Water fluoridation and dental fluorosis – debunking some myths

Dental fluorosis is really the only “negative” side effect of community water fluoridation (CWF). It occurs in non-fluoridated as well as fluoridated areas but is often a little more common in the fluoridated areas.

However, there is a lot of rubbish about dental fluorosis spouted by anti-fluoride propagandists. It is worth putting dental fluorosis into its proper context and debunking some of the misinformation they promote.

Here are some facts.

1: Diagnosis of dental fluorosis involves grading teeth into 6 levels:

  1. No dental fluorosis
  2. Questionable
  3. Very mild
  4. Mild
  5. Moderate
  6. Severe.

Here are some photos of the different grades

2: The moderate/severe grades are rare in areas considered for CWF and fluoridation does not increase prevalence of those grades of dental fluorosis. However, those more severe forms are more common in areas where dental fluorosis is endemic like parts of China, India and north Africa.

Dental and skeletal fluorosis is a real problem in these endemic areas, but it is not a problem in the areas where CWF is used.

The figure below contrasts data for prevalence of dental fluorosis in NZ and the USA where CWF is common with data for an area of endemic fluorosis in China.


3: The first 4 grades (none – mild) are judged purely “cosmetic. In fact children and parents often judge the grades questionable – mild more highly than none. Research finds these milder forms of dental fluorosis often improve dental health related quality of life (Do and Spencer, 2007; Chankanka et al., 2010; Peres et al., 2009; Biazevic et al., 2008; Büchel et al., 2011; Michel-Crosato et al., 2005).

In contrast research shows that the moderate/severe grades of dental fluorosis have a negative impact on health-related quality of life(Chankanka et al., 2010; Do and Spencer, 2007; Chikte et al., 2001).

4: Anti-fluoride propagandists often lump all grades together – presenting dental fluorosis as always bad. It also enables them to produce high figures to inflate the apparent problem. That is deceptive.

5: Anti-fluoride propagandists often use data from countries like India and China where fluorosis is endemic in their arguments against CWF. The figure above shows this is also deceptive.

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