Abstract
BackgroundThe addition of the chemical fluorine to the water supply, called water fluoridation, reduces dental caries by making teeth more resistant to demineralisation and more likely to remineralise when initially decayed. This process has been implemented in more than 30 countries around the world, is cost-effective and has been shown to be efficacious in preventing decay across a person's lifespan. However, attempts to expand this major public health achievement in line with Australia's National Oral Health Plan 2004–2013 are almost universally met with considerable resistance from opponents of water fluoridation, who engage in coordinated campaigns to portray water fluoridation as ineffective and highly dangerous.DiscussionWater fluoridation opponents employ multiple techniques to try and undermine the scientifically established effectiveness of water fluoridation. The materials they use are often based on Internet resources or published books that present a highly misleading picture of water fluoridation. These materials are used to sway public and political opinion to the detriment of public health. Despite an extensive body of literature, both studies and results within studies are often selectively reported, giving a biased portrayal of water fluoridation effectiveness. Positive findings are downplayed or trivialised and the population implications of these findings misinterpreted. Ecological comparisons are sometimes used to support spurious conclusions. Opponents of water fluoridation frequently repeat that water fluoridation is associated with adverse health effects and studies are selectively picked from the extensive literature to convey only claimed adverse findings related to water fluoridation. Techniques such as "the big lie" and innuendo are used to associate water fluoridation with health and environmental disasters, without factual support. Half-truths are presented, fallacious statements reiterated, and attempts are made to bamboozle the public with a large list of claims and quotes often with little scientific basis. Ultimately, attempts are made to discredit and slander scientists and various health organisations that support water fluoridation.SummaryWater fluoridation is an important public health initiative that has been found to be safe and effective. Nonetheless, the implementation of water fluoridation is still regularly interrupted by a relatively small group of individuals who use misinformation and rhetoric to induce doubts in the minds of the public and government officials. It is important that public health officials are aware of these tactics so that they can better counter their negative effect.
Highlights
The addition of the chemical fluorine to the water supply, called water fluoridation, reduces dental caries by making teeth more resistant to demineralisation and more likely to remineralise when initially decayed
In response to the objective of extending water fluoridation announced in the National Oral Health Plan, there has been renewed advocacy at the State and Territory level for fluoride to be added to public waters to improve oral health
The decay experience of children in a specific fluoridated area is compared unfavourably to that of children in a specific non-fluoridated area [59,77]. Despite such ecological comparisons providing a poor level of evidence due to their inability to take into account other variations between the areas which are related to dental health this type of 'evidence' has been frequently used to shore up the arguments of water fluoridation opponents [72]
Summary
In response to the objective of extending water fluoridation announced in the National Oral Health Plan, there has been renewed advocacy at the State and Territory level for fluoride to be added to public waters to improve oral health. Despite such ecological comparisons providing a poor level of evidence due to their inability to take into account other variations between the areas which are related to dental health (such as differences in diet, socio-economic status, exposure to discretionary fluorides, and oral health behaviours) this type of 'evidence' has been frequently used to shore up the arguments of water fluoridation opponents [72] Selected associations such as these provide no evidence of causality, many people may be inclined to accept ecological comparisons as a valid test of the effectiveness of water fluoridation and opponents of water fluoridation continue to use this approach to mislead the public and government officials. Bamboozling with science Anti-fluoridation literature attempts to overwhelm readers with claims about scientific research, with figures and http://www.anzhealthpolicy.com/content/4/1/25 statistics, and with scientific terms and buzzwords Unpacking such a dense presentation of facts, quotes and figures is beyond most people, who have neither the time nor capacity to access most of the publications required to check on the plethora of claims. No evidence is or can be offered for any of these claims
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