Fluoride is a common natural element found in water, soil, rocks and food. For the past several decades, fluoride has also been a cornerstone of dentistry and public health owing to its ability to protect against tooth decay.
Water fluoridation is a population-based program where a precise, small amount of fluoride is added to public drinking water systems. Water fluoridation began in Australia in the 1950s. Today more than 90% of Australia’s population has access to fluoridated tap water.
A recently published review found higher fluoride exposure is linked to lower intelligence quotient (IQ) in children. So how can we interpret the results?
Much of the data analysed in this review is poor quality. Overall, the findings don’t give us reason to be concerned about the fluoride levels in our water supplies.
Tooth decay (also known as caries or cavities) can have negative effects on dental health, overall health and quality of life. Fluoride strengthens our teeth, making them more resistant to decay. There is scientific consensus water fluoridation is a safe, effective and equitable way to improve oral health.
Nonetheless, water fluoridation has historically been somewhat controversial. A potential link between fluoride and IQ (and cognitive function more broadly) has been a contentious topic for more than a decade.
This study was a systematic review and meta-analysis, where the researchers evaluated 74 studies from different parts of the world.
A total of 52 studies were rated as having a high risk of bias, and 64 were cross-sectional studies, which often can’t provide evidence of causal relationship.
While this review combined many studies, there are several limitations that cast serious doubt over its conclusion. Scientists immediately raised concerns about the quality of the review, including in a linked editorial published in JAMA.
The low quality of the majority of included studies is a major concern, rendering the quality of the review equally low. Importantly, most studies were not relevant to the recommended levels of fluoride in water fluoridation programs.
Although no Australian studies were included in the review, Australia has its own studies investigating a potential link between fluoride exposure in early childhood and child development.
I’ve been involved in population-based longitudinal studies investigating a link between fluoride and child behavioural development and executive functioning and between fluoride and IQ. The IQ data in the second study were collected by qualified, trained psychologists – and calibrated against a senior psychologist – to ensure quality and consistency. Both studies have provided strong evidence fluoride exposure in Australia does not negatively impact child development.
This new review is not a reason to be concerned about fluoride levels in Australia and other developed countries with water fluoridation programs. Fluoride remains important in maintaining the public’s dental health, particularly that of more vulnerable groups.
In conclusion, while the recent review found an association between fluoride exposure and lower IQ, the quality of the review is poor, and the findings are not generalizable to the recommended levels of fluoride in water fluoridation programs. There is no cause for alarm, and fluoride remains an important tool in maintaining public dental health.
Q: What is the recommended level of fluoride in water fluoridation programs?
A: The recommended levels of fluoride in public water supplies range from 0.6 to 1.1 mg/L.
Q: Are there any Australian studies that have investigated the link between fluoride exposure and child development?
A: Yes, there are several Australian studies that have investigated this link, including population-based longitudinal studies that have found no negative impact of fluoride exposure on child development.
Q: What are the limitations of the recent review?
A: The review combined many studies, but the quality of the majority of included studies is poor, and the findings are not generalizable to the recommended levels of fluoride in water fluoridation programs.
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