Water fluoridation
Water fluoridation is the controlled adjustment of fluoride to a public water supply solely to reduce tooth decay. Fluoridated water contains fluoride at a level that is effective for preventing cavities; this can occur naturally or by adding fluoride.[2] 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.[3] Typically a fluoridated compound is added to drinking water, a process that in the U.S. costs an average of about $1.32 per person-year.[2][4] Defluoridation is needed when the naturally occurring fluoride level exceeds recommended limits.[5] In 2011, the World Health Organization suggested a level of fluoride from 0.5 to 1.5 mg/L (milligrams per litre), depending on climate, local environment, and other sources of fluoride.[6] Bottled water typically has unknown fluoride levels.[7]
Tooth decay remains a major
Although fluoridation can cause dental fluorosis, which can alter the appearance of developing teeth or enamel fluorosis,[3] the differences are mild and usually not an aesthetic or public health concern.[12] There is no clear evidence of other side effects from water fluoridation.[13] Fluoride's effects depend on the total daily intake of fluoride from all sources. Drinking water is typically the largest source;[14] other methods of fluoride therapy include fluoridation of toothpaste, salt, and milk.[15] The views on the most efficient method for community prevention of tooth decay are mixed. The Australian government states that water fluoridation is the most effective way to achieve fluoride exposure that is community-wide.[12] The World Health Organization reports that water fluoridation, when feasible and culturally acceptable, has substantial advantages, especially for subgroups at high risk,[8] while the European Commission finds that while water fluoridation likely reduces caries, there is no evidence that it is more effective than topical application.[16]
Public water fluoridation was first practiced in the U.S.
Goal
The goal of water fluoridation is to prevent tooth decay by adjusting the concentration of fluoride in public water supplies.
The goal of water fluoridation is to prevent a
Health and dental organizations worldwide have endorsed its safety and effectiveness.[3] Its use began in 1945, following studies of children in a region where higher levels of fluoride occur naturally in the water.[33] Further research showed that moderate fluoridation prevents tooth decay.[34]
Implementation
Fluoridation does not affect the appearance, taste, or smell of drinking water.[1] It is normally accomplished by adding one of three compounds to the water: sodium fluoride, fluorosilicic acid, or sodium fluorosilicate.
- reference standard.[35] It is a white, odorless powder or crystal; the crystalline form is preferred if manual handling is used, as it minimizes dust.[36] It is more expensive than the other compounds, but is easily handled and is usually used by smaller utility companies.[37] It is toxic in gram quantities by ingestion or inhalation.[38]
- Fluorosilicic acid (H2SiF6) is the most commonly used additive for water fluoridation in the United States.[39] It is an inexpensive liquid by-product of phosphate fertilizer manufacture.[35] It comes in varying strengths, typically 23–25%; because it contains so much water, shipping can be expensive.[36] It is also known as hexafluorosilicic, hexafluosilicic, hydrofluosilicic, and silicofluoric acid.[35]
- Sodium fluorosilicate (Na2SiF6) is the sodium salt of fluorosilicic acid. It is a powder or very fine crystal that is easier to ship than fluorosilicic acid. It is also known as sodium silicofluoride.[36]
These compounds were chosen for their solubility, safety, availability, and low cost.[35] A 1992 census found that, for U.S. public water supply systems reporting the type of compound used, 63% of the population received water fluoridated with fluorosilicic acid, 28% with sodium fluorosilicate, and 9% with sodium fluoride.[40]
Recommendations
The Centers for Disease Control and Prevention developed recommendations for water fluoridation that specify requirements for personnel, reporting, training, inspection, monitoring, surveillance, and actions in case of overfeed, along with technical requirements for each major compound used.[41]
Although fluoride was once considered an
In 2011, the U.S. Department of Health and Human Services (HHS) and the U.S. Environmental Protection Agency (EPA) lowered the recommended level of fluoride to 0.7 mg/L.
Previous recommendations were based on evaluations from 1962, when the U.S. specified the optimal level of fluoride to range from 0.7 to 1.2 mg/L, depending on the average maximum daily air temperature; the optimal level is lower in warmer climates, where people drink more water, and is higher in cooler climates.[46]
These standards are not appropriate for all parts of the world, where fluoride levels might be excessive and fluoride should be removed from water, and is based on assumptions that have become obsolete with the rise of
Occurrences
Fluoride naturally occurring in water can be above, at, or below recommended levels. Rivers and lakes generally contain fluoride levels less than 0.5 mg/L, but groundwater, particularly in volcanic or mountainous areas, can contain as much as 50 mg/L.
Evidence
Existing evidence suggests that water fluoridation reduces tooth decay. Consistent evidence also suggests that it causes dental fluorosis, most of which is mild and not usually of aesthetic concern.[9][12] No clear evidence of other adverse effects exists, though almost all research thereof has been of poor quality.[13]
Effectiveness
Reviews have shown that water fluoridation reduces cavities in children.[9][16][49] A conclusion for the efficacy in adults is less clear with some reviews finding benefit and others not.[9][49] Studies in the U.S. in the 1950s and 1960s showed that water fluoridation reduced childhood cavities by fifty to sixty percent, while studies in 1989 and 1990 showed lower reductions (40% and 18% respectively), likely due to increasing use of fluoride from other sources, notably toothpaste, and also the 'halo effect' of food and drink that is made in fluoridated areas and consumed in unfluoridated ones.[2]
A 2000 UK
Fluoride may also prevent cavities in adults of all ages. A 2007 meta-analysis by CDC researchers found that water fluoridation prevented an estimated 27% of cavities in adults, about the same fraction as prevented by exposure to any delivery method of fluoride (29% average).[52] A 2011 European Commission review found that the benefits of water fluoridation for adult in terms of reductions in decay are limited.[16] A 2015 Cochrane review found no conclusive research regarding the effectiveness of water fluoridation in adults.[9] A 2016 review found variable quality evidence that, overall, stopping of community water fluoridation programs was typically followed by an increase in cavities.[53]
Most countries in Europe have experienced substantial declines in cavities without the use of water fluoridation due to the introduction of fluoridated toothpaste and the large use of other fluoride-containing products, including mouthrinse, dietary supplements, and professionally applied or prescribed gel, foam, or varnish.[3] For example, in Finland and Germany, tooth decay rates remained stable or continued to decline after water fluoridation stopped in communities with widespread fluoride exposure from other sources. Fluoridation is however still clearly necessary in the U.S. because unlike most European countries, the U.S. does not have school-based dental care, many children do not visit a dentist regularly, and for many U.S. children water fluoridation is the primary source of exposure to fluoride.[31] The effectiveness of water fluoridation can vary according to circumstances such as whether preventive dental care is free to all children.[54]
Fluorosis
Fluoride's adverse effects depend on total fluoride dosage from all sources. At the commonly recommended dosage, the only clear adverse effect is dental fluorosis, which can alter the appearance of children's teeth during tooth development; this is mostly mild and is unlikely to represent any real effect on aesthetic appearance or on public health.[12] In April 2015, recommended fluoride levels in the United States were changed to 0.7 ppm from 0.7–1.2 ppm to reduce the risk of dental fluorosis.[55] The 2015 Cochrane review estimated that for a fluoride level of 0.7 ppm the percentage of participants with fluorosis of aesthetic concern was approximately 12%.[9] This increases to 40% when considering fluorosis of any level not of aesthetic concern.[9] In the US mild or very mild dental fluorosis has been reported in 20% of the population, moderate fluorosis in 2% and severe fluorosis in less than 1%.[55]
The critical period of exposure is between ages one and four years, with the risk ending around age eight. Fluorosis can be prevented by monitoring all sources of fluoride, with fluoridated water directly or indirectly responsible for an estimated 40% of risk and other sources, notably toothpaste, responsible for the remaining 60%.[56] Compared to water naturally fluoridated at 0.4 mg/L, fluoridation to 1 mg/L is estimated to cause additional fluorosis in one of every 6 people (95% CI 4–21 people), and to cause additional fluorosis of aesthetic concern in one of every 22 people (95% CI 13.6–∞ people). Here, aesthetic concern is a term used in a standardized scale based on what adolescents would find unacceptable, as measured by a 1996 study of British 14-year-olds.[13] In many industrialized countries the prevalence of fluorosis is increasing even in unfluoridated communities, mostly because of fluoride from swallowed toothpaste.[57] A 2009 systematic review indicated that fluorosis is associated with consumption of infant formula or of water added to reconstitute the formula, that the evidence was distorted by publication bias, and that the evidence that the formula's fluoride caused the fluorosis was weak.[58] In the U.S. the decline in tooth decay was accompanied by increased fluorosis in both fluoridated and unfluoridated communities; accordingly, fluoride has been reduced in various ways worldwide in infant formulas, children's toothpaste, water, and fluoride-supplement schedules.[32]
Safety
Fluoridation has little effect on risk of bone fracture (broken bones); it may result in slightly lower fracture risk than either excessively high levels of fluoridation or no fluoridation.[12]
There is no clear association between water fluoridation and
Fluoride can occur naturally in water in concentrations well above recommended levels, which can have
In rare cases improper implementation of water fluoridation can result in overfluoridation that causes outbreaks of acute
Like other common water additives such as
The effect of water fluoridation on the natural environment has been investigated, and no adverse effects have been established. Issues studied have included fluoride concentrations in groundwater and downstream rivers; lawns, gardens, and plants; consumption of plants grown in fluoridated water; air emissions; and equipment noise.[75]
Mechanism
Fluoride exerts its major effect by interfering with the demineralization mechanism of tooth decay. Tooth decay is an
All fluoridation methods, including water fluoridation, create low levels of fluoride ions in saliva and plaque fluid, thus exerting a topical or surface effect. A person living in an area with fluoridated water may experience rises of fluoride concentration in saliva to about 0.04 mg/L several times during a day.
Fluoride's effects depend on the total daily intake of fluoride from all sources.
Alternatives
The views on the most effective method for community prevention of tooth decay are mixed. The Australian government review states that water fluoridation is the most effective means of achieving fluoride exposure that is community-wide.
Fluoride
The effectiveness of
Milk fluoridation is practiced by the Borrow Foundation in some parts of Bulgaria, Chile, Peru, Russia, Macedonia, Thailand and the UK. Depending on location, the fluoride is added to milk, to powdered milk, or to yogurt. For example, milk powder fluoridation is used in rural Chilean areas where water fluoridation is not technically feasible.[88] These programs are aimed at children, and have neither targeted nor been evaluated for adults.[15] A systematic review found low-quality evidence to support the practice, but also concluded that further studies were needed.[89]
Other public-health strategies to control tooth decay, such as education to change behavior and diet, have lacked impressive results.
A 2007 Australian review concluded that water fluoridation is the most effective and socially the most equitable way to expose entire communities to fluoride's cavity-prevention effects.[12] A 2002 U.S. review estimated that sealants decreased cavities by about 60% overall, compared to about 18–50% for fluoride.[93] A 2007 Italian review suggested that water fluoridation may not be needed, particularly in the industrialized countries where cavities have become rare, and concluded that toothpaste and other topical fluoride are the best way to prevent cavities worldwide.[3] A 2004 World Health Organization review stated that water fluoridation, when it is culturally acceptable and technically feasible, has substantial advantages in preventing tooth decay, especially for subgroups at high risk.[8]
Worldwide prevalence
As of November 2012, a total of about 378 million people worldwide received artificially fluoridated water. The majority of those were in the United States. About 40 million worldwide received water that was naturally fluoridated to recommended levels.[18]
Much of the early work on establishing the connection between fluoride and dental health was performed by scientists in the U.S. during the early 20th century, and the U.S. was the first country to implement public water fluoridation on a wide scale.[17] It has been introduced to varying degrees in many countries and territories outside the U.S., including Argentina, Australia, Brazil, Canada, Chile, Colombia, Hong Kong, Ireland, Israel, Korea, Malaysia, New Zealand, the Philippines, Serbia, Singapore, Spain, the UK, and Vietnam. In 2004, an estimated 13.7 million people in western Europe and 194 million in the U.S. received artificially fluoridated water.[18] In 2010, about 66% of the U.S. population was receiving fluoridated water.[94]
Naturally fluoridated water is used by approximately 4% of the world's population, in countries including Argentina, France, Gabon, Libya, Mexico, Senegal, Sri Lanka, Tanzania, the U.S., and Zimbabwe. In some locations, notably parts of Africa, China, and India, natural fluoridation exceeds recommended levels.[18]
Communities have discontinued water fluoridation in some countries, including Finland, Germany, Japan, the Netherlands, and Switzerland.[95] Changes have been motivated by political opposition to water fluoridation, but sometimes the need for water fluoridation was met by alternative strategies. The use of fluoride in its various forms is the foundation of tooth decay prevention throughout Europe; several countries have introduced fluoridated salt, with varying success: in Switzerland and Germany, fluoridated salt represents 65% to 70% of the domestic market, while in France the market share reached 60% in 1993 but dwindled to 14% in 2009; Spain, in 1986 the second West European country to introduce fluoridation of table salt, reported a market share in 2006 of only 10%. In three other West European countries, Greece, Austria and the Netherlands, the legal framework for production and marketing of fluoridated edible salt exists. At least six Central European countries (Hungary, Czechia, Slovakia, Croatia, Slovenia, Romania) have shown some interest in salt fluoridation; however, significant usage of approximately 35% was only achieved in the Czech Republic. The Slovak Republic had the equipment to treat salt by 2005; in the other four countries attempts to introduce fluoridated salt were not successful.[96][97] When Israel implemented the 2014 Dental Health Promotion Program, that includes education, medical followup and the use of fluoride-containing products and supplements, it evaluated that mandatory water fluoridation was no longer necessary, stating "supply of fluoridated water forces those who do not so wish to also consume water with added fluoride. This approach is therefore not accepted in most countries in the world.".[98]
History
The history of water fluoridation can be divided into three periods. The first (c. 1801–1933) was research into the cause of a form of mottled tooth enamel called the Colorado brown stain. The second (c. 1933–1945) focused on the relationship between fluoride concentrations, fluorosis, and tooth decay, and established that moderate levels of fluoride prevent cavities. The third period, from 1945 on, focused on adding fluoride to community water supplies.[34]
In the first half of the 19th century, investigators established that fluoride occurs with varying concentrations in teeth, bone, and drinking water. In the second half they speculated that fluoride would protect against tooth decay, proposed supplementing the diet with fluoride, and observed mottled enamel (now called severe dental fluorosis) without knowing the cause.[100] In 1874, the German public health officer Carl Wilhelm Eugen Erhardt recommended potassium fluoride supplements to preserve teeth.[101][102] In 1892 the British physician James Crichton-Browne noted in an address that fluoride's absence from diets had resulted in teeth that were "peculiarly liable to decay", and who proposed "the reintroduction into our diet ... of fluorine in some suitable natural form ... to fortify the teeth of the next generation".[103]
The foundation of water fluoridation in the U.S. was the research of the dentist Frederick McKay (1874–1959). McKay spent thirty years investigating the cause of what was then known as the Colorado brown stain, which produced mottled but also cavity-free teeth; with the help of
In the 1930s and early 1940s,
Fluoridation became an official policy of the
McKay's work had established that fluorosis occurred before tooth eruption. Dean and his colleagues assumed that fluoride's protection against cavities was also pre-eruptive, and this incorrect assumption was accepted for years. By 2000, however, the topical effects of fluoride (in both water and toothpaste) were well understood, and it had become known that a constant low level of fluoride in the mouth works best to prevent cavities.[113]
Economics
Fluoridation costs an estimated $1.32 per person-year on the average (range: $0.31–$13.94; all costs in this paragraph are for the U.S.[2] and are in 2023 dollars, inflation-adjusted from earlier estimates[4]). Larger water systems have lower per capita cost, and the cost is also affected by the number of fluoride injection points in the water system, the type of feeder and monitoring equipment, the fluoride chemical and its transportation and storage, and water plant personnel expertise.[2] In affluent countries the cost of salt fluoridation is also negligible; developing countries may find it prohibitively expensive to import the fluoride additive.[114] By comparison, fluoride toothpaste costs an estimated $11–$22 per person-year, with the incremental cost being zero for people who already brush their teeth for other reasons; and dental cleaning and application of fluoride varnish or gel costs an estimated $121 per person-year. Assuming the worst case, with the lowest estimated effectiveness and highest estimated operating costs for small cities, fluoridation costs an estimated $20–$31 per saved tooth-decay surface, which is lower than the estimated $119 to restore the surface[2] and the estimated $201 average discounted lifetime cost of the decayed surface, which includes the cost to maintain the restored tooth surface.[28] It is not known how much is spent in industrial countries to treat dental fluorosis, which is mostly due to fluoride from swallowed toothpaste.[57]
Although a 1989 workshop on
U.S. data from 1974 to 1992 indicate that when water fluoridation is introduced into a community, there are significant decreases in the number of employees per dental firm and the number of dental firms. The data suggest that some dentists respond to the demand shock by moving to non-fluoridated areas and by retraining as specialists.[117]
Controversy
The water fluoridation controversy arises from political, moral, ethical, economic, and safety concerns regarding the water fluoridation of public water supplies.[95][118] For impoverished groups in both developing and developed countries, international and national agencies and dental associations across the world support the safety and effectiveness of water fluoridation.[3] Authorities' views on the most effective fluoride therapy for community prevention of tooth decay are mixed; some state water fluoridation is most effective, while others see no special advantage and prefer topical application strategies.[12][16]
Those opposed argue that water fluoridation has no or little
See also
References
- ^ PMID 9332806.
- ^ PMID 11521913. See also lay summaryfrom CDC, 2007-08-09.
- ^ S2CID 13189520.
- ^ a b 1634–1699: McCusker JJ (1997). How Much Is That in Real Money? A Historical Price Index for Use as a Deflator of Money Values in the Economy of the United States: Addenda et Corrigenda (PDF). American Antiquarian Society. 1700–1799: McCusker JJ (1992). How Much Is That in Real Money? A Historical Price Index for Use as a Deflator of Money Values in the Economy of the United States (PDF). American Antiquarian Society. 1800–present: Federal Reserve Bank of Minneapolis. "Consumer Price Index (estimate) 1800–". Retrieved 29 February 2024.
- ^ ISBN 978-1597450294.
- ^ ISBN 978-9241548151. p. 168, 175, 372 and see also pp 370–373. See also J. Fawell, et al Fluoride in Drinking-water. WHO, 2006. p. 32. Quote: "Concentrations in drinking-water of about 1 mg l–1 are associated with a lower incidence of dental caries, particularly in children, whereas excess intake of fluoride can result in dental fluorosis. In severe cases this can result in erosion of enamel. The margin between the beneficial effects of fluoride and the occurrence of dental fluorosis is small and public health programmes seek to retain a suitable balance between the two"
- ^ PMID 17485621.
- ^ PMID 15341615.
- ^ PMID 26092033.
- ^ a b c "Introduction to the SCHER opinion on Fluoridation". European Commission Scientific Committee on Health and Environmental Risks (SCHER). 2011. Retrieved 18 April 2016.
- ^ "Question: European countries have rejected fluoridation, so why should we fluoridate water?". www.wda.org. Wisconsin Dental Association. 8 March 2013. Archived from the original on 1 August 2019. Retrieved 6 February 2018.
- ^ PMID 18584000. See also lay summaryfrom NHMRC, 2007.
- ^ PMID 12047121.
- ^ ISBN 9241563192.
- ^ PMID 16211158. Archived from the originalon 14 March 2010.
- ^ a b c d e "What role does fluoride play in preventing tooth decay?". 2011. Retrieved 18 April 2016.
- ^ S2CID 31482952.
- ^ a b c d e f g
"The extent of water fluoridation". One in a Million: The facts about water fluoridation (3rd ed.). Manchester: British Fluoridation Society. 2012. pp. 55–80. ISBN 978-095476840-9. Archived from the original(PDF) on 22 November 2008. Retrieved 19 November 2008.
- ^ "Community Water Fluoridation … 2014 Water Fluoridation Statistics". www.cdc.gov. Retrieved 19 April 2016.
- ^ "Support for Water Fluoridation" (PDF). British Fluoridation Society. 2012. Archived from the original (PDF) on 6 March 2016. Retrieved 19 April 2016.
- PMID 10220250.
- ^ a b Tiemann M (5 April 2013). "Fluoride in Drinking Water: A Review of Fluoridation and Regulation Issues" (PDF). pp. 1–4. Retrieved 19 April 2016.
- PMID 17916854.
- ^ S2CID 204616785.
- .
- S2CID 30565431.
- PMID 16934120.
- ^ PMID 11474918.
- PMID 18630105.
- PMID 11014508.
- ^ ISBN 978-0195150698.
- ^ S2CID 30121985.
- ^ a b "The story of fluoridation". National Institute of Dental and Craniofacial Research. 20 December 2008. Retrieved 6 February 2010.
- ^ PMID 8474047. Archived from the original(PDF) on 4 March 2009.
- ^ a b c d Reeves TG (1986). "Water fluoridation: a manual for engineers and technicians" (PDF). Centers for Disease Control. Archived from the original (PDF) on 7 October 2008. Retrieved 10 December 2008.
- ^ ISBN 1583213112.
- ISBN 978-0444530868.
- ^ NaF MSDS. hazard.com
- ^ "Water Fluoridation Additives Fact Sheet". cdc.gov. Archived from the original on 21 February 2015. Retrieved 27 January 2015.
- ^ Fluoridation census 1992 (PDF) (Report). Division of Oral Health, National Center for Prevention Services, CDC. 1993. Retrieved 29 December 2008.
- PMID 7565542.
- S2CID 8491518.
- . Retrieved 19 April 2015.
- ^ U.S. Department of Health & Human Services (2011). "HHS and EPA announce new scientific assessments and actions on fluoride".
- ^ "FDA Issues a Letter for Manufacturers with Recommendations on Fluoride Added to Bottled Water". Food and Drug Administration. 27 April 2015. Retrieved 6 May 2015.
- ^ PMID 18614991.
- S2CID 85052718.
- ^ a b "CDC – Bottled Water and Fluoride – Fact Sheets – General – Community Water Fluoridation – Oral Health". www.cdc.gov. Retrieved 28 April 2016.
- ^ S2CID 5442458.
- PMID 18583997.
- S2CID 52267424.
- PMID 17891121.
- PMID 27177581.
- PMID 11021844.
- ^ a b "U.S. Public Health Service Recommendation for Fluoride Concentration in Drinking Water for the Prevention of Dental Caries" (PDF). CDC. Archived from the original (PDF) on 18 May 2015. Retrieved 9 May 2015.
- PMID 19179949.
- ^ PMID 11683551.
- PMID 19571048.
- ISBN 978-1864964158. Archived from the original(PDF) on 14 October 2009. Retrieved 13 October 2009.
- ^ "Water Fluoridation and Cancer Risk" Archived 29 November 2014 at the Wayback Machine, American Cancer Society, 6 June 2013.
- ^ "Cancer myth: Fluoride and cancer" Archived 14 September 2014 at the Wayback Machine, Cancer Council Western Australia.
- ^ "Basic Information about Fluoride in Drinking Water", United States Environmental Protection Agency.
- ^ "Community Water Fluoridation", Centers of disease control and prevention.
- ^ "Fluoride", Australian government national health and medical research council.
- ^ "Fluoridated Water", National Cancer Institute.
- PMID 24425828.
- PMID 2003628.
- PMID 21799046.
- PMID 7503344.
- PMID 27933467.
- ^ ISBN 9241563192.
- ISBN 9241563192.
- PMID 11579665.
- ^ "Asheboro notifies residents of over-fluoridation of water". Fox 8. 29 June 2010. Archived from the original on 4 July 2010.
- ^ S2CID 8577186.
- PMID 16393670.
- ^ PMID 18782377.
- ^ S2CID 34423908. Archived from the originalon 3 June 2009. Retrieved 13 September 2009.
- PMID 12097358. Archived from the originalon 1 June 2009. Retrieved 13 February 2009.
- S2CID 11339240.
- ISBN 978-0813824161.
- S2CID 40453568. Archived from the originalon 3 June 2009. Retrieved 13 September 2009.
- PMID 12586392.
- ISBN 0309063507.
- ^ PMID 15897335. Archived from the originalon 12 March 2011. Retrieved 8 March 2009.
- PMID 10884959.
- ^ PMID 18554382.
- ^ Bánóczy J, Rugg-Gunn AJ (2006). "Milk—a vehicle for fluorides: a review". Rev Clin Pesq Odontol. 2 (5–6): 415–426. Archived from the original (PDF) on 13 February 2009. Retrieved 3 January 2009.
- PMID 26334643.
- S2CID 31825557.
- PMID 18460675.
- PMID 20088215.
- ^ PMID 12091093.
- ^ "2010 Water Fluoridation Statistics". Centers for Disease Control and Prevention. Retrieved 30 July 2012.
- ^ PMID 17916854. Archived from the original(PDF) on 3 March 2016. Retrieved 9 April 2009.
- ^ Marthaler TM, Gillespie GM, Goetzfried F. "Salt fluoridation in Europe and in Latin America – with potential worldwide" (PDF). Kali und Steinsalz Heft 3/2011. Retrieved 9 August 2013.
- ^ "Salt fluoridation in Central and Eastern Europe". Schweiz Monatsschr Zahnmed, Vol 115: 8/2005. Retrieved 9 August 2013.[permanent dead link]
- ^ "End of Mandatory Fluoridation in Israel". Ministry of Health (Israel) (Press Release). 17 August 2014. Archived from the original on 17 November 2014. Retrieved 29 September 2014.
- OCLC 5015927.
- OCLC 14681626. Publication 225.
- ^ Eckardt [sic] (1874). "Kali fluoratum zur Erhaltung der Zähne". Der Praktische Arzt (in German). 15 (3): 69–70. A followup was translated into English in: Friedrich EG (1954). "Potassium fluoride as a caries preventive: a report published 80 years ago". J Am Dent Assoc. 49: 385.
- ^ Meiers P (2016). "Dr. Erhardts ("Hunter'sche") Fluoridpastillen" (PDF). Retrieved 13 June 2016.
- PMID 15117687.
- ^ Colorado brown stain:
- Peterson J (July 1997). "Solving the mystery of the Colorado Brown Stain". Journal of the History of Dentistry. 45 (2): 57–61. PMID 9468893.
- "The discovery of fluoride". Colorado Springs Dental Society. 2004. Archived from the original on 24 August 2012. Retrieved 11 June 2012.
- Peterson J (July 1997). "Solving the mystery of the Colorado Brown Stain". Journal of the History of Dentistry. 45 (2): 57–61.
- ^ S2CID 56981.
- PMID 10714718.
- ISBN 9780470463673.
- ^ PMID 17128347. Archived from the originalon 14 February 2009.
- PMID 14781280.
- ^ "Water fluoridation statistics for 2006". Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion, CDC. 17 September 2008. Retrieved 22 December 2008.
- PMID 19180863.
- PMID 15562942.
- ISBN 978-0195150698.
- PMID 16379137.
- S2CID 45728195.
- PMID 26776927.
- ^ Ho K, Neidell M (2009). "Equilibrium effects of public goods: the impact of community water fluoridation on dentists" (PDF). NBER Working Paper No. 15056. National Bureau of Economic Research. Archived from the original (PDF) on 23 October 2012. Retrieved 13 October 2009.
- PMID 18067684.
- PMID 25471729.
- ^ Hileman, Bette (4 November 2006) Fluoride Risks Are Still A Challenge Vol 84, Num 36 pp. 34–37, Chemical & Engineering News, Retrieved 14 April 2016
- ^ Sheldon Krimsky, Book review (16 August 2004) Is Fluoride Really All That Safe?, Volume 82, Number 33, pp. 35–36 Chemical & Engineering News, Retrieved 19 April 2016
- ^
- McNally M, Downie J (December 2000). "The ethics of water fluoridation". Journal. 66 (11): 592–593. PMID 11253350.
- Cohen H, Locker D (November 2001). "The science and ethics of water fluoridation". Journal. 67 (10): 578–580. PMID 11737979.
- McNally M, Downie J (December 2000). "The ethics of water fluoridation". Journal. 66 (11): 592–593.
External links
- Fluoridation at Curlie