and Effective? or Not?
From Volume 5 Issue 3 of Unless the Lord ... Magazine
Water fluoridation has been championed by the American Dental Association, the American Medical Association and U.S. public health officials for many years. Likewise, the World Health Association (WHO) has also strongly promoted fluoridation around the world. Water fluoridation is credited with being a critically important and economical public health measure. It is estimated that about 60% of the U.S. public drinking water systems are fluoridated.
Nevertheless, the merits of water fluoridation have been strongly debated since the practice began in the 1940s up through today. In many other countries, fluoridation has not been so warmly received.
Is water fluoridation truly beneficial and safe? And what about fluoride in toothpastes and from other sources? Following is a brief summary of the opposing positions on water fluoridation.
SAFE & EFFECTIVE (FOR)
NOT SAFE & EFFECTIVE (AGAINST)
1. There are many researchers who do not support fluoridation and do not believe it is either safe or effective in preventing cavities.
2. Early studies in support of fluoridation were seriously flawed. Many recent studies seriously question the effectiveness of fluoridation. If there is a real benefit, it appears to be fairly insignificant.
3. When fluoridation ceases, decay levels are often little changed or reduced, dental fluorosis is reduced, and health is improved (as supported by numerous studies).
4. Fluoride is a naturally occurring element, but a toxic one - more toxic than lead and almost as toxic as arsenic. The fluoride that occurs naturally in some water supplies is in the form of calcium fluoride. Water fluoridation uses silicofluorides (industrial by-products). These are more toxic than calcium fluoride and also contain small amounts of toxic metals and other impurities.
5. Water fluoridation results in an uncontrolled dosage of fluoride. Fluoride intake varies greatly with the amount of water consumed, use of fluoride toothpastes, supplements and dental treatments. Many fruit juices and other foods often contain high levels of fluoride. The nutritional status of the individual also impacts the amount of fluoride that can be safely consumed. Though fluoride consumption from other sources has risen, there has been no reduction in the recommended amount in water supplies.
6. There is a serious discrepancy regarding the EPA’s maximum contaminate level for fluoride vs. those for arsenic and lead, given the relative toxicities of these substances. Original recommendations of the Surgeon General’s panel were altered to allow a much higher level of fluoride.
7. Even at low
levels, fluoride tends to accumulate in the body over time. Numerous studies
point to potential harm, including
Throughout this article, I will often be presenting two opposing viewpoints. The "FOR" viewpoint is primarily taken from the American Dental Association’s writings, but also echoed in the writings of other key proponents. The "AGAINST" viewpoint is drawn from the writings of a number of opponents to fluoridation. See the list of references on page 28 for the source documents for this information.
Origins of Water Fluoridation
After opening a dental practice in Colorado Springs, Colorado in 1901, dental school graduate Frederick McKay was astonished to find that many residents teeth had ugly brown stains. With the help of a renowned dental researcher, Dr. G.V. Black, it was discovered that the staining resulted from developmental imperfections in children’s teeth. Residents whose permanent teeth were already calcified, were not at risk of developing the stains. It was also observed that the stained teeth appeared to be unusually resistant to decay.
Other locations around the U.S. were identified where there was a similar dental staining. At one of these locations, the chief chemist of ALCOA, H.V. Churchill, performed tests that discovered high levels of fluoride in the water. The some condition was found in the water of other locations where the staining was common.
Thereafter, the Public Health Service became interested and Dr. H. Tendley Dean, head of the Dental Hygiene Unit at the National Institute of Health began investigating fluorosis (the staining of teeth by fluoride). By 1936, he had determined that "fluoride levels of up to 1.0 ppm in drinking water did not cause mottled enamel; if the fluoride exceeded this level, however, fluorosis began to occur." Dean hypothesized that adding fluoride to the water of up to 1.0 ppm might help in the fight against tooth decay without danger of fluorosis or other health problems.
In 1944, after numerous discussions with public health agencies, the City Commission of Grand Rapids, Michigan, agreed to became the site of a test of Dean’s fluoride theory. Beginning in 1945, the city water supply was fluoridated and researchers monitored the rate of tooth decay among the city’s almost 30,000 school children. After just 11 years of the 15 year study, Dean announced that the caries rate among the Grand rapids school children had dropped by more than 60%.
What is Fluoride and Water Fluoridation?
"Fluoride is a naturally occurring element that prevents tooth decay systemically when ingested during tooth development and topically when applied to erupted teeth." "Fluoride compounds are constituents of minerals in rocks and soil. Water passes over rock formations and dissolves the fluoride compounds that are present, create fluoride ions. The result is that small amounts of soluble fluoride ions are present in all water sources, including the oceans. Fluoride is present to some extent in all foods and beverages but the concentrations vary widely."
"Water fluoridation is the adjustment of the natural fluoride concentration of fluoride-deficient water to the level recommended for optimal dental health."
There are only three basic compounds used to fluoridate community drinking water: sodium fluoride, sodium fluorosilicate, and fluorosilicic acid, all of which are derived from the mineral apatite. "Apatite is also the raw material used for production of phosphate fertilizers; however, standards and minimum requirements have been established for all three compounds used in water fluoridation." Compounds used must conform to standards established by the American Water Works Association, that require that there be no impurities in sufficient quantity to result in harmful effects to those consuming the water. 
"The plain fact that fluoride is an insidious poison, harmful, toxic and cumulative in its effects, even when ingested in minimal amount, will remain unchanged no matter how many times it will be repeated in print that fluoridation of water supply is ‘safe’." (Dr. Ludwig Gross, Cancer Research Scientist, in N.Y. Times 3/6/57.) 
"There is no such thing as "fluoride-deficient" water. In 1979, the Food and Drug Administration (FDA) ordered that all government documents remove all references to fluoride as an "essential nutrient" or even a "probable essential nutrient."
"Water fluoridation is the process of adding silicofluorides, or sodium fluoride, to our drinking water." "Only calcium fluoride occurs naturally in water, and it has never been used for fluoridation." "Silicofluorides never occur naturally in nature, and they are 85 times more toxic that natural occurring calcium fluoride." (see Industrial and Engineering Chemistry. July 1934, page 797). "Calcium is a well-known antidote for fluoride poisoning. When an antidote accompanies a poison, it makes the poison far less toxic to the body. Soft waters to which fluoride is artificially added lack this calcium which is present in most waters that contain natural fluoride."
"The chemicals used to fluoridate 90% of water fluoridated in the U.S. are not pharmaceutical grade. Instead, they come from the wet scrubbing systems of the superphosphate fertilizer industry. These chemicals are either hexafluorosilicic acid or its sodium salt. They are contaminated with toxic metals and trace amounts of radioactive isotopes. In other words, the public water supply is being used as a vehicle for hazardous waste management ." (Glasser, 1999, "It’s Pollution, Stupid", www.fluoridealert.org).
Dr. J. William Hirzy, EPA Sr. Scientist, testified before a senate subcommittee in 2000, speaking as a "representative of EPA headquarters professional employees, through their duly elected labor union." A part of his testimony confirmed that EPA management viewed the process of "recovering by-product fluosilicic acid from fertilizer manufacture" for use in water fluoridation was an ideal solution for minimizing water and air pollution while providing low cost fluoride to local water authorities. To quote Dr. Hirzy, "In other words, the solution to pollution is dilution, as long as the pollutant is dumped straight into drinking water systems and not into rivers or the atmosphere."
Effectiveness of Fluoride and Water Fluoridation in Preventing Cavities
"Overwhelming evidence already exists to prove the effectiveness of water fluoridation." "The effectiveness of water fluoridation has been documented in scientific literature for well over 50 years." 
"In 1993, the results of 113 studies in 23 countries were compiled and analyzed. … Taken together, the most frequently reported decay reductions observed were: 40-49% for primary teeth or baby teeth; 50-59% for permanent teeth or adult teeth."
McDonough and colleagues reviewed over 200 studies on the health effects of water fluoridation. Although these studies were generally of poor quality, the authors found a median 15% reduction in tooth decay – or a median 2.25 fewer decayed, missing, and filled primary/permanent teeth – amongst children living in fluoridated areas compared to non-fluoridated areas. ("Water Fluoridation: Benefits Should Be Considered Alongside Risks", Editorial: Fluoridation, fractures, and teeth, British Medical Journal, October 5, 2000 .)
"The original studies and many since then have proved that fluoridated water merely delays decay, it does not prevent it." 
"Today there is a great deal of scientific agreement that ingested fluoride does not reduce tooth decay. The largest study of tooth decay in America, by the U.S. National Institute of Dental Research in 1986-1987, showed that there was no significant difference in the decay rates of 39,207 fluoridated, partially fluoridated, and non-fluoridated children, ages 5 to 17, surveyed in the 84-city study. ("New Studies cast doubt on fluoridation benefits," by Bette Hileman, Chemical & Engineering News. Vol 67, No. 19, May 8,1989).
"There is less tooth decay in the nation as a whole, but decay rates have also dropped in the non-fluoridated areas of the United States, and in Europe - where fluoridation of water is rare. The observed world-wide decline in tooth decay over the past four decades has occurred at the same rate in areas that are not fluoridated as in areas that are. ("The Mystery of Declining Tooth Decay", Mark Diesendorf. Nature, July 10, 1986, pp. 125-129).
"‘Fluoride ions bind with calcium ions, strengthening tooth enamel as it forms in children.’ Many researchers now consider this more of an assumption than a fact, because of conflicting evidence from studies in India and several other countries over the past 10 to 15 years. Nevertheless, agreement is universal that excessive fluoride intake leads to loss of calcium from the tooth matrix, aggravating cavity formation throughout life rather than remedying it, and so causing dental fluorosis. Severe, Chronic and cumulative overexposure can cause the incurable crippling of skeletal fluorosis." (UNICEF’s Position on Water Fluoridation)
"A recent study showed that 83% of all caries in North American children are the "pit and fissure" type, which even the proponents admit, aren’t preventable by fluoride. They say they are prevented by sealants. " "Let me begin by saying that fluorides are most effective in preventing decay on the smooth surfaces of teeth. However, the chewing surfaces of posterior teeth are not smooth. They have crevices and pits and it is our experience that fluorides don’t really get access to these pitted areas." (Hearings: "Subcommittee of the Committee on Appropriations, House of Representatives." Mar 1984. Dr. Loe, Director of the National Institute of Dental Research.)
The Newburgh / Kingston Study
One of the key early tests of the effectiveness of fluoride was in the neighboring communities of Newburgh and Kingston, New York. The children in both cities were examined by dentists and physicians and then fluoride was added to Newburgh’s water supply.[2, et al]
FOR:"Ten years after fluoridation in Newburgh, New York, 6- to 9-year-olds had 58% less tooth decay than their counterparts in Kingston, New York, which was fluoride-deficient. After 15 years, 13- to 14-year-olds in Newburgh had 70% less decay than the children in Kingston." [2, 9]
An incorrect reading of the statistics in this study led to the false conclusion of large reductions in tooth decay. "They ignored the fact that fluoride interferes with proper growth of children’s permanent teeth, which causes teeth to erupt later than normal. Teeth that have not yet erupted cannot decay, therefore, at first (at age 6) the fluoridated Newburgh children had 100% less tooth decay, by age 7 also 100% less, age 8 – 67% less, age 9 – 50% less, and by age 10 – 40% less. Realizing their experiment was going down hill, the USPHS stopped their experiment early, totaled the five reductions shown, then divided by 5 to obtain what they called "an over-all reduction of 70%." Obviously, the only reduction that counted at that time was the 40% (age 10)." 
"Had the Heath Department continued their survey beyond age 10, they would have found that the percentage of reduction continued down hill to 30%, 20%, 0% and eventually these children had more cavities – not less. The rate of decay is identical, once the children’s teeth erupt. ("Fluoridation Benefits – Statistical Illusion." Testimony of Konstantin K. Paluev, Research and Development Engineer, Mar 6, 1957).
"John A. Forst, M.D., a New York public health official, found that after ten years of fluoridation in Newburgh, 63.2% of the school children had decayed teeth compared with fluoride-free Kingston, which had only 41.7% with tooth defects." (Statement from John A. Forst. M.D., from the University of the State of New York, Oct 26, 1954).
"Data by Dr. David B. Ast, who was in charge of the fluoridation experiment (Tables, page 319, Journal American Dental Association, 1961) shows delay in decay only until age 15. Then Newburgh passes non-fluoridated Kingston in decayed and filled teeth, after 16 years of fluoridation."
"A recent study by the New York State Department of Health, showed that after nearly 50 years of fluoridation, Newburgh’s children have a slightly higher number of cavities than never-fluoridated Kingston." ("New Studies cast doubt on fluoridation benefits," by Bette Hileman, Chemical & Engineering News. Vol 67, No. 19, May 8,1989).[3, 4]
FOR:In 1993-4, an oral health needs assessment of children in California found that children living in nonfluoridated areas had more tooth decay than those in fluoridated areas. Of most concern was the high decay rate affecting young children from low income families. Specifically, children in grades K-3, whose families were lifetime residents of nonfluoridated communities and whose income was below 200% of the Federal Poverty Level, had 39% more decay in their baby teeth when compared to counterparts who were lifetime residents of optimally fluoridated areas." 
The 1993-4 California Oral Health Needs Assessment was performed by the Dental Health Foundation (DHF) - a foundation created in 1985 for the sole purpose of promoting statewide fluoridation. "As a result, the findings were very biased. The first-ever independent review of the California Oral Health Needs Assessment of 1993-94 was delivered to the City of Escondido, California on February 1, 2000. The analysis of the Needs Assessment was performed by the international renowned Senes Oak Ridge Inc. Center for Risk Assessment in Tennessee. Escondido City Council Member Marie Waldron said the Needs Assessment report was "a classic example of the manipulation of science to prove a case. This study, in effect, compares non-poor children in fluoridated communities, with protective sealants on their teeth, against poor children in Head Start programs in non-fluoridated communities, with no sealants on their teeth." (Review of the California Oral Health Needs Assessment 1993-94" Jan 31, 2000). 
What Happens if Fluoridation is Discontinued?
"Dental decay can be expected to increase if water fluoridation in a community is discontinued for one year or more, even if topical products such as fluoride toothpaste and fluoride rinses are widely used." The ADA cites a number of studies (Antigo, Wisconsin; Wick, Scotland; Stranraer, Scotland; Coldwater, Michigan; Galesburg, Illinois) indicating that decay increased when fluoridation was ended.
The ADA gives examples in which they totally ignore the "delay in decay" that occurs due to fluoridation. (Antigo, by Harvey Petraborg, MD, July 14, 1965)
Many other studies are cited indicating a result of no increased decay and reduced fluorosis when fluoridation ceases (Durham, North Carolina; Spremberg & Zittau, Germany; Kuopio, Finland; La Salud, Cuba). "The analysis of data however, show a significant decrease in dental caries (caries decline) after the stop of water fluoridation in Japan, in the Netherlands, in Prague, in the German Democratic Republic, and in others. Never was an increase of dental caries found after a stop of water fluoridation." (Arbeitsgemeinschaft fur Alternative Gesyndheitspolitik, by Rudolph Ziegelbecker, Graz, Austria, June 1, 1998.) 
FOR:"The overwhelming weight of scientific evidence indicates that fluoridation of community water supplies is both safe and effective." "In August of 1993, the National Research Council, a branch of the National Academy of Sciences, released a report prepared for the Environmental Protection Agency (EPA) that confirmed that the currently allowed fluoride levels in drinking water do not pose a risk for health problems such as cancer, kidney failure or bone disease." "No charge against the benefits and safety of fluoridation has ever been substantiated by generally accepted scientific knowledge." 
Opponents of fluoridation cite numerous studies indicating possible harm from fluoride. These include: increased hip fractures, cancer (bone and thyroid cancer are particularly cited), lead poisoning (fluorosilicic acid leaching lead from plumbing), poisoning and inhibition of bodily enzymes, increased incidence of Downs Syndrome births, neurological impact (fluoride is the primary agent in many pharmaceuticals specifically intended to affect brain activity: Prozac, Phen-Fen, Rohypnol, and is the only toxic element in Sarin, the nerve gas, virtually every general anesthetic also contains fluoride), possibly contributing to Alzheimer’s (low doses found to cause brain damage similar to Alzheimer’s and to contribute to higher levels of aluminum in the brain), possible contributor to heart disease (statistics for Grand Rapids and Newburgh and other locations), possible kidney damage, related to thyroid dysfunction, etc. [3, 4, 6, 8, 10]
Concerns of the
EPA Professional Employees
Dr. J. William Hirzy, EPA Sr. Scientist, testified before a senate subcommittee in 2000, speaking as a representative of EPA headquarters professional employees, through their duly elected labor union. The members of this labor union include toxicologists, biologists, chemists, engineers, lawyers and others defined by law as "professionals", working for the Environmental Protection Agency (EPA).
According to Dr. Hirzy, the union first got involved in the issue of fluoridation as a matter of professional ethics in 1985. In 1997 they voted to oppose fluoridation and had become only more opposed by the time of this testimony in 2000.
Some of their concerns included: excessive and uncontrolled fluoride exposures; the "protected pollutant" status of fluoride within the EPA; the altered findings of a cancer study in 1990; the results and implications of recent brain effects research; the altered recommendations to EPA of a 1983 Surgeon General’s Panel on fluoride; the results of a fifty-year experiment on fluoridation in two New York communities; recent research linking fluoridation chemicals with elevated blood-lead levels in children; and changing views among dental researchers on the efficacy of water fluoridation.
Their concern about excessive exposure was related to a study showing that in the mid-1980s, 66% of American children in fluoridated communities were showing visible signs of over exposure and fluoride toxicity. The union does not agree that dental fluorosis is only a "cosmetic" effect. It occurs when children ingest more fluoride than their bodies can handle with the metabolic processes we are born with. Children’s bones and tissues, as well as their teeth, are accumulating too much fluoride.
Dr. Hirzy also noted that, "Europe has about the same rate of dental caries as the U.S. and most European countries do not fluoridate." With his statement he also presented letters from European and Asian authorities on this point.
He also cited a 1990 cancer study by the National Toxicology Program in which fluoride was implicated in the initial findings. However a special commission was convened to review the results before publication, which resulted in a down grading of the evidence in the final report. This change prompted a Dr. Marcus to "blow the whistle about the issue", which first led to his firing by the EPA. However, Dr. Marcus sued and was reinstated with back pay, benefits and compensatory damages. The union advocates a truly independent review of the study, as was called for by Dr. Marcus.
Similarly the union was concerned about how the original recommendation of the Surgeon Generals panel in 1983 "were altered to allow the EPA to set otherwise unjustifiable drinking water standards for fluoride." He also cited that, "Since 1994 there have been six publications that link fluoride exposure to direct adverse effects on the brain."
Dr. Hirzy also refers to two prominent dental researchers (Dr. John Colquhoun and Dr. Hardy Limeback) who were leaders of the profluoridation movement who in recent years announced reversals of their former positions because they concluded that water fluoridation is not an effective means of reducing dental caries and that it poses serious risks to human health. 
The Natick Report: An Analysis of Water Fluoridation
In 1997, the City of Natick, Massachusetts, commissioned a team of top scientists (Dr. B.J. Gallo, Research Microbiologist, U.S. Army Research; J Kupperschmidt, Environmental Chemist; Dr. Norman R. Mancusi, former Apollo Program Project Scientist; A. Murray, former U.S. Army Natick Research Labs; Dr. Strauss, Molecular Biologist) to analyze the data and make a recommendation concerning water fluoridation. Following are the summarized finding of their 91 page report. 
-- Findings --
The Natick Fluoridation Study Committee conducted a thorough review of the scientific literature and made the following findings regarding the benefits and risks of water fluoridation.
1) Recent studies of the incidence of cavities in children show little to no difference between fluoridated and non-fluoridated communities.
2) Ten to thirty percent (10-30%) of Natick’s children will have very mild to mild dental fluorosis if Natick fluoridates its water (up from probably 6% now). Approximately 1% of Natick’s children will have moderate or severe dental fluorosis.
3) Dental fluorosis can cause great concern for the affected family and may result in additional dental bills. It should not be dismissed as a "cosmetic" effect.
4) Fluoride adversely effects the central nervous system, causing behavioral changes and cognitive deficits. These effects are observed at fluoride doses that some people in the U.S. actually receive.
5) There is good evidence that fluoride is a developmental neurotoxicant, meaning that fluoride effects the nervous system of the developing fetus at doses that are not toxic to the mother. The developmental neurotoxicity would be manifest as lower IQ and behavioral changes.
6) Water fluoridation shows a positive correlation with increased hip fracture rates in persons 65 years of age and older, based on two recent epidemiology studies.
7) Some adults are hypersensitive to even small quantities of fluoride, including that contained in fluoridated water. At least one such person is a Natick resident.
8) The impact of fluoride on human reproduction at the levels received from environmental exposures is a serious concern. A recent epidemiology study shows a correlation between decreasing annual fertility rate in humans and increasing levels of fluoride in drinking water.
9) Animal bioassays suggest that fluoride is a carcinogen, especially for tissues such as bone (osteosarcoma) and liver. The potential for carcinogenicity is supported by fluoride’s genotoxicity and pharmacokinetic properties. Human epidemiology studies to date are inconclusive, but no appropriate major study has been conducted.
10) Fluoride inhibits or otherwise alters the actions of a long list of enzymes important to metabolism, growth, and cell regulation.
11) Sodium fluorosilicate and fluorosilicic acid, the two chemicals Natick intends to use to fluoridate the water supply, have been associated with increased concentrations of lead in tap water and increased blood lead levels in children, based on case reports and a new, as-yet-unpublished study.
12) If Natick fluoridates its water supply at the proposed level, most children under the age of three will daily receive more fluoride than is recommended for them. 
Besides fluoride toothpaste and dental treatments, certain food and drinks often carry high fluoride levels.
Andreas Schuld of Parents of Fluoride Poisoned Children of Vancouver, B.C., Canada, writes of a number of other significant sources of fluoride. "Tea leaves accumulate more fluoride (from pollution of soil and air) than any other edible plant. Fluoride content in tea has risen dramatically over the last 20 years, as has tea consumption." (From "Green tea, Fluoride, and the Thyroid", a paper by Andreas Schuld, published on Dr. Joseph Mercola’s website (mercola.com).
Many soft drinks, fruit juices, and even cow’s milk available from the store have been found to contain fluoride in levels equal to or exceeding the amount of fluoride in fluoridated water. Juice concentrates often resulted in concentrated levels of fluoride (attributed to fluoride-based pesticide residue and processing with fluoridated water.[3,6]
"U.S. Public Health documents show that even in 1991, non fluoridated communities were already receiving more than the targeted fluoride dosage of 1 mg per day. Fluoridated communities were receiving up to 6 times the optimal goal. ("Review of Fluoride Benefits and Risks," 1991, U.S. Dept. of Health and Human Services.)
I have devoted a lot of time to researching this issue, trying to objectively assess the evidence and arguments on both sides. Nevertheless, there is far more material on this subject than I could begin to cover in a few months time. I have not personally read the various studies cited by the opposing factions, but have quoted from secondary sources. So there is the very real possibility that some of the interpretations of the results of such studies may not hold up under strict scrutiny. Most of the material I have found was clearly written for the purpose of persuading or winning an argument – not for objectively considering the facts on both sides. So it would not be surprising to find that conclusions may sometimes be distorted or certain key facts conveniently omitted.
When considering the claims of various studies, consider the problems involved in truly totally proving something of this sort. How do you perfectly control all variables, especially when your experiment is with a whole community of people? Statistical studies are very helpful in pointing towards possible cause and effect, but often fall far short of positive proof. Longer term studies can be more valuable in proving long term benefit, but also subject to a host of other influences over time that may affect outcomes. Lastly there is the problem of bias and distortion. Studies can be engineered to produce the desired conclusions, data can be suppressed or manipulated, data can be interpreted with strong bias, etc.
So who do you believe? Some of us will be biased to trust the majority of the accepted experts, in other words, the majority of dentists and doctors who support the positions expressed in the ADA’s booklet: Fluoridation Facts. Others have a bias against the established "experts" and find it easier to believe those who appear to be well informed but take a position opposed to the "accepted" view. Still others will try to weigh both sides and try to determine who is truly more credible and has made the strongest argument with the best supporting "facts."
At this point, I am inclined to be very wary of fluoride and water fluoridation. Our water is not fluoridated and even if I believed fluoridation would reduce cavities by 50% or some other number, I would not desire it, as we have virtually no cavities anyway (50% of nothing is still nothing). However, I am somewhat concerned about how much fluoride we may be exposed to through other sources. I’m hoping that it is minimal, but it’s hard to say.
If your water is fluoridated and you are concerned about this, you should be aware of the following: "The fluoride molecule is smaller than the water molecule, therefore it cannot be removed by filtration – only by distillation. Reverse osmosis, however, will remove 80 to 90% of the fluoride." ("Intake and Metabolism of Fluoride," G. Whitford, from Adv. Dental Research, 8 (1):5-14, June 1994.)
 "The Story of Fluoridation" from the web site of the National Institute of Dental and Craniofacial Research (NIDR). (www.nidr.nih.gov/health/fluoridestory.asp).
 "Fluoridation Facts", The American Dental Association (www.ada.org/public/topics/fluoride/facts/index.asp).
 "The Fluoride Debate: A Response to the American Dental Association’s Booklet: "Fluoridation Facts"", Compiled by Anita Shattuck, Health Way House, 2000; 90 pages; (www.fluoridedebate.com).
 "Statement of Dr. J. William Hirzy Before the Subcommitte on Wildlife, Fisheries, and Drinking Water", United States Senate. June 29, 2000. 8 pages. (www.nofluoride.com/hirzy_senate.htm).
Fluoridation: Benefits Should Be Considered Alongside Risks;"
10/5/2000; British Medical Journal. (www.fluoride.oralhealth.org/papers/2000/bmj100500pr.htm)
Fluoridation: What Evidence Is there That Water Fluoridation Prevents
Cavities?", Commentary by Nicholas Regush, ABCNews.com. (www.abcnews.go.com/sections/living/secondopinion/secondopinion_116.html)
 "Fluoridation: Don’t Let the Poisonmongers Scare You!", by Bob Sprague and Mary Bernhardt; (http://fluoride.oralhealth.org/papers/1999/bernhardtsprague.html)
10] "UNICEF’s Position on Water Fluoridation"; Water, Environment & Sanitation. (www.unicef.org/programme/wes/info/fluor.htm) V