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Water fluoridation is the practice of adding fluoride compounds to water with the intended purpose of reducing tooth decay in the general population. Many North American and Australian municipalities fluoridate their water supplies in the belief that this practice will reduce tooth decay at a low cost. Currently 66% of United States residents on public water supplies have fluoridated water.^[1] Image File history File links Gnome-globe. ... Fluoride is the ionic form of fluorine. ... Impact from a water drop causes an upward rebound jet surrounded by circular capillary waves. ... Types of teeth Molars are used for grinding up foods Carnassials are used for slicing food. ... North America North America is a continent[1] in the Earths northern hemisphere and (chiefly) western hemisphere. ...

Water purveyors typically add a fluoride in the form of sodium hexafluorosilicate or hexafluorosilicic acid,^[2][3] at a level between 0.7 and 1.2 ppm. These compounds originate as side products from the processing ("defluorination") of phosphate ores to prepare fertilizers, food additives, etc.^[4][5] Fluorides such as sodium fluoride (NaF), sodium monofluorophosphate ("SMFP" or "MFP", Na₂FPO₃), tin(II) fluoride ("Stannous fluoride", SnF₂), and amine fluorides are common ingredients in toothpaste. Parts per million (ppm) is a measure of concentration that is used where low levels of concentration are significant. ... Sodium fluoride is an ionic compound with the formula NaF. This colourless solid is the main source of the fluoride ion in diverse applications. ... For sodium in the diet, see Edible salt. ... Distinguished from fluorene and fluorone. ... Sodium monofluorophosphate Sodium monofluorophosphate (also disodium monofluorophosphate or MFP) is a chemical with the formula Na2PO3F. Its molecular weight is 143. ... Stannous fluoride is the chemical compound with the formula SnF2. ... This article is about the metallic chemical element. ... Modern toothpaste gel Toothpaste is a paste or gel dentifrice used to clean and improve the aesthetic appearance and health of teeth. ...

History

While the use of fluorides for prevention of dental caries was discussed in the 19th century in Europe,^[6] community water fluoridation in the United States owes its origin in part to the research of Dr. Frederick McKay, who pressed the dental community for an investigation into what was then known as "Colorado brown stain."^[7] In 1909, of the 2,945 children seen by Dr. McKay, 87.5% had some degree of stain or mottling. All the affected children were from the Pikes Peak region. Despite having a negative impact on the physical appearance of their teeth, the children with stained or mottled teeth also had fewer cavities than other children. McKay brought the problem to the attention of Dr. G.V. Black, and Black's interest into the Colorado stain led to greater interest throughout the dental profession. This article is about the mountain in Colorado. ... Photograph of G.V. Black (left) studying the Colorado Brown Stain. Greene Vardiman Black (1836 - 1915), commonly known as G.V. Black, is known as one of the founders of modern dentistry in the USA. He was born near Winchester, Illinois on August 3, 1836 to William and Mary Black. ...

Initial hypotheses for the staining included poor nutrition, overconsumption of pork or milk, radium exposure, childhood diseases, or a calcium deficiency in the local drinking water.^[7] In 1931, researchers finally concluded that the cause of the Colorado stain was a high concentration of fluoride ions in the region's drinking water (Fluoride levels ranging 2-13.7 ppm) and areas with lower concentrations had no staining (1 ppm or less).^[8] Pikes Peak's rock formations contained the mineral cryolite, one of whose constituents is fluorine. As the rain and snow fell, the resulting runoff water dissolved fluoride which made its way into the water supply. The Nutrition Facts table indicates the amounts of nutrients which experts recommend you limit or consume in adequate amounts. ... For other uses, see Pork (disambiguation). ... A glass of cows milk. ... General Name, Symbol, Number radium, Ra, 88 Chemical series alkaline earth metals Group, Period, Block 2, 7, s Appearance silvery white metallic Standard atomic weight (226) g·mol−1 Electron configuration [Rn] 7s2 Electrons per shell 2, 8, 18, 32, 18, 8, 2 Physical properties Phase solid Density (near r. ... The term childhood disease is sometimes subjective, and does not refer to an accepted, categorical list. ... For other uses, see Calcium (disambiguation). ... For other uses, see Mineral (disambiguation). ... It has been suggested that this article or section be merged with sodium hexafluoroaluminate. ...

Photograph of Dr. G.V. Black (left) and Drs. Isaac Burton and F. Y. Wilson, 1909, studying the "Colorado Brown Stain" (picture taken by McKay, printed in Douglas W.A.:"History of dentistry in Colorado, 1859-1959").

Dental research then moved toward determining a safe level for fluoride in water supplies. The research had two goals: (1) to warn communities with a high concentration of fluoride of the danger, initiating a reduction of the fluoride levels in order to prevent the Colorado stain, currently known as dental fluorosis, and (2) to encourage communities with a low concentration of fluoride in drinking water to increase the fluoride levels in order to help prevent tooth decay. Image File history File linksMetadata Download high resolution version (1806x2526, 1141 KB) Summary File from the Center for Disease Control and Preventions Public Health Image Library (PHIL). ... Image File history File linksMetadata Download high resolution version (1806x2526, 1141 KB) Summary File from the Center for Disease Control and Preventions Public Health Image Library (PHIL). ... Picture of a mild case of fluorosis. ...

The classic epidemiological study to attempt to determine the optimal level of fluoride in water was led by Dr. H. Trendley Dean, a dental officer of the U.S. Public Health Service, in 1934.^[9][10] His research on the fluoride - dental caries relationship, published in 1942, included 7,000 children from 21 cities in Colorado, Illinois, Indiana, and Ohio. The study concluded that the optimal level of fluoride which minimized the risk of severe fluorosis but had positive benefits for tooth decay was 1 part per million (ppm). In 1939, Dr. Gerald J. Cox^[11] conducted laboratory tests on fluoride and suggested adding fluoride to drinking water (or other media such as milk or bottled water) in order to improve oral health.^[12] In 1937, dentists Henry Klein and Carroll E. Palmer had considered the possibility of fluoridation to prevent cavities after their evaluation of data gathered by a Public Health Service team at dental examinations of American Indian children.^[13] In a series of papers published afterwards (1937-1941), yet disregarded by his colleagues within the U.S.P.H.S., Klein summarized his findings on tooth development in children and related problems in epidemiological investigations on caries prevalence. The United States Public Health Service (PHS) was founded first by President John Adams as a loose network of hospitals to support the health of American seamen. ... Official language(s) English Capital Denver Largest city Denver Largest metro area Denver-Aurora Metro Area Area  Ranked 8th  - Total 104,185 sq mi (269,837 km²)  - Width 280 miles (451 km)  - Length 380 miles (612 km)  - % water 0. ... Official language(s) English[1] Capital Springfield Largest city Chicago Largest metro area Chicago Metropolitan Area Area  Ranked 25th  - Total 57,918 sq mi (140,998 km²)  - Width 210 miles (340 km)  - Length 390 miles (629 km)  - % water 4. ... For other uses, see Indiana (disambiguation). ... Official language(s) English de facto Capital Columbus Largest city Columbus Largest metro area Greater Cleveland Area  Ranked 34th  - Total 44,825 sq mi (116,096 km²)  - Width 220 miles (355 km)  - Length 220 miles (355 km)  - % water 8. ...

In the mid 1940s, four widely-cited studies were conducted. The researchers investigated cities that had both fluoridated and unfluoridated water. The first pair was Muskegon, Michigan and Grand Rapids, Michigan, making Grand Rapids the first community in the world to modify its fluoride levels in drinking water to benefit dental health on January 25, 1945.^[14] Kingston, New York was paired with Newburgh, New York.^[15] Oak Park, Illinois was paired with Evanston, Illinois. Sarnia, Ontario was paired with Brantford, Ontario, Canada.^[16] The research found a decrease in the incidence of tooth decay in cities which had added fluoride to water supplies. This article does not cite any references or sources. ... Grand Rapids redirects here. ... is the 25th day of the year in the Gregorian calendar. ... Year 1945 (MCMXLV) was a common year starting on Monday (link will display the full calendar). ... Kingston is a city in Ulster County, New York, United States. ... Coordinates: , Country United States of America State New York County Orange Settled 1709 Incorporated (village) 1800 Incorporated (City) 1865 Government  - Type Council-manager  - City Manager Jean McGrane  - Mayor Nick Valentine Area  - City  4. ... Downtown (Oak Park Avenue) Ernest Hemingway Museum Oak Park, Illinois Lake Theater and shops along Lake Street. ... Incorporated City in 1872. ... Sarnia is a city in Southwestern Ontario, Canada (city population 71,419, census area population 88,793, in 2006). ... Nickname: Coordinates: , Country Province Established May 31, 1877 Government  - City Mayor Mike Hancock  - Governing Body Brantford City Council  - MP Lloyd St. ...

Controversy

Main article: Water fluoridation controversy

Water fluoridation by public authorities has provoked controversy. Advocates of water fluoridation say that fluoridation is similar to fortifying salt with iodine, milk with vitamin D and grape juice with vitamin C and say it is an effective way to prevent tooth decay. Those opposed to public fluoridation of drinking water contend that water fluoridation can have harmful health effects such as dental fluorosis and bone cancer. Some opponents claim that fluoridation takes away individual choice as to the substances a person ingests and that it amounts to mass medication. Water fluoridation controversy refers to the debate about the safety of the addition of fluoride to public water supplies. ... Iodized table salt (left) and non-iodized table salt (right) The Morton Salt company began iodizing salt for Americans in the fall of 1924. ... A glass of cows milk. ... Vitamin D is a fat soluble vitamin that contributes to the maintenance of normal levels of calcium and phosphorus in the bloodstream. ... Concord grapes being cooked down into grape juice for use in making jelly. ... This article is about the nutrient. ... This article is about dental caries in humans. ... Picture of a mild case of fluorosis. ... A sarcoma is a cancer of the bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. ...

Bottled water and fluoridation

Currently, there is some concern among dental professionals that the growing use of bottled water may decrease the amount of fluoride exposure people will receive.^[17] Some bottlers such as Dannon have begun adding fluoride to their water. ^[18] Most bottlers, however, do not add fluoride, and fluoride concentrations are not usually labeled on the bottle. As a result, people who have fluoridated water supplies may receive less than the amounts of fluoride that fluoride proponents recommend if they choose bottled water over tap water. However, if consumers are merely choosing bottled water over other packaged drinks, such as orange juice or soda (when the latter is produced using water which has not been fluoridated), the effects may be absent, especially because consumers will still turn to tap water for cooking (i.e. preparing pasta or making bread). For other uses, see Orange juice (disambiguation). ... Look up soda in Wiktionary, the free dictionary. ...

Malfunctions in water fluoridation equipment

Water fluoridation equipment has, on occasion, malfunctioned in the United States. Perhaps the worst incident in the United States occurred in Hooper Bay, Alaska in 1992. When fluoridation equipment failed, a large amount of fluoride was released into the drinking water supply and 296 people were poisoned; 1 person died,^[19] marking the first reported death due to fluoride toxicity caused by drinking water from a community water system.^[20] Hooper Bay or Naparyaarmiut is a city located in Wade Hampton Census Area, Alaska. ...

International status

United States

As of May 2000, 42 of the 50 largest U.S. cities have water fluoridation.^[21] According to a 2002 study,^[22] 67% of Americans are living in communities with fluoridated water. As of 2001, 19 states have at least 75% of their population receiving fluoridated water.^[23] There is a CDC database for researching the water fluoridation status of neighborhood water.^[24]

In 1998, 70% of people polled in a survey conducted by the American Dental Association believed community water should be fluoridated, with 18% disagreeing and the rest undecided.^[25] The American Dental Association (ADA) is an American advocacy group that promotes Oral Health Care and the field of dentistry. ...

The issue of whether or not to fluoridate water supplies occasionally arises in local governments. For example, on November 8, 2005, citizens of Mt. Pleasant, Michigan voted 63% to 37% in favor of reinstating fluoridation in public drinking water after a 2004 ballot initiative ceased water fluoridation in the city.^[26] At the same time, voters in Xenia, Ohio; Springfield, Ohio; Bellingham, Washington; and Tooele City, Utah all rejected water fluoridation.^[27] Mount Pleasant is a city located in Isabella County, Michigan. ...

The cost of fluoridating water supplies in the United States has been researched.^[28] In cities with a population of over 50,000 people, fluoridation costs 31 cents per person per year. The cost rises to $2.12 per person in cities with a population below 10,000.

Canada

Approximately 40% of the Canadian population receives fluoridated water^[29]

Implementation of fluoridation usually lies with provincial or city governments. Brantford, Ontario became the first city in Canada to fluoridate its water supplies in 1945. In 1955, Toronto approved water fluoridation, but delayed implementation of the program until 1963 due to a campaign against fluoridation by broadcaster Gordon Sinclair.^[30] The city continues to fluoridate its water today.^[31] There have been some recent decreases in the amount of fluoridation used, however, from 1 mg per litre to between 0.6 and 0.8 mg per litre. Historically, British Columbia has been the province with least percentage of its population receiving fluoridated water.^[32] Montreal may be the last major city in Canada which does not fluoridate its water supplies. Gordon Allan Sinclair, OC , FRGS (June 3, 1900 – May 17, 1984) was a Canadian radio journalist and commentator. ...

Europe

In the United Kingdom 10% of the population receives fluoridated water - including two major cities: Birmingham and Newcastle upon Tyne.^[33] This article is about the British city. ... This article is about a city in the United Kingdom. ...

Some provinces of Spain allow drinking water fluoridation, but the extent of that practice is only 10% population coverage.^[34]

France does not fluoridate its water supply. As "[f]luoride chemicals are not included in the list [of 'chemicals for drinking water treatment']. This is due to ethical as well as medical considerations.", Directeur de la Protection de l'Environment, August 25, 2000).^[35] However, fluoridated salt is widely available.^[36]

In Switzerland since 1962 two fluoridation programmes had operated in tandem: water fluoridation in the City of Basel, and salt fluoridation in the rest of Switzerland (around 83% of domestic salt sold had fluoride added). However it became increasingly difficult to keep the two programmes separate. As a result some of the population of Basel were assumed to use both fluoridated salt and fluoridated water. In order to correct that situation, in April 2003 the State Parliament agreed to cease water fluoridation and officially expand salt fluoridation to Basel.^[37]

Oceania

Australia has fluoridation in all but one state, Queensland, in which water fluoridation is under local government control. The City of Geelong, west of Melbourne, does not fluoridate its water supplies. This is despite the fact that all of Melbourne's water is fluoridated. Many regional centres in Queensland do fluoridate their water supply, however Brisbane, the state capital, currently does not add fluoride to its drinking water. The first town to fluoridate the water supply in Australia was Beaconsfield, Tasmania in 1953.^[38] Slogan or Nickname: Sunshine State, Smart State Motto(s): Audax at Fidelis (Bold but Faithful) Other Australian states and territories Capital Brisbane Government Constitutional monarchy Governor Quentin Bryce Premier Anna Bligh (ALP) Federal representation  - House seats 28  - Senate seats 12 Gross State Product (2004-05)  - Product ($m)  $158,506 (3rd... For other uses, see Brisbane (disambiguation). ... Location of Beaconsfield Beaconsfield is a town near the Tamar River, in the north-east of Tasmania, Australia. ... See also: 1952 in Australia, other events of 1953, 1954 in Australia and the Timeline of Australian history. ...

New Zealand has fluoridated nearly all water-supplies except those in remote areas. The use of water fluoridation first began in New Zealand in Hastings in 1954. A Commission of Inquiry was held in 1957 and then its use rapidly expanded in the mid 1960s. ^[39] See also: 1953 in New Zealand, other events of 1954, 1955 in New Zealand, and the Timeline of New Zealand history. ...

Other

The government of South Africa supports the fluoridation of water supplies.^[40]

In Brazil, about 45% of the cities have a fluoridated water supply. Government studies reported a decrease in cavities on the affected population between 40% and 80%.^[41]

In Chile 70.5% of the population receive fluoridated water (10.1 million adjusted, 604,000 naturally occurring).^[42]

Israel adopted fluoridation beginning in 1981. By 2002, more than 2 million people (roughly one-third of the population) were receiving fluoridated water.

In China, fluorine levels higher than 1 ppm are banned for fears of skeletal fluorosis. Skeletal fluorosis is a bone disease exclusively caused by excessive consumption of fluoride. ...

See also

• Fluoride therapy
• Fluorine deficiency

Fluoride therapy is the delivery of fluoride to the teeth topically or systemically, which is designed to prevent tooth decay (dental caries) which results in cavities. ... Fluoride or fluorine deficiency is a medical condition in which a human, or other organism lacks the necessary compounds containing fluorine to keep bones and teeth healthy. ...

References

External links

• [1] York Review Executive Summary, Water Fluoridation
• CDC database for the fluoridation status of neighborhood water
• Letter on fluoridation from EPA (PDF) supporting fluoridation hosted by ADA
• Fluoride Action Network Interview of Nobel Laureate (2000, Medicine/Physiology) Arvid Carlsson
• History of Water Fluoridation
• 1970s discussion on fluoridation
• World Health Organization report on fluorine and fluorides (1984)
• Articles focusing on the potential risks and benefits of water fluoridation
• "Environmental Health Criteria for Fluorides," World Health Organization (2002)
• Fluoride Information - UK National Fluoride Information Centre - Joint venture between The University of Manchester and the UK Department Of Health. Content includes coverage of the York review (see above)
• Article on use of fluoridated drinking water in baby formula
• A Bibliography of Scientific Literature on Fluoride