An answer to the anti-fluoride critics – in one image

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Click image to enlarge. 

The chemical website Compound Interest, is producing a series of infograms to communicate some chemistry.  Here is an excellent one they produced on fluoride. I think it would make a great poster.

It is accompanied by some straightforward text describing the science behind fluoridation and countering a lot of the misinformation anti-fluoride propagandists promote.

Worth reading. See Fluoride & Water Fluoridation – An Undeserved Reputation?

The chemically minded may also be interested is some of their other infograms –  here are just a few examples:

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Some answers to the confusion about the #MH17 crash site

Given my comments yesterday (see Making political capital out of the deaths of innocents) I thought it worth sharing this video. It is of a press conference in Donetsk given by  Alexander Borodai, one of the leaders of the anti-Kiev forces in eastern Ukraine. Its about 30 minutes long, including the extensive Q&A. Video quality is not the best but there are English captions.

Personally I think it helps address some of the avalanche of  misinformation we are getting at the moment. And it is far more respectful to the innocent victims.

Alexander Borodai 19 Jul press conference about Malaysian #MH17 crash – YouTube.

Important Note: To activate subtitles, click on the (cc) button in the dashboard at the bottom of the video, then, in the Captions menu, select English or French.

Thanks to Sonya Roussina

Informed parents know water fluoridation is good for their children

Paul Connett is at it again. His latest project is aimed at manipulating the natural concern parents have for their children. He is using crude fear-mongering in the hope of getting parents to come out against community water fluoridation (CWF) – a social health policy known to be both effective and safe (see Calling All Parents).

zeditorial-parent-child

Image credit: Golisano Children’s Hospital

Sensible parents need to keep well away from this nonsense. If you have read his “statement” I offer instead the advice below as a counter to Connett’s rubbish. It is important for parents to learn the truth about this safe and effective social health policy so they can work together to counter attacks on it from ideologically motivated political activists like Connett.


1) Natural is not necessarily safe and “Nature” did not have “intentions for us.” Yes, mothers’ milk is low in fluoride, but it can also be deficient in other beneficial or essential trace elements. A brief scan of the scientific literature shows breast-fed children are prone to several microelement deficiencies. For example, Kodama (2004) and Domellöf, et al (2004) report deficient levels of zinc, selenium and iron in breast milk. Supplementation of breast-fed infants with micronutrients, including fluoride, is sometimes recommended.

2) Mild or very mild dental fluorosis is the only know negative effect of community water fluoridation. It is usually just cosmetic and often only noticed by a dental professional. Severe dental fluorosis is very uncommon in NZ, USA and most of Europe, but is usually caused by high fluoride intake from natural sources (eg in China or India), industrial pollution, consumption of fluoridated toothpaste, etc. Opponents of CWF often quote data for the common occurrence of mild dental fluorosis – but then describe it (or illustrate with photos) as if it were severe. See Dental fluorosis: badly misrepresented by FANNZ for an example of this misrepresentation.

3) CWF will not harm your child’s brain. Connett’s scare-mongering claims of CWF reducing the IQ of children are based on a selection of brief reports from areas of high natural fluoride in drinking water (Chio et al 2012). These are not relevant to CWF (Choi and Grandjean 2012). The reports are of poor scientific quality – mostly ignoring confounding factors like lead intake, breast-feeding and education which are known to influence IQ (National Fluoride Information Service 2013; Broadbent et al 2014). These reports also use data from naturally high fluoride areas in China and Iran where skeletal fluorosis and severe dental fluorosis are a problem.  More detailed studies at the lower concentrations used in CWF have not found any connections between CWF and IQ levels (Whitford et al 2009; Broadbent et al 2014).

4) There is ample evidence fluoridation is beneficial to your child’s teeth. This is not surprising because fluoride is a natural and normal constituent of the bioapatites your teeth and bones are formed from. At optimum concentrations it strengthens them and helps prevent their corrosion by acidic foods, etc. Be wary of anti-fluoridation propagandists claims of studies showing no beneficial effects of CWF. These usually refer to situations where children receive other forms of fluoride such as fluoride oral rinses, fluoridated salt or milk, or topical fluoride varnish dental applications. Some propagandist also attempt to claim that the general improvement of oral health in developed countries in recent years without CWF “proves” it is ineffective. This improvement arises from improved diet and personal dental hygiene as well as improved care by dentists. These positive effects are usually in addition to the benefits of CWF and this becomes obvious when communities with and without CWF are compared in the same country.

5) Fluoride in water and food, as well as that in toothpaste, is beneficial . Development of permanent and baby teeth occurs in the first 4 years of life. Incorporation of optimum amounts of fluoride into the tooth enamel at this stage, even before teeth erupt, helps reduce tooth decay throughout life. Even after tooth eruption the existing teeth benefit from the fluoride which transfers to saliva from food and water. This helps to maintain a concentration of fluoride in saliva which reduces the demineralisation of the tooth surface by acid derived from acid food and drink and from bacterial action on carbohydrates. It also helps the remineralisation of the tooth enamel as the acid concentration in saliva reduces with time. The beneficial role of fluoride with existing teeth is mainly due to this surface, or topical, effect. However, fluoride concentrations in saliva decrease rapidly with time so CWF is important because regular consumption helps to maintain concentrations. Consequently CWF supplements brushing teeth with fluoridated toothpaste which, by itself, cannot maintain concentrations through the day.

The beneficial effects of CWF results from both ingestion (particularly during tooth development in young children) and maintenance of an effective concentration of fluoride in saliva protecting existing teeth against decay throughout life.

CWF is a proven safe and effective social health policy. It works for everyone because it doesn’t need individuals to remember to use mouth-rinses, take supplements or make applications to their teeth. Once in place we can forget about it and it still works.

For these reasons parents should support community water fluoridation. They should also be very wary of ideologically driven activists who use scare-mongering and misinformation to raise fears. Parents naturally have their child’s best interests at heart. Unscrupulous activists can take advantage of that. But informed parents can protect themselves from emotive propaganda.

Informed parents will reject Paul Connett’s latest fear-mongering campaign.

References

Broadbent, J. M., Thomson, W. M., Ramrakha, S., Moffitt, T. E., Zeng, J., Foster Page, L. A., & Poulton, R. (2014). Community Water Fluoridation and Intelligence: Prospective Study in New Zealand. American Journal of Public Health.

Choi AL, Grandjean LC (2012). Harvard Press Release: Statement on fluoride paper.

Choi, A. L., Sun, G., Zhang, Y., & Grandjean, P. (2012). Developmental fluoride neurotoxicity: A systematic review and meta-analysis. Environmental Health Perspectives, 120(10), 1362–1368. Retrieved from

Domellöf, M., Lönnerdal, B., Dewey, K. G., Cohen, R. J., & Hernell, O. (2004). Iron, zinc, and copper concentrations in breast milk are independent of maternal mineral status. The American Journal of Clinical Nutrition, 79(1), 111–5. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14684406

Kodama, H. (2004). Trace Element Deficiency in Infants and Children — Clinical practice —. Journal of the Japan Medical Association, 47(8), 376–381.

National Fluoride Information Service. (2013). NFIS Advisory A review of recent literature on potential effects of CWF programmes on neurological development and IQ attainment.

Whitford, G. M., Whitford, J. L., & Hobbs, S. H. (2009). Appetitive-based learning in rats: lack of effect of chronic exposure to fluoride. Neurotoxicology and Teratology, 31(4), 210–5.

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Making political capital out of the deaths of innocents

Abby Martin’s Statement on Downed Malaysian Plane & State Sponsored Militias 

I have been absolutely disgusted with the contradictory information coming out about the crash of the Malaysian airline in Eastern Ukraine. And with the way politicians have used it to advance their specific agendas.

Seems to me that making political capital out of such a tragic event is an offense to the almost 300 innocent victims.

Abby Martin is one of the few spokespersons in the media who also seems to feel this way.

Elected officials must ignore activists and listen to own voters

Seel

Karen Williams Seel, a member of the county board of commissioners in Pinellas County, Fla.

A recent US blog article made some very pertinent points about the role of elected officials, such a local body councillors, on important social health issues like fluoridation.  These officials have a responsibilty to avoid pressure from misinfomred activists and must instead  listen to their constituents.

Karen Williams Seel, who wrote the article Fluoridation: Elected officials have a critical duty is a member of the county board of commissioners in Pinellas County, Fla., USA. Three years ago, the board voted 4-3 to stop fluoridating its water supply but reversed that decision in 2012 after voters defeated two incumbent commissioners who had voted against fluoridation. In both instances, Seel voted in favor of fluoridation.

She wrote:

“As Americans increasingly seek health information online, elected officials and other policymakers need to recognize that anti-fluoride activists have created a web-based panoply of false fears. For many fluoride critics, these online messages are the source of their concerns. This spring, for instance, a New York resident wrote a letter to his local newspaper, saying he “was surfing the Web and came across information on water fluoridation and the dangers that lie within this practice.”

And

“Public officials have a responsibility to listen to their constituents. We also have a duty to not allow false fear to drive public health decisions. We should direct our constituents to reputable websites like these sites. We shouldn’t let “guess what I read on the internet” be the reason that we abandon a proven, safe practice like water fluoridation.”

Rotorua District Councillors should take Seel’s points on board as they confront their own decisions about Rotorua’s fluoridation and how to consult citizens on it (see Council votes for referendum on fluoridation).

They should also beware of the”Tribunal” trap the Hamilton City Council fell into which effectively led to them being captured by politically and ideologically motivated anti-fluoridation activists, ignoring the information from scientific and health professionals, and ignoring the views of voters. A mistake which eventually led to pressure for another referendum and a reversal of the council’s faulty decision.

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The irony of some peer-review and citation complaints

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Anti-fluoridation propagandists and other promoters of pseudoscience have a sort of “love-hate” attitude towards science and the scientific literature.

On the one hand they love to cite scientific papers they claim support their message. Very often the citation is completely unwarranted, misrepresents the paper or even distorts the findings reported. Declan Waugh stands out as a repeat offender of such misrepresentation and distortion of the literature on the fluoride issue.

But, on the other hand they sort of recognise that they cannot rely on support from the scientific literature so will often denigrate the scientific process. Sort of having a bob each way.

A sordid affair

“Penelope Paisley” at Fluoride Free Hamilton NZ  is indulging in the latter by posting a link to a news report about exposure of a “peer review  and citation ring” at the Journal of Vibration and Control (JVC). This was reported at Retraction Watch in its article SAGE Publications busts “peer review and citation ring,” 60 papers retracted.

Besides retraction of the 60 papers this exposure led to the editor in chief of the journal resigning and a  professor in Taiwan who was responsible for the ring resigning from his employment.

A sordid affair which unfortunately does happen from time to time in the scientific community. We are, after all, human.

But it is ironic for local anti-fluoride propagandists to “point the finger” at this case. Periodically they promote “their own” peer-reviewed paper from a journal with a somewhat similar scandal. I wrote about this in Peer review, shonky journals and misrepresenting fluoride science.

The hypocrisy of the complaint

The paper is Peckham & Awofeso (2014), Water Fluoridation: A Critical Review of the Physiological Effects of Ingested Fluoride as a Public Health Intervention, The Scientific World Journal Volume 2014 (2014). It has been heavily promoted in the anti-fluoride social media –  “natural” health web sites, blogs, Facebook pages and Twitter.

However, The Scientific World Journal was described as a” bottom feeding” journal because of its approach to peer review and citation.  It relies on author fees, and not subscriptions, and is therefore open to the charge that it provides an easy way for unscrupulous authors to buy space for their articles. It was banned from lists of impact ratings because it allowed the unethical practice of self-citation.

So there is one irony in anti-fluoride propagandists’ exposure of  a shoddy incident in science publishing – they happy to use it to attack the scientific publishing process in general while on the other hand giving support to a similar shoddy case because it supports their word-view.

But there is another irony. “Penelope” is the on-line name used by Lynn Jordan – the  Fluoride Free NZ Committee member for Wellington. She also practices as a  cranio-sacral therapist in Wellington. Cranial-sacral therapy is an alternative or “natural” therapy which Edzard Ernst  described as more or less bogus (see Up the garden path: craniosacral therapy). I imagine that “Penelope” consults very few peer-reviewed scientific journals as part of her job. More likely she relies on “natural” health and pseudoscientific publications and on-line sites.

The irony here is that the “natural” health and pseudoscience publication industry will never have a scandal involving peer review and citation. Peer review and responsible citation is completely outside the ethos that guides them.

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Ken Ring pontificates on climate change

Another of Ken Ring’s “self help” books – Pawmistry: How to Read Your Cat’s Paws

Ken Ring runs a business predicting the weather. Apparently in that sort of business, and with the clients he has, conflict with evidence-based science and scientists is good for business. So,  it isn’t not surprising to find him trolling the internet debating issues from weather and climate change to earthquakes.

But his contribution to a recent debate on the NZ Skeptics Facebook page is a shocker. Here is his simple experiment proving that carbon dioxide does not influence climate and anthropogenic climate change is a fraud:

  • Ken Ring “Christopher, no, CO2 does not affect temperature at all. A bottle of Coke won’t warm a room, but a warmer room will increase the pressure of CO2 in the bottle. 

And just to dig the hole even deeper he adds:

  • Ken Ring “Ok William, just shake the bottle of Coke in a cold room and then open it. See if it warms the room. Then shake one in a warm room and open it. Note the difference. James, there is hardly any CO2 in the atmosphere. Roughly 99% of all the CO2 in the world is in the ocean or in the ground. Tiny fact you may have overlooked.”
Not the sort of thing that should inspire confidence of his scientific skills amongst prospective customers. But then again, with some people this sort of thing goes down well.

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Anti-science US Congressman on House science Committee!

This guy is spouting a  bunch of simple-minded anti-scientific rubbish. Not surprising in itself – he is actually opening a climate change denial conference in th US – one of the semi-annual get-togethers of climate change denialists organised by the Heartland Institute.

No – the surprise is that this guy, Congressman Dana Rohrabacher (R-CA), is a member of the House Science Committee, which oversees US federal policy on science and innovation.  The House Science Committee!

Bloody hell! How does that happen. Here is someone whose standard of scientific understanding is no higher than some of the anti-science blog commenters we get here – and they are on the US House Science Committee.

Thanks to: US Congressman Opens Climate Change Denial Conference with Rant Against Water Fluoridation.

“Creative” reporting of fluoridation science

duane

I am all for genuine creativity in science, and elsewhere. But some people seem to think anything goes when the are promoting their ideology or political views.

Again and again I come across campaigners , especially in areas like “natural” health, climate change denial and promotion of creationism, who seem to think “creative embellishment – or outright distortion – is OK when claim that science is “on their side.”

Here’s a typical example from Fluoride Free NZ (FFNZ) who are attempting to deny the science indicating that fluorosilicates used for fluoridation of water supplies decompose to form the fluoride anion. They are desperate to assert that fluorosilicate species remain and these “might” be toxic.

FFNZ cites the National Toxicology Program (NTP), part of the US Department of Health and Human Services. But puts words into their mouths to create exactly the opposite conclusion to tat which should be taken from that web site.

According to FFNZ:

the NTP “says the assumption that fluoridation chemicals disassociate into free fluoride ions is not supported by experimental evidence. This is good to remember when the fluoridationists claim that fluoride, is fluoride is fluoride. They are operating on belief rather than scientific fact.”

But the NTP says nothing of the sort. The page simply lists a 1999 nomination, from a “private individual”, for research to consider possible toxicity. Yes, the “private individual” gives as grounds “lack of toxicity information; assumed complete dissociation to free fluoride under normal conditions of use not supported by experimental evidence.” But that is the view of the nominator – not of NTP.

In fact, the NTP has a statement making clear that selection of an agent for study does not imply support for the nominators views:

” Selection of an agent for a study does not imply that the agent is hazardous or a potential carcinogen in laboratory animals; likewise, an agent not selected for toxicologic study by the Program should not be taken to mean that the agent is not potentially hazardous or potentially carcinogenic in laboratory rodents.”

Interestingly the cited web page includes “The following information related to “fluorosilicates  “including history from earlier or later nominations for this same agent.” Specifically  Nomination Background a pdf document “Review of Toxicological Literature.” It is a comprehensive review, but on page 4 it says:

“In water, fluorosilicic acid readily hydrolyzes to hydrofluoric acid and various forms of amorphous and hydrated silica. At the concentration usually used for water fluoridation, 99% hydrolysis occurs and the pH drops to 4.2. As pH increases, hydrolysis increases. At the pH of drinking water, the degree of hydrolysis is “essentially 100%” (Crosby, 1969; Urbansky and Schock, 2000).

H2SiF6(aq) + 4 H2O    →    6 HF(aq) + Si(OH)4(aq)”

Exactly the opposite of what FFNZ assert!

Now who is ” operating on belief rather than scientific fact.”

A clear example of extreme confirmation bias amounting to complete distortion.

For more information on the science of the decomposition of fluorosilicates in water have a read of Declan Waugh’s misinformation on fluorosilicic acid and An open letter to Declan Waugh – new mechanism for fluoride toxicity?

Credit: Thanks to Duane for the image.

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What happens when fluoridation is stopped?

Tooth fluoride protection icon isolated

When fluoride becomes incorporated in teeth, it makes the enamel more resistant to demineralization, preventing the decay process. Illustration: TuftsNow.

Anti-fluoride propagandists continually assert that fluoride is not effective in reducing tooth decay. One piece of “evidence” they rely on for this is a claim that when fluoridation is stopped dental health does not decline, But is this claim true? Does the scientific literature really show tooth decay doesn’t rise when fluoridation is stopped?

Connett misrepresents the science again

Well, here is what Paul Connett – the self-described world expert on fluoridation – claimed in our exchange (see Fluoride debate: Response to Paul’s 6th article. December 9, 2013):

“modern studies have not found tooth decay when fluoridation has been stopped in various communities.”

In chapter 5 of his book The Case Against Fluoride he provided more detail:

“there is no evidence that where fluoridation has been started and stopped in Europe there has been a rise in tooth decay. Indeed, two studies published in 2000, from Finland and the former East Germany, show that tooth decay continued to decline after fluoridation was halted.11,12 There have been similar reports from Cuba13 and Canada’s British Columbia.14

Pretty definite claim isn’t it? “No evidence” of the expected increase in tooth decay after fluoridation is stopped. And he cites scientific reports to “prove” his claim. But what do those four scientific reports actually say? Let’s look at each one in order and, unlike Connett, I will quote from the papers.

11. L. Seppä, S. Kärkkäinen, and H. Hausen,Caries Trends 1992–1998 in Two Low-Fluoride Finnish Towns Formerly with and without Fluoridation.” Caries Research 34, no. 6 (2000): 462–68. I can’t find the full text, or even an abstract, for this paper but the authors commented on this research in Seppa et al (2002). They found their “longitudinal approach did not reveal a lower caries occurrence in the fluoridated than in the low-fluoride reference community.” But commented:

“The main reason for the modest effect of water fluoridation in Finnish circumstances is probably the widespread use of other measures for caries prevention. The children have been exposed to such intense efforts to increase tooth resistance that the effect of water fluoridation does not show up any more. The results must not be extrapolated to countries with less intensive preventive dental care.”

12. W. Künzel, T. Fischer, R. Lorenz, and S. Brühmann,Decline of caries prevalence after the cessation of water fluoridation in the former East Germany Community Dentistry and Oral Epidemiology 28, no. 5 (2000): 382–89. These authors found no increase of caries in two German cities after fluoridation of water was stopped. But again the authors suggest why:

“The causes for the changed caries trend were seen on the one hand in improvements in attitudes towards oral health behaviour and, on the other hand, to the broader availability and application of preventive measures (F-salt, F-toothpastes, fissure sealants etc.).”

13. W. Künzel and T. Fischer,Caries Prevalence after Cessation of Water Fluoridation in La Salud, Cuba.  Caries Research 34, no. 1 (2000): 20–25. Again this study found no increase in caries after stopping fluoridation but the authors suggested why:

“A possible explanation for this unexpected finding and for the good oral health status of the children in La Salud is the effect of the school mouthrinsing programme, which has involved fortnightly mouthrinses with 0.2% NaF solutions (i.e. 15 times/year) since 1990.”

14. G. Maupomé, D. C. Clark, S. M. Levy, and J. Berkowitz,Patterns of dental caries following the cessation of water fluoridation.” Community Dentistry and Oral Epidemiology 29, no. 1 (2001): 37–47. The authors reported “Caries incidence . . .  was not different between the still-fluoridating and fluoridation-ended communities.” However, they considered other factors and limitations in their own study and concluded this issue was complex:

“Our results suggest a complicated pattern of disease following cessation of fluoridation. Multiple sources of fluoride besides water fluoridation have made it more difficult to detect changes in the epidemiological profile of a population with generally low caries experience, and living in an affluent setting with widely accessible dental services. There are, however, subtle differences in caries and caries treatment experience between children living in fluoridated and fluoridation-ended areas.”

So when we actually read these cherry-picked reports we find that, while no increases in tooth decay were found after fluoridation stopped, in all 4 cases this was attributed to the existence of other sources of fluoride and fluoride dental treatments. This is a similar situation to that I reported about one of Colquhoun’s papers in my recent article Fluoridation: what about reports it is ineffective? In that case all children from non-fluoridated areas had been given six-monthly dental fluoride treatments whereas most children from fluoridated areas had not. So the lack of an effect due to fluoridation is hardly surprising.

Read scientific literature critically and intelligently

This underlines the need to always read the scientific literature critically and intelligently, doing our best to avoid confirmation bias and cherry-picking. Perhaps that was Connett’s mistake – he was just selecting reports supporting his bias without being aware of these details. However, in his book he says:

“The ADA claims that in cases where fluoridation has been halted and no increase in tooth decay observed, other steps have been taken to fight tooth decay.”

So these details had been brought to his attention. But it did not stop him misrepresenting the scientific reports he cited. Nor has it stopped him continuing this misrepresentation, even today. All he has done is to attempt a diversion when these details arise:

“Whether or not that is the explanation, European countries have clearly demonstrated that there are other ways of reducing tooth decay without forcing everyone to take a medicine in their drinking water.”

He had the same response in our exchange when I pointed to the role of other fluoride treatments in these studies. Connett attempts to avoid the issue of his misrepresentation of the published science to support his claim that fluoride does not help prevent tooth decay – by acknowledging fluoride can be beneficial but pretending the argument was about the mode of delivery when it wasn’t!

Connett’s reference to ADA is actually to their booklet Fluoridation Facts. It appears the he has read page 15 – What happens if water fluoridation is discontinued. He has taken the 4 citations he uses from that page. But tellingly he ignores completely another 5 citations reporting deterioration of oral health when fluoridation was stopped. He cannot have missed those citations – in this case his cherry-picking amounts to dishonesty.

Studies do show increase in tooth decay when fluoridation stopped

The ADA booklet referred to above answers its question about the consequences of discontinuing fluoridation this way:

“Over time, dental decay can be expected to increase if water fluoridation in a community is discontinued, even if topical products such as fluoride toothpaste and fluoride rinses are widely used.”

In Fluoride debate: Ken Perrott’s closing response to Paul Connett? I discussed one of the ADA cited papers which did show an increase in tooth decay –  Attwood and Blinkhorn (1991),“Dental health in schoolchildren 5 years after water fluoridation ceased in South-west Scotland.”  They measured dmft and DMFT – decayed, missing and filled teeth in primary and permanent teeth respectively.

The figures below illustrate the data from this paper which compared changes in oral health of two Scottish towns  in both 1980 and 1988. One town, Annan, had never had fluoridated water while the other, Stranraer, had it until 1983. This enabled the effects of both cessation of fluoridation and the generally observed improvement in oral health due to other factors to be compared and considered. The graphics show the results for 5 year old and 10 year old children.

Decayed missing and filled deciduous teeth for 5 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.

Decayed missing and filled teeth for 10 year olds. Stranraer fluoridated until 1983. Annan not fluoridated.

The plots indicate aspects of the complexity of these sort of studies. Because 2 different towns were compared it was possible to measure the decline in oral health after discontinuation of fluoridation against a background of the general improvement in oral health, even in a non-fluoridated situation.

The moral here is don’t accept at face value the claims made by anti-fluoridation propagandists – even if they, or their supporters, insist the propagandist is “the world expert on fluoridation.”

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