… Given the certainty with which water fluoridation has been promoted and opposed, and the large number (around 3200) of research papers identified,9 the reviewers were surprised by the poor quality of the evidence and the uncertainty surrounding the beneficial and adverse effects of fluoridation.
… Water fluoridation aims to reduce social inequalities in dental health,10 but few relevant studies exist. The quality of research was even lower than that assessing overall effects of fluoridation. The results were inconsistent—fluoridation seemed to reduce social inequalities in children aged 5 and 12 when measured by the number of decayed, missing, or filled teeth, but not when the proportion of 5 year olds with no caries was used.
… evidence on the potential benefits and harms of adding fluoride to water is relatively poor.
… There is no such thing as absolute certainty on safety … In the case of fluoridation, people should be aware of the limitations of evidence about its potential harms and that it would be almost impossible to detect small but important risks (especially for chronic conditions) after introducing fluoridation.
… Public and professional bodies need to balance benefits and risks, individual rights, and social values in an even handed manner. Those opposing fluoridation often claim that it does not reduce caries and they also overstate the evidence on harm.21 On the other hand, the Department of Health’s objectivity is questionable—it funded the British Fluoridation Society, and along with many other supporters of fluoridation it used the York review’s findings9 selectively to give an overoptimistic assessment of the evidence in favour of fluoridation.22 In response to MRC recommendations,13 the department commissioned research on the bioavailability of fluoride from naturally and artificially fluoridated drinking water. The study had only 20 participants and was too small to give reliable results. Despite this and the caveats in the report’s conclusion,23 this report formed the basis of a series of claims by government for the safety of fluoridation.24
Against this backdrop of one sided handling of the evidence, the public distrust in the information it receives is understandable…