Linking the decision made by the United States Department of Health and Human Services to lower the recommended level of fluoride added to drinking water to the effectiveness of water fluoridation is inaccurate.1
This decision was based on studies showing that the levels previously accepted in the US presented a risk of dental fluorosis that was deemed unacceptable for infant formula reconstituted with tap water. The change was a dosage adjustment, not a retreat from water fluoridation. The reference to the balance of protection and risk confirms that the decision had nothing to do with “bone effects” and everything to do with fluorosis. There is no evidence that exposure to fluoride from water fluoridation leads to bone abnormalities of any kind.
The decisions by some municipalities to remove fluoride are a series of political decisions, not decisions based on scientific evidence. Further, several Canadian municipalities have recently voted in favour of keeping fluoride in their water.2–4 Dental disease is the number one chronic disease among children and adolescents in North America, and optimally fluoridated water is a safe and cost-effective public health benefit.
Over 90 national and international scientific and medical organizations, including the Canadian Medical Association, support the use of fluoride as a safe and effective measure to prevent tooth decay.5
One final point: Grand Rapids, Michigan, was the first city in the world to start water fluoridation in 1945, not in 1975, as stated in the CMAJ article.