A Chinese study the anti-fluoridation crowd won’t be citing

Tooth brushing programme carried out in kindergartens in a Chinese rural area. Image credit: Supervised tooth brushing programme

Anti-fluoridation campaigners love to cite Dr Q. Y. Xiang to “prove” that community water fluoridation (CWF) can lower IQ. Trouble is – Xiang’s research on fluoride and IQ took place in an area of endemic fluorosis in China where drinking water fluoride levels were much higher than those used for CWF. That hasn’t stopped Paul Connett from making mileage out of Xiang’s data – even though the link between IQ and drinking water fluoride shown by Xiang’s data is very tenuous (see Connett fiddles the data on fluoride).

However, I suspect Connett and his activist organisation, The Fluoride Action Network (FAN), will be very quiet about the latest paper from this group. This is because the research they report supports the scientific consensus – in particular:

• Fluoride at the concentration used in CWF does reduce tooth decay;
• Fluoride at the concentration used in CWF does not cause the cosmetically undesirable forms of  dental fluorosis.

The paper is:

Xiang, J., Yan, L., Wang, YJ., Qin, Y., Wang, C. &  Xiang, QY. (2016). The effects of ten years of defluoridation on urinary fluoride, dental fluorosis, defect dental fluorosis, and dental caries, in Jiangsu province, PR China. Fluoride, 49(March), 23–35.

Yes, I know, it is published in Fluoride – which is hardly a credible scientific journal. And the lack of proper peer review sticks out like a sore thumb with mistakes in the text, poor data presentation and poor data statistical analysis.

Fluoride improves dental health

This is shown by data they collected in 2002 for two villages -Wamiao (a “severe endemic fluorosis village” with drinking water fluoride in the “range of 0.57 – 4.50 mg/L”) and Xinhuai (a “non-endemic fluorosis village” with drinking water fluoride in the “range 0.15 – 0.77 mg/L”). They combined the data for the 2 villages to produce the following graphic – from which they concluded that a “possible desirable range for the fluoride level for minimizing the prevalence of dental caries” . . .  [is] “approximately 1.5 – 2.5 m/L.” Considering this is just one study and has limitations the result is similar to the recommended fluoride level for CWF – 0.75 mg/L in the USA and 0.75 – 1.2 mg/L in New Zealand.

OK, this is a poor graphic and I cannot see why they should have divided the data into the nine subgroups instead of statistically analysing the whole dataset (an indication of poor peer review by the journal?). But you get the picture. Dental decay declines as fluoride concentration in the drinking water in increased from near zero to about 1 mg/L.

CWF does not cause dental fluorosis

After 2002 the water sources used in the two villages changed:

“As a defluoridation project, water from two deep wells has been used as a tap water source of drinking water in Wamiao village since the beginning of 2003. The surface water in Yaohe river has been used as a tap water source in Xinhuai village since 2009.”

The current dental fluorosis study occurred in 2013 when the fluoride concentrations in both villages were in the range 0.85 – 0.95 mg/L. This is similar to the levels used in CWF.

In 2013, the researchers found very low levels of total dental fluorosis in both villages (3.1% in Xinhuai and 8.8% in Wamiao – no significant difference). They also measured “defect dental fluorosis” – a Chinese classification which includes some “moderate” dental fluorosis and all “severe dental fluorosis as diagnosed by Dean’s criteria (see  Water fluoridation and dental fluorosis – debunking some myths and the image below).

The prevalence of “defect dental fluorosis” in 21013 was zero for both villages.

This contrast markedly with the situation in 2002 where the prevalence of total dental fluorosis was significantly higher in Wamiao village (89%) than in Xinhuai (4.5%). The prevalence of “defect dental fluorosis” was 39% in Wamiao but zero in Xinhuai (data from Xiang, et al., 2004).

The 2013 data reported in this paper confirm what I have said again  and again in  articles here. CWF does not cause the cosmetically undesirable forms of dental fluorosis – the “moderate” and “severe” forms, or the “defect dental fluorosis” in the Chinese classification). Anti-fluoride campaigners always misrepresent this data by quoting figures for total dental fluorosis and claiming the effects are those only seen with “moderate” and “severe” forms.

Paper’s take home message

The new water supply in these two villages has solved the dental fluorosis problem while also maintaining a fluoride concentration comparable to that used in CWF and helping support a low level of dental decay in children. The data support other findings (and the current scientific consensus) showing that CWF does not cause any cosmetically undesirable dental fluorosis but does help prevent tooth decay.