzo et al. 2007 (PMID 17333303; cited twice),
• British Fluoridation Society et al. 2004,
• Petersen & Lennon 2004 (PMID 15341615),
• Petersen 2008 (PMID 18630105),
• the European Academy Of Paediatric Dentistry 2009 (PMID 19772841),
• Griffin et al. 2008 (PMID 18333872),
• Dixon & Shackley 1999 (PMID 10226722),
• Calman 2009 (PMID 19135693), and
• Cheng et al. 2007 (PMID 17916854).

That's ten citations to European sources, compared to (by my count) 13 citations to U.S. sources and 9 citations to sources that are neither U.S. nor European. There is certainly no bias against European views here; on the contrary, given the relatively small amount of literature on the subject generated in Europe, one could argue that there's a slight bias for European sources.

• "due to the absence of substantial secondary sources, primary sources can be used" But there is no such absence. As I mentioned in the previous bullet, that section already cites 10 European sources. Other sections cite many European sources as well. These are by and large secondary sources, which is better for Wikipedia.
• "Europe exists of many countries, all with there own approach" Yes, and it's beyond the scope of this article to discuss each country's approach: we need to draw a relatively-broad brush here, just as the coverage of North America does not discuss individual U.S. states or Canadian provinces (which have very different practices). That sort of detail is appropriate for Fluoridation by country, but is far too much detail for the more-general article.
• "the references on water fluoridation are mainly primary sources and even some gray literature" The references on almost any topic are mainly primary sources and/or gray literature. But Wikipedia articles should avoid these references: it should use reliable reviews (see WP:PSTS and WP:MEDRS). Water fluoridation relies mostly on secondary sources for its conclusions, and there's no reason to lower its standards on this particular point.
• "That the Dutch Supreme Court case is not mentioned in reviews may have several reasons." Yes, and in addition to the reasons given, it may not be mentioned because it's dated and limited in scope. There have been many court decisions all over the world about water fluoridation, and they're all based on legal principles and arguments about safety, rights, the law, etc. The text of the Dutch decision itself does not provide any evidence that the decision is still important enough to mention here.
• "In order to balance the section on ethics and politics" That section already gives a bit more space to opponents of fluoridation than it does to proponents. Giving even more weight to opponents would present obvious WP:WEIGHT issues. This is not to say that we can't change the section, but the section is already overlong, and any additions should be balanced with deletions (which can be moved into the see-also article).
• "Martin gives three main grounds for against fluoridation." Yes, and those three grounds are already covered in Ethics and politics:

• "First, opponents claim the benefits are exaggerated or not established." The article text currently says "Since fluoridation's inception, proponents have argued for scientific optimism and faith in experts, while opponents have drawn on distrust of experts and unease about medicine and science. Controversies include disputes over fluoridation's benefits and the strength of the evidence basis for these benefits,"
• "Second, there are claims of health risks to some members of the population" The article text currently talks about "the difficulty of identifying harms" and goes not to say, "Antifluoridationist literature links fluoride exposure to a wide variety of effects, including AIDS, allergy, Alzheimer's, arthritis, cancer, and low IQ, along with diseases of the gastrointestinal tract, kidney, pineal gland, and thyroid."
• "Third, fluoridation is thought to be an infringement on individual rights because it is compulsory medication of all members of a community, as opposed to chlorination, which is treatment of the water." The article text currently says "Fluoridation can be viewed as a violation of ethical or legal rules that prohibit medical treatment without medical supervision or informed consent, and that prohibit administration of unlicensed medical substances." and later, discusses "legal issues over whether water fluoridation is a medicine, and the ethics of mass intervention."

Perhaps the abovementioned wording could be improved without making it longer and causing weight problems: do you have specific suggestions? Eubulides (talk) 06:32, 7 November 2009 (UTC)

[edit] Calcium-fluoro-phosphate

A recent edit by an IP address added (without comment) the following material to the lead:

"It is important to note that calcium-fluoro-phosphate - a bone and teeth strengthening organic chemical - is NOT soluble in water[3]. Sodium flouride and hydrofluosilicic acid are used to fluoridate water and are not organic."

The first sentence relies on an unreliable source "Fluoride – The Lunatic Drug". The second sentence is unsourced. This insertion is therefore weak.

This material is already covered in the lead (which talks about "a fluoridated compound" and "Fluoridated water operates on tooth surfaces: in the mouth it creates low levels of fluoride in saliva, which reduces the rate at which tooth enamel demineralizes and increases the rate at which it remineralizes in the early stages of cavities.") and the material is discussed in great detail in the body, which makes it clear that sodium flouride and hydrofluosilicic acid are not the only two compounds used for fluoridation.

The change also added this paragraph to the lead:

"See Opposition to water fluoridation."

That sort of "See" is not appropriate in the lead; the Manual of Style says that it should be in a See also section, but if it's already referred to in the body (which it is, as a hatnote for the Ethics and politics section) then there's no need for it in a See also section.

For now I reverted the change, and suggest that further discussion about it be placed here. Eubulides (talk) 08:49, 8 November 2009 (UTC)