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Background Few studies have evaluated health impacts, especially biomarker changes, following implementation of a new environmental policy. This study examined changes in water fluoride, urinary fluoride (UF), and bone metabolism indicators in children after supplying low fluoride public water in endemic fluorosis areas of Southern China. We also assessed the relationship between UF and serum osteocalcin (BGP), calcitonin (CT), alkaline phosphatase (ALP), and bone mineral density to identify the most sensitive bone metabolism indicators related to fluoride exposure. Methods Four fluorosis-endemic villages (intervention villages) in Guangdong, China were randomly selected to receive low-fluoride water. One non-endemic fluorosis village with similar socio-economic status, living conditions, and health care access, was selected as the control group. 120 children aged 6-12 years old were randomly chosen from local schools in each village for the study. Water and urinary fluoride content as well as serum BGP, CT, ALP and bone mineral density were measured by the standard methods and compared between the children residing in the intervention villages and the control village. Benchmark dose (BMD) and benchmark dose lower limit (BMDL) were calculated for each bone damage indicator. Results Our study found that after water source change, fluoride concentrations in drinking water in all intervention villages (A-D) were significantly reduced to 0.11 mg/l, similar to that in the control village (E). Except for Village A where water change has only been taken place for 6 years, urinary fluoride concentrations in children of the intervention villages were lower or comparable to those in the control village after 10 years of supplying new public water. The values of almost all bone indicators in children living in Villages B-D and ALP in Village A were either lower or similar to those in the control village after the intervention. CT and BGP are sensitive bone metabolism indicators related to UF. While assessing the temporal trend of different abnormal bone indicators after the intervention, bone mineral density showed the most stable and the lowest abnormal rates over time. Conclusions Our results suggest that supplying low fluoride public water in Southern China is successful as measured by the reduction of fluoride in water and urine, and changes in various bone indicators to normal levels. A comparison of four bone indicators showed CT and BGP to be the most sensitive indicators.

US Public Health Service (PHS) recommendation for fluoride concentration in drinking water for the prevention of dental caries is presented. For these community water systems that add fluoride, PHS now recommends an optimal fluoride concentration of 0.7 milligrams/liter (mg/L). In this guidance, the optimal concentration of fluoride in drinking water is the concentration that provides the best balance of protection from dental caries while limiting the risk of dental fluorosis. This updated guidance is intended to apply to community water systems that currently fluoridate, or that will initiate fluoridation.

BackgroundWhile previous research has suggested that there is an association between fluoride ingestion and the incidence of hypothyroidism, few population level studies have been undertaken. In England, approximately 10% of the population live in areas with community fluoridation schemes and hypothyroidism prevalence can be assessed from general practice data. This observational study examines the association between levels of fluoride in water supplies with practice level hypothyroidism prevalence.MethodsWe used a cross-sectional study design using secondary data to develop binary logistic regression models of predictive factors for hypothyroidism prevalence at practice level using 2012 data on fluoride levels in drinking water, 2012/2013 Quality and Outcomes Framework (QOF) diagnosed hypothyroidism prevalence data, 2013 General Practitioner registered patient numbers and 2012 practice level Index of Multiple Deprivation scores.FindingsWe found that higher levels of fluoride in drinking water provide a useful contribution for predicting prevalence of hypothyroidism. We found that practices located in the West Midlands (a wholly fluoridated area) are nearly twice as likely to report high hypothyroidism prevalence in comparison to Greater Manchester (non-fluoridated area).InterpretationIn many areas of the world, hypothyroidism is a major health concern and in addition to other factors—such as iodine deficiency—fluoride exposure should be considered as a contributing factor. The findings of the study raise particular concerns about the validity of community fluoridation as a safe public health measure.

Emerging evidence has suggested negative associations between maternal urinary fluoride adjusted for specific gravity (MUFsg) and offspring intelligence quotient (IQ). Two prior studies report the MUFsg of pregnant women in the US, both in California, and more information is needed on population levels of MUFsg. The primary objective was to measure MUFsg in a large pregnancy cohort of women recruited from health departments and academic hospitals in Ohio and Kansas. A secondary objective was to compare associations between water fluoridation level and estimated fluoride intake from tap water and MUFsg. Pregnant women ( ) from the ADORE (Assessment of DHA on Reducing Early Preterm Birth) cohort provided a urine sample and dietary assessment at enrollment between 14 and 20 wk gestation. MUFsg was measured by fluoride-sensitive electrode and corrected for specific gravity. Water fluoridation levels were obtained for public water systems (PWS), matched to participant residence and multiplied by their tap water intake from dietary assessment. The association between MUFsg and water fluoridation level was estimated using a generalized linear model with gamma distribution and log link. MUFsg (median: ; Q1, Q3: 0.6, 1.5) was correlated with PWS fluoridation ( ; ) and self-reported tap water consumption ( ; ). For 87% of the cohort, MUFsg was above the safety benchmark for pregnancy proposed in a previous study. Similarly, 76.7% lived in areas with PWS fluoridation . The median MUFsg ( ; Q1, Q3: 0.7, 1.5) of those living in areas with a PWS fluoridation level was higher than the median MUFsg ( ; Q1, Q3: 0.5, 1.2) of women living in areas with PWS fluoridation ( ). MUFsg in this population of midwestern US women exceeds the safety benchmark for pregnancy. While we cannot account for all sources of fluoride, MUFsg was correlated to PWS fluoridation. Because so many exceeded the safety benchmark for MUFsg, there is a need for MUFsg evaluation in other US regions, especially where the PWS fluoridation exceeds US Department of Health and Human Services recommendations ( ). https://doi.org/10.1289/EHP14711.

There is a lack of research on the relationship between water fluoridation and pregnancy outcomes. We assessed whether hypothetical interventions to reduce fluoride levels would improve birth outcomes in California. We linked California birth records from 2000 to 2018 to annual average fluoride levels by community water system. Fluoride levels were collected from consumer confidence reports using publicly available data and public record requests. We estimated the effects of a hypothetical intervention reducing water fluoride levels to (the current level recommended by the US Department of Health and Human Services) and (below the current recommendation) on birth weight, birth-weight-for-gestational age -scores, gestational age, preterm birth, small-for-gestational age, large-for-gestational age, and macrosomia using linear regression with natural cubic splines and G-computation. Inference was calculated using a clustered bootstrap with Wald-type confidence intervals. We evaluated race/ethnicity, health insurance type, fetal sex, and arsenic levels as potential effect modifiers. Fluoride levels ranged from 0 to , with a median of . There was a small negative association on birth weight with the hypothetical intervention to reduce fluoride levels to [ ; 95% confidence interval (CI): , 0.0] and to ( ; 95% CI: , ). There were small negative associations with birth-weight-for-gestational-age -scores for both hypothetical interventions ( : ; 95% CI: , 0.000 and : ; 95% CI: , 0.000). We also observed small negative associations for risk of large-for-gestational age for both the hypothetical interventions to [ ; 95% CI: , 0.000 and ( ; 95% CI: , 0.000)]. We did not observe any associations with preterm birth or with being small for gestational age for either hypothetical intervention. We did not observe any associations with risk of preterm birth or small-for-gestational age for either hypothetical intervention. We estimated that a reduction in water fluoride levels would modestly decrease birth weight and birth-weight-for-gestational-age -scores in California. https://doi.org/10.1289/EHP13732.

Objectives. We examined demographic and socioeconomic differences in the consumption of sugar-sweetened beverages (SSBs), its association with dental caries in children, and whether exposure to water fluoridation modifies this association. Methods. In a cross-sectional study, we used a stratified, clustered sampling design to obtain information on 16 508 children aged 5 to 16 years enrolled in Australian school dental services in 2002 to 2005. Dental staff assessed dental caries, and parents completed a questionnaire about their child’s residential history, sources of drinking water, toothbrushing frequency, socioeconomic status (SES), and SSB consumption. Results. Children who brushed their teeth less often and were older, male, of low SES, from rural or remote areas consumed significantly more SSBs. Caries was significantly associated with greater SSB consumption after controlling for potential confounders. Finally, greater exposure to fluoridated water significantly reduced the association between children’s SSB consumption and dental caries. Conclusions. Consumption of SSBs should be considered a major risk factor for dental caries. However, increased exposure to fluoridated public water helped ameliorate the association between SSB consumption and dental decay. These results reconfirm the benefits of community water fluoridation for oral health.

Background Community water fluoridation began in the 1945 as a public health measure to prevent and control caries and was implemented in Israel in 1981. Community water fluoridation reduced caries significantly, but in 2014, the Ministry of Health decided to stop Community water fluoridation in Israel. The aim of our study was to examine the effect of fluoridation cessation on the dental health of children aged 3–5, treated in “Assuta Tel Aviv” dental clinics, under general anesthesia or deep sedation. Methods The computerized Maccabi-Dent database provided data for this retrospective study. Records from the years 2014–2019 including treatment codes for procedures relevant to the study, the number of stainless-steel crowns and restorations of all types were examined. Kruskal-Wallis test was performed to compare the results from before and after fluoridation cessation. Results A statistically significant increase in the mean number of treatments in the years after fluoridation cessation ( P  < 0.05) was found. There was approximately a two-fold increase in the number of all treatments for all ages. Conclusion The results of the study emphasize the advantages of water fluoridation and are further proof of the need to restore community water fluoridation in Israel.

Background Dental caries is a preventable non-communicable disease. Untreated caries in deciduous teeth may contribute to the development of caries in permanent teeth. Nevertheless, limited research has focused specifically on the risk factors in children. The current study examined the association between dental caries and socioeconomic risk factors among children aged 5–14 years across countries worldwide. Methods An ecological survey was conducted using nation-based, publicly available online databases from six reputable organizations: the World Health Organization, the Food and Agriculture Organization of the United Nations, the World Bank, the British Fluoridation Society, the United Nations Development Programme, and the Global Burden of Disease Project. Data were collected from these sources between 2014 and 2017. Independent variables included density of dental personnel, parental education, family income, water fluoridation, and sugar consumption. The dependent variables were the prevalence of caries in deciduous and permanent teeth. Data were analyzed using descriptive statistics, univariate analysis, and multinomial logistic regression. Results After eliminating countries without complete information, this study enrolled 120 countries with complete data for both dependent and independent variables. Univariate analysis revealed significant differences by parental education, income level, and water fluoridation. We further conducted multivariate logistic regression analysis, indicating that countries with low fluoridation (< 50%) had significantly higher odds of caries in permanent teeth (OR: 13.23; 95% CI: 1.22–143.53; p  = 0.03); shorter years of parental schooling was associated with lower prevalence of caries in permanent teeth (OR: 0.12; 95% CI: 0.03–0.47; p  = 0.002); and middle-income countries showed increased risk in both deciduous teeth (OR: 3.44; 95% CI: 1.26–9.43; p  = 0.02) and permanent teeth (OR: 6.93; 95% CI: 1.75–27.38; p  = 0.01) than high-income countries. Sugar consumption and density of dental personnel were not significantly associated. Conclusion This ecological study provides valuable insights into the global patterns of dental caries in children aged 5–14 years and their associations with selected socioeconomic indicators. Our results reveal significant correlations of dental caries with income level, water fluoridation coverage, and parental education. However, these associations should be interpreted with caution due to the ecological nature of the data and several important limitations.

Objectives To understand variables associated with support for community water fluoridation among ordinary citizens during periods of heightened issue salience, with a particular focus on how support varies on the basis of demographic characteristics, attitudes toward public health science, and political variables such as ideology, populism, and issue salience. Methods Statistical analysis of individual-level data from a large-scale survey of eligible voters in the City of Calgary, Alberta in 2021, collected at the time of a community water fluoridation plebiscite. Results Survey data ( N  = 1130) reveal substantively important and statistically significant relationships with fluoridation support in each of our three analysis categories (demographics, public health expertise, and politics). Support for fluoridation tends to be higher among men, university-educated, higher-income; among those with trust in experts and knowledge of fluoride governance; and among those who consider the issue important and have low levels of populist attitudes. Two exceptions to findings in past studies are age and ideology: younger respondents were more likely than older respondents to support fluoridation in Calgary, as were those on the ideological left, as compared to the right. Conclusion Incorporating studies of the correlates of public attitudes related to public health policies is important for understanding public health policy failure and success, especially in instances involving public consultation mechanisms, such as plebiscites.

The present study aimed to investigate the association between bone diseases and community water fluoridation (CWF). An ecological study with a natural experiment design was conducted in Cheongju, South Korea, from 1 January 2004 to 31 December 2013. The community water fluoridation program was implemented in Cheongju and divided into CWF and non-CWF areas. To observe adverse health effects related to bone diseases, we conducted a spatio-temporal analysis of the prevalence of hip fracture, osteoporosis, and bone cancer in residents who have lived in CWF and non-CWF areas using National Health Insurance Service data. First, we used standardized incidence ratios to estimate the disease risk. Second, the hierarchical Bayesian Poisson spatio-temporal regression model was used to investigate the association between the selected bone diseases and CWF considering space and time interaction. The method for Bayesian estimation was based on the R-integrated nested Laplace approximation (INLA). Comparing the CWF area with the non-CWF area, there was no clear evidence that exposure to CWF increased health risks at the town level in Cheongju since CWF was terminated after 2004. The posterior relative risks (RR) of hip fracture was 0.95 (95% confidence intervals 0.87, 1.05) and osteoporosis was 0.94 (0.87, 1.02). The RR in bone cancer was a little high because the sample size very small compared to the other bone diseases (RR = 1.20 (0.89, 1.61)). The relative risk of selected bone diseases (hip fractures, osteoporosis, and bone cancer) increased over time but did not increase in the CWF area compared to non-CWF areas. CWF has been used to reduce dental caries in all population groups and is known for its cost-effectiveness. These findings suggest that CWF is not associated with adverse health risks related to bone diseases. This study provides scientific evidence based on a natural experiment design. It is necessary to continue research on the well-designed epidemiological studies and develop public health prevention programs to help in make suitable polices.