Evidence-Based Dentistry (2002) 3, 31 ã 2002 Evidence-Based Dentistry All rights reserved 1462-0049/02 $25.00 www.nature.com/ebd editorial Water fluoridation Ð controversy or not? Derek Richards Editor

The fact that both sides of the argu- Controversy Ð a prolonged argument or dispute, especially when conducted ment have criticised the review in about publicly [Oxford English Dictionary] equal measure emphasises to me that the review is balanced. I must declare an In this issue we take a detailed look at the systematic review of water interest, however, as a member of the fluoridation published by the Centre for Reviews and Dissemination,1 a Advisory Panel. Clearly the review does not provide summary of which appeared in the British Medical Journal with additional 2 clear answers to all the questions related material available on their website. to fluoridation, but it did highlight a Evidence-Based Dentistry (2002) 3, 31. doi:10.1038/sj.ebd.6400120 number of potential issues in relation to future research. Currently we await the outcome of a Medical Research Council The story of introduction of water the early part of the last century. Despite review of what future research should fluoridation is now more than a century suggested links with a wide range of be conducted in the area of water old and artificial adjustment of the level other negative effects, such as bone fluoridation. Although there is a clear of fluoride in drinking water has been fractures and cancer, no evidence was need for more and better quality conducted for more than 50 years. found to support a link. The quality of research, I doubt whether the zealots Nevertheless, the long-standing argu- evidence, however, was too poor to on either side of the argument will ever ment over whether it is of benefit or establish this with confidence. be satisfied: it is difficult to prove a harm to humans still rages on. To my The York review team and its advisory negative. I leave you with a thought mind and according to the Oxford panel produced a balanced systematic from Oscar Wilde and hope that you English Dictionary, this means that view of the research evidence available. enjoy this latest issue: water fluoridation is a controversy: it Both pro- and anti-fluoridation groups is certainly a prolonged argument that have then used the review in equal `The pure and simple truth is rarely pure has been conducted in the public arena. measure to support their arguments. In and never simple.' What I believe the review shows is that both cases there has been much hyper- there is evidence related to water fluor- bole.Thoseofyouwhoareinterestedmay idation but the quality is not as high as liketolookathowtheresultsofthereview 1. NHS Centre for Reviews and Dissemination. A Systematic Review of Water Fluoridation. we believed. This finding is similar in have been interpreted on the following York: NHS Centre for Reviews and many other topics in dentistry where websites from each side of the argument: Dissemination, University of York; 2000 systematic reviews have been con- (see http://www.york.ac.uk/inst/crd/ ducted. The rigour of the review also . British Fluoridation Society, at fluorid.htm). means that the conclusions are more http://www.liv.ac.uk/bfs/ 2. McDonagh MS, Whiting PF, Wilson PM, Sutton AJ, Chestnutt I, Cooper J, et al. cautious than those in previous reviews. . National Centre for Fluoridation Systematic review of water fluoridation. There is evidence to support that fact Policy and Research, at BMJ 2000; 321:855±859 (see http:// that fluoride reduces tooth decay, but http://fluoride.oralhealth.org/ bmj.com/cgi/content/full/321/7265/855). not by as much as previously thought. The review confirms the link between and two anti-fluoridation sites: fluoride and fluorosis which, after all, is what started Frederick McKay off in . http://www.fluoridation.com/ and search of thecauseof `Colorado Stain' in . http://www.holisticmed.com/fluoride/