Table 2 Suggested responses to antifluoridationist arguments

Water fluoridation confers no oral health benefit

Numerous systematic literature reviews from a number of countries have found water fluoridation to provide a significant caries preventive effect.

Water fluoridation causes hip fractures, cancers, Alzheimer's, reduced intelligence in children, etc.

Research finding associations between water fluoridation and various diseases offer no proof, as causality cannot be established in these studies. Water fluoridation opponents handpick studies and may misrepresent the results so as to support their views. Large-scale systematic reviews have not confirmed any associations between water fluoridation and the large list of diseases linked to it by opponents of water fluoridation.

Fluoride is a toxic poison.

Fluorine is a naturally occurring element that, like many other natural substances, can be toxic if consumed in excess. Water fluoridation ensures ingestion of fluoride well below any toxic level, both for adults and children.

Fluoride is used in rat poison and other dangerous substances.

It is dose that determines the level of toxicity. Many essential and commonly occurring elements form poisonous or toxic substances.

Numerous other countries have rejected water fluoridation.

Some other countries have elected not to introduce water fluoridation because they prefer, or already have, other approaches to improving dental health. Nonetheless, many countries do have water fluoridation and benefits are conferred to all people, including those at high risk who may not effectively use individual fluoride exposures.

Water fluoridation is supported only by 'shoddy' science.

Decades of research and hundreds of scientific articles published in peer-reviewed journals support water fluoridation. This research is so convincing that almost all major dental and health authorities support it.

There should be a public plebiscite. It is undemocratic to have water fluoridation forced upon us.

In almost all democratic systems representatives of a population are elected to make decisions on behalf of the population. Plebiscites or public referendums are not required to pass legislation that is compatible with the constitution or charter under which the country operates. Water fluoridation fits within a government's duty of care to the country's citizens.

Tooth decay has declined in countries with and those without water fluoridation. Water fluoridation makes no difference.

Declines in tooth decay have occurred as a result of changing exposures to fluoride and dietary changes. Regardless, water fluoridation reduces tooth decay above and beyond these other effects. Ecological comparisons of some countries with others offer no support for or against water fluoridation as many other factors may account for differences in disease experience from one country to the next. Water fluoridation does make a difference.

Most people do not want water fluoridation.

Independent research in most places where water fluoridation is being considered shows that people support water fluoridation. Generally, the more knowledge people have the more likely they are to support it.

Water fluoridation is costly and not economically viable.

Research has previously found water fluoridation to be cost-effective. Newer technologies have made water fluoridation cost-effective for increasingly smaller populations. In addition to being cost-effective, it is also necessary to keep in mind the reduction in dental disease and therefore the pain and suffering reduced as a result of water fluoridation.

Water fluoridation infringes freedom of choice and individual rights and is unconstitutional.

Adding fluoride to water is just one of many instances where a chemical or nutrient is added to a food or beverage for public health benefits. It already occurs in water with the addition of chlorine, which aids greatly in eliminating water borne disease, as well as in several foodstuffs. Water fluoridation sets no precedent.

Water fluoridation is being pushed on us as a result of 'big business' interests.

The scientists researching the effectiveness of water fluoridation as well as health officials and dentists do not receive money from sugar, aluminium or any other companies for their research or opinions.

There is more caries in fluoridated X than in non-fluoridated Y. This proves water fluoridation does not work.

Ecological comparisons involving the arbitrary selection of fluoridated and non-fluoridated communities or areas do not provide credible evidence of the effectiveness or otherwise of water fluoridation as any differences may be the result of other factors which are linked to tooth decay but differ across the areas. Scientific research has found water fluoridation to be effective.

We should wait until water fluoridation is proved to be safe.

Water fluoridation has been implemented in some places for more than half a century – long enough that any dangers would be apparent if they existed. The weight of evidence strongly indicates that water fluoridation is safe.